Holy Smokes! - Kicking the Habit

Statistics show an estimated 10,000 Malaysian’s die from smoke-related diseases or conditions on a yearly basis. Thirty percent of smokers above the age of 30 suffer from a whopping 40 kinds of illnesses that include heart related problems and 57 different types of cancer. Also, every day, approximately 50 teenagers below the age of 18 pick up the habit adding to the 100,000 youths worldwide; becoming hardcore smokers in the process. Circa 1998, the Government introduced therapy for smokers in four major hospitals around the country, namely in Kuala Lumpur, Penang, Ipoh and Seremban. KPJ Ampang Puteri has also joined this initiative by conducting a Nicotine Replacement Therapy (NRT) programme for those who wish to curb this addiction. In this article, Care For Life looks into this method as well as other forms of treatment.

What is Nicotine Replacement Therapy?

Nicotine replacement therapy (universally abbreviated to NRT) is the counteractive administration of nicotine to the body by method other that tobacco – and thus eschews the damaging effects of smoking. It involves the use of products that provide low doses of nicotine but do not include toxins that are found in smoke. The aim of this form of therapy is to mitigate craving for nicotine and ameliorate the symptoms an individual might face when he/she stops using cigarettes and smokes less tobacco. Generally, this form of therapy benefits moderate-to-heavy smokers (individuals who smoke more than 15 cigarettes a day) the most. Studies have shown that the occurrence of smoking after undergoing nicotine replacement therapy is 1.5-2.0 times less than when therapy is not introduced.

Types of Nicotine Replacement Therapy

• Nicotine patches (transdermal nicotine systems)

Nicotine patches provide a measured dose of nicotine via the skin. The patch is placed on a dry area of skin without much hair, below the neck and above the waist (upper arm or chest). In this form of NRT, the individual is deterred from nicotine by switching to patches that contain a lower dosage of nicotine over a period of several weeks. These patches are available without a prescription from your doctor. Depending on your body-size and smoking habits, most smokers should start by using a full-strength pack (15-22 mg of nicotine) on a daily basis for approximately 4 weeks. This should be continued by use of a weaker patch (5-14mg of nicotine) for another 4 weeks. 

• Nicotine gum (nicotine polacrilex) 

Available over the counter without a prescription, nicotine gum is a fast-acting method of replacement in which nicotine is taken in via the mucous membrane of the mouth.  It is a preferred method of treatment, especially for those with sensitive skin, and are unable to make full use of a nicotine patch. Nicotine gum is highly recommended for smokers who smoke 25 or more cigarettes a day, feel the need to smoke within 30 minutes of waking up and have trouble refraining from smoking in restricted areas. One of the many advantages of using the nicotine gum is that it allows you to control the nicotine doses. Moreover, you can use it as and when you need to or on a fixed schedule during the day. Take note, that a fixed schedule has proved to be more effective, however, the as-needed approach will be favorable for when you need it most – when you experience cravings.

• Nicotine nasal spray 

Another fast-acting method of treatment, the nasal spray treatment delivers nicotine to the bloodstream rapidly because it’s absorbed through the nose. This form of NRT however requires a doctor’s prescription. As per the other forms of treatment, the nasal spray lets you control your nicotine cravings and helps relieve withdrawal symptoms rather quickly. While smokers generally perfer the nicotine spray due to the ease of use, however, nicotine is addictive and thus, a smoker can transfer their dependence from cigaretter to the nasal spray. Hence, the need for prescription. Users are also strongly advised to use the nasal spray as per prescription only.

• Nicotine Inhalers

Nicotine inhalers, too, are only available by prescription from a doctor. Made up of a thin plastic tube with a nicotine cartridge inside, when you take a puff from the inhaler, the cartridge puts out a nicotine vapor. Unlike other inhalers such as the ones used by asthma patients, which delivers medicine to the lungs; this nicotine inhaler delivers most of the vapor to the mouth. This form of treatment is the most similar to actual smoking, which is widely appreciated by smokers in general. Thus far, this form of replacement therapy is the most expensive on the market. On another note, these inhalers should not be confused for electronic cigarettes, especially since those have not been clinically proven to be effective.

• Nicotine lozenges

Similar to the nicotine gum, nicotine-containing lozenges are available in 2 strengths: 2mg and 4mg, and can be purchase without a doctor’s prescription. Smokers are advised to choose their dose based on how long after waking up they usually have their first cigarette. It is recommended that smokers use these lozenges as part of a 12-week program.

Choosing the Right NRT

Although there is no actual evidence that one type of NRT is superior than the other, there are several factors that you should take into consideration when choosing which treatment you would like to embark on. When choosing your NRT look into your lifestyle and your smoking habits/patterns. For instance, do you only need to quench your nicotine craving or will you prefer something that will keep your hands and/or mouth busy? 

Nicotine gums, lozenges and inhalers are substitutes you can put in your mouth that let you control your dosage and keep your cravings in check, however, nicotine gum may stick to dentures or other dental work, making it hard to chew. The gums and lozenges are also generally sugar-free. The nasal spray also works extremely quickly as and when you need it. On the other had, nicotine patches are more convenient as you only have to put it on once a day. However, if you are looking for more of a placebo effect, the inhaler allows you to simulate the use of cigarettes by holding and puffing the inhaler. Finally, studies have also shown that combing 2 types of NRT may work better than using just one single product. In that case, you may want to try using the patch for a steady dose of nicotine throughout the day and then using a fast-acting product i.e. nasal spray, inhaler, when the cravings become too overwhelming.

Other Methods

There are several other tools to aid in the process of quitting smoking that do not contain any forms of nicotine. Although some have acknowledged that these methods are useful, there is no strong proof that it improves the chances of quitting. These methods include hypnotherapy, acupuncture, and the use of smoking deterrents and/or herbal supplements. Although these methods have no scientific prove that it might work, certain individuals have found it useful. If you are interested in looking into these forms of treatment, discuss it with your doctor to see if it will be suitable for you.

Whichever method of treatment you choose to embark on, always remember to administer it at the recommended dosage only. There is a possibility, if you use a different dose or cease treatment prematurely that it will not work as expected. Whether you are a light smoker or a heavy smoker, it’s best to consult with your physician on a treatment plan that is tailored to suit your needs and match your lifestyle.

Written for AMG International, contract publishers of Care for Life

What A Pain!

Headaches are defined as pain that occurs in the head and upper neck region of the body. It affects the entire head but sometimes only affects specific regions such as eyes or the temples. Accompanied by a variety of symptoms such as light sensitivity and/or nausea, the pain caused by headaches can either be extremely sharp or dull. Whatever the specifics, one thing is for certain – headaches are extremely common. In this issue of Care for Life, we look into pain managements methods in dealing with a more severe, chronic type of headache; the ultimate pain in the neck – migraines.

Are You Having Migraines?

A migraine is a severe, painful headache which is a result of a combination of blood vessel enlargement and the release of chemicals from nerve fibers that coil around these blood vessels. It is often preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound. The excruciating pain that migraines bring can last for hours or even days. The symptoms of a migraine can present itself at any time before the headache occurs, during and even after the fact. Although not all migraines are alike, some of the more regular symptoms include moderate-severe pain confined to one side of the head, pulsing and throbbing pain in the head, increased pain during physical activity, nausea, vomiting and increased sensitivity to light and sound.

There are many triggers of a migraine headache. Some of the more popular causes of migraines are allergies and allergic reactions, bright lights, loud noises and certain strong odors or perfumes. Physical and emotional stresses as well as frequent changes in sleep patterns or irregular sleep have also been listed as precursors to a migraine bout. For certain individuals, consuming alcohol, smoking or exposure to smoke can trigger a bout of migraine. For women, menstrual cycle fluctuations, birth control pills and hormone fluctuations during menopause onset can also cause severe migraines. Other than that, foods containing tyramine (red wine, aged cheese, smoked fish and some beans), monosodium glutamate (MSG) or nitrates can also be triggers of migraines. Other “trigger-foods” include chocolate, nuts, peanut butter, avocados, bananas and fermented or pickled foods. If any of these symptoms and triggers sounds familiar to you, chances are you too are suffering from migraines. 

Migraines affect specific regions such as temples

Dealing with the Pain

There are three main aspects of treatment: trigger avoidance, acute symptomatic control, and pharmacological prevention. Individuals who experience several moderate or severe migraine headaches should consider modifications of their lifestyle (trigger avoidance) which include practicing a regular sleep cycle, exercise regularly, avoid skipping meals/fasting, limit stress and employ relaxation techniques. You should also limit your caffeine consumption and begin to identify and avoid which foods usually trigger your migraine episodes. Keep a diary of this and share it with your doctor. 

Regular exercise can help alleviate migraines

A number of analgesics are effective for treating migraines which include: Non-steroidal anti-inflammatory drugs (NSAIDs). An example would be Ibuprofen, which provides effective pain relief in about half of people. Also, a 1000 mg dose of aspirin could relieve moderate to severe migraine pain. Paracetamol/acetaminophen is also known to be effective for migraines. Simple analgesics combined with caffeine may help. Despite the fact that migraine sufferers are generally advised to limit their caffeine intake, it can be useful during an attack.

Prophylactic medications are a type of medication taken daily to reduce the regularity and length of migraine headaches. They are not supposed to be taken once a headache has begun. One example of prophylactic medication is beta blockers, which are class of drugs that block the effects of beta-adrenergic substances produced by the body such as adrenaline (epinephrine). By blocking the effects of adrenaline, beta-blockers relieve stress on the heart by decelerating the rate at which the heart beats. Although prophylactic medication may reduce the frequency and duration of migraine headaches, it will not eliminate migraine headaches completely.

Alternatively, Acupuncture is effective in the management of migraines. It appears to be more effective than routine care, with a smaller amount of adverse effects than prophylactic drug treatment. Chiropractic manipulation, physiotherapy, massage and relaxation might be useful for the prevention of migraine headaches.]

Being the first healthcare group to launch Pain Management Services in 2008, KPJ Healthcare (particularly KPJ Ampang Puteri Specialist Hospital) has invested heavily in the field of pain management for the benefit of its patients. The dedication to pain management is yet another example of KPJ's commitment towards providing comprehensive healthcare services for its patients.

Written for AMG International, contract publishers of Care for Life 

Healthy Beginnings - Insights into Postpartum Nutrition

Research shows that new-borns grow the fastest between the first 2 to 4 weeks. How you feed your newborn is the first nutrition decision you will make for your child. As such, the baby’s diet should contain all necessary nutrition to support and inspire optimal growth not only during those first weeks, but also for when he or she reaches the toddler stage. In this issue, Care For Life looks into the types of nutrition the baby needs, the ideal weight growth of a new-born as well as additional supplements and dietary requirements for breastfeeding mothers.

Breast or Bottle?

Not all women will prefer or even be able to breastfeed. Deciding to breastfeed or bottle feed a baby is usually based on the mother’s comfort level with breastfeeding and often includes other factors such as her lifestyle. The American Academy of Paediatrics (AAP) recommends that babies be breastfed exclusively for about the first 6 months but it is vital to remember that your baby’s nutritional and emotional needs will still be met whether you decide to breastfeed or bottle feed.

Perhaps the most important advantage of breastfeeding is that breast milk is the perfect food for a human baby's digestive system. It contains the vitamins and minerals that a newborn needs, and all of its components — lactose, protein (whey and casein), and fat — are effortlessly digested by a newborn's immature system. Commercial formulas may try their best to imitate breast milk but they only manage to come close, never really producing the exact duplicate. Breast milk also contains easily absorbed iron as well as antibodies that help protect infants from a wide variety of infectious diseases, including diarrhoea.

Additionally, breastfeeding is also great for moms as it helps burn calories and aids in shrinking the uterus. Breastfeeding may also protect mom from breast and ovarian cancer. Not forgetting, it also meets a variety of emotional needs for both moms and babies as skin-to-skin contact can enhance emotional connections.

Postpartum Nutrition

The nutrition necessities for breast-feeding are similar to those for pregnancy. Just as when you were pregnant, it's imperative to eat well while you're breastfeeding, with plenty of wholesome fruits, vegetables, whole grains, protein, and calcium-rich foods. However, a breast-feeding woman needs 200 more calories per day than she did during pregnancy, and it is important that the calories come from nutritious foods. Your need for fluid increases while you are breastfeeding. You may notice that you are thirstier than before.  Drink enough water and other fluids to quench your thirst. A usual recommendation is to drink a glass of water or other beverage every time you breastfeed.  Some beverages, such as soft drinks and fruit drinks, contain added sugars.  Limit your intake of these beverages. 

Vegetables are essential to provide nutrients
for mom and baby when breastfeeding    

Supplementary Nutrition for Infants

If a healthy mother is nursing a healthy infant, chances are he/she will not need any vitamins or nutritional supplements, the only exception being Vitamin D. Although breast milk does contain small amounts of Vitamin D, and Vitamin D is produced when the skin is exposed to sunlight, The AAP recommends that all breastfed babies receive vitamin D supplements within the first few days of life during the first two months continuing until the infant begins consumption of vitamin D-fortified formula or milk.

Supplements are usually unnecessary if the baby in on a formula diet as formula includes the right blend of vitamins, including vitamin D. Iron-fortified formula is also recommended for a baby's first year and should contain up to 12 mg/l of iron. Water, juice, and other foods are usually unnecessary during a baby's first 6 months. Breast milk or formula provides everything babies need nutritionally until they start eating solid foods.

Ideal Birth Weight

There are several factors that influence birth weight, which include size of parents, birth order and especially mother’s health during pregnancy. Babies are born with some extra fluid; therefore, it is a common occurrence for all babies to lose weight immediately after birth when that fluid is lost. Within a week, however, the new-born should regain his/her birth weight. For an average baby, a gain of about an ounce (30g) a day is normal. Babies also generally grow in height about 1 to 1.5 inches. Many newborns go through a period of escalated growth when they are 7-10 days old and again at 3 – 6 weeks.  At the end of the 5^th months, most babies will be double their birth weight.

Babies generally lose weight after birth    

KPJ Healthcare strives to provide newborns as well as their mothers with the best postnatal care with a string of trained professionals. All of who will be more than pleased to provide you with all the information and help you may need to care for mother and child.

Written for AMG International, contract publishers of Care For Life 7