World Stroke Day - 25102016 5x2a68

THE STAR, TUESDAY 25 OCTOBER 2016

WORLD STROKE DAY

New waves in treatment Stroke is the third largest cause of death in the country, but there is hope for a better life after stroke thanks to improving medical technology and rehabilitation.

2 World Stroke Day By NISSHANTHAN DHANAPALAN HELD every Oct 29, World Stroke Day aims to raise awareness on both the incidence of stroke and the millions of survivors who are still working to improve their lives through treatment and rehabilitation. According to the World Stroke Campaign under the World Stroke Organization, this condition affects 17 million people worldwide, with 5.5 million deaths and 26 million survivors between 2014 and last year. Stroke is the third largest cause of death in Malaysia. According to Dr Loh Pei Kee, consultant neurologist at Ara Damansara Medical Centre, it is estimated that almost 40,000 Malaysians suffer from stroke every year and it affects men more than women. Stroke itself is defined as the sudden and unpredictable result of tissue damage caused by a blood clot or haemorrhage in the brain. This localised tissue damage occurs due to the loss of oxygen transported to brain cells. The brain itself uses 25% of all oxygen used in the body. In line with this year’s World Stroke Day theme highlighting that stroke is a treatable disease, the perception about stroke treatment, rehabilitation as well as research and development is changing towards a more positive outlook.

Immediate action Current conventional methods of treatment revolve around addressing the cause of the stroke, alleviating symptoms and rehabilitation. Going back to the core of stroke treatment, time is everything. The faster a stroke patient has access to treatment, the higher the chance of saving the patient in of morbidity and mortality. Stroke is usually categorised into two types, ischaemia stroke and haemorrhagic stroke. Ischaemia stroke occurs when there is a restriction of a blood vessel in the brain due to a blood clot and plaque build-up. Haemorrhagic stroke, on the other hand, occurs when a weak blood vessel ruptures due to an increase in blood pressure. Upon ission, doctors will come up with a strategy to reduce the effects of the stroke on the brain through medication and drugs before assessing the type of

THE STAR, TUESDAY 25 OCTOBER 2016

It is treatable

The morbidity and mortality of a stroke patient is dependant on how fast they are treated. stroke the patient is having. This would include a thorough medical history check as well as certain diagnostic tests that will inform the doctor on suitable treatment strategies. “Evaluation of a patient with suspected stroke is performed after thorough history and clinical examination. “It is divided into imaging, blood tests and other diagnostic tests such as computerised tomography, magnetic resonance imaging and magnetic resonance angiogram of the brain,” says Dr Loh. “Other diagnostic tests that are commonly carried out are electrocardiogram, echocardiogram and transcranial Doppler study.” Treatment strategies for both ischaemic and haemorrhagic conditions differ as doctors race to reduce the impact of stroke on the affected brain tissue. “Acute treatment for ischaemic stroke such as blood-clot busting and endovascular treatment, if given or done early in carefully selected patients, can reverse the artery occlusion and reverse or minimise the severity of stroke,” says Dr Loh. In the case of an ischaemic stroke, blood thinners and clot-dissolving medications will be istered to the patient to break down the clot of the restricted blood vessel in the brain. One such strategy is to use a drug known as recombinant tissue plasminogen activator (tPA). Ischaemic stroke occurs when fibrin, a structure in our blood, traps blood cells and platelets, forming a clot along an artery in the brain. This usually occurs when there is an increased amount of plaque formation in the inner wall of a brain artery. The tPA then aids in the generation of an enzyme known as plasmin, which dissolves the clot, thus restoring blood flow. According to a 2014

meta-analytical study published in The Lancet, clot-busting drugs increase the chance of an effective treatment outcome by 30%. “The drug can be injected into patients within 4.5 hours of symptom onset. The earlier the treatment is given, the greater the effect. This treatment can also be istered for medium to severe stroke attacks,” says Dr Mooi Chin Leong, neurologist from Mahkota Medical Centre. Although this drug has significant impact in improving recovery outcomes, it is only available in selected hospitals due to its cost and scarcity. In addition to this, the istration of tPA also comes with risks. Thus, it can only be istered by experienced physicians as it can cause excessive bleeding in higher doses. Another advancement in the treatment of ischaemic stroke is through endovascular treatments. This involves a procedure known as mechanical thrombectomy, where a discreet wire-caged device or stent is sent via a catheter to the site of the blocked blood vessel to widen it and allow for more blood flow. Doctors proceed with this treatment only after the patient has received tPA and the blood clot has been cleared. Treatment for haemorrhagic stroke is a lot more different compared to ischaemic stroke. The aim of the treatment is to stop the bleeding from the ruptured vessel as fast as possible to reduce blood loss and a dip in oxygen concentration in the brain. According to the American Stroke Association, there are two main treatment strategies for haemorrhagic stroke – an endovascular procedure or a surgical procedure. Similar to ischaemic stroke, a catheter is inserted through an artery and travels to the site of vessel rupture to deposit a mechanical agent like a coil to prevent further damage and reduce blood loss. Endovascular procedures for haemorrhagic stroke has made great strides in of minimally invasive procedures. This decreases patients’ recovery time and allows them to proceed with rehabilitation therapy as

Rehabilitation is a process. The long-term goal is to facilitate a stroke survivor in becoming as independent as possible. Survivors will be encouraged to relearn basic skills such as eating, bathing, dressing, walking and communicating. soon as possible. Surgical procedures are prescribed for haemorrhagic stroked cause by an abnormal tangle of blood vessels or a severe aneurysm.

Road to recovery Rehabilitation is a process. The long-term goal is to facilitate a stroke survivor in becoming as independent as possible. Survivors will be encouraged to relearn basic skills such as eating, bathing, dressing, walking and communicating. Rehabilitation therapy starts in the hospital itself once the patient’s vitals have stabilised. “Once the patient is stable, rehabilitation will commence, even while he is in the intensive care unit. The type and level of rehabilitation will be increased according to the patient’s disability, tolerance and improvement,” says Dr Loh. Rehabilitation helps stroke patients relearn skills that are lost due to a damage at a specific position in the brain. Rehabilitation therapies help the brain create new neural connections in the damaged area, thus restoring function to the brain and improving physical function. Like the treatment process, rehabilitation is personalised and based on the severity of the stroke.

Physiotherapy, occupational therapy, counselling, recreational activities and light sports are some of the therapy modules in the rehabilitation process. However, rehabilitation therapy can be costly and time consuming. Survivors and their family have to assess available options and where they can get the best service possible. This is where associations and non-government organisations come in. “We know that hospitals generally charge RM100 to RM150 per hour for rehabilitation therapy. However, the queue is long and, often, patients may only be able to get two appointments in a month,” says Sylvia Chong, general manager of the National Stroke Association of Malaysia (Nasam) “At Nasam, our one-to-one rehabilitation therapy costs less and for group therapy, we seek a contribution of only RM300 per month at our Petaling Jaya centre and lower at our other centres. “Survivors who sign up for group therapy come to Nasam for rehabilitation for two hours every day. This works out to be a very minimal sum per hour,” she adds.

Beyond convention Some doctors believe that if complementary medicine does not cause excessive harm and does not interfere with an ongoing medical regime, patients can explore these options to reduce symptoms. “Complementary medicine such as acupuncture is suitable to relieve pain for some patients and it is being practised as a professional medical treatment in some countries. In addition, some patients are allergic to certain medications. Hence, complementary medicine offers them an alternative,” says Dr Mooi. Dr Mooi adds that there should be transparent communication between the doctor and survivor if they are pursuing alternative medicine so that doctors can advise on the risks of a certain complementary medicine treatment or modify their current treatment. There is a great deal of research and development that is being conducted to find new treatment and rehabilitation options for stroke survivors. Last June, a clinical trial conducted by Stanford University of Medicine, the United States, showed that modified stem cells injected into the brain of chronic stroke patients have the ability to restore motor functions. Although the trial produced promising pilot results, the true efficacy and safety of this therapy option will only be concluded at the end of the trial. Although stroke is treatable, it does not mean we are allowed to be complacent. Prevention is always better than cure and by maintaining a healthy lifestyle, we can reduce the risks of getting a stroke. On the flip side, the fact that stroke is treatable should be regarded as a moral boost for survivors to be more confident in regaining their physical functions and improving their quality of life. In future, stroke treatment will cost less yet be highly accessible with a spectrum of available treatment options.

> SEE ALSO PAGE 11

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THE STAR, TUESDAY 25 OCTOBER 2016

IT is that time of the year again to shed some light on the topic of stroke. Between 2010 and 2014, there was an increase in the number of stroke patients in Malaysia. World Stroke Day was first celebrated in 2006 and later fixed on Oct 29 as the World Stroke Organization (WSO) was officially formed on this day. WSO is an international non-governmental organisation recognised by the World Health Organization (WHO). Stroke, one of the leading causes of death in Malaysia, is disabling yet treatable. It costs money and time to treat hypertension and stress as they are considered the main contributing factors of stroke. Hypertension is increasing among Malaysians above the age of 30 and if a person experiences a stroke at the age of 55, the impact will greatly affect his earning ability and future. This year, iRehab decided to do something different to serve a greater cause. On this day, in the international fight for access to stroke care, iRehab signed a petition, calling out to stroke patients and Malaysians to in of this noble cause. This petition is in of the Global Stroke Bill of Rights petition launched by WSO. This petition is not a legal document – it is a stroke-care guide that s the best possible outcomes for both stroke survivors and their families. The physiotherapy and stroke rehabilitation centre takes pride in the care that is provided to all patients and is delighted that its facility s the Stroke Bill of Rights.

Proceed with speed Hypertension is increasing among Malaysians above the age of 30 and if a person experiences a stroke at the age of 55, the impact will greatly affect his earning ability and future.

Zalilah Salleh Ghany is the founder and chief executive officer of iRehab, a physiotherapy and stroke rehabilitation centre. Founded by Zalilah Salleh Ghany, the facility was initially conceived with strong foundations in neurological rehabilitation. However, it began providing services for other conditions, including back, neck and knee pain over time to meet clients’ needs. The centre strives for excellence in care and, as such, s evidence-based practice. One instance is the usage of robot-assisted gait training also known as Lokomat. A study in 2013 published by the Cochrane Database of Systematic Reviews shows that early rehabilitation and high-repetition

gait training ensures consistent brain stimulation, which, for example, helps individuals learn to walk again. Under one roof, iRehab provides a team of healthcare professionals (physiotherapist, occupational therapist, speech therapist, prosthetist, orthotist, doctors and nurses) in providing personalised care. Believing in continual care, iRehab’s services start from your doorstep. It offers transitional home care, a stay-in care centre that focuses on improving a stroke survivor’s independence through intense rehabilitation.

One such stroke survivor that has experienced the services in its fullness is Cheah Swee Peng. The 54-year-old stroke survivor with a left-sided weakness was wheelchair-bound, totally dependent on others for his personal care and was unable to walk when he first went to iRehab. Cheah's family sought transitional-care services that included nursing care, physiotherapy, occupational therapy and Lokomat. After four weeks of intensive rehabilitation, Cheah recovered and was able to care for himself, walk without a walking aid and

drive independently. To add the cherry on the cake, he returned to his pre-stroke employment as a sales executive at an international-based company two weeks after his discharge from rehabilitation. The WSO theme for this year is Face the facts: Stroke is Treatable with the tagline “Lives can improve with better awareness, access, and action”. Cheah’s recovery story surely s this tagline. Life can be recovered in light of a stroke when the right actions are taken at the right time.

n For more information

or to the Stroke Bill of Rights, visit www.worldstrokecampaign.org.

4 World Stroke Day

THE STAR, TUESDAY 25 OCTOBER 2016

The highs of exercise The NordicTrack T13 Treill is equipped with a wide selection of workout apps, OneTouch speed and incline controls, FlexSelect cushioning and a SpaceSaver design with EasyLift assist.

ACCORDING to the National Stroke Association of Malaysia, stroke is the third largest cause of death in this country with an estimate of 40,000 cases yearly. The risk of getting stroke can be reduced by adopting a healthy lifestyle – limiting alcohol consumption, eating a healthy diet, quitting smoking and being more physically active. Exercising helps to lower blood pressure, control weight, create a healthy balance of blood fats and improve the body’s ability to handle insulin. Aim to do moderateintensity exercise for 30 minutes for at least five days a week. Brisk walking is the easiest form of exercise suitable for people of all ages and fitness levels. It can be done at any time and

The console comes with a six-inch backlit display with a music port and the autoBreeze workout fan. even at home with a treill. An American brand, the NordicTrack T13 Treill is equipped with impressive features designed to make walking or jogging more enjoyable with the convenience of doing it at home. This treill features a smooth and powerful 2.75 CHP DurX Commercial Plus Motor to a 20-inch by 60-inch tread belt. Total calories burned and workout progress can be tracked with the six-inch large backlit display. It is equipped with a music port compatible with iPods and the autoBreeze workout fan that automatically adjusts its speed to match individual workout speed. Other performance features include: l A wide selection of workout apps – Burn calories through incline, speed or intensity built-in workouts designed by a certified personal trainer.

l OneTouch speed and incline controls – Increase workout speed up to 20km/h and incline up to 12% with the touch of a button to increase intensity and calorie burn. Stay focused on performance instead of scrolling through settings. l FlexSelect cushioning – Get the best of both worlds from an adjustable treill cushioning. Turn it clockwise for impact reduction and t comfort. Turn it back for a surface that feels like a road. l SpaceSaver design with EasyLift assist – Fold the treill up and it is out of the way for convenient cleaning and storage. A hydraulicdampening spring does the heavy lifting so the treill can be easily folded to save floor space. The NordicTrack T13 treill is available

The FlexSelect cushioning protects ts and ligaments by significantly reducing impact.

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n For more information, visit Fitness Concepts stores or roadshows, call 03-7726 7787 (IPC Shopping Centre store) or 03-2282 3200 (Mid Valley Megamall store), e-mail enquiries@ fitnessconcept.com.my or log on to www.fitnessconcept.com.my to shop online.

The OneTouch speed and incline controls allow you to intensify your workout with the touch of a button.

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THE STAR, TUESDAY 25 OCTOBER 2016

OSTEOPOROSIS is a chronic, debilitating disease that reduces bone density and quality. It affects bones by causing them to become porous and fragile, thus weakening the skeleton and significantly increasing the risk of fractures. Bone loss occurs silently and progressively, often without symptoms until the first fracture occurs, most commonly at the hips, spine and wrist. Although genetic factors largely determine the size and density of bones, lifestyle factors such as good nutrition, regular exercise, and avoiding smoking and excessive alcohol consumption also play key roles.

Keep the boost Calcium is a major building block of bone tissue, which also acts as a reservoir to balance calcium levels in the blood. Calcium requirements change during the various stages of our lives. When dietary calcium is mentioned, we generally associate it with milk and other dairy products. Although dairy products have high levels of dietary calcium, they also contain animal proteins and growth factors, lactose sugar, and a substantial amount of fat and cholesterol, making them a less favourable calcium option for those with allergies, bowel irregularities, obesity and cardiovascular disease. Gaining is as important as preserving, as getting the right amount of dietary calcium is important. However, a crucial aspect of bone health is to ensure that calcium in bone tissue is maintained.

Keeping bones strong Weight-bearing exercises such as running can help you maintain calcium in the bones and increase bone density. High salt intake is a commonly recognised risk factor for osteoporosis because it leads to hypercalciuria or excessive urinary calcium excretion. The blood level of calcium is carefully controlled whereby when it is too low, the calcium from bones dissolves into the bloodstream. When it is too high, extra calcium either es through the kidneys and out of the body through urine or gets stored in the bones. A study published in the Journal of Human Hypertension in 2009 showed that high blood pressure due to high salt intake is linked to high levels of dissolved calcium in blood, which leads to

loss of bone mass. Protein is also an important component in building and maintaining bone mass. Fish, poultry, lean red meat, eggs and dairy products are excellent protein sources, but they tend to encourage calcium’s age into the urine. This occurs due to high amounts of sulphur-containing amino acids in animal proteins that cause acidification of the blood. Calcium is released from the bones to neutralise it. Calcium is abundant in many food sources. Some of these sources include green leafy vegetables, legumes and fortified foods. Broccoli, Brussels sprouts and

other greens are also loaded with highly absorbable calcium and a host of other healthty nutrients. Plenty of calcium can be found in tofu and beans, which also contain magnesium that your body requires for better bone health.

Get physical Exercise is vital for maintaining calcium in the bones and increasing bone density. One of the best bone-building exercises is the weight-bearing kind, which forces you to work against gravity. Some examples include weight training, walking, hiking, tennis and dancing. Exercises that are

not weight bearing include swimming and cycling. Based on a study, individuals who practised aerobic exercises and weight-bearing activities combined with weight lifting three times a week experienced significant increase in regional bone density. Although non-weight-bearing exercises tone muscles, they have little impact on maintaining bone density and calcium content. With simple yet effective lifestyle modifications, you can take control of your bone health and prevent osteoporosis.

n This article is brought to you by your partner in health, Guardian Health and Beauty Sdn Bhd.

6 World Stroke Day THIS year’s World Stroke Day theme – stroke is treatable – is a beacon of hope for stroke survivors. It recognises that although stroke is a complex medical issue, there are ways to significantly reduce its impact, whether through prevention or effective treatment and rehabilitation. As one of the main drivers of healthcare advancement, technology plays a great role in improving stroke rehabilitation. It has a central role in mobility training and therapy today, with current and future applications ing the notion that there is hope for a good quality of life poststroke.

Humble beginnings The usage of electrical stimulation in targeted physiotherapy was not always the prescribed rehabilitation method for stroke patients – in fact, prior to the 1950s, physiotherapy was not popular in this area as physical activity was

THE STAR, TUESDAY 25 OCTOBER 2016

Tech-advanced rehabilitation vehemently discouraged after a stroke. In functional electrical stimulation, the actions of healthy muscles are imitated using small electrical signals that stimulate the nerves of the affected area. This electrical activity induces the contraction of muscles, which aids in their quick recovery and relearning. The signals come from nerve stimulators in the form of a small control box worn on the body or surgically implantable devices placed under the skin. Although widely used to improve the lower extremity of stroke patients – particularly to treat foot drop – it is also applicable to leg and arm muscles.

Regular prescribed sessions of electrical stimulation have proven to improve independent muscle function in shorter periods of time. Robot-assisted therapy is when specially designed machines take the place of a human physiotherapist, coaching patients through repeated exercises to train muscles affected by their stroke. Using robots and machines in rehabilitation allows patients to carry out their exercises even at home. On top of that, robots are more effective because they help with more repetitions than a therapist is typically able to.

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One of the oldest examples of technology application in stroke rehabilitation is seen in functional electrical simulation.

Importance of sufficient sleep IN today’s fast-paced, sleepdeprived world, the need for a restorative night’s sleep is more important than ever. According to Arianna Huffington, the co-founder and editor-in-chief of the Huffington Post, we are in the midst of a sleep-deprivation crisis. This has profound consequences on our health, job performances, relationships and even happiness, according to her book The Sleep Revolution. A study published in 2011 in the European Heart Journal examined the sleep habits of more than 470,000 participants across eight countries and reported that prolonged sleep deprivation increases the risk of suffering from a stroke or heart disease. Chronic short sleep produces hormones and chemicals in the body that increase the risk of developing heart disease, stroke and conditions such as high blood pressure, cholesterol, diabetes and obesity. Co-author of the report Prof sco Cappuccio, says, “If you sleep less than six hours per night and have disturbed sleep, you stand a 48% greater chance of developing or dying from heart disease and a 15% greater chance of developing or dying from a stroke. “By ensuring you have about seven hours of sleep a night, you are protecting your health and reducing the risk of developing chronic illnesses.” A three-year study of 5,666 adults presented at the SLEEP 2012 conference found that stroke risk was four times higher for those who habitually sleep less than six hours a night. “The public is less aware of the

impact of insufficient amounts of sleep. Sleep is important as the body is stressed when it doesn’t get the right amount of it,” says Megan Ruiter, lead author of the study presented at the SLEEP 2012 conference. Russian Academy of Medical Sciences professor of cardiology Prof Valery Gafarov says, “Poor sleep should be considered a modifiable risk factor for cardiovascular disease along with smoking, lack of exercise and poor diet. Guidelines should add sleep as a risk factor to recommendations for preventing cardiovascular disease.” Medical issues, stress, sleep hygiene and medications that could be possibly keeping you awake at night are some of the important details to consider when trying to improve sleep. A further key question is whether you are getting the healthy and restorative sleep the body needs. Healthy and restorative sleep occurs during slow-wave deep sleep and REM (rapid eye movement) sleep stages. It is during these stages that the body rests and repairs physically, emotionally and mentally, most effectively. Studies have shown that L-Theanine, an extract of green tea, and alpha casein tryptic hydrolysate, a peptide from milk, have calming properties that promote sleep quality and improve relaxation. This article is brought to you by LiveLife Sdn Bhd.

n For more information, call 1800 880 488 or e-mail [email protected].

World Stroke Day 7

THE STAR, TUESDAY 25 OCTOBER 2016

THIS Dec 11, the National Heart Institute (Institut Jantung Negara, IJN) will organise its inaugural IJN Ride 4 Your Heart cycling event with the theme Ride Hard, Strong Heart. Beginning and ending at The University of Nottingham Malaysia Campus, this activity will see people of all walks of life travelling 28km or 115km routes on their bicycles. “IJN is always looking to promote healthy living and since there are quite a number of cycling enthusiasts among the staff , cycling was identified as one of the ways we can achieve this,” says Datuk Dr Mohd Azhari Yakub, chief executive officer and senior consultant cardiac surgeon at IJN.

Getting the pedals moving cardiovascular complications or even stroke. The only way to halt this epidemic is to make significant changes to unhealthy lifestyles. IJN advocates eating a balanced diet and being physically active. It continuously conducts programmes that educate and empower the public to make more informed choices for their well-being.

Shared responsibility

Fun in fitness An avid cyclist for the past six years, Dr Azhari says his favourite routes include Gombak-Genting Sempah and Hulu Langat-Genting Peres. “When looking for alternatives to jogging that would not affect my knees and ankles as I get older, I found cycling to be a lowimpact exercise enjoyable at my own pace or with a group. Its benefits include better cardiovascular health and reduced impact on ageing ts compared to jogging or running,” he shares. Dr Azhari explains that cycling allows the heart to work at an optimal level, which, when done for a sustained period, trains the heart to cope with higher intensity levels. This makes it one of the best cardio fitness exercises for people

Dr Azhari is a cycling enthusiast who believes that people of all ages stand to reap multiple health benefits from the low-intensity sport. of all ages, contributing to its increased popularity in the country over the past decade. Contrary to popular belief, cycling is not an expensive hobby – all you require are a functional two-wheeler, a love for nature and determination. “Once you are committed to cycling twice or thrice a week, you can gradually upgrade your bicycle

but you do not need a high-end ride to start off,” says Dr Azhari.

Prevention through education “The nature of modern living has given rise to sedentary habits – we prefer travelling in cars over walking and the younger generation’s leisurely activities are

largely digital and do not require physical activity outdoors. “Fast food is widely available and affordable, and in Asian cultures, many social and business activities centre around food,” says Dr Azhari. All these and more, he explains, give rise to non-communicable diseases such as obesity and diabetes, which can lead to

ed Ride 4 Your Heart participants will gather at IJN on Dec 3 to collect their race pack, which consists of a T-shirt, goodie bag, bib number, timing chip, medal and e-Certificate. They will also be privy to a host of health talks and cardiopulmonary resuscitation (R) lessons conducted on the same day. Dr Azhari hopes that events of this nature can be organised on a regular basis, not only by IJN but other corporations and healthcare providers. He believes that these parties have a pivotal role to play in empowering the community to make better lifestyle choices, thus taking essential first steps to tackle the considerable socioeconomic burden of noncommunicable diseases.

n online for Ride 4 Your Heart at www.gosportz.my or call 03-2517 8200 for more information.

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Reliability and accuracy at home MEASURING one’s blood pressure at home or in any other relaxed environment can help prevent white-coat hypertension, which is a sudden and abnormal spike in blood pressure readings taken during visits to the doctor’s clinic due to anxiety. According to the American Heart Association, the best way to predict the risk of and prevent a stroke or heart attack due to high blood pressure is through continual monitoring at home rather than periodic checks at the clinic. While most people understand the importance of monitoring their blood pressure at home, they have yet to understand the importance of reliable, accurate measurements and the correct fitting of the arm cuff. Omron Healthcare, a global leading manufacturer of blood pressure monitors for home use, is equipped with technologies that ensure each measurement is reliable and accurate. The Omron Ultra Blood Pressure Monitor HEM-7320 is built with an easy-positioning wrap for reliable cuff positioning at a wide angle, allowing for effortless usage even for first-time s. Along with this feature, the preformed easy-fit cuff provides s with easy cuff application while providing accurate and anxiety-free blood pressure measurement. It is also designed to detect movement errors and irregular heartbeat to minimise the misreading of measurement values. The Omron Blood Pressure Monitor HEM-7320 gives s a more assured blood pressure measurement at home.

With the Omron Ultra Blood Pressure Monitor HEM-7320, you can take accurate and reliable blood pressure measurements in the comfort of your home. You can check out Omron’s value promotion for weighing scales and body composition monitors when you purchase the Omron Blood Pressure Monitor from October onwards.

n For more information, visit

www.omronhealthcare.com.my.

Norway-sourced, concentrated and pollutant free DUE to increasing consumer awareness about the health risk-associated with high-fat and high-cholesterol foods as well as products high in sugar and salt, Opceden is responding to the rapidly growing demand for pure and highly concentrated omega-3 by providing an added nutritional formulation on healthy ageing throughout life. As a result, Opceden Omega-3 Fish Oil TG 500/200 fish oils are now available. The marine omega-3 essential fatty acids offer health benefits. Marine sources of omega-3 are particularly important because omega-3 fish oil comprises polyunsaturated, essential fatty acids that cannot be synthesised by the human body and must be obtained from food or supplements. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the two key essential fatty acids in omega-3. Studies have shown that EPA and DHA are important for proper health maintenance and immune function. EPA and DHA may affect many aspects of body functions. Opeceden Omega-3 Fish Oil TG 500/200 is in the triglyceride (TG) form. Most fish oil supplements in the market are available in ethyl ester form or TG form. Structurally, the major difference between the two forms is that in ethyl ester, the fatty acids (EPA and DHA) are esterified to an ethanol backbone, while in the TG form, the fatty acids are esterified to a glycerol alcohol backbone.

MAL16055017N Opeceden Omega-3 Fish Oil TG 500/200 provides omega-3 essential fatty acids in the triglyceride form. Typically, fats in most food sources are found in their natural TG form. TGs are generally associated with standard fish body or fish liver oil. These fats comprise three fatty acids (such as omega-3 EPA and DHA) linked to a molecule of glycerol. Without glycerol, free fatty acids can oxidise rapidly. Therefore, the glycerol backbone helps to naturally stabilise the fat molecules and prevent breakdown and oxidation. To digest fatty acids in our diet, we need pancreatic lipase (enzyme). Studies have found that lipase hydrolyses the TG form 10 to 50 times faster and ensures that absorption into the body is optimised.

n Look out for the ment in this StarSpecial. KKLIU No.1818/2016

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GINTELL is celebrating its 20th anniversary with a mega deal so that everyone can enjoy their shopping experience with friends and family. Gintell caters to all needs and believes that everyone deserves love and care. Everyone needs time to relax and be pampered to release tensions of daily life. In this modern society, people tend to be busy with work and neglect their health. If a human body does not get enough rest, how can it be equipped to fight for the rest of its life? If your body could speak, it would be shouting in pain. Bring quality to your life with any of the packages available by Gintell. The Gintell DéWise Wisdomatic massage chair is a massage chair that serves all needs. Everyone will be amazed by the pleasure and satisfaction that the new Gintell DéWise brings, all within your comfort zone. To satisfy everyone’s needs, Gintell is introducing the 3D Acupressure Roller through Gintell DéWise. This feature allows the massage chair to automatically adjust to your body size. Furthermore, the Ultra Chiro Track will follow the curves of your body to provide an ergonomic precision massage and comfort from neck to thighs. This 95cm-long track will provide continuous massage to help you relieve backaches and soothe sore muscles. Plus, the 230° Royale Thai Stretch will help to relieve stress on the skeletal body, including the spine. This authentic Thai massage is created with numerous stretching techniques for tired bodies after a hard day. With the Gintell combo deal, enjoy a Gintell DéWise upgrade rebate of up to RM5,000. The Gintell DéWise Care massage chair has a unique butterfly massage technique, which provides more comfort and gives a full-body massage experience. This helps with prolonged stress and exhaustion. It is by far the longest massage-chair track available, having an impressive extended XV-Track length of more than 135cm. This enables deeper reaches and 48% more massage areas to the neck, shoulders, back, waist, hips and thighs, providing extra comfort and relief. The butterfly kneading massage technique provides a more natural and relaxed massage technique, alleviating sore muscles and back pain. It relieves tenderness and

Celebrate good times Twenty years of experience in building a comprehensive range of healthy lifestyle products has inspired Gintell to build a brand-new sofa with a massage function to cater to people’s needs. enhances muscle elasticity as well. The DéWise Care massage chair has been infused with the 3D Rotational Guasa technology. It targets the feet and toes, providing relief similar to results that can be obtained from a traditional massage therapist. Gintell is offering a discount of RM10,988 or RM305.22 monthly for both the DéWise Care Butterfly massage chair and DéVano S FUNtastic Sofa. Twenty years of experience in building a comprehensive range of healthy lifestyle products has inspired Gintell to build a brandnew sofa with a massage function to cater to people’s needs. Everyone can enjoy the goodness of the combination of all the therapeutic massage techniques by using the revolutionary Gintell DéVano S FUNtastic Sofa that combines an outstanding massage experience in a contemporary design that perfectly complements your home. The 105cm V-Track FUNtastic massage track follows the contours of your body to reach your back, lower back and hips for a hand-like massage experience to remove aches and stress. Unlike a typical massage chair that uses fixed-position heating, which often fails to target the required spots, the 3D Heating Massage Ball in DéVano S FUNtastic Sofa provides targeted relief, which promotes blood circulation and

The Gintell DéWise Wisdomatic massage chair.

metabolism to help you eliminate water retention and shoulder aches. The special butt-shaping and pelvic-correction massage airbags target your hip area to give you firmer and more shapely buttocks. Get the combo deal for the DéVano S FUNtastic Sofa with the G-Beetle Foot Massager for only RM110 a month. Visit the Gintell roadshow to find out more on these attractive deals. The roadshow will be held at IOI City Mall, Putrajaya, from Oct 18 to 30, Klang Parade, Klang, from Oct 21 to 30 and Imago Mall, Kota Kinabalu, from Oct 1 to 31. Gintell wishes you and your family health, love, life.

n For more information, visit www.GINTELL.com or call 1800 886 332.

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10 World Stroke Day FATS are responsible for weight gain and artery clogging. It provides 9kcal per gramme, which is a lot more calorie-dense compared to carbohydrates and proteins. Fat not used by body cells is converted into body fat and, over time, leads to obesity. Fats are thought to be the main contributor of the development of cardiovascular diseases. Fat is one of the macronutrients needed from our diet. It is a great source of energy to fight fatigue, deliver fat-soluble vitamins, manage moods and keep skin healthy. It is also important for eyesight and brain development. There are two types of dietary fats, which are bad and good fats. Bad fats are saturated fatty acids that typically appear in solid form at room temperature. They are abundant in animal sources such as lard and poultry skin. Bad fats also include trans fatty acids that are found in processed food, margarine and fried food. Both saturated and trans fatty acids consumed in excess can contribute to health-related issues such as high triglyceride and cholesterol levels. Good fats are the fatty acids that have health benefits. Good fats include polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids. These fats typically appear in liquid form at room temperature. The two main groups of PUFAs that are important to our health are the omega-3 and omega-6 families. Omega-3 fatty acids are also known as essential fatty acids

THE STAR, TUESDAY 25 OCTOBER 2016

Omega-3 fatty acids are beneficial for heart, eye and brain health and protect against cardiovascular diseases.

Fight the fats since they cannot be produced by the body and must be obtained from diet. There are three major types of omega-3 fatty acids, which are α-linolenic (ALA) acid that is commonly found in plant oils, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The best source of EPA and DHA is oily fish. The intake of omega-3 fatty acids, particularly EPA and DHA, is beneficial for heart, eye and brain health. The role of omega-3 fatty acids in protecting against cardiovascular

diseases is well recognised. It has anti-atherosclerotic and anti-inflammatory properties that protect against the progression of atherosclerotic plaques, which narrow the arteries. An omega-3 fatty acids intake of about 4g per day lowers serum triglycerides by 25% to 30%. In addition, omega-3 fatty acids aid in reducing blood pressure, one of the risk factors for cardiovascular disease. Based on a study conducted in 2012 by International Medical University (IMU), the dietary

Wholesome nutrition HIGH cholesterol is a serious issue faced by many Malaysians and one of the causes of coronary heart disease, peripheral vascular disease and stroke. According to the Health Ministry, 47.7% of Malaysian adults suffer from high cholesterol. Although cholesterol is often portrayed as something that is not good for you, it is actually an essential component in our body. Cholesterol is a waxy substance produced by the liver. It plays a vital role in cell function and is needed to synthesise vitamin D, some hormones and bile for digestion. External sources of cholesterol can be found in foods that are derived from animals such as meats, seafood, eggs and milk. Cholesterol is classified into two categories – high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The latter is often referred to as bad cholesterol because too much of it is unhealthy. An increase in LDL is known as high cholesterol. Prevention is always better than cure. Whole grains have the unique ability to lower cholesterol levels before the onset of any chronic diseases as they have the three component layers that are rich in nutrients. These layers are the bran, germ and endosperm. The bran layer has most of the grain’s fibre and is rich in B vitamins, antioxidants, phytonutrients, iron, zinc and magnesium. Endosperm, the middle region of the grain, contains most of the carbohydrate and some protein of the grain. The germ, or the inner core, is rich in antioxidants, vitamin E, B vitamins and healthy oils. Whole grains are food sources that are high in dietary fibre. Studies show that a diet high in fibre can be beneficial in lowering high cholesterol, help manage weight, ease constipation, maintain a

levels of omega-3 fatty acids were found to be very low among the Malaysian population. The intake of omega-3 fatty acids was reported to range from 0.22% to 0.28% of total energy intake, which is below the Malaysian recommended range of 0.3% to 1.2%. Hence, we should include more omega-3-rich foods such as oily fish, walnuts, plant oils and seaweed in our daily diet. The American Heart Association suggests consuming fish at least twice weekly and

including oils rich in α-linolenic acid in your diet. For those with coronary heart disease, 1g of EPA and DHA per day is recommended. Supplementation is suggested for those who are unable to fulfil their daily omega-3 recommendation. This article is brought to you by BiO-LiFE Marketing Sdn Bhd.

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Virtual > FROM PAGE 6

Guardian Mixed Grains & Oats 30+ contains oat bran, brown rice, barley and chia seeds to provide a nutritious meal. healthy digestive system and stabilise blood sugar levels. In addition to this, beta-glucan – a type of fibre found in grains – can help reduce blood cholesterol levels and stabilise blood sugar levels. Whole grains such as brown rice and chia seeds contain nutrient-rich bran and germ layers as well as natural plant-based nutrients needed to regulate cholesterol levels. Barley and oat bran powder, on the other hand, are power foods that help lower cholesterol as they are rich in beta-glucan. Guardian Mixed Grains & Oats 30+ is enriched with brown rice, barley and chia seeds to provide adequate amounts of beta-glucan, dietary fibre and plant-based nutrients.

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Machines such as the MIT-Manus, for example, requires the patient to brace his lower arm and wrist to the robotic arm, then carry out the simple exercises instructed on the screen. The machine guides the affected arm as needed, and if patients are unable to conduct certain movements independently, MIT-Manus prompts the movement. Today, advances in human-machine interface and virtual reality systems enhance robotic-assisted therapy. Brain-computer interface controlled therapy, which is used together with functional electrical stimulation, picks up brain signals through an electroencephalogram cap worn by the patient. These signals are translated into intended movements and the patient can then control different outputs whether on screen or through the electrical stimulation mechanism. This sort of therapy has been lauded for its ability to reestablish pre-stroke communication between the brain and body, which is a precursor for successful rehabilitation. Immersive virtual reality takes this one step further with inventions such as MindMaze’s MindMotionPRO (pic), which uses motioncapture sensors to produce real-time mapping of the patient’s avatar on

multiple viewing screens. Patients are placed in a virtual reality where they can watch and control themselves performing actions that they were able to execute effortlessly before the stroke, learning new ways to carry out activities such as reaching, lifting and walking. Throughout this process, neurological activity is recorded along with its correlation to movement performance to monitor progress as well as enhance individual sessions to optimise patients’ recovery. The usage of computer graphics also allows games and mini activities to be incorporated in therapy sessions, making them less daunting and more fun to encourage patient involvement.

World Stroke Day 11

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WITH fast treatment and the right rehabilitation, stroke survivors can live a fairly healthy life.

Leong Yee Khiam On Feb 19 this year, Leong Yee Khiam was wheeled into the National Stroke Association of Malaysia (Nasam), Petaling Jaya, for the first day of therapy by his wife and business partner. It was four weeks after his stroke due to a brain aneurysm and it affected the mobility on his left side. His rehabilitation programme at Nasam consisted of 12 one-on-one sessions, three times a week. After six sessions into the third week, he was able to stand and walk independently. This achievement came six weeks after his stroke. On April 1, he ed the advanced group for daily rehabilitation and on April 3, Leong bravely ventured into the shallow end of the kid’s swimming pool. He tried to float but balancing was an issue. “Leong was healthy and exercised regularly as he loved sports. He comes from a family with a history of high blood pressure. He was taking medication but irregularly. We were shocked when he had the stroke. When the neurosurgeon told me his condition was very bad, I didn’t know what to think or what to ask,” says Poh Chan, Leong’s caregiver. “It is a great relief now that he is recovering well from the stroke and happily getting back to what he used to enjoy before. Generally, he is a cheerful, jovial and flamboyant gentleman. Much of his good nature has returned as he continues to work hard at recovery,” she adds. Leong now spends four hours every week in a swimming pool. According to Leong, getting into the water gives him a power boost. The natural buoyancy of water allows a person with weak muscles on one side of the body to stand and walk with much less effort than on

Life after stroke by the pool. Now that his swimming has picked up pace, he is getting back into the swing of golf and hopes to start tennis soon.

Lai Seng

dry land. “Working out is more fun when you are splashing around. It’s so relaxing that you don’t notice how hard you are working,” says Leong. Leong’s twice-a-week routine in the water consists of walking and jogging, which he does in a forward and backward direction as well as a few laps of breast stroke. After that, he enjoys a welldeserved cup of coffee while resting

Lai Seng is no stranger to having a good time in the pool. As a child growing up by a river in Teluk Sisek, Kuantan, Lai’s main sports activity was swimming. He fondly re the fun long hours spent diving into the water with his childhood buddies. On Jan 20 this year, his left leg felt odd when he was busy working. He called his family and was taken to a hospital. He was diagnosed with a right haemorrhagic stroke with a weakness on the left side. There was no surgery and he was discharged after two days of monitoring and conservative treatment. “My initial reaction was that I could not give up on life. All that ran through my mind was I had to find a way to recover. Moreover, since I was able to move my hands and legs, I considered myself blessed with a second chance at life. “My main issue after the stroke was balance and coordination. Due to this weakness I did not think I could swim, but I was pleasantly surprised when I went into the pool during Nasam’s hydrotherapy session. My body just took over and, with the help of my therapists, I was able to swim,” says Lai. Just seven weeks after his stroke, Lai returned to his favourite sport. He practises swimming once a month during Nasam’s hydrotherapy session but his goal is to swim for one

a stroke on the left side of the brain will affect the left side of the body. However, if it happens on both sides of the brain, it will leave someone in a locked-in state. Stroke is treatable and if treatment is given fast enough, you may be able to save a person’s life and prevent long-term disability. The easiest method to identify if someone is having a stroke is to go through a series of steps known as FAST, which stands for face, arms, speech and time. Here is a detailed explanation of FAST and how to identify the signs of someone having a stroke: Face – Ask the person to smile. Check if the affected individual’s

face droops or find it difficult to smile. Arms – Ask the person to lift both arms in unison. Identify if the person is struggling to lift one or both arms. You may also notice one arm drifting downwards. Speech – Using a simple phrase and ask the individual to repeat it. Pay attention to the way they speak and check if it sounds strange. Time – If the first three signs indicate a face droop, arm weakness and difficulty in speaking, immediately call for an ambulance. The faster you get the individual to a hospital for treatment, the better the recovery outcome.

Leong has a new lease on life thanks to rehabilitation.

Working out is more fun when you are splashing around. It’s so relaxing that you don’t notice how hard you are working. Leong Yee Khiam

Lai Seng enjoys his hydrotherapy sessions.

Fast and meticulous SEEING someone having a stroke can be scary but sometimes it may be subtle and unnoticeable. This is when a person may approach you to tell you that he or she is feeling a little strange and weak. It is important for bystanders to recognise signs of a stroke as swift action can save a life. When a person is having a stroke, he or she will exhibit tell-tale signs of mobility, muscle and cognitive weakening. When a stroke occurs, it usually affects muscles along the left and/or the right side of the body. If the stroke is happening on the left side of the brain, the right side of the body will be affected while

Lai Seng is undergoing rehabilitation through swimming. hour a week. “I like this sport as it enables me to move all my limbs effortlessly and it is less tiring than exercising on land. It is

also a lot more cooling and provides a good cardio workout. “Since I began swimming, my hand and leg coordination as well as gait, which was affected by the stroke, have improved tremendously. “The water therapy helped me reduce my dependency on a walking aid. It has also increased my stamina and now I am able to finish my regular walk of almost 500m with less effort,” says Lai. Lai encourages stroke survivors to keep themselves motivated through recovery by finding a sport that they enjoy and incorporating it into their rehabilitation. “Find a sport you enjoy and you can practise regularly. Start slow and gradually increase your sessions. Never give up and stay positive.” – Case studies courtesy of Nasam.

12 World Stroke Day ACCORDING to the National Stroke Association of Malaysia, stroke is the third largest cause of death among Malaysians. It is a clinical syndrome or sign of global loss of cerebral function caused by a blocked blood vessel or a blood vessel that is experiencing a haemorrhage. Symptoms include functional limb weakness, numbness, difficulty speaking, affected memory and loss of higher mental function. In severe cases, stroke can lead to the loss of mobility and muscle function. Besides physical disability, stroke presents a host of psychological, behavioural and emotional disorders such as disturbance of sleep, anxiety disorder, depression, denial and even erectile dysfunction. Stroke can be divided into two types – ischaemic stroke, which occurs as a result of obstruction within a blood vessel supplying blood to the brain, and haemorrhagic stroke, which occurs when a weakened blood vessel in the brain ruptures.

Cause and effect Age is a significant nonmodifiable factor in the incidence of stroke. Men who are 55 years old and above and women aged 65 and above are at a higher risk of getting a stroke. However, modifiable factors contribute to higher incidences of stroke especially among younger individuals. “High blood pressure due to hypertension is the largest contributing factor of stroke among Malaysians while patients with diabetes have two to five times higher chance of getting a

THE STAR, TUESDAY 25 OCTOBER 2016

Quick action is crucial stroke in their lifetime,” says Dr Mooi Chin Leong, neurologist from Mahkota Medical Centre, Malacca. Other modifiable factors for stroke include cardiovascular disease, diabetes, obesity, lack of exercise, and excessive smoking, alcohol and salt intake. “The key to reducing morbidity and mortality in a stroke is to act fast. Hence, it is important for people to recognise the symptoms of a stroke when it is happening so that they can seek immediate medical attention,” he adds. One of the typical signs of a stroke is sudden numbness of the face and limbs. This is followed by confusion and difficulty in speaking or seeing. Individuals who are having a stroke may also experience difficulty walking, loss of coordination and a combination of severe headache and vomiting. Stroke diagnosis differs on a case-to-case basis. After going through a patient’s medical history, a neurologist will prescribe a diagnostic brain scan such as a computerised tomography or a magnetic resonance imaging scan. “Images produced from these scans will be able to confirm if a patient has experienced an ischaemic or haemorrhagic stroke. A blood test is also conducted to identify the prothrombotic state or coagulation in the blood,” says Dr Mooi. As cardiovascular disease is a risk factor for stroke,

Dr Mooi Chin Leong. cardiovascular diagnostics such as an electrocardiogram is used to identify any abnormality in the heart.

Time is key Treatment for stroke patients depends on the type and severity of the stroke. The most important aspect is to make necessary lifestyle modifications once the patient has been discharged from the hospital. Stroke patients should consume a diet low in sugar and salt as well as completely quit smoking and alcohol consumption. In of physical rehabilitation, stroke patients are required to undergo multiple sessions of physiotherapy, speech therapy and occupational health therapy. Lifestyle modifications and

therapy can be challenging but the right encouragement from friends and family can go a long way on a patient’s road to recovery. “It is important to give patients milestones during their recovery period so that they are motivated to recover without giving up,” says Dr Mooi. Oral medication may also be prescribed to patients. In addition, surgery may be considered if the patient’s condition is life-threatening. It is crucial to treat stroke patients rapidly to minimise physical disability

and avoid mortality. “About 70 to 80% of stroke cases can be treated if patients come to us early. In Malaysia, stroke symptoms tend to become severe due to delay in treatment. Time is of importance and rapid treatment provides better recovery outcomes,” says Dr Mooi.

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