10 Myths About Palliative Care

10 Myths About Palliative Care

Palliative care is a multidisciplinary approach to specialised medical, dietary, physiotherapy and nursing care for people with life-limiting illnesses such as end-stage cancer or stroke or conditions requiring long term care such as Parkinson’s disease or dementia. The care focuses on providing relief from their symptoms, pain, physical and mental stress.

The goal of palliative care is to improve quality of life for both the person AND their family by providing comfort care and supportive care. This care can be given in the hospital, at a hospice or in the comfort of the patient’s home.

Here are some myths and facts surrounding palliative care.

Image: Shutterstock

1.

Myth: Palliative care is only for people dying of cancer

Fact: Palliative care can benefit patients and their families from the time of diagnosis of any illness that may shorten or disrupt their quality of life

2.

Myth: Palliative care hastens death

Fact: Palliative care does NOT hasten death. It provides comfort and improved quality of life from diagnosis of an advanced illness until the end of life

Image Source: iStock

3.

Myth: Palliative care is often expensive and unaffordable

Fact: There are a range of care services catering to different needs and budget. You can choose to stay in a nursing home, join a shared-living community or even receive care at home from visiting palliative healthcare team which usually includes a doctor, nurse, dietician and physiotherapist

Image Source: Solace Hospice

4.

Myth: People in palliative care who stop eating die of starvation

Fact: People with advanced illness usually lose their appetite. Palliative healthcare team includes a dietician who prepares a nutrition plan for the patient. Terminal patients die from their illness and not from starvation

Image Source: Visiting Nurse Association of Staten Island

5.

Myth: Palliative care is only provided in hospitals

Fact: Palliative care can be provided wherever the patients live – at nursing homes, long-term care facilities and even at home

Image Source: iStock

6.

Myth: Morphine is administered to hasten death

Fact: Patient are kept comfortable from their pain using pain medication (analgesia) but they do not hasten death

Image Source: US News

7.

Myth: Taking pain medication in palliative care leads to addiction

Fact: Keeping patients comfortable often requires increasing doses of pain medication with time because of tolerance as well as disease progression. This is NOT due to addiction

8.

Myth: Pain is part of dying

Fact: Although pain occurs in patients with advanced disease, they do not need to suffer this pain unnecessarily because pain can be controlled using pain medication

Image Source: Kiplinger

9.

Myth: I have let my family member down because he/she did not die at home

Fact: Sometimes the healthcare needs of the patient is more than what can be provided at home.  Providing the best care for the patient regardless of setting is not a failure

10.

Myth: Palliative care means my doctor has given up hope on me

Fact: Palliative care provides comfortable and supportive care to ensure the patient is pain-free and lives a dignified quality of life

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Age and Fertility in Male

Age and Fertility in Male

For many years we have known the importance of age and female fertility. A woman’s chances to get pregnant decline with advancing age.

As for men, we used to think that he can reproduce as long as he can produce sperm. That’s not the entire truth. Men’s fertility also decline with age. However, the decline is much more subtle. In the last 5-10 years , we are seeing a rapid decline in male fertility, i.e. the sperm quantity and quality is poorer even in a younger men.

In my daily practice, I too have noticed the same trend in male fertility.

Image Source: iStock

Scientific research over the last decade has shown that children born to older men has higher risk of certain condition such as autism and schizophrenia. This again reminds us that men should not delay his first child.

Interestingly, a recent research found that older men maybe can produce smarter kids! When the researchers looked at relationship between father’s age and certain features in their son, they noticed that older father’s have a more ‘intelligent’ sons.

Image Source: Entrepreneur 

This intelligence is measured in an index called geek index. “Geekiness” is linked to higher intelligence and better academic performance.

So, should men delay their first child just to get a smarter kid ?

I would say NO. The relationship between smarter kid and older fathers is not proven yet. Moreover, the smartness of these kids most probably liked to the autism genes, which we know linked to older fathers.

Image Source: iStock

Remember that the wife’s fertility declines with age and it’s not reversible. In my opinion, better to start your family earlier when your chances are optimal than suffer through infertility later.

A child’s educational success depends mainly on their upbringing and parental/ teacher’s guidance. WE make a difference in how our children turn out to be.

Source: Medical News Today

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Dr. Agilan Arjunan

Dr. Agilan Arjunan

Obstetrician & Gynaecologist (infertility)

 

What is Infertility?

What is Infertility?

1.What is infertility ? Infertility is defined as inability to conceive after 1 year of unprotected sexual intercourse.

2.How do I know if I have problem of infertility? If you have difficulty to get pregnant after having unprotected sexual intercourse with your partner over the last 1 year, you may have problem with infertility. However, you must bear in mind that if given more time (ie another 1 more year), you may have a chance to get pregnant on your own. This time limit will also depend on your age. If you are younger (ie age less than 25 years), you may want to give a bit more time to yourself. If you are older, then seeking medical advice earlier than later may benefit you. If you are known to have medical condition that predisposes you to infertility (ie endometriosis), you may want to seek a fertility specialist earlier (ie after 6 months of trying to conceive on your own).

Image Source: Focus on the Family

4. Where do I find the right Fertility Consultant?
There are many Fertility consultants. The right one for you will depend on your expectation of the doctor and what the doctor can actually offer you. The set-up of a fertility clinic can differ widely. Some are stand alone clinic with or without fertility laboratory (fertility laboratory is needed for treatments such as Intra-utrine Insemination/IUI and In-vitro Fertilization/IVF) .

Image Source: Express

Some are within a hospital with fertility laboratory. If the fertility clinic has a in-house fertility laboratory and operating theatre, it may be of benefit to you. This is because many woman with infertility has endometriosis or adenomyosis and surgery may be needed in the treatment of infertility for those woman. So, the right fertility consultant for you will depend on the cause of your infertility and the treatments that are needed.

5. Can I just see a family doctor / general doctor in clinic?

You can see a general practitioner (GP) who knows which initial investigation to be done correctly. If initial investigations are not done at the appropriate time (ie some blood test are done on Day 2 of menses), you may end up repeating fertility investigation when you see a fertility consultant.

6. Should I do anything before seeing a Fertility Consultant?

Image Source: Boudica

You just have to relax! A fertility consultant will be able to guide you through your journey to parenthood. However, if you have your previous fertility investigations or treatment records, please bring it along.

7. What test(s) my partner and I will need?
For male partner, a semen analysis will be done to assess the sperm count, how fast sperm moves, how normal are the sperms and the viability of sperms. Depending on semen analysis results, further test may or may not be needed.

Image Source: 123rf

For female partner, blood tests are usually done on day 2 or 3 of menses to assess ‘ovarian reserve’ (ovarian reserve means ability of the ovary to produce female eggs). Blood test also may be done around day 21 (mid-cycle) of menses to asses ovulation. A test to assess patency of fallopian tube will be arranged around after your menses. Ultrasound scan to look at your womb and ovaries will be done routinely. Further test such as hysteroscopy (looking into the womb with a telescope) may be needed. Your fertility consultant will advise you.

8. What are the treatment options?

Image Source: Chapel Hill

Treatments options depend on the cause of infertility. For male infertility, depending on the sperm count, treatments such as IUI or IVF maybe needed. If there is no sperms for male partner and its probably due to obstruction, sperm can be retrieved via a minor surgery to the testis (TESA/TESE), and IVF/ICSI can be done. For female infertility, bilateral blocked fallopian tubes will need IVF/ICSI. If ovulation is the cause, ovulation pills or even IUI can be done. However, there are couples with unexplained infertility, in such a case, IUI or IVF maybe needed. 9. Can I do anything to improve my chances of getting pregnant?

Image Source: Shutterstock

Yes you can! There are some lifestyle modifications that you can do to improve your chances of getting pregnant. The important thing to remember is that you and your fertility consultant need to work together to achieve success.

Read more on the next article on ‘How To Improve My Chances of Getting Pregnant’.

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Dr. Agilan Arjunan

Dr. Agilan Arjunan

Obstetrician & Gynaecologist (infertility)

Normal Fertility

Normal Fertility

1.Normal Pelvic Anatomy

Female reproductive organs consist of uterus (womb), Fallopian tubes and ovary. The uterus / womb is a hollow, peared-shaped organ with thick muscular wall. It is subdivided into corpus (body) and cervix (neck). The top portion of corpus is called fundus. The inner part of corpus is the cavity, where the embryo/foetus develops during pregnancy. The inner lining of the cavity is called the endometrium.

Every month, endometrium thickened in preparation for potential pregnancy and sheds during menstruation if pregnancy does not occur. The cervix (neck) allows sperm to enter the corpus during fertile period of a woman. The Fallopian tubes are the channel that connects the ovaries to the uterus.

The inner lining of the fallopian tubes is made up of finger like projections called the cilia. These cilia are important in assisting the movement of the female eggs (oocyte) towards the uterine cavity and the sperms towards the oocytes. The ovary are oval-shaped paired glands that are attached to each sides of the uterus. Every month, one of the ovaries releases an oocyte/female egg. The ovary also produces female hormones oestrogen and progesterone.

2. Normal menstrual cycle

Normal menstrual cycle length (from beginning of one period till the beginning of next period) average between 21-35 days. If you are menstruating regularly, most probably you are ovulating.

The first day of your bleed is considered Day 1 of your menses. A woman may bleed for 4-7 days, but it varies for every woman. During the bleeding phase of your menses, the endometrial lining is shed and becomes thin. The ovary now produces female hormone called Oestrogen, which slowly thickens the endometrial lining. At the same time, the ovary also produces and develops few early stage eggs or oocytes.

Subsequently, only 1 egg or oocyte will mature every month. By mid-cycle (approximately day 14 in a woman with 28 days menstrual cycle), the matured egg or oocyte will be released into the Fallopian tube. This is also called ovulation. The ovary now will secrete female hormone called Progesterone, which will support the pregnancy if it happens. If there is no pregnancy, the endometrial lining will began to shed and menstrual bleeding will start and the woman will be in her Day 1 menses again.

 3. How Do I Get Pregnant?

Pregnancy occurs when the sperm meets the egg or oocyte in the fallopian tube. Out of millions of sperms that reaches the oocyte, only 1 sperm gain entry into the oocyte. Once inside, the genetic materials (building blocks for human beings) of the sperm and the oocyte will merge to form the embryo (early stage baby). The embryo will then move through the fallopian tube to get implanted in the endometrial cavity.

4. What is my chances of getting pregnant?

Generally, the chances of getting pregnant decline with age. The older the women gets, the lesser her chances of getting pregnant, even with advanced techniques like IVF (test tube).

5.If I don’t get pregnant, is there a problem with me?

Not necessarily. Nearly half of infertility are caused by male/husband’s problem(male infertility). Thus, it is important that both partners undergo evaluation for infertility.

6.How long should I be trying before getting help to get pregnant?

If you do not have any known factors that can lead to difficulty in getting pregnant, you and your partner can try up to 1 year before getting some help. You should try to have regular unprotected sexual intercourse around the time of ovulation.

7.Where can i get help?

You could see your own family doctor to get initial advise. You could also get an appointment to see a fertility specialist. There are abundance of information available in the internet about infertility.

Download Teleme’s mobile app and consult Dr Agilan, Obstetrician & Gynaecologist (infertility)

Dr. Agilan Arjunan

Dr. Agilan Arjunan

Obstetrician & Gynaecologist (infertility)

Sleep Disorders

Sleep Disorders

The normal sleep cycle consists 4 stages of non-REM sleep cycles and 1 cycle of REM (Rapid Eye Movement) sleep throughout the night. When your sleep cycles are disturbed, you wake up feeling tired and difficulty concentrating during the day.

  • NREM sleep. These four stages start from very light sleep during Stage 1 down to very deep sleep in Stage 4. Throughout NREM sleep, there is little muscle activity and it is very difficult to wake someone in stage 4 sleep. Deep sleep helps to restore your body and muscles from stresses of the day
  • REM sleep: This is the stage of sleep in which most dreaming occurs and our eyes are thought to move in relation to the visual images of our dreams

Each cycle lasts around 90 minutes consisting of the 5 stages of sleep.

During the night, the amount of time spent in each stage varies; we spend more time in stages 3 & 4 in the beginning of the night and more time in REM stage towards the morning. Increasing age also changes our sleep patterns as we require less time sleeping while babies spend 50% sleep time in REM stage.

Our internal clock situated at the hypothalamus dictates our normal circadian rhythm which helps us stay awake during the day and gets us ready to sleep at night. However, this rhythm can be disturbed by travelling through different time zones (jet lag) or doing shift work. Psychological issues such as stress or depression can also disturb your sleep pattern.

How can sleep deprivation affect health or quality of life?

  1. Good sleep is important for healthy brain function such as thinking, memory, learning, decision making and creativity
  2. Important for physical health such as:
  • Healing and repair of the body
  • Growing in children
  • Maintaining balance hormones (growth hormone)
  • Sleep deprivation results in poor blood sugar control
  • Obesity risk in sleep deficiency
  • Ensuring good immune system

Common Sleep Disorders
Common sleep disorders include insomnia and Obstructive Sleep Apnoea (OSA)

  1. Insomnia

Image Source: iStock

Insomnia is the inability to fall asleep or maintain sleep or wake up too early in the morning and feeling tired. The usual time to fall asleep is 10-20 minutes.

The causes can be:

  • Primary (not related to any medical issues)
  • Secondary (related to medical issues such as depression, stress, anxiety, chronic pain from arthritis, asthma, cancer or side-effects of medication)

Treatment involves practising good sleeping habits such as:

  • Going to bed (and waking) at the same time every night
  • Follow the same routine to help you relax before sleep
  • Avoid playing with light emitting devices just before sleep as they stimulate the brain and makes it harder to fall asleep
  • Try to avoid a heavy meal prior to bedtime
  • Avoid caffeine 3-4 hours before sleep
  • Avoid vigorous exercise close to bedtime as the adrenaline release stimulates the brain and body making it difficult to fall asleep
  1. Obstructive sleep apnoea (OSA)

OSA is the most common type of sleep apnoea. Around 15-20% of adults experience OSA and it is associated with being overweight, older age groups, smokers, rhinitis, pharyngeal reflux and in males. During sleep, our muscle tone relaxes and the airway lumen diminishes which requires more respiratory effort. This increase in respiratory effort results in negative airway pressure causing the airway soft tissue to flop back and obstruct the airway.

Image Source: Science based medicine.org

Symptoms of OSA

Most common symptoms include snoring and restless sleep with periods of silence (apnoea) followed by sudden gasping and even arousal from sleep. This causes poor quality sleep which results in early morning headache, unexplained daytime sleepiness, trouble concentrating, mood changes such as irritability and poor work performance.

There are also heath implications as they are more likely to get hypertension, heart disease, stroke, diabetes and involved in accidents.

Investigations

Image Stock: iStock

Important to have a complete examination by an ENT doctor to check BMI, neck circumference, nose and oral cavity to look for any anatomical obstruction by any polyp, septum deviation, tongue or lymphoid tissue.

Sleep study (PolySomnoGram or PSG) is the ‘gold standard’ to diagnose OSA and can be done at home by technicians who will do a home visit. Some other parameters which can be measured include heart rate, oxygen saturation, airflow and sleeping position. The Apnoea: Hyponoea Index (AHI) is used to grade the severity of the sleep apnoea depending on the number of ‘events’ detected per hour of sleep.

An ‘apnoea event’ is defined as complete cessation of airflow for at least 10 seconds while ‘hyponoea event’ is defined as 50% decrease in airflow for at least 10 seconds or 30% decrease in airflow with associated decrease in oxygen saturation or an arousal from sleep.

Treatment options

  • Lifestyle modification such as losing weight, gentle regular exercise (read ‘How much should we exercise daily?’) and avoid stimulants such as caffeine, alcohol or light emitting devices before sleep.
  • Treat any nasal symptoms such as allergic rhinitis
  • Continuous Positive Airway Pressure (CPAP) device
  • Surgery such as Cautery Assisted Palatal Stiffening Operation (CAPSO) or mandibular advancement procedure may be helpful

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