The overlooked workhorses
WHEN it comes to awareness of diseases, the kidneys are rarely a topic of discussion. Dr Tan Li Ping, consultant nephrologist at Ara Damansara Medical Centre, opines that this is because symptoms of kidneys problems are generally not apparent until it is too late.
“When people have early kidney problems, they often aren’t aware of it. The kidney is silent when mild damage is present, and by the time symptoms are noticeable, the condition could have already become severe. Unfortunately, treatment is often delayed,” says Dr Tan.
Because symptoms of kidney problems are not apparent, Dr Tan advises all Malaysians to go for regular check-ups, be it at public or private clinics. This factor is extra important as Asians are known to be more genetically susceptible to kidney disease caused by diabetes.
He says, “According to the US Renal Data System 2013 Annual Data Report ,64%of Malaysian patients on dialysis have kidney failure thought to be a complication from diabetes. This figure is much higher than the 44% rate reported in the United States. Given that Malaysia is considered a hotspot for high blood pressure, high cholesterol, diabetes and obesity, it stands to reason that this percentage will only go up.
“If you have diabetes, you should get a urine and blood test at least every three to six months. If you are physically healthy, once a year should suffice.”
Passing health on
Giving advice about preventing kidney disease, Dr Tan shares that losing weight, practising a healthy diet, exercising regularly, making sure your blood pressure and sugar levels are normal, and avoiding or quitting smoking are important to mitigate your risk of kidney disease.
He asserts, “The golden time for you to protect your kidney is right now, when your kidney is still functioning optimally.”
While Dr Tan notes that there is still room for improvement in terms of public education on kidney disease, he prefers to focus on behavioural changes of Malaysians.
He says, “While most people today are aware of how lifestyle diseases such as diabetes cause illness, that knowledge hasn’t translated into any real changes in behaviour.
The medical community has noticed that the public has not been making effective lifestyle modifications despite being repeatedly informed about the dangers of habits such as inadequate physical activity and unhealthy diets.”
Nevertheless, Dr Tan shares that there is hope for those who experience kidney failure – renal replacement therapy.
“The most common form of renal replacement therapy for kidney failure is dialysis, where toxins and excess fluids are filtered out of the bloodstream. Another option for patients with kidney failure is a kidney transplant. Ask your nephrologist which option is the better one for you.”
A common misconception is that diabetes medications cause kidney damage. This belief often guides patients to avoid taking their medications regularly, or at all, contributing directly to health deterioration. Dr Tan says, “Most medications pose only a small risk of causing kidney damage; a risk that is further reduced when the medication is prescribed under expert guidance. The likelihood of uncontrolled diabetes causing kidney problems far outweighs the small risk of medications harming your kidneys.”
It is important for Malaysians to pay attention to all parts of their health, from the brain to the kidneys, as the body acts as a unit and no organ is more important than another in ensuring that we lead happy, healthy lives.
Protection of the mind
When one is diagnosed with a chronic illness such as diabetes, high cholesterol or kidney problems, it is understandable when he or she goes on a roller coaster of emotions. This can be the same for the patient’s loved ones, who go through their own respective grieving processes.
Michelle Ho Sueh Yeng, clinical psychologist at ParkCity Medical Centre, says, “Coping with an illness is never easy, even more so with chronic illnesses that are longlasting and can potentially stay with the patient for life. On top of having to cope with the initial shock of the diagnosis, patients must adjust to physical weakness, lifestyle changes and probable financial burdens because of treatment.
“World Health Organization statistics show that one in four individuals develop a common mental disorder such as depression or anxiety every year. People with chronic diseases are at a higher risk of developing mental health disorders because of unexpected life changes. As a result, they can become less active, avoid social contact, and be irritable, moody and anxious.”
Be the helping hand
During difficult times, it is especially important for a patient to receive adequate support to enhance her mental state and quality of life. Ho lists four types of social support, which are:
Emotional – Expressions of empathy, love, trust and care
Instrumental – Tangible aid and service Informational – Advice, suggestions and information
Appraisal – Expressions of confidence or encouragement
While Ho recognises the difficulty of facing the reality of diagnosis head on, she opines that it is the best way for a patient to cope with her situation.
She shares that people who actively confront their diagnoses, seek social support and use active coping strategies could experience better adjustment, inner peace and life satisfaction compared with those who feel resigned to their fates and deny or avoid their diagnoses, citing findings from studies such as a 2004 one titled Coping responses following breast cancer diagnosis predict psychological adjustment three years later published in Psycho-oncology.
Ho advises loved ones and guardians to accompany the patient in her journey.
“Empowering the patient with accurate knowledge of the disease and treatment and helping her develop coping strategies may also be beneficial.”
Besides that, she asserts how important it is for patients to surround themselves with positive, supportive people. “Try to find small things that you enjoy every day and set realistic goals for yourself. Small goals such as a visit to the park or phoning a close friend can help you make the most of each day.”
Creating a safe place
While Ho acknowledges the increased awareness about mental health in Malaysia, it is not proportionate to the growing number of people facing mental health issues, and she recognises the ingrained stigma these people still face.
“Despite experiencing overwhelming emotions from being diagnosed with a chronic illness, patients may have an underlying fear that getting mental health treatment equals being ‘crazy’. This stigma causes them to avoid seeking help for fear that their family members will be shamed.” Although many initiatives have been implemented by the Government, public and private healthcare providers and nongovernmental organisations, Ho suggests that the stigma surrounding mental health and the optimism of “this will never happen to me or my loved ones” tend to dominate societal mindsets, thus deterring muchneeded care. Therefore, more impactful awareness programmes are needed to educate the public on the existence and debilitating effects of chronic diseases on patients and their families and communities.