Giant panda Mei Xiang enjoys an ice cake at the Smithsonian's National Zoo in Washington, D.C., the United States, on July 22, 2023. Photo: Xinhua
Can cute pandas still be seen in the US? With the recent announcement by the Smithsonian's National Zoo in Washington that giant pandas "Mei Xiang," "Tian Tian," and their 3-year-old cub "Xiao Qi Ji" will be sent back to China this month, American public opinion quickly seized on the "sensitive issue," reporting with astonishment that if the loan agreement for the four giant pandas at Zoo Atlanta expires next year and the pandas also return to China, there could be no pandas in the US for the first time since 1972.
Some American media reflexively attribute this situation to political factors, claiming that "China appears to be gradually pulling back its pandas from multiple Western zoos." This is pure sensationalism aimed at driving the false narrative that China is no longer friendly toward the US-led West so that to create or strengthen the opinion that "China is becoming more closed." Despite the clear statement from Brandie Smith, the director of the Smithsonian's National Zoo in Washington, to the media that negotiations are researcher-to-researcher and not politically driven, many mainstream American media outlets appear disinterested in this statement.
The giant pandas "Mei Xiang" and "Tian Tian" arrived in Washington in 2000. During their stay in the US, they gave birth to a total of four panda cubs, including "Xiao Qi Ji," born in 2020. The initial loan agreement signed between China and the US was for a period of 10 years. Subsequently, both parties extended the agreement twice, for five years each time. In 2020, China and the US jointly announced another extension of three years of their cooperation, prolonging it until December 7, 2023.
As the agreement is about to expire, "Mei Xiang" and "Tian Tian" are now in their 20s and are facing some age-related health issues. They are no longer suitable for living abroad. For them, 23 years of life in the US is already a substantial period. Returning to their habitat is obviously a better choice. Anyone who genuinely loves and cares for giant pandas, whether Americans or Chinese, will understand this decision and wish "Mei Xiang" and her family all the best.
Giant pandas are "image ambassadors" of China-US friendship and cooperation and a bridge connecting the people of China and the US. This has never changed and will not change. The giant pandas, including "Mei Xiang" and her family, are beloved by a wide array of American citizens. Long lines outside the panda enclosures at zoos are common, and there are numerous panda-related products. DreamWorks' Kung Fu Panda movie franchise has even produced four installments. Meanwhile, several generations of giant pandas have lived in the US, successfully breeding healthy offspring, which reflects the relentless efforts made jointly by China and the US for panda conservation. It should be noted that this situation is generally similar in the US and other developed Western countries.
Over the past couple of years, some giant pandas have returned to China after their loan contracts expired, while others have had their loan agreements extended. This is normal. The loan standards are in place to ensure the well-being of each giant panda, with contract renewals primarily being a technical matter. However, some Western media outlets have been closely monitoring those contracts that are not being renewed, blowing them out of proportion, and using them to tarnish China's "diplomatic style."
Thus, when China gifted or leased giant pandas to the US, some American politicians and media figures sternly warned, with a straight face, that pandas could be China's "united front tool," cautioning everyone to be vigilant. However, when pandas in the US need to return to China due to lease expirations, some argue that this might signify the "end" of China's "panda diplomacy." In short, they seem determined to tarnish the symbol of warmth, friendship, and cuteness represented by the "giant panda," turning the word "Panda" into something negative and unfavorable. This not only fuels anger but also evokes a sense of sadness.
The Smithsonian's National Zoo in Washington was the first zoo to receive giant pandas after Nixon's visit to China in 1972. It has witnessed the deepening of people-to-people emotions between China and the US in the course of their friendly interactions. In a heartfelt farewell to the panda family "Mei Xiang," the zoo previously organized a nine-day "Panda Palooza: A Giant Farewell" event. Many residents in Washington DC and visitors from across the US flocked to the zoo to bid farewell to the three giant pandas, creating a heartwarming scene. This is a real-life representation of people-to-people diplomacy between China and the US. Those in the American media who only focus on geopolitics and the anti-China politicians who cannot tolerate giant pandas have a much narrower perspective and a less open heart compared to the average American citizens.
The disconnect of our Political "Elites" and the problems this causes the rest of us
The more we interact with our political "elites" in elected office or running (or funding) the bureaucracy and special interests that serve them, the more apparent their disconnect from regular people has grown worse. These are not people who have experienced the regular hardship or labor of average people in most communities. Instead, their arrogance, elitism, and disdain for regular people is likely to only cause more problems.
Our immune system is made up of many different organs which contribute to our immunity:
Our skin prevents pathogens from entering our body
Various internal organs (e.g. bone marrow, spleen, lymph nodes) produce cells/antibodies that specifically target pathogens.
The digestive system helps defend against pathogens entering via the gastrointestinal tract. The digestive & immune systems work together to signal immune cells. The gut is also the largest immune organ in human body. The gut microbiota, which are the microbes living in the gut, enhances immunity by forming a protective barrier and signalling (communicating) with immune cells. Good bacteria (gut microbiota) also helps your body digest food and supports your child’s immune system. Keys to good digestive health:
Consume balanced, nutrient-dense diet rich in fruits, vegetables and whole grains
Eat a variety of food as they provide important vitamins, minerals, and dietary fibre. Some vegetables also contain prebiotics (i.e. indigestible fibres that good bacteria feed on). This will contribute to optimal digestive health, which in turn helps improve the digestive process.
Exercise & hydrate
Helps improve diversity of gut microbiota. Try simple exercises, e.g. brisk walking around the house compound or indoor exercises such as stationary bike workouts, yoga, tai chi, and light stretching exercises.
Drink plenty of water to stay well-hydrated. Exercise and staying hydrated help ensure proper food digestion, bowel movement and also helps maintain a healthy balance of good vs bad bacteria.
Manage stress & get enough sleep
Stress and lack of sleep can negatively affect both digestive health and mental wellbeing. To prevent this, manage stress effectively and get sufficient sleep daily.
Include probiotic-rich foods in our diet
This includes food such as cultured milk drinks, yoghurt that contains probiotic live cultures, and fermented food (e.g. kimchi, sauerkraut, tempeh). Studies have found that probiotics promote good digestive health and can both directly and indirectly enhance our immune system.
Take oral nutritional supplements with live probiotic cultures
Supplementing your probiotic intake is usually not a worry. It is good to consult your doctor first to learn if supplementation is necessary and to see the most suitable probiotic supplement for you or your family.
How probiotics help:
Inhibits pathogenic (bad) bacteria by competing for nutrients.
Forms a protective barrier preventing harmful pathogens from entering our body.
Modulates our body’s immune responses (e.g. stimulates production of antibodies, signals immune cells) in response to infection.
Tips for consuming probiotics:
The probiotic strain in a product or supplement must be clinically proven and supported by studies and data that show the safety and efficacy of the product. E.g. Bifidobacterium lactis BB-12 and Lactobacillus paracasei L.CASEI 431.
Choose products with minimal or no added sugar.
Store probiotic products properly to optimise their effectiveness. This helps to maximise the viability of live strains before consumption. Some products require no refrigeration while others need to be refrigerated.
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The heart has to work very hard if you have aortic stenosis, a condition where the aortic valve narrows and blood cannot flow normally.
OUR heart’s main job is to supply oxygen-rich blood to the body.
Our life literally hangs on how well blood is pumped through our four heart chambers with the help of four heart valves (aortic, mitral, pulmonary and tricuspid), which open and close with each heartbeat.
Imagine the precision and intricacies of a healthy heart – it beats 100,000 times a day during which the mitral and tricuspid valves control blood flow between the heart chambers.
The pulmonary valve controls blood flow to the lungs while the aortic valve controls blood as it flows out from the heart’s lower left chamber to the aorta, the main artery bringing blood to the rest of the body.
A life-threatening condition
When the aortic valve does not function optimally, blood flow is restricted due to the narrowing (stenosis) of the area where blood is moving out of the heart.
Your heart will then need to work harder to pump blood to the rest of your body, affecting your health and limiting your daily activities.
This condition is called aortic stenosis and it’s a progressive disease that ranges from mild to severe.
Often, this condition may go unnoticed as patients go about their daily lives discounting the irregularities in their well-being.
Aortic stenosis is the most common valvular heart disease worldwide, with its prevalence increasing with age.
It is estimated that up to 12.4 % of people over age 75 have aortic stenosis, and about 80% of adults with symptomatic aortic stenosis are male.
Symptoms generally occur when narrowing of the aortic valve is severe.
However, some people with aortic stenosis may not even have symptoms for many years.
If you demonstrate symptoms such as chest pains or discomfort during physical activity, dizziness, fatigue, shortness of breath and an irregular heartbeat, don’t dismiss it.
Consult a physician.
Understanding the disease
If diagnosed with aortic stenosis, it means your aortic valve is not opening or closing properly.
This limits the amount of blood pumped out to your body and strains your heart.
Over time, the left ventricle of your heart can thicken and enlarge.
Heart muscles will weaken and this can lead to heart failure and complications such as stroke, blood clots, bleeding, irregular heart rhythms and infections of the heart.
Left untreated, it can be fatal. It is important to understand the difference between aortic stenosis, atrial fibrillation and myocardial infarction.
While all are cardiovascular related, they are different and require different treatment approaches.
Atrial fibrillation is a disorder that originates from the atrium (upper chambers of the heart).
When the atrium does not contract effectively, irregular and rapid heart rhythm occurs.
Blood can pool in the heart, running the risk of blood clots which may lead to stroke.
Myocardial infarction, commonly known as a heart attack, occurs when there is a rupture of an atherosclerotic plaque in a coronary artery.
This causes a blood clot that obstructs blood flow.
Very simply put, aortic stenosis is a valve disorder, atrial fibrillation is an irregular heart rhythm and myocardial infarction is a heart attack caused by a blocked coronary artery.
Root cause
Aortic stenosis is commonly due to a build-up of calcium compounded by contributing factors such as age and existing congenital heart defect.
Some individuals may be born with aortic valve disorders and are more prone to aortic stenosis later in life.
Other causes include infection of the heart, chronic kidney disease, heart disease risk factors such as diabetes, high cholesterol and high blood pressure, or a result of radiation therapy.
Diagnosis and evaluation
If aortic stenosis is suspected, your cardiologist will recommend diagnostic tests, as outlined below, depending on the assessment of your condition.
> An ultrasound imaging test called an echocardiogram to visualise the aortic valve and assess its structure and condition.
This test identifies weakened muscles and determines the severity of the aortic stenosis.
> An electrocardiogram or ECG measures the electrical activity of the heart and detects any potential issues with the heart’s chambers.
> A chest x-ray determines the condition of the heart and lungs and detects if there is swelling in
the aorta and/or calcium build-up on the aortic valve.
> If needed, a cardiac computerised tomography (CT) scan or a cardiac magnetic resonance imaging (MRI) may be done.
> Only when needed or when other non-invasive test are inconclusive, a cardiac catheterisation or a cardiac angiogram may be recommended.
Treatment modalities
Lifestyle modifications are necessary, regardless of the stage of your aortic stenosis.
Start consuming a hearthealthy diet.
Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish and whole grains.
Avoid saturated and trans-fat and excessive salt and sugar.
If you are overweight, lose weight through regular exercise; brisk walks each day are recommended.
Manage your stress levels. Indulge in wholesome activities.
If you are a smoker, consider quitting.
In cases of mild aortic stenosis, your cardiologist will prescribe medications which are a non-invasive.
It can provide a temporary relief of symptoms and may reduce risk of complications.
However, medications alone do not address the underlying valve issues.
Patients may risk a decline in their condition over time.
Thus, it is essential to diligently keep your regular heart checkups to monitor the progression of your condition.
In more severe cases, aortic stenosis patients may have to undergo procedures to repair or replace their defective valves such as :
> Balloon valvuloplasty (BAV)
This is a non-surgical option which involves a balloon being inflated in the aortic valve to improve blood flow.
This treatment typically provides only temporary relief of symptoms and patients risk restenosis of the valve over time.
> Surgical aortic valve replacement (SAVR)
This offers a longer lifespan for the replaced valve and is often the conventional treatment for aortic stenosis.
However, being an open-heart surgery, it carries inherent risks especially for elderly patients and those with underlying health conditions.
These surgical valve replacements may also wear out over time and can start to fail and causes stenosis and regurgitation (valve does not fully close and blood flows backward through the valve).
Patients are advised to stay in the hospital for seven days.
> Transcatheter Aortic Replacement (TAVR)
This is a minimally invasive procedure performed between one to two hours as compared to an invasive open-heart surgery.
A small cut is made in the groin, neck or between your ribs so that a thin, flexible tube with the TAVR can be guided and placed in your diseased valve.
The new valve will then work immediately, and the tube is removed.
TAVR is designed to work like your own heart valve as the materials used allow the frame to mold itself to your anatomy.
It’s worth noting that the artificial TAVR valve can be made of porcine or bovine materials.
This procedure is suitable for patients who are considered highrisk or unsuited for open-heart surgery.
Patients can consult their cardiologist for other suitability criteria.
This involves shorter hospital stays of about three days as patients recover faster.
Institut Jantung Negara (IJN) was the first hospital in Malaysia to do a TAVR procedure in 2009.
At that time, some in the medical fraternity shared their uncertainty about the durability or longevity of a TAVR and thought it may only last for five years or less.
They preferred conventional surgery which was known to last for about 10 years.
The TAVR has since grown in acceptance and has been proven to stand the test of time.
For 83-year-old aortic stenosis patient, Siti Rahmah, who was implanted with a TAVR in 2011, it has still been functioning effectively.
She recently shared, “I am very pleased with the progress I have made. It has been 12 years since I did the procedure. I am thankful that I can go about my daily activities quite comfortably. My condition has been well managed.”
Take action
Those at-risk patients and 65 years and above should never undermine the importance of regular heart check-ups to detect irregularities of the heart.
Aortic stenosis is a serious cardiovascular condition.
Left untreated, it can lead to significant health problem while early diagnosis and a personalised treatment can prolong life.
By Datuk Dr Shaiful Azmi Yahaya is a senior consultant cardiologist at Institut Jantung Negara. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Any exercise, resistance or aerobic, brings about a significant increase in human growth hormone (HGH). Insulin-like growth factor and growth hormone are responsible for increased collagen synthesis after exercise and aids muscle recovery. Growth hormone itself does not directly cause muscle hypertrophy but it aids muscle recovery and thereby potentially facilitates the muscle strengthening process.[15] The accumulation of lactate and hydrogen ions (eg in hypoxic training) further increases the release of growth hormone. [13]
High intensity training has been shown to down regulate myostatin and thereby provide an environment for muscle hypertrophy to occur.[12] Myostatin controls and inhibits cell growth in muscle tissue. It needs to be essentially shut down for muscle hypertrophy to occur.
