unit -)) y Island Hospital Sn hd a wwwislandhospital.com Volume 14/2013 ~@ Taking care: vsecet © BAVC Metis = Food for Thought sm by Ms Supance Saroraks 7 factors in determining your ‘optimal daily caloric intake According to Harvard University We've Got @ sedentary men require about ‘srk 1Salores pero bsyeht Do you know tat the someting men ever yor_—| tpg ar os beast shonkvta Gm teabolicrate that alowed And.dor forget sbeut obesity. | forsee aoe ns Dect oaders you to burn up the super-size Your solution is ~ eat smart 18 calories for men taking part burgers in your 20s is slowing _ So bring out your ee in vigorous training, such as Getting to know. = dropping by 1H avery knife, spoon and fork bodybuilding or sprinting, ‘the American Journal of Clinical i active 150lb man who jogs for Nutrition, scientists found that General Information 30 minutes a day should aim to men who managed to maintain The nutritional needs of men get 2,400 calories each day. 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Harvard University recommends limiting fat intake to less than 35% of your daily caloric intake. If you're trying to lose weight, consuming 25% of your daily calories from fat. Choose unsaturated fats such as omega-3s in olive oil and fish, rather than saturated fats found in fatty meats, fried foods and salty snacks. [exer Carbohydrates should make up the majority of calories you consume each day. Men should aim for nine servings of fruits and vegetables per day to get enough energy and most of the vitamins, minerals and fibre. Good sources of carbohydrates include whole-grain breads, cereals and pasta; vegetables such as broccoli, green beans and com; and fruits such as apples, bananas and oranges. Food for thought A. Cance: National Cancer Insitute researchers determined that people with the highest intakes of carotenoids ~ pigments that occur naturally in plants ere as much at sx times less likely to develop skin cancer than those with the lowest intakes. Thats because the vitamin plans itself in your skin (internal sun protector), where its orange and yellow pioments help deflect sunlight. rone Skin Your goal: ‘As a preventive, eat two sweet potatoes every week, This will provide you with the same amount of weekly beta- carotene as in men who demonstrated the lowest skin-cancer risk. Other top sources ae carrots, papaya, mangoes, ‘watermelon and pumpkin. Shrinking Muscles and Testosterone Level The average auy loses 6 pounds of muscle by the time he’s 50. But, in addition to lifting weights, you can protect your hard-earned muscles by feeding them with a steady supply of high-quality protein, As testosterone levels start to drop, it takes longer for your muscles to return to full strength after each workout, Your goal: Plan in daily 2 egg whites and include fish, tofu and lean meat /chicken in your choice. You should restrict those ‘which are cooked with high fat and minimize those processed meats. Munch an two handfuls of walnuts, peanuts, or almonds every day. Research shows that men with diets high in mono-unsaturated fat = the kind found in nuts ~ have higher testosterone levels than those who don't eat enough of the healthy fat. Nuts are also the best food source of arginine, an amino acid that improves blood flow throughout your body including below the belt. Eat broccoli and bell peppers. Together, they're ppacked with vitamins C and E, two nutrients that fight free radicals rogue molecules that slow the repair of exercise-induced muscle damage, impeding recovery. C: Elevated Risk of Prostate Cancer Harvard researchers found that men with the highest levels of selenium had 48% lower incidence of advanced prostate cancer than those with the Towest intakes. Folate is a B vitamin that helps to construct body cals Low intake could cause your body to produce irregular DNA, which can eventually cause cancer, Your goal: Eat three Brazil nuts every day. That‘ provide you with 200 meg of selenium, the exact amount you need to keep your prostate-cancer risk at rock- bottom levels. Mushrooms help, too: A half cup of cooked shitake contains more than 35mcg, or nearly 20% of the amount you need daily. Only few en get sufficient folate their bodies required from fruits and vegetables. Other altematives should be considered. Have a cup of folate-fortiied cereal 4 days a week. Boiled lentils have about 16 grams of fibre in every cup. Cooked lentils also contain 27% more folate per cup than cooked spinach does. And if you eat coloured lentils - black, orange, red - there are compounds in the seed hulls that contain disease-fighting antioxidants D: Worsening Vision National Institutes of Health found that people who consume the mast lutein ~ a carotenoid found in plant foods ~ are 43% less likely to develop macular degeneration. Lutein helps filter blue light, preventing it from damaging retinal tissues, Your goal: Eat at least two servings of greens each day. Consider one serving to be % cup of cooked spinach, broccoli, or brussel sprouts E: Narrowing Arteries High cholesterol isa killer. Harvard scientists found that every one-serving increase in daily vegetable intake decreases your risk of heart disease by 4%. Your goal: Grab a handful of grapes every day. Antioxidants in the skin of red grapes have been linked to lowering LDL cholesterol and preventing clogged arteries. A glass of red wine is also beneficial. In a recent Spanish study, scientists found that red wine reduced markers of arterial inflammation by 21%. Eat 1 tablespoon of around flaxseed daily. I's the best source of alpha-linolenic acid, or ALA —a healthy fat that improves the workings of the cerebral cortex, the area of the brain that processes sensory information, including that of pleasure. F: Fast-Food Addiction On average, men eat 500 more total calories on the days they drive-thru fast food outlets instead of drive past. Indulge just twice a week and that's, 15 pounds of extra weight in a year.Your goal: Limit yourself to one “single” burger or sandwich, and make it the only food item you order. (Choose water diet soda, or unsweetened tea or coffee ‘as your beverage). U.K. researchers found that men who ate a low: dlycemic lunch - one without bread, Tice, or pasta - burned more fat for 3 hours after eating than those who ate a high-glycemic meal, even though both groups had the same number of calories. Other smart choices are chicken stir-fry or even a 6- to 8-ounce lean steak with a side salad or steamed vegetables. You're Becoming More Injury-Prone Until one bone snaps, you are not likely to give them much thought, Your goal: Drink two 8-ounce glasses of vitamin D-fortitied low-fat milk every day. This provides your body with 600 milligrams mg) of calcium and 5 micrograms (mcg) of vitamin D, the perfect combination of nutrients to build break-resistant bones. Plus, in a 20-year study, U.K. researchers determined that ‘men who drink more than 6 ounces of rmilk a day have half the risk of stroke of ‘men who drink less, H: Corroding Joints Even though arthritis doesn’t usually set in until you are in your 50s, the damage ‘that causes itis happening now. Your goal: Eat three 6-ounce servings of cold: water fish weekly. Specifically, have salmon, mackerel, trout, halibut, or white tuna - each packs more than 1,000mg of fish oll. A U.K, study found that regularly consuming this amount of fish oil appeared to halt cartilage- eating enzymes in 86% of people ho are facing joint-replacement surgery. Fish oll slows down cartilage degeneration and reduces factors ‘that cause inflammation, says lead researcher Bruce Caterson, Ph.D. t: Rising Blood Pressure ‘The scientists from the Netherlands discovered that besides the obvious factors ~ obesity, lack of physical activity, and high salt consumption = diets containing too litle potassium ‘was the primary cause of hypertension, In their analysis the scientists used 3,500mg daily as the cut-off for defining alow potassium intake. The average intake for aman in his 30s was only 3,100mg, Your goal: Add % cup of beans, a banana, or @ handful of raisins to your daily dit. Each will increase your potassium intake by about 400mg a day, boosting you above that 3,500mg benchmark. Four sticks of celery a day have seen modest redluctions in the blood pressure — about 6 points systolic and 3 points diastolic. It's possible that phyto- chemicals in celery, called phthalides, are responsible for this health boon These compounds relax muscle tissue in artery walls and increase blood flow. And beyond the benefits to your BP, celery aso fills you up — with hardly any calories. Seaweeds area great plant source of calcium and also loaded vith potassium, which is essential for maintaining healthy blood-pressure levels. Scallops are another food to consider es your choice. Scallops are more than 80% protein. One 3-ounce serving provides 20grams of protein and just 95 calories. They'e also a good source of both magnesium and potassium. (Clams and oysters provide sinilar benefits) 4: Your Metabolism is Slowing By snacking on the right foods ~ those that are low in sugar but rich in protein = you'll keep your metabolic rate high, and be less likely to binge between meals, Your goal: Have one slice of hard or semi-hard cheese ~ for instance, Cheddar, Swiss, (oF provolone — two or three times a day, Cheese has 7 grams of protein per slice and contains no sugar, That means it does not raise blood-sugar levels which ensure that your body stays in fat-bumning mode. You can opt for a cup of low-fat plain yogurt or a handful of almonds. K; Alcohol Indulgence ‘Among drivers in fatal motor-vehicle traffic crashes, men are almost twice as likely as women to have been intoxicated (ie, a blood alcohol concentration of 0.08% or greater). Excessive alcohol use can interfere with testicular function and male hormone production resulting in impotence, infertility, and reduction cof male secondary sex characteristics such as facial and chest hait. Alcohol Consumption increases the risk of cancer of the mouth, throat, esophagus, liver, and colon in men. Your goal Keep alcohol as special treats on special occasions. A standard drink is 109/ 12.7 millilitres of alcohol A standard drink is 30ml of straight spirits, a 330mI can of beer, or a 100m glass of table wine. To calculate standard drinks, use the following formula: Volume of container (litres) x% alcohol by volume (mt / 100ml) x 0.789 The number of standard drinks. General recommendations around the world limit for men are in the range. 209-40g alcohol per day.Pah Re ete culed Perea aca} Prostate cancer occurs only in males, The prostate gland is located at the base of the bladder, surrounding the urine passage tube. Prostate gland’s normal function is to produce secretion which is important for normal functioning of sperms. Prose land as deters Teale In Malaysia, prostate cancer is the sixth most frequent cancer in males. In Malaysia, Chinese men have the highest incidence compared to Malays and Indians. There are several factors which influence the risk which can't be changed such as age. The older you are the sk increases. After the age of 50 the risk increases. About 65% of prostate concer patients are above Family history is another important factor, a man whose father or brother has, or had, prostate cancer is twice as likely to develop the disease Compared to the normal population. The risk further increases if it develops at a younger age, before 55. Several other risk factors such as smoking, a diet low in vegetable, sedentary lifestyle and obesity are prevalent in high risk agaressive form of prostate cancer. Not every patient experience symptoms, many cases of prostate cancer are detected during routine examination, However the common symptoms are difficulty in passing urine, passing urine frequently or blood in urine. In the later stages, there might be bone pain or leg swelling due to spreading to bone or lymph nodes. How far you need 10 be investigated depends on your symptoms, Prostatic Specific antigen (PSA) value and or result of Digital Rectal examination (ORE), If your risk of having prostate cancer is high based on these tests, you will need a Transrectal Guided needle biopsy (TRUS biopsy). This is done by your urologist to get a sample tissue from the prostate gland for confirmation. More tests such as CT scan, MRI or bone scan will sometimes be needed to determine if the cancer has spread to other parts of the body. This is called staging and is important in deciding the treatment and how you will respond to the treatment. The treatment that might be recommended to you will depend on your age, health status, how agaressive is the cancer and the stage/ spread of the cancer. Stage Il Stage IV Generally ifthe cancer is confined to your prostate gland, the options are curative treatments such as Surgery or radiotherapy, These can be further divided into robot assisted surgery, conventional surgery, external radiotherapy or brachytherapy. All these treatment options have their advantages and shortcomings. ‘The suitable treatment for one patient might be different from another patient. In those patient in whom the disease is discovered in an advanced stage, where the cancer has spread out of the prostate gland, anti male hormone medication is used to control the growth and activity of the cancer. In later stages, chemotherapy is used, ‘There have been some advances in the treatment of late stages of prostate cancer such as tumour vaccines but unfortunately these are not widely available, Prostate cancer is an important health issue in male patients and a significant number of patients are sill being diagnosed in advanced stages of the disease. Effective treatments are available and as with any other diseases, early diagnosis gives more options forthe patient and doctors treating this. If you or your loved ones ate worried about prostate cancer, talk to your urologist about it nove Why is prostate cancer more common in the western culture compared to Asia? Why Asian men who migrate to the west and adopt western way of life have a higher incidence over time? One major cause is food that causes oxidative damage to DNA. Diet and lifestyle modification have been shown to reduce the tsk of prostate cancer development and progression. Men already diagnosed \ith prostate cancer can live better and longer by adopting these changes. These are some things you can do: Eat fewer calories and exercise more, Maintain ideal weight. Reduce fat intake from red meat and dairy product. Watch your calcium intake. Do not take more than 1500mg/ day. Eat more fish. These have good omega 3 fatty acids. Avoid tans fatty acid found in margarine Ty taking more cooked tomato in olive oil. Take more broccoli and cauliflower. Soy and green tea are alsa good. Stop smoking, Consume alcohol in moderation, Seek medical treatment for high blood pressure, cholesterol, depression and stress. Relax and enjoy life. Finally if you are over 50, have a family history of prostate cancer or have any urinary symptoms, you should consider getting a rectal examination and PSA test. oy5 | exposure Vol a Medi Compression Stockings tite For a Healthier Venous Life DO YOU HAVE... Scns Be Se een cna etc Seen a emake et ese Cae These are the first signs of damaged veins. What You Need To Know Medi's Graduated Compression Stockings (clinically proven) Sizing Styles ey? Meaiven® Travel ca Duomed® = > Mealven Teaval, Calflongth, Class 1, Close too Mediven® Elegance vg Mediven® for Men % be Purchase onlin ight now at our online store (wn. medife com my) cor conlat us fer mere info at JU 1A, Ara Damansara, 47301 Petaling Jaya Selangor 4886 Fax: 06-7642 4887 Email info@med-fe.com.myCigarette smoking is among the most important modifiable risk factors for adverse health outcomes and a major cause of morbidity and mortality Direct smoking is responsible for the death of about 5 million people across the globe each year. There are more than 1 billion smokers in the world, Nearly 80% of the smokers live in low to middle income countries. In Malaysia, there are about § million smokers. 46.4% of men in Malaysia smoke and 1.6% of female in Malaysia smoke. The early forms of cigarette advertising ‘campaigns focused solely on men. The advertisements expressed how men who smoked were more masculine and ‘were adored by throngs of women. Smoking was deemed to bea man’s activity and it was considered to be not very lady ike for a woman to smoke, in the eariy part of the nineteenth century. That perception still holds true to some extent, Furthermore, women who were pregnant had to stop smoking because smoking could result in fetal abnormalities and other perinatal comlcatonss Increase the risk of osteoporosis ( inde (ritabiy & sess) Increase the problem of infertility Increase the risk of preterm irth, low birth death syndrome Many smokers are aware of the harms caused by smoking but what is stopping them from quitting? It is addiction Nicotine in the cigarette stimulates the brain to release dopamine, which is associated with pleasurable feelings and smokers quickly develop regular smoking habits. Eventually, smokers ‘need increasing level of nicotine to feel ‘normal’. When the nicotine level in the blood drops below certain level, they begin to crave for cigarette, 2» ond ealnnass 20 minutes after quitting Your heart rate and blood pressure drop. 12 hours after quitting ‘The carbon monoxide level in your blood drops to normal 2 weeks to 3 months after quitting ‘Your circulation improves and your lung functian increases. 1 to 9 months after quitting Coughing and shortness of breath decrease, 1 year after quitting The excess risk of coronary heart disease is half that of a continuing smoker's 5 years after quitting Risk of cancer ofthe mouth, threat, esophagus, and bladder are reduced by hal, Cervical cancer risk falls to that of 2 non-smoker. Stroke risk can fall to that of a non-smoker after 2-5 years If you are a smoker, go through the test below to find out if you are nicotine dependent. Fagerstrom Test Within 5 minutes How soon after waking do you smoke Sm 20 nwt your first cigarette? 31 t0 60 minutes Do you find it difficult to refrain from Yes smoking in places where itis forbidden? No Which cigarette would you hate to The first in the morning fyeuel Any other 10 or less How many cigarettes a day do you 14-20 smoke? ae Srooking hers Haat ormy Oe ——- Increase the risk of coronary heart Do you smoke more frequently inthe Yes disease by 2 to 4 times morning? No. Increase the risk of stroke by Do you smoke even if you are sick in bed Yes 2to 4 times most of the day? No. Increase the risk of lung cancer by 20 times Increase the risk of dying from COPD by 12 times Total score Score: 1-2 fow dependence, 3-4 low to maderate dependence, 5-7 moderate dependence, 8 and above figh dependence10 years after quitting The risk of dying trom lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx (voice box) and pancreas decreases. 15 years after quitting The risk of coronary heart disease is that of a non-smokers. These are just a few of the benefits of quitting smoking for good. Quitting smoking lowers the risk of diabetes, lets blood vessels work better, and helps the heart and lungs. Quitting while you are younger will reduce your health risks ‘more, but quitting at any age can give back years of life that would be lost by continuing to smoke Ue MMM) Determination Support group Behavioural therapy Pharmacological Bupropion + Itisan antidepressant + Reduces nicotine withdrawal symptoms Varenicline Reduce nicotine withdrawal symptoms and reduce the satisfaction a smoker receives when smoking a cigarette Nicotine replacement therapy Therapeutic nicotine targets nicotine receptors in the brain to overcome cravings and withdrawal symptoms. Then by following a step down programme, the brain will begin to demand less nicatine and one can ‘gradually reduce nicotine intake to zero. ‘There many forms of nicotine replacement therapy. There are nicotine ‘chewing gum, patch, inhalers and lozenges. There is no evidence that ‘any one type of NRT is superior to others, The choice of NRT will depend con one's lifestyle and pattern of smoking, Only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help. Counseling, support group and medicine will help to increase the success rates, ma Comfort eee reac PT Ren er et tue at Pn aaah cae your healthcare needs.CR Cu Rett ala ees eee OR iaitg SUR ae In Malaysia, 1 in 6 people die of heart disease. In the US, itis 1 in 4. Around the world, heart disease, mainly coronary heart disease is the number 1 killer. Heart disease affect men and women differently. Men tend to get heart disease earlier than women. The female hormones protect women from getting heart disease earlier. However, ‘once women reach menopause, the risk between men and women is similar. CPR UMUC TT} Men tend to experience heart disease 10 years earlier than women ‘Women tend to fair poorer if they suffer a heart attack ‘Symptoms in men are more typical Half of men who die suddenly of coronary heart disease have no previous symptoms Chest pain Difficulty to breathe Nausea and vomi Giddiness Sweating In women, symptoms tend to be more subtle, There may not be any chest pain. Women tend to experience unexplained breathlessness and fatigue as symptoms of heart disease. ee | High cholesterol High blood pressure Diabetes Cigarette smoking Overweight and obesity Poor diet Physical inactivity Alcohol use Stressful lifestyle Family history of heart disease MeCN ee Apart from the risk factors, there are specific conditions that are associated with heart disease and puts you at higher risk of heart disease. These include erectile dysfunction, peripheral vascular disease (blockages in blood vessels in other parts of the body), kidney disease and stroke. ORO IPT TUN AULCULE You may begin by visiting your doctor/ heart specialist for a health check. Tests specific for the heart include a ECG, exercise stress test, echocardiogram and cardiac CT scan. Blood tests are useful to look for risk factors that ‘can put you at higher risk of getting heart disease. This includes tests to ‘check your blood sugars, cholesterol levels, kidneys and uric acid. Should any of the tests indicate the presence ‘of coronary heart disease, your cardiologist will advise for 2 coronary angiogram / cardiac catheterization, Medications Treatment of coronary heart disease indudes treatment of the heart disease as well as controlling risk factors. Ths will include medications to improve heart function, blood thinners, cholesterol medications as well as medications to treat associated conditions like diabetes and high blood pressure Lifestyle modification is advocated involving a suitable dietary adjustment and exercise Balloon ans stenting Many patients who remained symptomatic will require a minimally invasive procedure called angioplasty This involves clearing the blockages in the heart blood vessels using a balloon and stent. A stent isa small metal scaffold to keep the blood vessel ‘open. This procedure is minimally invasive involving only a local ‘anaesthetic and can be completed usually within 1 to 2 hours and a short hospital stay plasty and Angioplasty lat builehup blood vessel cont poe 19A community airline for a dynamic region Frefly, a wholly owned subsidiary of Malaysia Airlines, focuses on serving the dynamic Malaysia, Indonesia, Thailand and. Singapore growth region, populated by more then 70 million people. second sentence change to: It mission is to connect these countries with cross-border route network. Straddling an area of exotic cultures, spectacular vistas and exciting flavours, Firefly’ destinations offer plenty of travel ‘opportunities - whether itis lying on sun-kissed beaches in Thailand's southern island gems of Phuket and Koh Samui, jungle trekking in the highlands of Sumatra, bargain shopping in Penang, enjoying urban vibes in Kuala Lumpur and. PTC M MeL orem MA ere ee as Senn Ee oe ees ce am Coon rein Coates ia iS c I Se as gy www. fireflyz.com.my | +603 7845 4543Orca yg Going bald is a fact of life for millions of men and is a big worry to many of them. If you have a worrying amount of hair in the basin after shampooing, you may think you are on the way to baldness, but this is not usually the case. Adults lose about 50 - 100 hairs each and every day. Hair loss can occur for a number of reasons and can often be treated successfully. ‘Alopecia is the medical term that describes baldness or hair loss. Sometimes, hair loss is a side effect of the cancer treatment medicines that are Used in chemotherapy. In these cases, hair loss is usually temporary. Any type of hair loss can reduce confidence and self-esteem. ‘We can generally divide hair loss [according to its aetiology) into "Scarring Alopecias” and "Non-scarring Alopecias” Scarring alopecia is hair los that ‘occurs asa result of complications ‘rom another condition. In this type of alopecia, the hair follicles are completely destroyed. This means that the hair over the affected areas will not grow back. Conditions that can cause Scarring alopecia include discoid lupus, scleroderma, lichen planus, shingles, and rarer conditions e.g, folliculitis decalvans and frontal fibresing alopecia Fig. 1: Discoidkypus wth scaring alopecia Non-scarring alopecias include androgenetic alopecia, alopecia areata, telogen effluvium and anagen effluvium. They are much more ‘common than the scarring alopecias Hair Loss in Men POM eee eee EI au ‘Androgenetic alopecia is the commonest type of hair loss in men. Itis better known as male-pattern baldness. As well as affecting men, it can sometimes affect women (femalepattern baldness). ttcan be particulary dificult for both men and women to cope with Male- and female-pattern baldness follows a pattern of a receding haitine, followed by thinning of the hair on the crown and temples. Fig. 2: Androgenetic alopecia receding haitne wth thinning of hair on the crown. The term ‘androgenetic! means that the condition is strongly linked to male hormones and genetics. This type of hairloss is linked to the hormone dilhydrotestosterone (DHT), which is made from the male hormone testosterone. The condition occurs in men who are genetically predisposed to be more sensitive to the effects of DHT. Researchers now believe that the condition can be inherited from either side of the family ‘Androgenetic alopecia affects approximately 50% of men at some point in their lves. It affects different populations at different rates, probably because of genetics. Up to half of ‘male Caucasians will experience some degree of hair loss by age 50, while other population groups such as Japanese and Chinese men may be less affected, The severity of hair loss can be graded by the Hamiiton-Norwood classification, Androgenetic alopecia can have 2 serious psychological impact. Studies have shown that hairloss can be associated with low self esteem, by Dr Lo Keng Shang Chit Consultant Dermatologist & Physigan MOUS scr Ue, Bp ow a, B70 (Coriea) ae hed Dery (terre a) depression, introversion, and feetings of unattractiveness. This is reinforced by attitudes in Western society, which place great value on youthful appearance and attractiveness. Some studies have shown that based on appearance alone, men with hairloss are seen as less atractve, less assertive, less likeable, and less successful than men without hair lass. Current treatment options include. Hair replacement/ transplantation Cosmetic hairpieces / wig Minoxidil solution Finasteride tablets (type i 5-alpha reductase inhibitor) vl 1 vil 6866 S8GH €e2e@e¢6¢¢60@ Fg. 3: Hamiton Norwood casted the seventy and patter of hairless in males into Grad "0 Grade Vi‘Alopecia areata is another type of hair loss, involving patches of baldness that may come and go. It can occur at any age, but mostly affects teenagers and young adults, Six of 10 people who are affected develop their fist bald patch before they are 20 years old Fig. 4: Alopecia an y patch of Speers smo0 (a non scaring alopecia ina 10 year oe boy ness. The affected Alopecia areata is thought to be caused by a problem with the immune system (the body's natural defence against infection and ilfness). Like many other health problems, it sometimes starts after a stressful event. Alopecia areata itself may be emotionally very distressing Some people with alopecia areata go ‘on to develop a more severe form of hair loss, such as alopecia totalis [no scalp hair) and alopecia universalis {no hair on the scalp and body) Without treatment, 70% - 75% of the patients with a single patch of alopecia areata grow back their hair but the process may takes a long time, Usually after about one to two years Sometimes the new hair may regrow ‘grey or white, but after a while the original colour usually returns. Injecting a cortisone medicine into the area of hair loss may speed up the natural regrowth of hair. This ‘treatment is known as an ‘intralesional triamcinolone acetonide injection’ The regrowth occurs only in the area that has been injected. There is no way of preventing new areas of hair loss. However if they appear, regrowth can be helped by further injections, Many other treatments have been introduced for alopecia areata, but the results are variable, Some lotions applied to the scalp do seem to rosult in temporary improvement in some people, but the hair falls out again as soon as they are stopped. Medicines which are often tried include topical steroids and minoxidil, and irritants, such as dithranol, For extensive hair loss, there is no reliable treatment Steroid pills, or a special form of Ultraviolet light treatment (PUVA), are sometimes worthwhile, but may result in side effects, Fig. 5: Intralesonal triamcinolone acetonide Injection for alopecia areata od ht growth fling month Hair grows in a cycle: anagen (living growing hair), catagen (in-between hase) and telogen (resting or falling: out phase). Anak to seven years, Telogen lasts a few normally lasts two ‘bexposure Vol 14 months and is terminated by a new anagen hair. The result is shedding a hair with a bulb at the end (lub hair) itis normal to lose 50 or more telogen hairs a day. Telogen effluvium is a common type of alopecia where there is widespread thinning of the hair, rather than speafic bald patches. Hair is shed from the scalp, usually as a reaction to stress or medication e.g. a couple of months after an event such as childbearing, fever, a major operation, weight loss or certain medications. In anagen effluvium, significant acute hair loss occurs following chemotherapy or radiation for cancer treatment. New growth can be scen at the hairline as a sign of recovery. These types of hair loss tend to improve without treatment after a few months. Fig. 7: Anagen eflvm, bar os following chemotherspy, Hair loss can occur for a number of reasons and can often be treated successfully. Consult your dermatologist if You are losing hair in an unusual pattern, You are losing hair rapidly or at an early age. You have any pain or itchi the hair loss. 9 with The skin on your scalp under the involved area is red, scaly, or otherwise abnormal You have bald spots on your beard or eyebrows. You have been unwell, losing weight or have excessive weight gain, or have muscle weakness, intolerance to cold temperatures, fatigue, etc.aan res In basic terms, @ hernia is simply @ hole —a weakness or split in the muscle wall which allows the abdominal contents (usually some part of the intestine or fat) to bulge out. The bulge is particularly naticeable upon tensing the abdominal wall muscles - such as occurs when coughing, sneezing, staining or simply standing One in ten of us will get a hernia in his or her lifetime. The commonest location for a hemia is the abdomen, as there are natural openings in the abdominal wal that are potential areas of weaknesses (fig. 1). Examples of these are the inguinal and femoral canals which allow passage of vessels down to the scrotum and the legs, respectively. Inguinal hernias are the most common hernias (about 70% of al hernias), The umbilical area is another area of natural weakness frequently prone to hemia, Yet another type of hernia con ‘occur due to the breakdown of a scar from an incision for a prior operation an ‘incisional’ heria, Often, a hernia is just uncomfortable although prolonged standing or walking Umbilical Inguinal Cran Cum RW ase) Pea ia is tu can cause pain in the affected area. This swelling will often disappear completely when lying down, as the contents of the hema slip back through the hole into the abdomen. This is the most common and obvious sign of a heria, Once this is confirmed on examination, further tests such as Xrays and special scans are not usually required. ‘Aheria that does not reduce or ‘go back in’ is termed an irreducible or incarcerated hema (fig. 2). It should be attended to urgently as it may contain intestine that is in danger of strangulating. A strangulated hemia occurs when a tight defect clamps and shuts off the blood vessels inside the intestine which would result in tissue death, In the groin, the vessels to the testes can be severely compressed as well (fig, 3). Dead tissues release all kinds of toxins (poisons) into the blood stream which can be rapidly fatal. Ironically, the most commen cases of strangulation are the smaller hernias - very large ones tend to slide in and out easily so being less at risk of being strangulated. Epigastric Femoral Fa, 1: Some ofthe commoner abdominal wall herias. bby Mr Badral ‘Hisham Yeap Consultant Surgeon Once a hernia is diagnosed, repair is recommended because: 1. Hernias do not get better or simply go away, and will almost certainly enlarge with time, becoming more of a problem. 2. Any symptoms, such as discomfort and pain will also worsen, affecting the quality of life and ability to work. 3, Delaying surgical repair and allowing the hernia to enlarge significantly is likely to make later ‘operation more complicated when it is eventually required. 4. There is always the possibility of strangulation, requiring emergency surgery. ‘An outdated, useless attempt at avoiding surgery is to use a hernia truss, which is belt with a pad that presses on the hernia defect to block the opening and stop the hernia popping out. They never work well and carry the risk of serious side-effects. The best advice is to have the hernia repaired as soon as possible and as well 2s possible. Fig, 3: A srangiated inguinal her Note the gangrencus (ded) small intestine ae testscont from page 12 Therefore, the only treatment for a hernia is surgery. The repairs of hernias remain the commonest of all surgical operations, ‘of which there are multiple different techniques. Regardless of the method, it requires two basic steps Le. returning the content to where it belongs followed by closing the defect in a tension-free manner. Hemia operations can either be performed under local, spinal or general anaesthetic. The stitching or suturing technique (e.g. the Shouldice operation) involves repairing the hernia defect in layers, one above the ther. A tension-ree ‘patch’ or mesh can. also be placed over the hernia defect (fig. 4), Fibrous tissue will grow around and through the mesh, incorporating it in a ‘way similar to the placing of the steelwork inside reinforced concrete. These types of repairs fix the hernia from the outside. Fig. 4: Oper mesh repair of hei. Laparoscopic (or Keyhole) hernia repair ses three small incisions to repair hernias from inside the abdomen i.e, the ‘other side’ of the abdominal wall (fig. 5). The hernia defect is covered with mesh from inside and fixed with staples (fig. 6), As with all laparoscopic operations, no large cut is made on the abdomen so there is less post-operative pain and a faster return to normal activities H there is a hernia on both sides bilateral hernia), both can be repaired at the seme time without making extra incisions. This technique is also especially useful i there hhas been a previous failed open repait, particularly if a mesh was used because repairing from the ‘other side’ goes ‘through unscarred tissues. Fig. 5: A herma defect as seen from the inside wth a lpparoscope 13) ‘The rationale for laparoscopic hernia repair capitalises on the physics of Pascal's principle of hydrostatics by using the forces that create the hernia defect to hold the mesh in place. Imagine a bathtub ‘where a stopper is applied at the outlet inside the tub. The water pressure inside the bathtub wil keep the stopper fixed there, as opposed to placing the stopper outside, where increasing pressure ‘will push the stopper out. tis only logical that something coming from inside is best dealt from inside, No particular after care is required after 4a hemia operation. There are no stitches to be removed. Many patients are able to return to ight routines in about three days. More physical occupations, including sports and driving, may take a litle longer, ‘commonly up to about two weeks. BN Fig. 6 A mesh being placed over 2 hema defect vis Iaparoscony, a cont fom page 8 Pear Diaz n Men) 17) 98 Revoition1 Revolution 2 batoon baeNes! frmentsy cay | | Sons) Anew non metallic scaffold This year, a totally new generation of drug coated scaffolds are made available to patients. This scaffold is nat made of metal. Itis made of a new compound called poly (Llactide), which is naturally resorbed and fully metabolized in the body, It disappears | 2001 Revolution 3 ‘Coronary Orug-Eluting Stents (DES) Revolution 4 Bioresorbable Vascular Scaffold (BV5) System within 2 years and after that, there are no more foreign abjects in the body. In addition, people with allergy to metal ie. nickel allergy will find this type of stent particular suitable for them and also in younger patients who may need reintervention in the future. Heart bypass operation Should there be severe extensive blockages, your cardiologist will advise you to undergo a bypass operation. This involves putting in new blood vessels to bypass the blockages. Ait involves general anaesthesia and ‘2 major operation, @ longer stay in hospital is expected, The good news is the advancement in cardiology has put years to patient's, lives. Many patients with coronary heart disease can now live into the golden years, continue to wark or retire with a good quality of life, The advancement of modern treatments in medications, stent and angioplasty technology and surgery have made coronary heart disease one of the most treatable disease. aexpesure Vol ta Throughout history, we humans have projected the spine as an allegory of strength physically and of righteousness ‘morally. Thus, we have “A man can't ride your back unless it's bent." Martin Luther King, Jr “Vocation is the spine of life.” Friedrich Nietzsche “spineless, savage, harpooning fish- eaters, incapable of any feeling of...” King Triton, before being interrupted by Princess Ariel in the movie ‘The Litle Mermaid! (1989) The anatomic reality of this is that the human spine truly is a wondrous structure displaying both strength as well as flexibility. Made up of 33 individual building blocks of hone articulated with each other via intervening discs, the spinal column is a sinuously long column of mobile segments, distantly reminiscent ofa milipede’s body. This bony column contains a hollow canal within which transmits the spinal cord — a leash of nerves that transmit signals between the brain and the rest of the body. These signals control movement, enable perception of senses like touch, pressure, pain and temperature and regulate the internal environment of body organs like the heart, lungs and intestines 1 rays depicting a sgnfiantscooss deformity corrected by Insumented spine survey, Itis no wonder, then, that ancient man attributed much to the backbone. In Greek mythology, the deity of medicine, Asclepius, wielded a serpent-entwined wooden staff which represented the spine as the nerve centre of all psychic forces believed responsible for bodily functions. The primordial Greek Titan, Atlas, who held the human world on his shoulders, lent his name to the topmost spinal bone segment holding up the human head, For ages, youa practitioners in India have paid emphasis to maintaining proper back posture for health purposes. In recent times, chiropractors believed that spinal instability, termed “subluxation”, was responsible for a whole cartful of diseases ranging from arthritis to diabetes to cancer. Realization of the importance of the spine in enabling motion and sensation was followed by the devising of techniques to treat back disease and injury. (Over four thousand years ago, spine injuries were documented by Egyptian healers who dutifully recorded such «cases on illustrative papyri. Unfortunately therapy methods were mostly of dubious value, what with attempting to treat spine injuries by wrapping the neck with slabs ‘of meat and pouring honey on the skin at intervals. In 400 BC, Hippocrates — widely considered to be the "Father of Medicine” advocated splints and traction to treat spinal injury and deformity. Limited to the technology and anatomic knowledge of his time, some of his devices resembled medieval torture machines, By 1000 AD, a breath of fresh air came in the form of Ibn Sina, the great Muslim physician who described the functional neuro-anatomy of the spine and the body in accurate detail. This enabled the development of practical devices to stabilise the backbone after injury oF deforming diseases. However, truly meaningful spine treatment had to sit it out unti the discovery of antiseptics, radiological imaging and safe delivery of anaesthesia came by in the 19th and 20th century by Br Oh Kim Soon Consultant Orthopaedic {Spinal Surgeon a ao ooh (esti: Geren ab be In 2010, the United States National Institutes of Health estimated that up to 85% of all adults suffered from back pain at some time in their lives. In Britain that same year, health authorities pointed at back pain as the major cause among British workers for absenteeism from ‘work. Such symptoms have cost the United Kingdom an estimated 12 milion lost hours annually, An alarming trend \was reported in the United States where the national burden for complex spine surgery rose 15-fold between 2002 till 2007 and tallied USS85 billion, compared to the cost of combating cancer at US$89 billion during that same period. This rise is expected to continue outpacing that of ‘cancer treatment and is caused by both the sheer number of patients suffering from spine disorders as well as the high cost of spinal surgery. ‘The ubiquity of back-related symptoms ‘can be backed by the observation that it affects the man who delivers your LPG cinder tank and lugs 50-plus kiogram, ‘weights everywhere as much as the person having a sedentary occupation and having to brandish only a pencil or a computer mouse for a living. While we can understand why a hunched up 80-year ‘old wheezing frailty with every breath may have backpain, we cannot comprehend ‘why our 20-year old strapping cousin has ‘excruciating pain when he is the epitome of physical fitness. Occasionally, such symptoms take on a little more gravity ‘when a spinal nerve is “pinched” by a "slipped disc” and treatment becomes ‘more than just taking pills and going for therapy, No one, it seems, is immune to back pain and back-related diseases, There are other conditions where back pain is a harbinger of more ill things to come. Of late, spinal infections have increased in prevalence in the country ‘These infections sometimes ply on for months before breaking out into fever and general body malaise. Nerves may get damaged by destroyed bone and collection of pus. Sometimes, tumours arising from other parts of the body may seed the spine with multiple colonies of ‘tumour cells all ready to devour bone andcause not only pain, but also instability and nerve compression leading to paralysis. Uncommon, spinal deformities may worsen rapidly in the growing child and may necessitate corrective surgery to prevent worsening of the curve oo The very term back pain itself may be misleading. Many spine-related conditions eventually end up with the sequel of a spinal nerve getting compressed, but the symptoms are wholly in the lower part of the body ~ the regions which that harassed nerve was responsible for. These symptoms could be pain and numbness in the thigh, heel, the calf, or meandering down the entice lower limb. The absence of any back pain makes it very dificult forthe patient to accept the doctor's opinion that the spine is the culprit at al To back the diagnosis up, doctors often resort to imaging techniques like simple radiographs or more costly modes ike the magnetic resonance imaging (MRI) scan which renders the spine in exquisite detail. Bones, cerebrospinal fluid, discs and nerves are seen in fine detail This physical column of bone strong yet vulnerable ~ should be given proper attention. Healthy ergonomics, proper maintainence of normal health and timely consultation with your doctor all go a long way in keeping the spine healthy. Fig, 3- Ul scans shoving a large sequestered dsc (liped sn common palace) causing backpain ‘adating down te loner ibs, numbness and Siew in vinating, Fg 2 Ancien ack aes gray stem devise by Hippocrates to attempt treating the spine ‘Adapted fom the vga arc publishes in the Suny Sta uy 15th 2012 TL the Thies day evening that Exposure anne: Made to jedan yeste hare with you th vey! yest ot i wetye and 80 foe en sa pack from M ike to Thank you for all your wonderful feedback. It is always a pleasure to share. So do anticipate for our upcoming issues as we continue to share with you more informative articles on daily health and medical matters. Together let us strive for a healthier lifestyle. — ass parbare Willems Request fom CO Ir LEL aL Thirse am Viale MA | Would like to than on diabetes. | am al ISSUES Of Exposure. Thany acta wo san industial muse Island Hospital for the newslette snttested in ecg future You mata, Sanyo Automedta Praexposure Vol 1416 Getting to know our New Consultants Seca Dr Damian Wong Nye Woh MaBsilaya), MRCP (UR), FRCP (Casa), FRC (Edn, FAP (ond) FAN Consultant Anaesthesiologist Dr Zainisda Zainuddin Mo (UR, ed (nae) UB Consultant Neurosurgeon Consultant Plastic & Reconstructive Surgeon Dr Darren Khoo Teng Lye MD, Mates a Suge Ps ue. Pom reo sun pp scan Consultant q Physician & Nephrologist Dr Michelle Kao Pei Ching MUche (Dundee, UNI, MAC (9 MD Dundee, UN, CCST Nepvoigy (U0 Mr Lee Hock Keong 15 (U0), Masersn Suny Wewesugey)t3¥0 Consultant Neurologist Dr Lim Thien Thien MO (UNAS), MRCP (U9, Fonsi InPrknzn Diaee& Meret acer (Gavan Gn, USA) Visiting Consultant Psychiatrist Dr Kelvin Lee Yuan San SP 0 15M, Master of Meine Pyehiany) Consultant Cardiologist Dr Chiew Kean Shyong 1 at MRC, Consultant Cardiologist Dr Donald Ang Swee Cheng Mache (Dundee, UK. MRCP (UN, MMO (unde, UN), CCST Cabiogy (UN), Fellwipin Advanaed inteventional Carlo een Hospital Newcastle)‘exposure Vol 14 Glen E Eslezir Carey//77) tHe BIGGEST _g HOMECARE CHAIN STORES IN MALAYSIAespera vet 18) Stent Arteri Koroner Sekilas mengenai Penyakit Jantung Koroner (PJK) IK merupakan pembunuh utame di dunia dengan 16,7 juta kematian setiap tehunnya. PiK adaleh keadaan dimana terdapat plak yang menyumbat di dalam pembuluh darah arteri, Hal ini menyebabkan suplai darah ke jantung berkurang. Plak adalah gabungan leak, kolesteral, kalsiurn, dan bahan lain dh dalam dara, Walaupun lak-akt sering dikaitkan dengan PIK namun wanita menopause juga berisko terserang ppenyakit tersebut. Di kalangan laki-laki, faktor isiko utama PIK adalah merokok. Selain itu faktor risko lainnya adalah sia lanju, Kurang berolahraga, riwayat keluarga PIK. dan sakit kronik kolesterol obesitas, tekanan dereh tinggi, diabetes ‘elitus), Angioplasti dan bedah pintas koroner (CABG atau BYPASS) merupakan terapi standaruntuk penanganan plakarten Definisi Stent ‘Apa yang dimaksud stent arteri koroner? Stent (berbentuk cincin) arteri koroner ‘adalah kawat stainless steel berbentuk tabung yang digunakan untuk membuka pembuluh darah arteri keroner yang tersumbat di dalam prosedur angioplast. Stent tersebut dikecilkan hingga diameter terkecil dimana di dalamnya terdapat kateter balon, Stent dan balon tersebut akan diarahkan ke area yang tersumbat. Ketika baton dikembungkan, maka stent juga membesar, sesuai dengan ukuran dan bentuk serta melekat di dinding pembuluh darah. Hal ini menjaga arteri tetap terbuka ketika balon dikecilkan kembali dan dikeluarkan, Stent tersebut menetap di afteri secara permanen, menjaganya tetap terbuka, meningkatkan alican darah ke tot jantung, dan menyembuhkan gejala Penyekit Jantung Koroner (biasanya nyeri dada). Seiring dengan berjalannya wektu, dinding arteri akan menyembuh dan bagian dalam dari arteri (endothelium) ‘akan tumbuh di sekital kawat metal dari stent untuk menjaga artes tetap, membuka, Stent arte koroner merupakan salah satu prosedur angioplast. Angioplasti adalah terapi minimal invasif yang dilakukan di rumah sakit untuk membuka arten yang tersumbat menagunakan kateter dengan balon di yjungnya. Selang panjang berbentuk tabung tipis yang dikenal sebagai kateterdimasukkan mela inguinal (selangkangan) atau pergelangan tangan dan kemudian berjalan melalui pembuluh darah utama menuiu tempat penyumbatan_Balon dengan ukuran kecil diletakian di ujung dan katete,balon tersebut kemudian dipompa sehingaa menjadi besar untuk melebarkan arteri dan mengurangi sumbatan. Prosedur Pemasangan Stent Bagaimana prosedur pemasangan stent? Penggunaan stent tergantung dari beberapa kondisi tersumbatnya arteri, Hal in termasuk ukuran arteri dan lokasi dart sumbatan. Kateter jantung dimasukkan. ke arteri melalui inguinal atau lengan. Di Bawah visualisasi X-ay, ujung kateter ‘ersebut menuju ke jantung. Tekanan diukur, dan angiogram atau film dari Jantung dan pembuluh darah direkam, Sementara itu zat pewarna iodine atau zat tkontras) disuntikkan ke arteri melalui kateter. Zat kontras tersebut membantu arteti koroner agar dapat tervisualisasi melalui angiogram. Setelah mengevaluasi film x-ray tersebut, ahil jantung dapet menentukan ukuran dar arteri Koroner serta sumbatan dan dapat memilih tipe balon kateter dan kawat pemandu yang ‘akan digunakan untuk menterapi. Pada kebanyakan kasus, stent arteri koroner didahulu: dengan angioplasti. Hal ini disebut “pre-diatasi”, yang membantu membuka sumbatan dan membuat lebih mudah untuk memasukkan stent. Kawat tipis tersebut merupakan pemandu Jalan bagi balon kateter menuju arteri yang tersumbat. Balon tersebut akan, terus dikembangkan di tempat sumbatan selama 15-30 detik dan kemudian dikempiskan, Stent yang dibawa ‘oleh balon tersebut sekarang sudah dibenamkan di dinding arten yang tersumbat, menjaga agar arteritetap terbuka, Pemasangan stent adalah prosedur yang sering dikerjakan, pada faktanya sekitar >80% dari prosedur angioplasty koroner adalah pemasangan stent, Semasa pemasangan stent dilakukan, paasien akan diberi obat incir darah, ia itu Aspirin dan Plavix. Obat incir darah dapat menurunkan kemungkinan terbentuknya bekuan darah selama prosedur diiakukan, Pasien akan tetap terjaga selama prosedur pemasangan stent dan sedasiringan digunakan untuk menjaga relaksasi dan kenyamanan. Pemasangan stent akan berlangsung selama 30-60 menit, tergantung dari tingkat kesultan Kasus, Seberapa aman prosedur stent ini? Di tangan seorang ahii jantung yang berpengalaman dan dengan ketersediaan teknolog) modern, risiko kematian selama prosedur pemasangan stent umumnya kurang dari 1%. Komplikasi berat berkisar 1%, tefjadi pada 1 atau 2 per 1000Ingutan cari aban 18 pasien. Bagaimanapun juga riko yang ferjadi lebih rendah bila dibandingkan dengan keuntungan yang didapat ‘Apakah pemasangan stent koroner dilakukan pada setiap kasus? Jawabannya adalah tidak. Meskipun stent lebih superior dibandingkan angioplast hamun stent lebih sult dimasukkan pada plak atau sumbatan yang sangat keras dan sempit di pembuluh darah (umumnya depasit calcium). Stent sendiri juga tidak dapat digunakan pada pembuluh darah arteri yang sangat kecl. Saat ini pemasangan stent dilakukan pada 70% - 80% dari seluruh tindakan angioplasti Paska Pemasangan Stent Apakah dapat terjadi penyempitan_ kembali setelah pemasangan stent? ‘Ya. Penyempitan kembali atau restenosis adelah masalah yang dapet terjadi akibat pemasangan stent. Restenosis biasanya teqadl dalam 3.6 bulan setlah penanaman stent, tap sangat jarang feral setelah 12 bulan, Beberaps ‘tahun terakhir ini para dokter sudah menagunakan stent tipe baru yang disobut Drug eluting Stents (DES) yaitu stent berlapiskan obat dan polymer (baban kimia) yang bekera sara lepas lambat dan mencegah pertumbuhan dan jaringan parut yang dapat menyebabkan pembuluh flayah arterimenyempit kembal,Polimee fersebut membawa dan melindungi abat di stant sebelum dan selama prosadur Demasangan stent. Kemudlian, seal Font tersebut sudah dimplantasikan {aipasang) darter korones,polimer tersebut membantu mengontrol pelepasan obat ke dinding arter, Perla menjadi pethetian bahwa pasien yang sudeh melakukan prosedur pemasangan stent jens apapun sebalknya meminum obat anti pembekuan seperti yang disarankan ‘leh dokter Peryempitan Kembali send, merupakan kombinasi berbagai macam faktortermasukclastisitas pombuluh darah arten dan pembentukan seta pertumbuhan jaringan roa yang sudah Siteaoi, Dengan stent generas baru (DES) kemungkinan peryerpitan kembali <1 0% dan dapat datas dengan mengulangi ongionlast ‘Apa saja yang perlu dilakukan setelah pemasangan stent? 1) Setelah prosedur Setelah stent dipasang, pasien akan dirawat biasanya 1 maiam sahaia di rumah sakit untuk pengawasan. 2) Aktivitas Ikutinstruksi yang diberkan oleh dokter Pengembalian aktivitas ke normal dlilakukan secara perlahan-lahar 3) Obat-obatan Pasien yang sudah melekukan prosedur stent sebaiknya meminum 2 obat incir darah. Contohnya adalah aspirin dan clopidogrel, Obat-obatan ini membantu mencegah pembekuan darah yang terjedi pada stent dan menyumbat 19) besposure Vol 14 ater ker Penelitan terbara ‘menyebutkan bahwa pembekuan darah dopot teria dalam waka atau lebih setelah pemasangan st ppads DES. Karena itulah sangat Penting untuk mengkonsumsl obat- Dbatan yang disarankan oleh abi jantung anda, Aspirin pada umumnya ikonsumsi seumur hidup dan dopidagrel dikensumsi antara 1-12 bulan (tergantung tipe stent) setelah prosedur dilakukan. Clopidogrel pat menyebabkan efek samping, jadi pemeriksaan darah lengkap akan Gilakukan secera rutin. Apabila anda mengkonsums! obat tersebut, perlu iingat bahwa sebelknya anda tidak ‘menghentikan pengoatan anda tanpa hberkonsultasi terlebih dahulu dengan ahlijantung anda. Laporkan segala efek samping obat-obatan yang ada. 4) Follow-up. Kunjungan kontrol setelah tindakan perlu dilakukan. Selam kunjungen ini okter akan memonitar perkembangan dan mengevaluasi obat, status dar Penyakit Jantung Koroner (PK) yang diderita, dan seberapa jauh stent boerfungsi bagi anda Secara informasi unum, pemasangan stent koroner tidak menganggu dengan ppemeniksaan skan MRI dan juga tidak akan berbunyikan alat metal detektor (di-airport dan lain-lain) Sumber: Klkeloktor engan keriasama Dr JK. Yeoh (Direktur dan Pakar Jantung Pusat i Heart, RS Island Hospital, Penang) Hepatitis Mengintai Kebiasean buruk berbagi makanan ddan minuman dengan teman perl diwaspadai terlebih dengan maraknya asus penyebaran penyakit hepatitis A yang mulai dianggap sebagai kejadian luar biasa (KLB) di beberapa daerah di Jawa Barat Mewabahnya kasus hepatitis tahun ini pertama kali muncul di akhir Oktober dengan lebih dari 40 mahasiswa Universitas Parahyangan Bandung postf mengidap enyakit hepatitis. Tidak lama berselang, hari Senin kemarin (7/11) telah cikabarkan bahwa daerah Depok juga sudah terserang virus yang Sema, Sebaryek leh dart 70 saa dan {utu SKN 2 Depok beserta beberepa bruh disekitar sekolah mengalami gejala mata kuning, tubuh lemas dan kult menguning yang menandakan mereka feriangkst penyakit hepatitis dan 68 dar mereka posit teriangkit hepatitis Meskipun kasus mewabahnya hepatitis ‘A baru terinat di dua tempat, namun penyebaran penyakit ini mampu meluas pabila tidak dlakukan pencegahan sedini mungkin. Sehingga lokalisasi pengidap tidak hanya sebagai cara menanggulengi KIB namun juga dlakukan upaya pemantauan Ketat dan penyuluhan oleh Dinas Kesehatan dan Badan Pengendali Penyakit & Penyehatan Lingkungan (P2PU) Dari Kedua kasus ini meskipun belum diketemukan secara langsung asal muasal penyakit hepatitis A menjangkit para pelajat, namun satu hal yang menghubungkan kedua kasus tersebut adalah penyebaran melalui berbagi makanan dan minuman sesama teman Untuk ity perlu kranya kita mula sling sadar di untuk tidak membahayakan dir kita sendir dengan berbagi makanan dengan orang lain maupun memberkan resiko orang lain tertular penyakit yang mungkin kita idap. Karena ternyata virus hepatitis A baru akan terjangkit saat kekebalan tubuh seseorang sedang rendah, Schingga tidak semua orang mengalami dampak yang sama saat terserana virus ini, Bahkan lingkungan tidak bers juga menjadi sebab mewabahinya virus hepatitis ‘A sebagai peringatan kepada kita untuk tefus membiasakan hidup bersih dan tidak jajan sembarangan. Sumber: Kikdokter Dengan keyjasamma Dr Seow Eng Lok (Pakar Lambung, Usus & Liver - Gastroenterologst, '5 Island Hosptal, Penang)Kolesterol dan Stroke Dampak dati penyumbatan pada pembuluh darah yang terjadi akibat ‘timbunan plak yang disebabkan oleh kolesierol LDL, sangat tergantung pada Tokasi penyumbatan terjadl Dalam hubungannya dengan stroke, penyumbatan terjadi pada eliran darah ke otak, Dar tinjaunan definisinya sendii stroke merupakan kematian jaringan otak {infark serebral) yang terjaci arena berkurangnya aliran darah dan oksigen ke otak Namun stroke tidak hanya terjadi karena sumbatan (skermk) saja. Stroke dapat Juga hadir dari dampak perdarahan {hemoragik). Pada stroke iskemik, aliran darah ke otak terhenti karena aterosklerosis atau bekuan darah yang telah menyumbat suatu pembuluh darah Sementara pade stroke hemoracik, pembuluh darah pecah sehingga menghambat aliran darah yang normal dan darch merembes ke delam suatu daerah di otak dan merusaknya. Hampir 70 persen kasus stroke hemoragik tera pada pendenta hipertensi Pada stroke iskemik, penyumbatan bisa triad di sepanjang jalur arteri yang menuju ke otak, Misainya suatu ateroma (endapan lemak) bisa terbentuk di dalam arter karotis sehingga menyebabkan berkurangnya alan darah, Keadaan ini sangat serius karena setiap arteri karotis dalam keadaan normal memberikan darat ke sebagian besar otak Endapan lemak juga bisa telepas dari dinding arteri dan mengalr i dalam darah, kemudian menyumbat arteri yang lebih kecil Sebagian besar kasus stroke torjadi secara mendadak, sangat cepat dan menyebabkan ketusakan otak dalam beberapa menit (completed stroke). Stroke bisa menjadi berramboh buruk akibat bertambah luasryjeringan otak yang mati (stroke in evolution). Perkembangan penyakit biasanya (tetapi tidak selalu) diselingi dengan periode stabil, dimana periuasan jaringan yang mati berhenti sementara atau tejadi beberapa perbaikan. Gejala yang terjadi tergantung kepada daerah otak yang terkena: PWGIEIelh Glas) - Consultant Obstetrician Date for the Antenatal Class 2013 oe Session 1 Session2 Session 3 ‘Mr Chan Fook Hong 15Jun 2013 224un 2013-29 Jun 2013 Dr Eric Soh Boon Swee (Mandarin class) 17 Aug 201324 Aug 2013 7 Sep 2013 ‘Mr Mah Siew Lee a TN a a NE ES et 26 0ct2013 | 9Nov2013_| NEWSLETTER. Chairman: Puan Nora seid a rrittge Members: Carol Lim, Chual psmasthy sister Khor Gaik Hn, Island Hospital Sdn Bhd (cs ws 207654) 16 Nov 2013 Dr. Karen COMMITTEE. CEU eee 1 chong Chew, Dy Sister Yong Pek Lan, in Loh, Grace Lim, Leong Kar Hit ‘SN Ang Foong Ling, SN isa Hat's, Supanee Sararaks, Vincy Locl Hi ra tal ‘adanya sensad abrommal a ea fen, cen atau Sah sat 31 tubuh + Kelemahan atau kelumpuhan atau tungkai atau salah satu sisi tubuh + Hlangnya sebagin pengihatan ata pea + Penglihatan ganda * push / yong * Bicara tidak jelas (pelo) * Sulit memikirkan atau mengucapkan_ kata-kata yang tepat + Tidak mamnpu mengenal agian dar tub Prat eres at ae ee + Hlangnya pengendalia terhadap kandung Kemih + Ketidakseimbangan dan tertuh * Pingsan Kelainan neurologis yang teradi lebih berat, lebih luas, berhubungan dengan koma atau stupor dan sifatnya menetap. Selain itu, stroke bisa menyebabkan depresi atau ketidak mampuan untuk mengendalikan emosi Tekanan yang timbul bisa lebih jauh merusak jaringan otak dan memperburuk kelainan neurologis, meskipun strokenya sendin tidak bertambah luas. Hal ini berbahaya karena rang dalam tengkorak sangat terbatas, h Sumber: Klkeokter Dengan kerjasama Dr Ha Henifah 8. Haji ‘Abdul Gafoor (Dokter Pakar Seraf—Neuroloai, RS Island Hospital, Penang) Interested in joining us? Call our Customer Service at 04-2288 222 ext. 5043 ian Tan, Loh Cheng Siang, Nr Ong Chee Keon Enjoy reading i-Exposure? Interested in getting future issues? Log on to wwwislandhospital.com to download digital copies of our newsletter or send.us your details and comments via e-mail to marketing @ istandhospital.com and welll send youa copy! 308, Macalister Road, 10450 Penang, Malaysia, 604-228 8222 F 604-226 7989. Emergency Direct Line (24 Hours) 604-226 8527 marketing@islandhosptalcom Thomson prea and onmaicon apenas nt be emda evan med sin oration publi th aides wot tee oral, spre an th 3 ao por oer eaters un tal ord Hp ort Ge ry way acy contr nay, eo aes 2iSthecrier opsnng nt ews nana sepa ori al aren fa yas Sesto papa anata meses das nary fam ea nuh rman