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It's best to identify danger zones in the home and make them safe for your child.

YOUR home is your child's world; it is where he spends most of his time eating, playing, sleeping, exploring and otherwise experiencing everything he can as his mind and body develops.

Home is also where you can shower your child with the comfort, love, and care that he deserves.

However, statistics have shown that home is also the most common place for injuries to occur.

It is the very innocence of your child that makes the home environment such a dangerous place, as it can be filled with many unexpected hazards.

As parents, you should do your part in making the home environment as safe as possible by eliminating any hazards.

In some cases, it may be necessary to buy safety products that will help prevent injuries, such as a stairguard to prevent your toddler from accessing the stairs/balcony.

Most of the time, injuries can be predicted; as they are preventable, the onus is on you to make the effort to identify possible hazards, and subsequently to address them by either removing the hazard or making it inaccessible to your child.

It is best to start this process of making the home environment as safe as possible before your baby arrives, and definitely before your child starts crawling and walking around the house.

Since most injuries happen in the kitchen, living room and staircases, these are locations that you must pay particular attention to.

Child-proofing the home

What's the best method to reduce the risk of injury?

Ideally you should rearrange the layout of your house to create a safer environment.

It is easier if you are renovating your house as these changes can be incorporated into your home's design; it is never too early to start making some changes or additions well before your baby begins to crawl.

However, it is sufficient if you can make it physically impossible for your child to venture into the danger zones on his own.

As a parent, you should understand your child's developmental stages to gauge his abilities at different ages.

Preventive strategies can then be developed based on your child's development. Just because your child cannot crawl or walk now does not mean that he cannot do it at a later stage.

So take the time to look at your home and assess the obvious risks and hazards that your child may face. If possible, remove the risk or hazard; otherwise, add a safety product to minimise the chances of injury, e.g. attaching corner covers on low tables with sharp corners.

It is recommended that every home be equipped with first aid kits, smoke alarms and fire extinguishers.

Other important safety products to consider include door barriers to keep young children out of the kitchen, especially during busy times, such as when you are busy preparing dinner. This will allow you to keep an eye on your child if you have placed him in a playpen in an adjacent room.

Barriers or stairguards for stairs are also an important safety product, as many falls that happen at home often occur on the stairs. By denying your child easy access to the stairs, you will be eliminating a potential hazard.

Another frequent fall area is from the bed, so ensure that baby sleeps in a cot with the sides up.

To get started on creating a safe haven at home for your child, there are three key areas that you need to focus on, namely, the living room/bedroom, kitchen and bathroom.

Living room/bedroom

The living room/bedroom is one of the most dangerous areas of the house as it is an area that is often taken for granted.

Take the time to get down on the floor and see the world at your child's level.

This will allow you to spot potential hazards that you may not see if you just walk around at your own height.

Other items to take note of include:

*Install door/stair barriers to keep your child away from staircases and/or balconies.

*Stow all cables properly by using cable organisers.

*Place televisions or any heavy objects on sturdy furniture and as far away from the front edge as possible.

*Find and identify all sharp and pointed edges; install corner guards to protect your child from head injuries, bumps and bruises.

*Keep all sliding glass doors and windows closed and locked.

If your child can walk and run, make sure you place visual cues on the sliding glass door at your child's eye level so that he will not run into the glass by mistake.

*Avoid furniture that has glass; if you have a glass table, install a safety film to prevent the glass from shattering. Otherwise, ensure that tempered glass is used if you have no choice.

*If you have a chest-of-drawers, ensure that it will not topple on your child if he climbs it by keeping heavy items at the base.

*Carpets, rugs or any sort of covering placed on the floor should be treated with anti-skid material on its underside. This will prevent your child from slipping and falling when he walks/runs on it.

*Keep all bags, handbags, purses or anything that has straps or contains small items (e.g. silica gel in shoe boxes, etc), out of reach, as your child become entangled on the straps, and choke on or swallow the small items.

Kitchen

Injuries relating to the stove or oven can be very serious.

Some of the hazards may be obvious, such as hot stove tops, kettles of boiling water, or sizzling woks.

Other dangers may be hidden, such as drawers full of sharp knives. Here are some tips to take note of:

*Ensure all sharp utensils and appliances are kept out of your child's reach.

*Install child-proof door locks on all drawers, cabinets or doors.

*Install a stove-guard at your stove; this prevents your child from reaching up and getting burnt or scalded.

*Stow all electrical cables for appliances by using cable organisers.

*Keep pots and pans away from the edge of the counter or stove, and just as importantly, their handles should face inwards.

*Never cook, prepare, carry, eat or drink hot foods while holding your child.

*Place hot foods or drinks away from the edges of the table/countertop.

*If you use table cloths, ensure they are fastened securely with pegs/clips to hold them in place; your child may pull on it and anything on the table could fall on your child and hurt him.

Bathroom

Most injuries in the bathroom relate to drowning and falling on slippery floors. The following points will help minimise injuries from happening:

*Always keep the door to the toilet/bathroom closed at all times.

*Never allow your child to go to the toilet/bathroom alone.

*Never leave baby alone in the toilet/bathroom or near any water (wading pool, pail, etc).

*Always start with cold water when preparing your baby's bath. Add in the hot water and test the temperature until it is correct before putting your baby in. If you must add hot water, take your baby out of the bath first.

*If your bathroom has a bathtub, install a rubber mat or anti-slip pad at its base to prevent your child from slipping and falling.

*Keep all electrical appliances (hair dryer, etc) away from sinks, tubs or toilets.

*Unused pails should be emptied of water; if you are using a pail to soak clothes, either cover it up securely or keep your bathroom door closed to keep your child out.

It is every parents' wish to see their child grow up safe from harm and danger. In light of this, there is no harm in being overly cautious, especially when it comes to your child's safety.

Datuk Dr Zulkifli Ismail is a consultant paediatrician and paediatric cardiologist. This article is a courtesy of Malaysian Paediatric Association's Positive Parenting programme. The opinion expressed in the article is the view of the author. For further information, please visit www.mypositiveparenting.org.

Let's operate!

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In this second article to commemorate National Anaesthesia Day, we take a look at what goes on in the operating theatre.

OPERATIONS can be done using regional or general anaesthesia, as discussed in the previous article on preoperative assessment (Not just 'sleep' doctors, Star2, Oct 2).

Monitoring devices will aid in monitoring heart rate, blood pressure and oxygen content, and any changes will be addressed immediately.

Your anaesthesiologist is the lifeline of surgery. They stay with you throughout your surgery, watching over you and ensuring your safety.

Regional anaesthesia

The type of regional anaesthesia given will depend on the site of surgery. The most common ones are spinal and epidural, which are done for surgeries involving the lower half of the body.

Spinal anaesthesia involves injecting local anaesthetics into a space behind your back, which contains fluid that bathes the nerves supplying the lower half of your body. This will numb the lower half of your body for two to three hours. It is normal for the lower half of your body to feel numb and your legs weak with spinal anaesthesia.

Only when both you and your anaesthesiologist are satisfied with the effectiveness of the spinal anaesthetics will the surgery proceed.

The benefits of spinal anaesthesia include: less risk of chest infections after surgery; less effect on the heart and lungs; excellent pain relief immediately after surgery; less need for strong pain-relieving drugs; less sickness and vomiting; earlier return to drinking and eating after surgery; and less confusion after the operation in older people.

As with all anaesthetic techniques (as well as surgeries), there is a possibility of unwanted side effects or complications. To help quantify the risks, the following scale is usually used: If something is 'very common', this means that about one in 10 will experience it; 'common' means about one in 100; 'uncommon' means about one in 1,000; 'rare' means about one in 10,000; and 'very rare' means about one in 100,000.

Very common and common side effects include:

Low blood pressure – As the spinal takes effect, this may lower blood pressure and make you feel faint or nauseous. This is usually alleviated by giving you fluids in the drip or medication to bring up your blood pressure.

Itching – This may occur if a group of medication called opioids are given together with local anaesthetics. This can be treated as long as you let the medical staff know about it.

Difficulty passing urine – You may find it difficult to empty your bladder when the spinal anaesthetic is in full effect. Your bladder function will return to normal once the spinal anaesthesia wears off. Until then, you may require a catheter to be placed in the bladder temporarily while waiting for the anaesthetic to wear off or as part of the surgical procedure.

Pain during injection – You must immediately inform your anaesthesiologist if you feel pain or pins and needles during the injection as this may indicate nerve irritation or damage, and requires repositioning of the needle.

Headache – Severe headache may occur after spinal anaesthesia and this can usually be treated with pain relief medications.

Rare complications include:

Nerve damage – temporary loss of sensation, pins and needles, or weakness of the legs, may occur for days or several weeks, but almost always recover fully with time. Permanent nerve damage is extremely rare.

An epidural anaesthesia is quite similar to a spinal anaesthesia. The difference is that a small plastic tube (catheter) is inserted into the epidural space (a space in the spine), which is near the nerves in the back.

This means that the anaesthesiologist is able to add on medications as the anaesthetic wears off, without repeated injections. The epidural is used for longer surgeries, as well as for postoperative pain relief.

The risks and complications for epidural anaesthesia is similar to that of spinal anaesthesia.

General anaesthesia

You will be given a few breaths of oxygen before the anaesthesiologist injects a medication through the intravenous cannula in your arm and you will quickly become unconscious.

At the end of the surgery, your anaesthesiologist will stop giving you the anaesthetic medication and you will wake up gradually. If muscle relaxants have been given, another medication that reverses it will be administered.

Once the anaesthesiologist is satisfied that you have recovered properly, you will be transferred to the recovery room.

Common side effects and complications of general anaesthetics include:

Feeling nauseous and vomiting – this can last from several hours to several days. It can be treated with anti-vomiting medications.

Sore throat – This usually lasts a few hours and will subside once you start eating and drinking.

Headache – Most headaches will get better with time or treatment with analgesic agents.

Aches, pains and backache – this could be due to the surgery itself or being in a similar position for hours during the surgery. This also usually resolves with time and treatment with analgesic agents.

Confusion and memory loss – this is more common in the elderly. It is usually temporary, but some can be permanent.

Uncommon side effects and complications include:

Damage to teeth, lips, gums or tongue – minor cuts over the lips and tongue may occur during insertion of a tube into your windpipe to help you breathe. Damage to the teeth is uncommon.

Breathing difficulties – this may be related to any preexisting medical conditions that may be compounded by anaesthetic drugs

Rare and very rare complications include:

Serious allergy to medications – Allergic reactions are usually noticed quickly and treated aggressively.

If you or your family members have any allergy problems, you should inform your anaesthesiologist.

Awareness – Being aware during a general anaesthetic is extremely rare.

These days, there are monitoring devices to guide the anaesthesiologist to ensure that adequate medication is given to keep patients in deep sleep throughout the operation.

Deaths – This is extremely rare. The incidence is about five deaths for every one million anaesthetics given.

If you have any doubts or queries about anaesthesia, discuss this with your anaesthesiologist prior to surgery.

National Anaesthesia Day

Interested to learn more about anaesthesia? We invite you to unveil an anaesthesiologist's mask during this National Anaesthesia Day celebration on Oct 12.

This year, "Your LIFE... We CARE!!!" has been chosen as the main theme for the celebrations, and refers to our commitment to ensure that your life is in safe hands under our care.

Listed below is a snapshot of our activities:

Taman Tasik Titiwangsa (Oct 12)

1. Walk Treasure Hunt – Registration forms can be downloaded from www.msa.net.my.

2. Learn to save a life with a hands-on cardiopulmonary resuscitation (CPR) session.

3. Video shows and exhibitions.

4. Free medical check-up.

5. Blood donation drive and organ donation pledge.

Hospital Kuala Lumpur

1. Exhibitions at the main foyer (Oct 21-25).

2. Health talks on Oct 25 at the Main Auditorium.

See you there!

*Datin Dr V. Sivasakthi is head of Anaesthesiology and Intensive Care Services, Malaysia, as well as head of the Department of Anaesthesiology and Intensive Care, Hospital Kuala Lumpur. Dr Lee Yan Wei is from the Department of Anaesthesiology & Intensive Care, Hospital Kuala Lumpur. October 16th was observed as World Anaesthesia Day in 1996, 150 years after the specialty was founded, and it is now celebrated annually worldwide. The Malaysian Society of Anaesthesiologists and the Department of Anaesthesiology & Intensive Care, Hospital Kuala Lumpur, is launching National Anaesthesia Day to increase awareness about the role of anaesthesiologists and how they contribute towards patient care.

Menopause/cancer link?

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Though the incidence of serious conditions like cardiovascular disease, osteoporosis and cancer increase after menopause, some of these changes may not be related to decreased hormone levels.

MENOPAUSE does not increase the risk of cancer. However, the risk of cancer increases with increasing age. Hence, women who reach menopause are naturally more likely to get cancer simply because they are older.

Furthermore, some treatments for cancer, like surgery, chemotherapy or hormonal therapy, lead to cessation of ovarian function, resulting in menopause and its symptoms.

There are three types of cancer treatments that result in premature menopause.

The surgical removal of the ovaries (oophorectomy) in the treatment or prevention of ovarian, uterine and vaginal cancers, results in immediate onset of menopause because the primary source of the female hormones is removed.

Radiotherapy to the pelvis, where the ovaries are located, or chemotherapy, can result in premature menopause. Sometimes, the periods return in younger women after completion of the treatment. However, this is less likely to occur in women who are 40 years and above.

Some breast cancers use the oestrogen and/or progesterone produced by the body to grow. Such breast cancers are diagnosed by positive oestrogen and/or progesterone receptor findings. Hormonal (or endocrine) therapy is used to treat such breast cancers.

The medicines include anti-oestrogens like anastrozole, letrozole and exemestane, as well as tamoxifen. These medicines are also used to reduce the likelihood of the breast cancer returning after the completion of treatment.

Medicines like tamoxifen and raloxifene, are also used to reduce the likelihood of breast cancer occurring in women who are at increased risk.

Common cancers

The most frequent types of cancer that affect Malaysian women are breast (31.0%), cervix (12.9%), colon (6.0%), endometrium (4.3%), rectum (4.1%), and ovary (4.1%).

Women who reach menopause after the age of 55 years are at an increased risk of ovarian, breast and uterine cancers.

The risk is greater if their periods started before the age of 12. This is because there is increased exposure to more oestrogen, and increased ovulation. An increased exposure to oestrogen increases the risk of uterine and breast cancers, and more ovulations increases the risk of ovarian cancer.

Breast cancer is the most common cancer. It is the most feared by women and is frequently the focus of the media, so much so that many women think it is very common.

In fact, its incidence is much less than cardiovascular disease or osteoporosis. When detected and treated early, it is very amenable to treatment. Death rates have declined in recent years. The five-year survival rate for localised breast cancer is more than 90%.

There are several factors that increase the risk of breast cancer. The risk increases with age, reaching about 10% by 80 years of age. A woman's risk is increased if there is a family history of ovarian cancer. The risk is also increased in women who had their first period below 12 years of age; late age of menopause; or have never been pregnant.

Women who have mutations of the BRCA1/BRCA2 genes, or a breast biopsy finding of atypical hyperplasia, are also at increased risk.

Obesity, alcohol consumption and a sedentary lifestyle are also risk factors.

Long term (more than five years) hormone therapy (HT) has been reported to be associated with a slightly increased risk of breast cancer.

Cervical cancer is very treatable if detected early, with five-year survival rates of more than 90%. It is caused by the human papillomavirus (HPV) infection, which is acquired through sexual intercourse.

There are more than 100 HPV types, of which 13 are high-risk types that cause cervical cancer.

The risk of cervical cancer increases with early sexual intercourse, multiple partners, smoking, other sexually transmitted infections, and HIV infection. Other risk factors are smoking and use of the combined oral contraceptive pill.

Neither the menopause nor the use of HT increases the risk of cervical cancer.

Endometrial (uterine) cancer is very treatable if detected early, with five-year survival rates of 95%. The risk of endometrial cancer is increased with increased exposure to oestrogen, i.e. in women whose first period started at an early age; late menopause; never been pregnant; or in rare oestrogen-producing tumours.

The risk is also increased in women who are obese; have polycystic ovarian syndrome; have diabetes or high blood pressure (hypertension); or those who have endometrial hyperplasia.

The use of oestrogen without progestogen or tamoxifen also increases the risk.

Previous pregnancy and the use of the birth control pill appear to provide some protection against endometrial cancer.

Ovarian cancer is not common, yet it causes more deaths than any other cancer of the reproductive organs, mainly because it usually presents at an advanced and less curable stage.

One of the main reasons for its late detection is the absence of symptoms in the early stages. If detected and treated early, five-year survival rates can exceed 90%.

The risk of ovarian cancer increases with age; late menopause; in women who have never been pregnant; those with a family history of breast or ovarian cancer; and those who are obese.

About one in 20 cases is due to faulty genes that increase the risk of breast and ovarian cancer.

Lung cancer is a leading cause of cancer death in women in many developed countries. The increase parallels the increasing number of women who smoke cigarettes.

As such, it can be expected to pose a problem for Malaysian women in future years. About nine in 10 lung cancers are caused by smoking. Exposure to secondhand smoke, radioactive materials, arsenic, nickel, chromium and air pollution, are also risk factors.

Colorectal cancer is not associated with menopause, but with increasing age, a family history of the cancer, colorectal polyps, inflammatory bowel disease, physical inactivity and smoking.

Most cancers can be successfully treated today. The most important factor in treatment success is early detection. Regular check-ups and seeking early medical attention is advisable, not only for menopausal women, but for all elderly women.

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.

Kredit: www.thestar.com.my

Ahad, 6 Oktober 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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