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Posted: 01 Oct 2011 08:15 PM PDT

Today, a breast cancer diagnosis does not mean losing one or both of your breasts.

THERE was a time when losing one or both breasts was the only treatment option that was available for women who were diagnosed with breast cancer.

Healers of ancient times removed growths and the affected breasts with tools that looked like torture instruments.

Later, for almost a century after surgeon William Stewart Halsted performed his first radical mastectomy in 1882 (the removal of a woman's breast, surrounding lymph nodes, and part of her chest wall muscles), the procedure had been the treatment of choice.

However, 50 years ago, things started to change for the better.

First, radiation therapy came along, and more surgeons decided to leave their patients' chest wall muscles alone. Women still lost their breasts, but they could at least keep the contour of their chests intact.

Then, it got better in the past decade when surgeons started to preserve as much of their patients' breast tissue as they could through breast-conserving surgery.

Now, more and more women are able to keep the appearance of their breasts, even after the tumours or part of their breasts are removed.

Yet, despite all these improvements, women are still afraid of losing their breasts.

"One of the first questions women always ask is 'Do I need to remove the whole breast?'" notes Dr Tee Shin San, a general surgeon at the Assunta Hospital in Petaling Jaya. Fortunately, for him and his colleagues, it is now often possible to answer, "no".

Be an early bird

The catch is, to qualify for breast conserving surgery, women have to show up at their doctors' offices earlier.

According to Dr Tee, about seven out of 10 women whose breast cancer is picked up (in the early stages) by mammograms can be offered breast-conserving surgery. Even for women who see their doctors when they can feel a mass or lump in their breasts, there is a 50% chance that they would be eligible for breast conserving surgery as well.

The problem is, there are still a lot of women who seek treatment late.

In 2007, statistics by the National Cancer Registry showed that among the 2,114 women who had their breast cancer staged upon diagnosis, about 41% of them came to their doctors at the late stages of 3 or 4.

One of the reasons, says consultant clinical oncologist and radiotherapist Dr Manivannan A. B., may be due to the fact that most breast lumps are painless at early stages. And because breast cancer is more likely to occur at a time when women are usually busy with their families and careers (above 40 years old), these early changes are likely to go unnoticed, or dismissed.

"Sometimes, women talk to other women, who tell them these changes are normal at their age," says Dr Manivannan. The truth is, they are not.

He stressed that it is important to get any lump in the breast or discharge (fluids that seep out) from the nipples checked by a medical doctor.

The newly published clinical practice guidelines for the management of breast cancer by the Health Ministry recommends that screening mammography (for women without symptoms) may be done once in two years in all women between 50 and 74 years of age. (The guidelines can be downloaded from the Health Ministry website, www.moh.gov.my)

However, for women who are at high risk for breast cancer (like those who have a personal history of breast cancer or have siblings or a parent with breast cancer), screening should be done from the age of 30 with both a mammography and an MRI of the breast.

The test is not recommended as a routine for women in between 40 and 49 years old, but those who wish to do so should not be denied the test.

While there is no sufficient evidence that breast self-examination alone is effective in changing the outcomes of breast cancer, the guidelines recommend its use to raise awareness among women as its practice appears to encourage them to take responsibility for their own health.

The possibility of finding something amiss during a breast self-examination or mammogram may be scary to some, but women should bear in mind that the sooner they find out about their cancer, the better their chances of surviving are.

Breast alternatives

While surgery is usually the first line of treatment for breast cancer, it is often combined with other therapies, like chemotherapy, radiotherapy, hormone therapy and targeted therapy.

Unfortunately, in some circumstances, surgeons would not be able to offer breast-conserving surgery to their patients. These include situations when the tumour is too large in relation to the breast, located in several areas in the breast, or when the tumour is centrally located and surgeons may need to remove the nipple and areola as well.

However, there are still options available to help women preserve the appearance of their breasts.

First, their doctors can give them radiotherapy to shrink their tumours so that they can still go for breast-conserving surgery. If that is not an option and a mastectomy has to be done, surgeons can also help reconstruct their breasts with implants or natural tissue with breast reconstruction surgery.

Women also have the option of using breast prostheses or special bras that come with the prostheses so that they could maintain their former appearance even after the surgery.

"(A mastectomy) is not the end of the world," says Dr Tee.

Reaching out

In many ways, breast cancer is considered one of the "better cancers", says Dr Tee. The chances of surviving it are higher and in many instances, it does not stop women (or a small number of men) who have it from carrying out their normal activities.

However, like any other cancer, it can be a harrowing experience for those who are diagnosed with it.

That is why in the new guidelines, psychosocial support is strongly recommended for women with breast cancer. Regardless of its form – therapy, support groups, the help of a breast care nurse, or counselling – emotional support is important to help breast cancer patients cope with the challenges of living with the disease.

The good thing is, thanks to the countless awareness campaigns about breast cancer, help is available almost everywhere. Beyond the compounds of a hospital, there are non-governmental organisations and breast cancer support groups that are able to provide useful advice.

All a breast cancer patient needs to do is to reach out.

In conjunction with Pink October, the Assunta Hospital, in collaboration with Asia Assistance, Jaya One and PJ Live Arts, has kicked off the Passionately You campaign to educate the public about breast cancer and cervical cancer. For more information about the campaign, visit the campaign website www.dontduckit.com.

Eyeing diabetes

Posted: 01 Oct 2011 08:13 PM PDT

This week, our new column on eye health and food looks at diabetes and eye health.

Dr Fong: I'm feeling depressed. Post-raya holiday blues and overwork is part of it, but the main reason is because one of my young adult diabetic patients has gone blind in one of his eyes.

I have been treating his diabetic retinopathy for the past year, and despite all my best efforts, his vision has continued to get worse.

Diabetes is probably the most serious medical issue facing Malaysians today. The figures are frightening. More than 20% of our population has diabetes, and this figure is projected to increase by another 50% in the next 20 years.

One of the more serious complications of diabetes is diabetic retinopathy. This is bleeding from small blood vessels at the back of the eye, and occurs in one out of three diabetic patients.

Further growth and bleeding from the retinal vessels can be prevented by early laser treatment and this is needed for 10% of diabetic patients with retinopathy.

Diabetic patients can also get macular oedema or swelling of the centre of the retina.

The macula is the most sensitive part of our eye and is used for seeing sharp images. Macular oedema causes more blindness in the working diabetic population than retinopathy itself. This is treated with gentle laser and drug injections into the eye. About 10% of diabetic patients can get macular oedema, and often, also have concurrent diabetic retinopathy. Retinal detachment and glaucoma are two other serious eye complications of diabetes that requires surgery to treat them.

A national screening programme for diabetic retinopathy is the most cost-effective to prevent blindness in our diabetic population. These patients essentially have digital photographs of their retina taken in the local hospital or clinic and the images are sent remotely for grading by an eye doctor or trained grader.

Patients with signs of proliferative diabetic retinopathy or macula oedema seen on their photos can then be sent to their local eye department for prompt treatment.

Many stakeholders were consulted about the guidelines for diabetic eye screening and I am very excited about this new proposal. This would be money well spent by our government.

Prevention is better than cure and diabetic retinopathy is one disease that illustrates this. I hope that our government will focus on developing a viable national screening programme for diabetic retinopathy. This will save much more money in the long term as we will allow active working diabetic patients to continue working and contributing to our economy.

To prevent blindness from diabetes, we need good and consistent control of the blood sugar levels. Blood pressure and lipid level control are also very important.

We all know the obvious steps that must be taken to prevent complications from diabetes, but the barriers are many. These barriers include cultural and social issues that prevent good diabetic control like stigma associated with needles, excess sugar in our diet, lack of access to regular exercise, and lack of a national eye screening programme.

Chui Hoong: How do you take charge of your diet? Carbohydrates are our main source of energy. Too much carbohydrate in the diet can raise your blood sugar levels too high. Current studies have shown that consistency in day-to-day carbohydrate intake improves blood sugar levels. This means, having two bowls of nasi lemak for lunch today and cutting back to ½ bowl of white rice the next day to make up is not advisable.

It is best to spread your carbohydrate intake evenly throughout the day. Do not skip meals. This prevents high and low blood sugar levels.

Eating at regular intervals helps control hunger and prevents overeating at the next meal. If you monitor your blood sugar levels regularly, you will be able to identify patterns in your diet – what triggers high sugar levels – and avoid it.

Enjoy a variety of fruit, vegetables and wholegrains. These foods are good sources of fibre which helps to lower total cholesterol levels.

Fat does not raise blood sugar levels, but can lead to being overweight. Excess body weight can raise blood sugar levels.

A high-fat diet also increases your risk of heart disease.

Assoc Prof Dr Fong Choong Sian is a consultant opthalmologist, while Goo Chui Hoong is a consultant dietitian. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice.

Here's a recipe you can try at home:

Green peas, tuna and wolfberry rice

Peas are a good source of vitamin C, fibre, beta-carotene and contain some amount of omega-3. This is an excellent one-pot meal which is complete on its own and easy to prepare.

Serves five

Preparation and cooking time: 35 minutes

Ingredients:

180 g (1 cup) uncooked white rice

180 g (1 cup) uncooked brown rice

1 tbsp cooking oil

20g (2 cloves) garlic, chopped

50g dried shrimp, soaked in 200ml water, pounded, retain soaking liquid

10g (6) dried Chinese mushroom, soaked in 200 ml water, sliced, retain soaking liquid

1 tin (185g) canned tuna in water, drained and flaked

3 tbsp dried wolfberries

325ml (1½ cup) water

320g (2 cups) frozen green peas, thaw in a bowl of water, drained

Garnish:

2 tbsp chopped spring onions

40g (4) shallots, sliced and fried

Method:

Rinse the rice in a large bowl and drain. Heat the oil in the rice cooker. Add in the garlic, dried shrimp and fry till aromatic.

Stir in the sliced mushroom, tuna flakes and dried wolfberries. Finally, stir in the washed rice. Add all the soaking liquid and water into the rice cooker.

Cook the rice until all the liquid is absorbed or vaporised. This will take about 25 minutes. Switch off the rice cooker and stir in the green peas until it is well mixed. Leave the rice to sit for at least two minutes. Garnish with spring onions and fried shallots.

For a healthier nation

Posted: 01 Oct 2011 08:10 PM PDT

As a nation, we have to improve efforts to make all Malaysians healthier.

WE have just celebrated Merdeka and Malaysia Day (the nation's birthday), and the Prime Minister surprised everyone with the suggestion to abolish several outdated laws that had made a large section of the population very unhappy for a long time.

One of my own relatives was a victim of this law, and I witnessed how his incarceration deprived his four young children of their daddy (they were just toddlers or in primary school at the time), and how the family suffered.

So I join my fellow Malaysians in applauding our PM for his brave decision, as he continues to transform our nation into a more progressive, democratic, economically competitive, eco-conscious, people-friendly nation.

Although there is much unhappiness about the high and continually rising cost of living, we are also enjoying a much higher standard of living and affluent lifestyle compared to our parents. We are a rich and prosperous nation.

We have reasons to be happy indeed, although we look forward to more affirmative actions to address the other outstanding grouses and issues simmering on the ground (eg rising crime, poor public transport system, etc).

As a health enthusiast, my concern is about the transformation of Malaysians' health. We have seen the positive impact of the various transformation programmes implemented by Datuk Seri Najib's administration.

The economic, government and social transformation plans have been put in place, but we have yet to see a major health transformation plan to improve the health of our people.

We have to make a distinction between health parameters related to clean water, clean environment, accessibility of health facilities, and prevention/control of infectious diseases, all of which have been well taken care of by the relevant authorities; versus the health parameters related to the health of the individual – that indicate overall health (or unhealthiness) and the likelihood of getting chronic diseases like obesity, hypertension, heart disease, stroke, diabetes, kidney disease, liver disease, arthritis, and cancer.

In fact, many adult Malaysians are already afflicted by one or more of these diseases.

While the government has provided us with among the best and cheapest (government clinics and hospitals) health facilities in the world, the Health Ministry's efforts to make Malaysians healthier needs to improve. We have affordable and readily accessible health facilities which will be overburdened because we are also getting unhealthier and sicker.

Over the last three decades or so, the national health surveys have revealed that as a nation, we are getting fatter, more hypertensive, diabetic, and cancerous!

If surveys on arthritis and heart disease were done, I am sure we will be declared arthritic and heartsick as well.

The obesity plague

The Third National Health & Morbidity Survey 2006 (NHMS III) revealed that 29.1% of adults were overweight (BMI 25.0 – 29.9), with another 14% obese (BMI above 30). Obesity means gross overweight that should be treated as a chronic disease.

Altogether, about 45% of adult Malaysians were too fat. In comparison, only 21% were overweight or obese in 1996 (NHMS II – the prevalence of overweight was only 16.6%, and 4.4% were obese).

That's more than double in 10 years.

The survey also showed that Indians had the highest prevalence of overweight, followed by Malays and Chinese, while women had higher obesity prevalence (17.4%) than men (10.0%).

While the figures are alarming, they are not surprising to me. It is obvious that our people have not yet understood the importance of a healthy lifestyle, nutritious diet, maintaining optimal weight, and adequate exercise. These are the basis of healthy living.

In this Hari Raya Open House season, I had ample opportunity to observe how fat people continue to gorge on heapfuls of food on their plates, often going for multiple servings because there is so much to choose from. Malaysia is a food haven, and also fast becoming a sick nation, if we don't reverse the trend immediately.

I also noted with sadness that many of my former patients and staff whom I met during this festive season are now much fatter then they were before.

The most obvious are the ladies who were in their svelte teens or twenties when I first met them 10 to 30 years ago, and are now obese and rotund (in their 30's to 50's). I had observed that they were progressively getting bigger and bigger over the years. Some of them are now HUGE!

We eat too much

The cause for this observation? Malaysians eat too much, and we eat the wrong foods. We have delectable and delicious dishes that we are trying to promote to the world, but that does not mean delicious cannot be healthy too. If you know what to eat, you can still enjoy delightful, nutritious meals.

To be healthy and avoid obesity, we have to change our mindset and start eating for health.

For a start, we need to reduce our rice consumption. Much of the overweight/obesity problem can be blamed on this (over-consumption of rice or other processed carbohydrates like mee, laksa, roti canai, bread, etc).

Several years ago, a local newspaper reported that a Malay lady lost 180kg (yes, one hundred and eighty kilograms!) in just one year without going through a torturous regime like starvation diets or The Biggest Loser competition. She did so just by avoiding rice and the carbohydrate substitutes.

She ate plenty of vegetables, some fruits, fish and nutritional supplements to ensure that she was well-nourished.

After one year, she dropped from 260kg to 80kg, and also cured herself of hypertension and diabetes. She did not spend thousands of ringgit at slimming salons. Her success was solely due to her determination, perseverance, discipline, and the correct understanding of what makes a healthy, balanced diet.

Although her story is an extreme case, we can learn from her that over-consumption of rice causes obesity, and reduction (or avoidance as in her case) of rice consumption can indeed reduce weight.

Remember that a small cup of rice has the fattening calorie-equivalent of about 10 teaspoons of sugar, while a large bowl of rice (and this is the standard serving in many Mamak restaurants) equals about 20 teaspoons of sugar.

I would also like to share that many of my patients who reduced their rice intake reported that their waists became slimmer faster than when they tried to exercise the belly fat away. This has important health implications, because central obesity (fat accumulation around the belly) predisposes to diabetes and heart disease.

A healthy, balanced diet

A healthy, balanced diet should provide energy, essential fats, proteins, plenty of other nutrients, and sufficient water for all our metabolic needs.

Those of you who are overweight/obese already have too much calorie-energy stored in your body, so you don't even need to worry about this.

Just a small portion of carbohydrate (eg rice/bread) daily is sufficient. There will be plenty of unhealthy "hidden" fats in your food. The protein is best sourced from eggs, fish or beans. Most of the nutrients we need should come from fruits and veggies.

Malaysians generally do not take enough veggies. In fact many deliberately avoid them. It is a pity since veggies provide many important vitamins, minerals, antioxidants and other phytonutrients.

We are also blessed with a rich variety of fruits, which also provide ample health-enhancing and disease-preventing nutrients.

While you can take as much of the leafy veggies as you like (they are low-calorie nutrient-dense foods), however, you must be cautious about eating too much fruits because they also have plenty of sugars/calories.

For fruits, the rule is – go for variety, but not quantity. For veggies – go for variety and quantity.

If you are like the majority who don't take enough fruits and veggies, you should consider supplements to provide the important nutrients not adequately provided by your diet.

I recommend whole-food supplements (extracts from whole fruits, veggies, greens, grains, grass, legumes, etc) instead of the artificially formulated supplements, which may not necessarily give the promised the health benefits.

Whenever possible, I begin my meals by stuffing myself with veggies, followed by some fruits, then only the meal "proper", so that even if there are delicious dishes (that are often unhealthy), I am assured that the protective nutrients have already gone in, and because my stomach is already full of veggies and fruits, I will not be able to binge on the unhealthy dishes.

Sometimes I am already satiated after the veggies and fruits, and the junk food does not get in. And I try to avoid the sweets/desserts, but not always!

A call for health transformation

That is my personal diet transformation. For a total health transformation, it will have to include maintaining a healthy weight and exercising more as well. To preach health, I have to start with myself.

When the NHMS III results were released, the researchers (from the Health Ministry and universities) jointly made this statement: "This alarming trend calls for serious re-examination of public health programmes for more effective reduction of obesity among Malaysian adults." (http://psasir.upm.edu.my/6543/)

Five years down the road, I don't see any improvement as far as obesity reduction is concerned. In fact it is worsening. With it comes the worsening statistics for diabetes, heart disease, stroke, arthritis, kidney disease, liver disease, cancer and many other chronic lifestyle diseases.

I call upon the government to embark on serious and effective health programmes to combat this obesity plague before we become a totally fat and sick nation.

All our successes with the other transformation programmes will come to naught if so many of us become crippled by chronic diseases, or die early.

I acknowledge that there have been many health campaigns and programmes implemented by the Health Ministry in the past, but we have yet to see their effectiveness, at least when it comes to combating obesity and the chronic diseases, or even smoking. Obviously we must do something different to achieve results.

Let us work together towards a healthy, happy 1Malaysia.

Dr Amir Farid Ishak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Kredit: www.thestar.com.my

Ahad, 2 Oktober 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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