[Health Watch]

PCOS Treatment:

Lifestyle changes vital

Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder that usually begins during puberty and affects 5 to 10 percent of women of reproductive age.

According to Consultant Obstetrician, Gynecologist at the De Soysa Maternity hospital and Senior Lecturer in Feto-Maternal medicine of the faculty of Medicine in Colombo University Dr.Hemantha Dodampahala, it is the most common hormonal disorder among women in this age group despite their races and nationalities.

It should be noted that most women with the condition have a number of small cysts in their ovaries. The cysts are under-developed follicles which contain eggs that haven't developed properly. Normally, one or more eggs are released during a woman's period.

This is called ovulation. In PCOS, mature eggs are not released from the ovaries. Instead, they can form very small cysts in the ovary. It means ovulation doesn't take place,” he said.

It is important to make the distinction between polycystic ovaries and polycystic ovary syndrome. Polycystic ovaries are often, but not always, seen in women with PCOS. But, some women without menstrual or hormonal abnormalities have polycystic ovaries.

The syndrome is thus defined by the menstrual and hormonal abnormalities with or without polycystic ovaries.

The most women with the PCOS can be diagnosed based on factors such as signs/symptoms, patient history, physical examination, transvaginal ultrasound, and special blood tests.

Symptoms

The exact cause of PCOS is unknown. The following characteristics are very often associated with PCOS, but not all are seen in every woman.

The most common symptoms are acne, weight gain and trouble losing weight, extra hair on the face and body, often women get thicker and darker facial hair and more hair on the chest, belly, and back, thinning hair on the scalp, irregular periods. 

Some women have no periods. Others have very heavy bleeding, and fertility problems. Many women who have PCOS have trouble getting pregnant (infertility) and depression.

The long-term health risks for women with PCOS, which include insulin resistance, type 2 diabetes, cardiovascular disease, metabolic syndrome, lipid abnormalities, obstructive sleep apnea and endometrial cancer.

PCOS seems to run in families, so the chance of having it is higher than other women if any family member has PCOS, irregular periods, or diabetes. PCOS can be passed down from either mother's or father's side.

Diabetics

Women with PCOS who have a family history of diabetes appear to be at highest risk for abnormalities in glucose tolerance. A malfunction of the body's blood sugar control system (insulin system) is frequent in women with PCOS, who often have insulin resistance and elevated blood insulin levels.

It is also known that the ovaries of women with PCOS produce excess amounts of male hormones known as androgens. This excessive production of male hormones may be a result of or related to the abnormalities in insulin production.

While PCOS cannot be cured, but there are helpful treatments, as well as a number of things women can do to help reduce symptoms and long term associated effects. With relevant information about this condition women can make lifestyle changes, access support, and lead healthy and fulfilling lives.

The goals of treatment for women with PCOS include weight loss for obesity, suppression of elevated male hormone levels that cause hyperandrogenism and its associated symptoms, such as hirsutism and acne, restoration of normal menses, helping women with an ovulatory infertility to achieve pregnancy and deliver a healthy baby, reversing insulin resistance and, thereby, restoring normal metabolic and hormonal function, preventing the long-term health complications that can occur as a consequence of PCOS.

The symptoms and risk of developing long-term health problems due to PCOS can be greatly improved by losing excess weight. A normal body mass index (BMI) is 19-25.

Losing weight reduces the amount of insulin that the body needs to produce. This in turn leads to reduced testosterone levels and improves the chances of ovulation.

With treatment, women with PCOS are usually able to get pregnant. There is an increased risk of high blood pressure and gestational diabetes during pregnancy.

“I think by far and away the most effective intervention in PCOS are lifestyle changes, by dietary modification, by moderate exercise, not necessarily excessive, but moderate exercise, this can make significant changes to the hormonal environment and this can lead to a significantly reduced lifetime risk for heart disease, diabetes and for cancer of the lining of the uterus,” he added. –

IR

Geriatric care - not everybody's job

Dr Devi Ranasinghe (FAAQHC) Australia

Care of the elderly is a growing concern all around the world. Sri Lanka is a country rich in culture and care of the elderly is a family responsibility. The world is changing and most people live longer and healthier lives compared to those who lived in past generations.

Today we witness advancement in science and technology, better health care combining western medicine with holistic healing and a greater awareness of how to care for ourselves both physically and mentally. These are all part of the processes that increases the life expectancy of humans. Some elderly people are able to live normal lives and care for themselves but many others need additional support and care as they age and become more frail.

The attitude of our young and older generations are very different in today's society. Beliefs of the young can also be very different to those of the older generation. People of all generations enjoy freedom, dignity and respect. Members of the older generation are independent and do not want to be a burden to their family or anyone else. As a society the question we should be asking is: Do we rate the quality of life and wellbeing of older people highly enough?”

As a person becomes increasingly frail, their simple demands are correspondingly increasingly ignored.

The United Nations report indicates that developing countries in Africa, Asia and other regions are experiencing the most rapid aging of their populations. It has been said that “today, almost two in three people aged 60 or over, live in developing countries, and by 2050, nearly four in five will live in the developing world”.

Developing countries are also seeing the fastest growth in their population. It is estimated there will be 280 million people in developing countries by 2050. It is anticipated that there will be more females than males and that the females will live longer than males. These figures are compared to an anticipated 122 million people living in developed regions. This is the population group most likely to become frail by virtue of age and illness and to require the greatest assistance.

Here are some other facts that make your head spin:

Almost 58 million people worldwide will turn 60 in year 2013.

By 2050, there will be more old people than children under the age of 15 for the first time in history.

It's hard to wrap one's mind around a demographic change of this magnitude and the caregiving challenges that it entails. This prospect is a true nightmare with:

People living longer, with more chronic illnesses such as high blood pressure or diabetes and in poorer health. Many of these people will be requiring more attention from family members and costly medical care.

The best picture is this:

People living longer whilst enjoying good health, being productive and a valued member of society by contributing in their workplaces, communities and to their families throughout their later years. That they are treated respectfully and supported economically and socially as they become frail.

With well thought-out policies and a firm commitment to care for the elderly these goals are achievable. We need to take advantage of the wisdom, skills and experience of the elderly.

Other challenges include the fact that older people experience moderate to severe disabilities such as visual impairment such as cataracts, glaucoma,refractive errors and macular degeneration, hearing loss, osteoarthritis and ischemic heart disease to name just a few.

Responsibility

Who will take care of older adults with these problems? Once it was assumed that families would look after older adults. Today, older adults can be left behind to care for grandchildren and take care of themselves as best they can, without the aid of adult children.

The informal support systems for older persons are increasingly coming under stress as a consequence, among others, of lower fertility, out-migration of the young, and women working outside the home etc.

What this means in many instances is that we have the old taking care of the old. We all agree that life is often about being taken care of in childhood, or being a caretaker for others. The lessons are sometimes about nurturing, love and compassion. The older we get, our needs change and we need more help with daily activities, support, love and compassion.

No one wants to live with, and take care of an older person who is ill and generally difficult to deal with due to physical and emotional problems. These situations often require more care than can be provided. It is emotional and hard to see someone you love slip away. If you are able to look after this person, the burden is eased.

Not everyone is capable of being a caretaker. Some can care take children, but not people with special needs and illnesses at any age. Others have no problem caring for an older person with whom they feel a soul connection.

For some, the journey is about taking care of others both family and friends at work, eventually causing them to burn out and wonder, “Who is going to take care of me when I get old.” Many never leave home, and wonder when their life will begin, not realizing they are here to act as parental caretakers.

Lack of a caretaker is a serious problem for older people who have chronic conditions and limitations on their ability to care for themselves and their homes. Their problems are often compounded by increased medical costs due to poor health and the need for more supportive services.

Unfortunately, those who are most vulnerable are also most likely to live alone and to have limited incomes. Most people living alone are women and nearly half of people aged 75 or older live alone.

Many family members force themselves to be caretakers and relieved when the experience is over, but knowing it is why they are here, or, that there is just no one else to do it.Caretaking the elderly is difficult and depressing much of the time. Watching someone die is not easy, especially if you love them. We all have our limitations.

Great pressure

Sometimes caretaking an elderly mother or father can mean living in their home and this can create a great pressure and responsibility for the person mainly involved in care. When the person crosses over, the person taking care of their mother or father needs to face all sorts of new issues. Sometimes these family members have not created a family of their own, so life becomes meaningless.

Many are lost and alone never finding themselves as they wander through life. They may have jobs, friends, and an interest or two, but they are lost once the karma is over. They wonder why they are here. Often they turn to metaphysical studies to help bring deeper meaning to their lives. Things become boring and they get depressed. Many ‘leave’ early to re-join the person who died.

I can remember when my mother and father were sick. We all were exhausted especially my younger sister who tirelessly looked after our parents. She never complained, but I have seen how tired she was. She has a young family and she was a nurse. It was an advantage but looking after an older person is a specialised area. We hired some people to provide basic personal

hygiene but we knew that they didn't have any basic skills in supporting any of other tasks.

One friend told me how she looked after her aged mother and cancer ridden sister. She said it was the hardest thing she has ever had to do. She said there was no help available for her.

Caretaking an aging parent, while trying to handle your other responsibilities is often as difficult as a parent raising a child alone, struggling to provide proper care and attention. Life moves in these cycles, through time.

When does the body age?

Ageing in humans is a biological change process that involves physical, psychological and social change. Age is measured chronologically, and a person's birthday is often an important event. We tend to categorize chronological age into young old (65-74), the middle old (75-84) and the

oldest old (85+) but it does not correlate with functional age. For example, two people may be at the same age, but differ in their mental and physical capacities. This does not necessarily have to occur when someone is old.

Some people are challenged from birth and require special care taking all of their experience in the physical. The soul determines how the physical body will perform and how needy it will be, and the type of physical experience the soul will have in that body. The body stops ‘working’ when it is emotionally exhausted. Some elderly are not as lucky as others and face issues. Physical reality is all about issues:

One or more illnesses that leave them limited and often co-dependent lack of money to enjoy life families who abandon them as they cannot handle the responsibility of caretaking depression, loneliness unable to handle their own emotions and physical illnesses Some illnesses move quickly after which the person crosses over, others are slowly debilitating.

Once such illness is Alzheimer's Disease.It lasts for years and affects not only the caretakers, but as with all illnesses in a family, it affects everyone, especially those who live with the sick person. Ordinary persons are not always cut out to care take of someone in this situation On the positive side of the ageing - today is all about quality of life, health and healthy attitudes.

No one suggests enough is being done but increasingly there is an awareness of that we need to do something for members of our aging population.

Enlightened policies, including those dealing with caregiving, may make a great difference in the experience of older adults in the years to come. Stasis and a failure to envisage new ways of responding to these demographic shifts, no longer seem an option. It's a reality, here and now, and unfolding at breathtaking speed. Having worked in the field of aging for some 20 years I believe there are many things, in addition to the answer above, that would help us provide better care for the elderly.

A very important part of care is allowing the elder to have options for how they want to live. All of us want to stay in an environment which is comfortable and familiar and this would more than likely be their own home.

Some people prefer to go into an institutional setting especially if all of their needs can be met and there is some socialization but this is the exception rather than the rule.

We all feel that there is someone to take care of us when we need help other than our own children. We want our children to enjoy life without undue pressure from us. We want to have control in our lives and be independent as much as possible. Being helpless is humiliating and a fearsome process.

As a nation we could do more by creating a workforce who are trained and understand the ageing process and can support elderly people which in turn allows families and friends to better care for the elderly.

What does an aged care worker do

The goal of an aged care worker is to provide personal care and support to an older person to help them maintain their independence and improve their quality of life. Aged care workers are also multi-skilled and work in an interdisciplinary team. Aged care work is especially rewarding as it gives you the opportunity to form close relationships with clients and their families. Whilst some personal care workers may choose to work in residential care (nursing homes) others may prefer to work in the community visiting clients in their homes.

The Wickramasinghe Institute of Training provides competency based training for students to gain appropriate knowledge and skills. They include but are not limited to:

* Aged Care Studies which aim to advance knowledge of ageing and nursing of the aged. It explores the implications and challenges of a rapidly ageing population and encourages students to acknowledge the individuality of the ageing experience and the need for older people to maintain their own health and health care management where possible.

* Students will have the opportunity to reflect on, and explore, the complexity of the issues associated with nursing the elderly, and will use as a focus the policies which impact on the professional, organizational and political context of aged care nursing practice.

* Students critically analyse ageing issues and theoretical perspectives under-pinning the ageing process and are able both to examine the complexities associated with nursing and ageing.

* The training is conducted in a supportive but self-directed flexible learning environment in which students will be encouraged to explore,question, discuss and debate the challenges they face.

Importantly, training also provides direct assistance to the thousands of family and friends who support older people, frail aged people and younger people with disabilities.

* The men and women who are employed in the Aged Care Sector gain personal satisfaction knowing they provide flexible, timely support - which is individually tailored to meet the physical, psychological and social needs of each person they assist.

* Aged care is about maximising, restoring and maintaining the independence and wellbeing of individual people.

* The opening of the Wickramasinghe Institute of Training will be marked by a lecture on “The benefits of introducing aged care training to the Sri Lankan health system” at Renuka Hotel Colombo on March 29 at 9.30 a.m