Finding peace on a yoga mat

Sunday was International Yoga Day, which gave me the perfect excuse for some reflection.

A friend got me to attend my first yoga class at Pacific Plaza in 2010.

At that time, I was just about to turn 40 years old. I was no longer a spring chicken. I had given up the battle of attempting to get fit after my second child was born and, like most despairing mothers across the globe, had convinced myself that my pear-shaped body was here to stay.

I reconciled myself with my body shape by drinking more white wine and munching on more curry puffs.

Before attending the yoga class, friends had extolled the benefits of yoga to me. "Life changer," I was told.

As a journalist, I think I was curious to see if all the global yoga hype was justified. During the first class, the postures were not too complex, yet I could barely stretch.

Yet even when my body was at its most inflexible, the yoga teacher had me hooked from the word go.

In "Yoga: The Science Of Living", Indian spiritual teacher Osho writes: "Remember, nobody can start it for you. You have to start it for yourself. Yoga teaches you to trust yourself; yoga teaches you to become confident of yourself. Yoga teaches you that the journey is alone. A master can indicate the way, but you have to follow it."

My cynical, questioning self opened up to that possibility - of a master indicating the way and making the choice to follow it.

After many false starts in getting fit and after a series of trainers who had given up on me, I finally found what I was seeking in a simple yoga mat.

The tonal variations, the range of poses. In just 60 minutes, I went from a gentle meditative state to an intense Surya Namaskar workout.

My heart pumped like it rarely had before and then my body relaxed as it slipped into Shava Asana (The Corpse Pose). It was a physical and emotional release like no other.

There was a line I heard in 2010, which I would hear many times again in the classes I started attending. "No ego, no comparison, no competition."

It seemed too good to be true - this six-word mantra. It seemed too idealistic to try, but try I did. I started fitting at least three yoga classes each week into my busy work schedule. During holidays, I did more.

At some point, while I was not looking, I began looking different and, well, feeling different. I remember that moment when I could fit into a size 10 H&M dress my daughter had picked for me.

But my yoga journey has not simply been about the challenges of losing weight and keeping fit.

Yoga has taught me how to cut out the surround sound, to stay singularly focused. I am an inherently restless soul who gets bored easily.

I am constantly seeking new things to do, yet yoga has kept me rooted. It has allowed me to channel moments of stillness which I never knew existed. It is in those very moments that new beginnings showed up.

In 2013, I went on a sabbatical to write my debut novel, "The Red Helmet", about love and loss against the backdrop of 1980s India.

I do not think that I could have finished the novel if not for the sheer discipline I had learnt from doing yoga.

Yoga has taught me to focus my mind, to cut out the chatter, to put my cellphone on silent and not give in to the temptation to touch it for the next 60 minutes.

Doing yoga is like going on a journey. Because once you start, there is always a second and a third time.

You see, once you are on a mat, you simply stop counting. You learn to go with the flow. (hhr)

Dealing with scoliosis 

Scoliosis is a medical condition of which, in 90 percent of cases, the cause is unknown . Scoliosis can happen to anyone, including toddlers. 
 
According to Dr. Luthfi Gatam SpOT, an orthopedic specialist who practices at the Ramsay Spine Center at Premier Bintaro Hospital, the name scoliosis is derived from the word "scolios", which means crooked. It is a medical condition in which a person’s spine is curved and, when viewed from behind, tends to curve to the right or left. 
 
"Generally, the spine curves to the left side of the body,” said Luthfi.
 
There are many types of scoliosis. Idiopathic scoliosis is the most common type. Luthfi said that “idiopathic” was derived from the words “idiot” and “pathic” and had no known etiology. 
 
Luthfi stressed that scoliosis is not a disease, but a descriptive term. All spines have curves. Some curvatures in the neck, upper trunk and lower trunk are normal. Humans need these curves to help the upper body maintain proper balance and alignment over the pelvis. 
 
However, when there are abnormal side-to-side curves in the spinal column, the condition is called scoliosis. And the problem with scoliosis is that it can progress. Data shows that 10 percent of people with scoliosis are experiencing an advancement in the condition. 
 
People with idiopathic scoliosis can actually carry out normal daily activities. They do not experience significant abnormalities. But if their scoliosis progresses, they can suffer from impaired function. 
 
“People with scoliosis experience pain in their back, waist and neck. And there is the possibility of impaired lung function and breathing disorders. Impaired heart function and digestion can also occur,” explained Luthfi. 
 
Over time, the spinal curvature may get worse. Some patients will not even be able to chew or digest properly. 
 
“When that happens, the progression of the scoliosis must be stopped as it can be fatal.” 
 
There is non-surgical treatment as well as surgical options available to stop the scoliosis from progressing, as well as to balance the body, to correct the posture and to improve the quality of life of patients. Non-surgical treatment usually consists of swimming, stretching, physiotherapy and dorsal exercise. This is effective to strengthen the muscles. 
 
“But this treatment is only for patients with a spinal curvature of under 20 degrees,” said Luthfi. “Patients with a spinal curvature of 20 to 40 degrees should use a neck and body brace to correct or restrain the progress of the scoliosis. For a spinal curvature that exceeds 40 degrees, the right medical treatment would be surgery.” 
 
Luthfi explained that surgery can stop the progress of scoliosis, as well as correct the crooked bones. These days, scoliosis patients in Indonesia can also easily access medical help as Premier Bintaro Hospital now has a spinal center. 
 
The Ramsay Spine Center provides facilities and services to solve all types of spinal problems in an integrated and comprehensive way. At the Ramsay Spine Center, spinal problems are handled by a team of doctors from various specialized fields, such as orthopedic spine specialists, neurologists, neurophysiology specialists, medical rehabilitation specialists and radiology specialists.
 
For more information, please contact the Ramsay Spine Center, Premier Bintaro Hospital on +62 21 2762 5500 Ext. 3338 (Dani) or visit www.ramsayspinecenter.com 

Health sense: Managing osteoporosis and bone-mineral density for men 

Eddie, who is 70, had been suffering from constant low back pain. He took painkillers but the pain kept recurring. When he finally decided to consult his doctor, an X-ray showed a compression fracture in a vertebra in his lower spine. 

This was the likely cause of his back pain. Eddie was puzzled, as he did not recall having suffered any direct injury to his spine. 

His doctor sent Eddie for a bone mineral density assessment, a simple procedure, which confirmed that he has significant osteoporosis of his spine. Eddie was referred to me for further assessment. 

Although osteoporosis is common in older women, this condition is unusual in men. Unlike women who begin to lose bone quite rapidly after menopause, the rate of bone loss in men as they grow older is much slower. 

Apart from a healthy intake of calcium and vitamin D, adequate levels of sex hormones are also necessary to help maintain good bone quality. 

On the other hand, conditions causing excessive levels of thyroid or parathyroid hormone can lead to bone loss. 

Bone mineral density (BMD) may be assessed using dual X-ray bone absorptiometry, a simple inexpensive and non-invasive X-ray scan that assesses a person’s bone quality in comparison to healthy young adults. 

BMD results are expressed as normal, or osteopenia (or pre-osteoporosis, in layman’s term) or osteoporosis. 

However, it does not mean that a person classified as osteopenia is at low risk of sustaining a fracture. Other independent risk predictors include factors, such as frailty, small build, frequent falls, cigarette smoking, heavy alcohol consumption, a family history of fractures, the use of steroids (frequently found in traditional medicine) and diseases like rheumatoid arthritis.

Therefore, these must be considered in conjunction with a person’s BMD result and the fracture risk estimated using a risk calculator designed for specific populations or communities, such as one developed by the WHO specifically for Indonesia.

It turned out that Eddie has been a heavy smoker for many years, puffing about 20 cigarettes daily, already a strong risk factor. Blood investigations also revealed that Eddie had low levels of vitamin D as well as testosterone, the essential sex hormone for men. 

Besides vitamin D, the maintenance of good bone quality is highly dependent on testosterone. As testosterone declines with age, older men are at higher risk of bone loss and fractures.

Low testosterone also predisposes men toward loss of muscular strength and frailty, poorer sexual function and quality of life (becoming easily tired, lacking in stamina), development of diabetes and higher mortality from heart disease. 

Although Eddie’s bone density measurement placed him in the osteopenic category (i.e., not quite osteoporotic, but already poorer than expected), he is clearly at risk of further fractures as he has already had a vertebra fracture.

In Eddie’s case, treatment has to be instituted from all fronts. While most people may be familiar with vitamin D3, which is dosed at 1,000 units daily, this will not be enough to overcome deficiency.

Instead, Eddie was started on high-dose vitamin D2 at 50,000 units weekly for two months. His testosterone deficiency was treated with an injection of testosterone depot that can last up to three months. 

This form of treatment ensures that none of the testosterone is wasted through poor absorption. Improvement in BMD can be seen six months after the start of testosterone therapy and continues to be well-sustained for as long as testosterone therapy is continued. 

Eddie also experienced a dramatic improvement in his quality of life once his testosterone level has been restored. His stamina was better, he no longer felt sleepy in the afternoon, his back pain disappeared and his sexual interest returned. He also noticed that his waist line decreased. 

Standard treatment for osteoporosis, such as bisphosphonates, must also be administered. 

While bisphosphonates are commonly taken orally on a weekly basis, its efficacy in older persons may not be as good due to poorer absorption. 

Zoledronate, one of several bisphosphonates, is available as a once-yearly intravenous infusion that can easily be administered in the clinic. Eddie, being a busy person who is fairly absent-minded as well, much preferred this convenient and cost-effective treatment. 

As its effects are long-lasting, zoledronate could be stopped after 3-5 years of treatment, while testosterone therapy and maintenance vitamin D were continued to ensure that Eddie’s restored BMD continues to be well-maintained. 
_________________

The writer is a consultant physician and endocrinologist at Glen Arden Endocrinology Specialist Clinic at the Gleneagles Medical Centre in Singapore and a previous president of the Endocrine & Metabolic Society of Singapore. For more information, visit klinikdiabetessingapura.com

maintain health

maintain health
rain hit the water and hurt - careful if you are sick because of the rain could be a hassle later treatment can be to health centers and major hospitals are expensive and therefore do not get sick if you can keep kesehatantubuh to stay fit always let me be able to do daily activities smoothly and keep the good condition of the body fit to consult a doctor if you can eat mutivitamin supplements to keep the body strong and durability of disease

Health sense: Ankle arthroscopy and treating ankle instability

Health sense: Ankle arthroscopy and treating ankle instability 

Ankle sprains are one of the most common injuries sustained through activity.

They normally heal with proper rest, ice massage, compression and elevation therapy for a few days.

However, if pain or instability is persistent, it is advisable to get an early assessment done by a medical practitioner. Some signs of serious injuries are an inability to bear weight, an inability to push off or tiptoe, tenderness over the bony prominences at the side of the ankle (i.e., the medial and lateral malleoli) or a tenderness in the foot.

Among the underlying problems related to persistent instability, the most common is a tear or stretching out of the lateral ligaments of the ankle.

Other causes include dislocations or subluxations of the peroneal tendons, muscle weakness, nerve injury, pain from a structure in the ankle that inhibits the muscles supporting the ankle or deformities of the foot or ankle.

Ankle pain may be due to osteochondral fractures or bruises of the talus, loose bodies, tears of the peroneal tendons, sinus tarsi syndrome or even early ankle arthritis.

The diagnosis of the problem includes a physical examination or even inspection of shoes and footwear, which can give clues to possible problems and abnormalities in gait.

X-rays, ultrasound or MRI scans may be ordered. Sometimes, when diagnosis is difficult, diagnostic injections can be helpful.

For most common ankle injuries, acute treatment consists of RICE therapy (rest, ice, compression and elevation) for the first 48 hours or so, followed by one to two weeks of gradual return to activity. An ankle brace or ankle guard may also be helpful in this phase of recovery. Physiotherapy is often helpful and may speed recovery.

For more serious conditions, surgery may be necessary

For ankle instability — which is mainly caused due to a tear or ‘stretching out’ of the lateral ankle ligaments — the affected ligaments can be repaired using a small incision. The ligaments are stitched back together in the proper position. Immediately after surgery the foot is protected in a cast for about four weeks. 

This may be followed by another one to two of physiotherapy — a progressive programme of regaining motion, strength, balance and agility — ensures the maximal benefit of the surgery and allow the patients to return to their normal daily routine.

Other options include arthroscopic or “keyhole” surgery, which can be done for removal of the unhealthy cartilage and “micro-fractures” to stimulate new cartilage growth.

w Larger bone-cartilage lesions can be repaired with bone-cartilage or artificial transplants and even cartilage cell culture and repair.

The rehabilitation procedure after an ankle arthroscopy depends on the diagnosis and treatment done. In most cases, the leg can actually bear weight on the same day, and achieve full recovery within a month.
The writer, a physician and visiting consultant at Alexandra Hospital, Changi General Hospital, and the National University Hospital, graduated from the National University of Singapore in 1989 and was admitted as a Fellow to the Royal College of Surgeons (Edinburgh) in 1994. He also manages sports medicine injuries. For more information, visit ortho-intl.com.

Health sense: Managing and mitigating childhood myopia

Health sense: Managing and mitigating childhood myopia 

Parents — especially those who are short-sighted and who have had to wear glasses since childhood — are often concerned about the causes of myopia and whether their children are also fated to be as visually impaired. 

Childhood myopia begins during a child’s growing years and worsens throughout childhood. 

Those suffering from this visual condition usually complain of having difficulty seeing distant objects such as oncoming bus numbers, classroom whiteboards or even television screens. 

In a bid to “see better”, some might squint or hold objects up close to their eyes. 

These are signs that should alert parents to the need for their child to see an optician. After all, it is commonly understood that myopia can easily be corrected with eyeglasses. 

Myopia is a type of refractive error or focusing problem of the eye, where the light rays entering the eye are focused at a point in front of the retina rather than on it. This results in blurry vision when viewing distant objects and is why myopia is also known as short-sightedness. 

The most common mechanism for myopia’s progression is a gradual elongation of the eyeball. So in essence, childhood myopia occurs because the eye has grown too large.

Researchers typically attribute myopia to a combination of two risk factors — genetics and environment. 

For instance, if both parents are short-sighted, there will be a greater risk that their child will be short-sighted. 

However, simply looking at a couple’s family tree will not always provide definitive answers, as environmental factors, such as the extent of close visual work, level of education and lack of exposure to outdoor activities have been documented to affect the progression of childhood myopia. 

To fight this, parents can encourage their children to go outdoors to play and ensure that there is adequate lighting when they are reading. Children should also hold reading material at least 30 centimeters from their eyes and sit back from the computer or television. 

Parents should also ensure that children sit up to read whenever possible, take vision breaks of 5 to 10 minutes after long periods of close work and have a healthy diet and adequate sleep each night.

If your child already has good eye habits — and if your child’s myopia continues to progress rapidly — interventional measures such as atropine eye drops can be considered.

Clinical trials by the Singapore National Eye Centre and the Singapore Eye Research Institute have shown that low-dose (0.01 percent) atropine is effective in slowing myopia’s progression by 50 to 60 percent over a two-year period. 

While normal concentrations of the drug might cause side effects such as pupil dilation, the inability to focus on near objects and a sensitivity to light; the low dosage in this treatment means the side effects are almost unnoticeable. Treatment is most suitable for those aged between 6 and 12 years. 

Typically, children undergoing this treatment would apply low-dose atropine eye drops to the eyes once daily. 

In the rare case that a child does not respond to the low dosage, a higher concentration might be considered. There may be 7 percent of children who may not respond as well to atropine.

For children with myopia, parents should be aware that their vision needs to be checked at least once a year to see if their glasses need to be changed.

If you suspect that your child has myopia, or any other eye conditions such as amblyopia (“lazy eyes”) or strabismus (“misaligned eyes”) that commonly manifest during childhood, do bring your child to an eye specialist to ensure early treatment. 

Health sense: Finding non-invasive solutions for injuries

Health sense: Finding non-invasive solutions for injuries 

In the last two decades, extracorporeal shock wave therapy (ESWT) — a non-invasive procedure with virtually no down-time after treatment, has proven effective in treating certain common but troublesome tendon conditions, such as plantar fasciitis, tennis elbow and shoulder calcific tendinitis.

Shock waves, generated in specially designed ESWT devices, are acoustic pressure waves with a very unique waveform, i.e., a very rapid rise to a high magnitude and a very rapid fall time. These, when focused by an acoustic lens onto the targeted area in the human body, can result in certain biological effects.

The effects include interruption of “pain-spasm” cycles that occur in many chronic pain situations, reduction of pain by influencing the nerves carrying pain signals, and the release of certain growth factors in the targeted tissues, which may lead to the formation of new vessels (angiogenesis) and other biological effects associated with tissue healing.

While the nerve related effects can occur almost immediately, they may be temporary.

The release of growth factors, however, occurs over several weeks, resulting in a facilitation of regeneration and repair in chronically injured or degenerated tissues over the subsequent months.

ESWT has also been used to assist bone healing in certain situations of non-union or delayed union of fractures. More recently, ESWT has also been used in myofacial trigger point treatment for pain management

Mainly an outpatient treatment, an ESWT session typically takes 20 minutes per site.

In most cases, over 2000 shocks will be used per session, with no local anaesthetic needed. For the majority of conditions, one to three sessions, with the interval between each varying from four days to several weeks, would suffice.

The injured structure is first identified, and then precisely targeted by the ESWT device by means of real-time ultrasound guidance. Shock-waves are then delivered in rapid succession, ramping up from low levels to therapeutic levels.

The patients may experience some tolerable discomfort during treatment. This is usually described as a deep “hammering” feeling. While there is usually no pain after treatment, a small percentage of patients may experience slightly increased soreness for a few days. If this occurs, painkillers or a simple ice-massage can help.

There is no restriction to the number of times ESWT treatment can be carried out, as there is no long-term risk involved, provided treatment is carried out correctly.

ESWT should not be used in areas of tumor, infection or in the early and late stages of pregnancy.

Focusing and targeting of ESWT treatment needs to be accurate, especially where the site of treatment is close to structures such as the lung, the spine and any large blood vessels, as these could be damaged by poorly focussed ESWT.

As such, the International Society of Musculoskeletal Shock-Wave Therapy (ISMST) has recommended that ESWT be carried out only by trained physicians, using proper ESWT devices.