Archive for October, 2008


The Internet is not just changing the way people live but altering the way our brains work with a neuroscientist arguing this is an evolutionary change which will put the tech-savvy at the top of the new social order.

Gary Small, a neuroscientist at UCLA in California who specializes in brain function, has found through studies that Internet searching and text messaging has made brains more adept at filtering information and making snap decisions.

But while technology can accelerate learning and boost creativity it can have drawbacks as it can create Internet addicts whose only friends are virtual and has sparked a dramatic rise in Attention Deficit Disorder diagnoses.

Small, however, argues that the people who will come out on top in the next generation will be those with a mixture of technological and social skills.

“We’re seeing an evolutionary change. The people in the next generation who are really going to have the edge are the ones who master the technological skills and also face-to-face skills,” Small told Reuters in a telephone interview.

“They will know when the best response to an email or Instant Message is to talk rather than sit and continue to email.”

In his newly released fourth book “iBrain: Surviving the Technological Alteration of the Modern Mind,” Small looks at how technology has altered the way young minds develop, function and interpret information.

Small, Director of the Memory & Aging Research Centre at the Semel Institute for Neuroscience & Human Behaviour and the Centre on Aging at UCLA, said the brain was very sensitive to the changes in the environment such as those brought by technology.

He said a study of 24 adults as they used the Web found that experienced Internet users showed double the activity in areas of the brain that control decision-making and complex reasoning as Internet beginners.

“The brain is very specialized in its circuitry and if you repeat mental tasks over and over it will strengthen certain neural circuits and ignore others,” said Small.

“We are changing the environment. The average young person now spends nine hours a day exposing their brain to technology. Evolution is an advancement from moment to moment and what we are seeing is technology affecting our evolution.”

Small said this multi-tasking could cause problems.

He said the tech-savvy generation, whom he calls “digital natives,” are always scanning for the next bit of new information which can create stress and even damage neural networks.

“There is also the big problem of neglecting human contact skills and losing the ability to read emotional expressions and body language,” he said.

“But you can take steps to address this. It means taking time to cut back on technology, like having a family dinner, to find a balance. It is important to understand how technology is affecting our lives and our brains and take control of it.”

(Source:  http://www.reuters.com/article/lifestyleMolt/idUSTRE49Q34A20081027)


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Brain Cells Start To Grow

A new study suggests that seniors who line dance, play bridge or a musical instrument may be doing more than just having fun: They may be warding off the risk of developing dementia, including Alzheimer’s, a progressive brain disease which afflicts four million Americans.

People who played the hardest gained the most. For example, seniors who did crossword puzzles four days a week had a 47% lower risk of dementia than those who did puzzles once a week.

Line dancing also offered a hedge against dementia because it forces the brain to work and the body parts to coordinate. Any mentally challenging activity like learning a new dance step might spur the brain to establish new connections or perhaps to grow new brain cells. The extra brain power may compensate for any loss of brain cells that could result from Alzheimer’s.

According to the Keiser Institute on Aging, by the year 2010, those in the 55-74 age group will outnumber 25-34-year-olds by 18 million. Statistics show 800,000 individuals are turning 65 every month with China, the US and UK leading the pack.

More ageing-related health problems are expected to surface around the world. So, do something to keep your brain active and protect yourself against future memory loss.

(Source: New England Journal of Medicine)

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Fading memories

(Source: By Catherine Siow, The Star Newspaper, 17 September 2008)

In conjunction with World Alzheimer’s Day on Sunday, a caregiver shares her roller-coaster ride as her mother enters a more severe stage of the illness often referred to as The Long Goodbye.

DEALING with losses is an everyday affair in my life as sole caregiver to my mother who was diagnosed with Alzheimer’s disease in 1998 at age 66. In the early days when mum lost her cooking skills, I removed her wok and gas stove from the kitchen. When she started misplacing money and other possessions, I took over her finances and removed clutter from our home environment.

My fellow caregivers from the support group and I used to brainstorm on how best to care for our loved ones, making things as safe and secure as possible for them. But none of what we had discussed since our group started in 1998 was of any help to me on the day when mum lost recognition of me.

It was the usual weekend at home and mum and I had just finished dinner. She had bathed earlier and was in her pyjamas. I was at the dining table preparing the weekly marketing list. Mum came up, looked at me and asked (in Hakka): “Why has Li Moi (my Chinese name) not come to take me home yet?” After my second or two of shock, I stared at her and demanded: “Then who am I, who am I?” Mum looked at me for a while, then walked away – she had no answer. I ran upstairs, hot tears streaming down my cheeks, and cried for a couple of minutes. Then I went downstairs, put on her favourite Karaoke VCD and distracted her back into sorting her box of coloured beans (her occupational therapy).

The following weekend, the non-recognition episode repeated. After this second incident, I started mum on day-care seven days a week.

It has been one-and-a-half years since that fateful day which signalled the start of a more severe stage in mum’s illness and the start of another roller-coaster ride for me in dealing with the emotional stress of care-giving for her.

For several months, I was overwhelmed with guilt for my confrontational reaction. I slipped into depression as I could not accept that mum could forget me. There’s just the two of us at home and I have been her sole caregiver for the past 10 years, giving her the best care even as I struggled with the role reversal in our mother-daughter relationship.

In three months, I lost 10kg. My support group friends did their best to help me but to no avail. Ironically, I snapped out of depression when I was assailed with various health problems. I had to make myself well so that I could take care of mum.

And so, mum and I adjusted again to another new routine. I am extra vigilant of the way I talk and behave with her. Every day, I make peace with the fact that mum is gradually withdrawing into a world of her own, one which is increasingly out of my reach.

But since mum went for day-care seven days a week, she has not failed to recognise me. Every evening, when I pick her up (it is a nursing home 10 minutes’ drive from our house), she would happily announce: “My daughter is here. Thank you. Bye-bye.” In the car, she would go into her usual tirade: “Why so late from work? I am very hungry. The people here don’t give me food,” even if she had just eaten.

Mum still has quite a bit of her social skills intact. She is ever the cheerful and gracious “hostess” and my pride and joy. Some of the elderly at the home are wheelchair-bound and mum would sit beside them and “entertain” them. Seeing mum chatting away happily is rather gratifying for me and helps mitigate my guilt for putting her there. They close the gate at 8pm, which allows me time to get through the evening traffic on work days. On weekends, I pick mum up at six. I usually send her at 10am after we’ve had breakfast together and she has had her bath. Mum can still bathe herself but I run a strict “quality control” check.

Though I wrestle with constant adjustments in care-giving for mum as the illness strips away more and more of her memory, it is not always downtime as we do have fun escapades together, especially when we holiday abroad.

We toured Sydney-Melbourne in 1998, London-Paris in 2000, the French Alps-Lake Geneva in 2004 and Perth, Australia, in 2006. I always opt for the two-seater row near the washroom and let mum have the window seat. On take-off, I’d hold her hand and tell her to “swallow saliva”. When the plane is still in mid-flight, mum would ask: “Why is the bus not moving?” and I’d answer: “It’s picking up passengers.” When there’s turbulence, mum would remark: “Why doesn’t the bus driver know how to drive?” and I’d say: “Oh, the road has many potholes.” The best part of the flight is when the plane is about to land on a clear day. Mum would be in awe of the sight below: “Wah, so many cars and houses, all so tiny!”

The Perth trip was the first time I used the wheelchair service for mum. At Perth airport, I had to queue up at the immigration checkpoint while mum was wheeled away by an airport attendant. When I rejoined mum, she waved to the pretty blonde attendant and said: “Terima kasih banyak banyak.”

Last December, when my elder brother (my only sibling) and his three teenage children took mum for a weekend stay at Awana, Genting Highlands, mum had a similar non-recognition episode after dinner. She went up to him and asked: “Who are you?” After his initial shock, my brother answered gently: “I am Fah Chai” (his childhood name). Mum looked at him and retorted: “Fah Chai where got so fat?” (My brother has doubled in size since his schooldays.)

That night and the following night, my brother and his kids played mahjong with mum till bedtime. Mum can still play mahjong well and that’s what we did this Chinese New Year when I spent two whole days with her at home.

I am blessed that mum still listens to me when I tell her to do things. Every night, after she has had her snack and bath, I’d prepare her for bed at 9.30. Then it’s lights off except for the little lamp in her room. I’d go upstairs and listen to her for about five minutes. Then I’d have my quiet time till 11 before calling it a day. I’d be up by 5.30am and would be all freshened up before I go downstairs to see to mum who gets up around seven.

Lately, mum has started wandering at night so I removed even more “clutter” from the area downstairs, where she is queen of the territory. Mum has never climbed upstairs, where I reign over my sanctuary.

I am grateful that mum is still independent enough to allow me this private space but I constantly make sure that she feels safe and loved in her current space so that she does not retreat too quickly into her distant world where I would be forgotten.

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Lost world

(Source: By Catherine Siow, The Star Newspaper, 17 September 2008)

The effects of Alzheimer’s disease in the later stages are devastating as the afflicted person slips into oblivion.

INEVITABLE is the progressive deterioration in the health of an Alzheimer’s disease (AD) patient as the years pass by. The emotional and physical toll on both the afflicted person and their family caregivers are tremendous, especially when the patients do not recognise their nearest and dearest anymore – a condition referred to as agnosia. Distressing though it may be, the caregivers can still help to maintain the dignity and quality of life of their loved ones by managing the symptoms.

Dr Yau Weng Keong, Consultant Physician and Geriatrician at Hospital Kuala Lumpur, visiting Consultant Physician and Geriatrician at Hospital Tuanku Jaafar, Seremban, and member of Alzheimer’s Disease Foundation Malaysia (ADFM) Advisory Panel of Medical Specialists, gives the low-down on agnosia and related symptoms of sundowning and wandering in AD patients.

What is agnosia?

Agnosia is the inability to recognise close ones or objects. The affected person is unable to make meaning out of one or more of their senses despite intact sensory abilities. For example, the person may have good vision but is unable to identify a lamp.

Agnosia can lead to the inability to recognise family members and even one’s own reflection in the mirror. There are multiple other causes besides AD.

What about Sundowning? Why does it occur?

Sundowning is a phenomenon unique to AD whereby the person becomes more confused, agitated, restless and insecure in the late afternoon and early evening. The patient may become more demanding, suspicious or disoriented.

No one is sure what causes sundowning, but most likely it is from progressive deterioration of the brain. As the AD progresses and the person understands less about what is happening around them, they become more frantic in trying to restore their sense of familiarity or security.

Sundowning may relate to lack of sensory stimulation after dark. At night, there are fewer cues in the environment, with the dim lights and absence of noises from routine daytime activity. It can be worse after a move or change in the person’s routines. Also, AD patients tire more easily, even with very few demands on their thinking ability. This makes them more restless and difficult to manage when they are tired.

How can one deal with such a problem?

Strategies for handling sundowning include the following:

· Keep the person active in the morning and encourage him/her to have a rest after lunch. If tiredness worsens sundowning, an early afternoon rest may help.

· Don’t physically restrain the person. Let them pace where they are safe. A walk outdoors can help reduce restlessness.

· Some people are comforted by soft toy animals, pets, hearing familiar tunes or an opportunity to carry out a favourite pastime.

· Try not to arrange baths or showers for the late afternoon if these are upsetting.

· Nightlights or a radio playing softly may help the person sleep.

· Some people find warm milk, a back rub or music calming.

· Some may need medication. Discuss with the doctor.

· Avoid arguing or asking for explanations.

· As caregiver, remember to have adequate rest yourself.

Why do they wander?

AD patients wander for multiple reasons. Some of them may be searching for something, such as the bathroom, or trying to get away from a noisy or confusing environment. A few may even be trying to fulfil tasks from their former occupations or reliving the past.

If they’ve recently moved to a new environment, wanderers may be searching for something or someone familiar. They may also be trying to satisfy a basic need, such as hunger or thirst, but can’t remember what to do or where the kitchen is located.

AD sufferers often lose the ability to vocalise pain. Instead, they may become restless or try to escape their pain by wandering.

If wandering occurs at the same time every day, it may be linked to a lifelong routine. For instance, a woman who tries to leave the nursing home every day at 5pm may believe she’s going home from work. This belief could be reinforced if she sees the nursing home staff leaving at that time. Having an activity at that hour could distract her urge to wander. Another option might be to have staff exit through a different door.

How best can the family caregiver deal with such episodes of non-recognition, sundowning and wandering?

The most important element is the person caring for the patient. There is a need for the caregiver to have inner strength and a cheerful spirit to give their loved one tender loving care. Caregivers must try and get more information (through reading and talking to others), and ventilate their problems and feelings.

Otherwise, their emotions may have a negative impact on their loved ones. This is especially so with agnosia.

Seeking help from doctors, nurses and others is also important.

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Find out what breast familiarity entails and review self-examination techniques.

UNLIKE internal organs where cancers strike such as the ovaries, and intestines or even the lungs, breasts are in plain sight. It gives you the best chance of detecting a growth earlier than if the organ was inside you and this in turn makes treatment easier for surgery, chemotherapy or radiotherapy.

Until now, no direct cause for breast cancer has been found.

The best chance we have in combating breast cancer is secondary prevention, “Early detection.”  One way women can be familiar with their breasts is through Breast Self Examination (BSE).

Women should be aware of how their breasts normally look and feel (breast awareness) and report any new breast change to a health professional. Early detection saves lives and every woman from 18 years onwards is encouraged to practice BSE.

Even after treatment for breast cancer, a woman still needs to do BSE. Patients who have had breast cancer and have been treated may probably find this difficult because it will remind them every month of what they have gone through. But BSE should be a routine part of every woman’s life.

Mothers should also talk to their daughters (at the appropriate age) about the importance of BSE so it will become a routine part of their lives.

The best time to do BSE is about three days after your period ends. This will allow your breast changes in the build-up to menstruation to “subside”. If you no longer have periods, choose a date of the month and do it on the same date every month. The first day of the month is easy to remember.

For mothers who are breastfeeding, it could on the same day each month after nursing. If you are on oral contraceptives, do it on the day you start the next cycle of pills. If you are on Hormone Replacement Therapy (HRT), check with your doctor for the best time. (HRT formulations may vary).

“There is no need to feel paranoid by constantly touching or feeling your breasts as this will only generate anxiety. It is counter productive,” explains Dr Evelyn Ho, President of the College of Radiology. “Develop a positive attitude. After all, you just want to check that your breasts are in good health. We normally look in the mirror to ensure that our lipstick is put on properly, and our hair is in place or the mascara is not ‘running’. “It’s time to extend that below the neckline to give our breasts some attention as well.”

Knowing your breasts, “Where it feels thicker, or bumpier, where there may be depressions, size, shape, colour, “flow”, nipple positions and specific features of your own unique breasts” is essential. If you find a change that persists for some two menstrual cycles, you would want to go and get it checked with your doctor.

To have breast cancer, one does not have to literally feel sick either. “By the time they actually fall sick, the cancer would have spread to their other organs. So they live with their breast changes, lumps, until the skin ulcerates and still they continue to deny that they could be having breast cancer,” adds Dr Ho, who has also written a book entitled “The Art of Being Breast Aware: Self Breast checks for the Beginners”. The book is available in English, Malay and Chinese languages and can be obtained at the Breast Cancer Welfare Association and the Resource and Wellness Centre.

All said and done, a BSE is not a substitute for a Clinical Breast Examination (CBE) or a mammogram. Where in doubt, see your doctor. Otherwise, assuming one feels nothing wrong with oneself, a regular screening mammogram once a year or two years once would be good for women above 40.

“The gold standard in breast screening methods is still mammography, which has been shown to reduce breast cancer mortality by around 30% in the screened group, consisting of women aged 50- 69 years old, over a period of 10 years. With early detection, the chance of a cure is much higher,” explains Dr Yip Cheng Har.

For women with early breast cancer, lumpectomy, which is preserving the breast instead of its complete removal (mastectomy), is possible, but only if the cancer is localised and not widespread.

“Mammograms will help us decide if the breast can be saved by doing a lumpectomy. Nowadays, MRI breast is increasingly being used in the West to determine whether the cancer is really localised. But it is not common practice in Malaysia yet because the MRI is a slow process and it is very expensive,” notes Dr Yip.

Mammography is an x-ray image of the breast and is presently the most effective and accurate way to detect breast cancer at its earliest stages. A mammogram can pinpoint very small abnormalities before they can be physically felt. It usually takes as little as 15 minutes where the technologist will take two or more pictures of each breast after it has been gently compressed.

There are two types of mammogram “Traditional film and digital. Both take an x-ray picture of the breasts. “Traditional film and digital mammography both use x-ray but digital captures the image on a computer, allowing radiologists and other health specialists to view and manipulate the images on high resolution computer monitors to enhance visualisation of the structures within the breast tissue,” explains Harizal Hamed, Carestream Health Country Sales and Service Manager for Malaysia and Brunei.

“Both traditional and digital types are considered comparable although digital mammography may offer more benefits. For example, the patient losing her mammogram films or forgetting to bring them for her next mammography appointment will no longer be an issue if the hospital or centre has a digital image management system. The system transfers images to a computer so that they can be electronically stored.”

There is no age limit to undergo a mammogram. If your doctor or radiologist suspects you have a cancer, and you are just 25 years old (and especially after a preliminary ultrasound of the breasts), a mammogram will very likely be done as well. It is recommended that women get mammograms regularly based on their doctor’s recommendations.

To learn more about the steps you can take to perform Breast Self Examination, visit the College of Radiology website at: http://www.radiologymalaysia.org/breasthealth/BSE/index.htm

(Source: By Khaleb Talib, Sunday Star, 12 October 2008)

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Breast Health Message Reaches Out To The Disabled.

IT started as a discussion between two friends on the need for people with disabilities to be included in health promotion activities.

Dr Evelyn Ho, a Consultant Clinical Radiologist, and Mary Chen, Editor of Challenges Magazine, felt that these people were often taken for granted when it comes to their medical and health needs.

It is generally assumed that these matters are well taken care of along with their primary disability conditions.

Paradoxically, because they have to deal with their primary problem first, they have little time or energy for other aspects of health-care.

Ho, who is also President of the College of Radiology, feels that the disabled, like anyone else, are also at risk of cancer, yet may not be aware of or provided with appropriate health-care information.

Like anyone else, they should be included in all health promotion activities, including breast health awareness.

Chen, whose magazine seeks to promote awareness of all forms of disabilities, says those with disabilities need to know where they can go for mammograms, attend workshops or have workshops organised for them to access the latest information.

“We have had women trying to find a centre where mammograms can be performed for those in wheelchairs,” she said.

It was with these issues in mind that a workshop on breast health was held recently for this group of people. More than 60 people turned up to learn about effective self breast examination and other related issues.

While some participants came with expectations of a serious workshop, they were surprised at the light-hearted approach taken by the Organizers, who wanted to dispel fear and anxiety.

Bathmavathi Krishnan, Protem President of the Association of Women with Disabilities, lauded the efforts of the Organizers. “This is definitely welcome as no one has thought of it before,” she said.

Five participants came from the Beautiful Gate Foundation. The youngest was only 13 and needed assistance even in a wheelchair.

She proved to be a challenge to the facilitator for the hands-on session on effective breast self examination as her arms were weak.

For the facilitators, the workshop proved to be a real challenge as this was the first time they were dealing with people who were not fully mobile and had weak limbs.

Radiographer Kwan Yau Oi realized that it was not so easy to ask someone to examine her own breasts when her arms were weak. “I had to modify the standard procedures and develop a technique that would overcome her arm weakness. It was also a learning experience for me,” she said.

There were also male participants at the workshop. They were taught how to support their loved ones who have breast cancer and also the role they can play in preventive measures.

They were also taught to take care of themselves as well as men are not immune to breast cancer.

Shivanand Sivamohan, 18, attended the workshop to equip himself for voluntary work with the Breast Cancer Welfare Association this coming Pink October.

“Men used to be a forgotten lot in breast health activities but men are heads of households in Asia and therefore wield great influence on the womenfolk. Since the College of Radiology began its community role in breast health in 2001, we have included men in our activities,” said Ho.

> For more information about The College of Radiology, go to http://www.radiologymalaysia.org. The Challenges website is at http://www.challengesmag.com.

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Spreading the message


Creating Cancer Awareness is A Continuing Mission.

OCTOBER, by tradition, is the month when cancer advocacy groups throughout the world go pink to build awareness of breast cancer issues.

The first Breast Cancer Awareness Month programme took place in October 1985 in the US as a week-long event to fill the information void in public communication about breast cancer.

In the past two decades, many countries around the world, including Malaysia, have embraced the programme.

Although the primary focus is on breast cancer, this programme has also successfully created awareness on other cancers.

As a cancer survivor myself, I look forward to this month because it provides great opportunities for several national public service organisations, professional medical associations, and government agencies to work in partnership to build breast cancer awareness, share information and provide access to screening services.

Cancer patients also take this opportunity to share their experiences at this time of the year.

I was reflecting on how different this month will be from previous years and it struck me that if all our politicians were to take a breather from the world of politics, they will learn many useful lessons from the world of cancer.

Those who lament about how tense ethnic and religious issues have become in recent months have probably not stepped into the oncology wards.

I have been to many, both in public and private hospitals, and I can assure you that no one “Patient, doctor, nurse, caregiver” thinks or acts in ethnic or religious terms.

We patients are united as one. We do not need a Race Relations Act to remind us how to act and speak to one another.

My own journeys, first in 1999 and then last year, have reaffirmed my conviction about this wonderful mosaic of Malaysia that is truly caring and truly muhibbah.

Anyone needing blood will realise that while we may have different blood groups, the colour of blood is red and it can flow into the veins of anyone regardless of race or religion.

When I was undergoing chemotherapy last year, my fellow patients used to laugh about the fact that we were taking in similar drugs and growing bald around the same time.

There was one day when I was totally bald and the three women in the same room took off their wigs to be in solidarity with me. One was Chinese, one Malay and one Indian.

I am much encouraged that through events in Pink October, there is so much more awareness on the need to recognise the symptoms early and go for treatment fast.

The various groups and individuals who come out in full force this month are truly the unsung Malaysian heroes.

For all that they do, and continue to do, may God bless them in all their endeavours.

To all the politicians who seek to grab headlines for all the wrong reasons, I would encourage you to drop by one of the many cancer-related events to be held this month and see for yourselves what is being done and reflect on what you can do in the political sphere to complement the work in this area.

> Soo Ewe Jin is Deputy Executive Editor, The Star. His cancer journeys are chronicled via www.geocities.com/ejsoo

(Source: The Sunday Star, 12 October 2008)

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