Glaucoma: The thief of sight

By Henrylito D. Tacio
 
* Names have been changed to protect privacy
 
George Javier didn’t think much was wrong when he woke up one Sunday morning in March 2003 with his right eye feeling, sore, heavy, and itchy.  It’ll get better once I wash my face, he thought while examining his reddish eye in the bathroom mirror.  “I took it lightly because the pain and itchiness were still tolerable,” admits Javier.
 
Since he was already scheduled for a party with his family and friends that day, he still went along.  While everyone where enjoying, it was a different story for Javier: his vision suddenly became blurred in his right eye, and everything he looked were foggy.  The following day, he consulted a doctor and was then hospitalised for further examination.  The diagnosis: glaucoma.
 
“I was totally shocked.  I never thought it would happen to me,” says the 63-year-old Filipino journalist.  “More shocking is the fact that glaucoma is so widespread in the country.”
 
There are 14 million people worldwide who have glaucoma, a debilitating eye disorder that can lead to blindness.  Glaucoma is a leading cause of blindness across Asia, topping the list in Hong Kong and coming a close second to cataracts in the Philippines. In Singapore, glaucoma accounts for 20 percent of blindness. 

Glaucoma is expected to become more prevalent, with the number of aging population in the region increasing.  “Glaucoma affects three percent of all adults above 40 years old,” says Dr Gerard Chuah, a consultant ophthalmologist at the Mt. Elizabeth Medical Centre in Singapore.
 
Unfortunately, half the people with glaucoma don’t know they have it because the condition usually destroys eyesight without warning and often without symptoms.  “It’s a slow, gradual disease that often goes undetected,” says Dr Manolette Roque, a consultant ophthalmologist at the Asian Hospital and Medical Center in Manila.
 
Glaucoma develops when the production of liquid in the eye (called aqueous humor) increases or the liquid is not drain adequately. The pressure rises in the eye to unhealthy levels. Nerve fibers and blood vessels in the optic nerve – which carries visual impulses from the eye to the brain – become compressed and can be damaged or destroyed.
 
At first, glaucoma damages peripheral vision.  Over time, glaucoma may also damage central vision and result in blindness.  Sight is lost slowly over many years.  “Should there be some hints, the patient may still doesn’t know since there is a lack of general knowledge about the symptoms of glaucoma,” says Dr Saw Seang Mei, associate professor of the department of community, occupational and family medicine at the National University of Singapore.
 
“Glaucoma is an important public health problem in Asia,” says Dr Chuah, the author of A Patient’s Guide to Glaucoma and Glaucoma Treatment. “Blindness due to glaucoma is irreversible, unlike other eye diseases such as cataract where some amount of vision can still be restored after a successful surgery.”
 
Although advancing age is the biggest risk factor, glaucoma can strike anyone. “Family history of glaucoma, especially first degree relatives, is one of the major risk factors for developing glaucoma later in life,” says Dr Liza Sharmini Ahmad Tajudin, a lecturer of the ophthalmology department at the Universiti Sains Malaysia in Penang.
 
Smoking, extended use of steroids, extreme nearsightedness (myopia), and previous eye surgery also increase the risk of glaucoma.  Ditto for diseases that affect blood flow to the optic nerve like diabetes, high blood pressure, and migraine. Sleep apnea, a sleep disorder that affects breathing and reduces oxygen thereby distressing the optic nerve, is another risk factor.

Going for regular eye examinations is the best way to detect glaucoma early.  A glaucoma test usually includes an optic nerve check with an ophthalmoscope, eye pressure check or tonometry, and, if necessary, a visual field assessment that tests the sensitivity of side vision, which glaucoma strikes first.

“Early detection of glaucoma is important because it is a blinding disease,” says Dr Maria Imelda Yap-Veloso, a Filipino ophthalmologist professor and a full-time consultant at the Asian Eye Institute in Makati City. “If glaucoma is diagnosed early, then the disease may be controlled and the visual complications from this disease may be prevented.”
 
Chronic glaucoma
 
Of the two major forms, acute and chronic, the latter affects about 90 per cent of sufferers.  Chronic glaucoma happens when the drainage canals in the eyes are blocked gradually slowly.  Symptoms include teary, aching eyes, blurred vision, occasional headaches, and progressive loss of sight.
 
Since chronic glaucoma attacks slowly, most people do not realise they have the problem until the disease has affected both eyes or they have an eye exam. That’s what happened to 45-year-old John Tan* from Singapore. Using an tonometer, his optometrist found high eye pressure and referred him to the Clearvision Eye Clinic. 
 
At the clinic, Dr Tony Ho dilated his eyes and examined the optic nerve with a hand-held ophthalmoscope. The ophthalmologist discovered Tan had moderately advanced glaucoma. The patient was surprised by the diagnosis but realized he had been bumping into things more often.  “It’s as if I’m looking at the world through a long, narrow tunnel,” Tan, a systems analyst, recalled.
 
“In clinical practice, there haven’t been many changes in the basic principles of the management of chronic glaucoma,” admits Dr Steve Seah, senior consultant and head of the glaucoma service at the Singapore National Eye Center.  “Our primary concern is to lower the high pressure in the eyes to prevent further visual field loss.”
 
Generally, medicines – in the form of eye drops – are the first line of treatment against chronic glaucoma. Oftentimes, doctors prescribe beta-blocker eye drops to lower liquid production in the eye.  “For many people, prescribed eye drops are enough to reduce eye pressure and prevent further loss of vision,” says Dr Roque of the Philippines.
 
“I recommended that he would undergo an eye drop therapy,” said Dr Ho of his patient, John Tan.  “I prescribed xalacom, which is a prostaglandin inhibitor and beta-blocker eye drops roll into one to control his eye pressures.  The root cause of glaucoma is an imbalance between the eye pressure and micro-blood supply to the optic nerve head.”
 
Topical drugs for glaucoma are serious medicine and they should not be confused with over-the-counter eye drops for easing common eye irritations.  Every year, new glaucoma eye drops are introduced into the market.  Among those currently available in Asia include alphagan, azopt, betagan, betoptic, cosopt, epifrin, isoptocarpine, lumigan, ocupress, pilogel, and propine.  “There is no single ‘best’ eye drop for glaucoma – all the latest eye drops have their advantages and side effects,” says Dr Chuah of Singapore.
 
In some instances, eye drops may not be enough.  In such case, the doctor may prescribe oral tablets or intravenous injection.  “Whether taken orally or injected, the drugs do not cure the disease but only reduce the ocular pressure and its fluctuations,” says Dr Liza Sharmini of Malaysia.
 
The two main oral medications prescribed by ophthalmologists are acetazolamide and glycerol. Likewise, there are two main intravenous medications recommended: intravenous acetazolamide and intravenous mannitol.  Patients must talk with their doctors and ask for possible side effects of these medications.
 
Prostaglandin analogues represent a new category of medications that have been commonly used for treating glaucoma since 1996.  Among those that are currently available in the market are latanoprost, bimatoprost, and travoprost.  These medications are administered once daily and do not have side effects.
 
“A person diagnosed to have chronic glaucoma should understand that this is a life-long disease,” reminds Dr Yap-Veloso of the Philippines. “It is not cured with any form of treatment but only controlled. Glaucoma patients should religiously use their anti-glaucoma drops as directed by their physician.”
 
That’s what John Tan is now doing.  “He has to take the recommended eye drops and medications throughout his life,” says Dr. Ho.
 
In cases where eye drops and drugs do not stop deterioration in the field of vision, surgical treatments become the treatment option of choice.  Trabeculectomy, the most commonly performed surgery for glaucoma, was developed in the 1950’s and the actual surgical technique has not changed much since that time. “However, there are ongoing modifications of surgical techniques to ensure greater safety and lower failure rates of surgery,” says Dr. Chuah of Singapore.
 
Surgical treatments are often performed with a local anesthetic and may require only a short hospital stay.  “The main purpose of surgery is to lower the eye pressure to acceptable levels, thereby preventing further optic nerve damage and arresting visual loss caused by the glaucoma,” explains Dr Chuah.
 
If surgery is not applicable, other options are available to destroy the cells that produce too much aqueous humor: ultrasound treatment (uses high-frequency sound waves), diathermy (heat), and cryosurgery (a freezing process).
 
Acute glaucoma
 
Although rare – about five per cent of all cases around the world – acute glaucoma causes far more rapid and permanent blindness if not treated immediately.  The most common form among Asians and people who are farsighted, this happens when the drainage canals in the eyes become blocked or covered.  Pressure in the eye rises rapidly, because fluid drainage is abruptly blocked while production continues.

Unlike the other type, acute glaucoma is usually accompanied by symptoms and affects one eye and rarely both eyes.  An abrupt onset of headache and pain around the eye and face, impaired vision, rainbow-colored halos around lights, and sudden loss of vision ensue.  There may also be nausea and vomiting.

“Acute glaucoma is an ocular emergency,” says Dr Zahari of Malaysia.  Adds Dr Ho of Singapore: “If not treated immediately, acute glaucoma results in complete and permanent blindness within two to five days.”

Fifty-four-year old Cherry Lee* is a high school teacher in Kuala Lumpur, Malaysia.  Last April, she felt a throbbing headache and severe pain in her right eye, which she thought was another migraine attack.  She went home early and took a long afternoon nap hoping it would disappear.  When she woke up, the problem got worse as she was already having trouble seeing. 

Lee never took it seriously and went back to school the following day.  Then, it recurred again.  While reading an essay written by one of her students, she could not read it thoroughly since the words were blurred.  This went on for more than a week and just took paracetamol to ease the pain.  But when her headache intensified and started to vomit after eating her favorite breakfast, she decided to see her doctor.  After hearing her woes, she was referred to an ophthalmologist, who diagnosed her of having acute glaucoma.

Oftentimes, doctors recommend the use the intravenous acetozolomide to decrease the liquid production. Although the drug can be taken orally and use as an eye drop, injecting it “is the fastest and most effective way to get a response, usually by half an hour,” says Dr Zahari.

That was what the doctor prescribed to Lee, along with topical eye drops timolol and pilocarpine.  Experts caution, however, that many of the drugs used for glaucoma interact with common medications.  Mannitol, for instance, is not advisable for patient with congestive cardiac failure or severe hypertension.

After the eye pressure came down, Lee went to a definitive treatment: surgery.  “The main objective in treating acute glaucoma is to prevent the recurrence of an attack,” reminds Dr. Zahari.  This can be achieved through iridotomy, where a small hole is placed in the iris to give way for the aqueous humor to drain thus relieving the pressure build up. This technique can be performed by laser surgery without making an incision in the eye.

There have been various studies on the ways to achieve an immediate reduction during an attack in acute glaucoma.  Doctors in Hong Kong, for instance, have tried poking a small hole in the cornea to let the liquid out slowly.  In Singapore, some doctors remove the lens as an early measure. “The difficulty in these methods is that the cornea is usually hazy due to the high pressure, so the view of the front eye is limited,” Dr Zahari reports. 

If acute glaucoma does not respond to any standard procedure, drainage implants may be used to drain the liquid. An implant, most commonly a half-inch silicone tub, is inserted into the eye’s anterior chamber.  Complications include cataract, implant failure, detached retina, breakdown of the cornea, bleeding complications, and double-vision. 
 
Another treatment is diode laser transscleral cyclophotocoagulation, which reduces fluid production by destroying the muscles that control the lens for near and far vision. There is a 20 per cent chance of vision loss with this procedure, so it is reserved for people with end-stage glaucoma or those who fail to benefit from any other therapies.
 
Again, the best defense against acute glaucoma is early detection.  “Medical treatment usually slows or stops it from worsening.  But whatever visual field a person has already lost can no longer be restored,” reminds Dr Chuah of Singapore.

On the Horizon 
 
Among the more promising treatments for glaucoma are gene therapies designed to relieve fluid pressure that leads to optic nerve damage in the eye or to protect the nerve from such damage. Another potential therapy involves newly discovered natural molecules that act to regenerate nerve cell growth in the optic nerve, thereby promoting vision recovery.
 
Many new glaucoma drugs – with higher potency and lesser side effects – have been introduced recently.  In Asia, the Singapore National Eye Center is involved in several clinical trials of these drugs.  “Drug-coated contact lenses that release drugs over a period of time is one possible development in the near future,” says Dr Seah.
 
In the laser front, newer laser that causes less destruction to the target tissue has already been launched.  “The results have been promising,” Dr Seah reports.
 
Still, early detection and treatment of glaucoma before it causes major vision loss is the best way to control the disease, points out Dr Roque of the Philippines. — ###

Air Pollution: Death by Lethal Inhalation

By Henrylito D. Tacio
 
A couple of years back, a 50-year-old bus dispatcher in Manila came to the Pasay Filipino-Chinese Charity Health Center.  The only breadwinner of his family, the man has two teenage sons and a daughter.  For the past two years, he noticed that whenever he sniffed the sooty bus exhausts, he would develop chest pains.  At home, he observed that he was tired easily and there were some nights when he would wake up short of breath.
 
Dr. Willie T. Ong, a cardiologist and the man’s attending physician, could not decipher the cause of the patient’s many heart attacks.  An echocardiogram bared that his heart has expanded like a rubber and is only pumping at 20 percent capacity.  Medical studies showed that people with such a lame heart may live for three more years.
 
The man could not believe when told the situation.  After all, he didn’t smoke or drink and never taken prohibited drugs.  History records showed that both his parents never suffered from any heart diseases.   Taking a closer look at his case, Dr. Ong traced the culprit of the patient’s heart problem: air pollution.
 
In 2000, the World Bank’s annual review reported that in Manila alone more than 4,000 Filipinos die each year because of air pollution. The mortality figure is the third highest for a city in the East Asian region after Beijing and Jakarta. Bangkok and Seoul were ranked 4th and 5th.
 
Five years later, the problem got worse.  Manila’s skies are among the most polluted in the world, surpassed only by Mexico City, Shanghai and New Delhi, said the regional office of the World Health Organization (WHO).  In a press conference, Ramon Paje, then undersecretary of the Department of Environment and Natural Resources (DENR), admitted, “The air in Metro Manila is still dirty but significantly improving.”
 
Today, with more people flocking to the metropolis and more vehicles plying the highways, significant improvement of air quality is no where in sight.  “Growing human and vehicle populations and increasing industrial activities are the main causes of worsening air quality in the urban centers of the Philippines,” said the World Bank report in 2002.
 
A perception survey done in 2001 showed that more than 72 percent of Manila’s residents were alarmed by air pollution and 73 percent said they were not aware that the government was doing something to control it.  Two years earlier, the government actually signed the Clean Air Act, which aimed to provide a comprehensive air pollution control policy for the country.
 
Sources of air pollution in the Philippines include emissions from three sources: mobile like vehicles, stationary such as power plants and factories, and area which comes from garbage burning, road dust and open cooking.  Burning of agricultural waste in rural areas also causes air pollution.
 
In Metro Manila, the air quality crisis is due to growing vehicle population.  Statistics showed that vehicle densities have increased from 675,310 in 1990, to 1.2 million in 1998, to over 2 million in 2001. Vehicle density in Metro Manila has gone from 1,600 per square kilometer in 1995 to 3,144 per square kilometer in 2000, and at an accelerating rate of growth.  “There is a direct correlation between the number of cars on the road and the amount of pollution in the air,” said Dr. Rafael R. Castillo, a medical doctor and a newspaper columnist.   According to Paje, 70 to 80 percent of air pollution in the country is caused by vehicle emissions.
 
“Increased levels of air pollution are threatening the well being of city dwellers, and imposing not just a direct economic cost by impacting human health but also threatening long-term productivity (material and vegetation damage, quality of life, reduced tourism to the country, discourage foreign investment, etc.),” the 2002 World Bank report pointed out.
 
“Nowadays, breathing can be a dangerous business,” commented Framelia V. Anonas, a media service staffer of the Department of Science and Technology.  “The air that breathes you life is the same one that can snuff life out of you.”
 
Air pollution affects health in both short and long term. Short-term effects include irritation to the eyes, nose, and throat, and infection on the upper respiratory tract such as pneumonia and bronchitis. Other effects are headache, nausea, and allergic reaction. Air pollution can also worsen asthma and emphysema conditions.
 
An epidemiological study conducted by the University of the Philippines College of Public Health, showed that the prevalence of chronic obstructive pulmonary disease (COPD) is 32.5 percent among jeepney drivers, 16.4 percent among air-conditioned bus drivers, and 13.8 percent among commuters.
 
In March 1999, the British Medical Journal quoted Dr. Miguel Celdran, a pediatrician at the Makati Medical Center, saying:  “About 90 percent of my patients have respiratory illness, and we’re seeing babies as young as two months suffering from asthma. Twenty years ago, this was unheard of.”
 
The Philippine Pediatric Society surveyed doctors and asked them to describe the most common illnesses that they treat.  The doctor’s response was unanimous: diseases of the upper respiratory tract.   One study found out the urine samples from children living and begging on the polluted streets showed that at least 7 percent had high lead concentrations.
 
Many air pollutants – a mix of gases, droplets, and particles – are able to pass through the lungs into the bloodstream and are eventually transported to the heart and the entire body through blood vessels. 
 
“Because the cardiovascular system is dependent on the functioning of the respiratory system, it is also indirectly affected by the deleterious effects of the pollution on the lungs,” the UN health agency explained.  “These impacts combined, damage and inflame blood vessels and affect heart function.”
 
This has been supported by a study published in Lancet.  Dr. Gerard Hoek from the Netherlands, found that those living near a major road have a higher risk of dying than the rest of the population.  He concludes that long-term exposure to traffic-released air pollution may shorten life expectancy. 
 
Other studies also revealed that heart attacks, life-threatening heart rhythms, and thickening of the blood can also be traced to exposure to air pollution.  “To make it clear:  all these bodily changes spell doom for the Filipinos living in Metro Manila (and other highly-urbanized centers),” warns Dr. Ong, who said they treat about 400 indigent patients annually in the health center where he sometimes work.
 
According to a World Bank study, poor air quality does not only threaten the people’s well-being but also their productivity.  The study revealed that filthy air costs the country 2,000 lives lost prematurely plus US$1.5 billion in lost wages and medical treatment. At the then exchange rate of P53 to US$1 when the study was made, a whopping P79.5 billion was lost due to air pollution.
 
World Bank valued the 2,000 lives lost due to particulate matter at $140 million (or P7.42 billion); 9,000 people suffering from chronic bronchitis at  $120 million (or P6.36 billion); and 51 million cases of respiratory diseases at $170 million (or P9.01 billion). “About 65 percent of drugs purchased by the health department every year were for treatment for respiratory diseases,” Paje reported.
 
Filipinos spend about P2,000 per year on air pollution-related health expenses.  — ###

The Friends Connection

By Henrylito D. Tacio
 
Have you ever thought of this before: What do you think your world would be, if you don’t have any friend? 
 
I am lucky to have three best friends in life.  One came into my life when I was a little boy.   I met the second friend when I was in high school.  When I was working, I had the opportunity of working with an officemate who became my friend later.
 
Ralph Waldo Emerson defines friend in these words: “A friend is a person with whom I may be sincere.  Before him I may think aloud.  I am arrived at last in the presence of a man so real and equal, that I may drop even those undermost garments of dissimulation, courtesy, and second thought, which men never put off, and may deal with him with the simplicity and wholeness with which one chemical atom meets another.”
 
“Friendship improves happiness, and abates misery, by doubling our joy, and dividing our grief,” said Joseph Addison. Pam Brown adds, “In loneliness, in sickness, in confusion – the mere knowledge of friendship makes it possible to endure, even if the friend is powerless to help.  It is enough that they exist.  Friendship is not diminished by distance or time, by imprisonment or war, by suffering or silence.  It is in these things that it roots most deeply.  It is from these things that it flowers.”
 
In some instances, a friend is more than that.  Here’s a thought from Dinah Craik, author of ‘A Life for a Life’: “But oh! the blessing it is to have a friend to whom one can speak fearlessly on any subject; with whom one’s deepest as well as one’s most foolish thoughts come out simply and safely.  Oh, the comfort – the inexpressible comfort of feeling safe with a person – having neither to weigh thoughts nor measure words, but pouring them all right out, just as they are, chaff and grain together; certain that a faithful hand will take and sift them, keep what is worth keeping, and then with the breath of kindness blow the rest away.”
 
Yes, we ought to have someone whom we can trust and talk with.  For as the Bible states, “Two are better than one; because they have a good reward for their labor. For if they fall, the one will lift up his fellow: but woe to him that is alone when he falls; for he has no one to help him up.”
 
I was reminded of a story shared to me by a friend.  It goes this way:  Horror gripped the heart of the World War I soldier as he saw his lifelong friend fall in battle. Caught in a trench with continuous gunfire whizzing over his head, the soldier asked his lieutenant if he might go out into the “No Man’s Land” between the trenches to bring his fallen comrade back.
 
“You can go,” said the Lieutenant, “but I don’t think it will be worth it. Your friend is probably dead and you may throw your own life away.” The Lieutenant’s words didn’t matter, and the soldier went anyway.
 
Miraculously, he managed to reach his friend, hoist him onto his shoulder, and bring him back to their company’s trench.  As the two of them tumbled in together to the bottom of the trench, the officer checked the wounded soldier, and then looked kindly at his friend. “I told you it wouldn’t be worth it,” he said. “Your friend is dead, and you are mortally wounded.”
 
“It was worth it, though, sir,” the soldier said. “How do you mean, ‘worth it?'” the Lieutenant responded.  “Your friend is dead!”  The soldier replied, “Yes, sir.  But it was worth it because when I got to him, he was still alive, and I had the satisfaction of hearing him say, ‘I knew you’d come.'”
 
While reading the story, I can hear the Burt Bacharach song being sung by Dionne Warwick: “And if I should ever go away, well then close your eyes and try to feel the way we do today.
And then if you can remember: Keep smiling, keep shining knowing you can always count on me, for sure.  That’s what friends are for.  For good times and bad times, I’ll be on your side forever more.  That’s what friends are for.”
 
Another favorite song I usually sing is this: “When you’re down and troubled and you need a helping hand.  And nothing, nothing is going right.  Close your eyes and think of me.  And soon I will be there to brighten up even your darkest nights.  You just call out my name.  And you know wherever I am, I’ll come running to see you again.  Winter, spring, summer, or fall, all you have to do is call.  And I’ll be there, yeah, yeah, yeah, you’ve got a friend.”  James Taylor popularized this song way back in the 1970s.
 
Why I singing those songs?  Because Donna Roberts reminds, “A friend knows the song in my heart and sings it to me when my memory fails.”  C.S. Lewis also stated, “Friendship is unnecessary, like philosophy, like art…. It has no survival value; rather it is one of those things that give value to survival.”
 
Indeed, blessed is a person who has a friend.  An unknown author gives this ultimate picture of friends; be sure to listen carefully: “Friends answer your needs before their own.  You come to them with your hunger, and they satisfy you with peace.  That’s how friends are.
 
“Friends let you speak your mind, without worrying what their thoughts will be.  Friends know when you are silent they need to listen your heart.   Friends share the joy and the pain.  They know about desire and rejection.  Friends allow you to be who you are, without expectations of who you should be.
 
“Friends don’t come with a purpose and they don’t come with a plan. They come to enlighten your spirit and they come to brighten your heart.  They come to give you a hand when needed and expect nothing in return.  It is the little things that friends do.  Like fill your heart with pleasure, hope and joy.”
 
Yes, a friend is worth far more than gold.
 
For comments, write me at henrytacio@gmail.com

Overcoming dyslexia

By Henrylito D. Tacio

 

Consider the following four dead-end kids.   

 

One was thrown out of school when he was 12.  He was noted to be terrible at mathematics, unable to focus, and had difficulty with words and speech.  Another did not do very well in school getting mainly C’s and D’s.   The third grew up being called dumb and stupid because she had a lot of problems reading.  The last finally learned to read in third grade, devouring Marvel comics, whose pictures provided clues to help him untangle the words.

 

The four losers are, respectively, Thomas Edison, Jay Leno, Whoopi Goldberg, and David Boies. 

 

Over the course of his career, Edison patented 1,093 inventions.  Edison believed in hard work, sometimes working twenty hours a day. He has been quoted as saying, “Genius is one percent inspiration and 99 percent perspiration.”

 

Despite his poor grades, Leno was determined to attend Emerson College in Boston. While told by the admissions officer that he was not a good candidate, he had his heart set on attending the University and sat outside the admission officers’ office 12 hours a day 5 days a week until he was accepted into the University.

 

Goldberg had a lot of difficulty in school, but it was clear to her teachers and family that she was neither slow nor dumb, but had some problem that had not yet been well defined.  The Oscar-winning actress of ‘Ghost’ was already an adult when she learned what she was suffering from.

 

Boies is a celebrated trial attorney in the United States.  He is best known as the guy who beat Microsoft.

 

These four people have one thing in common, though; they are all dyslexic.  So is Nobel Prize winner Baruj Benaceraft, brain surgeon Fred Epstein, singer Cher, comedian Robin Williams, Olympic gold medalist Steve Redgrave, philanthropist Nelson Rockefeller, film producer Brian Gazer, television chef Jamie Oliver, and playwright Wendy Wasserstein. 

 

What exactly is dyslexia?  Hav ingdys lexiac anmake it hardtoread!  Translation: Having dyslexia can make it hard to read! Writing that looks just fine to you might look like this to someone who has dyslexia.

 

Dyslexia is a specific learning disability that manifests primarily as a difficulty with written language, particularly with reading and spelling. It is separate and distinct from reading difficulties resulting from other causes, such as a non-neurological deficiency with vision or hearing, or from poor or inadequate reading instruction.

 

To most dyslexics, going to school is not a pleasant experience. “I never read in school. I got really bad grades – D’s and F’s and C’s in some classes, and A’s and B’s in other classes,” recalls the Oscar-winning singer-actress Cher.   “In the second week of the 11th grade, I just quit. When I was in school, it was really difficult. Almost everything I learned, I had to learn by listening. My report cards always said that I was not living up to my potential.”

 

Evidence suggests that dyslexia results from differences in how the brain processes written and/or verbal language.  Dyslexia occurs at all levels of intelligence, average, above average, and highly gifted. There is also a change in judging speed and distance.

 

Stupid, dumb, and retard – these are the words most dyslexic kids hear from their classmates or teachers.  A poll conducted in the United States showed that almost two-thirds of the people still associate learning disabilities with mental retardation.  That’s probably because dyslexics find it so difficult to learn through conventional methods.  “It is a disability in learning,” points out Boies.  “It is not an intelligence disability.  It doesn’t mean you can’t think.”

 

He’s right.  Dyslexia has nothing to do with IQ.  In fact, many smart, accomplished people have it, or are thought to have had it, including Sir Winston Churchill, Leonardo da Vinci, Albert Einstein, Michelangelo, General George S. Patton, American president Woodrow Wilson, and W.B. Yeats.

 

Dr. Sally Shaywitz, a leading dyslexia neuroscientist at Yale University, believes the disorder can carry surprising talents along with its well-known disadvantages.  “Dyslexics are overrepresented in the top ranks of people who are unusually insightful, who bring a new perspective, who think out of the box,” she says.

 

“Being dyslexic does not make life easy, although there are one or two advantages,” says well-known British swimmer Duncan Goodhew, who was called ‘illiterate moron’ when she was a kid attending school.  “Dyslexics tend to think laterally because the creative side of the brain is more dominant than the logistical side, which is good for problem-solving.”

 

Dyslexia comes from the Greek word which means “difficulty with words.”  It was first suspected in 1896, when Dr. Pringle Morgan published an article in the British Medical Journal on “A Case of Congenital Word Blindness.”  But the word “dyslexia” didn’t become commonly used in the United States for more than five decades.

 

In the Philippines, it has taken even longer.  This was the reason why it took several years before Jonathan knew he was suffering from dyslexia.  He was like many other kids. He enjoyed playing, talking, and singing.  But there’s one problem about him: He didn’t like writing and reading.

 

“When my son first started school at the age of five his writing was appalling,” the mother recalled.  “You could hardly read a thing he wrote.  He went from being a happy child to being very unhappy, miserable, tearful, because he just couldn’t understand why all those children around him could pick up this business of reading and writing.”

 

Jonathan’s teachers simply thought he was taking a little longer than the other children and that he could catch up with them later on.  Unfortunately, he didn’t.  It wasn’t until three years later that they realized Jonathan is dyslexic. Now, the 18-year-old Michael has the reading age of a 12-year-old and the spelling ability of a 10-year-old.

 

Experts say that a child who has dyslexia might start out doing fine in school. But gradually, it can become a struggle, especially when reading becomes an important part of schoolwork. A teacher might say that the kid is smart, but doesn’t seem to be able to get the hang of reading.  If a teacher or parent notices this, the best thing to do is to go to a specialist who can help figure out what’s wrong.

 

Dyslexia can only be formally diagnosed through a comprehensive evaluation by a reading specialist or psychologist. Pediatricians often know the signs of dyslexia and can guide families to proper help. It is important to make sure that the person who evaluates your child has training and experience with dyslexia.

 

“A specialist in learning disabilities knows a lot about learning problems that children have – and what to do about them,” says Dr. Laura Bailet.  During a visit with a specialist, a child might take some tests. But the idea isn’t to get a good grade; it’s to spot problems.  Discovering a learning disability is the first step toward getting help that will make it easier for the child to learn.

 

Last year, Indian director Aamir Khan made the “Taare Zameen Par” (Stars on Earth), about a dyslexic child. The film portrays the child’s world, his difficulty in comprehending letters and the people around him including his parents labeling him as lazy and idiotic. One of his teachers eventually discovers that his problem is dyslexia and successfully helps him to overcome it.

 

“Parents, who recognize their child as a dyslexic, should find a skill the child does well and build on it, encourage it – whether it’s art or athletics.  That will help the child to believe in himself, the most important element in helping a dyslexic to become successful in society,” says Dr. Allan R. Magie, an American doctor who specializes on children’s behavior. — ###

Is there a pain in your head?

By Henrylito D. Tacio

 

On May 3, 2002, 37-year-old Emma Salle and her three Filipino friends – all from Metro Manila — went to the nature-laden Baguio for relaxation and to know what was currently going on with their lives.  The following day, they meandered around the city and visited some tourist spots before returning to their hotel at 9:00 p.m.

 

At around 10:00 pm, Emma took a shower.  “I was in the middle of my shower when I felt something terrible in my head,” she recalls.  “It was as if somebody was cutting my head from the upper middle of my forehead going down sideways to my nape — something I have never ever felt before in my entire life.”

 

While she was trying to make sense of what was happening, she kept on tilting her head from one side to another and up and down hoping to ease the pain.  Then, she remembered her aunt who died of an appalling headache while taking a meal.  That spurred her into action.  She immediately finished her shower and came out as fast as she could from the bathroom.  She told her friends that she was experiencing a terrible headache.

 

“I went straight to bed and kept on touching my head not knowing what to do,” she says.  An hour later, the pain was getting worse.  She would throw up every now and then.  Her friends decided to bring her to Baguio General Hospital.  A resident doctor asked her some questions but Emma could not answer.  “My head never stopped hurting me – it was as if a huge bomb was exploding inside my head. I got really very weak and didn’t know what to do to stop the pain,” she says.

 

After some tests, the doctor found out that Emma’s blood pressure was high.  She was given some medicines and four hours later, she felt better.  She went to sleep and was discharged at 2:00 a.m.  They returned to their hotel and checked-out that day.

 

Back home, when her family heard about the news, Emma was brought again to the hospital at 10:00 p.m.  The doctor at the Makati Medical Center took some tests.  At 5:00 a.m. the following day, Emma underwent a CT scan.  After that, she was brought to a private room.  “Although I still didn’t know what was happening, I had a suspicion that there was really something wrong,” she says.

 

There was.  The doctor’s diagnosis: brain aneurysm.  In fact, an artery in her left brain burst causing severe headache.  But thanks to her doctors, she was saved from death giving her a new lease of life.

 

Headache is a disorder that afflicts millions of people across Asia.   “Like in other parts of the world, headache is very common in the region,” says Dr Shuu-Jiun Wang, a neurologist with the Taipei Veterans General Hospital in Taiwan who specializes on headache medicine.  “It’s a very rare person who has never experienced a headache.”

 

In Thailand, almost half of those polled in the online health survey conducted by The Nielsen Company claimed to have suffered a headache within the last month.  About 30-40 percent of people in Taiwan suffer from tension-type headaches.  In Singapore, migraine afflicts 360,000 people.

 

More than 300 known medical disorders can produce headaches.  Headache types are described as primary or secondary.  Primary headaches include migraine, tension-type and cluster headaches.   If you’ve had the same pattern of headaches for years, chances are that it’s going to continue that way for years more. 

 

Often a headache is just a pain the head but if your headache is so severe that you miss work or social gatherings, or if over-the-counter painkillers don’t help, see your doctor.  The headache you may be suffering from might be classified under the secondary headaches or those that are often the result of some underlying disease, of which head pain is just a symptom. 

 

“Those severe and sudden headaches could be a symptom of something more serious that needs immediate medical attention,” says Dr Delfin Valdez, head of the emergency room at the Brokenshire Memorial Hospital in Davao City, Philippines.

 

Here, according to Asian health experts, are life-threatening diseases of which headache is almost always the first thing that most people complain about:

 

Brain aneurysm.  If a brain aneurysm bursts, as in the case of Emma Salle, it causes instantaneous onset of an unusually severe headache, says Dr Philip Chua, chairman of the cardiovascular surgery centre at the Cebu Doctors’ Hospital in the central Philippines.  Other symptoms include nausea and vomiting, blurred vision, pain above and behind the eye and stiff neck.

 

Brain aneurysms are deadly.  About 10 percent of patients with ruptured aneurysm die before receiving medical treatment.  (Martial arts movie star Bruce Lee is thought to have died from a brain aneurysm.)  If untreated, another 50 percent will die within a month, with 25 percent of the patients sustaining another bleeding episode within a week.  Dr Chua suggests that aneurysms be removed immediately before they burst.

 

Dr Alfred Cheng, head of the cardiac clinic at the Mount Elizabeth Medical Centre in Singapore offers two pieces of advice: If you suspect a burst, go to a vascular neurosurgeon immediately.  “Quick surgery can save a person’s life,” he says.  Second, if you are at risk for having an aneurysm – if you smoke, have high blood pressure and high cholesterol – ask your doctor to do an MRI screening.

 

Brain tumor.  Often, tumors found in the brain have started somewhere else in the body and spread to the brain.  New onset or change in pattern of headaches is one of the initial signs.  The headache gradually becomes more frequent and more severe.  Other symptoms include blurred vision, difficulty with balance, speech difficulties, confusion in everyday matters, personality or behavior changes, hearing problems, and seizures (especially in someone who doesn’t have a history of seizures).

 

Brain tumors are often challenging for doctors to treat.  But many types of brain tumors can be successfully treated with one or more methods.  In the United States, some approved treatments for brain tumors include BCNU, Temodar, Gliadel wafers, and radiation.  While these approved treatments are considered safe, it does not mean there are no side effects.  On the whole, the benefits to brain tumor patients outways the risks.

 

Glaucoma.  The headache caused by glaucoma may be felt in or around the eyes or the forehead, and vary in intensity from mild to severe.  Accompanying the headache is nausea, blurred vision, and haloes around lights. 

 

Glaucoma is a condition of increased fluid pressure inside the eye.  The higher pressure causes compression of the retina and the optic nerve, which can eventually lead to nerve damage, interfering with or stopping images as they are transmitted from the eye to the brain.  “The headache is due to a sudden increase of eye pressure,” says Dr Gerard Chuah, a senior consultant ophthalmologist at the Mount Elizabeth Medical Centre in Singapore.

 

There are two types of glaucoma: chronic and acute.  Although the latter accounts for only about five percent of all cases worldwide, studies indicate that Asians are more susceptible to it.   Eye drops, oral medications, and surgical procedures can prevent or slow further damage.  “Acute glaucoma should be treated as an emergency,” says Dr Mimiwati Zahari of the ophthalmology department at the University of Malaya in Kuala Lumpur, Malaysia.  “If not treated immediately, it can result in complete and permanent blindness within one to five days,” warns Dr Tony Ho, the director of Clearvision Eye Clinic in Singapore.

 

Hypertension.  Although hypertension itself doesn’t kill, its complications can be deadly: increased risk of heart attack, stroke and kidney failure.  The condition is caused by an increase in the amount of blood pumped by the heart or an increased resistance to blood as it flows through the arteries.  “A person suffers from hypertension when their blood pressure is persistently elevated beyond a normal level,” says Dr Willie Ong, a consultant cardiologist at the Makati Medical Center.

 

More often than not, people suffering from hypertension don’t usually see or feel any clearly identifiable symptoms.  But if blood pressure is extremely high, severe headache ensues.  “Patients complain of heaviness or uneasy feeling around the nape area,” says Dr Ong.  Other symptoms include fatigue or confusion, vision problems, chest pain, irregular heartbeat, and difficulty breathing.

 

Unfortunately, there is no cure for hypertension, but it can be managed.  “Mild cases of hypertension may still respond with a change in lifestyle,” says Dr Ong.  Unhealthy lifestyles include smoking, drinking too much alcohol or coffee, and eating too much salt.  “But for more severe cases, medication is for life.  Even if your blood pressure has been returned to normal, it’s important to continue to take the medications.”

 

Stroke.  A stroke, also known as brain attack, occurs when a blood vessel breaks and interrupts blood flow to an area of the brain (called cerebral hemorrhage) or when a blood clot blocks a blood vessel or artery (cerebral infarction).   Almost always, cerebral hemorrhage patients experience a sudden, severe “bolt out of the blue” headache, which may be accompanied by a stiff neck, facial pain, pain between the eyes, vomiting, confusion, and unusual forgetfulness.  “When any of these symptoms occur, the best course is a quick trip to the doctor,” says Dr Rafael Castillo, a cardiologist at Manila Doctors’ Hospital.

 

What’s tricky with stroke is that symptoms of the disease may be momentary, but they are a warning that must be acted on promptly.  Among the early signs are: numbness, tingling or weakness in an arm, leg or side of the face; temporary blindness; temporary speech difficulty; and dizziness, unsteadiness or sudden falls.   “Ignoring these signs and not getting to a hospital immediately could make a serious problem even worse,” reminds Dr Castillo.

 

Preventing a stroke is much better than treating it.  Most physicians recommend the following: Get screened for high blood pressure at least every two years, especially if you have a family history of high blood pressure. Have your cholesterol checked. Treat high blood pressure, diabetes, high cholesterol, and heart disease if present.  Follow a diet low in fat and salt.  Quit smoking.  Exercise regularly. Lose weight if you are overweight.  Avoid excessive alcohol use. — ###

 

So, you’re feeling tired?

By Henrylito D. Tacio

 

You feel like you just ran the Olympic marathon – only you just got out of bed.  Strange, isn’t it?  You’re completely drained.  Washed out.  Running on empty.  Not just today, but every day.

 

Call it fatigue, exhaustion, weariness – whatever.  If you have it, you’re not alone.  “Fatigue is second only to pain as the most common symptom doctors see in patients,” says Dr. David S. Bell, a chronic fatigue researcher at Harvard Medical School in Massachusetts.

 

The word “fatigue” is used in everyday life to describe a range of afflictions, varying from a general state of lethargy to a specific work-induced burning sensation within your muscles.  It can be both physical and mental.  It is not the same as drowsiness, but the desire to sleep may accompany fatigue.

 

Fatigue can have many causes.  “The most common energy eaters are usually related to a person’s lifestyle,” says Dr. D.W. Edington, director of the Fitness Research Center at the University of Michigan.  “Poor eating habits, obesity, crash diets, lack of rest and exercise, smoking, drinking – all take heavy tolls on the body.”

 

Stress, job pressures and depression can all build up until they simply wear you down.  Even something like not drinking enough water can be a factor.  Some medications, including beta blockers and antihistamines, can cause fatigue. 

 

Sudden or persistent fatigue, despite adequate rest, may mean it’s time for you to consult your doctor.  Unrelenting exhaustion may be a sign of an underlying medical problem.  In general, talk to your doctor if you’re extremely tired or unable to regain your energy after several weeks of increased rest.  Medical causes of fatigue can include:

 

Hypotension.  The exact opposite of hypertension, it is a condition in which the blood pressure is so low that the flow of blood to the organs of the body is inadequate.  “When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidney,” explains Dr. John Cunha, an attending physician in the emergency department of Holy Cross Hospital in Fort Lauderdale, Florida, “the organs do not function normally and may be permanently damaged.”

 

Low pressure alone, without symptoms or signs, usually is not unhealthy.  The symptoms include lightheadedness, dizziness, and fainting.  These symptoms are most prominent when you go from the lying or sitting position to the standing position.

 

Low blood pressure can cause strokes, heart attacks, kidney failure.  It’s most severe form is shock, a life-threatening condition where persistently low pressure causes organs to fail rapidly.  Common causes of hypotension include a reduced volume of blood, heart disease, and medications.  The cause of low blood pressure can be determined with blood tests, radiologic studies, and cardiac testing to look for arrhythmias.  Treatment is determined by the cause of the low pressure.

 

Hypothyroidism.   The thyroid is a small, butterfly-shaped gland found just below the Adam’s apple.  When it fails to make enough thyroid hormone to maintain the body’s metabolism, the body starts slowing down.  Sufferers gain weight, feel tired and can experience memory lapses – the symptoms are myriad and confusing.

 

Women are five times more likely to develop hypothyroidism than men.  “The disease tends to manifest itself as the person ages,” sys Professor Mafauzy Mohamed, consultant endocrinologist at Universiti Sains Malaysia. 

 

Aside from fatigue, a diagnosis of hypothyroidism can be suspected in patients with cold intolerance, constipation, swelling of legs, muscle cramps, dry and flaky skin, sleep difficulties, and hair loss.  A blood test is needed to confirm the diagnosis.

 

Properly diagnosed, hypothyroidism can be easily and completely treated with thyroid hormone replacement.  On the other hand, untreated hypothyroidism can lead to an enlarged, worsening heart failure, and an accumulation of fluid around the lungs.

 

Sleep apnea.  Cartoons have long poked fun at thunderous snoring, but experts are realizing the noise is serious.  Snoring may indicate sleep apnea, which can lead to high blood pressure, heart disease and strokes.

 

A collapsing airway triggers the snoring, and it can interrupt breathing for as long as a minute. “People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping,” says Dr. Adrian Siew Ming Saurajen, a consultant at the Ear, Nose, Throat and Snoring Center of the Mount Elizabeth Medical Center in Singapore.  These short stops in breathing can happen up to 400 times every night. 

 

It was once thought to affect only men who smoked, drank or were obese, but post-menopausal women and children also suffer from it.  Snoring is the most ubiquitous symptom.   Also, daytime sleepiness, morning headaches, inability to concentrate, depression, decreased sex drive, and fatigue.

 

Those with mild cases are urged to stop use of alcohol and sleep medicines and quit smoking.  Sleeping on the side can also help.  For more severe cases, patients find relief by using a machine that forces air through the nasal passages during sleep.

 

Chronic fatigue syndrome.  Sometimes called the “yuppie flu,” chronic fatigue syndrome (CFS) is a debilitating disorder that leaves you immobile and inactive for months, even years.  “It doesn’t have a single cause but is a combination of viral infections, an altered immune system and other factors,” says Dr. Nelson Gantz, chairman of the Department of Medicine and chief of the Infectious Disease Division at the Polyclinic Medical Center in Harrisburg, Pennsylvania.

 

The early sign is a strong and noticeable fatigue that comes on suddenly and often comes and goes or never stops.  You feel too tired to do normal activities or are easily exhausted with no apparent reason.  The fatigue does not go away with a few good nights of sleep.  Instead, it slyly steals your energy and vigor.

 

Although the cause of CFS is still unknown, doctors can diagnose it by ruling out other possible causes of fatigue.  Aside from fatigue, other symptoms include headache, tender lymph nodes, muscle and joint aches, and inability to concentrate.

 

Some experts consider CFS a sleep disorder, since its victims often sleep twice as long as other people yet still feel severely fatigued.  Others think it results from stress, since CFS often strikes young high achievers who lead stressful lives but otherwise are in good health.  And researchers wonder why 80 percent of CFS patients are women, most of them between the ages of 25 and 45.

 

CFS has no cure, but eventually it runs its course and some people who have it recover fully.  Others have persistent symptoms that wax and wane. — ###

 

Walk, for your health’s sake!

By Henrylito D. Tacio

 

I like walking.  When I was in New York City a couple of years ago, I tried to explore Manhattan by walking.  I just walked from the hotel where I was staying to Central Park, to Times Square, and to the United Nations headquarters.  I also did the same trick when I was in Melbourne, Australia.  Instead of riding a taxi, I walked from the hotel to the conference venue, about five blocks away.

 

Here, in the Philippines, I work at an office that entails me to sit for eight hours – save only for those few minutes when I walk going to the canteen or just to unwind myself.  So much so that I don’t ride from my house going to the bus terminal, which is about 600 meters.  My friends are wondering why I never ride (except when it is raining!).  I tell them I am saving money.  However, the truth is walking is my form of exercise.

 

Many people walk as a hobby.  Fitness walkers and others may use a pedometer to count their steps. The types of walking include bushwalking, racewalking, weight-walking, hillwalking, volksmarching, Nordic walking, and hiking on long-distance paths.  Sometimes people prefer to walk indoors using a treadmill. In some countries walking as a hobby is known as hiking (the typical North American term), rambling (a somewhat dated British expression), or tramping (the invariable term in New Zealand).

 

Hikers, mall walkers, and the like have always known that walking is good for the body.  Walking, after all, is one of the safest things we can do with our body.  It’s much easier on the knees than running and doesn’t trigger untoward side effects.  In fact, increasing documented evidence suggests that walking offers several health benefits. 

 

“Regular physical activity is probably as close to a magic bullet as we will come in modern medicine,” says Dr. JoAnn Manson, chief of preventive medicine at Harvard’s Brigham and Women’s Hospital in the United States.  “If everyone were to walk briskly 30 minutes a day, we could cut the incidence of many chronic diseases by 30 to 40 percent.”

 

Even if you’re 50 and have never taken part in a physical activity, a brisk half-hour walk three times a week can “basically reverse your physiological age by about ten years,” says Dr. Gareth Jones, a Canadian geriatric specialist.

 

His source?  A three-year study of 220 retirement-age men in which half didn’t exercise and the other half walked briskly for 30 minutes three times a week.  After a year, the exercise group showed a 12 percent increase in aerobic power and a ten percent increase in strength and hip flexibility – equivalent to what they would have lost over a decade had they not exercised at all.

 

People in France and the Mediterranean tend to be slim because they’re a lot more active.  And it’s all because they walk more.  A study of 200,000 Americans at Rutgers University in New Brunswick, New Jersey, found that city dwellers were almost three kilograms lighter than their suburban counterparts, largely because, instead of driving, they walked more.  “You’re not working out,” says Dr. Will Clower, author of ‘The Fat Fallacy: The French Diet Secrets to Permanent Weight Loss.’  “You’re just moving.”

 

Those three are only for a starter.  Here are more health benefits you get from walking:

 

Heart disease.  Brisk walking is good for the heart, which makes a lot of sense.  The heart is a muscle and anything that makes the blood flow faster through a muscle helps keep it in shape.  But regular walking also lowers blood pressure, which decreases the stress on the arteries.  It can boost the amount of HDL cholesterol (the good one) in the blood.  It even seems to make the blood less “sticky,” and therefore less likely to produce unwanted clots.  This all adds up to as much as a 50-percent reduction in the risk of suffering a heart attack, according to doctors.

 

Stroke. Walking also decreases the risk of a stroke.  In an analysis of the health habits of 72,488 nurses over the past 14 years in the United States, researchers from the Harvard School of Public Health recently found that those who walked six or more hours per week decreased by 40 percent their risk of suffering strokes caused by a clot.

 

Low blood pressure.  In one study of older people with low blood pressure after meals, walking afterward restored their blood pressure to normal.  “These findings support an old German proverb – ‘After meals, you should rest or walk a thousand steps,’” says Dr. Lewis A. Lipsitz, assistant professor of medicine at Harvard Medical School in Boston.

 

Diabetes.  If you’re diabetic, doctors recommend exercise.  “The best exercise for people with diabetes is brisk walking,” says Dr. Henry Dolger, former chief of the Diabetes Department of Mount Sinai Medical Center in New York City.  “It’s by far the safest, least stressful, and most productive of all exercises.”

 

Walking, he explains, improves the efficiency of every unit of insulin taken in or produced by the body.  “That means you get more effectiveness out of every gram of food you eat than you would without exercise,” Dr. Dolger says.  “It also gives you a great sense of well-being and requires no equipment.” 

 

Osteoporosis: For those having osteoporosis, walking is another good form of exercise.  “If you don’t exercise, you lose bone,” says Dr. Robert Heaney, a professor at the Creighton University.  Experts claim that walking does not only strengthen the muscles, but also builds up the bones.  They suggest walking at least 20 minutes a day, three or four days a week.

 

Insomnia.  Having trouble getting a sleep?  Get some exercise late in the afternoon or early in the evening, says Dr. David Neubauer, general psychiatrist at the Johns Hopkins University Sleep Disorders Center.  It shouldn’t be too strenuous – a walk around the block will do just fine.  Not only will it fatigue your muscles, but also it will raise your body temperature.  When that begins to fall, it may help induce sleepiness.  Walking also may help trigger the deep, nourishing sleep that the body craves the most for replenishment.

 

Constipation. Any form of regular exercise will tend to alleviate constipation, but the one mentioned most often by experts is walking.  Walking, they claim, is particularly helpful for pregnant women, many of whom experience constipation as their inner workings are altered to accommodate the growing fetus.

 

Anyone, including mothers-to-be, should walk a “good hearty 20 to 30 minutes” a day, suggests Dr. Lewis R. Townsend, clinical instructor of obstetrics and gynecology at Georgetown University Hospital in Washington, D.C.  However, he cautioned that pregnant women should take care not to get too winded as they walk.

 

Premenstrual Syndrome.  When a woman’s mood takes a walk on the wild side, experts suggest that she takes a walk.  “Exercising has been found to significantly reduce many physical and psychological PMS symptoms,” says Dr Ellen Yankauskas, director of the Women’s Center for Family Health in Atascadero, California.

 

“It’s best to exercise at least three times a week, even when you don’t have PMS,” she advises.  “Walking is the exercise I recommend, because weight-bearing exercises help keep bones strong.”  She suggests going out for at least 12 minutes, though 30 minutes or more is even better.

 

Varicose veins.  Prolonged sitting or standing can cause problems in your legs because the blood tends to pool.  A little bit of exercise throughout the day, particularly walking, can often prevent this pooling, according to Dr. Eugene Strandness, a professor of surgery at the University of Washington School of Medicine.  In fact, a recent study found that sedentary adults were more likely to have varicose veins than those who were active.

 

Unknown to many, American president Harry S Truman took to walking briskly until the ripe old age of 88.  Astronaut John Glenn credited his celebrated return to orbit at age 77 to his two-mile daily power walk.  Famous author and naturalist Henry David Thoreau admitted he couldn’t have preserved his health and spirit without walking at least for four hours through the woods or fields everyday.

 

Now, you know why I like walking. – ***

 

 

True love is forever

By Henrylito D. Tacio

 

I was in college when the movie, ‘Endless Love,’ came out.  The melodrama moved some people to cry.  But what made this film memorable was the theme song, sung by Diana Ross and Lionel Richie.   

 

Some memorable lines include: “My love there’s only you in my life, the only thing that’s bright.  You’re every breath that I take.  You’re every step I make.  And I want to share all my love with you, no else will do.  And your eyes they tell me how much you care.  Oh yes, you will always be my endless love.”

 

The song came into my mind as I read the story send to me by a friend via e-mail.  I don’t know who wrote it (a lady physician most probably) but after reading it you would wish you have such of love and devotion.  The end of the story has this message: “True love is neither physical, nor romantic. True love is an acceptance of all that is, has been, will be, and will not be.”

 

Now read the story for yourself:

It was a busy morning, about 8:30, when an elderly gentleman in his 80’s, arrived to have stitches removed from his thumb.  He said he was in a hurry as he had an appointment at 9:00 am.

I took his vital signs and had him take a seat, knowing it would be over an hour before someone would to able to see him.  I saw him looking at his watch and decided, since I was not busy with another patient, I would evaluate his wound.

On exam, it was well-healed, so I talked to one of the doctors, got the needed supplies to remove his sutures and redress his wound.   While taking care of his wound, I asked him if he had another doctor’s appointment this morning, as he was in such a hurry.  The old answered negatively but he added that he needed to go to the nursing home to eat breakfast with his wife.

I inquired as to her health.  He told me that she had been there for a while and that she was suffering from Alzheimer’s disease, a disorder which destroys brain cells, causing problems with memory, thinking and behavior severe enough to affect work, lifelong hobbies or social life.  As we talked, I asked if she would be upset if he was a bit late.  He replied that she no longer knew who he was, that she had not recognized him in five years now.

I was surprised, and asked him, “And you still go every morning, even though she doesn’t know who you are?”  The old man smiled as he patted my hand and said, “She doesn’t know me, but I still know who she is.”

I had to hold back tears as he left, I had goose bumps on my arm, and thought, “That is the kind of love I want in my life.”

 

Love can never be out of season.  No one runs out of ideas about it.  Poets can go on and on with the subject. A lot of songs have also been written about love.  Eric Carmen croons: “Love is all that matters.”  Perry Como believes, “Love makes the world go round.”  Kenny Rogers agrees, “Love will turn you round.” However, the Eagles band thinks that “love will keep us alive.”  Peabo Bryson knows that “love always find a way.”

 

If love someone now, tell that person how much you love him or her.  Do it everyday if possible.  Never wait for the day when that person is gone.  He or she is no longer to hear your words.  Perhaps the words of Troy David Bowden is enough to remind you what love is and how important it is to let your beloved to know your feelings:

 

“The miss of a lost love can darken the soul. Wishing to see her in the moonlight or day can cause pain and it does in my heart. Her walk was of a God and her eyes were of the dove. Lost am I in this world without her. Her touch her sound the kiss of forever and the words that came to be.

 

“She died in my arms, and the pain will never go away. Some nights I cry praying for her to be here, but only alone I come to be. If only someone knew how the pain burns like fire slowly burning the heart. Tears are the only memory of her and her smile.

 

“No cure could be found and it was only up to God’s time. So many things I still wanted to say to her and so much to do with so little time. Like to take a walk through a park and hold hands as the birds fly free with the wind or to make love on a beach as the waves crash to the shore. She was my true love and to see her go away kills my soul.

 

“I did all I could to make her time happy, we talk about memories and stories, went to the tree outside our house were I asked her to marry me, but most of the time I just watched her get sicker and sicker and on the day of her death I blew out the candle of our dreams never to light it again.”

 

Bowden’s final words to his beloved: “Wherever you are I’ll always be here waiting for the day we can once meet again.  For when the day comes tears of the past will be gone and tears of the future will lead the way.”

 

Just what is true love?  I Corinthians 13:1-8 states: “If I speak in the tongues of men and of angels, but have not love, I am only a resounding gong or a clanging cymbal. If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have a faith that can move mountains, but have not love, I am nothing. If I give all I possess to the poor and surrender my body to the flames, but have not love I gain nothing Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always perseveres. Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be stilled; where there is knowledge, it will pass away…”

 

The 13th verse says it all:  “And now these things remain: faith, hope and love. But the greatest of these is love.”

 

For comments, write me at henrytacio@gmail.com

Save your life, see a dentist now!

By Henrylito D. Tacio

* Names have been changed to protect privacy

Jonathan Chew* has been smoking since he was a teenager.  The 24-year-old office clerk from Kuala Lumpur quit smoking only recently when his gums did not stop bleeding after brushing his teeth.   Then, after a month of tolerating the problem, he noticed a tooth in upper left portion started to loosen each day.  

Chew talked with one of his friends, who recommended that he should see a dentist.  The tooth bothers me every time I eat, he told the dentist, who extracted the affected tooth.  Five days later, however, Chew returned to the clinic and complained of a pain in the socket which should have healed already.

The dentist attempted to debride the non-healing socket.  That will solve your problem, the dentist assured him.  But it didn’t happen.  In fact, the socket still failed to show signs of healing even three weeks after the tooth extraction.

Chew returned to the clinic again and it was at this point that the patient was referred to Dr Siti Mazlipah Ismail, an oral and maxillofacial surgeon with the University of Malaya.  Can you get rid of the pain I am suffering now? Chew asked the dentist.

After examiningg Chew, Dr Siti observed that there was something wrong with him.  So, Dr Siti asked him if they could get some tissues for biopsy.  Chew wondered; after all, the problem he was suffering from was only his non-healing socket.  “We had to explain to him the need to investigate on other parts of his skeletal and lungs as he didn’t realize that his tooth problems could also have an implication on other parts of his body,” Dr Siti says.

After a much thorough examination in the laboratory, Dr Siti told the patient that he was suffering from Langerhans cell histiocytosis, a rare spectrum of disorders characterized by proliferation and accumulation of a white blood cell in the various tissues and organs of the body.  A chest radiograph revealed significant lesions in the lungs of the patient, which caused some parts of the lungs to collapse. 

Chew did not show any signs of the disease despite the collapsed lung.  Had it not been for the non-healing socket, he would never be diagnosed of having the disease.  Immediately, Dr Siti referred the patient to a chest physician, who took the necessary steps of saving Chew.  “He was very lucky,” Dr Siti says now.  “If not treated immediately, Langerhans cell histiocytosis is fatal, especially if the lungs are affected.”

Chew’s case is not isolated.  Across Asia, people don’t equate oral health with their overall health.  They fail to recognize that some mouth infections can be treacherous. They have eaten through the skin in people’s necks, choked off airways, migrated to the heart, burrowed into brains and, yes, even killed people.

Have we scared you enough yet? Here’s the point: Everyone is vulnerable, because bacteria that routinely lurk in the mouth cause tooth decay and gum disease. The problem: Most people don’t know they have these infections. They often cause no pain and few symptoms, but can lead to far worse. Gum disease may also heighten the risk for heart disease, diabetes, pneumonia and premature birth, according to recent clinical trials. But the good news is that with good old regular brushing and flossing, you may prevent all that. And by seeing your dentist often, you can nip most problems in the bud.

Unfortunately, in almost all parts of Asia, people are courting death because they have neglected their oral health.  “I find it odd that that dental treatment is not always a part of an employer’s medical benefit plan,” observes Dr Siti.   “Oftentimes, it is equated with aesthetic needs rather than functional.  As a result, the amount located for dental treatment per year would only suffice for scaling or single filling of teeth.”
 
Compared with other medical problems, oral health issues in the region are often regarded as trivial.  “People don’t go to dentists for checkup because they do not consider oral diseases as debilitating or life-threatening,” points out Dr Zosima Reyes, chairperson of the Department of Dentistry and Oral Medicine at the St. Luke’s Medical Center in Manila.   
 

Most Asian experts cite low education on dental health as one of the primary reasons.  “I believe the government should give attention and importance on oral health in educating our people,” says Dr Malcolm Ming-Kuang Guo, a professor of pediatric dentistry at the National Taiwan University Hospital.
 
Dental experts are urging Asians to rethink their commitment to oral health.  After all, regular dental checkups can pay off in some other ways. For example, dentists can spot signs of diabetes, heart disease and cancer, along with a variety of rare skin and autoimmune diseases.  Your dentist can do much more than save your teeth and gums. Your dentist can also save your life.

“Early detection of symptoms and early treatment may prevent the progress of the disease and its complication, and hopefully, save the life of the person,” explains Dr Perla Cruz-Triviño, chair of the dental medicine department of Manila Doctors Hospital.  “You never know what your dentist may tell you on your next visit,” adds Dr Eugene Tang Kok Weng, immediate past president of Singapore Dental Association and general dental practitioner with Drs Tang and Associates.

An Oral Epidemic

Like their Western counterparts, Asians have brighter smiles than ever before, thanks to ubiquitous teeth-whitening systems. But behind those gleaming smiles, all is not well. Oral health has improved some in recent decades: Children in Japan, Hong Kong and Singapore have among the lowest rates of dental decay in the world. In Taiwan, the incidence of mild gum disease (gingivitis) among those in the age bracket of 20-34 has decreased by 38 percent in 30 years.

But here’s the bad news: In Malaysia, ninety per cent of school children between the ages of 6 and 18 suffered from dental caries more than 40 percent of older people suffer from total tooth loss.  In Taiwan, approximately 58 percent of the adults still have gum disease (periodontitis). 

Not getting enough fluoride may be part of the problem.  When fluoridation was introduced in Hong Kong, Singapore and parts of Malaysia, only around half of the children have dental caries compared with those in nearby countries.  In comparison, 98 percent of the population in the Philippines, where the water supply is not fluoridated, have dental caries and 50 percent suffer gum disease.

Children Not Spared

Oftentimes, children suffer the most since they cannot really tell what the problem is.  Last November 2005, William Chen* came to the pediatric clinic of Dr Guo along with her three-year-old daughter, Sandra*.  A day earlier, the two visited the clinic because the little girl had a mild toothache on her upper left molar.  The attending dentist at that time didn’t give any treatment since clinical examinations and X-ray showed no obvious and significant findings.

They returned to the clinic since the left side of Sandra’s face was swelling.  Dr Guo was very alarmed, so he decided to check the little girl.  After a thorough examination, his verdict was pulpitis (a painful inflammation of the tooth pulp, the innermost part of the tooth that contains the nerves and blood supply) with cellulitis (an acute spreading bacterial infection).

Dr Guo opened the pulp chamber and a very putrid odor came out.  After that, the girl felt better.  The dentist inserted a cotton pellet and prescribed an antibiotic.  At home, later that night, the swelling got worse and spread to Sandra’s left eye area. 

The parents rushed the little girl to the oral surgery ward of the university hospital and intravenous antibiotic was given but still the swelling didn’t subside but got worse.  The next day, the swelling spread across the facial mid-line to the right face.  Seeing this, the doctors immediately carried out an emergent surgery, incision and drainage in the operation room under general anesthesia.

Two days later, Sandra was discharged from the hospital.  “This case terrified me, since it happened despite dental and antibiotic treatments,” bares Dr Guo.  “If she wasn’t properly treated, brain abscess may occur which may kill the little girl.”

A Silent Threat

Gum infections, too, harm more than just mouths. While mild gum infections called gingivitis may lead to red and swollen gums, they’re not especially dangerous by themselves. But they can worsen into periodontitis, painless but chronic gum infections that, if left untreated, degrade bony sockets and ligaments that hold teeth in place. The immune system fights gum infections to keep oral bacteria from spreading to other parts of the body. It usually succeeds, but not always. Gum-disease bacteria can enter the bloodstream and move to the heart, creating life-threatening infections in previously damaged heart valves. What’s more, scientists believe the resulting inflammation releases infection-fighting compounds that can inadvertently damage other tissues.

The arteries may be the most common target. People with periodontitis were twice as likely to die from a heart attack and three times as likely to die from a stroke, according to a study that examined 18 years of medical histories for 1,147 people in the United States. Dr Steven Offenbacher, director of the Center for Oral and Systemic Diseases at the University of North Carolina School of Dentistry, who co-authored the study, is helping conduct another to see if treating periodontitis in heart patients will cut the risk of heart attacks.

Pregnant women with serious periodontal disease have about four times the risk of delivering preterm babies, and they face an increased risk of preeclampsia, in which blood pressure climbs sky-high after the 20th week, threatening the lives of both mother and fetus. In an early clinical trial, American researchers found that treating seriously infected gums reduces pre-term births fivefold, but the work needs to be confirmed in larger trials.

Diagnostic Dentists

The gums of 56-year-old Indira Ramesh* were painful, red, and swollen.  For the past three weeks, she had been getting less sleep because of the sore gums.  Not only that, her tooth on the lower right posterior jaw had been loosening.  Her eldest son, Biman*, urged her to see a dentist, she declined.

But when the Indian immigrant Ramesh could no longer endure the excruciating pain, she immediately went to see her Singaporean dentist. Upon a thorough examination, the dentist decided to refer her case to oral and maxillofacial surgeon Dr Kok-Sen Ho.

While reading the report of Ramesh’s dentist, Dr Ho asked the patient some important details about her medical and social history.   He found out that before she came to Singapore, the patient had been chewing betel nuts for more than half of her life.  She quit her habit just a year ago.

After examining her oral tissues, Dr Ho gave an initial diagnosis of tissue burns as Ramesh had been applying salt and tamarind to ease the pain.  He removed the loosen tooth.  But Dr Ho knew there was more it, so he excised some tissues from the affected area for routine biopsy.
 
When the biopsy report came back, Dr Ho’s findings were confirmed.  Ramesh was suffering from oral cancer.  Immediately, Dr Ho referred her to a public hospital with all the necessary records.  At the hospital, the cancer team of doctors performed a resection of her lower jaw followed by a reconstruction using bone from her leg.

“Dentists in the hospital settings would be more likely to screen for oral cancer as compared to general practitioners,” says Dr Siti.  The dentist thoroughly checks the tongue, palate, inside of the cheeks, and lips for any bumps or unusual sores.  If the dentist doesn’t do it, “the patient can always ask his dentist regarding his fear of the possibility of having cancer,” Dr Cruz- Triviño admonishes.

“Like any other types of cancer, oral cancer is not detected until it is in advanced stage,” says Dr Tang of Singapore.   “If detected early, it has a high chance of being successfully treated. Hence, it is very important for you to visit your dentist regularly.”

Cancerous cells can develop on the lips and anywhere in the mouth – on the gums, cheeks, tongue, or the upper part of the throat.  Most oral cancers emerge from flat, scaly cells that line the inside of the mouth.  Oftentimes, the cancer does not spread beyond the head and neck.

Besides spotting oral cancer, dentists can recognize signs of leukemia and lymphoma (cancer of white blood cells).  But diagnosing cancer is just the beginning. Dr Siti of Malaysia had once referred a pale and tired-looking patient to a physician who later diagnosed him of having heart failure.

Dentists can also spot signs of gastrointestinal problems like Crohn’s disease, skin diseases, autoimmune diseases and more. “I have been in practice for 25 years now, and from time to time, I pick up cases of anemia, diabetes, herpes, and rarely oral cancer,” informs Dr Tang of Singapore.  

If more people realized the consequences of not taking care of their teeth and gums, they’d probably call a dentist tomorrow. Still, only about one-fifth of the patients of Taiwan’s Dr Guo come for regular checkup.  “We advice our patients to return for follow-up every 3 or 6 months after treatment,” he says.  In the case of Singapore’s Dr Ho, some of his patients come back only when they have problems.  “So I see them maybe once in a year or two years,” he claims.

Healthy teeth and gums allow us to talk, smile, laugh and kiss without embarrassment. That’s reason enough to take care of our oral health. But as medical science reaffirms that head and body are indeed connected, there’s more reason than ever to brush twice a day, floss daily, get dental checkups every six months, or see a dentist promptly if you have a problem. 

Jonathan Chew learned that lesson the hard way. As he recovered from his illness, Chew remained at home for recovery.  He was wondering if he had not visited his dentist immediately.  “I thought my dental problem was just miniscule,” he says now.  “After this incident, I have now known better.  Never again!” — ###

Looking for a perfect vision?

By Henrylito D. Tacio

Since he was 10 years old, David Ho has eyesight problems.  For instance, he had trouble seeing his alarm clock clearly when he got up from bed.  He could not play games like water polo, which loves doing. To correct his vision, he used glasses and sometimes contact lenses.  Both were inconvenient.

“My glasses were leaving an imprint on my nose and I had to spend money to buy new pairs every other year or when they break,” says the Singaporean computer programmer, now 49 years old.

Dr Bernard Cheong can relate.  After four decades of poor vision and dependence on glasses, the 46-year-old general practitioner was looking for help.  “The worse thing is not being able to see while in bed, in the bedroom, in the bathroom, and in the swimming pool.  No one really wears contacts or glasses in these places.”

A few years ago, David and Bernard would have been out of luck. Eye surgery, at least as it existed then, could not address their problems.  

But thanks to new technologies and new therapies, surgeons can now treat many kinds of eyesight problems, including myopia, a condition of nearsightedness.  Both walked into the Clearvision Eye Clinic in Singapore, and walked out with smiles on their faces and glasses in their pockets.

Laser eye surgery, a high-tech, relatively painless way to correct eyesight problem, is now in Asia.  Bernard got the procedure known as Lasik. Dr Tony Ho, his attending surgeon and director of the clinic, used a laser to change the shape of his corneas, correcting one eye so she could see faraway objects clearly and tuning the other for up-close objects.  “I am the luckiest guy around,” Bernard says now.  “I see perfectly as I go to bed, and on waking up, I can enjoy the view of the hilltop from my bed as I look out through the window lying down.”

David, however, needed a different solution since he also suffered from astigmatism, an abnormal condition of the eye in which the curve of the cornea is unequal.  His brother performed another form of laser surgery, called wavefront, because it posed less risk and give the patient better vision. David still can’t believe how well things went. “My dream has come true,” he says. “I no longer need eye glasses.”

Dr Ho observes: “Ten years ago, these things would have been impossible.  In fact, I would have turned them down outright.”

Eyesight problems differ and solutions also vary. Among those that can now be performed are the PRK (Photorefractive Keratectomy), Lasek, CK (Conductive Keratoplasty), and Intraocular lenses.  Today, doctors are treating patients who would have been routinely rejected before, and patients are experiencing fewer side effects. “Thanks to modern science, we now have the solution to most eyesight problems,” says Dr Gerard Chuah, consultant ophthalmologist at the Mt. Elizabeth Medical Centre and author of several books, including A Patient’s Guide to Myopia and Myopia Treatment.  “Name it and we may have the technology for it.”

Even for people wearing reading glasses, a solution is at hand.  With the technique known as monovision, surgeons have been able to address presbyopia, a stiffening of the eye lens that makes focusing close up—when reading newspapers, books, or your computer screen, for example—nearly impossible. So surgeons correct one eye for reading, the other for distance. Since monovision won’t work for everyone, researchers are still scrambling for a better fix for this common problem.

Despite this, Asians are seeing the light in droves. At the Asian Eye Institute in Makati City, for instance, about 1,000 people take the plunge every year.  “On the average, there is an increase of 20 percent per year in the number of Lasik being done at the institute,” reports Dr Maria Imelda Yap-Veloso, an ophthalmologist professor and a full-time consultant at the institute.

Most eye procedures are about as safe and effective as surgery can get. Overall, more than nine in ten people without severe vision problems wind up with 20/40 vision or better—good enough to drive a car without glasses. (The results are even better with the new wavefront lasers.) That’s nearly perfect eyesight cost US$750 an eye in Taiwan (although in some Asian countries may be lesser or higher than this). And less than 1 percent of all patients experience a serious surgical complication.

However, for an industry that promises clarity, many centers have kept their patients in the dark about the risks and realities. Governments are no help either as there are no laws on buying medical instruments and equipments.  But the good thing is: most hospitals – government or private – insist that some form of medical accreditation must be done before allowing any doctor to perform eye surgery.

Despite the stellar record of the surgery, stories about eye operations that go awry abound.  As some patients in industrialized countries have discovered, the technique may not be as effective and safe as originally thought.  The consumer advocate website surgicaleyes.com posts a sobering archive of unhappy endings—a litany of botched flaps, infected corneas, triple vision, daily nausea and permanently marred eyesight. The message boards are full of people who came out of Lasik with 20/20 or 20/40 vision but are still in misery, handicapped by poor night vision, stinging dry eyes and worse.

That’s why it’s vital to research the subject if you’re considering surgery. Here’s a step-by-step guide to help you see things clearly.

Know What You’re Getting Into

If you believe all the ads, after eye surgery, you’ll be able to read the bottom line of an eye chart through a brick wall. If only it were true. “Of course, people who have eye problems want to have a perfect vision,” says Dr Fung-Rong Hu, a professor of ophthalmology at the National Taiwan University Hospital, “but not everyone can have that.  I advice that patients should study carefully first the pros and cons before undergoing any surgery.”

• You may not wind up with 20/20 vision. The research on Lasik indicates that more than 80 percent of patients with mild or moderate nearsightedness wind up with 20/20, while 95 percent get 20/40 or better. And experts estimate that more than 98 percent of people who qualify for wavefront get 20/20. Not surprisingly, the numbers are lower for people with more serious myopia, farsightedness or an astigmatism. Your doctor should be able to tell you what he’s likely to achieve given your vision problem.

• You might be a poor candidate. Eye surgery still isn’t for people with certain severe vision problems, a prescription that’s changed in the last year, or an eye disease. The same goes for folks under 18 and pregnant women, whose eyes may be undergoing changes. So don’t be shocked if an ophthalmologist gazes into your eyes and then shows you the door. “I turn down about 3-5 patients a month,” says Dr Ronald Yeoh, a senior consultant at Gleneagles Hospital in Singapore.   “I found that some of my patients have corneas not thick enough for laser surgery.   In some instances, I discover glaucoma, cataract or retinal problems.”

• Be prepared for side effects. Even if your surgery goes without a hitch, you may feel like your eyes need help. Many people complain of dry eyes and require eye drops known as artificial tears for months or more. Fortunately, the symptoms usually go away in time. Other patients see halos and star bursts while they drive at night. Again, these symptoms tend to be minor and fade away, but some people have serious lingering problems. These days, better knowledge can ensure that patients will get the right surgery, reducing the risk of complications.

Find a Doctor

Ask friends or family members for referrals. If no one you know has had surgery, ask around to see who’s the best in your city. Of course, you can always ask your optometrist or an ophthalmologist for a referral.

You can also look for a surgeon on the Internet. In the Philippines, for instance, the Eye Center (eyecenter.com.ph) has a list on their site that can help you find member specialists in your area.  

Whatever you do, don’t make a decision based on a rock-bottom price. Sure, the procedure can be painfully expensive, and your health insurance is unlikely to help. “While I agree that patients should consider the cost of the surgery, they should not think of it as discount surgery,” says Dr Manolette Roque, consultant ophthalmologist of the Asian Hospital and Medical Center in Manila. “After all, we have only one set of eyes.”

“I understand that patients may also have a budget when it comes to medical expenses,” says Dr. Yap-Veloso.  “But the low price should not be the basis for undergoing a surgery.  After all, we have only one set of eyes.”

Ask the Right Questions

The process isn’t over once you’ve picked a surgeon. After all, this man or woman is going to slice your cornea and laser your eyeball. You need to grill this person, and you need to feel very comfortable and confident with the answers. If you’re not, get a second opinion. Make sure you ask your surgeon these ten questions.

1. Who will be doing the procedure?

The surgeon who will be performing your Lasik should meet you, answer your questions, and examine your eyes before you set foot in an operating room. Yet at some centers, you don’t meet your surgeon until you’re flat-out under the laser. “That’s outrageous,” says Dr Yeoh of Singapore. “Easily available and open communication with the surgeon and his team are the hallmarks of a good practice.”

2. What are your credentials?

Your doctor should be board certified, which means he’s passed a series of exams on medical and ophthalmological subjects.  In Singapore, a guidebook on the city’s private medical care lists surgeon who are certified to perform Lasik.  “Of course, the doctor must have done eye surgeries under the supervision of a surgeon accredited in Lasik surgery or by the company which provided the equipment,” says Dr Liza Sharmini Ahmad Tajudin, lecturer of the ophthalmology department at the Universiti Sains Malaysia. 

Even better: Your doctor is a fellowship-trained corneal or refractive surgeon, a specialist who received extra training in the conditions of the cornea. It may not matter if your case is straightforward, but you’ll be thankful if a complication arises.

3. How will I be tested before you operate?

Preoperative testing can identify people who are bad candidates for surgery, but it’s one of the areas where cheap centers may cut corners. Ideally, your doctor (or his staff) will conduct a detailed eye exam, including measuring your pupils in the dark, determining corneal thickness and mapping corneal topography.

4. How much experience do you have?

In the United States, more than 500 surgeries is ideal. A study done by the University of California at Los Angeles found that the rate of surgical complications for four doctors doing Lasik was 1.3 percent in their first 1,000 procedures—and 0.47 percent for their next 3,000 surgeries. That’s some learning curve. 

5. What’s your complication rate?

The best doctors have a serious surgical complication rate below 1 percent. Be wary of surgeons who can’t answer this question or centers that won’t give you information about the doctor who will be operating on you.

6. What’ your enhancement rate?

Typically, good surgeons perform enhancements (the term surgeons use to describe touch-up procedures) in 5 to 15 percent of patients. Anything below 5 percent may suggest a center is discouraging fixes that would give a patient better vision; above 20 percent can indicate sloppy surgery.

7. Will my surgeon be available to treat me after surgery?

At some centers, the surgery may be performed by itinerant surgeons who fly into town one or two days a week and then split. If that’s the case, who’s going to take care of you if a problem emerges?

8. Have you ever been sued?

Even cream-of-the-crop surgeons get sued. But more than one malpractice suit per decade of practice can be a warning flag.  “In refractive laser surgery, there are bound to be cases where the surgical result is not to the patient’s satisfaction,” explains Dr Chuah of Singapore.  This is expected as there is no guarantee of 100% result.”

If you’re too embarrassed to ask about your surgeon, find the information from his former patients or from other sources like medical council or organizations.  “Currently, we don’t hear any doctor being sued yet as laser eye surgery is still new in Asia,” says Dr Sharmini of Malaysia.   “I think in years to come, we will encounter this problem for sure.”

9. What’s included in the price?

Watch out for centers that offer a low-ball price and then charge you for extras such as postoperative visits, enhancements or a high degree of vision correction. While this can be the hook these centers use to get you in the door, it doesn’t necessarily mean they are a bad deal or offer inferior care. You just don’t want any surprises.

10. What procedures do you do?

Many of the deep discounters do nothing but Lasik. As the saying goes: If all you have is a hammer, everything begins to look like a nail. But Lasik may not be right for you, and there are plenty of options these days. The best doctors turn away a significant number of patients who are bad candidates. In some centers, nearly everyone is a “perfect candidate.” Try to go to a center that offers more than one type of surgery and make sure all your questions are answered to your satisfaction. The moment you begin to feel pressured, it’s time to walk. — ###