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The Star Online: Lifestyle: Health

Keeping a pledge

Posted: 28 Dec 2013 08:00 AM PST

A new year signals a new beginning, but are fitness resolutions necessary when most people can't sustain them?

RESOLUTIONS are never easy to keep, especially fitness ones.

Every year-end, I hear these mantras from at least a dozen people: lose weight, get toned, enrol in yoga, run faster, muscle up, eat less...

It's like a pledging ritual, but without proper planning and implementation. Only one, at most two, will doggedly stick to the resolve. Hats off to them.

Most people gear up to hit the gym come Jan 1, follow through for the first couple of months, hit a roadblock (most likely from laziness, muscle soreness or injuries), and eventually, slide off the commitment ladder. This is also the period when gyms, as well as wellness and slimming centres, offer huge promotions to entice new clients.

Don't be fooled or gullible enough to fall into this trap unless you know you have the perseverance to succeed.

Resolutions seem possible at the start of the year, but become impossible as the days and months whiz past. Or, you've set unrealistic expectations. Habits and behaviours require time to change, so don't be too tough on yourself.

One of my Pilates students has told me countless times that his intention is to lose his belly fat. He'll point to a macho guy at the gym and say, "I want to look like that."

Not wanting to engage in a lengthy discussion about body types, every year, I'll advise him on a workout regime he can adhere to. He'll pump iron, run on the treadmill, and attend classes diligently the first few weeks.

Then poof!, he disappears, citing work, travel, weather and family issues. By year-end, he'll reappear, pinch his spare tyre and exclaim, "Look at this!"

I'll look and smile knowingly. This scenario has continued for the past five years. Buddy, I can't help you if you don't help yourself.

So this year, why not do something different before embarking on your fitness goals?

First, sit on the couch and get your cravings out of the way. Yeah, that's right. Allow yourself to binge to your heart's desire to usher in the New Year. Put your feet up, snack on your favourite food – junk included, and sip your preferred drink, while watching the telly.

It'll feel good for a while, but pretty soon, you'll be sick of the over-indulgence and yearn for a more meaningful activity.

When you have mental clarity, focus on a fitness programme that is attainable. Ditch the impossible resolutions (e.g. losing 20 kilos in six months), but take your health and self-improvement goals one baby step at a time.

Unlike food, the endorphins released during exercise leave you feeling high for a longer time. Not only does it boost your mood, it also helps you get in shape.

Have you heard of anyone feeling depressed after a round of exercise? Fatigued, yes, but they're rarely down in the dumps.

Physical activity doesn't have to be complicated, so here are some tips for a healthy start:

Always warm up before starting a physical activity

Warming up is essential to prepare the body for energetic activity and reduce the risk of injury. The purpose is to ease both the mind and body from a state of rest into a state of strenuous activity.

A warm-up routine should consist of a 10-minute cardio workout, such as skipping or brisk walking, and five to 10 minutes of gentle loosening exercises, which produces a light sweat (for example, rotation of the ankle, wrists, shoulders and hips).

Increasing the core and muscle temperatures helps to make muscles loose and supple. Besides increasing the heart rate and boosting blood flow, warm-ups supply oxygen to the muscles and prepare the body for action.

Walk, walk and walk

If you have limited finances or lack time to join the gym, go brisk walking, weather permitting. Avoid taking lifts, but walk up the stairs, walk to the shops, walk around the park or walk to your colleague's cubicle instead of phoning or sending her/him an Intranet message.

Walking has multiple benefits, including helping against heart disease, high blood pressure and type 2 diabetes.

Work out with a friend

Two heads are always better than one, so grab a friend to exercise with. The support and motivation will go a long way towards achieving results. And with the crime rate these days, it's better to have a companion, especially if you're doing an outdoor workout.

Commit to early morning exercise

Everyone needs an extra minute of sleep, but if you can rise early and squeeze in at least 30 minutes for exercise, you'll be more likely to keep to your regime.

Plus, once you get the exercise bit out of the way, you'll also have plenty of energy left for the rest of the day.

Combine cardio and strength training

Instead of allocating separate days for cardio and strength training, combine both. Do a two-minute cardio routine and add two strength moves (e.g. crunches and push-ups). Repeat the cardio and add two more strength moves (e.g. squats and tricep dips).

Not only does it help with muscle retention, but it also promotes a faster metabolic rate and enhances lipolysis, speeding up the rate of fat loss.

Cool down and stretch

Cooling down is equally as important as warming up, though many people fail to realise this and jump into the next activity immediately.

Cooling down restores the body to a pre-exercise state in a controlled manner, helps the body repair itself, and can lessen muscle soreness the following day. Gentle walking for five to 10 minutes is good to recover the heart's resting rate. After that, perform some static stretches by holding the stretch for at least 20 seconds.

Eat healthy

Try to eat healthy (cut out the fried stuff) and load up on fruits and veggies, but don't skip your favourite desserts, no matter how sinful they are. Instead, have a mini serving to satiate your taste buds.

Research reveals that skipping dessert can backfire and leave you wanting more. In a 2010 study published in the journal Obesity, dieters who were restricted from eating a small dessert were more likely to be left "wanting" than those who had a bite of sweets. Eliminating your favourite foods can be a recipe for disaster and may create an obsession.

Personally, I can't keep to resolutions. As I get older (translation: injuries that take longer to heal), I occasionally cut myself some slack and allow my body a break to recharge for a week. But, that doesn't mean I do nothing. I still stretch in bed, do breathing exercises, or take long strolls and get to know the neighbourhood dogs.

After all, you're not participating in a sprint to get fit. Rather, we're all runners in this slow, steady marathon for better health. There are no winners or losers, just healthier, trimmer individuals and less medical expenses.

On that note, here's wishing readers a happy new and fit year ahead!

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. She hopes to do one final dance in 2014 before gracefully bowing out from stage to make way for the next generation.

Speaking of lumps ...

Posted: 28 Dec 2013 08:00 AM PST

When your blood pressure spikes, it may not be what you think it is.

WHEN I first started out on my "lumpy" journey, it was a lonely one as it was almost impossible to find a fellow patient. You see, I have a rare condition called paraganglioma.

Rare tumours that usually form in the peripheral nervous system, paragangliomas are often benign, though there are the even rarer exceptions.

The odd case or two may turn out to be bilateral carotid tumours, but I had – at the last count, and hopefully, it is truly the last – six tumours, in various parts of my body, growing along the parasympathetic chain.

In the last eight years, I underwent a series of surgeries (both invasive and non-invasive); the first epic one started the ball rolling, lasting 22 hours as there were complications.

In the process of excising my "lumpy additions", I became the stuff of legends for medical journals, in Malaysia anyway.

I had published my experience in the hopes that it would create awareness of paragangliomas (My lumpy journey, Fit4life, Aug 12, 2012). And in the process, I stumbled upon others like me.

Thanks to the Internet, my story caught the attention of the "Pheopara Troopers", a support group for those who suffer from this condition.


According to Dr Hew, pheos can come in various shapes and sizes, meaning there are different presentations and symptoms.

This US-based non-profit organisation was started by Amy Pitzer, Matthew Capogreco, Laura Becktel and Allen Wilson, whose personal experiences with the disease and collective interest led to the setting up of this patient-run outfit.

While it was heartening to share stories, it was also disconcerting to learn that there is another manifestation of paraganglioma, known as pheochromocytoma (or pheo for short), which comes from the same type of tissue.

With the former, the tumours tend to grow outside the adrenal gland, and apart from growing (very slowly) and obstructing passages, they are often hardly detectable.

Pheos, which grow in the adrenal gland, on the other hand, may secrete higher than usual amounts of hormones (epinephrine and norepinephrine), thereby causing havoc in the body.

Naturally, I consulted my vascular surgeon, who assured me that it was highly unlikely (although he did not dismiss the possibility altogether) for me to have pheos as I didn't display any symptoms.

Apparently, if I did, the hormonal imbalance would have given off warning signals immediately.

But there could be a genetic link and my doctor suggested that perhaps at some point, it would be good that my children be tested, just in case it was in the genes.

But then, it struck me that Malaysia may not have facilities to test for this anyway. (Today, genetic testing for von Hippel-Lindau [VHL] disease and other hereditary links can be carried out at the Cancer Research Initiatives Foundation in Subang Jaya, Selangor.)

The Great Mimic

That lead me to a story that needs telling – what exactly is pheochromocytoma anyway?

Someone asked me why I wanted to pursue this "dry" subject, especially since the disease was so rare. But just as I found relief and comfort in better understanding my own condition, surely, pheo sufferers would be glad to finally have an answer for their unexplained symptoms.

The first time I had heard of it was on the TV series Grey's Anatomy.

Scott Foley played a patient with VHL disease, and was diagnosed with a "dangerous tumour of the adrenal gland" called a pheochromocytoma.

Foley was great eye candy, but it was also an eye-opener as to how dangerous pheos can be, as they emit bursts of adrenaline at random intervals.

This can cause sudden spikes in heart rate or blood pressure, and can sometimes even lead to a heart attack or stroke.

The problem is, the symptoms often tend to masquerade as other diseases, and less experienced doctors may give the wrong diagnosis. Hence, pheo is sometimes referred to as "The Great Mimic".

And no wonder, as ordinary symptoms such as headaches, sweating, and heart palpitations associated with hypertension, are usually primary indicators that something's not right.

Consultant endocrinologist Dr Hew Fen Lee says that pheos "can come in various shapes and sizes", meaning there are different presentations and symptoms.

"Many are classical symptoms, but even if they are, any doctor who doesn't think of it will easily miss it. Thus, many patients often end up seeing a host of doctors before somebody stumbles on the right path and looks for it.

"The test for pheo may even turn out negative sometimes as the hormone may be secreted intermittently.

"Some patients only find out during an operation (for something else). There are also many who show no or mild symptoms.

"One patient was incidentally found to have a swelling in the adrenal gland and this subsequently turned out to be pheo," he explains.

Drugs (tyrosine kinase inhibitors) may be prescribed to inhibit the formation of hormones by the tumour.

Alpha blockers to control blood pressure may be used as well.

In Malaysia, pheo cases are relatively rare, although not as rare as paragangliomas, which statistics indicate as one in 300,000 cases per year in the population. In the US, about 800 new pheo cases are diagnosed each year.

Pheos can also occur in combination with other tumours, conditions and in some familial (inherited) syndromes, and a series of tests can ascertain if specific hormone levels are not normal.

It is also associated with VHL syndrome, a rare, autosomal dominant genetic condition in which haemangioblastomas (blood vessel growths) are found in the cerebellum, spinal cord, and retina.

Usually benign

According to MedicineNet.com, pheos may occur at any age, but usually appear in those between their 30s and 50s, and approximately 10% occur in children.

Although the majority of cases are benign, about 10% of extra-adrenal pheos end up being malignant, especially when they occur in parts of the body that don't contain chromaffin cells and are not part of the sympathetic nerve chain.

Those in the liver, lungs, or bones may be considered malignant with possible metastases to other organs.

"A malignant pheo is rare and very often, surgery is the only cure as other treatments don't work so well.

The problem is whether they (pheos) are recognised and referred appropriately," Dr Hew elaborates.

Scans such as MRI or CT scans will reveal any mass in the adrenal glands, and usually, surgery is recommended to remove the tumour(s).

In the case of malignant pheos, chemotherapy or radiation therapy may be required after surgery.

"Pheo is rare and the symptoms fairly non-specific. If you're concerned, consult a doctor and request initial tests or referral to an endocrinologist," he advises.

Unfortunately, as with any other paraganglioma, there's no guarantee the tumour won't recur after surgery, and the only way to manage pheo effectively is long-term consistent follow-up care.

Related story:

Dealing with the unseen

Dealing with the unseen

Posted: 28 Dec 2013 08:00 AM PST

WHEN that many doctors tell you there's nothing wrong even though you feel quite unwell, you begin to seriously doubt yourself. One doctor even suggested that perhaps Annie Ling should see a psychologist.

"At one stage, I told my husband I didn't want to see any more doctors as they would just dismiss me.

"I've always felt not right. I would feel hyper, with lots of energy, yet I constantly felt tired and drained. I needed short naps, after which I could actively multi-task," says the 46-year-old project trainer.

Since her 20s, Ling says she has had symptoms, but general physicians often put it all down to stress and prescribed rest.

"I was particularly sensitive to all things new. By that I mean the smell of new paint, the inside of a new car, fresh leather seats, newly renovated rooms.

"I would get nauseous and suffer severe migraine," she explains.

No wonder doctors didn't understand her disposition. It didn't seem logical.

In 2003, she had bought a new car, and unknowingly, this brought on a slew of new physical problems. Ling was admitted for high blood pressure, which again was attributed to stress.

At the hospital, while she lay horizontal, her pressure returned to normal. But when she attempted to get up, it spiked and she almost passed out.

Before this, she was already on hypertension drugs, but they didn't seem to work very well as she frequently experienced fluctuations in her blood pressure.

What was frustrating was that the check-ups showed normal blood pressure levels a few hours later.

As Malaysia didn't have adequate facilities then, her tests were sent to Australia. However, after her condition stabilised and she was discharged, Ling didn't bother to call back to find out the results.

"Interestingly, a clinic doctor did suggest once that it might be pheochromocytoma (pheo) three years ago. But it was very rare and I promptly forgot about it."

The following year, when her symptoms persisted, Ling did some research on the Internet and realised her symptoms typically matched that of pheo patients.

Finally, she saw an endocrinologist and an MRI revealed a tumour on her right adrenalin gland.

She sought a second opinion and this was confirmed by Datuk Dr Noor Hisham Abdullah, who was Putrajaya Hospital surgical department head and consultant breast and endocrine surgeon.

This was the turning point in her health as Dr Noor Hisham (who is currently the Health director-general) was one of the few surgeons in the country then who had experience dealing with pheo.

After a four-hour surgery in October 2004, the tumour was successfully removed.

Today, she is considered cleared of pheo. Initially, she was required to go for follow-up every three months. But now, it's only once a year.

For years, Ling had felt all alone in her physical distress, and it was frustrating trying to explain what she had to other people who probably thought it was all in her head.

"Thankfully, all my earlier symptoms were finally explained and resolved. But I still don't feel great as now I have low energy levels and hormonal imbalance. The doctor says it's the body trying to adjust, which has made me hypo instead," she adds.

"I've since learnt that one of the most telling signs are inconsistent blood pressure spikes. When that happens, the doctor should check for pheo," Ling concludes. – Patsy Kam

Related story:

Speaking of lumps

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