Thursday, April 30, 2009

Down to your last legs?

Shaking limbs at night can be a neurological movement disorder 

090428-SleepDeprivation For over a year, Mdm Josephine Tan (not her real name) could not get a good night’s sleep because strange, prickling sensations in her legs would invariably lead to them shaking. 

“My legs kept moving,” said the retired banker, who is in her late 60s. “On nights when the attacks were bad, the shaking would be so violent that it’d disturb my husband too.” 

The worst part, added Mdm Tan, was that her problem was dismissed by her doctor friends, who had not heard of the condition. 

But the dark rings under her eyes, poor appetite and fatigue due to lack of sleep were proof that she wasn’t imagining her troubles. 

What Mdm Tan suffers from is Restless Legs Syndrome (RLS), a neurological movement disorder that sleep expert Dr Lim Li Ling, director of the sleep disorders unit at Singapore General Hospital, believes is under-recognised in Singapore

Dr Lim is the co-editor of medical publication Sleep Medicine: A Clinical Guide to Common Sleep Disorders and author of the guide’s chapter on RLS. 

She said that the disorder affects less than 1 per cent of the population in Singapore but added that this figure may be an under-estimate because RLS is not widely known to healthcare professionals who are not familiar with sleep-related disorders. 

“These symptoms are often mistaken for similar conditions such as leg cramps and arthritis pain,” she said. As a result, many cases of RLS may not be diagnosed. 

Shake a leg 

Living with RLS can be frustrating at the very least. For Mdm Tan, it is physically and emotionally debilitating. 

The condition causes uncomfortable creepy-crawly sensations in the legs, accompanied by an irresistible urge to move the legs. 

Often, inactivity worsens the condition, according to Dr Kenny Pang, a sleep specialist and ENT consultant, and director of the Pacific Sleep Centre. 

He added that sufferers tend to experience worse attacks in the evening and at night. According to Dr Pang, almost 85 per cent of RLS sufferers report difficulties falling asleep. And when they do sleep, their rest is disturbed by the involuntary, repetitive and periodic jerking of their limbs. As a result, many RLS sufferers feel tired or sleepy during the day. 

While the exact cause of RLS is unknown, it has long been associated with iron deficiency. 

The mineral is needed by the body to produce dopamine, or neurotransmitter. Dopamine pathway abnormalities are thought to be a factor in RLS, said Dr Lim. 

Genes may also play a part. Occasionally, RLS is associated with medical conditions such as nerve disease, kidney failure and pregnancy. Iron deficiency is common in the latter two conditions. 

No permanent cure 

For Mdm Tan, having to see several doctors and undergo weeks of tests before she was diagnosed with RLS was a costly and distressing experience. Even more depressing was the fact that there is no permanent cure. 

But making simple lifestyle changes can alleviate symptoms, said Dr Pang. They include cutting down on caffeine, smoking and alcohol, and following a regular sleep and exercise routine. 

Drugs such as dopamine agonists used to stimulate dopamine may relieve the symptoms. So can iron supplements, if the patient is iron-deficient. 

For those with RLS arising from kidney failure or pregnancy, treating the underlying conditions can alleviate the symptoms. 

Mdm Tan now keeps her restless legs under control by taking medication and following an elaborate evening routine of walking, practising qi gong and wrapping her legs in a thermal wrap before she goes to bed. 

“Imagine having to live your life with this disorder. I was depressed when I found out there wasn’t a cure but I told myself I won’t be defeated by it,” said the gung-ho lady. 

From TODAY, Health – Tuesday, 28-April-2009
In collaboration with Health Promotion Board

Khaw: Play safe, assume the worst

Neo Chai Chin,

His ministry is working "round the clock" to stay abreast of swine flu developments around the world. And Health Minister Khaw Boon Wan yesterday sounded a reassuring note, saying the nation is in a better position to deal with a global pandemic compared to six years ago when Sars hit.

Back then, 33 people here died from the Severe Acute Respiratory Syndrome. Since then, progress has been made in laboratory capabilities and as well as alertness levels at hospitals and airports.

The Ministry of Health (MOH) is also looking at restricting the number of visitors for hospital patients — if developments over the next two days warrants it.
"As a general principal, if you don't have to visit hospitals, don't visit because it's not exactly a clean place. Why expose yourself unnecessarily?" said Mr Khaw.

Those who need to visit loved ones should maintain a high level of personal hygiene including frequent hand-washing.

Singapore also has a stockpile of Tamiflu — one of the antiviral drugs found to be effective against the swine flu virus — as well as personal protective equipment for hospital staff, he said.

MOH is likely to request hospital staff working in high-risk areas such as accident and emergency (A&E) wards and intensive care units to wear the personal protective equipment.

At least one hospital has already taken the initiative. Since Saturday, National University Hospital staff at the A&E temperature screening area have put on protective gowns in addition to the face mask routinely worn.

NUH and the Singapore General Hospital said patients are also asked about their travel histories. "Patients ... with travel history to Mexico, USA and Canada will be asked to alert our staff. Visitors with travel history and who are feeling unwell are advised not to visit patients, and to seek medical attention," said SGH chief executive Prof Ang Chong Lye.

Indeed, disclosure of travel history becomes "very important", said Mr Khaw, given how swine flu symptoms such as fever, cough and sore throat are similar to that of regular flu.

And while the swine flu outbreak could be "just a very localised" one that will "eventually burn itself out", Mr Khaw said Singapore will "play safe and assume the worst."

From TODAY, News – Monday, 27-April-2009

Agencies take action: Scanners at the airport

English: Aerial view of Singapore Changi Airpo...
English: Aerial view of Singapore Changi Airport and runways (centre), located on the right side is the Changi Air Base (East) and its single runway. (Photo credit: Wikipedia)

Swine flu alert
Neo Chai Chin,

THERE are no known cases of swine flu in Singapore, but preventive measures have already kicked in at Changi Airport.

From 11pm yesterday, thermal scanners were deployed to screen passengers arriving from the United States. And from 8am today, all passengers arriving at Terminals 1, 2 and 3 will also have to undergo thermal scans just before their immigration checks. Those arriving at the Budget Terminal and Seletar Airport will have to do so from Wednesday, said the Health Ministry and the Civil Aviation Authority of Singapore in a joint statement last night.

Those with higher-than-normal temperatures will be put through further medical assessments.

Speaking to the media after a block visit in Woodlands yesterday, Health Minister Khaw Boon Wan said it is too early to close our borders as this will affect the economy and food supply.

However, given the US' connectedness with the rest of the world, he warned it could be a matter of hours before swine flu reaches Singapore, hence the high level of alertness.

The Ministry has also advised Singaporeans to postpone or avoid non-essential travel to Mexico.

Those who develop flu-like symptoms including high fever, cough, and runny nose within seven days of travel to California, Texas or Kansas in the United States, or to Mexico, should seek medical attention.

So far, the World Health Organization does not consider a human swine flu pandemic to be imminent — the outbreak in Mexico and the US, however, constitute a Public Health Emergency of International Concern.

And although humans cannot get swine flu from eating pork or pork products, the Agrifood and Veterinary Authority will be testing incoming pork products for the flu virus.

It will also step up surveillance testing of pigs from Pulau Bulan in Indonesia — Singapore's only source of live pigs — to ensure they are not infected with the virus behind the current outbreak.

Singapore does not import pork from Mexico, nor does it import pigs from the US.

From TODAY – Monday, 27-April-2009

Race to contain outbreak

WHO to consider tomorrow whether to raise threat level

WASHINGTON — The world's governments raced to avoid both a pandemic and global hysteria yesterday as more possible swine flu cases surfaced from Canada to New Zealand and the United States declared a public health emergency.

Mexico, the outbreak's epicentre with up to 86 suspected deaths, closed churches, markets and restaurants. Few people ventured onto the streets, and some wore face masks. Canada became the third country to confirm cases, in six people, including some students who — like some New York City spring-breakers — got mildly ill in Mexico.

In Mexico, soldiers handed out six million surgical-style masks to deal with a deadly flu strain that officials say may have sickened 1,400 people since April 13.

Countries across Asia promised to quarantine feverish travellers returning from flu-affected areas.

The US declared the health emergency so it could ship roughly 12 million doses of flu-fighting medication from a federal stockpile to states in case they eventually need them — although with 20 confirmed cases of people recovering easily, they do not appear to for now.

Make no mistake: There is not a global pandemic — at least not yet. It is not clear how many people truly have this particular strain, or why all countries but Mexico are seeing a mild form of the disease. Nor is it clear if the new virus spreads easily, one milestone that distinguishes a bad flu from a global crisis. But waiting to take protective steps until after a pandemic is declared would be too late.

"We do think this will continue to spread but we are taking aggressive actions to minimise the impact on people's health," said Dr Richard Besser, acting chief of the US Centres for Disease Control and Prevention.

President Barack Obama's administration sought to look both calm and in command, striking a balance between informing Americans without panicking them. Mr Obama himself was playing golf while US officials used a White House news conference to compare the emergency declaration with preparing for an approaching hurricane.

"Really that's what we're doing right now. We're preparing in an environment where we really don't know ultimately what the size or seriousness of this outbreak is going to be," Homeland Security Secretary Janet Napolitano told reporters.

The World Health Organisation and the US were following precautions developed over the past five years to prepare for the next super-flu.

The WHO, which on Saturday asked all countries to step up detection of this strain of A/H1N1 swine flu, will consider tomorrow whether to raise the pandemic threat level, in turn triggering additional actions. AP

From TODAY – Monday, 27-April-2009

Wednesday, April 29, 2009

Mexico closes all schools as swine flu kills 60; disease has spread to US: WHO

Main symptoms of swine flu in humans "Cen...
Main symptoms of swine flu in humans "Centers for Disease Control and Prevention > Key Facts about Swine Influenza (Swine Flu)" . . Retrieved April 27, 2009 . (Photo credit: Wikipedia)

MEXICO CITY — A rare outbreak of human swine flu has killed 60 people in Mexico and has spread to the United States where authorities are on alert, the World Health Organisation (WHO) said on Friday.

Mexican authorities on Friday closed all schools in the capital and central Mexico. According to the UN health agency, swine flu regularly hits pigs but rarely humans.

"To date there have been some 800 suspected cases with flu-like illness, with 57 deaths in the Mexico City area," said Ms Fadela Chaib, a spokeswoman for the UN health agency. Three deaths were recorded in San Luis Potosi in central Mexico.

In a televised statement, Mexican Health Minister Jose Angel Cordova urged people to avoid large crowds, shaking hands, kissing as a greeting, or using the subway.

Most of the Mexican cases were found in healthy young adults with no known record of prior illness. The Mexican government has gathered 600,000 vaccines to help protect health care workers.

Warning that swine influenza — which combines pig, bird and human viruses — could potentially cause a human flu pandemic, the WHO said there are at least seven cases in the United States, in three clusters - five in California and two in Texas.

All the US victims have recovered, but the cases are a medical mystery because it's unclear how they caught the virus.

None of the seven were in contact with pigs, which is how people usually catch swine flu and only a few were in contact with each other, said the US Centers for Disease Control and Prevention.

Scientists keep a close eye on flu viruses in pigs, because pigs are particularly susceptible to both avian and human viruses and a likely place where genetic reassortment can take place that might lead to a new form of pandemic flu. Agencies

From TODAY, World – Weekend, 25/56-April-2009