Over the past two years, Khairul has often felt he was heading towards a breakdown. Caring for his 78-year-old father who is coping with the debilitating effects of Parkinson’s has been tough, both physically and emotionally.

Khairul’s father, a retired schoolteacher, has always been the pillar of strength in his family and community. Even after he was diagnosed with Parkinson’s, he tried to continue living independently. But after witnessing the rapid progression of the disease in just two years, Khairul persuaded his parents to move in with him.

Caring for his ailing father is tough – physically, mentally and emotionally. But the 40-year-old web designer wants to do it, even if it means scaling back on his work to tend to his father. But it also means that Khairul is stretched thin and has less patience to reason with his 74-year-old mother who tries to help him.

“One day, I came home to find her lying down in pain. She had fallen while trying to support my dad to the bathroom for his bath. This pint-sized old woman was trying to support a man more than twice her size,” he says.

“I had to hold myself back from yelling at her. What if she hurt herself seriously? I’d have to look after both of them and then what?” Khairul vents, before quickly apologising for raising his voice.

Khairul’s struggles are shared by many caregivers of the elderly as their task is a demanding one.

“There are various factors that contribute to caregiver burden: the multiple demands on the caregiver, lack of control over the situation, loss of social support, deterioration of the elder person who requires care, duration and intensity of care, the unpredictable nature of the illness and also the difficult behaviours of the elder care recipient,” says Universiti Malaya lecturer Assoc Prof Dr Farizah Mohd Hairi, who is with the Medical Faculty’s Department of Social and Preventive Medicine.

Sometimes, when the older adults have dementia or other conditions that cause a progressive decline in their ability to function, the role of the caregiver will evolve and stretch on for years.

“Even in situations where they don’t have such illnesses, families often deal with cumulative conditions (brought on by age) that require medical care or rehabilitative services. And often, the caregivers have to look after more than one parent or other relatives, on top of their own daily responsibilities. It isn’t easy,” says Dr Farizah, who is part of the university’s Prevent Elder Abuse and Neglect Initiative (PEACE).

Caregiver stress, however, isn’t a topic that is often discussed, particularly when it comes to caring for the elderly.

“Children are expected to bear it and carry on. But the effects of caregiver stress can be long-lasting and damaging,” she points out.

In many families, resentments over caring for the aged can lead to family discord and even break-ups. If caregiver stress is not managed, it could lead to other effects such as depression, disturbed sleep, career interruptions, financial difficulties, a lack of personal time, poor physical health, psychological, emotional and mental strain as well as feelings of anger, guilt, grief, anxiety, hopelessness and helplessness.

However, if caregivers recognise their stress early and take measures to manage it, the experience of caregiving can be positive and affirming.

Dr Farizah and her team are conducting workshops for caregivers on how they can recognise symptoms of stress and learn to manage it.

“We need to raise society’s awareness about this very real condition. Many may be experiencing this burden but may not realise or acknowledge their problem. We need to place more importance on caregiver well-being. We should look at how caring for a dependent loved one can be a positive experience. With the proper support and stress management measures, care-giving can give us personal growth, strengthen relationships and give us a deep sense of satisfaction,” she says.

Japan’s environment ministry recently released scientific findings on UV that cites the effects of aging and ultraviolet light as risk factors for developing cataracts.

As we age, the sun’s rays become increasingly dazzling and painful to our eyes. When selecting sunglasses, it is good to know that different lens colours each have their own properties.

Sunlight is composed of rays of varying wavelengths, including, in ascending order, ultraviolet, blue, green, yellow, red and infrared. Ultraviolet and infrared light are invisible to the naked eye. Electromagnetic energy increases as wavelengths become shorter, and exposing the eyes to short wavelengths for long periods of time should be avoided.

In the Environment Ministry’s “Health Care Manual for UV 2008,” which introduces the latest scientific findings and related information on UV, the effects of ageing and ultraviolet light are cited as risk factors for developing cataracts. When a cataract forms, the lens of the eye becomes clouded and scatters light, which gives the feeling of dazzling brightness and reduces visual acuity. If patients with mild, early-stage symptoms are included, 100 per cent of people aged 80 or older develop cataracts, some research data suggests.

In recent years, there has also been an increase in cases of age-related macular degeneration, whereby visual acuity declines as the central area of the retina ages. Experts indicate that ultraviolet rays and other short-wavelength lights are contributing factors.

“It is easier to halt the development of eye diseases if they are detected and treated at an early stage. People who feel that sunlight is glaringly bright due to light scattering should wear sunglasses to make themselves more comfortable,” says Jun Kozaki, director of the Kozaki Eye Clinic in Osaka.

When choosing the right sunglasses, Masami Kondo at Miki Optical Institute, which researches eyes and glasses in Okayama, says it’s best to wear sunglasses that have ultraviolet protection.

“Additionally, since the way light passes through the lenses depends on their colour, people should select sunglasses with the colour that best suits them.”

Yellow is the colour that best blocks out potentially harmful short-wavelength light and suppresses glare caused by light scattering, followed by brown. Although gray lenses are not as good at blocking short wavelengths as yellow and brown ones, they do block out all wavelengths of light in an almost uniform fashion.

Meanwhile, yellow lenses are not very effective at reducing the amount of light that enters the eyes. For this reason, many lenses are a mixture of yellow with brown or grey.

Although it may be true that the darker the colour, the more effective lenses will be at reducing glare, some experts point out that this can actually cause the pupils to dilate and admit more light.

“The rule of thumb is to get lenses that are not so dark that the pupils can barely be seen through them. People with sunglasses like this don’t need to worry about their pupils dilating too much,” Kondo says.

There is also a type of lens that has a gradient. An 88-year-old man from Amagasaki, Hyogo Prefecture, who had cataract surgery 11 years ago, uses this type.

“They are very convenient, as I just need to look through the transparent area at the bottom of the lenses when I want to see the true colour of something,” he says.

Another recommendation is to select large sunglasses that fit snugly so that less light comes in from the gap between them and the face. In order to check how things look under natural light with sunglasses, it is suggested that customers ask the store if it is possible to try them on outside the building.

Protection against sunlight exposure is made even more effective by wearing a hat or using a parasol in addition to sunglasses.

Points to keep in mind when selecting sunglasses:

Select lenses with ultraviolet protection

Lenses should be translucent enough so that the pupils can be seen through them

Choose large lenses with minimal gaps between the sunglasses and the face

Try them on under natural light on a sunny day

Check your overall appearance in a full-length mirror.

More than 600 million people around the world suffer from allergic rhinitis so if you are sneezing while reading this, you are hardly alone.

While the condition is rarely life threatening, its symptoms, which can range from streaming eyes, sneezing and unsightly and itchy blotches to severe breathing difficulties, have a substantial impact on the health and quality of life. The good news is that help for allergy patients is now available through a new non-sedating generation of anti-histamines that if taken properly, can cure different types of allergies and asthma.

Professor Ralph Mosges, chairperson of the ENT Section at The European Academy of Allergy and Clinical Immunology and of the International Standardisation Committee for the Objective Assessment of the Upper Airways, flew into Bangkok recently to talk about the latest medications for allergy control.

Allergic rhinitis, he began by noting, is frequently under-diagnosed and undertreated, while urticaria is often inappropriately managed.

“Allergies or allergic diseases are a hyper-reactivity of our immune system, which reacts toward such allergens as pollens, house dust mites and pet dander. The number of allergic patients has been increasing steadily over the last four decades and many patients are found in industrialised countries and where standards of hygiene are high. Moreover, weather and exhaust gases from vehicles and industrial factories are factors that trigger allergic symptoms and render allergies more aggressive,” he explains.

“In the US and Western Europe, more than 50 per cent of children have sensitisation to one or more allergens. And there are many types of allergy, for example, allergic rhinitis, food allergies and urticaria, which cause symptoms like a blocked or running nose, itching, sneezing, red eyes and tearing. The danger here is that asthma can develop and become a disabling disease.

“These symptoms are caused by a substance known as histamine, which the body releases to react to the allergens it receives as it tries to get rid of these or prevent the body from receiving more.”

Surprisingly, the highest sensitisation levels are found in Singapore where for the most part, they are caused by house dust mites.

“Singapore is an industrialised country. It has a high standard of hygiene and while hygiene is of course beneficial in terms of preventing infectious diseases, it can be detrimental in terms of allergies as our immune system hyper-reacts to some allergens in very clean and industrialised environments with a warm and humid, climate,” he explains.

“Our data show that 75 per cent of the population has sensitisation and about 40-50 per cent have clear symptoms of an allergy to house dust mites allergy as well as asthma.

“Data also show that house dust mites are now found in Greenland. You’d think that once you were close to the North Pole, the cold would prevent them but that’s not the case. The bad news is that dust mite are found everywhere from the pole to the equator. The good news is that there are drops and tablet that you can take for three years to get full relief,” Mosges says,

Another factor that causes allergy is genetics. The odds of developing allergies is six times higher when the mother suffers from an allergy though only twice as high if the father has one. And if both parents have allergies, the odds go up to 8-9 times higher than for a normal child. While passing allergies from parents to their children cannot be prevented, experts agree that breast feeding the child for at least 4-6 months decreases that risk. Also, during pregnancy, the mother should avoid food that contains allergens such as cow milk and seafood.

Guidelines for treating allergies involve avoiding the allergen to which the patient is sensitised, keeping the environment clean and seeking medical treatment if necessary. First-line treatment is one or more anti-histamines, which can be in tablet, eye-drop or nasal-spray form depending on the symptoms. For a patient with severe symptoms, a nasal wash or spray containing steroids may be used.

“Anti-histamines block the histamine receptor at the nose, at the eye and also the lower airways. That’s why anti-histamines are so important in our treatment. They work quickly too, with the patient feeling relief within 10-30 minutes,” Mosges says.

“For inflammatory disease there is the corticosteroid group, usually in the form of a nasal spray. It doesn’t work immediately so the patient won’t feel relief on the first day but the inflammation will be regulated within a week.

There is also is a specific treatment called immunotherapy but while it is effective, it can take years before the full effect is seen and it is also a lot more expensive. In this case, the doctors adjusts the patient’s immune system to the allergen, starting from injecting low doses of the allergen so the body can adapt, then increasing the dose until the body no longer reacts.

This method might take from one to three years but it is effective and also decreases the chance of the disease developing into asthma.”

Urticaria, more commonly known as hives, is a skin allergy also caused by the release of histamine. The symptoms are red or white itchy bumps or wheals on skin. The symptoms come and go. Urticaria is not a lethal disease but it makes the patient uncomfortable and interferes with sleep. This can also be cured by giving anti-histamines, but the patient needs a dose two or four times higher than that used for allergic rhinitis. And because classic anti-histamines have a sedative potential, taking such a high dose is going to make the patient feel sleepy and unable to function properly.

“We now have a new generation of anti-histamines that are endorsed by the international therapeutic guidelines. The dose is higher than the classic one but the drugs have no sedative potential or other nasty side-effects,” he says,

While eating a healthy diet and exercising are important to strengthening the immune system, they have little effect on allergies. “Making immunity stronger is not an option because with an allergy, the immune system is overacting. However, those with a strong immune system are not so prone to developing cancer,” Mosges explains.

“The first year of life is decisive in terms of whether the immune system develops in the direction of tolerance or sensitisation so breast feeding is important.

“But for those who do have allergies, certain steps can be taken to ease problems, such as washing hair before going to bed so pollens are removed and you don’t sleep in a pollinated environment. Some allergic patients might have to take medication and it is essential that this is taken on a regular basis. Remember, even if the symptoms are not so dominant, the inflammation is still there and may turn into asthma. This is a chronic disease. The modern medication is completely safe nowadays and can be taken for years. But you must take it regularly and |not just when needed.”

Segmented from the neck to the waist, the human spine is comprised of 24 articulating spinal bones. The upper part of the spine consists of seven vertebrae in the neck, called the cervical spine (C1-C7), 12 vertebrae in the thoracic spine (T1-T12), and five vertebrae in the lumbar spine (L1-L5). The lower nine are fused, with five in the sacrum and four in coccyx or tailbone. Each vertebrae has facet joints that make you flexible and enable you to bend and twist. All 33 vertebrae are separated from each other by intervertebral discs and it is here that problems occur.

When the outer lining that surrounds a disc tears, the jelly-like centre in the disc can squeeze out and press on the nerve through the opening, leading to a herniated disc and back pain.

A common source of back pain is the lumbar spine L1-L5. This is commonly found in older adults and people of working age. The patient may experience pain from the waist down. There are two types of back pain:

• Acute muscular pain that may last from a few days to one to two weeks. In most cases, this is the result of playing sport or having an accident.
• Pain caused by a spinal abnormality. The pain often lasts two weeks or more and is caused by a herniated disc, spondylolisthesis or spinal stenosis. The most common type of abnormalities are those affecting the intervertebral discs.

When the fibrous outer covering of the disk loosens, breaks or tears to the point where the disc moves and presses on the spinal nerve, the result is a herniated disc.

Warning signs that require immediate medical attention are pain running down the back of the legs lasting for more than two weeks, numbness beginning at the waist and continuing down the legs or the instep of the foot, leg muscle weakness, and loss of control in the bladder.

When experiencing these symptoms, you can assume that you likely have a herniated disc. You should see a doctor to receive a professional diagnosis and identify the cause of the symptoms. The likely causes include age-related degenerative disc disease, a disc injury after an accident, and possibly damage caused by improper movement in daily activities, such as lifting heavy objects the wrong way or exercising the wrong way.

There are several treatment options, depending on each patient’s decision. If the symptoms are mild, |surgery is not necessary and non-surgical treatments may be sufficient, such as medications for pain and inflammation, physical therapy, or epidural steroid injections

In the case of severe nerve compression, the doctor may suggest surgery. The latest medical technologies and advanced surgical techniques for treating a herniated disc make patients feel safer. With Minimally Invasive Surgery (MIS), a C-Arm fluoroscope x-ray and microscope are used to identify the optimal position to place a small incision of only 1 to 1.5cm. Microsurgical instruments are inserted through a small tube and the segment of the herniated disc compressing the nerves is removed. Patients undergoing this procedure experience less pain and only need to stay in hospital for one to two days.

Chronic back pain can be treated once the diagnosis is completed and the exact cause of the pain is identified. Today, there is no longer as much need to worry about the surgery due to the advances in medical technologies.

There are several safe surgical techniques for chronic back pain that are less painful and with a shorter recovery time than traditional surgery.

DR CHALAT WINMOON is an Orthopaedic Surgeon attached to the Sports & Orthopaedic Centre of Samitivej Sukhumvit Hospital. Call (02) 711 8494-6.