Category Archives: Medicines & Sciences

Features medical breakthroughs and the latest in healthcare through informative articles

BE FAST TO COMBAT STROKE

by Dr Tan Kenny – Consultant Neurologist & Physician 

(Subspecialty in Parkinson’s Disease & Movement Disorders)

Having sudden facial or limb weakness and numbness?
Sudden slurred speech or drooling?
Sudden blurred vision?
Is that a concern?
What is going on with your body?

Stroke is preventable and treatable. It is important to recognise early stroke symptoms and BE FAST to act during the golden hour so that immediate emergency stroke treatment can be initiated to reduce brain injury.

Stroke occurs when there is reduced blood supply to the brain. In general, stroke can be classified based on the etiology of reduced blood supply, i.e. ischemic (blockage) and hemorrhagic (bleed). Ischemic stroke is the most common type of stroke. Symptoms suggestive of stroke include sudden poor balance, visual problems, face or limb weakness or numbness, speech difficulty. An easy acronym to remember is BE FAST (Balance Difficulties, Eyesight Changes, Face Weakness, Arm Weakness, Speech Difficulties, Time to call for help).

Around 2 million brain cells die every minute during acute stroke, increasing the risk of permanent brain damage, disability or death. Thus, it is pertinent to identify stroke early so that the necessary medical treatment can be implemented.

Upon reaching the hospital, the neurologist will initiate emergency stroke assessment to establish the diagnosis of ischemic stroke before initiating acute stroke treatment. One such treatment is thrombolytic therapy, i.e., administration of a ‘clot buster’ medication to dissolve blood clots that have blocked the arteries in the brain causing stroke, in the hopes of breaking the clot to reperfuse and return blood flow to the affected brain cells. To be effective, the therapy needs to be initiated as soon as possible within the golden hour (4.5 hours from the onset of symptoms), before permanent irreversible damage has occurred.

For ischemic stroke patients who arrive beyond the treatment window period (>4.5 hours) and not suitable for acute thrombolytic therapy, appropriate investigations and medical treatment to stabilise patient will be initiated i.e. blood thinners, blood pressure and blood sugar control. The first three months after a stroke are the most important for recovery as patients will see the most improvement. Thus, besides providing best medical treatment, patient will require neuro-rehabilitation i.e. physiotherapy, occupational therapy and speech therapy.

Stroke can be debilitating but the bright side is it can be prevented and may be attributed to modifiable and non-modifiable risk factors

In Malaysia, hypertension was the most common risk factor followed by diabetes mellitus. Modifiable risk factors are the focus of primary prevention and they include the following risk factors:

a) Lifestyle, i.e., smoking, unhealthy diet, lack of physical activity.

b) Metabolic, i.e., hypertension, diabetes, high cholesterol, obesity (measured by high body mass index or BMI)

c) Environmental, i.e., stress, air pollution.

Many are not aware that stroke can recur. The recurrence rates are 3-4% in the first month and 12% in the first year after a stroke. This emphasises the importance of secondary stroke prevention, and this may involve medical interventions including anti-platelet therapy, anti-hypertensive treatment, cholesterol and blood sugar control. Besides compliance to medication, lifestyle modification plays a vital role.

It is recommended to maintain an active lifestyle by exercising 30 mins daily or at least 150 mins per week, stop smoking, avoid heavy alcohol drinking and healthy diet. Mediterranean diet (low glycemic with high intake of vegetables) supplemented with nuts, diet high in fruits and leafy green vegetables are beneficial. It is also recommended to follow the Dietary Approaches to Stop Hypertension (DASH diet) to reduce blood pressure, emphasising on high consumption of fruits, vegetables, whole grains, low-fat dairy foods, legumes and nuts, and low intake of sodium, sweetened beverages, and red and processed meat.

In Malaysia, there is still lack of awareness in regards to recognition of stroke symptoms and the significance of time-sensitive stroke treatment. As a result, delay in early intervention may lead to prolonged hospital stay and increase of stroke-related morbidities and mortality. BE FAST to ensure better outcome as time loss is brain loss in acute stroke. Stroke strikes fast, so should you.

Dr Tan Kenny is a Consultant Neurologist and Physician at LohGuanLye Specialists Centre. He has vast experience in diagnosing and managing stroke, dementia, headaches, Parkinson’s and various other neurological conditions. He established the emergency neurology stroke service at LohGuanLye Specialists Centre and obtained the World Stroke Organization (WSO) Angels Award Platinum Status for the hospital’s stroke service. He is committed to creating awareness, education and holds the position as the Medical Advisor for the Penang Parkinson’s and Rehabilitation Association.

SLEEP IS DIAMOND – INCREASE OPTIMAL HEALTH

by Dr Mecherl Lim 

MD (MA) Naturopath (ND), Holistic Kinesiology

How a series of sleep loss impacts mental & physical wellbeing
Three consecutive nights of sleep loss can have a negative impact on our mental and physical health and cause both to greatly deteriorate. Sleep deprivation can lead to an increase in anger, frustration, anxiety and a weakened immune system and amongst others.

A new study published in Annals of Behavioural Science looked at the consequences of sleeping fewer than six hours for eight consecutive nights – six hours is the minimum duration of sleep that experts say is necessary to support optimal health in average adults.

Lead author Soomi Lee, Assistant Professor in the School of Aging Studies at the University of South Florida, found the biggest jump in symptoms appeared after just one night of sleep loss. In a study by the University, the number of mental of physical problems steadily got worse, peaking on day three. At that point, the research showed that the human body has gotten relatively used to repeated sleep loss. But all that changed on day six, when participants reported that the severity of physical symptoms was at its worst.

Many of us think that we can pay back our ‘sleep debt’ on weekends and be more productive during the week. However, results from this study shows that having just one night of sleep loss can significantly impair your daily mental abilities and functioning.

Data provided by the Midlife, included a study of nearly 2,000 middle-aged adults who were relatively healthy and well-educated. Among them, 42 percent had at least one night of sleep loss, sleeping one and a half hours than typical routines.

They recorded their mental and physical behaviours in a journal for eight consecutive days, allowing researchers to review, how SLEEP LOSS causes wear and tear on the body.

Participants reported a pile-up of angry, nervous, lonely, irritable and frustrated feelings as a result of sleep loss. They also experienced more physical symptoms, such as upper respiratory issues, aches and pain, gastrointestinal problems, and other health concerns.

These negative feelings and symptoms were continuously elevated throughout consecutive sleep loss days and did not return to baseline levels unless they had a night’s sleep of more than six hours.

About one third of adults sleep less than six hours per night. Once that becomes a habit, it’s increasingly difficult for your body to fully recover from lack of sleep, continuing the vicious cycle of worsening daily wellbeing, which could impact one professionally.

A previous study led by author Sommi found losing just 16 minutes of sleep could impact job performance. Her previous findings also showed that minor sleep loss can decrease daily mindfulness, which is a critical recourse for managing stress and maintaining healthy routines.

So, I would advise the best way to maintain a strong daily performance is to set aside more than SIX HOURS of SLEEP NIGHTLY.

Visit : http://www.drmecherlherbs.com

Email : drmecherherbs@gmail.com

FACEBOOK : drmecherlherbs for further enquiries.

A2 Milk – The Future of Dairy

By Dr. Lim Ban Keong, D.V.M (UPM)GM of Rhone Ma Holdings Bhd

The ruminant industry in Malaysia only started taking off over the last ten years with many participants being small farmers. To help them out, we plan to share our combined expertise and technological knowhows for dairy farming and milk production with other farmers and other interested parties,”  – said Dr. Lim Ban Keong


There’s nothing better than a splash of milk in your morning coffee for the important nutrients for our body. However, sometimes consuming milk and milk products might result in tummy problems. If that happens, it’s time to try A2 milk.

Tummy problems from milk may not necessarily be due to lactose intolerance or trouble digesting lactose sugar in milk. Recent research suggests that a less-known protein, A1, may be one of the culprits. A1 produces a protein fragment known as Beta-casomorphin-7 (BCM-7) during digestion which triggers tummy discomfort and symptoms similar to those with lactose intolerance.

There are 2 kinds of proteins in milk: A1 and A2. While most cows’ milk contains both, A2A2 cows produce only A2 protein, which results in A2 milk.

Rhone Ma Holdings Berhad, a homegrown end-to-end animal health solutions provider, introduces the A2 milk to the local market through its acquisition of 49% interests each in three livestock companies in February 2020. The Group has teamed up with One Lazuli Sdn. Bhd., Nor Lazuli Nutrition Sdn. Bhd. and Nor Livestock Farm Sdn. Bhd. in order to expand into the dairy farming business.

As a first step, the Group and its partners injected RM3 million capital in Nor Livestock Farm Sdn. Bhd. who operates a 6-acre dairy farm in Batang Kali, Selangor which currently house more than 160 A2A2 Holstein cattle. The Group expects to further expand the herd to 500 heads as they are expecting around 90 more female cows to be born in a few months’ time. In addition, they are also planning to import another batch of 100 impregnated cows in 2021. The farm’s milk production currently averages 12,000 litres/month and soon the farm is expected to produce approximately 65,000 litres/month. 

The Group’s shift into the ruminant sector is part and parcel of its responsibilities as a key industry player to further develop the local ruminant industry. Rhone Ma, a proponent of the Total Solutions Programme (TSP) which allows customers the flexibility to customise the animal health services and animal health products to form their desired animal health solution, has pledged to work together with local dairy farmers to support them and establish more dairy farms in the country in line with the government’s heed to stimulate the industry. 

“The ruminant industry in Malaysia only started taking off over the last ten years with many participants being small farmers. To help them out, we plan to share our combined expertise and technological knowhows for dairy farming and milk production with other farmers and other interested parties,” said Dr. Lim Ban Keong, Managing Director of Rhone Ma Holdings Berhad.

“This will also include advocating the use of Milk Boosta the premium cattle feed that was specially formulated to induce energy for maximum milk production for cattle in a tropical climate. The combination of Milk Boosta and Alfalfa Hay and some kind of supplements also helps to reduce heat stress,” added Qasem Alhasan, Managing Director of Nor Livestock Farm Sdn. Bhd.

With the establishment of more farms, the Group will not only be able to encourage their peers to thrive in the industry but also address the issue of fresh milk insufficiency in Malaysia head on. On top of that, as consumers become more health conscious and discerning in their food consumption, the Group and its partners envisage a big future for fresh A2 milk in the local market.

reflections on healthcare here & beyond

Bryan Lin Boon Diann
Chief Executive Officer of Sunway Medical Centre


2020 has brought upon a new wave of change to people everywhere – from wearing a face mask in public areas, social distancing, practising good personal hygiene at all times to working and studying at home. 

Likewise, the hospital landscape has altered due to the unprecedented arrival of the COVID-19 pandemic. Today, patients can meet their doctors from the comforts of their homes through virtual clinics, evolving the way hospitals operate as digitisation becomes the norm. 

The pandemic has effectively changed the way businesses are run and for healthcare institutions like Sunway Medical Centre, we need to be innovative. We were the first tertiary hospital to establish the telemedicine service at the start of the pandemic, and this is one of the ways that has transformed the way we support care outside of our facility. 

We have made healthcare more accessible by extending services such as medicine delivery, nursing care, diabetes care, wound care, physiotherapy and phlebotomy to homes through our personalised, mobile healthcare services and home nursing under Sunway Home Healthcare (formerly known as SunMed@Home). 

We have also set up a Telemedicine Command Centre which facilitates referrals for patients with medical emergencies to the hospital. This will provide better patient experience journey and peace of mind during their times of need. This project is likely the first in the country and will be another game changer in the clinical landscape.

The ultimate goal is to improve patient value, and the only way the healthcare industry will achieve this is by digitalising healthcare, leveraging on artificial intelligence, telemedicine, Internet of Things (IoT) and other digital platforms to propel it to the next level. Robotics and automation will also be vital in improving overall service delivery and customer experience while enabling more personalised medical care. 

We need to demonstrate greater value in the healthcare system in this challenging time while continuing to care for patients requiring multispeciality and multidisciplinary care services and/or complex technologies. 

Setting up new and advanced quarternary service offerings like bone marrow transplant, renal transplant and paediatric cardiac surgery has also set Sunway Medical Centre apart in the market. The hospital is also focused on Women & Children Services and Acute Services to ensure that communities are well taken care of. 

As the industry grows, the requirement for highly-skilled, professional talent will also increase. 

Healthcare providers like us will need to continue developing a sustainable talent pipeline, while strengthening the existing talent pool with strategic hires, retention initiatives and continued employee training and development.

While diseases will never be completely eliminated, through science, data and technology, we will be able to identify it earlier, intervene proactively and better understand its progression to help consumers more effectively and actively sustain their wellbeing. 

Personalised medicine will progress and as researchers find out more about the particular genetic makeup of diseases, we will be able to give specific drugs to target it. And by 2030, healthcare will be centred on patients empowered to prevent diseases rather than seek treatment. They will receive personalised health solutions in ways that are integrated seamlessly into their daily lives. 

In short, healthcare providers need to change accordingly in order to forge ahead. As the rate of change in healthcare is accelerating, healthcare providers must harness the forces of driving transformation and use them to its advantage and in this case, growth, innovation and diversification. 

THE LOW-FODMAP DIET

by Dr Mecherl Lim 

MD (MA) Naturopath (ND), Holistic Kinesiology


In 2006, researchers Dr Sue Shepherd & Professor Peter Gibson from Monash Uni, linked several highly fermentable but poorly absorbed short chain carbohydrates and polyols to symptoms associated with IBS, including wind & diarrhoea, as well as to the increased intestinal permeability associated with Crohn’s disease.

These fermentable aligo-di-and monosaccharides and polyols are now known collectively as FODMAPs.  They comprise oligosaccharides (fructans and galactans), disaccharides (lactose), monosaccharides (fructose) and polyols, which is the technical word for sweetener.  In the 2006 study, 74 per cent of patients with IBS and fructose/fructan diet such as the FODMAP diet.

HOW DOES THE LOW-FODMAP DIET WORK?

Research shows that FODMAPS in meals are poorly absorbed in the small intestine and increase the delivery of water to the colon-suggesting the catalyst for diarrhoea in some people.  Breath test show that eating a low-FODMAP diet reduces hydrogen production (in both healthy volunteers and patients with IBS), linking the short chain carbohydrates with bloating, abdominal distension and pain and excessive flutulence. 

Since the first study, research has consistently tied global restriction of FODMAPs (rather than restriction of individual components) with reduced symptoms of IBS.  In a challenge trial (in which participants restricted fructose/fructans-containing foods and then restored the foods to the diet) showed a return of symptoms after the foods were reintroduced.

In those with Crohn’s  disease, sweeteners such as sorbitol, maltitol and isomalt are absorbed, but the digestibility of the other nutrients in the foods is reduced because these polyols cause an osmotic load, meaning that more water remains in the intestine, leading to watery stool.

FODMAP group had reduced bloating, 87 per cent enjoyed less flatulence and 85 per cent experience a reduction in abdominal pain.

The researchers concluded that the low-FODMAP diet is more effective than standard dietary guidelines for symptom control of IBS.

FODMAPS AFFECT HEALTHY PEOPLE TOO

It’s interesting to note the research has also uncovered information about how FODMAPS are digested by healthy participants.  We know, for example, that fructans (polymers of fructose found in asparagus, leeks, garlic, onions and onions and wheat) and galacto-oligosaccharides (lactose from cows milk) are always fermented by intestinal flora, and cause wind production and flatulence in healthy people too.  The effects are merely worsened in those with hypersensitivity and motility disorders as found in IBS.

READY TO TRY IT

The low FOD-MAP diet eliminates sugars that can’t be fully  digested and absorbed in the small intestine.  When following this diet, journal ling is critical.  Be sure to keep accurate records of what you eat, when and how your body responds.

After following the diet until all of your symptoms have disappeared, the goal is to reintroduce foods to determine whether they are a trigger for your symptoms.  When doing so, add one food back at a time and wait 72 hours to determine that symptoms haven’t re-appeared before moving on to the next food. 

This way of eating is not as restrictive as some other prescription diets, but if you are interested in following it, you are wise to get nutritional guidance from an expert so you are sure to get all of your health-supportive nutrients.  You may have to use vitamin and mineral supplementation to be sure to meet nutrient requirements, particularly in the elimination and re-challenge phases. 


Visit : http://www.drmecherlherbs.com

Email : drmecherherbs@gmail.com

FACEBOOK : drmecherlherbs for further enquiries.

Breast Cancer & Breast Reconstructive Surgery

By Dr Teoh Mei Shi (Consultant Breast, Endocrine & General Surgeon)  & Dr Wong Thai Er (Consultant Plastic and Reconstructive Surgeon)

Dr Teoh Mei Shi
Dr Wong Thai Er

Dr Teoh Mei Shi is a Breast, Endocrine and General Surgeon. Dr Wong Thai Er is a Plastic and Reconstructive Surgeon. Both are consultants at Loh Guan Lye Specialists Centre. As a team they work together to treat the cancer and help reconstruct the breast to give patients a more positive outlook in their recovery from cancer.


Over the last few decades, surgical treatment of breast cancer has undergone a paradigm shift from radical mastectomy that involves removal of whole breast and large portion of muscle underlying the breast tissue to breast conserving surgery and now oncoplastic breast reconstructive surgery. Concomitant advances in chemotherapy and radiotherapy have played major role in this shift.

Oncoplastic breast reconstructive surgery involves the oncological removal of breast cancer combined with reconstructive plastic surgery techniques to rebuild or reshape the breast for an aesthetically pleasing final outcome. The combined reconstructive surgery can be carried out immediately at the time of breast cancer surgery or as delayed procedure performed months or years later. The current practice of Breast Reconstruction results in single hospitalization saving time and cost with shorter time away from work. Moreover immediate breast reconstruction certainly helps them to regain confidence with positive outlook. 

Multidisciplinary discussion between patient, oncologist, breast surgeon and reconstructive surgeon is pertinent to decide the best approach for each patient for appropriate oncological treatment for breast cancer followed by appropriate breast reconstruction. 

Choice of Oncoplastic breast reconstructive surgery will depend on 

• stage and subtypes of breast cancer 

• breast size and volume

• adequate autologous tissue for reconstruction

• patient’s choice and expectation

• location of the breast tumor

• tumor response to neoadjuvant treatment 

Types of oncoplastic breast surgery

• Breast conserving surgery with volume replacement and volume displacement techniques

• Nipple-sparing / Skin-sparing mastectomy with autogenous tissue reconstruction eg Back tissue / Tummy tissue

• Nipple-sparing / Skin-sparing mastectomy with Implant reconstruction 

There are many options for breast reconstruction following surgery for breast tumour. As such, these options have to be discussed with the patients and the most appropriate option is then chosen and tailored for them. Many factors need to be taken into consideration during the discussion as these factors would affect not only the outcome of the reconstruction, but also the adjuvant therapies (radiotherapy and chemotherapy)

The options for reconstruction are:

• External prosthesis

• Silicone implant

• Fat injection

• Autogenous tissue flap reconstruction

External prostheses are made of foam-like material into well-designed breast-shaped prostheses, to be placed inside the inner wear. They are suitable for those who had undergone breast tumour surgery and do not want any reconstructive surgery at all. 

Commonly used for breast augmentation, silicone implants, can be used for breast reconstruction in selected cases. They come in various sizes and shapes, to be inserted after breast surgery. It is suitable for those who will not require chemotherapy and radiotherapy as both these therapies can affect the outcome and enhance the complications and risks associated with silicone implants.

Fat injection involves harvesting fat from either the tummy or the thigh and injected into chest. This technique requires multiple sittings of harvesting and injection to achieve the desired size as some of the injected fat shrinks after each sitting, thus can significantly elevate cost with this technique. This technique is also suitable for those who will not require chemotherapy and radiotherapy as both these therapies can affect can affect fat cell survival and the outcome.

Autogenous tissue flap reconstruction is still the gold standard in breast reconstruction. It involves harvesting the patients’ own tissue together with the underlying muscle and blood supply and the flap is then repositioned into the chest. Tissues commonly harvested are usually from the tummy (TRAM flap) or the back (LD flap). As these tissues have their own good blood supply, they have been well documented to facilitate healing, making it more robust and reducing complications and risks associated with radiotherapy and chemotherapy. Hence this method is strongly advisable for those patients who had undergone or going for chemotherapy and radiotherapy. For patients with advanced large breast tumour, this technique is also helpful for closure of chest wound and in preparation for chemotherapy and radiotherapy.

CONCLUSION

Breast cancer patients are now enjoying a longer lifespan due to better understanding of tumour biology with more advanced treatment options. By removal of the breast tumour coupled with choice of breast reconstruction, we aspire the survivors not only will enjoy a longer and better quality of life, but also live with restored confidence and esteem in their ongoing and future endeavours. 

Does Key Hole Surgery Hold The Key To The Future?

Mr. Low Kah Pin

Obstetrician & Gynaecologist
MBBS (UM), MObGyn (UM), MRCOG (UK), FMAS/ART (India), MSc BHARE (Spain)

Mr Low Kah Pin is an enthusiast in Obstetrics and Gynaecology with a soft spot for laparoscopy and fertility. An avid multi-sports lover with penchant for creative literature snippets, humor, art and the occasional minute dose of politics.


Key hole surgery is the laymen term for laparoscopy or minimally-invasive surgery where the surgeon makes a small incision of 5mm, usually at the patient’s belly button and puts a camera, called laparoscope, into the abdominal cavity to visualize the cavity via the television screen. The non-toxic and odourless carbon dioxide gas is used to create an air pocket within abdomen for the surgeon to operate. Additional small incisions are made, to insert surgical instruments into the cavity to perform the operation.

Misconception

In my clinical practice, there are a few misconceptions by the general public. Laparoscopy is incorrectly regarded as “laser” surgery although no laser equipment is being used. Laparoscopic removal of ovarian cyst are being known as “sucking” out the cyst or the tumor, not knowing that the actual procedure requires surgical dissection of the lesion, extraction out from the cavity through the key holes and prevention of bleeding from the surgical site. It is not just sucking out the lesion like using a vacuum cleaner. Lastly, the public has the idea of laparoscopy being “incomplete” or “not clean enough” surgery as the incision is small, but in actual fact, the laparoscope camera allows the surgeon to view the entire abdomen cavity, which is impossible in open surgery. Washout and suturing can be done efficiently via laparoscopic instruments.

Advantages

The glaring advantage of laparoscopy, as compared with traditional large incision surgery is less postsurgery pain. Hence, patients have less discomfort, use less painkillers, better cosmesis and able to resume activities much earlier. Indirectly, patients will less likely to develop blood clots in vessels or pneumonia as patients are ambulated earlier. Some laparoscopy surgery can be done as daycare surgery, meaning no overnight hospitalization is required. Patients are being admitted to ward in the morning, to be operated in the afternoon and walk back home in the evening.

The other benefits of laparoscopy include rare occurrence of hernia from incision and less likely to have wound infections. Therefore, patients can lift or carry objects earlier. The incisions are closed with dissolvable sutures or held together with small dressings without going through the discomfort of removal of stitches or staples.

Limitations

Laparoscopy requires patients to undergo general anaesthesia requiring patients to be put to sleep on the breathing machine during the operation. This may cause sore throat and nausea. Air pockets within abdomen cavity may lead to the feeling of belatedness and occasional neck and shoulder pain, especially when the air pockets are trapped under the diaphragm (muscle between chest and abdomen cavity).

Thus, laparoscopy surgeries are off limits to patients with severe heart or lung disease as surgeries should be safely performed in open surgery with regional anaesthesia. Laparoscopy should be done in caution for patients with multiple prior operations as built-up of previous scar tissues increases the difficulty of laparoscopy surgery as well as the risk of complications.

Evolution and the future

The first laparoscopic procedure was performed in dogs by Georg Kelling of Dresden, Germany in 1901 and in humans by Hans Christian Jacobaeus of Sweden in 1910. More than a century later, by today, laparoscopy had evolved greatly. Key hole surgery can even be performed during pregnancy ie removal of ovarian cyst. Personally, I had removed large cyst of more than 10 centimeters ie mucinous cyst, endometriotic cyst, dermoid cyst with pregnancy unaffected and progressed normally postoperatively till delivery. Laparoscopic surgeries are usually done with at least 3 small incisions, but currently many surgeons are trained in single port laparoscopy where only one incision is required or key hole surgery through natural orifices such as removal of ovarian cyst through incision in vagina, hence the incision are hidden and appear scarless! 

Living with Parkinson’s

Dr. Tan Kenny

Neurologist & Physician (Subspecialty in Parkinson’s Disease & Movement Disorders)
MD (UKM), MRCP (UK), Fellowship in Neurology (Mal.), Fellowship in Parkinson’s Disease & Movement Disorder (Northwestern University, USA), CMIA (NIOSH)

He is a Neurologist and Physician at Loh Guan Lye Specialists Centre. He has vast experience in diagnosing and managing various neurological conditions. He has special interest in treating Parkinson’s disease and movement disorders including tremors, involuntary movements and gait disorders. He is committed in creating awareness and education and holds the position as the Medical Advisor for the Penang Parkinson’s Disease Association, Honorary Lecturer for Penang International Dental College and Penang Medical College.


What is Parkinson’s Disease (PD)?

PD is a slow progressive nerve cell degeneration disease causing reduced production of dopamine, a brain chemical that is responsible for brain cell signal transmission. Lack of dopamine will cause PD symptoms like tremor, stiffness, slow movement and other associated complications like constipation, mood disorders (depression, anxiety), sleep disorders (insomnia) and memory decline (dementia).

There is an estimate of 10 million people worldwide having PD. It is the second most common neurodegenerative disorder after Alzheimer’s disease and it affects 1% of people above the age of 60. It may also affect younger individuals as approximately 4% of people with PD are diagnosed before age 50.

How to recognize PD? How does it affect people with PD?

The diagnosis of PD is a challenge as currently there is no lab investigation or imaging to confirm it. PD is a clinical diagnosis requiring specific neurological assessment skills to accurately identify the cardinal symptoms i.e. tremors, slow movement (bradykinesia) and stiffness (rigidity).

In the early stages, PD may be difficult to diagnose as symptoms are subtle like mild hand tremors, lack of facial expression and stooped posture. As the disease progresses, other symptoms may set in i.e. stiffness in the arms, difficulty getting up from bed and slow small steps when walking. Simple routine activities of daily living like eating, dressing and driving may become challenging as response and movements become slower, affecting dexterity as the disease progresses. At late stages, balance might be affected posing dangers to falls and injuries.

At times, people with PD may become socially withdrawn due to their motor limitations and PD features. They are often misunderstood as being inattentive or show lack of interest due to their limited facial expressions, slow responses and monotonous voice. Hand tremors and their slow, shuffling gait may cause psychological stress and embarrassment to both patients and their family especially when attending public functions. Some people with PD may concurrently have depression and anxiety that further inhibit their social circle.

What are the treatment options?

The treatment of PD needs to be individualized as no two patients are the same. Currently, there is no cure for PD but modern medicine aims at controlling symptoms to improve their quality of life. Besides oral PD medications, there are surgical options and advanced therapeutics with modern devices like deep brain stimulation for symptomatic control. With the help of advanced therapeutics, there can be better regulation of PD symptoms and less dependence on medications.

PD patients will require physiotherapy, occupational therapy and speech therapy as well. Some of the aspects that needs special attention include balancing, gait training, posture correction, fine motor skills for activities of daily living and speech training. These also include exercises to improve muscle strength, agility and stability.

Interestingly, new evidences show that some leisure activities can actually help to improve PD symptoms. Activities like dancing, cycling, tai chi and non-contact boxing are encouraged as they show promising results providing extra-benefits like relaxation, reduce falls, improve balance and coordination.

Any special diet required for PD?

There is no food restrictions or special diet for PD. Generally a healthy, balanced diet rich in vitamins, fiber and fluid help them stay energized and relieve constipation that is a common problem in people with PD. Adequate hydration is important to prevent dehydration as PD patients frequently experience low blood pressure which may cause dizziness or falls.

Both PD patients and their family members face daily challenges living with Parkinson’s. However, it is important to understand that PD is not a fatal disease as with adequate and appropriate treatment, they can have a normal and fruitful active lifestyle. 

Infertility

by Dr. Mecherl Lim

MD (MA) Naturopath (ND), Holistic Kinesiology


Absolute infertility is where there are no eggs and no sperm. This is rare, so what most couples are really experiencing are partial or sub-infertility, or they can’t conceive within their proposed time frame.

A general definition of infertility is when a couple does not conceive after one or two years of regular, unprotected sex.  This assumes the couple are sexually active at the woman’s fertile time, which is typically from day nine (day one is when menstruation starts) to day 21 in a 28 -day cycle. The peak fertility day is usually 14 days before the beginning of menstruation (in a regular 28-day cycle) and at this time there are around three successive days of high female fertility where the vaginal mucus is clear and slippery or stretchy and there’s at least a sensation of lubrication.

The Website Infertility BBT Charts shows the correlation between all indicators of fertility. If it seems too complicated, or if you have an irregular cycle, discuss this with your GP or Naturapath Practitioner.

WHO IS AFFECTED?

About 15 per cent of couples have difficulty conceiving and this figure doubles where the woman is over 35 years of age. In about 40 per cent of cases the infertility problem lies with the man, and in 40 per cent of cases with the woman. In 10 per cent there is a problem in both partners and in 10 per cent there is no known cause.

Some researchers say that in 25 per cent of cases there is a problem in both partners, and the majority of researchers say sperm quantity and quality are declining.

HOW IS IT DIAGNOSED?

Sometimes couples get anxious because they can’t conceive when it’s suitable for them and they need reassurance. A medical diagnosis is needed to establish the cause of infertility, which may involve blood and sperm test, ultrasounds and laparoscopy.

WHAT CAUSES IT?

  • In women and men
  • Ageing
  • Hormonal imbalances
  • Immune problems
  • Sperm antibodies (the body does not appropriately recognise sperm)

Contributing factors:

  • Poor general health and unhealthy lifestyle
  • Severe stress, including anxiety about conceiving
  • Insufficient restorative sleep

In Men

  • Low sperm count or problems with the shape or activity of sperm
  • Blocked spermatic cords
  • Testicular disease and infections

In Women

  • Endometriosis
  • Blocked fallopian tubes caused by infections, disease or tissue (Many natural therapies have successfully treated women who have been told their fallopian tubes are blocked, which confirms there are degrees of blockage).
  • Ovarian problems such as polycystic ovarian disease.
  • Disorders of the uterus such as polyps
  • Problems with the shape of the cervix or in the texture of the mucus.
  • Early menopause in young women.
  • Obesity.
  • Oral Contraceptive (over the years) I have seen a number of women who do not return to normal ovulation and menstruation and this seems to be linked to long term use of oral contraceptives).

HOW THE DOCTORS TREAT IT

Medical treatments depend on the cause of the problem.

Following a basic check, your doctor may refer you and your partner to a fertility specialist.

  • Hormonal pharmaceuticals may be prescribed.
  • Surgery may be recommended to remove polyps, cyst blocked fallopian tubes or endometriosis.
  • In Vitro fertilisation (IVF) involves a surgical procedure for collecting the egg, together with pharmaceutical hormones. It involve sperm or eggs from donors and the conception rate is about 20 percent. Before undertaking IVF, most centres organise a counselling session and provide written details so you know what to expect from the treatment, the cost involved and, the risks and outcome.

THE HOLISTIC APPROACH

HERBS FOR WOMEN

A combination of a few herbs such as Dong Qui for abdominal pain, False unicorn for bleeding, Paeonia if Oestrogen is known to be high, Ginger to improve digestion and circulation & Chaste tree is commonly prescribed. The capsule is named as SHE 18,  if you need more info, send a message to http://www.drmecherherbs.com for more advice. The remedies are discontinued as soon as you know you are pregnant.

Caution: If you are taking pharmaceuticals there may be interactions and I would not advise self treatment with herbs in this case.

It is also a must to take a combination of Nutrition Supplements such as Multi-Vitamin /minerals, Fish Oil, B complexes and Folate. In a scientific study of 30 women who had been trying to conceive for 6 to 36 months, half were given a placebo and half were given a combination of Herbs & Nutrition Supplements. After 5 months 5 of 15 women taking the complete course were pregnant compared to the ones without.

As we know some women have a deficiency in B vitamins, especially B12, B6 & Vitamin E.

The trials confirm my clinical experience from 1989 when I began working as a Natural Therapist Practitioner. I was surprised at the number of middle age pregnant patients. They, too, were surprised, because most have teenage or older children and have not used any form of contraception for many years. I myself, had a baby boy at the age of 40. I concluded that pregnancies resulted from improved health and the high intake of correct prescribed nutrition.

Caution: Women, particularly those with vegan or vegetarian diets, may be infertile because of vitamin b12 deficiency, however deficiency symptoms may be masked by high folate diets or folate supplementation.

GOOD ADVICE:

Don’t leave it till it is too late to try to conceive. It will actually be quite difficult for the egg and the sperm to get together. You may have many competing needs such as careers and financial security, but nature may not coincide with these.

Before investing time and money in extreme fertility processes, get your body as healthy as you reasonably can so you will be able to create a healthy baby. However, no amount of healthy living will achieve conception if the sperm are absolutely dead or both fallopian tubes are completely blocked.


Visit : http://www.drmecherlherbs.com

Email : drmecherherbs@gmail.com

FACEBOOK : drmecherlherbs for further enquiries.

Endometriosis

by Dr. Mecherl Lim

MD (MA) Naturopath (ND), Holistic Kinesiology


Endometriosis occurs when tissue comparable to the lining of the uterus is found in other areas of the body such as on the ovaries, fallopian tubes, bladder, bowel and vagina.  The misplaced tissue may grow and is occasionally found on the organs and other parts of the body. Endometriosis affects 10 percent of women of childbearing age. 

WHAT ARE THE SIGNS AND SYMPTOMS?

  • Pain before and during menstruation, at ovulation (midway between periods) and during intercourse.
  • Painful urination and pain in bowel movements during menstruation.
  • Bladder discomfort and urinary frequency.
  • Gastrointestinal upsets such as irregular bowel motions, flatulence and bloating.
  • About 30 to 40 per cent of infertile women have endometriosis- commonly because the fallopian tubes are blocked. Sometimes infertility is the only symptom.
  • Heavy or irregular bleeding, sometimes with large clots.
  • A number of women have endometriosis but no symptoms and occasionally there may be unusual symptoms such as sciatica- caused by pressure of the endometrial growth.  Some women may experience fatigue, especially if they are bleeding heavily and become iron deficient.

HOW IS IT DIAGNOSED?

Diagnosis is by laparoscopy; That is, under anesthetic a small telescopic instrument is inserted into the abdomen.

WHAT CAUSES IT?

Basically, the misplaced tissue behaves like the lining of the uterus and each month it swells, breaks down and sheds. This may cause inflammation, pain, pressure, internal scar tissue formation and abdominal problems such as bowel congestion.  In severe cases bands of scar tissue (adhesions) may develop.  There are no known causes of the misplaced tissue and below are some of the suspected causes:

  • Menstrual back flow, either via the uterine wall and blood circulation or via the fallopian tubes.  Some suggest tampons may encourage back flow, so it may be wise to use external pads, at least during the night.
  • Hormonal imbalances, especially high oestrogen levels or inappropriate oestrogen metabolism. It can recur or start when postmenopausal women go on hormone replacement.
  • Other possibilities include genetic predisposition, immune imbalances, following abdominal surgery, or the body may reactivate some “embryonic ability” to make new tissue.

HOW THE DOCTORS TREAT IT?

Pharmaceuticals

These may include painkillers, progesterone, anti-progesterone, and testosterone derivatives such as Danazol. GnRH agonist (such as nafarelin) suppresses the body’s production of reproductive hormones and reduces symptoms, but has many potential adverse effects, including pseudo-menopause. Other analagesics may be used for pain relief. Hormone therapy that disrupts the secretion of estrogen and may be employed to limit growth is also used. Currently, prescribed pharmaceuticals rarely help  endometriosis.

SURGERY

The type of surgery now available varies from minor “day surgery” to cauterization of endometriosis spots, laser technology and extensive removal of scar tissue and microsurgery. If it is possible to remove all endometrial tissue, regrowth is unlikely to recur or cut out visible growths, and to reduce adhesions between pelvic organs.

THE HOLISTIC APPROACH

There is not one single remedy that will significantly improve the symptoms of endometriosis.  You should find a practitioner experienced in treating the problem, that is, a herbalist, Naturopath, Traditional Chinese Medicine practitioner or Homeopath.

TEA RECIPE

You can use chamomile and ginger, both of which help reduce inflammation. Simmer finely chopped ginger root in water for about 5 minutes. Use half to 2 teaspoons of ginger per cup of water, depending on your taste. Then add the chamomile and let it stand covered for a few minutes. For bloating, try combining peppermint and lemon balm tea.

OTHER HOLISTIC SUPPORT

Effective results in the treatment of endometriosis involve replacing saturated fats in membranes with EFA. This is a slow process and can take months to reverse the concentrations of fatty acids in the membranes. Because of this, it may be necessary to take GLA for about 6 months before reasonable effects are observed.

Fish Oils can also be used for their PGE3 anti-inflammatory effect. The activity of Delta-6-Desaturase Enzyme can be increased with nutrients such as : Zinc, B6, C, and Magnesium, whereas vitamin A and copper will inhibit Delta-5-Desaturase Enzyme thereby inhibiting PGE2 and arachidonic acid production.

Oestrogen receptor density may be increased in hypothyroidism. Therefore, women should be checked for hypothyrodism or decreased utilisation of thyroid hormones.

SUPPLEMENTATION such as DrMecherlHerbs SHE 18, (TCM herbs) Thyroid 17 (TCM) has been shown to decrease oestrogen effects and promote progesterone effects via anterior pituitary regulation which will regulate cell surface receptors that will benefit in these women. SHE 18 is also traditionally used in dysmenorrhoea, ovarian and uterine pain as an anti inflammatory and spasmolytic.

DIET

If you have high oestrogen levels, a diet rich in Phyto oestrogens may “crowd out” at least some of your stronger oestrogens- such as DrMecherlHerbs PhytoNutrients plus Soya food, linseed, sunflower seeds and an intake of whole grain food twice daily.

HOW CAN YOU PREVENT IT?

According to a scientific survey, women with a higher consumption of green vegetables and fresh fruit have a 40 per cent relative reduction in the risk of endometriosis while those with a high intake of beef, other red meat and ham have an 80 to 100 per cent increase in risk.

  • Reduce your meat intake, have two fish meals weekly and some nuts and seeds, as these foods provide essential fatty acids and help reduce inflammation.
  • Have a salad or soup with lunch, including green vegetables.
  • Include cooked vegetables with your evening meal.
  • Eat at least two pieces of fruit daily.

GOOD ADVICE

Endometriosis is a difficult and complex problem. Do your best to follow the dietary and lifestyle advice and get a practitioner ‘sadvice for specific treatment.


Dr Mecherl Lim

An Intuitive Medical Practitioner in Alternative Medicine (MD) (MA), Naturopath (ND), Holistic Kinesiology (HK), and Functional Medicine (FM)

Next  No 54 Issue : INFERTILITY

Visit : http://www.drmecherlherbs.com

Email : drmecherherbs@gmail.com

FACEBOOK : drmecherlherbs for further enquiries.