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The Star Online: Lifestyle: Health

Radiation therapy: A child fights for his life in isolation

Posted: 03 May 2014 09:00 AM PDT

Child has to be isolated during treatment because of high-dose radiation therapy.

AT precisely the time six-year-old Sammy most needed his parents, they were forced to keep their distance because his unique cancer treatment made him radioactive.

Even his favourite blanket and stuffed animal were off-limits, lest they, too, become contaminated.

Two weeks ago, Sammy Nahorny became the first patient at Comer Children's Hospital to undergo high-dose radiation therapy for neuroblastoma, one of the deadliest paediatric cancers.

The treatment confined him to a room of less than 200 square feet, lined with 450,000 pounds of bricks that contain lead.

Every inch – including the floor – was covered in paper or plastic, as well as any object Sammy touched, such as video games and the remote control.

For five days, Sammy was mostly alone, waiting for his radioactivity levels to drop closer to normal.

"Not being able to snuggle him completely breaks my heart," said his mother, Erin Nahorny. "It's probably the worst feeling I have experienced. He gives me these puppy dog eyes and just wants me to hold him."

Erin and Chris Nahorny interacted with their son primarily through a closed-circuit TV monitoring system and walkie-talkies. They helped care for Sammy and made brief visits, but they could not linger or comfort him the way they wanted.

Only one parent at a time was allowed in the room, for a total of about 40 minutes a day between the two of them.

When his mother or father entered his room, she or he would don a disposable gown, gloves and shoe coverings and stand behind a large lead shield, covered with yellow tape usually associated with crime scenes.

Despite the hurdles, the Nahornys consider themselves "so fortunate" to be at Comer, one of about a dozen children's hospitals in the US to offer the treatment and the only site in Illinois.

The family made the 10-hour trip from its home in Columbus, Nebraska, to the University of Chicago because surgery, chemotherapy and a stem-cell transplant have not slowed the primary tumour and growth of neuroblastoma cancer cells, which have spread to Sammy's bones and bone marrow, physicians said.

And so this is the couple's "Hail Mary". They have put their lives on hold – he's in manufacturing, and she's a social worker – because they have run out of options. The radiation therapy has been shown to have a 30 to 40% response rate for patients.

"You can read all the statistics you want," his father said. "But all you really care about is how it affects just one."

MIBG, short for metaiodobenzylguanidine, is a compound that can be combined with radioactive iodine and delivered intravenously, where it has been effective destroying neuroblastoma cells while sparing surrounding healthy tissue, said Dr Susan Cohn, a paediatric oncologist at Comer and one of the nation's leading experts on the disease.

While the infusion process takes only about 90 minutes, it imposes a daunting burden on the family, typically requiring a three- to five-day hospital stay.

Young patients are mostly confined to their beds, alone in their rooms while waiting for their radioactivity to diminish. Any beloved toy that accompanies them would need to be quarantined for up to six months after treatment or thrown away.

The family decided to keep Sammy's favourite stuffed frog at home. "We bought him another frog," his mother said, "but he wouldn't have any part of it."

The Nahornys had to do more than keep their son occupied under trying circumstances. Anyone who entered the unit was exposed to gamma radiation emitted from Sammy's body – from his urine, saliva, even perspiration.

For medical staff, radiation exposure is an ongoing occupational concern. So the parents must sign a contract and agree to be trained and take on many caregiving duties, such as dispensing medications and emptying his catheter into a lead-lined box.

The Nahornys both wore a gadget – called a dosimeter – to monitor their exposure, which they dutifully logged into a notebook every time they left. How meticulously they followed the rules would greatly affect the health risks to them and others.

One lapse – for example, walking out of Sammy's room without first removing the paper booties – could contaminate an entire hospital corridor.

Given all the upheaval, the treatment is not for everybody, Cohn said. "To be eligible, a child must not just have a tumor that can take up MIBG but also be in the room alone safely."

Sammy's illness started with complaints about his neck in June 2012. The next month, he was in the emergency room with stomach and leg pains, dismissed as constipation and growing pains.

On July 30, he became one of the 650 cases of neuroblastoma diagnosed every year, usually in children younger than five.

The hospital and the family are allies in making the protocol as kid-friendly as possible. Sammy didn't have much of an appetite, but he had access to frozen pops and chocolate milk.

The Nahornys transferred their Netflix account to Comer's iPad, allowing Sammy to spend hours playing video games. Bingo is on the hospital's in-house TV network, in which a doctor calls out the numbers.

Then, staff members bring a cart around stocked with prizes to the anteroom, just beyond Sammy's door. From his bed, he chose Hot Wheels and a memory card game.

The night shift, though, can be the toughest. Nurses talked to Sammy through the intercom, but the majority of nocturnal duty was up to the Nahornys.

"On that first night, he asked if I could please hug him before he went to sleep, and I could not say no," his mother said. "It's too much to expect from a six-year-old. ... Yep, I broke the rules."

Amid all the safeguards, it's easy to forget that at the centre is a 21kg boy who barely dents the mattress. The sign taped to his door listed his career aspirations as FBI agent, firefighter or bobsledder.

After four days, Sammy learned he could not yet be discharged because his radiation level was still too high. He expressed his frustration as only a six-year-old can: by hurling his plastic dinosaur at the door.

On Good Friday, though, the Nahornys got good news. Sammy could leave his room, and the family would be back home in time for Easter. – Chicago Tribune/McClatchy-Tribune Information Services

Walking can help creative thinking, not just fitness

Posted: 03 May 2014 09:00 AM PDT

Study shows a walk around the park can boost mental fitness.

People who rely on walks to overcome writer's block or solve a tricky problem seem to have it right: new research shows that walking – whether indoors or outdoors – can encourage creative thought.

Researchers at Stanford University's Graduate School of Education, United States, conducted experiments on 176 people and found that participants who walked, rather than sitting or being pushed in a wheelchair, gave more creative responses on tests used to measure creative thinking.

Previous research has shown that regular aerobic exercise can have a positive effect on cognitive ability, but this study suggests that walking can have a very temporary effect on certain kinds of thinking.

The researchers explain their decision to focus on walking, rather than more strenuous exercise: "Asking someone to take a 30-minute run to improve creativity at work would be an unpopular prescription for many people," said co-author Dr Daniel L. Schwartz. "We wanted to see if a simple walk might lead to more free-flowing thoughts and more creativity."

In one test, researchers named an object, then asked a subgroup of 48 students to think of alternative ways to use it. So, "button" might lead a student to say "as a doorknob on a dollhouse".

In another test, 48 students were asked to complete word associations involving three-word groups – for example, "cottage-Swiss-cake", for which the correct answer was "cheese".

Of the students tested while walking, 100% came up with more creative ideas in one experiment, while the other experiments saw 95%, 88% and 81% of the walkers come up with more creative responses than when they were sitting.

Whether indoors or outdoors, the walkers had more creative responses.

Interestingly, when asked to solve problems with a single answer, walkers scored slightly lower than the sitters.

While the authors say more research is necessary, one thing is clear: "Incorporating physical activity into our lives is not only beneficial for our hearts, but our brains as well. This research suggests an easy and productive way to weave it into certain work activities," said study co-author Dr Marily Oppezzo, of Santa Clara University, California.

The study was published in the American Psychological Association's Journal of Experimental Psychology: Learning, Memory and Cognition. – AFP Relaxnews

A road well travelled: My Cholesterol Journey In Malaysia review

Posted: 03 May 2014 09:00 AM PDT

A journey spanning 40 years of exciting cholesterol research is revealed in a prominent cardiologist's latest publication.

MODERN Western medicine as practised today probably saw its genesis in the 19th century, when advances in science and other discoveries ushered in the era of more systematic analysis of disease.

However, it was not until the 20th century that the application of the scientific method to medical research began to produce important developments in healthcare, with great advances in various fields.

Today, the practice of Western medicine is rooted in the notion of evidence-based medicine, where extensive research results inform clinical decision-making in the diagnosis, investigation or management of patients.

This has seen much success, and the health scourges of earlier centuries have been significantly curtailed, especially infectious disease, to the extent that some have even been completely eradicated (e.g. smallpox).

However, the downside of this has been the rise in incidence of what many term lifestyle or non-communicable diseases.

These are diseases that come about as a result of a sedentary lifetsyle, as well as unhealthy dietary habits.

Of the many lifestyle diseases that plague modern humanity, heart disease, particularly coronary artery disease (CAD), has become the number one killer in many developed and developing countries.

His life¿s work: My Cholesterol Journey In Malaysia provides an intimate insight from a doctor¿s perspective into the cholesterol landscape in Malaysia.

My Cholesterol Journey In Malaysia provides an intimate insight from a doctor's perspective into the cholesterol landscape in Malaysia. – Filepic


Also known as atherosclerotic heart disease, coronary heart disease (CHD) or ischaemic heart disease, CAD is the most common type of heart disease and cause of heart attacks.

It is characterised by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.

According to the World Health Organisa-tion, it is, as of 2012, the most common cause of death in the world, and a major cause of hospital admissions.

It is now universally recognised that one of the most important risk factors for developing CAD is high cholesterol levels, though this recognition only came decades after the first hint of a cholesterol-coronary heart disease link in the early 1900s was discovered by a young Russian pathologist named Nikolay Anichkov.

The key breakthrough came in 1955, when a nutritional scientist at the University of Minnesota, United States, Ancel Keys, suggested that it was important to conduct large-scale clinical studies where diet and health were researched.

The clinical trial that ended speculation about the role of cholesterol as a primary cardiovascular disease risk factor was the Coronary Primary Prevention Trial (CPPT) in 1973 by the NHLBI Lipid Research Clinics. It showed that lowering blood cholesterol leads to a reduction in heart attacks.

Today, the cholesterol "controversy" has not subsided, what with claims by some that it does not cause heart disease. But that's a story for another day.

What's more relevant today is the experiences of Malaysian consultant cardiologist Datuk Dr Khoo Kah Lin in treating hypercholesterolaemia patients, and his recently published book, My Cholesterol Journey In Malaysia.

In the book, Dr Khoo writes: "On the whole... this book chronicles my journey when I first asked this question in the early 1970s: how do we tackle the epidemic of cholesterol and CHD in a developing country like Malaysia, where resources are limited and there are other things that seem to take priority?"

The healthcare landscape has significantly changed since the 1970s, but Malaysia is still grappling with the problem of CAD, which remains the number one killer in the country.

Dr Khoo is a past president of the Malaysian Medical Association (MMA), and is currently director of the Heart Foundation of Malaysia (known by its Malay acronym, YJM), as well as Master of the Academy of Medicine of Malaysia.

He started the Inherited Cholesterol Disorder Club (ICD) in 2001 in collaboration with the pharmaceutical company Merck, Sharpe and Dohme (MSD), and YJM.

Other than providing statins at a discounted rate for familial hypercholesterolaemia (FH) patients, the club also educates and creates awareness of FH.

The book sheds light on many aspects of Dr Khoo's work, with the most significant being his involvement in treating Malaysians with FH.

FH is an inherited condition, where the level of low-density lipoprotein (LDL) cholesterol in the blood is higher than normal from birth.

This is a result of a defect in the gene which controls how cholesterol is handled in the body. As a result, LDL cholesterol is not broken down properly, which leads to increased levels in the bloodstream.

In most cases, the defective gene is inherited from one parent (heterozygous inheritance). If it is inherited from both parents (homozygous inheritance), the condition is much more severe.

Heterozygous familial hypercholesterolaemia affects about one in 500 people while the homozygous condition is very rare.

The most important consequence of FH is the development of heart disease at a young age, which can also lead to heart attacks at a very young age.

In his book, Dr Khoo recommends a very simple test for FH: just reach down and feel your Achilles tendon. Is it thickened? If it is, and you have an LDL-cholesterol reading of 5 mmol/l and more, then you are clinically a FH patient.

The book also delves into various aspects of Dr Khoo's work, and documents his early years in medicine to the time he started developing an interest in lipids.

He explains the basic concepts of blood lipids, which include the structure of cholesterol, triglycerides, phospholipids and apoproteins.

He also describes coronary risk factors and its frequency peculiar to the Malaysian lifestyle – food, physical activities and cigarette smoking – as well as the various treatment options available.

The book is a reflection of a lifelong journey of service and discovery, one Dr Khoo describes as follows: "All that I achieved with my colleagues was done without money or study grants, but sheer enthusiasm. People came into my life when I needed them most, and when I reflect on this, I'm always reminded of Dorothy in the Wizard of Oz. Today, I feel so blessed that the dreams that I dared to dream at the start of my cholesterol journey really did come true."

Kredit: www.thestar.com.my

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