Vaginal Yeast Infection

by Dr. Nor Ashikin Mokhtar

A vaginal yeast infection is one of the most irritating yet common conditions that affect women.

In fact, it is so common that about 75% of women will have a yeast infection at some point in their lives. Of these, almost half will have recurrent infections, meaning 2 or more infections later on in life.

What Is a Yeast Infection?

Yeast infection is also called candidiasis, and is due to the fungus Candida albicans that infects the vagina.

You must be wondering why yeast would grow in the vagina. In fact, it is natural to find small amounts of yeast living in the vagina under normal conditions. However, the natural acidity of the vagina can be unbalanced, causing the yeast to overgrow and cause an infection.

The infection will then cause irritation of the vagina and the vulva (the area around the vagina). This may cause you to suffer extreme itchiness in and around the vagina. This may be accompanied by a thick, white, odourless vaginal discharge that has the texture of cottage cheese.

You may also notice other symptoms like burning, redness and swelling of the vagina and vulva, pain upon urinating, and pain or discomfort during sex.

What Causes It?

Vaginal yeast infections are usually caused by a weakened immune system that can lead to changes in the acidity of the vagina. The various conditions that can lower a woman's immune defences are stress, lack of sleep, sickness, poor diet, extreme intake of sugary foods, pregnancy, menstruation and disease such as poorly-controlled diabetes and HIV infection.

You may also find that taking certain medications can increase your risk of getting a yeast infection, such as birth control pills, antibiotics and steroid medicines.

What about sex? Some women believe that they can get yeast infections through sexual intercourse with their partners. However, this is actually very rare.

A woman could be at higher risk if she has unprotected intercourse with a partner who has a yeast infection, but this condition is rare in men. There is a slightly higher risk following oral sex given by men who carry yeast organisms in their mouth.

Nonetheless, yeast infections are not likely to be transmitted from partner to partner. Having said that, however, other infections can be contracted sexually, and women should always practise safe sex with their partners.

Don't Be Shy – See a Doctor

It can be embarrassing to admit that you have symptoms of a vaginal infection. However, it is important that you overcome your shyness and see your GP or gynaecologist.

Sometimes, the signs of a yeast infection are similar to that of sexually transmitted diseases, such as chlamydia and gonorrhoea. Getting a medical check-up could help you determine whether you have a yeast infection or something more serious.

A yeast infection is easily diagnosed. Your doctor will examine you to look for swelling and discharge. He or she may also take a sample from your vagina and examine that under the microscope to look for yeast organisms.

Treatment is often in the form of antifungal creams, tablets, ointments or suppositories (inserted into the vagina).

Do not attempt to treat the infection yourself – always get your doctor's advice, even if you want to use over-the-counter medicines. Taking antifungal medications when you do not have a yeast infection could make your condition worse and increase your risk of getting a resistant strain of infection in the future.

Avoiding Repeat Infections

It is very common for women to develop recurrent yeast infections, even several in one year. Here are some tips to prevent another yeast infection from occurring :

* Don't use douches.

* Avoid scented hygiene products like bubble bath, sprays, pads and tampons.

* Change tampons and pads frequently when you are menstruating.

* Don't wear clothing or underwear that are tight in the crotch.

* Wear cotton underwear or pantyhose with a cotton crotch.

* Change out of wet swimsuits and exercise clothes as soon as possible.

* Keep your vaginal area clean.

* After a shower or bath, dry the vaginal area completely before getting dressed.

* After using the toilet, always wipe from front to back.

* Avoid sharing towels with others.

* Don't take antibiotics unless prescribed by your doctor.

* Eat a diet high in vegetables, protein and grains, and avoid processed foods, sugars and alcohol.

* Abstain from sex while undergoing treatment for a yeast infection.

* If you are experiencing chronic yeast infections and are using birth control pills, consider changing your birth control method.

Finally, see your doctor for more advice about avoiding repeat yeast infections. Ignoring it will not make it go away.



Urinary Bladder Cancer

by Dr. Clarence Lei Chang Moh and Datuk Prof. Dr. Tan Hui Meng

The urinary bladder is a reservoir which stores and discharges urine at the appropriate time. Urine itself is produced from the 2 kidneys. Urothelial cancer may occur anywhere along the urinary tract, from the kidney to the proximal part of the prostatic lining. The most common site for urothelial cancer is in the bladder.


The most common symptom is that of blood in the urine. Other conditions such as urinary stones and infection can also give rise to blood in the urine, but these conditions are usually associated with some amount of pain or discomfort at urination.

Therefore, if one passes blood in the urine without any pain (a condition known as painless haematuria), one must rule out cancer of the urinary tract.

In the early stages, there are no other symptoms nor signs. Of course, the bleeding can be diluted by taking more fluids or diuretics. Haematuria detected during microscopic analysis also has similar implications and warrants a full medical evaluation. The bleeding from the tumour can be intermittent. Therefore, one must be ever vigilant, even if there is only one episode of painless haematuria.


Bladder cancer is commoner in the older age group (above 60 years of age) and is very rare in children. It is more common in males compared to females, with a ratio of 4 to 1. It is the 6th most common cancer in the US.

According to the National Cancer Registry of Malaysia 2002, it ranks as the 10th commonest cancer in males. For Malaysian men, it comprises 4.1% of all new cancers, with a peak incidence of 33.5 per 100,000 for men in the age group of 60 to 69 years of age.

Other than the above epidemiological factors, the most well known cause is smoking. Smoking increases the incidence of bladder cancer by 3-fold, and also worsens the outcome of bladder cancer patients who continue to smoke.

Certain chemicals (eg aromatic amines) used in industry (eg dye in textile or rubber) and in agriculture may increase the incidence of bladder cancer. Hence, workers in the rubber, chemical, leather, textile, metal, and printing industries are exposed to substances such as aniline dye and aromatic amines that may increase their risk for bladder cancer. However, such occupational hazards take up to 20 years to manifest.

Chronic infections and irritation (eg by kidney stones) may predispose to certain types of bladder cancers, eg squamous cell carcinoma (SCC).


If you have blood in the urine, you should consult a doctor who specialises in the urinary tract, namely, a urologist. Based on the clinical features, he will be able to determine the relevance of your symptoms and decide on further tests.

Blood in the urine can be confirmed by a simple urine dipstix test. The red blood cells can also be quantified with microscopy.

The urologist will usually arrange for appropriate imaging studies of the urinary tract. A minimum screening test is that of an ultrasound of the urinary tract. A full urinary bladder would give a better image on ultrasound.

Nowadays, multi-slice computerised tomography (MSCT) give good pictures not only of the urinary tract but also any extension of the growth to any other areas, eg outside the bladder or the lymph nodes.

Intravenous urography, which can pick up a space-occupying growth along the urinary tract, can be done if the patient has a normal kidney function. The excretion of the radiocontrast material will indicate the functioning of the kidneys as well as the blood supply to the kidneys.

Initial Treatment

All suspected bladder tumours require endoscopic assessment which can be easily carried out by a urologist. A special endoscope called a cystoscope is used to examine the urinary bladder. Any tumour seen is then biopsied with a forceps, together with any other suspicious areas of the bladder.

Most bladder tumours are cancerous and biopsy alone (which may cause bleeding or tumour seedling) is insufficient. Endoscopic treatment is carried out, immediately after the biopsies, with another endoscopic instrument known as a resectoscope.

All the tumours that protrude into the bladder are resected. The base of the tumour is also resected as deep as possible, without making any perforation of the urinary bladder.

The bladder tumours are then sent separately for histological examination and staging. A dose of chemotherapy (usually Mitomycin-C) is then instilled into the bladder immediately to reduce the risk of tumour cells seedling to other parts of the urothelium.

Staging of Urinary Bladder Cancer

The staging system used is usually TNM staging (Tumour, Node, Metastasis). The T stage is divided into T1, T2, T3, T4 with T1 tumour being confined to the mucosa and T4 tumour invading the surrounding organs, eg the prostate.

About 70% of bladder tumours are confined to the mucosa at presentation. Many patients in Malaysia tend to procrastinate and eventually have treatment only when the tumours have already invaded the bladder muscle layers.

Another important feature of bladder cancer is that of the grade of cells of the cancer, with grading (1) indicating well differentiated cells, grade (2) moderately differentiated and grade (3) poorly differentiated.

Bladder cancers in the higher T stage, with nodal involvement, metastasis and poorly differentiated bladder cancers are more aggressive and more likely to spread to adjacent or other parts of the body.

Definitive Treatment

After the initial endoscopic treatment by the urologist, definitive treatment is then stratified according to its stage and grade.

For patients whose cancer is localised to the mucosa, the treatment remains that of endoscopy. A second cystoscopy with a view to further biopsies and endoscopic resection is undertaken at around 6 weeks. This is to ensure that the previous endoscopic treatment is adequate and there is no understaging of the bladder cancer.

Thereafter, the patient can be followed up with 3-monthly cystoscopy for 2 years, 6 monthly cystoscopy for another 2 years and then yearly cystoscopies. In the event the patient has recurrent gross haematuria or if there is progression of the cancer earlier, a change of treatment is necessary.

For such superficial bladder tumours who tend to recur, a more intensive chemotherapy into the bladder is necessary to control the cancer. This may be in the form of chemotherapy (eg Mitomycin-C, MMC) or immunotherapy with BCG (Bacillus Calmette-Guerin).

MMC or BCG ± Interferon are usually given into the bladder on a weekly basis for 6 weeks. BCG has been used in the prevention of tuberculosis (TB) for a long time. When BCG is given into the bladder, it induces a very strong reaction in the body's immune system to kill the bladder cancer cells.

Cancer Invade Deep Into the Bladder Muscle

Such cancers are not amendable to endoscopic resection as this would create a hole in the bladder. If the patient is fit and there is no evidence of spread to the lymph nodes or metastasis (eg to the liver, lung or bone), the standard treatment is to remove the entire urinary bladder. This is known as radical cystectomy.

A new urinary bladder has to be constructed from the segments of isolated intestines. A simple one is that of the ileal conduit. In the ileal conduit, one end of the intestines is joined to both urinary tubes (ureters) draining the kidney, and the other end comes up to the abdomen as a stoma.

For suitable patients, the new constructed bladder may be reconnected to the urethra and the patient may be able to empty his or her urine normally or taught to empty with a clean catheter.

If the patient is not fit for radical long surgery, another option is external radiotherapy.

Tumour Spread Beyond the Bladder

If the patient is reasonably fit, then intravenous chemotherapy has been shown to be of some benefit. However, the benefits of chemotherapy have to be weighed against that of its side-effects.

For bladder cancers which are limited to the mucosa, the prognosis is good. However, these patients do require close monitoring.

For cancers which have spread outside the bladder and require radical cystectomy or radiotherapy, the prognosis is moderate. The mean 5-year survival of such bladder cancers is about 85%.

For patients who have bladder cancers extending to the lymph nodes or metastasis to other organs, the prognosis is poor. Such patients should go for good palliative treatment. If the patient continues to smoke, the outcome or prognosis is worsened.



Care For Your Joints

Cycling is a low-impact exercise that is good for the joints.

When you reach a certain age, the aches and pains will begin, especially in the joints.

While it may not be possible to prevent ageing, there are certain do's and don'ts that you can adhere to so that the pain in the joints will be minimal.


1. Exercise at least 30 minutes a day as it helps to strengthen the muscles that protect our joints.

It does not have to be a workout, but it can include chores such as gardening, washing the car or even an evening stroll around your neighbourhood.

If you are already suffering from joint pains, you can try low-impact activities, such as biking or swimming, that are gentle on the joints but still help burn calories.

2. Protect your joints from injuries. Remember to warm up before exercising and cool down after your workout.

This precaution is not restricted to sports or exercise alone. Even physical activities such as lifting a box should be done properly. For example, when lifting, be sure to carry the box as closely to your body as possible. Also, use your arms instead of just your hands to support the weight.

3. Respect your body's fitness level. If you work out in the gym, do not feel pressured to keep up with the people around you as everyone has different levels of stamina.

Always remember that what is tolerable for someone else might not be tolerable for you.

4. Try and maintain a healthy weight. Being overweight will put unnecessary stress on your joints as every 2.2kg gained puts as much as 4 times the stress on your knees.

Even minimal weight loss can do wonders to ease the pressure and your joints will thank you for it.

5. Supplement your diet with essential fatty acids (EFAs) such as Omega-3 which can be found in cod liver oil. When taken in high concentrations, cod liver oil has been scientifically proven to reduce inflammation and help slow down the progression of cartilage destruction.

As EFAs are not produced by the body, the only way we can get it is from eating EFA-rich foods or, more conveniently, from supplements.


1. Do not ignore muscular aches and pains. If your body aches after a workout, you might be working out the wrong way.

Consult exercise instructors or follow home exercise videos which will be able to lead you in a proper workout. If you are a gym member, try to book a session with a trainer who can then tell you where you might be going wrong.

2. Always make sure to seek medical attention if you have a muscular ache that will not go away as it may be a sign that your joints are injured.

Humans generally have a tendency to develop a tolerance to pain that we experience every day. The same can be said for joint pain. Bear in mind though, that any lingering pain could be a symptom of something more serious, so take note of it and seek treatment.

3. Do not forget to always eat balanced meals and try and cut down on fatty foods. If you need energy to keep you going throughout the day, stock up on more fibre-rich foods like whole-meal bread, cereals and nuts.

4. Do not wait until you are thirsty to drink water. This is because by the time we get thirsty, we are already mildly dehydrated. Be sure to drink at least 8 glasses of water every day, especially before and after exercising.

75% of our muscles and 22% of our bones consist of water. Water also helps in cushioning joints. Drink up as water loss can be detrimental to joints, robbing them of their ability to lubricate. Staying well hydrated is the simplest way to minimise unnecessary joint pain.

5. Do not forget to treat your muscles and joints from time to time by going for a good body massage. The benefits are known to include decreased pain and increased circulation, energy and flexibility. A warm bath can also relieve muscle tension and ease aching joints.

More info on JOINTS here.


FAQ on Stem Cells

by Dr. Y.L.M

I have been hearing so much about stem cells from billboards, newspaper reports and talk shows discussing about the ethics of it all. I am not quite sure I understand the concept of stem cells.

Stem cells are cells from humans and animals (and yes, all of us have them) that are unspecialised. This means they have not yet been differentiated within the body to perform a specific function. For example, our red blood cells are specialised to carry oxygen, our brain cells are specialised to govern our body's workings and our reproductive cells are specialised to reproduce.

But a stem cell has not been differentiated yet to become a specific cell that performs any of these highly specialised functions, which makes their capacity tremendous. Only recently have scientists understood their potential in the treatment of disease and healing.

You see, stem cells have three very important properties :

* They can divide and replicate many times. They are capable of long-term cell renewal.

* They are yet unspecialised, as mentioned before.

* They can develop into any type of cell that you need in your body, and can be induced to develop into what is needed. Stem cells are often described as a 'blank microchip' in which you can programme what you need.

In 1998, scientists discovered a method to harvest human stem cells from test tube human embryos.

Is it true that only babies have stem cells?

There are two types of stem cells. Embryonic stem cells (from a 3- to 5-day old embryo) basically consist of stem cells which will divide and later differentiate into functional cells that will form the organs and system of the body.

Adult stem cells still exist in adults even though most of your body's cells are already specialised, especially in areas where high growth and regeneration is needed, such as your bone marrow, skin, gut or your reproductive cells (eggs, sperm). And stem cells from one type of tissue, for example your bone marrow, can give rise to cells of a totally different tissue, for example your nerves. This is a phenomenon known as plasticity.

For harvesting purposes, adult stem cells are usually harvested from your bone marrow or your blood stream.

So the furore over the use of stem cells is mainly due to the fact embryonic stem cells have been harvested and used?

Yes. The process involved is as follows :

The embryos are cultivated in a test tube by in-vitro fertilisation. The donors of the sperm and the egg have completely given their consent. Then the embryo is grown on a culture dish.

It is the inner cell mass of the embryo that is desired, so these are allowed to divide, multiply and when they crowd out a dish, they are transferred to another dish. After 6 months or so, an original cell mass of 30 cells may have proliferated to millions of embryonic stem cells. This is called an embryonic stem cell line.

Batches of embryonic cells can be frozen and shipped to other labs.

The ethical furore of course is over whether or not embryos should be used for these purposes, because some people deem a 5 day embryo to have a life of its own.

Moreover, an embryo is meant to differentiate into a human being – and by stopping and cultivating its differentiation, test tube or not, you are deemed to be stopping a human life from developing on its own and channelling it to develop into something grotesque, without mass or form.

It is, in part, like the ethical issue over abortion.

What can stem cells be used for?

There is much scientists do not know yet. However, stem cells can theoretically offer a renewable source of replacement cells to treat diseases such as Parkinson's (a renewable source of dopamine producing cells), Alzheimer's, spinal cord injuries (where nerve cells can be regenerated), burns (where skin grafts can be regenerated), strokes (brain cells), heart diseases (cardiac muscle and lining cells), diabetes (insulin producing cells in a person's pancreas that has been partially destroyed by antibodies, which give rise to type 1 diabetes mellitus), osteoarthritis and rheumatoid arthritis (bone cartilage cells and even bone cells which have been destroyed) and blindness (where retinal cells can be grown to repopulate a destroyed retina).

In the future, perhaps research will enable us to treat cancer, grow new limbs and grow new organs to replace the ones that have been destroyed.

Already, the stem cells of the bone marrow can be used to seed an 'empty' bone marrow which has been destroyed by cancer (leukaemia) or chemotherapy. This is the basis of bone marrow transplant.

In Malaysia, there is a stem cell laboratory where you can harvest your cells and use them to treat diseases like diabetic ulcers and thalassaemia.

Of course, bone marrow transplant has been going on in many centres already for many years. You can also bank in your baby's cord blood (which contains stem cells) so it can be used in the future.

More info on STEM CELLS HERE.


FAQ on Influenza A(H1N1)

Although the signs and symptoms of Influenza A(H1N1) have been widely publicised, many are still unclear about the way it could affect them personally. Here are a few frequently asked questions :

I. How do we get infected with Influenza A(H1N1)?

The A(H1N1) virus is mainly transmitted person to person by droplets that comes out the noses or mouths of infected people when they cough or sneeze. We can get infected if we inhale the droplets or touch something – such as a surface or object – with flu viruses on it and then touch our mouth, nose or eyes.

A person can remain infectious as long as symptoms of influenza-like illness persist, or one day before and up to seven days after symptoms (especially fever) appear. Children and those whose immune systems are compromised can spread the virus longer.

That is why you should ...

a. practise good cough etiquette and personal hygiene

b. clean commonly touched surfaces in the house/workplace

c. practise social distancing (stay 1m away from a person who is sneezing/coughing)

II. How does the Influenza A(H1N1) virus make us sick?

The Influenza A(H1N1) virus is a virus that mainly affects our respiratory system. It penetrates cells lining our airways and replicates inside them. When they are released from infected cells, the infected cell is damaged.

As our immune system fights the infection with an inflammatory response, it may cause swelling in our airways and we may have fever, cough, sore throat, and difficulty in breathing.

III. How is Influenza A(H1N1) different from the common cold?

High fever (>38°C) that lasts for 3 to 4 days, sore throat, headaches, severe body aches, extreme fatigue and severe cough are common in Influenza A(H1N1) but rare in common colds. Running or stuffy nose and sneezing, however, is sometimes present in Influenza A(H1N1) but prominent in common colds.

While Influenza A(H1N1) can lead to other complications, colds generally do not result in serious health problems such as pneumonia, bacterial infections, or hospitalisations.

IV. How does the Influenza A(H1N1) virus cause complications and death, and how can we prevent them?

Pneumonia (an inflammatory illness of the lungs) is the major serious complication of influenza virus infections, including the Influenza A(H1N1) virus. The inflammation in the lungs may cause difficulty in breathing or cause the lungs to be filled with fluid, making it difficult for the body to get enough oxygen.

It can develop about 3 to 5 days after symptoms start. But it is uncommon, and usually occurs in susceptible individuals from the high-risk groups.

Pneumonia can be caused by the spread of the influenza virus into the lungs, or by unrelated bacteria, which infects the lungs after a person's immune system is weakened by the virus infection.

Other complications include cardiovascular, muscular, neurological and systemic ones. Cardiac events following influenza are not uncommon.

So far, about 70% of those who died due to Influenza A(H1N1) related complications had underlying medical conditions or were from other high-risk groups. However, 40% of deaths in the country are linked to delays in seeking treatment, while 13% of them have sought medical help but were treated with a low index of suspicion.

If you have influenza-like illnesses, follow medical advice, and be watchful for emergency warning signs. SEEK IMMEDIATE MEDICAL ATTENTION if you have any of the warning signs.

V. How does anti-viral medication work, and does it have any side effects?

Oseltamivir and zanamivir are drugs called neuraminidase inhibitors. They help prevent influenza viruses from multiplying in the body by interfering with the production and release of virus from cells that line the airways. This may slow the spread of the infection within the airways and lungs.

Oseltamivir is taken orally while zanamivir is taken by inhalation.

Although generally well tolerated, the most common side-effects associated with oseltamivir are nausea and vomiting. People with the flu, particularly children and adolescents, may be at an increased risk of self-injury and confusion shortly after taking oseltamivir and should be closely monitored for signs of unusual behaviour. A healthcare professional should be contacted immediately if the patient taking oseltamivir shows any signs of unusual behaviour.

As many patients with asthma or chronic obstructive pulmonary disease (COPD) have had bronchospasm (wheezing) or serious breathing problems when they used zanamivir, it is not recommended for people with chronic respiratory disease such as asthma or COPD. If you develop worsening respiratory symptoms such as wheezing or shortness of breath, stop using zanamivir and contact your healthcare provider right away.

More info on INFLUENZA A HERE.


FAQ on Flu Pandemics

by Dr. Y.L.M

I am curious about how many influenza pandemics there have been in history, because this is the first time I have ever been in a WHO Pandemic Level 6 situation. Then again, I am only 15 years old! What is a pandemic anyway?

A pandemic (pan = all; demos = people or population) is defined as an epidemic (or sudden outbreak of a certain disease) that becomes very widespread and goes on to affect a whole region, or continent, or even the world.

A WHO definition of Pandemic Level 6, the highest level, is when a disease is widespread and sustaining rapid human-to-human transmission in 2 or more regions around the world. The H1N1 flu pandemic is the first global flu pandemic in over 41 years since the 1968 Hong Kong flu!

Note that the term 'Pandemic Level 6', which is scary-sounding in itself, denotes the spread of the disease, but not its severity. Being in a Pandemic Level 6 does not necessarily mean that a lot of people will die from the disease that is spreading.

Seasonal influenza, the type you get in certain months like winter, is not considered a pandemic.

Have all the flu pandemics been recorded only from the 20th century?

The first major influenza epidemic (not pandemic) was recorded by Hippocrates, the father of medicine, in 412 BC, though it was not called 'influenza' then. Only in 1357 AD was the term 'influenza' coined, from the Italian word 'influence'. At that time, it was thought that flu was 'influenced' by the stars in the sky!

The first ever pandemic was recorded in 1580 – and you guessed it, it involved influenza. It originated in Asia Minor (the Middle East) and Northern Africa and swept into Europe within 6 weeks. It entered Europe by way of Malta into Italy, then propagated rapidly north through the Italian peninsula. It also entered Spain because at that time, Spain ruled several North African ports.

At least 10% of all Rome's population (then numbering 81,000 people) died within the first week of contracting it. Some Spanish cities were almost completely depopulated.

Then for a long, long time, there was no further pandemics until the 18th century.

How do you explain that?

This historical fact has also baffled many scientists. This is called a period of pandemic stability. Many questions arise as to whether a pandemic comes by chance. Because during the period between 1580 and 1729, there were plenty of epidemics. And the question remains to be answered whether epidemic situations prevent pandemics, or at least help delay them.

So when was the next pandemic and what happened?

There were 3 pandemics in succession then, the first from 1729 to 1730, the second from 1732 to 1733 and the third from 1781 to 1782. You must remember that in the 18th century, doctors did not know influenza was caused by a virus. They blamed it an unknown poison in the air and wind/temperature and meteorological phenomena. So their documents on pandemics are filled with these theories!

The 1729-1730 pandemic was a flu, and it is believed to have originated from Russia. There were two outbreaks in Moscow and Astrakhan on the Caspian Sea in April. Surprisingly, the summer of 1729 was a quiet one, Then suddenly there were influenza reports in Sweden in Sept 1729, and in Vienna come October. By November 1729, the flu had swept through Hungary, Poland, Germany and England.

But this particular pandemic, although virulent, caused relatively few deaths. Flu was unknown in North America until 1732 (yes, the American Indians never had flu before that!), because of the settlers in New England.

The 1781-82 pandemic on the other hand was not only virulent but deadly. This one started in China, involved then British-occupied India and then spread to the Western hemisphere. There were tens of millions of cases, spreading through all transport modes available then.

1918 Spanish flu pandemic.

I heard that the worst flu pandemic occurred in the 20th century.

Yes. There were major pandemics from 1830 to 1834. Then in 1918, the Spanish flu began. (Though researchers think it actually started in the US.) It was also caused by a H1N1 flu virus, and is the worst flu pandemic to date. It was very dangerous to young adults, especially those from age 20 to 40.

The Spanish flu was memorable because it killed millions of people and it killed those in the prime of their lives. At first, it attracted little attention as people thought it was the 'normal' flu. Then when a second killer wave descended and young adults began to be affected, people panicked.

This pandemic was extremely deadly as well as virulent. From North America, it spread to Europe and the rest of the world. In Switzerland in July 1918, 53,000 people alone died in that one month.

By August 1918, the flu had morphed into a 3rd deadly strain. World War 1 occured, and the spread of troops and disruption of the world's population then helped transmit the virus. What is worse, this particular pandemic came before treatment was available, so people succumbed easily.

At the end of it, it was estimated that 20 million to 100 million people worldwide had died. In the US alone, half a million people died. It is difficult to say today whether this 1918 flu would have the same impact on us with the advent of antibiotics to treat secondary pneumonia.

More info on SWINE FLU HERE.


Fat Loss Basics

Believe it or not, losing a little or a lot of fat involves pretty much the same concept - consistent dieting coupled with cardiovascular exercise and weight training. This is how the professionals do it, and it works.

Many of you may be hesitant to start a weight training program, but the benefits far outweigh any reservation you may have. Weight training enhances your fat loss by increasing your muscle mass and more muscle means more calories burned (faster metabolism). It also gives your skin a more tone, tight appearance, lowers your blood pressure, strengthens your bones, improves your agility, increases your flexibility, strengthens your immune system and gives you more energy and a brighter outlook on life.

If you have a high level of body fat, or you have never been able to successfully lose fat, you should consider trying a program that not only focuses on dieting, but also includes adequate cardiovascular activity and weight training.

If you are already very muscular, and you just want to lose a little body fat, then a fat loss program that includes regular cardiovascular activity and weight training is perfect for you. The best way to get ripped and maintain as much muscle as you can is to diet slowly. The truth is, when you are on a low calorie diet, your body prefers to use muscle tissue for fuel rather than excess body fat. So, the slower you lose weight, the more likely you are losing fat and not muscle.

Ideally, you should aim to lose no more than 1lb - 1.5 lbs per week. That's it. If you are obese, then you should try to lose no more than 1% of your bodyweight per week. Any more than that and you are sacrificing muscle.


Women do tend to lose fat at a slower rate than men, but don't let this discourage you. Women simply store fat more efficiently than men because it is needed during and after pregnancy. As your body fat levels drop, you will notice that the fat loss comes off in reverse of how it was put on. So, the most recent fat gains will come off first, while the old fat that has been there for a while will take the longest to lose.

The most difficult fat to lose usually centers around the waist, belly and lower back areas for men, and the upper thigh and buttocks, area for women. The fat in these areas are the most difficult to totally get rid of. These areas are comprised of mostly brown adipose tissue (fat). This type of fat is difficult to lose because the low blood flow in these areas hinder the fat mobilization. So, if the fat can not be moved into the bloodstream to be used as fuel, those love handles will never go away.

That is why thermogenic agents like ephedrine and blood thinning supplements like aspirin help to improve fat loss - they increase circulation into these hard to reach areas and mobilize the stubborn fat.

Remember that you cannot spot reduce! What it means by this is that you can't pick and choose the areas that you would like to lose the fat and do exercises that work those areas expecting the fat to just magically disappear in those areas. Your body does not work that way. The only way to decrease the amount of fat in certain key areas is by lowering your total body fat levels. As you lose fat, it will come off all over your body, not just in specific areas.

Fat Loss Program

If you follow a complete diet and weight training program for at least 12 weeks, you will begin to see dramatic changes occurring with your body, and we are not just talking about the obvious physical changes, but also about the psychological and physiological changes. You can expect lower body fat (of course), increased muscle mass, increased metabolism, increased sense of well-being, more energy, lower bad cholesterol level, increased good cholesterol level, decreased risk of heart disease, deeper more restful sleep and most important, increased self-confidence.

To be successful, your fat loss program should include the following:

* A calorie restrictive diet, which requires you to eat no less than 10x and no more than 15x your LEAN bodyweight in calories.

* Regular cardiovascular activity for at least 30-45 minutes 3-4 times per week. Some recommend a moderate pace while other recommend a vigorous pace -- it doesn't really matter as long as you are exercising.

* Weight training.

* Supplementing your diet with vitamins, minerals and amino acids. Vitamin C, L-glutamine, and a good multi vitamin are the bare essentials.

* Adequate dietary fat, including high amounts of Essential Fatty Acids (Omega-6 and Omega-3).

Finally, make sure that the program you decide on is compatible with your lifestyle and schedule. You can have the greatest program in the world, but if you cannot implement it then it is worthless. There are thousands of fat loss diets and workouts that will work, but the hard part is finding one that works for you and the specifics of your diet and schedule restraints.

A Word On Consistency

OK, so you want the secret to fat loss? Well, here it is : CONSISTENCY. You can have the best diet, the best training schedule, join the best gym that has the best equipment, but without consistency it's all worthless.

Over the past two years, a researcher talked to hundreds of people who have successfully transformed their physique. Though most of them trained in totally different ways, there was one common denominator that appeared throughout each success story : Day in and day out, they followed their pre-determined plan, consistently without fail. There are many paths to your goal but you will never reach it unless you consistently put one foot in front of the other. You must find the determination and drive within yourself to see this through. If not now, then when?

In the grand scheme of your life, can you afford a slight inconvenience to create a fantastic physique -- or will you continue to be an "Average Joe" for 80 more years! Which sounds more inconvenient to you?

It's easy to make excuses, after all, most people used to do the same thing. Don't get caught up in this. The truth is, the hardest part any training routine is getting started. You've got to break your old habits and make new paths for yourself.

Gaining muscle or losing fat, like anything in life, is a simple matter of staying focused and being consistent. Fortunately, it's never too late to get started, and you will thank yourself a few months down the road. Remember that saying, "Do what you've always done, and you will get what you've always gotten". Now, read it again.


Q : I am slightly overweight female who has a good amount of cellulite on my upper legs and rear. Is it possible to get rid of this?

A : For women, lower body fat and cellulite are very common problems. Unfortunately, it is an area in which the fat stored there has very little circulation. In other words, the lack of blood vessel activity in those areas make it very difficult for the body to move that fat into the bloodstream where it can be used as fuel by the body. The only non-surgical way to remove the cellulite is to simply go on a long-term fat loss program. To begin to see a reduction in these areas, you will have to get your body fat levels down to around 16-18%.

Men have a similar common fat storage area around their stomach and waist.

More info on FAT LOSS HERE.


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