Winning the war against colon cancer: we are curing more patients than ever before

Gut wars
Winning the war against colon cancer: we are curing more patients than ever before.
COLON (or large intestines) cancer is one of the most common cancers in the world. It is the third most common cancer found in both Malaysian men and women, with the National Cancer Registry reporting over 1,446 new cases in 2003L
Recent advances in treatment have resulted in more patients living a longer and more productive life compared to a decade ago.
Cancer awareness campaigns and early detection combined with advancements in chemotherapy treatment have increased the likelihood of cure for early-stage colon cancers.
Misconceptions about chemotherapy can deprive a patient of effective treatment. Many are still ignorant about the recent
advancements in the treatment for colon cancer. We really should understand the benefits of additional therapy after surgery, and not be influenced by misconceptions surrounding chemotherapy.
Misconceptions may do harm and could potentially deny patients the possibility of cure.

How colon cancer starts
Colon cancer refers to cancer that forms in the tissue lining of the colon. Unlike most cancers, colon cancer grows slowly, often starting with a tiny non-cancerous growth of tissue known as a "polyp", which may then become cancerous after many years.
Regular screening helps in early detection of polyps, which can be easily removed before they turn cancerous. It may also aid in detectmg cancer still at its early stage. Early detection remains an important step in curing colon cancer.

What are my risks?
Some of us are at higher risk of getting colon cancer than the average population, We need to recoguise these risk factors, which include some of the following:
* Age
The chance of developing colon cancer increases with age, commonly affecting those above 50 years of age.
* Diet
Certain diets may increase the risk of colon cancer, such as one that is rich in red meat (e.g. beef, lamb) and processed meat (e.g, hotdog) and low in vegetables and fruits.
* Family history
Having a close relative with colon cancer increases a person's risk of getting colon cancer, This risk increases further if the dose relative had colon cancer at a young age.
* History of bowel diseases
A history of inflammatory bowel diseases increases a person's chances of getting colon cancer.

Treating colon cancer
Surgery is tile main treatment for colon cancer4, and in early stages, surgery alone will suffice.
However, in patients with highrisk features, a combination of surgery and chemotherapy gives better outcomes.
Chemotherapy given after surgery is known as "adjuvant" treatment.
In this context, chemotherapy is used to mop up microscopic or unseen cancer cells that may still be present in the body, therefore reducing the risk of recurrence. Chemotherapy here serves as extra "insurance" to back up the surgical procedure.

Chemotherapy - emergence of a new era
5-fluorouracil(5-FU) is a chemotherapy agent that has been used for the past few decades in the treatment of colorectal cancers.
Research has shown that adjuvant treatment with 5-FU, given after surgery, will lower the risk of cancer relapsing, compared with no adjuvant treatments. Today, 5-FU is still widely used and is given either through injection into a vein or taken by mouth.
It has taken many decades and years of research to come up with new drugs that are suitable for the treatment of colorectal cancer. Since the late 1990s, significant progress has been made in drug therapies.
in June 2007, the long awaited final results from years of research have confirmed that a two-drug combination of chemotherapy can cure patients with early-stage colon cancer who have high risks features2. These patients call now hope to live longer than ever before2.
This two-drug combination chemotherapy involves the use of 5-FU together with a drug known as oxaliplatin.
In selected patients, such as those with stage Ill colon cancer, oxaliplatin, when added to 5-FU treatment as a two-drug
combination, has been shown to increase the survival rates by as much as 20%, compared with just 5-FU alone2.
Oxaliplatin is a chemotherapy agent that has been approved in Malaysia for the treatment of late-stage (stage IV) colorectal cancer since the late 1990s. Years of research have proven it to be an effective treatment in patients with stage IV diseaseL
And finally today, with intensive research, we call now confirm that oxaliplatin plays a definitive and significant role in the treatment of early-stage colon cancer2.

Into the future
For many years, chemotherapy treatment for early-stage colon
cancer only involved 5-FU. However today, a two drug combination of 5-FU and oxaliplatin has emerged as the new standard of
care for high risk early-stage colon cancer.
Medical research and advancements will continue to propel us forward to search for more effective treatment options for early-stage colon cancer. Researchers are now carrying nut investigations on three-drug combination treatments, using 5-FU, oxaliplatin and biologic agents (cetUximab or bevacizumaby. We await with optimism on the results of these studies.
We hope to cushion offthe breaking of bad news to colon cancer patients with an even more optimistic message of better cure rates and survival in the near future.
The war against colon cancer is far from over. However, the future looks optimistic.

References:
1.2rid Report of the National Cancer Registry - cancer incidence in Malaysia 2003
2. de Gramont et al. Final results of MOSAIC presentation. ASCO 2007
3. American Society of Cancer, http://www.cancer.org. Accessed on 5th April 2008
4. National Comprehensive Cancer Network ( NCCN ). Colon and rectal cancer - treatment guidelines for patients. Version V/October 2007. 5. O'Connell MJ, et al.J Clin Oncol 1997;15:246-50
6. www.bpflcgov.my
7. de Gramont et aI. J Clin Onco1 2000; 18:2938-2947
8. de Gramont et al. Semin Oncol 33(suppl 11) : $42-45

The father of psychoanalysis, sigmund freud and his theories

Wanna talk about it?

The father of psychoanalysis, Sigmund Freud, and his theories.

IKEEP hearing about Sigmund Freud from my cousin, who seems to think he is the inventor of modern psychoanalysis. I don't even understand the word 'psychoanalysis'. who is freud and why is he so famous?

Sigmund Freud is actually a Czech Austrian Jewish neurologist and a psychiatrist. He lived from 1856 to 1939. He founded the Psychoanalytic school of psychology and is commonly referred to as the 'father or psychoanalysis'.

During his day and even today, he remains an extremely controversial figure with controversial theories on the unconscious mind and why people behave the way they do. A lot of his theories involve sex, which is what makes them so controversial and memorable!

Freud was an atheist.

In 1930, he received the Goethe Prize for his contribution to psychology. But three years later, when the Nazis came to Austria, his books were burned and Freud had to go into exile.

Psychoanalysis is a therapeutic (meaning treatment) method for treatment of mental disorders by investigating the interaction between the conscious and unconsciou~ parts of the patient's mind, and coaxing out repressed fears and conflicts using certain techniques.

It's basically the process that occurs When you visit a psychologist in that clich6d, oftenfilmed sequence of a "shrink" sitting you on a couch and saying, "Tell me about your childhood".

What is 'unconscious' and 'conscious' in my mind? I thought I am fully conscious at all times, except when I'm asleep. I am also fully conscious with all my memories.
Freud's theory is that the majority of what we experience in lift- the underlying emotions, beliefs, feelings and impulses are not always available to us at a conscious level. He believes that what mostly drives us to behave the way we do lies in oar unconscious, out of our awareness.

We bury these feelings and emotions because they often cause us great anxiety.

In Freud's theory, our "conscious" makes up only a very small part of ourselves, Most of what makes our personality is buried and inaccessible.

Take for example a child who has been repeatedly abused by his parents, He grows up, burying the memory because it causes him so much anxiety, in his adult life, he resorts to drinking excessively and being abusive to his wife and children.

One way this can be interpreted is that our example patient is acting the way he does now because he was abused in childhood.

So is Freud saying what goes into our personality is our experiences?
Freud has a lot more complex theories on that. Really, it's a postgraduate course!

But in a nutshell, Freud postu lates that our personality's structural model can be divided into three - id, ego and super-ego.

The "id" is the part of us that we are born with. It's an extremely selfish part that allows us to get our basic needs like food, sex, pleasure. The "id" wants whatever feels good with no consideration whatsoever about the situation or other people.

When you think of this, it is true because as newborns (and babies and even older children), we have no consideration of anyone else.

If we are hungry, we cry for milk. If we soil our nappies, we cry. If we're uncomfortable, we cry with no consideration what soever for OUF mother's rest or time.

Then as we grow up, we begin to interact with the world and realise others have needs too, This part of the personality is called the "ego". The "ego" meets the demands of the "id" while taking into consideration other people and the situation. The older child no longer wakes up his mother at 3am to cry because he wants milk.

Then as we continue to age (by age five or so), the "superego" develops, This is the moral part of our personality, or "conscience". Things that shape this include school, religion, our elders, philosophy etc.

All this is very above board so far. Where does the sex and controversy come in?
Freud has yet anotber theory of personality development focusing on sex, According to him, we move through a series of psychosexual stages:

Oral stage (birth - 15 months): Only the id is present here, and the infant seeks gratification through its mouth by feeding, crying and biting. If this stage is disturbed, in adulthood, you may resort to oral behaviours like smoking, overeating, thumb-sucking, being greedy and impatient.

Anal stage (15 months - three years): the toddler derives pleasure from defecating. Too much parental control at this stage leads to an "anal" character like obsessiveness, rigidity, obstinacy and possessiveness.

Phallic stage (three to five years): now the child focuses pleasure on his genitals, such as showing curiosity. Freud postulates that boys have an "Oedipus complex" by wanting his mother and therefore being jealous of his father. He's afraid his father will find out and expresses this as "fear of castration", but this is finally resolved when the boy identifies with his father.

In girls, there is the "Electra complex", where the girl has "penis envy" and resents her mother for not providing her with a penis. If you have a problem at this stage, says Freud, it may lead to homosexuality, authority problems and rejection of gender roles.

We did say he was controversial!

Smoking early in pregnancy raises risks of heart defects in newborns

My baby doesn't smoke

Smoking early in pregnancy raises risks of heart defects in newborns.

MOTHERS who smoke early in pregnancy are more likely to give birth to infants with heart defects, according to a study funded by the Centers for Disease Control and Prevention (CDC).

The study, published in the April issue of Pediatrics, shows that women who smoked anytime
during the month before pregnancy to the end of the first trimester were more likely to give birth to infants with certain congenital heart defects (CHDsl compared to women who did not smoke during this time period.

The association was stronger for mothers who reported heavier smoking during this time period.

"Most people know that smoking causes cancer, heart disease and other major health problems," said Dr Margaret Honein, one of the researchers in the CDC's National Center for Birth Defects and Developmental Disabilities, "The indisputable fact is that women who smoke during pregnancy put themselves and their unborn babies at risk for other health problems."

The findings from the study, "Maternal Smoking and Congenital Heart Defects", were based on the US National Birth Defects Prevention Study, which is the largest population-based study ever done on the causes of birth defects in the United States.

Nine states participated in the study: Arkansas, California, Georgia, Iowa, Massachusetts, New York, North Carolina, Texas and Utah. This research included 3,067 infants with CHDs and a comparison group of 3,947 infants with no major birth defects.

The study found that septal heart defects - a hole in the heart between the left and right heart chambers, which disrupts the flow of blood and oxygen to the body - were the most common defect found among infants who were born with a cardiac defect.

Researchers also found conotruncal (poor blood circulation from lower heart chamber), right-side obstructive (blood is blocked from flowing freely from the right side of the heart) and left-side obstructive (blood is blocked from flowing freely from left side of heart) defects.

CHDs are the most common type of birth defect, occurring in eight to 10 of every 1,000 live births in the United States. Many infants with CHDs die in the first year of life, and infants who survive often require numerous surgeries, lengthy hospitalisations and a lifetime of treatment for related disabilities.

Women who smoke should know that in addition to smoking being a possible cause for heart defects, the following are also of concern:

* Smoking makes it harder for a woman to get pregnant. * Women who smoke during pregnancy are more likely than other women to have a miscarriage. * Smoking during pregnancy causes major health problems for both mother and baby. For example, smoking is one of the causes of problems with the placenta - the source of the baby's nutrition and oxygen during pregnancy. * Smoking during pregnancy can cause a baby to be born too early and have low birth weight - making it more likely the baby will become sick or die. * Babies born to women who smoke are more likely to have a cleft lip or cleft palate-types of birth defects. * Smoking during and after pregnancy is one of the causes of sudden infant Death Syndrome (SIDS).

For information about birth defects, please visit http://www.cdc.gov/ncbddd.for more information about smoking please visit
http://www.cdc.gov/tobacco or call 1-800-CDC-INFO.-HealthNewsDigest

Kids ask lots of question - KidsHealth has the answer

Mummy,why does....

Kids ask lots of question-KidsHealth has the answers.

WHY does my nose run? What are taste buds? Where do tears come from?

Parents know that kids have many questions about their bodies. To help kids - and parents uncover the mysteries of the
human body, KidsHealth.otg, the most-visited website for children's health information, has launched a new version of its #1
feature for kids, "How the Body Works".

Since 2004, more than 1.6 million people have viewed a "How the Body Works" feature. Using kid-friendly language animations, and activities "How the Body Works" is a popular resource for homework help and an entertaining way for kids to
get answers to their questions.

The new interactive module builds upon the previous features and now includes more than 100 articles, quizzes, wor searches, activities, and movies featuring everything from the adventures of Glandman to Col Lucy Leukocyte, commander of a body's immune system.

"Children are naturally inquisifive and have lots of questions about their bodies, whether they're looking for an answer for school or just curious about what's going on inside of them," says Dr Mary L Gavin, medical editor for KidsHealth.org and a paediatfician at the Alfred L duPont Hospital for Children in Wilmington, DE.
"How the Body Works' makes learning fun."

To view "How the Body Works," visit: http://www.kidsbealth.org/kid/hthw/htbw-main-page.html -HealthNewsDigest

Chornic Pain is generally defined as persistent pain

Despite the pain.....

Ninety per cent of all pain is easily managed by simple means; it is the remaining 10%, which requires a special approach. Hence, the role of pain clinics in helping people manage pain.

PAIN-we all know what it is and we've all experienced it. Thankfully, for most of us, it is a temporary phenomenon, which fades away once the underlying cause is dealt with and treated, with relief offered by medication.

Ninety per cent of all pain is easily managed by simple means; it is the remaining 10%, which requires a special approach.

For the significant number of people who are sufferers of the latter, pain, unfortunately, is something that is not so transient.

The recently completed National Health and Morbidity Survey IlL conducted by the Public Health Institute, Ministry of Health, showed that 7% of the Malaysian population aged 18 years and above, suffer from chronic pain. Although only a small percentage of the population, this nevertheless translates to about a million people, out of whom 82% say it interferes with their daily lives.

Chronic pain, says anaesthesiologist Dr Mary Cardosa, is generally defined as persistent pain which lasts three months or more, or pain that persists after the injury has healed.

"This type of pain can be very debilitating, giving rise not only to physical, but also emotional and psychological stresses," she continues.

"It should be recognised as a disease in its own right and not merely as a symptom of an injury or illness. Pain associated with injury or tissue damage, also known as acute pain, usually goes away after the injury heals.

Chronic pain on the other hand, says Dr Cardosa, is a result of something gone awry at the cellular level in the brain and spinal cord. The underlying pathology in this kind of pain is, difficult to research and as such, even more difficult to treat.

"Ultimately, however, regardless of the source of the pain, these patients all have the same problem - the disruption of normal, everyday life."

The effects of chronic pain are far and wide reaching. Just imagine that you have a simple but absolutely splitting headache for 24 hours straight and you can envisage the effects chronic pain has on its victims who live it day after day after day...

Typically, patients with chronic pain, go from doctor to doctor, seeking relief. However a pill alone cannot work by itself, as although chronic pain is not a visible ailment, the entire person - physical, mental, and emotional - is affected.


Pain clinics
The problem is hence often not resolved and the patient either somehow learns to manage the situation by themselves or end up living in misery. For many,everyday life is thrown into chaos, depression can set in, the patient withdraws into himself,mood is low, selfesteem plunges, and work and relationships suffer.

This is where Dr Cardosa and her team of dedicated professionals play a significant role for these patients.

Dr Cardosa helped set up the country's first Pain Clinic with the Ministry of Health in the year 2000. To date there are five such clinics-Selayang, lpoh, Kota Barn, Johor Baru and Malacca.

The pain clinic offers a holistic and multidisciplinary approach to chmnk pain management, incorporating medication, medical procedures, exercise, relaxation techniques, physiotherapy and psychological counselling.

"This can only be done in a specialised setring. pulling on the expertise of three major disciplines, namely anaesthesia, clinical psychology and physiothelapy, with the assistance of occupational therapy and social workers as well."

Although in the West, orthopaedics, rheumatology and neurology are included in the pain clinics teams, in Malaysia, they are a source of reference at present.

With the tagline - "Despite the Pain" - the objective of these pain clinks is to help patients live as normal a life as possible while coping with and managing their pain.

During the very first visit to the pain clinic, the patient will spend one hour each with the pain specialist, the physiotherapist and the clinical psychologist, who will then get together to assess the case and formulate a management plan.

Management is always multi-pronged, and includes the rational use of medication, nerve blocks when indicated, exercise, applied relaxation techniques and psychological approaches.

"It is important for us to reinforce patient's understanding of the problem as self management is one of the key success factors,"
explains Dr Cardosa, adding that the patients would be strongly encouraged to accept the management plan in its entirety.

They would then follow the plan specially mapped out for them, guided by a team of healthcare personnel who work as one, offering personalised and individualised warmthand care.

Dr Cardosa stresses that the pain clinic measures its success from a more functional point of view. While the first and foremost goal, of course, is pain relief, this is not always possible. The objective then becomes to help the patient cope with the pain while living a satisfactory life.


Personal experiences
The success stories of many grateful patients say it all.

One patient suffering from spinal spondylosis for 11 years finally found relief after countless treatment methods in a management technique called "pacing" which helped him to control and manage his own pain - all in just within one month.

Another who lived with continuous pain after an operation for a slipped disc is grateful for the help of the pain clinic while her husband has lived a migraine-free life after acupuncture treatment.

Yet another success is the stow of a young man who was housebound with pain after a bad road accident, hut who now has found freedom and has set up a small business of his own.

From accident victims, to "painfully overworked arms, from rheumatism to migraines, from the young and the not-so-young, the pain clinics have given people back their lives and this was very evident in the smiles on the faces of former and current patients who gathered at the Ipoh Hospital's first Pain Clinic gathering in November 2007.

Organised for the first time since the inception of the Ipoh Pain Clinic in 2003, the gathering was to rally the patients together, providing them a platform to share their experiences while also functioning like a support group.

As seen during the gathering, there is also strong camaraderie and genuine warmth and caring between staff and patients. However, the pain clinics in Malaysia have only just begun their task with only a small number of patients being treated in view of certain limitations.


Spreading awareness
"Pain clinics are held only once or twice a week, as all theprofessionals involved have responsibilities and duties in their respective departments. Additionally, we do not have enough anaesthesiologists or pain specialists who have to handle so many other areas including anaesthesia work, palliative care and pain management as well.

Additionally, the awareness level is insufficient, even among healthcare professionals and doctors themselves.

"Doctors should be encouraged to refer patients to the pain clinics and they need to understand that a patient can have pain despite normal scans and an apparently healthy countenance.

"They also need to play a role in preventing the ramifications of chronic pain problems, such as the psychological and emotional stresses of continually seeking treatments which fail," says Dr Cardosa, who also encourages her peers to spend that little bit of extra time talking to their patients.

Globally, there is also the drive of the International Association for the Study of Pain CLASP) to make pain more visible and to create a better understanding of pain in the general public right up to the policy makers.

Global Year for Pain campaigns are carried out with specific themes each year, with last year's being "Pain in Women - Real Women Real Pain".

The themes each year look into the vulnerable groups such as the elderly, women and children, it is interesting to note that there is a higher prevalence of chronic pain in women as compared to men, and also among the lower socio-economic strata.

With an estimated 10% to 20% of the world's population suffering from pain without a definite cause, education is the forerunner in bringing this problem to brighter light and better awareness, leading to effective assistance and service.

For as one wise man once said, no one is free till all of us are free.., for we are all connected to each other by the silvery fine threads of inter-dependence and relationshins.

How to get Reiki treatment

REIKI is a complementary healing practice that uses spiritual energies of a Reiki master or healer to treat varioee kinds of conditions and symptoms.

* You should have a little bit of understanding of the basics of Reiki, The practice usually involves long periods during which the Reiki healer places his hands on the patient to channel energy.

* Reiki can be performed as a total body or a local treatment.

* Locate a qualified practitioner. Reiki practitioners go through a series of courses and training sessions that earns them different levels of expertise.

* The levels go from level one, the most basic and novice level, to level three. After level three, a practitioner is considered a master.

* Continue other treatment. Reiki is not intended to replace or substitute for other medical treatments.

* Consider group Reiki.