Asthma

Also see Allergy page 197

During an asthma attack, the muscles in the walls of the small airways contract (bronchopasm), the linings of the small airways become inflammed, and excessive mucus is produced in the small airways. All three reactions combine to narrow the airways, thus limiting the passage of air, especially during breathing out. The disorder usually begins in childhood, with about half the children outgrowing it.

Symptoms

• Chest tightness.
• Breathing difficulty; laboured breathing in episodes. (Symptoms are worse at night.)
• Wheezing (a whistling sound while breathing).
• Coughing, with or without thick sputum.
• During severe attacks, cyanosis (bluish discoloration) around the lips, sweating, and a fast pulse rate.
• In infants, fast breathing, with the lower ribs being drawn in.

Complications

• Pneumothorax (collapsed lung due to an air leak).
• Acute respiratory failure.
• Death.

Common causes
Asthma is the result of a hypersensitivity reaction to stimuli, inflammation and constriction of the air passages. It is a condition due to both hereditary and environmental factors. An asthma attack may be provoked by:

• Allergens (eg. animal dander, dust, certain food and medicines, mites, mold spores, pollen, etc).
• Viral or bacteria infections (eg. bronchitis, common cold, coughs, sinusitis).
• Environmental irritations (eg. exhaust gases, hair spray, perfumes tobacco smoke).
• Emotional stress (eg. excitement, upheaval).
• Strenuous exercise.

What you can do

• Consult a doctor the first time you start wheezing, or if the condition does not respond to the prescribed treatment.
• Take the medication prescribed by the doctor (eg bronchodilator). Inhaled bronchodilators are usually recommended. Wait 15-20 minutes after an inhaled dose. Rrepeat if necessary.
• Take your peak expiration flow rate.

Call your doctor or go to the hospital if:
. you or your child is not getting better after following the doctor's instructions.
. you or your child is unable to talk because of breathing difficulty.
. you or your child requires inhaled bronchodilator very often (eg more than 3-4 hourly).
. your child looks exhausted.

• Try to be calm and call for help if you cannot cope. See HELPLINES.
• Rush the nearest hospital's emergency room if you have an accute attack.

The bystander:

• Sit the person upright and make him lean forward, with both arms resting on the table.
• Rush the person to the nearest hospital's emergency room if an acute attack does not respond to the prescribed medication.

What your doctor can do for you

• Administer oxygen.
• Administer a bronchodilator via nebulisation.
• Administer oral or intravenous steroids.
• Treat an accompanying chest infection with antibiotics.
• Prescribe long-term anti-inflammatory treatment.
• Teach you how to manage acute attacks, and how to use certain devices (eg inhaler, turbuhaler, rotahaler, diskhaler) to ensure optimum benefit from them.
• Teach you how to use a peak flow meter to monitor your asthma.

Prevention tips

• Know what triggers the asthma attack. If possible, avoid the factors that trigger the disease. (Keep your home free of dust, animal hair, mites, etc.; and stay away from irritations such as cigarette smoke, exhaust fumes, etc).
• Stop smoking.
• Take the medications prescribed by the doctor to reduce the frequency and severity of subsequent attacks.
• Exercise regularly to improve lung and heart function.

Helplines
Persatuan Asma Malaysia 03-757 6641

This article is reffered to Malaysia Healthcare Guide - The family health guide, MIMS, 2nd edition, 1997, page 223-224

Eczema

Skin rash

Also see Allergy page 197

Eczema is a skin rash or inflammation characterised by blistering, cracking, itching, oozing, redness, or scaling. The skin often becomes thick and discolored due to constant scratching. Eczema is common, recurrent, and sometimes persistent, but it is not contagious. Most affected children outgrow the condition by puberty.

Symptoms

• Swelling and redness.
• Itchy rash, which is sometimes intense.
• Blisters (small bumps filled with fluid) that may ooze due to scratching.
• Crusty, dry and cracked, leathery, scaly, thickened, or weeping areas of skin.
• Pain, soreness, discomfort.

Complications

• Secondary bacterial infection.

Cause
There are many types of eczema. They are due to combination of endogenous (internal) and external factors.

• Allergy - allergic contact eczema.
• Skin irritation - irritant contact eczema.
• Photosensitive eczema - sunlight-induced.

What you can do

• Seek treatment early.
• Avoid scratching as much as possible, as it can lead to bacterial infection.
• Apply cream, lotion, or moisturizer to prevent dryness.
• Apply soothing ointment on the affected area to ease irritation and cover with dressing to prevent scratching.
• Wear cotton clothes. Do not use wool and synthetic fabrics as this tend to irritate the skin.
• Take antihistamine (anti-allergy medicine). Take sedative antihistamines at night and non-sedative in the day or at work.
• Consult a doctor if the condition shows signs of spreading or is distressful, or if there is an infection.

What your doctor can do for you

• Conduct skin allergy tests.
• Prescribe hydrocortisone (anti inflammatory cream) or other creams.
• Prescribe antibiotics for bacterial infection.
• Diagnose the type of eczema, help to identify the cause.
• Prescribe oral histamines.

Prevention tips

• Try to determine the substances that cause allergic reactions or skin irritation in you and avoid them as best as you can.

For products see Skin antiseptics & disinfectants page 498, Skin anti-itch agents & antihistamines page 491

This article is reffered to Malaysia Healthcare Guide - The family health guide, MIMS, 2nd edition, 1997, page 342-343

That You Will Love

Psoriasis

Psoriasis is a skin disorder characterised by thick, red patches of skin that are covered by white or silvery scales. It usually appears between the ages of 20 and 30, and it tends to run in families. It is not infectious although the patient can go into remission by treatment on spontaneously. Psoriasis, even in mild causes severe embarassment, shame and social isolation. Psoriasis, cannot kill easily but ruins people's lives.

Symptoms

• Raised red patches of skin, covered with dry white or silvery scales. The patches usually appear on the elbows, knees, nails (fingers and toes) scalp, and trunk.
• Itch, in some cases.
• Pitted, cracked, or deformed nails; loose nails.
• Profuse shedding of dead skin (looks like dandruff when on the scalp), in severe cases.
• Cracked painful skin, blisters on the palms and soles.

Complications

• Arthritis (inflammation of the joints), in severe cases.
• Impaired use of hands or feet.
• Depression due to social isolation and anxiety.

Cause
Not yet fully known, but is associated with:

• The overproduction of new skin cells (10 times as fast as normal), leading to the buildup of live cells (the cause of thickened patches) and profuse shedding of the outer skin layer.
• A combination of factors have been implicated including hereditary factors, stress, after physical illness or infection.
• Immunologic.

What you can do

• Sunbathe for 15-30 minutes daily, but not to the point of being sunburnt. A sun (ultraviolet) lamp is an alternative.
• Apply petroleum jelly to the affected areas.
• Avoid ingestion of alcohol.
• Avoid or learn to manage stress.
• Proper stress management and follow a healthy lifestyle. Keep a healthy body weight.
• Consult a doctor if you suspect psoriasis. He will help you control the disorder.

What your doctor can do for you

• Explain the condition; counsel.
• Recommend cream, ointment, or other treatment to clear the psorisis (eg coal targel).
• Prescribe anti-inflammatory medicine for arthritis.
• Recommend ultraviolet treatment.

Helplines
Psoriasis Association of Malaysia 03-254 6160

For other products see Skin medicated soaps/cleansing agents/gloves page 501

PRODUCT GUIDE
BE-PROSALIC K H Hoe
Ointment 15 g, 450 g (871164A)
Contains Betamethasone dipropionate 0.064%, salicylic acid 3%.
Uses Relief of skin inflammations, eg psoriasis, dermatitis & seborrheic dermatitis.
How to use Wash & dry the affected area. Apply the ointment sparingly to the affected areas & rub-in twice daily, or as prescribed by the doctor.
Precaution For external use only. If symptoms persist, consult your doctor. This medicament is to be used only for your present condition. Do not allow use by other person & discard unused ointment after healing is complete. Caution in use if to be applied to large areas, particularly in children. Avoid prolonged use & contact with eyes. Burning sensation, irritation, skin eruptions, dryness & changes in skin color may occur.

BEPROGEL K H Hoe
Topical solution 0.5 mg x 30 ml [913399A]
Contains Betamethasone dipropionate 0.064%
Uses Treatment of skin inflamation, eg eczema, dermatitis, seborrheic dermatitis & psoriasis.
How to use Wash & dry the affected area. Apply the topical solution sparingly to the affected areas & rub-in once or twice daily, or as prescribed by your doctor.
Precaution For external use only. If symptoms persist, consult your doctor. This medicament is to be used only for your present condition. Do not allow use by other person & discard unused solution after healing is complete. Caution in use if to be applied to large areas, particularly in children & in occlusive dressing. Avoid prolonged use.

BEPROGENT K H Hoe
Cream 1.5 g, 450 g (871377A)
Ointment 450 g (871378A)
Contains Per g Betamethasone dipropionate 0.64 mg, gentamicin sulphate 1.7 mg
Uses Treatment of eczema, dermatitis, seborrheic dermatitis & psoriasis aggravated by secondary bacterial infection.
How to use Apply the cream or ointment to the affected area twice daily.
Precaution For external use only. If symptoms persist, consult your doctor. This medicament is to be used only for your present condition. Do not allow use by other person & discard unused cream/ointment after healing is complete. Caution in use if to be applied to large areas, particularly in children & in occlusive dressing. Avoid prolonged use & contact with eyes. Deafness, burning sensation, irritation, skin eruptions, dryness & change in skin color may occur.

BEPROSOL K H Hoe
Ointment 15 g (940218A)
Contains Betamethasone dipropionate 0.064%
Uses Treatment of skin inflammation, eg eczema, dermatitis, seborheic dermatitis & psoriasis.
How to use Wash & dry affected area. Apply the ointment sparingly to the affected area once or twice daily, or as prescribed by your doctor.
Precaution For external use only. If symptoms persist, consult your doctor. This medicament is to be used only for your present condition. Do not allow use by other person & discard unused ointment after healing is complete. Caution in use if to be applied to large areas. Avoid prolonged use.
Warning Do not use in chicken pox, acne, viral, bacteria or fungal skin infections, on the eye or occlusive dressing.

BEPROSONE K H Hoe
Cream 15 g, 450 g (870597A)
Ointment 450 g (870596A)
Contains Betamethasone dipropionate 0.064%
Uses Treatment of skin inflammation, eg eczema, dermatitis & psoriasis.
How to use Apply the cream/ointment to the affected area as prescribed by your doctor.
Precaution Caution in use in applying to large skin areas, particularly in children & in occlusive dressing. Burning sensation, skin irritation, dryness, changing in skin color & skin eruptions may occur.

BETNOVATE
Glaxo Wellcome
Cream 5 g x 12's, 15 g x 12's, 100 g [860146A]
Ointment 5 g x 12's, 15 g x 12's, 100 g [870601A]
Contains Betamethasone valerate 0.1%
Uses Treatment of eczema, psoriasis, seborrheic dermatitis & other skin inflammations not due to virus, bacteria or fungi.
How to use Apply a small amount of cream or ointment to the affected area 2 or 3 times daily until there is an improvement.
Special Instruction occlusion may be applied, using a plastic film in severe cases.
Precaution Avoid prolonged use, especially in infants & children. Thinning of the skin may occur.
Warning Do not use in acne, chickenpox & mouth ulcers, viral, fungal or bacterial skin infections.

Keep all medicines safely out of reach of children.

BETNOVATE SCALP APPLICATION
Glaxo Wellcome
Scalp application 30 mL [870598A]
Contains Betamethasone valerate 0.1%
Uses Treatment of hair scalp infections eg psoriasis & severe dandruff.
How to use Apply a small amount to the scalp night & morning until there is an improvement.
Precaution Avoid contact with the eyes or use near an open flame. Avoid prolonged use.
Warning Do not use if there is scalp infection.

BETNOVATE-N
Glaxo Wellcome
Cream 5 g x 12's, 15 g x 12's, 100 g [871159A]
Ointment 5 g x 12's, 15 g x 12's, 100 g [871152A]
Contains Betamethasone 0.1%, neomycin sulphate 0.5%
Uses Treatment of eczema, psoriasis. Also helps relief insect bites, sunburn, prickly heat, itching arround the skin of the anus & external ear infections.
How to use Apply a small amount of cream or ointment to the affected area 2 or 3 times a day until there is an improvement.
Special Instruction Occlusive may be applied , using a plastic film in severe cases.
Precaution Avoid prolonged use, especially in infants & children. Thinning of the skin may occur.
Warning Do not use in acne, chickenpox & mouth ulcers, bacterial, viral or fungal skin infections. Do not use if you have a perforated or injured ear drum.

CELESTODERM-V
Schering Plough
Cream 15 g, 450 g [870619A]
Contains Betamethasone valerate 0.1%
Uses Relief of skin inflammations, eg eczema, dermatitis, seborrheic dermatitis & psoriasis.
How to use Apply a thin film of cream to the affected area 1-3 times a day.
Precaution For external use only. Avoid contact with eyes or mucous membranes, prolonged use or occlusive dressing, particularly in infants & children. Disconue use if irritation or rash occurs & consult your doctor.
Warning Do not use for bacterial, viral or fungal skin infections.

CELESTODERM-V WITH GARAMYCIN
Schering Plough
Cream 15 g, 450 g [871375A]
Contains Per g Betamethasone valerate 1 mg, gentamycin sulphate 1 mg
Uses Treatment of skin inflammations or allergy, eg eczema, pruritus (severe itch), dermatitis, seborrheic dermatitis & psoriasis.
How to use Apply a small amount of cream to the affected area twice daily, or as prescribed by the doctor.
Precaution For external use only. Avoid contact with eyes or mucous membranes. Caution in use when applying to large surface areas or under occlusive dressing.
Warning Do not use in bacterial, viral or fungal skin infections.

CELESTODERM-V WITH NEOMYCIN
Schering Plough
Cream 15 g [871173A]
Contains Per g Betamethasone valerate 1 mg, neomycin sulphate 5 mg
Uses Relief of skin inflammations eg psoriasis, eczema, dermatitis & seborrheic dermatitis.
How to use Apply a thin film of cream to the affected area 2 or 3 times a day.
Precaution For external us only. Avoid contact with eyes or mucous membranes, open wounds or damaged skin, prolonged use or occlusive dressing, particularly in infants & children. Irritation, burning sensation, dryness or deafness may occur.
Warning Do not use for bacterial, fungal or viral skin infections.

CLODERM SCALP APPLICATION
K H Hoe
Scalp application 30 mL [930240A]
Contains Clobetasol propionate 0.05%
Uses Treatment of hair scalp inflammation, eg psoriasis & eczema.
How to use Wash & dry the affected area. Apply the scalp application sparingly to the affected area & rub-in twice daily, or as prescribed by your doctor.
Precaution If symptoms persist, consult your doctor. This medicament is to be used for your present condition only. Do not allow use by other person & discard unused scalp application after healing is complete. Caution in use in children, large surface areas & long-term treatment. Avoid contact with eyes. Burning sensation, irritation, dryness, skin eruptions & changes in skin color may occur.
Warning Do not use in children below 1 yr, infection of scalp & dermatitis.

DAIVONEX Leo
Ointment 50 ug/g x 30 g [921382A]
Contains Calcipotriol
Uses Treatment of psoriasis vulgaris.
How to use Apply the ointment to the affected area twice daily, up to a maximum of 100 g weekly.
Precaution Avoid contact with the face since it may cause facial irritation. Wash hands carefully after application.

DERMOVATE
Glaxo Wellcome
Cream 5 g x 12's, 15 g x 12's, 100 g [870583A]
Ointment 5 g x 12's, 15 g x 12's, 100 g [870584A]
Contains Clobetasol propionate 0.05%
Uses Treatment of psoriasis, eczemas & other conditions which do not respond to less active steroids.
How to use Apply the cream or ointment sparingly to the affected area once or twice daily until there is an improvement.
Special Instruction Occlusion may be applied, using a plastic film in severe cases.
Precaution Avoid prolonged use, especially in infants & children. Thinning of the skin may occur.
Warning Do not use in acne & mouth ulcers, in children under 1 yr & in nappy rash, chickenpox & fungal, viral or bacterial skin infections.

DIPROCEL, DIPROGENTA, DIPROSALIC, DIPROSONE
All by Schering Plough, see page 466

EGOPSORYL TA Ego
Cream 30 g, 500 g [913162X]
Contains Sulphur 0.5%, coal tar 1%, phenol 0.5%
Uses Control of general psoriasis & psoriasis of the scalp. Chronic dermatitis.
How to use Apply 2-4 times daily. As the condition improves, reduce the number of times of application gradually.
Special Instruction Do not stop application suddenly. For enhanced effect, apply petroleum jelly over Egopsoryl TA.
Precaution For external use only. Irritation, acne-like eruptions on the skin & sensitivity to light may occur. Discontinue use if irritation occurs.
Warning Do not use on acutely inflammed or weeping skin. Do not use for a long time without consulting a doctor. If you are using another medication inform your doctor.

ESPERSON Hoechst
Ointment 0.25% x 30 g [870492]
Contains Desoximetasone
Uses Treatment of eczema, psoriasis, severe skin infections, burns, sunburn, insect bites & stings.
How to use Apply the ointment to the affected skin areas & if possible, rubbed in slightly 2 0r 3 times a day at the beginning of treatment. If there is improvement, the frequency of applications may be reduced. To prevent the disease to recur, treatment should be continued for some time even after the complete disappearance of symptoms.
Precaution Caution in use for infants & small children; long-term treatment & application to large area or near eyes.
Acne, changes in skin pigmentation may occur.

FLUCIDERM K H Hoe
Cream 15 g [913400A]
Contains Fluocinolone acetonide 0.025%
Uses Treatment of skin inflammation, eg eczema, dermatitis, seborrheic dermatitis & psoriasis.
How to use Wash & dry the affected area. Apply the cream sparingly to the affected areas & rub-in once or twice daily, or as prescribed by your doctor.
Precaution For external use only. Avoid contact with eyes. Caution in use in large areas or occlusive dressing. If symptoms persist consult your doctor. This medicament is to be used only for your present condition. Do not allow use by other person & discard unsed cream after healing is complete. Caution in use in children & in large areas of the skin. Burning sensation, dryness of skin, changes in skin color & skin eruptions may occur.
Warning Do not use in acne, chickenpox, viral, bacterial or fungal skin infections.

H-S-C K H Hoe
Ointment 450 g [871319A]
Contains Per g Hydrocortisone 10 mg, salicylic acid 20 mg, strong coal tar solution 30 mg
Uses Treatment of psoriasis.
How to use Apply the ointment thinly to the affected area once or twice daily depending on the seriousness of the condition. When use in scalp disorders, a small amount of ointment should be rubbed gently into the roots of the hair.
Precaution Avoid prolonged use or occlusive dressing, or when using on large areas especially in children. Caution in use when exposed to sunlight. For external use only. Not for use on the eyes. Burning sensation, dryness, change in skin color & skin eruptions may occur.
Warning If you are sensitive to sunlight, consult your doctor first before using this medicament.

K H HOE HYDROCORTISONE
K H Hoe
Cream 450 g [870471A]
Ointment 450 g [870472A]
Contains Hydrocortisone 1 %
Uses Treatment of skin inflammations, eg eczema, dermatitis & psoriasis.
How to use Apply thinly the cream or ointment to the affected area 1-4 times a day, depending on the seriousness of the condition. Occlusive dressing may be used when treating psoriasis.
Precaution For external use only. Avoid prolonged use or contact with eyes. Caution in use when applying an occlusive dressing, in children. Burning sensation, dryness of skin, changes in skin color & skin eruprions may occur.

NERISONE Schering AG
Cream 10 g, 50 x 10 g [900556A]
Fatty ointment 10 g, 50 x 10 g [900558A]
Ointment 10 g, 50 x 10 g [900557A]
Contains Diflucortolone valerate 0.1%
Uses Skin infections, eg in dermatitis, eczema, psoriasis, burns, sunburns & insect bites.
How to use Apply the cream or ointment thinly to the affected area 2-3 times daily.
Special Instruction Use the cream for weeping skin conditions; ointment for skin that is neither weeping nor very dry; fatty ointment for very dry conditions.
Precaution Avoid application to large areas of the skin or for prolonged periods. Avoid contact with the eyes.
Warning Do not use if you have viral diseases, eg chickenpox, shingles.

NEUTROGENA T/GEL SHAMPOO
Neutrogena
Shampoo 4.4 fl oz, 8.5 fl oz [911817X]
Contains Solubilized coal tar extract 2%
Uses Helps control psoriasis, seborrheic dermatitis & dandruff.
How to use Wet hair thoroughly. Massage liberal amount into the scalp. Leave lather on scalp for several minutes. Rinse well & repeat.
Precaution For external use only. Do not apply to inflammed or broken skin. If irritation develops, discontinue use & consult your doctor. Discoloration of gray, blonde, bleached or tinted hair may occur.

PINETARSOL BATH OIL
Ego
Bath oil 200 ml [912398X]
Contains Pine tar 2.3%
Uses Dry, itchy, inflammed, or flaky skin conditions. Supplementary relief of the symptoms of dry skin, eczema & psoriasis.
How to use Adults Bath Add 10-15 mL to a lukewarm water & bathe for 5-10 minutes daily, more often in severe cases. Shower Wet skin, then smooth a small amount onto the skin. Leave on for 2-3 minutes, then rinse off. Pat skin dry. Patients in bed, elderly patients Add 3 ml to a basin of water & wash skin gently. Pat skin dry. Infants Add 3 ml to a baby's bath. Pat skin gently dry. Do not rub.
Precaution For external use only. Avoid contact with eyes. Skin irritation may occur.

PINETARSOL/PINETARSOL GEL
Ego
Gel 100 g [912381X]
Solution 200 mL, 5 L [912380X]
Contains Gel Pine tar 1.6%, glycerin 5% Solution Pine tar 2.3%, triethanolamine lauryl sulphate 6%
Uses Relief of itch & inflammation associated with dermatitis, psoriasis & eczema, chicken pox, heat rash & eruptions in the napkin area of various origins.
How to use Gel : Use as an alternative for shower use & patients in bed. Apply to wet skin & gently smooth over affected area. Leave on for 2-3 minutes & rinse. Pat skin dry.
Solution : Bath Add 15-30 ml to a lukewarm bath (3 ml to a baby's bath) & bathe for 5-10 minutes daily, more often in severe cases. Pat skin dry. Shower Wet skin & spray on a small amount. Leave for a few minutes, then rinse. Pat skin dry. Patients in bed Add 15 ml to 3 L of water & sponge freely. Pat skin dry.
Avoid using with Soap on inflammed areas skin. Precaution For external use only. Avoid contact with the eyes & nostrils. Skin irritation & acne-like eruptions may occur.

PSORIGEL Galderma
Gel 4 oz [920445X]
Contains Coal tar solution 8.8% (equivalent to 1.75% coal tar)
Uses Controls skin itching, flaking & scaling associated with psoriasis.
How to use Apply to the affected areas 1-4 times daily or as directed by a doctor. Rub in well, let dry & remove any excess by patting with tissue paper.
Avoid using with Utltraviolet radiation treatment, other medicines for treating psoriasis. Precaution For external use only. Avoid contact with eyes. Upon contact, flush eyes with water. Do not use this medicament in or arround the rectum, the genital area or groin except on medical advise. Do not use on highly inflammed or broken skin. Avoid exposure to direct sunlight after applying this medicament. If undue irritation develops, discontinue use & consult your doctor/pharmacist.

SEBITAR Ego
Liquid 250 mL [912421X]
Contains Pine tar 1%, coal tar 0.2%, salicylic acid 2%, undecylenamide 1%
Uses Relief of itch, inflammation & flaking skin conditions associated with dandruff, seborrhea, eczema & psoriasis of the scalp.
How to use Wet hair, apply to the affected area & massage well. Apply to the remainder of the scalp & hair & work into a lather. Leave for 5 minutes, rinse thoroughly.
Precaution For external use only. Avoid contact with eyes, nostrils & broken skin. Skin irritation & acne-like eruptions may occur.

TRAMSONE K H Hoe
Cream 15 g [913401A]
Contains Triamcinolone acetonide 0.1%
Uses Treatment of skin inflammations, eg eczema, dermatitis, seborrheic dermatitis & psoriasis.
How to use Wash & dry affected area. Apply the cream sparingly to the affected area & rub-in once or twice daily as prescribed by your doctor.
Precaution If symptoms persist, consult your doctor. This medicine is to be used for your present conditon only. Do not allow use by other person & discard unused cream after healing is complete. Avoid contact with eyes. Caution in use in children & if to be applied to large areas or when under occlusive dressing. Burning sensation, dryness & skin eruptions may occur.
Warning Do not use in skin viral infection, eg chickenpox, acne & skin tuberculosis.

Are you in the habit of eating fast? If you are, you may tend to overeat! This is because your body takes 20 minutes to tell your mind that it's satisfied. Try to chew your food well, eat slowly and enjoy every bite. This way, your body will have time to tell your brain that you've had enough!

This article is reffered to Malaysia Healthcare Guide - The family health guide MIMS 2nd edition 1997 page 464-468

Diabetes

Diabetes mellitus ia a condition which results from a lack of insulin. Insulin is a hormone produced by the pancreas. It is needed for the assimilation of glucose, amino acids and fatty acids by the body for energy or storage. Defiency of or ineffectiveness of insulin results in high glucose level in the blood. The disease cannot be cured but it can be controlled by lifelong treatment. There are two major types of diabetes mellitus. Type I (insulin-dependent) occurs mostly in young people and requires regular insulin injections. Type II (non-insulin dependent) occurs mainly in older people: some can be controlled with proper diet and exercise alone; and others may need antidiabetes medication. Some may also need insulin injections. Most of those who suffer from non-insulin dependent diabetes are overweight or obese. Diabetes tends to run in families.

Symptoms

• Constant thirst.
• Polyuria or frequent urination. Getting up frequently to pass urine at night.
• Frequent hunger, strong appetite.
• Weight loss despite a hearty appetite.
• Tiredness, weakness.
• Tingling sensation and numbness in the hands and feet.
• Blurred vision.
• Recurrent skin infections.
• Itching in the private parts.

Complications

• Severe hyperglycemia (too much glucose in the blood) with too much acid in the body, can cause confusion and loss of consciousness. (See LOSS OF CONCIOUSNESS page 415.)
• High blood pressure, heart disease, stroke, and kidney damage.
• Blindness (due to retinal damage), cataracts, and other eye disorders.
• Poor healing of wounds.
• Gangrene (tissue death) due to cut off of blood supply. This usually occurs in the toes and feet.
• Infection, in particular skin, and soft tissue, vaginal infection.
• Numbness, due to nerve damage with loss of sensation especially the feet.

Cause

• Not fully known yet. However, it is beliaved to be due to:
• Heredity.
• An autoimmune disorder. The body's defences attack and destroy the cells in the pancreas that produce insulin.
• A viral infection that damages the pancreas which may than set off an autoimmune process.
• Lack of exercise, poor dietary habits and obesity.

What you can do

• Consult a doctor if you think you have diabetes.
• Stick to a lifelong low-sugar, low-fat, high fibre diet. If overweight, lose weight. Contol your intake of refined sugar. Spread out intake of food over the day. (Diet and weight management are often enough to keep non-insulin dependent diabetes in check and may prevent diabetes-prone people from developing diabetes.)
• Exercise regularly.
• Regularly look over your body, especially the feet, for wounds or infection; never walk bare foot. Wash your feet daily, dry them thoroughly, and apply talcum powder. Take extra care when cutting your fingernails and toenails. Shave with care.
• Practice good hygiene.
• Maintain good dental health.
• Take prescribed medicine religiously. Never stop medication without consulting your doctor.
• Monitor your blood or urine sugar regularly.
• Have regular medical checkups.

What your doctor can do for you

• Take blood tests initially to confirm the presence of diabetes and subsequently to check whether blood sugar is under control.
• Recommend an appropriate diet regimen and exercise.
• Prescribe anti-diabetes tablets or insulin injections if necessary. Teach you how and where to inject insulin on yourself.
• Teach you how to monitor the glucose level in your blood.
• Watch out for the development of complications and treat them.

If you are or suspect you may be pregnant, take extreme care about any medicine you take, particularly during the first 12 weeks - consult your doctor or pharmacist.

Injection sites for insulin:

1. Abdomen - fast absorption 2. Arm - intermediate absorption 3. Thigh - slow absorption 4. Buttock - slow absorption 5. One hand's width from shoulder, elbow, hip and knee 6. Skin 7. Subcutaneous tissue 8. Muscle 9. Inject insul;in into subcutaneous tissue into the fat (between skin & muscle layer)

Foot care for diabetics:

1. Dry the feet well especially between toes to prevent fungal growth.
2. Examine the feet daily for any blister, sore, scratch, skin discolouration, calluses or ingrown toenails. See a doctor immediately if any of these symptoms appear.
3. Change socks or stockings daily. Cotton or wool socks are better as nylon can cause perspiration.
4. Wear soft leather shoes to allow the skin to breathe.
5. Wash feet daily with luke warm water & mild soap.
6. Cut your nails straight across. Gently file rough edges.
7. Keep the skin, heels & soles supple by applying lanolin, but do not apply between toes. If you tend to perspire, dust feet with foot powder or baby powder.
8. Examine your shoes everyday for cracks, pebles, nails & any roughness which may cause skin irritation.
9. Do not walk barefoot either indoors or outdoors. Wear comfortable shoes, slippers or sandals that fit well.
DON'T: a. Soak feet in hot water or use hot water bottle for the feet. b. Use com plasters & other commercial foot preparations.

Recommended exercises for diabetics:

1. Tiptoe exercise: Hold on to a chair. Raise & lower yourself on your toes alternately. Repeat 20 times. 2. Leg swing: Hold on to a table & stand with one leg slightly raised on a thick book. Swing the other leg to & fro 10 times. Repeat the same procedure on the other leg 10 times. 3. Calf stretch: Lean with palms of your hands against the wall. Keep your feet some distance away and flat on the floor. Bend your arms 10 times keeping your back and knees straight without raising the heel. Sustain the stretch for 10 seconds. 4. Knee bend: Hold on to a chair & do deep knee bends keeping your back straight. Repeat 10 times (start with 5 times & increase gradually). 5. Daily walk: Take a walk daily of 1/2 - 1 hour. Try to increase duration every week. 6. Ball roll: Sit on a straight backed chair, with your foot on a rubber ball. Grip the ball with your toes, then relax your hold. Repeat a few times for each foot.

Prevention tips

• Avoid refined sugar, honey and excessive intake of sweets and simple carbohydrates, fats and salt.
• If overweight, reduce weight.
• Exercise regularly. Aerobic exercise (eg. cycling, jogging, vigorous sports, swimming, brisk walking), decreases the risk of heart disease, helps control your weight, and helps the body to maximise the effects of insulin.
• If you have a family history of diabetes and you are over 40 years, have your blood checked for sugar 2 hours after a good meal. You should repeat this every year or two as many people have diabetes for years without feeling unwell.

Helplines
Malaysian Diabetes Association 03-750 2385

This article is reffered to Malaysia Healtcare Guide - The family health guide MIMS 2nd edition 1997 page 323-325

Headache

Also see Facial neuralgia page 355, Jaw joint pain page 413

Just about three out of four persons suffer from headache each year. Headache is seldom a symptom of an underlying brain disease, even when the pain is intense. The two main types of headache are migrane and tension headache which are described in the following pages.

Headache-migraine
Migraine

Migrane, a common and painful headache that typically occurs on one side of head, often begins at puberty or early adulthood, runs in families and tends to recur. More women than men suffer from migraines (about 75% of the cases), usually before menstruation, with the attacks tapering off after menopause.

Symptoms
Migraine without aura:

• Pain, usually felt on one side of the head. It gradually builds up to full throbing intensity and is aggravated by movement, light or noise.
• Nausea.
• Vomiting.

Migraine with aura:

• An aura (unusual sensation) coming about 20 minutes before the headache. The symptoms may include nausea, vomiting, enlarging blind spots, flashing or zigzagging light, strange noises or smells, and numbness in one side of the body.
• Same symptoms as common migraine, but the onset of pain is more abrupt.
• Sensitivity to light.
• In rare cases, paralysis on one side of the body.

Cause
Not yet fully known, but attributed by many experts to chemical inflammation of the dural blood vessels, which stimulate the nerve endings. Factors that trigger the condition include:

• Stress (eg. anger, changes in climate, distress, overexertion, shock).
• Certain kinds of beverages, food, and food additives (eg. alcohol, chicken liver, citrus fruits, monosodium glutamate, nitrites, red wines).
• Head injury.
• Sensory stimulation (eg. bright light, blaring sounds).
• Overexertion.
• Hunger
• Hormonal imbalance, oral contraceptives.

What you can do

• Lie down and sleep or rest in a dark, quiet room.
• Apply an ice pack to the painful area.
• Take a cold shower.
• Take simple painkilllers.
• Try to identify the factors that trigger the headache and avoid them.
• Consult a doctor if the pain is unbearable or if the recommended measures offer no relief.

What your doctor can do

• Rule out serious underlying causes of headaches.
• Prescribe stronger painkillers.
• Prescribe prophylactic (preventive) medicine for migrane.
• Prescribe medicine to stop the migraine.

Prevention tips

• Avoid the factors that can trigger the headache.

Helplines
Headache Society of Malaysia 03-757 6588

For other products see Painkillers & antifever medicines page 439


Headache-tension headache
Tension headache, Neck ache
A tension headache, unlike a migraine, is characterised by generalized pain, a feeling of fullness or pressure over the top of the head or at back of the neck. It can occur everyday, is not associated with vomiting and is not aggravated by movement. The disorder is the most common type of headache, affecting people of all ages.

Symptoms

• Dull, sometimes intense pain over the top of the head, the temples, or at the back of the neck.
• Sore scalp and neck muscles.

Cause
Not yet fully known. Factors that trigger the condition include:

• Stress (eg. anger, changes in climate, distress, overexertion, shock).
• Poor posture; not moving for a long period.
• Depression.
• Lack of sleep.
• Eye strain.

What you can do

• Apply an ice pack to the head.
• Take a hot or cold shower.
• Massage head, neck, and shoulders.
• Do stretching and other relaxation exercises.
• Discontinue or minimize your intake of caffeine (eg. coffee, tea).
• Avoid the glare of strong sunlight. Wear sunglasses if you have to stay outdoors.
• Take simple painkillers.
• Consult a doctor if:

1. The headache is continuous or recurs frequently.
2. The headache is accompanied by fever and stiff neck (may be meningitis), numbness or weakness in the limbs and visual or speech disorders (may be a stroke).
3. Slight exertion brings on an attack.

What your doctor can do

• Rule out serious underlying causes of headaches.
• Prescribe muscle relaxants.
• Prescribe stronger painkillers.

Prevention tips

• Relax. Learn relaxation techniques and meditation. Do stretching and relaxation exercises in between extended periods of work or sitting.
• Exercise regularly.
• Avoid or minimize stress.
• Try to get enough sleep.
• Minimize your intake of caffeine (eg. coffee, tea).
• Avoid excessive sunlight by staying indoors on bright, sunny days or wearing sunglasses outdoors.

For products see Painkillers & antifever medicines page 439

This article is reffered to Malaysia Healthcare-The family health guide MIMS 2nd edition 1997 page 392-394.

Gout

Gout is a metabolic disease that brings on sudden and intensely painful arthritis (inflammation of the joint). The disorder usually attacks only one joint at a time, often the one at the base of the big toe. Gout tends to run in families and affects 9-10 times more men than women. Occasionally, gout can attack many joints at one time.

Symptoms

• Red, swollen, and tender joint.
• Sudden, excruciating pain, which worsens at the slightest movement.
• Slight fever, in some cases.

Complications

• Tophi formation.
• Kidney stones.
• Kidney failure.

Cause

• Buildup of uric acid in the blood, which collects and forms crystals in joints or tissues. The crystals irritate the joint, causing inflammation. An attack can be provoked by a sudden rise or fall in the blood uric acid level, eating too much food rich in purine content like organ meats, sardines, wine, and heavy alcohol consumption. About 20% of gout sufferers have a normal uric acid level in the blood during an acute attack.

What you can do

• Consult a doctor if you suspect gout.
• Drink plenty of fluids to lessen the risk of contracting kidney stones.
• Take simple painkillers.

What your doctor can do for you

• Prescribe nonsteroidal anti-inflammatory medicine.
• Prescribe specific medicines for gout to maintain normal blood uric acid level.

Prevention tips

• Avoid factors that can provoke a gout attack.
• Minimize your consumption of purine-rich food.

For other products see Painkillers & antifever medicines page 439.

This articles is reffered to Malaysia Healthcare-The family health guide MIMS 1997 2nd edition page 387

"Forbidden" Foods (Foods to Avoid)

Some health problems are prevented and treated by avoiding certain foods, even though the problem or condition itself may not be thought of as a nutritional problem.

ARTHRITIS
Many patients with rheumatoid arthritis (RA) are convinced that they will have less pain by eating certain foods and avoiding others. However, there is very little scientific proof for this, and malnutrition can result if essential foods are avoided unnecessarily.
However, some recent research is showing that avoiding fatty foods, and even avoiding meat altogether, may reduce swelling and pain in many people with RA. But to see real improvement, a very low fat diet must be followed or one must become a strict vegetarian.
Some studies have also shown that going on a complete fast for a day or two gives great relief to some sufferers of RA.
A very low fat diet, a strict vegetarian diet, and 1-2 days of complete fasting - are difficult to adhere to, and not practical. They can also be harmful to health if continued for too long a period of time. Consult your doctor or a Registered Dietitian.
However, overweight and obese sufferers of rheumatoid and other forms of arthritis can minimize their pain by loosing some weight. Eat a variety of healthy foods in moderation be as active as possible.

DENTAL CARIES
Ideas concerning food and dental caries have changed dramatically. Notions such as "sugar rots your teeth...avoid sticky sweets...more sugar in a food makes it more dangerous to the teeth" are to simplistic according to recent dental research.
Carries occur when bacteria in the mouth produce acid that then wears away the hard enamel covering of the teeth. Traditionally, sucrose (table sugar) was thought to be used by the bacteria to make the acid that harms tooth enamel.
New research shows that other sugars can also be used by the bacteria to make acid. These include fructose and glucose, the sugars naturally occuring in honey, fruits, and some vegetables, and also corn sweeteners and other sweeteners used in making canned and packaged foods. Some research suggests that even starchy foods, such as potatoes, rice, wheat flour, may sometimes contribute to caries. Some foods, such as potato crisp, contain little sugar but actively contribute to caries.
Some candies are less destructive to teeth than breads and cookies, and some fruits, such as apples, previously considered safe, can actually contribute to caries. Unfortunately, there is no clear cut way of telling which foods contribute to caries. The best way to avoid caries, therefore, is brushing one's teeth regularly immediately after meals and rigorously swishing water between and arround the teeth after each snack.
Snacking is a major culprit of tooth decay in children and adults, because the teeth are usually not brushed afterward. Particles of food which stay in the mouth contributing to caries.
"Baby-Bottle Tooth Decay" is caused by routinely putting babies to sleep with a bottle of sweet liquid, such as sugar water, milk, formula, and fruit juice, as a pacifier. Plain water should be used instead.

GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFIENCY
This rare condition is inherited by 3-4% of Chinese males in Singapore and even fewer women. It is tested for at birth. A severe form of anaemia will occur if certain drugs or other substances that trigger it are consumed.
The main food known to trigger G6PD defiency is fava beans, also called broad beans. Canned broad beans are available, but are commonly sold as dried salted snacks.
G6PD deficient persons should also probably avoid taking large doses of the vitamins C and K, especially those found in mega-dose vitamin preparations.
Some suggestions have been made that the Chinese herbs San Tze Chze and Chuan Lian also may trigger G6PD, but this has not been proven.

GOUT
Gout is a form of recurring arthritis that affects the joints of the fingers and toes. Crystals of a type of salt called monosodium urate collect in the joints causing swelling and pain. This salt is from a substance called purine which is produced by the body during metabolism but which also occurs in some foods. Animal organ meats and some seafood are concentrated sources of purines.
Gout patients should avoid these high purine-foods: anchovies, brains, beef kidneys, beef/calf liver, sweetbreads (thymus), herring, mackerel, sardines, and scallops.These foods are also high in purines and should be eaten in moderation: asparagus, whole grain breads and cereals, cauliflower, eel, fresh & saltwater fish, legumes, beans, lentils, and peas, meats, meat soups, broths, and gravies, poultry, shellfish, mushrooms, spinach, wheat germ and bran.

LACTATION
While a mother is breastfeeding, she needs nourishment for herself and to make sufficient milk for the baby's rapid growth and development. A general diet following guidelines for good health is recommended. However, there are a few things that should not be done. A low calorie diet should not be followed while breastfeeding, as breast milk volume can decrease.
Alcohol should only be taken in small amounts, if at all, as large amounts can inhibit milk letdown and many cause poor infant growth.
Caffeine-containing beverages should be limited to 2 cups per day to avoid infant irritability. Chocolate contains a similar stimulant and so should be eaten sparingly while breastfeeding. If herbal tea are substituted for caffeine-containing beverages, avoid teas that may cause nausea, vomiting, etc. This can be transmitted to breast milk and cause similar effects in the infant. Sugar substitutes (artificial sweeteners) should be used in moderation, because the effects on breast milk and the infant are unclear. Drink plenty of liquids to maintain milk volume, but avoid extreme conditions such as dehydration or excess fluids.

DIABETES
For many years, patients with diabetes were instructed to strictly avoid all simple sugars, including sugar and sugary foods/drinks. Recent research has shown, however, that small amounts of sugar or sugary foods may be acceptable in a diabetic diet. These should be taken in substitution for other carbohydrate foods, not in addition to them, as the overall amount of carbohydrate in the diet is still important.
In deciding to substitute some sugar for other carbohydrate foods, the individual with diabetes must still remember that sugar contributes to dental carries. Also, many foods high in sugar content are also high in fat and therefore, in calories. If excess body weight is a concern, such foods should not be eaten often.
For optimal dietary management of diabetes it is essential that the patient consult a registered dietitian for an individualised nutritional plan which will take into account, among other factors, the patient's blood glucose and lipid profiles, weight status and lifestyle.

MIGRAINE
Medical researchers are studying the possible roles of food in causing migraine headaches, but no conclusions have been reached yet. Research shows that in some people, migraine can be triggered by alcoholic beverages, chocolate, cheeses, and foods that are salted, pickles and cured. This is thought to be caused by the large amounts of certain types of protein which they contain. However, some migraines are not caused by these foods.
Migraine patients are advised to keep detailed food diaries to try to determine which food, if any, trigger their migraine.

This articles is reffered to Malaysia Healthcare-The family health guide MIMS 1997 2nd edition page 135-137