Health Watch

Arm against osteoporosis

Senali S. PERERA

Most women seem frightened of the word itself: Osteoporosis. Will I have to face it someday? Others seem to have little or no idea about what it is. What is osteoporosis? Why do women have to be frightened of it? Dr. Harindu Wijesinghe, Consultant Rheumatologist in an interview with Daily News Health Watch provides answers to many of such questions, shedding light on common confusions.

According to the International Osteoporosis Foundation, it is estimated that currently, over 200 million people worldwide suffer from this disease. “Ageing of populations worldwide will be responsible for a major increase of the incidence of osteoporosis on postmenopausal women.”

“Osteoporosis is a disease of bones,” Dr. Wijesinghe said. “It makes your bones weak. Because of the decreased strength of the bones, fractures can happen easily.” Dr. Wijesinghe made it clear that osteoporosis does not involve joints. “It is false if you assume the pain in your joints will turn into osteoporosis. No, it does not happen. Osteoporosis is plainly a disease that involves your bones rather than joints.”

Silent disease

Osteoporosis does not cause symptoms until you break a bone. “It is a silent disease. Most commonly fractured parts are forearm, the spinal column and the hip. A person with osteoporosis may break their bones, falling from a standing height.”

He also said that very rarely, fractures can occur without a person falling. In sudden movements such as sneezing, these fractures can happen. But it is very rare.

How do I know if I have osteoporosis? Since, there are no symptoms shown, Dr. Wijesinghe said that the disease can be diagnosed through screening. The best test is a bone density test called the “DXA test”. It is a special kind of X-Ray. People with ‘risk factors’ are recommended to face this test.

The main risk factors are,

* Premature menopause in women.

* Being very thin.

* Smoking.

* Less active lifestyle.

* Family history of osteoporosis.

“Apart from this, it is recommended for women older than 60 to get themselves tested for osteoporosis,” said Dr. Wijesinghe. That is because women in this age group have the highest risk of osteoporosis.

Did you know that our skeleton is being replaced by new bones several times during our lifetime? Osteoblasts are one type of bone cell (out of three) that is found in bone tissue. They are bone forming cells (make bone). It deposits bone even as another bone cell, osteoclasts, breaks it down. This process in which the bones are being remodeled is called, the bone resorption formation cycle.

Common among women

Up to age 30, a person’s bones are lay down actively. But after that, the born absorption formation cycle is reversed. Therefore, more bone is absorbed and because of this, the bone mass tends to reduce. “In females, when they go through menopause, their bone absorption - the removal phase of your body’s bone remodeling process- is faster than normal,” he said.

Therefore they rapidly lose bone mass. “So now you know why females are more prone to osteoporosis than males.”

Out of the fractures that may happen due to osteoporosis, “the initial fracture is usually the forearm,” said Wijesinghe. Usually, this heals by itself.

But if not treated properly, a person might face the next big fracture: the spinal column. It has been shown that an initial fracture is a major risk factor for a new fracture. This causes severe pain and might cause stoop position where you will lose your height.

According to Wijesinghe, the worst fracture that happens due to osteoporosis is the hip fracture. Elderly people tend to be bed-bound because of this and the consequences may lead their life span to be reduced. How do I prevent osteoporosis? “Firstly, the simplest way is to prevent a fall. If you don’t fall, there is no chance of breaking bones,” said Dr. Wijesinghe.

To do that:

* Make sure all your rugs have no-slip backing to keep them in place.

* Tuck away electrical cords, so they are not in your way.

* Light all walkways well.

* Watch out for slippery floors.

* Wear sturdy, comfortable shoes with rubber soles.

* Have your eyes checked.

* sk your doctor to check if any of your medicines might make you dizzy or increase your risk of falling.

Calcium intake

It is also important to achieve high density of Calcium in young ages. (Because as mentioned earlier, a person reaches his/her peak bone mass at age 30.) How much Calcium a person needs per day depends on how old he or she is. “A normal person needs 800mg to 1000mg per day from the diet,” said Dr. Wijesinghe. “It is also important to obtain sufficient amount of Vitamin D. This, you obtain through food as well as sunlight.”

A person with osteoporosis needs 1500mg of Calcium which he or she obtains through diet and directly through medicine. Too much Calcium can cause heart diseases and stones. But how can a person’s Calcium intake be too much? “This happens when you take too many Calcium tablets. But under a physician’s supervision, this can be prevented,” said Wijesinghe further.

Once low Calcium and Protein levels which make the bones brittle and weak re identified, additional amounts of Calcium and Vitamin D should be given through tablets and modified diet. Among these are Bisphosphonates which enables bones to take up more Calcium and therefore making them strong. This can be taken weekly or monthly through tablets. Or else, it can also be taken once a year through injection.

What can you do to keep your bones healthy?

* Eat foods with lot of Calcium.

* Eat foods with lot of Vitamin D

* Be active for at least 30 minutes, most days of the week.

* Avoid smoking.

* Limit the amount of alcohol you drink.

Types of food

Foods rich with Calcium are soy milk, kale, broccoli, milk, cheese, almond, yoghurt, cereals, beans, tofu and green leafy vegetables. Foods rich with Vitamin D are canned tuna fish, cod liver oil, ready-to-eat cereals, cooked salmon, canned sardines, mackerel and eggs.

Daily exercise is always important. “Walking is a recommended exercise,” he said. It makes your muscles strong; increasing balance and thus, your chances of falling is reduced. It also strengthens bones.” To make bones strong, Dr. Wijesinghe recommended weight bearing exercises such as walking, jogging, dancing, Tai Chi and yoga. These also help to increase balance.

For muscles, he recommended resistance training -using light dumbbells and resistance bands- and sports like swimming.

Daily exercises - a must

“Encourage your children and yourself to exercise daily rather than staying indoors all the time,” and to eat healthy foods with Calcium and Vitamin D rather than drinking soft drinks and eating fast food.”

Making yourself healthy is a process that you should work on since childhood. But you are not too late to start afresh today. Because as we always here they say, “Prevention is better than cure.” Because saving your life no one’s responsibility but yours alone.

Breast cancer:

Causes and treatmnet

Ishara JAYAWARDANE

The death of a person due to cancer is particularly distressing because the enemy comes from within. If it is a person who threatens your life at least you can fight him off. However there is hope with the many advances in medical science. Dr.Neomal Perera of Lanka Hospitals talks to Daily News Healthwatch on types of cancer with special emphasis on breast cancer.

“Incidence wise cancer is increasing. Compared to 1980 and 2000, for the last 20 years the number of a cases diagnosed with cancer has doubled. The number of deaths during these 20 years has got doubled. So it is on the increase. In the 1980’s cancer was the sixth leading cause of death. By year 2000, it has become the fifth.

As the health sector in Sri Lanka are targeting more communicable diseases and as those things are going down, without our knowledge these non communicable diseases are going up. One interesting thing which we have seen is because of the health education, certain cancers like oral cancer which were due to chewing of betel and alcohol and smoking it has gone down. Those days it as the commonest cancer and we see a more westernized picture in Sri Lanka as well. So breast cancer has become the number one cancer,” said Dr. Perera

When you compare both males and females breast cancer is the commonest. When you take breast cancer, although we know it affects the females there is a one percent chance that it could affect the males as well. The breast cancer is mainly because of the female sex hormones. The males also have sex hormones - low quantity but for some reason males also can get it.

Female hormones

“Breast cancer is mainly because of the female hormones. So if women are exposed to these female hormones they are prone to get breast cancer. One way they can get exposed for a longer time is if they attain puberty at an early age. Those days we have heard puberty was around 12-14. But now we hear girls attain puberty earlier than that - 8-9 years. It could be because of the westernized food which contain lots of hormones. And also if the menstruation gets prolonged even after menopause or if the menopause is quite late, let’s say in their 60’s or if someone takes artificial Hormone Replacement Therapy to prolong their menstruation they get exposed to this breast cancer.

They are at a high risk of getting breast cancer. The way to stop this breast cancer is, if they get pregnant earlier in their life. You can reduce the number of hormones exposed on the breast that has a reversal effect. The incidence goes down if they get pregnant.”

Having multiple pregnancies and breast feeding are factors which prevents a person from getting breast cancer. “Even hormone contraceptive pills, if you take it for a longer time maybe 7-8 years or up to 10-15 years, then still you are prone to getting breast cancer. Hormone tablets can be taken as oral contraceptive pills and some people get it injected once in three months. That also increases the risk.

The international worldwide data it says five to eight percent of breast cancers can go in the family. In Sri Lanka fortunately we see at a lower percentage, 2- 3 percent can be familial or Genetical but worldwide it is five to eight percent. In Sri Lanka the genetic predisposition is a bit low.”

When we see the age of breast cancer in the developed countries we see the elderly population getting breast cancer 55 - 65. “ But in Sri Lanka we see it more in the younger generation- 40-45. It affects the Sri Lankan economy because this is the prime age where the women are having their children, starting their careers it affects their families so there is an impact on the Sri Lanka economy.

To avoid this, the best thing is to do breast self examination. Examine their breasts on their own. It is economically not cost effective to have a mass scale screening program. In American and UK they have mass scale screening programs using mamographies. In those countries over 50, all women have to do a mammography.

But in Sri Lanka we can’t do that because it is not economically cost effective. So the way to detect the cancer early is to ask women to examine their own breasts once a month. They should start when they are 25 years old and examine their breasts until they die, every month. The ideal time is soon as the finish their periods or menses.

That is the best time to examine their breasts. If they notice a lump or they squeeze their nipple and see blood coming out or some lumps in the armpits, those are early symptoms of breast cancer. A painful lump is probably not a cancer. That is myth people thinking that if it is painful you should go ahead. Actually the cancers are painless. You should not wait until you feel pain because the cancer will grow without your knowledge. Painful lumps are usually benign and not cancers.

Investigation

So once we see a lump we must investigate. We investigate in three ways - Clinically we examine and see, then we do imaging- take a picture. We take the picture in two ways - one is mammography and the second is the scanning. Both ways we do it and see if we can get some information out of those things.

The third thing is the needle test. We pass a needle and take some cells put it on a slide and see. So in three ways, once we confirm it is cancer, we tell the patient and start the treatment. Treatment wise, in the early stage surgery is a must. In early stage sometimes without removing the entire breast if we catch it early, we can do a breast conservation where we don’t remove the entire breast but we remove the lump. But in breast conservation the risk of having a recurrence is high.

The tumor can recur again. Because we don’t remove the entire breast we remove only a part. The next way is to remove the entire breast. But the price the patient has to pay is they get deformed. So to avoid that we have the surgical technique of reconstruction, where we re- construct the entire breast using either a silicon influx or the fat from their abdomen and put it there or use the fat from the back and reconstruct the breast as it is.

This is very important and popular in Sri Lanka as well as we see younger women getting breast cancer and they have the option of getting it reconstructed after removal. So one we remove we decide if they patient should get chemotherapy or radiotherapy. The important message is if we pick up early we can cure. If it is an advance tumor cure rates come down gradually and if is an advance tumor I would say survival rate is two years.”

Oral cancer

The second commonest cancer is oral Cancer. It was the first those days now it has become the second commonest cancer. Oral Cancer there are very clear risk factors like Smoking, betel chewing and alcohol. However we see certain patients without being exposed to these, still they get it. So that is a very small percentage.

But the sad part is although they know that this is a cancer they try to hide it because they can’t get over their habit. They know there is a tumor and that it is growing. So we see a lot of advanced cancers in the oral. The sad part is there are a lot of important organs very close together. If we do a surgery we have to take parts from the adjacent organs as well. For example if there is a small lesion in the cheek sometimes when you do the incision it might touch the tongue, so part of the tongue we may have to remove although it is not affected.

Workplace Safety and Health

Prof Hemantha Wickramatillake, Professor Occupational and Public Health,

Johns Hopkins Perdana University, Malaysia

The Universal Declaration of Human Rights, adopted by the United Nations General Assembly in 1948, recognizes the right of all people to just and favourable conditions of work. Unfortunately, millions of people around the world are employed in conditions that deprive them of dignity and value.

It is estimated that workers suffer 250 million accidents every year, with 330,000 fatalities. Further avoidable suffering is caused by 160 million cases of occupational diseases and an even higher number of threats to workers physical and mental well-being. The economic losses are equivalent to 4 per cent of the world’s gross national product; in terms of shattered families and communities, the damage is incalculable.

Policy makers and employers need to ensure that the provision of a safe and healthy working environment is a key consideration in all investment and production decisions, and the workers are involved in those decisions. This is an enormous task, for Governments, employers and workers alike.

Situation in Sri Lanka

The situation in Sri Lanka is no different to many developing countries. With an estimated, current, work force of around 8 million people, the legal safety and health cover is only for, around 3 million workers in the formal sector. This too is restricted to those who come under the Factories Ordinance.

As a result of ILO’s and the present Government’s concern ( President Mahinda Rajapaksa was one time the Minister of Labor), a new law named ‘Safety, Health and Welfare” is to be enacted in Parliament during the course of this year.

This new law will bring about many changes and a new era in safety and health, with stringent regulations to safeguard the safety and health of a huge population. Some of the important features are that it will provide a legal cover for all workers in the country, whether they are in the formal or informal sector and this will, also, include the public sector.