Kenapa Perlu Minum Air Gula Ketika Hamil

January 15, 2020

Satu persoalan yang sering ditanya oleh setiap wanita hamil. Minum air gula bukanlah hal yang disengajakan. Hakikatnya ada beberapa sebab yang memerlukan ibu hamil untuk minum kandungan air gula ini sebaiknya. Dr Norintan Zainal Abidin daripada Hospital Columbia Asia, Seremban menjawab segala persoalan.

Diabetes atau kencing manis I adalah penyakit yang boleh berlaku sebelum hamil, ia juga boleh berlaku sewaktu hamil. Oleh kerana kencing manis membahayakan wanita yang hamil dan juga bayi di dalam kandungan, Kementerian Kesihatan Malaysia (KKM) telah mengeluarkan memo supaya ibu hamil yang berisiko untuk melakukan ujian saringan untuk melakukan Gestational Diabetes Mellitus (GDM) pada 24-28 minggu ke hamilan dengan ujian modified OGTT (mOGTT). mOGTT inilah yang dikenali sebagai ujian Minum Air Gula! Bagi pesakit-pesakit diabetes yang belum hamil, mereka perlulah menghadiri pre-pregnancy counselling (PPC) sebelum hamil supaya mereka mampu mengawal paras gula dalam darah dengan lebih baik sebelum dan sewaktu kehamilan.

Memanglah tidak sedap minum air gula untuk ujian mOGTT ini, yang dibuat daripada 75g serbuk glukos yang dilarutkan dalam segelas air. Rasanya amat manis, malah perlu dihabiskan sehingga habis dalam masa 20 minit. Bila masuk ke dalam tekak, rasa payau dan mual mula berlaku. Kadang-kala menyebabkan pesakit muntah dan ini menyebabkan ujian mOGTT terbatal dengan sendirinya. Pesakit sering mengeluh kerana mereka akan dipanggil untuk datang semula bagi ujian yang sama dalam satu atau dua minggu kemudian.

Penat lelah pesakit serta kakitangan kesihatan dalam menjayakan ujian minum air gula ini ada sebabnya. Di antaranya ialah: Pertama, jumlah kes kencing manis ( Type 2 Diabetes Mellitus) di negara kita Malaysia meningkat dari 11 % ( 2006) hingga 15% ( 2011). Bagi wanita hamil pula, satu kajian menunjukkan kes gestational diabetes dalam wanita hamil juga meningkat sama hingga ke 27.9%! ( 2017, Selangor) Kedua, kencing manis sewaktu hamil atau "Gestational diabetes" membawa risiko kepada ibu dan bayi.

JIKA ANDA SUDAH SEMEMANGNYA
SEORANG PESAKIT KENCING MANIS
, DAPATKAN NASIHAT DOKTOR UNTUK MENSTABILKAN
GLUKOS DALAM DARAH
, MENJAGA PEMAKANAN,
MENJALANI SENAMAN YANG SESUAI
, BERHENTI DARI AKTIVITI TIDAK SIHAT SEPERTI
MEROKOK
 DAN SEBAGAINYA.

Yang ketiganya, sebanyak 17 -63% wanita yang mengalami "gestational diabetes" akan terus berisiko untuk mengidap penyakit kencing manis selepas bayi dilahirkan.

Jadi Siapakah Wanita Yang Berisiko Ini?

1. Wanita yang mempunyai BMI melebihi 27 kg/m2.

2. Wanita yang pernah mengalami gestattional diabetes.

3. Wanita yang mempunyai ibu, bapa, adik-beradik yang juga pesakit kencing manis.

4. Wanita yang pernah melahirkan bayi 4kg atau lebih.

5. Sejarah perbidanan, keguguran, kelahiran yang bermasalah.

6. Pemeriksaan air kencing didapati mempunyai glukos (sebanyak 2 kali).

7. Masalah kandungan seperti darah tinggi, air tuban bayi yang berlebihan dan penggunaan steroids ketika hamil.

Bagi wanita-wanita yang berisiko, staf klinik kesihatan dan hospital akan menasihati wanita ini untuk menjalani ujian minum air gula secepat mungkin.

Bagi wanita berusia 25 tahun ke atas, tidak mempunyai risiko, akan disarankan menjalini ujian saringan mOGTT tadi ketika bayi berusia di anatara 24 ke 28 minggu.

Bagi wanita berusia 25 tahun ke bawah dan tidak mempunyai risiko, anda bernasib baik kerana tidak perlu minum air gula.

Ujian mOGTT memerlukan darah diambil dua kali. Kali pertama juga dikenali fasting blood sugar, dikatakan normal jika keputusannya kurang atau sama dengan 5.1mmol/L. Kali kedua, darah diambil dua jam selepas minum air gula ( 2-hour-post prandial), keputusannya mestilah 7.8mmol atau kurang dari itu.

(Jika keputusan fasting blood sugar lebih tinggi dari 7 mmol/L, besar kemungkinan wanita ini sudah mengalami diabetes SEBELUM hami lagi).

Jika keputusan saringan mOGTT anda melebihi hadnya, seterusnya ibu hamil akan diberi kaunselling mengenai "diabetic diet" DAN menjalani empat ujian darah yang dikenali sebagai blood sugar profile atau BSP. Jika keputusan BSP adalah normal, pesakit akan terus mengamalkan diabetic diet sehingga kelahiran bayi. Jika keputusan BSP menunjukkan tahap glukos dalam darah terlalu tinggi, doktor akan memulakan penggunaan insulin sebagai rawatan bagi "gestational diabetes" ini.

Photo Credit: Freepik.com

Elak Diri Dari Ujian?

Apakah yang boleh berlaku jika mereka yang berisiko "lari" dari menjalani ujian minum air gula ketika hamil? Golongan wanita sebegini mungkin mengalami penyakit kencing manis tanpa disedari.

Ketika hamil, hormon kehamilan merupakan faktor utama mengapa insulin tidak mencukupi di dalam tubuh wanita yang mengandung. Fenomena ini dikenali sebagai "insulin resistance".

Keadaan di mana insulin tidak mencukupi mengakibatkan tahap glukos dalam darah wanita hamil ini berada ditahap tinggi. Glukos yang tinggi boleh menyebabkan masalah di dalam bayi seperti Keguguran Kelahiran pramatang Polyhydramnios ( Air ketuban yang banyak) Makrosomia ( Bayi yang besar) Sudden fetal death ( Kematian bayi dalam kandungan secara tiba-tiba) Masalah jantung dan tulang belakang di dalam bayi Masalah bagi ibu pula adalah seperti sentiasa kerap kencing, sering lapar dan dahaga, kenaikan berat badan dan jika paras glukos dalam darah semakin tinggi, berat badan boleh menurun.

Selain itu ibu juga adakan merasa penat dan tidak bertenaga, risiko kelahiran secara Caesarean section juga menghadapi risiko mengidap penyakit kencing manis di masa hadapan/di usia yang lebih tua.

Bagi mengelakkan masalah-masalah ini, pada pendapat saya, setiap wanita yang ingin hamil mestilah berusaha untuk menjaga kesihatan dari peringkat "sebelum hamil" lagi. Jalani hidup yang sihat, lakukan pemeriksaan kesihatan, pastikan tiada kencing manis, darah tinggi dan masalah tiroid misalnya.

Pastikan berat badan sesuai dengan ketinggian. Jika anda sudah sememangnya seorang pesakit kencing manis, dapatkan nasihat doktor untuk menstabilkan glukos dalam darah, menjaga pemakanan, menjalani senaman yang sesuai, berhenti dari aktiviti tidak sihat seperti merokok dan sebagainya. Doktor juga akan menasihati puan mengenai senarai ubat-ubatan yang selamat diambil ketika hamil.

Kesimpulannya, jika kita hamil di usia 25 tahun ke bawah dan tidak mempunyai risiko untuk kencing manis, kita tidak perlu untuk minum air gula ketika hamil. Bagi wanita-wanita yang lain, nampaknya pilihan yang yang bijak adalah untuk cekalkan hati dan jalani ujian mOGTT ini.

Dr. Norintan Binti Zainal Shah

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Seremban

MBBCh BAO (Ireland), LRCP & SI (Ireland), MMed (Obs & Gyn) (USM)

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PDF and Online Articles:

Kenapa Perlu Minum Air Gula Ketika Hamil – Majalah Pa & Ma, 25 Januari 2020

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Kenapa Ramai Pesakit Diabetes Meningggal Dunia Akibat Covid-19? Ini Jawapannya

May 27, 2020

SEHINGGA
 hari ini jumlah kematian akibat Covid-19 adalah 157,970 orang seluruh dunia melibatkan ratusan negara di seluruh dunia (20 April 2020).

Pusat Kawalan dan Pencegahan Penyakit di Amerika Syarikat melaporkan, dari jumlah pesakit Covid-19 yang dimasukkan ke hospital, 90 peratus menghidapi sekurang kurangnya satu penyakit kronik.

Di antaranya adalah darah tinggi, obesiti, diabetes mellitus, penyakit paru-paru dan penyakit jantung.

Menurut Pakar Perubatan Dalaman Hospital Columbia Asia, Puchong Dr Muhammad Shahruddin diabetes mellitus menyumbang hampir 30 peratus dalam statistik ini.
Pesakit diabetes lebih berisiko tinggi berdepan dengan kematian akibat Covid-19.

"Sebahagian besar dari pesakit Covid-19 yang mengalami simptom teruk, komplikasi atau maut, dikesan menghidapi penyakit kencing manis. Antara faktor-faktor yang menyumbang kepada tahap and kesan jangkitan Covid-19 adalah jumlah virus, replikasi virus di paru paru dan juga reaksi imuniti terhadap virus.

"Lapan puluh peratus dari pesakit yang dijangkiti Covid-19 akan sembuh kerana sistem imun mereka bertindak balas secara normal. Namun dalam sesetengah pesakit, sistem imuniti bertindak secara melampau atau berlebihan menyebabkan keadaan pesakit boleh merosot," jelasnya kepada
mStar.
Teori saintis

Salah satu teori saintis mengapa pesakit diabetes mempunyai risiko yang lebih tinggi adalah kerana sistem imuniti yang terjejas atau tidak normal.

"Ini menyebabkan perbezaan dalam respon imun kepada jangkitan Covid-19. Masalah ini juga dilihat dalam pesakit diabetes yang dijangkiti kuman lain seperti influenza dan bakteria.

"Selain dari tindak balas imun yang tidak sempurna atau normal itu, pesakit diabetes yang dijangkiti Covid-19 juga boleh mendapat komplikasi dari penyakit diabetes itu sendiri seperti kandungan glukosa terlalu tinggi atau rendah (hipoglisemia) serta komplikasi ketoasidosis kencing manis.
Warga emas yang mengalami diabetes berisiko tinggi dengan kematian sekiranya dijangkiti Covid-19.

"Oleh itu, pesakit yang menghidapi penyakit kencing manis perlu menjaga kesihatan dengan baik terutamanya dalam memastikan stok ubat mencukupi dan mengambil rawatan yang diberikan doktor untuk memastikan kandungan gula dalam badan terkawal," jelasnya.

Di samping itu juga perlu mengawal pengambilan makanan terutamanya yang mengandungi kadar gula atau karbohidrat yang tinggi. Selain itu, praktikkan juga penjarakan sosial dan penjagaan kebersihan. Ini adalah sangat penting untuk mengelak dari terkena jangkitan kerana mencegah lebih baik dari merawat.

Di Malaysia, rekod kematian sehingga 21 April adalah 92 orang dengan rekod positif keseluruhan 5,483 kes.

Dr. Muhammad Bin Shahruddin

Consultant Internal Medicine Physician

Columbia Asia Hospital - Puchong
Bachelor Of Medicine & Bachelor Of Surgery (MBBS), Doctor of Internal Medicine (UKM), CIMA (NIOSH)

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Kenapa Ramai Pesakit Diabetes Meningggal Dunia Akibat Covid-19? Ini Jawapannya - mStar, 22 April 2020

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Kesan AF Awal, Cegah Strok

Kesan AF Awal, Cegah Strok

August 05, 2019

Seringkali apabila berjumpa doktor terutama dalam kalangan mereka yang berusia 40 tahun ke atas soalan yang sering ditanya adakah mereka mempunyai risiko diserang penyakit jantung. Namun amat jarang yang bertanya sama ada mereka mempunyai risiko menghidap penyakit fibrilasi atrium (AF).

Penyakit AF mempunyai kaitan dengan serangan strok atau angin ahmar dan berlaku apabila ruang atas jantung menjadi bengkak hingga menyebabkan litar elektrik di kawasan itu terganggu atau menjadi tidak teratur.

Menurut Pakar Kardiologi Hospital Columbia Asia, Dr. Ng Yau Piow, pesakit yang menghidap AF boleh mengalami strok atau angin ahmar kerana wujudnya darah beku di bahagian atas jantung ekoran denyutan nadi yang tidak teratur.

“Darah beku ini boleh mengalir ke otak dan menyebabkan strok. Penghidap AF, malah orang ramai lazimnya tidak sedar mereka menghidap AF kerana tanda-tandanya tidak ketara,” ujar beliau.

Justeru, pengesanan AF menjadi lebih penting atas keperluan mendapatkan cara dan rawatan yang efektif bagi mencegah strok.

Faktor umur adalah salah satu faktor utama menyebabkan seseorang itu menghidap AF. Semakin berusia, risikonya lebih tinggi dan lazimnya ia mempunyai hubung kait dengan penyakit lain antaranya darah tinggi, kencing manis, penyakit obesiti, masalah injap jantung dan tiroid.

“Biasanya pesakit jarang merungut tentang masalah denyutan nadi yang tidak teratur ini cuma mereka akan kata penat, sesak nafas atau jantung berdegup laju,” katanya.

Pengesanan awal penyakit AF amat mudah dilakukan iaitu pesakit hanya perlu menjalani pemeriksaan elektrokardiogram (ECG).

“Untuk mengesan penyakit berkaitan jantung, doktor akan melakukan pelbagai pemeriksaan dan ujian terhadap pesakit selain angiogram. Ini mengambil masa yang lama tetapi jika seseorang itu melakukan

pemeriksaan ECG terlebih dahulu kita akan dapat mengenal pasti siapa penghidap AF dan dengan rawatan yang efektif ia dapat mengelaknya daripada diserang strok,” katanya lagi.

Menurut Dr. Yau Piow, pengesanan AF lebih awal amat penting untuk mengelak atau mencegah pesakit daripada strok iaitu dengan cara pengambilan ubat cair darah. Bagaimanapun pesakit perlu mendapatkan nasihat doktor sama ada ubat itu sesuai untuk diberi kepada mereka atau sebaliknya.

Antara ubat yang diberi doktor untuk mencegah strok dalam kalangan pesakit AF dikenali sebagai Novel Oral Anticoagulation (NOAC), ubat antipembekuan atau antipenggumpalan. Tujuannya adalah untuk mencegah pembentukan darah beku daripada berlaku.

Antara NOAC yang ada di pasaran ialah Dabigatran, Rivaroxaban atau Apixaban yang lebih mudah diambil berbanding warfarin yang sebelum ini merupakan ubat pencair darah untuk pencegahan strok.

Beliau berkata, pengambilan warfarin memerlukan pesakit kerap hadir ke hospital setiap dua minggu atau sebulan untuk memastikan sama ada darah terlalu pekat atau cair .

“Selalunya orang ramai peka terhadap serangan jantung sebab mereka tahu penyakit ini boleh membawa kematian secara tiba-tiba tetapi mereka tidak fikir bahawa strok juga memberi impak yang besar terhadap diri pesakit dan keluarga sedangkan kita boleh halang strok dengan pengambilan ubat ini,” ujar beliau.

Kata Dr. Yau Piow, penyakit AF adalah sejenis penyakit gaya hidup justeru untuk mengurangkan risiko orang ramai dinasihatkan mengamal cara hidup sihat, mengurangkan berat badan selain kerap melakukan pemeriksaan darah dan paru-paru.

Dr. Ng Yau Piow

Consultant Cardiologist

Columbia Asia Hospital – Cheras
MBBS (UM), MRCP (UK)

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Kesan AF Awal, Cegah Strok – Utusan Malaysia, 4 Ogos 2019

Artikel ini disiarkan oleh Utusan Malaysia, 4 Ogos 2019.

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Ketagih Gajet, Jadual Makan Tidak Teratur Punca Anak Kecil Kurang Selera

February 04, 2021

SOALAN 1:

DOKTOR, anak saya berumur 2 tahun 9 bulan, selera makannya pun tidak berapa baik. Dalam sehari, beliau kadang-kadang langsung tidak mahu menjamah makanan dan hanya mengambil beberapa suap makanan sahaja. Apakah cara terbaik untuk menaikkan selera makan beliau? Bantu saya doktor.
-INGIN TAHU, SITI FAIRINA FUZI, 36, KUALA SELANGOR, SELANGOR

JAWAPAN

MASALAH kurang selera makan dalam kalangan kanak-kanak memang amat meresahkan ibu bapa.

Secara ringkasnya, selera anak-anak kecil berumur 1 hingga 5 tahun akan menurun apabila kurang sihat akibat demam, batuk dan selsema. Perkara itu biasanya bersifat sementara dan kebanyakan mereka akan kembali berselera apabila sudah pulih.

Selain itu, kanak-kanak yang sembelit akan cuba mengelak daripada makan kerana tindak balas gastrokolik selepas makan menyebabkan si kecil senak usus dan sakit pada bahagian duburnya.

Ramai juga kanak-kanak di peringkat umur tersebut gemar bermain dan suka minum susu atau air yang manis secara berlebihan sehingga menyebabkan kurang pengambilan makanan pejal harian.

Bukan itu sahaja, isu ketagihan menggunakan gajet dalam kalangan kanak-kanak dan jadual tidur yang bercelaru berkait rapat dengan masalah tingkah laku dan kelainan aktiviti pemakanan anak-anak di era moden kini.

Berkenaan cara untuk menaikkan selera makan seperti yang diajukan, saya mencadangkan beberapa langkah yang boleh diguna pakai iaitu:

Sebagai permulaanya, ibu-bapa digalakkan agar mencipta persekitaran aktiviti pemakanan yang sihat dan menceriakan. Usahakan rutin dan masa makan utama yang tetap secara berkala setiap hari.

Pastikan sarapan pagi diambil. Disarankan mengambil snek ringan seperti kekacang (bagi yang tiada masalah alergi), yogurt dan avokado boleh membuka selera kanak-kanak.

Minum air masak sejam sebelum waktu makan untuk membantu mengaktifkan sistem usus.

Kenal pasti makanan kegemaran anak dan gunakan kreativiti dan inovasi sendiri untuk menyediakan makanan bagi membuka selera anak. Ia termasuklah mempelbagaikan jenis diet, warna dan bentuk-bentuk makanan yang menarik perhatian.

Suka juga diingatkan, usaha untuk memujuk anak untuk makan memerlukan kesabaran yang tinggi. Jangan sesekali memarahi, mendenda apatah lagi memukul kerana tindakan itu hanya akan membuatkan anak memberontak dan membenci masa makan.

Puan, seboleh-bolehnya, cari jalan agar budaya menggunakan gajet ketika memberi anak makan dihentikan. Selain itu, anak-anak yang kecil tubuhnya biasanya mengambil makanan dengan kuantiti yang sedikit pada satu-satu masa.

Oleh itu, jangan memaksa, sebaliknya pastikan pertumbuhan terus normal semasa pemeriksaan bulanan di klinik. Paling penting, aktiviti senaman keluarga bersama anak-anak dapat membantu menaikkan kadar metabolisme tubuh anak dan seterusnya menaikkan selera mereka.

Namun demikian, tidak dinafikan ada sebilangan anak-anak yang memerlukan nasihat dan pemeriksaan pakar kanak-kanak, pakar nutrisi atau pasukan pakar kaedah pemakanan kanak-kanak.

Ia adalah kerana berkemungkinan anak kecil mempunyai permasalahan kesihatan yang melibatkan sistem pemakanan seperti mengunyah, menelan ataupun kelainan sistem tiub makan (esofagus) dan usus.

Tidak kurang juga yang mengalami masalah yang berkaitan dengan tingkah, autisme dan kelainan sensori (deria rasa).

Jadi, eloklah berjumpa dgn pakar kanak-kanak untuk mendapatkan pemeriksaan dan maklumat lanjut juga mengesahkan permasalahan si kecil dengan lebih tepat dan rawatan yang sewajarnya.

Anak hilang selera makan selepas demam perkara biasa

SOALAN 2:

DOKTOR, anak saya berumur 1 tahun 5 bulan. Saya ingin bertanya, kenapa anak saya sekarang seakan-akan seperti hilang selera makan. Sebelum ini beliau memang suka makan, tetapi selepas keluar dari wad akibat demam panas, selera makannya sudah berkurang. Bukan itu sahaja, anak saya juga kerap muntah. Mohon penjelasan doktor.
IBU GUSAR, ROZAINA JAMAL, 31, SEREMBAN, NEGERI SEMBILAN.

JAWAPAN

TERIMA kasih atas soalan yang diajukan. Saya amat memahami kegusaran puan apabila melihat anak yang asalnya seronok makan, kini beliau hilang selera secara tiba-tiba.

Namun demikian, perlu diketahui ia adalah satu fenomena biasa bagi kanak-kanak malah orang dewasa yang baru sembuh daripada demam apabila mengalami masalah putus selera makan dan kelesuan.

Penting untuk diketahui, masalah berkenaan bergantung atas faktor individu dan tahap jangkitan yang dialami (ia boleh memakan masa selama beberapa hari atau minggu).

Lazimnya, keadaan berkenaan hanya bersifat sementara dan saya menjangkakan pada minggu berikutnya anak puan akan kembali mendapat selera makan asalnya semula, malah tidak kurang juga beliau akan makan lebih daripada biasa.

Puan juga ada menyatakan bahawa anak kerap muntah, jika simptom itu terjadi selepas pulih daripada demam, saya nasihatkan agar berjumpa dengan pakar segera untuk pemeriksaan selanjutnya kerana bimbang berlakunya komplikasi kesihatan lain.

RESIPI AYAM PARMESAN

Bahan-bahan untuk salutan ayam

1/2 cawan tepung serba guna

2 biji telur

2/3 cawan serbuk roti

1/3 cawan keju parmesan

1/4 sudu teh garam

1/4 sudu teh lada hitam

2 sudu besar campuran herba segar yang dicincang halus seperti thyme, pasli atau rosemary

Bahan-bahan untuk ayam

4 ketul bahagian dada ayam tanpa tulang, ditumbuk sehingga 1/4 ketebalan

Garam dan lada hitam

2 sudu besar minyak sayuran

2 sudu besar minyak zaitun

Lemon

Cara penyediaan:

Sediakan tiga bekas atau mangkuk untuk proses penyediaan iaitu masing-masing diletakkan tepung, telur dan herba yang dicincang.

Ayam digaul rata bersama garam dan lada hitam.

Kemudian, celupkan ayam ke dalam mangkuk pertama berisi tepung dan goyangkan sedikit sehingga lebihan tepung jatuh. Hanya lapisan nipis sahaja kekal tersalut pada ayam.

Seterusnya, celupkan ayam ke dalam telur, terbalikkan ayam sehingga telur bersalut rata pada ayam. Pastikan tiada lebihan salutan telur pada ayam.

Akhir sekali, celupkan ayam dalam campuran herba, terbalikkan ayam beberapa kali untuk memastikan campuran herba menyaluti ayam dengan baik.

Letakkan ayam yang tersedia bersalut di dalam pinggan lain. Terus ulangi langkah yang sama pada isi ayam yang lain.

Campurkan kedua-dua minyak dan panaskan dalam kuali dengan api sederhana.

Apabila minyak sudah panas, masukkan ayam yang sudah bersalut dan masakkan selama 2 hingga 3 minit sehingga ayam bertukar berwarna coklat keemasan.

Hidangkan ayam parmesan bersama potongan lemon.

Dr. Azhar Napis

Consultant Pediatrician

Columbia Asia Hospital - Iskandar Puteri
MD (UKM), MRCPCH (UK)

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PDF and Online Articles:

Ketagih Gajet, Jadual Makan Tidak Teratur Punca Anak Kecil Kurang Selera - SinarPlus, 3 Januari 2021

Ketagih Gajet, Jadual Makan Tidak Teratur Punca Anak Kecil Kurang Selera – SinarPlus, 3 Januari 2021

Artikel ini disiarkan oleh SinarPlus, 3 Januari 2021.

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Kick Starting Fitness Without Injury - Dr Harjeet Singh [BFM - Podcast]

January 17, 2013

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon.

Doctor Harjeet Singh Consultant Orthopaedic Surgeon talks to us about kick starting your fitness without injury this year. I know most of us have made New Years Resolutions to go to the gym to be healthier this year. But after a long holiday break period and all that binging that we’ve done with food how do you kick start that fitness program. He’s going to shed more light on that!

Listen to the podcast
here
.


Kolestrol : Jangan Fitnah Santan

Kolestrol : Jangan Fitnah Santan

May 18, 2021

JANGAN guna santan segar dalam masakan kerana ia mengandungi kolesterol yang boleh menyebabkan masalah kesihatan’.

Ini antara ayat popular yang sering dikaitkan dengan santan segar membuatkan ramai mempercayainya.

Hinggakan ada sanggup beralih kepada penggunaan santan kotak yang disangka tiada kandungan kolesterol.

Tidak kurang juga ada yang memilih menggunakan susu bagi menggantikan santan segar semata-mata mahu masakan yang dimasak lebih sihat.

Kekeliruan ini sudah lama wujud dan kembali tular baru-baru ini, Pegawai Perubatan Columbia Asia Hospital, Dr S Malar Santhi berkata, sebenarnya santan segar tidak mempunyai kolesterol kerana ia daripada tumbuh-tumbuhan yang hanya mempunyai kandungan lemak.

“Pengambilan makanan berlemak akan diproses menjadi kolesterol di dalam badan. Proses itu (kolesterol) dilakukan oleh pundi hempedu dan hati,” katanya.

Menurutnya, makanan yang mengandungi kolesterol adalah daripada haiwan atau tubuh manusia.

Beliau berkata, terdapat tiga jenis makanan berlemak iaitu lemak tepu, lemak tidak tepu serta lemak trans.

“Lemak adalah sumber tenaga yang diperlukan tubuh sama seperti karbohidrat, protein dan nutrien lain. Pengambilan apa juga jenis tenaga berlebihan (bukan saja santan) boleh menyebabkan masalah obesiti serta tinggi kolesterol.

“Oleh itu, ‘memfitnah’ santan sebagai pilihan makanan tidak berkhasiat adalah tidak wajar.

“Sekiranya makan di restoran, kita perlu peka dengan jenis makanan yang diambil, sama ada ia terdiri daripada kategori berkenaan atau tidak,” katanya.

Dr Malar berkata, makanan yang mengandungi lemak tepu adalah seperti ayam, daging, minyak sapi dan santan.

“Namun, apabila kita mengambil makanan yang mengandungi lemak tepu, hati dan pundi hempedu akan memprosesnya menjadi lipoprotein ketumpatan rendah (LDL) yang dikategorikan sebagai kolesterol jahat.

“Selalunya LDL ini menyebabkan serangan jantung, angin ahmar dan penyakit kronik yang lain.

“Walaupun santan tidak mempunyai kolesterol, kandungan kalorinya adalah tinggi. Sebab itu, orang dahulu seperti nelayan dan petani mengambil santan bagi mendapatkan lebihan kalori untuk melakukan kerja berat,” katanya.

Jelasnya, bagi individu yang mengambil makanan tinggi kalori, ia (kalori) akan digunakan sebagai tenaga di dalam badan, sama ada untuk bekerja, bernafas, membina protein, sel seperti hormon, enzim dan sebagainya.

“Sebaliknya, jika terdapat lebihan kalori, ia akan ditukar menjadi lemak yang tersimpan dalam badan.

“Bukan saja santan, lebihan kalori daripada makanan lain seperti nasi dan gula juga akan melalui proses sama,” katanya.

Ditanya sama ada pengambilan santan dalam hidangan adalah sihat atau sebaliknya, Dr S Malar berkata, ia bergantung kepada berapa banyak dan kerap mengambil makanan bersantan.

“Di samping itu, perlu tahu bagaimana mahu membakar kalori berkenaan. Ramai dalam kalangan individu yang aktif bersenam di gimnasium dan atlet, mengambil banyak makanan tinggi protein seperti susu serta telur.

“Ini kerana mereka memerlukan banyak tenaga dan kemudian membakar semula kalori berkenaan untuk membina otot badan,” katanya.

Menurutnya, apa yang lebih penting adalah, keseimbangan di antara pengambilan kalori dan membakarnya menerusi aktiviti fizikal untuk kesihatan tubuh.

Dr S Malar berpendapat, tidak salah mengambil makanan bersantan asalkan pengambilannya bukan secara berlebihan.

“Ada orang elak mengambil makanan bersantan, tetapi mereka masih makan makanan segera termasuk kentang goreng, keju, sosej dan sebagainya.

“Sebenarnya makanan ini (makanan segera) mengandungi lemak trans iaitu sejenis lemak yang tidak sihat dan juga tinggi kalori.

“Kentang goreng yang dijual di restoran menggunakan minyak lemak trans kerana minyak jenis ini lebih sesuai digunakan berulang kali,” katanya.

Menurutnya, pengamal perubatan turut memberi tip, pilihan minyak yang lebih selamat ialah seperti minyak zaitun dan minyak bunga matahari.

Katanya, lemak tidak tepu sebenarnya adalah pilihan lemak lebih selamat berbanding lemak tepu.

“Lemak tidak tepu terdiri daripada minyak zaitun, kacang badam, kekacang dan ikan. Makanan berunsur ini (lemak tidak tepu) sebenarnya lebih sihat daripada segi pilihan lemak yang diambil,” katanya.

Katanya, apabila memasuki usia 40 tahun, seseorang itu perlu berubah ke arah pemakanan sihat iaitu mengira kalori makanan, kategori lemak dan kurangkan penggunaan garam dalam masakan.

Paling penting ialah bersenam.

Dr. Malar Santhi A/P Santherasegapan

Medical Officer

Columbia Asia Hospital - Cheras
M.D (CSMU), IES (London), MBA (Hons, UTM)

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Kolestrol : Jangan Fitnah Santan – MYKMU.NET, 26 Mac 2021

Artikel ini disiarkan oleh MYKMU.NET, 26 Mac 2021.

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Laparoscopic Appendectomy

Laparoscopic Appendectomy

February 03, 2011

WHAT IS THE APPENDIX?

The exact function of the appendix is essentially unknown.The appendix produces a bacteria-destroying protein called Immunoglobulins which help fight infection in the body. This function, however, is not major. People who have had appendectomies do not have an increased risk towards infection. Other organs in the body like the Liver and the Spleen produce a lot more Immunoglobulins to serve this function.
WHAT IS A LAPAROSCOPIC APPENDECTOMY?

Appendicitis is one of the most common surgical problems. One to two out of every 1,000-2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall.

In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient’s internal organs on a television monitor.
ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY

Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are:

Less postoperative pain

May shorten hospital stay

May result in a quicker return to bowel function

Quicker return to normal activity

Better cosmetic results

ARE YOU A CANDIDATE FOR LAPAROSCOPIC APPENDECTOMY?

Although laparoscopic appendectomy has many benefits, it may not be appropriate for some patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the appendix has ruptured. A traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.A thin patient with early Appendicitis may be better treated with conventional open Appendectomy.An obese lady with a doubtful diagnosis of Appendicitis may be better treated with Laparoscopic Appendectomy since other abdominal and pelvic organs can ve inspected at the same time.
HOW IS LAPAROSCOPIC APPENDECTOMY PERFORMED?

The words “laparoscopic” and “open” appendectomy describe the techniques a surgeon uses to gain access to the internal surgery site.

Most laparoscopic appendectomies start the same way. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions. A drain may be placed during the procedure. This will be removed before you leave the hospital.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?

In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. Factors that may increase the possibility of converting to the "open" procedure may include:

Extensive infection and/or abscess

A perforated appendix

Obesity

A history of prior abdominal surgery causing dense scar tissue

Inability to visualize organs

Bleeding problems during the operation

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.
WHAT SHOULD I EXPECT AFTER SURGERY?

After the operation, it is important to follow your doctor’s instructions. Although many people feel better in just a few days, remember that your body needs time to heal.

You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the risk of blood clots in your legs and of soreness in your muscles.

You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, working and engaging in sexual intercourse.

If you have prolonged soreness or are getting no relief from the prescribed pain medication, you should notify your surgeon.

You should call your surgeon and schedule a follow up appointment for about 1-2 weeks following your operation.

WHAT COMPLICATIONS CAN OCCUR?

As with any operation, there are risks including the risk of complications. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique.

Bleeding

Infection

Removal of a normal appendix

A leak at the edge of the colon where the appendix was removed

Injury to adjacent organs such as the small intestine, ureter, or bladder.

Blood clot to the lungs

It is important for you to recognize the early signs of possible complications. Contact your surgeon if you have severe abdominal pain, fever, chills or rectal bleeding.
WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following:

Persistent fever over 101 degrees F (39 C)

Bleeding

Increasing abdominal swelling

Pain that is not relieved by your medications

Persistent nausea or vomiting

Chills

Persistent cough or shortness of breath

Purulent drainage (pus) from any incision

Redness surrounding any of your incisions that is worsening or getting bigger

You are unable to eat or drink liquids

This article is not intended to take the place of your discussion with your surgeon about the need for an appendectomy. If you have questions about your need for an appendectomy, your alternatives, billing or insurance coverage, or your surgeon's training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow-up, please discuss them with your surgeon before or after the operation.
Source:
http://www.sages.org
Abd Hamid Mat Sain

Consultant Surgeon

Columbia Asia Hospital - Seremban


Laparoscopic Inguinal Hernia

Laparoscopic Inguinal Hernia

February 03, 2011

Hernia repair operations are commonly performed by the conventional "open" method in Malaysia. Some are performed laparoscopically. Laparoscopic hernia repair is a relatively new surgical technique to fix tears in the abdominal wall (muscle) using small incisions, a patch (mesh), and special cameras to view inside the body.

It frequently offers a more rapid recovery for the patient, less post-operative pain, and a quicker return to work and normal activities.
What is a Hernia?

A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery. Both men and women can get a hernia. You may be born with a hernia (congenital) or develop one over time. A hernia does not get better over time, nor will it go away by itself.
What causes a Hernia?

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, ageing, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, and difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.

Laparoscopic Hernia Repair is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). If may offer a quicker return to work and normal activities with a decreased pain for some patients. The scars are cosmetic and it allows inspection and repair of concomitant obturator, femoral and bilateral inguinal hernias in the same sitting.
Are you a candidate for laparoscopic Hernia Repair?

Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery or underlying medical conditions.
What preparation is required?

Most laparoscopic hernia operations require a short hospital stay, and therefore you will probably go home on the next day after the operation is performed.

Preoperative preparation includes blood work, medical evaluation, chest x-ray and an ECG depending on your age and medical condition.

After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.

It is recommended that you shower the night before or morning of the operation.

After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.

Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) will need to be stopped temporarily for several days to a week prior to surgery.

Quit smoking and arrange for any help you may need at home.

How is the procedure performed?

A laparoscope (a tiny telescope) connected to a special camera is inserted through a trocar, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen.

Other trocars are inserted which allow your surgeon to work "inside." Three 1/2 to 1 cm incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples or sutures. This operation is usually performed under general anesthesia.

What happens if the operation cannot be performed or completed by the laparoscopic method?

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
What complications can occur?

Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.

There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.

Difficulty urinating after surgery is not unusual and may require a temporary tube into the urinary bladder.

Any time a hernia is repaired it can come back. This long-term recurrence rate is not yet known. Your surgeon will help you decide if the risks of laparoscopic hernia repair are less than the risks of leaving the condition untreated.

What should I expect after surgery?

Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.

Once you are awake and able to walk, you will be sent home.

With any hernia operation, you can expect some soreness mostly during the first 24 to 48 hours.

You are encouraged to be up and about the day after surgery.

With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.

Call and schedule a follow-up appointment within 2 weeks after you operation.
WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following:

Persistent fever over 39 C

Bleeding

Increasing abdominal or groin swelling

Pain that is not relieved by analgesic drugs

Persistent nausea or vomiting

Inability to urinate

Chills

Persistent cough or shortness of breath

Purulent drainage (pus) from any incision

Redness surrounding your incisions that is worsening or getting bigger

You are unable to eat or drink liquids

This information is not intended to take the place of your discussion with your surgeon about the need for laparoscopic inguinal hernia surgery. If you have questions about your need for hernia surgery, your alternatives, billing or insurance coverage, or your surgeons training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow-up, please discuss them with your surgeon before or after the operation.
THE ABOVE INFORMATION HAS BEEN TAKEN FROM THE SAGES WEBSITE FOR PATIENT INFORMATION
Dr. Shanker Sathappan

General & Laparoscopic Surgeon

Columbia Asia Hospital- Taiping


Laparoscopy

Laparoscopy

June 02, 2020

Insight into minimally invasive surgery.

Laparoscopic surgery is an operation performed within the abdominal or pelvic cavity using small incisions with the aid of a camera. Laparoscopy which is a minimally invasive procedure which allows the surgeon to see inside of the body in real-time, without open surgery

Laparoscopy is a revolutionary procedure which has seen the greatest advance in surgery that benefits both the patients and the doctors. It is almost the same as the open surgery procedure but using a different method of access. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialities, including gastrointestinal surgery, gynecologic surgery, cardiology, orthopaedics and urology.
Did you know Laparoscopy invented by George Kelling in 1901, in Germany?

LAPAROSCOPIC DEVICES

Devices typically used during laparoscopy which enables the surgeon to operate through small incisions, generally between 3 to 5 mm.

ENDOSCOPIC DEVICES

Comprise flexible tubes attached to cameras and lights. Aids the surgeon in the use of the laparoscopic devices during the surgery to oversee the entire surgical procedure.

Developments in laparoscopic instrumentation and procedures are still ongoing, both in the application of vision system and the automation of instruments. The camera is an important component in laparoscopic surgery as it acts as the eyes of the surgeon. Recent advances have been made in enhancing the experience of surgeons through 3D technologies, improving the image quality and the field of vision of endoscopic cameras.

Applications have been developed, enabling multiple views for surgeons using 3D technology. The endoscope 3D visualization system provides customized 3D image with adjustable disparity to serve the very different eye movements and visual of each surgeon at very different operating environment. The fusion of advanced 3D technology provides flexible depth perception adjustment to accommodate doctors during surgery. The 3D images come in handy for the surgeons to perform more precisely and safely. Moreover, it shortens the operating time significantly.

Robots since the year 2000 have been used in operating theaters to facilitate laparoscopic surgeries in various disciplines. It was first approved for prostatectomy and has become the mainstream procedure of minimally invasive surgery of localized prostate cancers in USA and United Kingdom. For surgeons, the recognized advantages of robotic laparoscopic surgery include 3D vision, ten-fold magnification, Endo-wrist technology and tremor reduction. They are thus enabling the surgeon with better control and higher precision to work beyond the limitation of conventional open surgery. Thus, delivering better outcomes for the patients.

InfoMed spoke with Dr Md Hamsan bin Abdul Wahab, Consultant General Surgeon, Columbia Asia Hospital -Klang on laparoscopic surgery to get his perspective on the procedure.

What is laparoscopic surgery?

Dr Hamsan: Laparoscopic surgery is a surgical technique in which the surgeon uses a series of small incisions in the patient to insert a camera to view the surgical field, along with the necessary tools for the surgical procedure or is a type of surgery that uses smaller cuts than you might expect.

What are the surgical interventions suitable for laparoscopy?

Dr Hamsan: Laparoscopy surgery is suitable for gallbladder surgery and gynaecology operations. Then it came in play for the hernia, intestines, liver, joints surgery and other organs surgery.

When would laparoscopic surgery be considered better to open surgery

Dr Hamsan: Nowadays most of the elective surgeries especially gallbladder, gynaecology operations, hernia and joint surgery or for emergency cases like perforated gastric or duodenal ulcer and appendicitis, are suitable for laparoscopy surgery. Working this way has several advantages compared with traditional surgery. Because it involves less cutting:

You have smaller scars.

You get out of the hospital quicker.

You’ll feel less pain while the scars heal, and they heal quicker.

You get back to your normal activities sooner.

You may have less internal scarring.

When would you recommend your patients for surgical intervention?

Dr Hamsan: It depends on the disease, pathology, symptoms that patient suffers from, risk and benefit of the laparoscopy surgery to the patient.

What’s your speciality interest?

Dr Hamsan: My special interest is laparoscopy cholecystectomy, appendicectomy, perforated gastric or duodenal ulcer, hernia and adhesiolysis for adhesion colic due to previous operation or infection in the abdomen.

What per cent of your surgeries are performed as minimally invasive?

Dr Hamsan: About 25%

How long does it take to recover from a laparoscopy?

Dr Hamsan: Most of the laparoscopy surgery have shorter recovery time with the average around two to five days, depending on the type of surgeries.

Photo credit: Blausen

Are all patients suitable for laparoscopy?

Dr Hamsan: Not all patients suitable for laparoscopy surgery. It depends on the risk and comorbid illness of the patient.

Can you perform most of the minimally invasive surgeries as a day-care procedure?

Dr Hamsan: Depend on the type and risk of the patients, in general most of the low-risk patient’s laparoscopy surgery can be performed as a daycare procedure.

Is the recovery from a laparoscopic surgery much faster?

Dr Hamsan: Yes, as I mentioned earlier, the recovery from laparoscopy surgery is faster as compared to open surgery.

Minimally invasive surgery is more cost-effective with better outcomes. Your views?

Dr Hamsan: Overall costs for minimally invasive procedures are significantly lower than open procedure costs for appropriately indicated patients. A 2011 study published in the SAS Journal showed the cost for minimally invasive transforaminal lumbar interbody fusion was $14,183 on average, versus $18,633 for open lumbar fusion.

Less invasive procedures can be performed in the outpatient setting, including the ambulatory surgery centre, which typically costs less than inpatient hospital stays. Eliminating the hospital stay and lowering the risk for complications and re-operations creates significant cost-savings for laparoscopy procedures.

What are the risks in laparoscopy surgeries, and how do you mitigate them?

Dr Hamsan: The risk of laparoscopy surgeries can be divided into two types, namely risk of anaesthesia and risk of surgery. For risk of anaesthesia, normally are patients with many comorbid illness, they need to be optimized and medically stabilized first by physician before the operation and these patients need multi-disciplinary approach involving anaesthetist, ICU intensive service, physio and dietician support for preoperative and post-operative care. For surgical risk like wound infection, the patients will be given antibiotics pre and post-operation. Bleeding can be minimized using good surgical technique and energy device like harmonic scalpel.

Does laparoscopy prevent or reduces infections after surgery?

Dr Hamsan: Yes, due to small wounds for access to surgeries.

What new laparoscopic services would be introduced in the near future?

Dr Hamsan: In some countries the robotic laparoscopy has been the trend for laparoscopy surgeries, however in Malaysia only certain medical centres have the robotic facilities.

Advances in laparoscopy that would improve further the surgical outcomes?

Dr Hamsan: Since the first laparoscopy surgery 32 years ago, evidence indicating laparoscopic surgery’s superiority over open alternative has been provided for a variety of procedures and the advanced laparoscopic surgery has been extended hepatectomy, pancreatectomy, urology and gynecology. Given the time, expertise and the advances in laparoscopy surgery, this revolutionary procedure would continue to grow over the years to improve the surgical outcome. This continuous development would enhance the surgeon’s experience and capability to efficiently perform the tasks and make it affordable for the patients.

Can we consider minimally invasive surgery is evolving towards precision surgery?

Dr Hamsan: In general laparoscopy or minimally invasive surgery is evolving towards precision surgery.

The use of robotics in laparoscopic surgeries. Your views?

Dr Hamsan: The use of robotic surgery is a more precise and effective way of doing surgery, but it will require training for the operators which have different learning curve, and it is involved high investment cost for any health centres.

How is the progress with the latest surgical techniques?

Dr Hamsan: The laparoscopy surgery is always progressing parallel to the progression of the technology and new surgical devices. Good progress has been done for the vision system of laparoscopy including improvement of viewing angle and field of view, and clarity of images.

ADDITIONAL BENEFIT OF LAPAROSCOPIC SURGERY

Decreased risk of postoperative venous thromboembolism.

Fewer complications.

Reduced risk of acquiring infections.

Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.

Dr. MD Hamsan Bin Abdul Wahab

Consultant General Surgeon

Columbia Asia Hospital – Klang
MBBCh BAO (Ireland), MRCS (UK), MS (General Surgery)(UKM)

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PDF and Online Articles:

Laparoscopy - InfoMed Malaysia, Jan - Mar 2020

This article first appeared in InfoMed Malaysia, Jan - Mar 2020.

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Lega… Buasir Boleh Dirawat Hanya Guna Laser

July 25, 2019

Hemorhoid Atau Lebih Dikenali Sebagai Buasir Merupakan Penyakit Yang Sering Menjadi Sasaran Kepada Golongan Lelaki.

Ia berpunca daripada beberapa faktor, termasuk mengangkat barang berat yang memberi tekanan di bahagian pinggang ke bawah.

Menurut Pakar Bedah Hospital Columbia Asia, Dr Khairul Izan Mohd Ghani, terdapat faktor lain yang turut menjadi punca yang tidak disedari iaitu duduk terlalu lama di “tandas duduk” sambil bermain telefon bimbit, tidak kira lelaki atau wanita.

“Ini yang biasa dilakukan oleh ramai orang, iaitu duduk di tandas duduk dengan begitu lama, sambil bermain telefon bimbit, ini juga menjadi punca berlakunya buasir, ramai yang tidak tahu perkara ini.

“Jadi selepas ini perlu lebih berhati-hati,” katanya kepada FMT.

Menurutnya, buasir kini mendapat peratusan lebih tinggi menyerang golongan lelaki iaitu 60 peratus sementara 40 peratus daripadanya adalah wanita.

Malah jika dahulu mereka yang berumur 60 tahun keatas lebih berisiko menghidap penyakit itu, namun kini penyakit tersebut menyerang golongan lelaki seawal usia 40 tahun.

Tambahnya, bagi golongan wanita, ia sering terjadi kepada mereka yang mengandung.

Menurut Khairul, rawatan buasir sebelum ini perlu melalui kaedah tradisional dan ia bergantung kepada tahap keseriusan buasir itu berlaku.

Namun dengan adanya rawatan laser yang mula diperkenalkan sejak 2011, pesakit tidak lagi perlu gusar dengan kesakitan yang perlu dihadapi.

“Kaedah yang paling popular digunakan dulu adalah ‘rubber band’ dan ‘stapler’ untuk tahap 1 hingga 3. Manakala ‘open technique’ untuk tahap 4 pula mengambil masa yang lama untuk sembuh sehinggakan anda terpaksa menggunakan kerusi roda selama 3 minggu.

“Kini, anda tidak perlu lagi melalui semua itu kerana jika anda menggunakan kaedah rawatan laser, selain kurang rasa sakit ia juga mampu menjimatkan masa ‘procedure’ iaitu sekitar 30 minit sahaja,” katanya.

Bagaimanapun menurut Khairul, kaedah laser hanya boleh dilakukan kepada pesakit yang menderita sehingga tahap 3 sahaja.

Jika tahap 4, ia perlu menggunakan kaedah asal iaitu “open technique”.

“Caranya kita akan guna laser dan forcep, saya akan tarik buasir guna forcep, kemudian ibaratnya kita akan ‘welding’ iaitu hanya masukkan laser ini, memang tak ada pendarahan yang banyak, pembedahan yang sangat terkawal,” katanya lagi.

Rawatan laser untuk buasir semakin popular sejak 3 tahun lalu kerana bukan semua hospital menggunakan keadah ini yang dikategorikan sebagai kaedah baru di Malaysia.

Jadi bagi pesakit buasir, anda tidak perlu lagi bimbang menanggung kesakitan secara berlarutan kerana kaedah laser mampu merawati tanpa sebarang kesan.

Dr. Khairul Izan Mohd Ghani

Consultant General Surgeon

Columbia Asia Hospital – Petaling Jaya
MD (UKM), Doctor of Surgery (UKM)

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PDF and Online Articles:

Lega… Buasir Boleh Dirawat Hanya Guna Laser – Free Malaysia Today, 22 Julai 2019

Artikel ini disiarkan oleh Free Malaysia Today, 22 Julai 2019

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Lelaki Lebih Terdedah Kanser Kolon

Lelaki Lebih Terdedah Kanser Kolon

September 22, 2020

Pakar masih mencari punca tercetusnya penyakit maut itu, namun pemakanan dikatakan menjadi faktor.

DUA minggu lalu, dunia hiburan anlarabangsa dikejutkan dengan pemergian pelakon yang terkenal dengan watak Black Panther, Chadwick Boseman di Los Angeles, Amerika Syarikat.

Adiwira kulit hitam pertama di dunia yang berusia 43 tahun itu bukan mati di tangan musuhnya, Thanostetapi disebabkan kanser kolon atau kanser usus.

Boseman sebenarnya telah didiagnosis menghidap kanser itu pada tahap tiga beberapa tahun lalu, namun tiada siapa pun yang mengetahui penderitaannya itu sehinggalah selebriti yang sedang mencipta nama itu menghembuskan nafas terakhir.

Apabila berita kematiannya disahkan sebagai kanser kolon, carian mengenal penyakit itu dalam bahasa Melayu menerusi Google semakin popular.

Berdasarkan data Kementerian Kesihatan Malaysia, kanser merupakan penyebab kedua tertinggi kematian di Malaysia. Kanser kolon telah disenaraikan sebagai kanser tertinggi dalam kalangan lelaki dan kedua tertinggi bagi kaum Hawa.

Sebenarnya, apakah itu kanser kolon? Bagi memperincikan lebih lanjut mengenainya, SinarPlus mendapatkan pandangan Perunding Kolorektaldan Pakar Bedah Umum, Pusat Pakar Perubatan Loh Guan Lye, Pulau Pinang, Dr R. Prabhu.

Ujar Dr Prabhu, kanser kolon sebenarnya dideritai lebih kurang 1,400 rakyat Malaysia pada setiap tahun.

"Sesiapa sahaja dalam kalangan orang dewasa boleh menghidapnya. Bagaimanapun, ia jarang bertaku pada mereka di bawah lingkungan umur 50 tahun.

"Fakta seterusnya, lelaki lebih terdedah kepada kanser ini berbanding wanita," katanya sambil menambah, berdasarkan trend semasa, rata rata pesakit yang didiagnosis sudah berada pada tahap tiga dan empat.

Mengulas lanjut, Dr Prabhu berkata, punca kanser kolon masih tidak diketahui, namun penyakit itu sering dikaitkan dengan karsinogen (agen penyebab kanser) dalam diet ataupun pemakanan seharian seperti makanan yang diproses dan rendah serat.

Ketumbuhan kecil

Ujarnya, kanser usus selalunya bermula dengan satu ketumbuhan kecil bukan kanser (benigna) yang wujud pada dinding usus yang dikenali sebagai polip adenoma "Sesetengah polip boleh berkembang menjadi kanser kolon malignan dari masa ke masa jika ia tidak dikeluarkan semasa kolonoskopi (prosedur melihat lapisan dalam usus).

"Jika hal itu bertaku (tidak dikeluarkan), sel-sel yang telah berubah menjadi sel kanser usus besar akan 'menceroboh' dan merosakkan tisu sihat yang terdapat berhampiran tumor utama sekali gus menyebabkan timbulnya banyak komplikasi yang tidak diingini," jelasnya.

Terang beliau, selepas tumor berkembang, sel-sel kanser boleh bergerak melalui sistem darah dan limfa sebelum merebak ke bahagian badan yang lain.

"la (sel kanser) juga boleh tumbuh di beberapa tempat, menyerang dan memusnahkan tisu sihat yang lain di seluruh badan.

"Satu satu rawatan kanser itu semakin rumit jika pengesanan dan rawatan pada peringkat awal tidak dilakukan," ungkap Dr Prabhu.

Pakar itu menambah, selain pemakanan yang dipercayai menjadi faktor tercetus penyakit berkenaan, terdapat kajianyang menyatakan bahawa kanser usus terjadi disebabkan oleh 'kesilapan' usus membina DNA mereka sehingga terbentuknya kanser.

"Namun, ada juga kebarangkalian kanser yang terbentuk pada dinding usus adalah disebabkan jangkitan daripada tumor yang lain (metastasis). Oleh itu, sangat mustahak untuk seseorang merawat kanser yang ada, sebelum ia merebak ke bahagian lain di dalam tubuh badan," katanya.

Saringan

Mengenat rawatan, Dr Prabhu berkata, kanser jenis itu biasanya akan dirawat mengikut tahap. Secara lazimnya, pesakit perlu menjalani pembedahan untuk membuang bahagian di mana kanser itu terbentuk.

Seterusnya, rawatan lanjutan seperti kimoterapi dan radioterapi akan diberikan bergantung pada tahap kesihatan pesakit itu sendiri.

"Perlu ditegaskan sekali lagi, kanser usus berpotensi untuk menjangkiti bahagian lain tubuh seperti hati, paru paru, otak dan juga lapisan rongga perut jika ia sudah mencapai tahap empat," beritahunya.

Sementara itu, Pakar Bedah Umum, Hospital Columbia Asia Iskandar Puteri, Johor Bahru, Dr Zulkarnain Hasan turut melontarkan pandangannya.

Katanya, kanser kolon turut disebut sebagai kanser kolorektal kerana ia terjadi di kawasan di antara pangkal usus besar hinggalah penghujungnya yang dipanggil rektum.

"la bermula sebagai gumpalan kecil dipanggil polip yang lama kelamaan boleh bermutasi menjadi barah," ujarnya mengukuhkan lagi fakta yang diutarakan oleh Dr Prabhu.

Dalam hal itu, Dr Zulkarnain menegaskan peri penting seseorang melakukan pemeriksaan awal.

Dalam hal tertentu katanya, kanser usus juga boleh menyerang orang muda termasuklah kanak kanak.
KANSER kolon perlu didiagnosis lebih awal agar la tidak merebak ke bahagian lain badan.

Berikut ialah kaedah pengesanan dan saringan kanser kolon yang sering digunakan:

Ujian darah okultik fecal imunologi

Ujian ini memerlukan sampel najis yang diuji untuk mengesan kehadiran darah. Ini kerana pendarahan tidak dapat dilihat dengan mata kasar. Andai terdapat darah, pesakit perlu menjalani ujian kolonoskopi. Jika ujian tersebut negatif, ia perlu diulang setiap dua tahun.

Kolonoskopi

Kaedah ini merupakan piawai standard untuk mendiagnosis kanser kolon dan rektum. Tiub fiber optik khas yang disambungkan dengan sistem kamera video digunakan untuk melihat ke dalam usus dan seterusnya mengambil sampel jika terdapat bahagian yang disyaki mengalami kanser atau penyakit lain. Sampel akan dihantar ke makmal untuk menjalani pengesahan jenis penyakit yang dialami.

Ujian darah

Ujian darah dilakukan untuk melihat kandungan hemoglobin darah kerana kebiasaannya kanser kolon akan mengakibatkan pendarahan dalam usus. Ujian pengesanan tumor antigen karsinoembrio (CEA) juga boleh dijalankan. Namun demikian, tahap CEA dalam darah biasanya digunakan untuk memantau pesakit yang telah disahkan menghidap kanser kolon dan rektum.

Dr Zulkarnain menambah, sekiranya kanser kolon didapati telah merebak ke bahagian lain badan, pakar perubatan mungkin akan membuat ujian pengimejan tomografi berkomputer
(CTScan)
.

"Ujian itu antara lain menentukan keadaan kanser tersebut sebelum sebarang pembedahan dilaksanakan," kata beliau.

LANGKAH-LANGKAH yang boleh diambil untuk mencegah kanser kolon:

Membuat pemeriksaan kanser kolon dengan doktor jika mempunyai keluarga yang pernah menghidap kanser tersebut.

Pada usia 45 tahun, pastikan kekerapan pemeriksaan dilakukan berdasarkan keputusan pemeriksaan pertama.

Sekiranya tiada ahli keluarga yang pernah menghidap kanser berkenaan, lakukan pemeriksaan pertama pada usia 50 tahun. Kekerapan pemeriksaan selanjutnya adalah berdasarkan keputusan pemeriksaan pertama.

Kerap bersenam untuk mengekalkan berat badan dan menjaga kesihatan tubuh.

Makan makanan yang menjamin kesihatan usus seperti sayur sayuran, buah buahaa bijiria daging dan ayam tanpa lemak serta produk tenusu rendah lemak.

Kurangkan atau berhenti menghisap rokok sepenuhnya.

Photo credit: Freepik.com

Dr. Zulkarnain Hasan

Consultant General Surgeon

Columbia Asia Hospital - Iskandar Puteri
MD (USM), AFRCS (Ire), M.Med. Surgery (USM)

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PDF and Online Articles:

Lelaki Lebih Terdedah Kanser Kolon - Sinar Harian, 13 September 2020

Punca kematian Black Panther, kenali kanser kolon – SinarPlus, 13 September 2020

Artikel ini disiarkan oleh Sinar Harian, 13 September 2020

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Let’s Fight Dengue!

Let’s Fight Dengue!

July 20, 2020

While we take pride in our efforts in controlling COVID-19 pandemic in our country, dengue cases have been increasing at a worrying pace. According to data from Ministry of Health, since January 2019 until 6th June 2020, a total of 48,584 dengue cases have been reported. An increase of 8% of dengue cases recorded every week is of grave concern with 84 deaths and counting. Majority cases which were fatal were due to patients’ delay in seeking treatment. According to Malaysia’s Health Director-General, Datuk Dr Noor Hisham Abdullah, the surge of dengue cases in 2020 is from June till September.

Re-introducing dengue

Dengue is a vector-borne disease caused by the dengue virus. The virus spreads through the Aedes mosquito which is most active during sunrise and sunset. There are four strains of the dengue virus; namely, DEN 1, DEN 2, DEN 3 and DEN 4. A person who has contracted a particular strain of the dengue virus will have immunity against that particular strain only. For example, a patient with DEN 1 only has immunity against the DEN 1 virus strain so he/she is still at risk of contracting dengue fever from DEN 2, DEN 3 or DEN 4.

What to look out for

A dengue patient will show symptoms after four to seven days after being bitten by the Aedes mosquito. These include:-

Fever

Joint pain

Muscle pain

Headaches

Eye pain

Nausea

Diarrhoea

Rashes

The three phases of dengue

Dengue fever can be divided into three phases: febrile, critical and recovery.

The febrile phase comprises of fever that lasts three to five days. During this phase, the patient experiences fever, joint pain, muscle pain, headaches and other symptoms mentioned earlier.

After three to five days, the patient enters the critical phase. This lasts between 48 to 72 hours. During this phase, the patient recovers from fever but there is a fall in platelet count and white blood cell count. Following that, the patient starts showing different symptoms. Some of them do not has serious symptoms whereas some experience complications such as internal bleeding, water retention in the lungs or stomach, low blood pressure, kidney failure and liver failure as well as coma.

This can lead to death.

After 48 to 72 hours, the patient will go through the recovery phase where dengue symptoms dissipate while blood platelets and white blood cells return to normal count.

On average and from end to end, it takes seven to 10 days before a dengue patient starts recovering from the disease. The following diagram is from the 2015 Management of Dengue Infection in Adults – Malaysia Clinical Practise Guidelines. It explains all three phases:

What to do when you display symptoms

To date, there are no specific treatments or immunisation for dengue fever. Patients who experience signs and symptoms of dengue must seek treatment immediately. Blood test must be carried out in order to get the diagnosis. Dengue cases must be notified to health officers so that preventive actions can be taken. This includes fogging in the patients’ area of residence.

For patients who have mild symptoms, he or she should rest at home under observation with daily blood tests at the clinic or hospital. For those who have warning signs, he or she must be referred to the hospital for treatment and close monitoring. On average and from end to end, it takes seven to 10 days before a dengue patient starts recovering from the disease. The following diagram is from the 2015 Management of Dengue Infection in Adults – Malaysia Clinical Practise Guidelines. It explains all three phases:

Warning signs include:-

Stomach pains

Vomiting more than three times in 24 hours

Diarrhoea more than three times in 24 hours

Water retention in the lungs, heart and stomach

Spontaneous bleeding

Fatigue

Disorientation/confusion

Liver tenderness on palpation

Abnormal blood test results

The high risk group

Apart from patients who have warning signs as mentioned above, high risk patients should also be referred to the hospital for close observation. These comprise patients with the following existing conditions:

Diabetes mellitus

High blood pressure

Heart disease

Kidney disease

Obesity

Aged 65 and older

Pregnant

On blood thinning medication

What we can do to improve situation

One of the most effective ways to do this is to ensure that the Aedes mosquito has no breeding grounds. The Aedes mosquito breeds in stagnant water even if the container is as small as a 50-cent coin. Therefore, we must be vigilant and make sure that we:-

Pour out water that collects in plant pots and trays.

Dispose containers that could potentially collect water.

Unclog drains including rooftop drains.

Ensure water tanks are covered.

Try to avoid getting bitten by the Aedes mosquito. Avoid outdoor activities during sunrise and sunset because this is when the Aedes mosquito is active. If you need to be outdoors during that time, wear bright-coloured clothing with long sleeves and long pants. Apply mosquito repellent on exposed areas. Should you find Aedes mosquitos in your house compound, use a mosquito repellent spray.

In short, we must work together to fight dengue. Just like COVID-19, dengue too is a fatal disease. Always be vigilant and protect yourself and your family against dengue.

Dr. Tee Shin Kuan

Consultant Internal Medicine Physician & Nephrologist

Columbia Asia Hospital – Tebrau
MBBS (UM), MRCP (UK)

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PDF and Online Articles:

Takutkan Covid-19, Jangan Sampai Abai Gigitan Aedes – mStar, 26 Jun 2020

Let’s Fight Dengue! – The Iskandarian, 15 July 2020

Let’s Fight Dengue! – Waves Lifestyle, 15 July 2020

This article first appeared in mStar, 26 Jun 2020

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A Letter from a Doctor On Exercising During the MCO

April 14, 2020

Staying active has perhaps become more important than ever.
Medical frontliners Image credit: DepositPhotos

Malaysia’s frontliners are national heroes today (and rightly so!) because of the deep sacrifices they have made for our nation during the COVID-19 pandemic. Many are working long hours, exposing themselves to the risk of infection, barely getting any sleep and even forced to stay away from loved ones so they don’t pass the virus on to their families.

One doctor from Johor, Dr Hazli Sufian Sulaiman, a Consultant Orthopaedic Surgeon at Columbia Asia Hospital Tebrau, took time off during this Movement Control Order (MCO) period to stress on the importance of exercise while we stay home and help the country flatten the curve of COVID-19 cases.

Here’s what he said:

“All of us are adjusting to this “new normal” life where physical interaction becomes limited and emotional adjustments need to be made. Staying active has perhaps become more important than ever to keep your physical and mental well-being intact (click here for ways to stay mentally well during this time). One of the ways you can stay active during this MCO period is by exercising. Exercise helps your body and mind in many ways as it can help manage stress levels, improve energy levels, for weight management and reduces the risk of serious health problems such as diabetes, heart disease and stroke.

But, more importantly now given the current situation, regular exercise helps boost your immune system.

Although your usual workout routine may no longer be possible, there are still lots of ways to get a good workout, even if you are in self-isolation. If you are new to exercise, even 10 minutes of movement a day can help your body and mind feel better. You can start small, with 10 minutes of yoga or low impact aerobics a day, and gradually build up. If a structured routine is not your style, you can get creative and build your own exercise routine like using household items such as water bottles and canned foods for weights, jumping jacks, jogging on the spot for 30 second intervals, sit-ups and push-ups. Anything to get your heart rate up a little will benefit you greatly.

Another popular option now is to take your workout online. There are many free online videos that are suitable for various fitness levels and are suitable for even a small-sized living space. From low-impact aerobics that are easier on your joints, to high-intensity interval training (HIIT), to strength workouts, Zumba, Pilates and Yoga (check out this easy yoga routine you can do in bed). With just the click of a button, you can choose to do these workouts at any time of the day. There are also many great workout apps available now, where you can mix and match your routines, if you prefer to do exercises at your own pace.

Other enjoyable ways to increase your physical activity, and perhaps include your kids and family members in as well, are virtual reality and physical movement games from Nintendo Switch, Xbox Kinect and Playstation 4 Move. Some of the games available include Ring Fit, Fitness Boxing (Switch), Kinect Sports Rivals, Zumba Fitness World Party (XBox Kinect) and Just Dance 2019 (PS4). All of these games cater for various levels of fitness and are fun ways to spend quality time with your family members during this MCO.

But don’t worry if you don’t have any of those things. You can opt to just walk around inside the house. Walking is one of the best forms of exercise because of its low impact to your joints, ability to keep your heart rate up, the fact that you can still do it within a confined space, and because it doesn’t cost you anything!

When all else fails, a simple increase in physical activity doing domestic chores such as mopping the floor, vacuuming or even gardening can build up a sweat, and be beneficial for your heart health.”

Thank you, Doctor! And thank you, from the bottom of our hearts, to all the frontliners in the medical field, and others who provide food, and various essential services. Stay safe, stay healthy.
*This letter was provided to SHAPE by Columbia Asia Hospital.

Dr. Hazli Sufian Bin Sulaiman

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Tebrau
MBBCh BAO (Ireland), Doctor of Orthopedic & Traumatology (UKM), CMIA (NIOSH), Special Interest Arthroplasty (Germany)

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PDF and Online Articles:

A Letter from a Doctor On Exercising During the MCO - HerInspirasi.com, 9 April 2020

This article first appeared in HerInspirasi.com, 9 April 2020

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Lightweight Runners and Teenage Weak Bones

July 26, 2017

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Dr. Harjeet Singh returns for his monthly show to talk about bones. In this episode, we pore over three recent studies that found weaker bones in idle teenagers and that lighter runners were at higher risk for stress fractures.

Dr. Harjeet Singh Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Bukit Rimau
MBBS (India), MS (Orthopedics) (UKM), MRCS (Edinburgh), Fellowship in Orthopedic Sports Medicine & Arthroscopy (Germany), CMIA (NIOSH)

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Podcast:

Listen to the podcast here

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Limb Deformity/ Length Discrepancy

Limb Deformity/ Length Discrepancy

June 29, 2017

Photo credit: depuysynthes.com

Limb deformity is an abnormality in the shape of the limb. Deformities can happen in upper limbs or lower limbs. Arms or legs can appear bent, rotated or shortened. Joints, commonly knees and ankles, can also be deformed or bent. Among the common deformities are bowlegs, knock knees, limb length discrepancies and other conditions. One may be born with deformities (congenital) or acquire it as a result of an injury, accident, tumour or infection.

Deformities can disturb our functions, causing disability. It can affect our appearance and cause cosmetic disturbances. At times, we are unable to perform routine chores or our activity of daily living due to deformities. Deformity involving lower limbs/ legs are more prominent since it affects our walking pattern. A person with lower limb deformity walks with an abnormal gait and a limp especially if there is shortening. This often leads to pain over the bones or joints. Some deformities may worsen over years, making the limbs or joints appear more bent and causing more disability. If limb deformities are left untreated, they may lead to long-term complications. Complications such as chronic back pain, early osteoarthritis of nearby joints and chronic pain are among the possible long term effects of untreated limb deformities.

Those with deformity can benefit from treatment. Treatment depends on the type and severity of deformity as well as the age of the person. In some cases, the limb deformity corrects naturally especially in children. However, some deformities can persist or the abnormality becomes more severe.

Treatment can consist from simple braces and exercises or even shoe raise if the deformity is mild or the limb length discrepancy is minimal. However, in more prominent deformities, surgical correction is needed. Short limb with significant limb length discrepancy requires limb lengthening. In a patient with deformity, a thorough examination with measurements is done by the surgeon. Necessary imaging including X-rays will be done before any treatment or surgery is done.

Corrective surgery generally involves using either internal implants such as plates and nails or external implants. With proper planning and surgery, most deformities and shortening can be corrected. Arms or legs can be realigned. Deformed joints can be straightened. Limb length discrepancies are corrected by lengthening the affected bone to achieve near normal limb. As a result, patients improve in cosmetic appearance, function and gait. This also reduces the incidents of possible long-term complications.
Dr. Ramesh Naidu a/l Applanaidu

Consultant Orthopedic

Columbia Asia Hospital – Petaling Jaya


Limping Gait in Children

Limping Gait in Children

July 31, 2016

Limping Gait is defined as deviation from normal gait resulting in an asymmetrical walking pattern. Limping gait also means, the stance phase on the affected limb is shorter than normal side. Dr. Paul Ngalap Ayu, Consultant Orthopedic & Pediatric Orthopedic / Spine Surgeon shares with you on Limping Gait in Children.

Limping Gait in Children – Parenthood, Issue July 2016
.


Liposuction

Liposuction

June 21, 2012

While definitely not a replacement for a healthy diet and regular exercise, modern-day liposuction surgery (sometimes referred to as liposculpturing) can safely and permanently address those hard-to-lose fatty deposits that simply don't respond to diet and exercise, creating big improvements in body contour and shape.

For some of us, certain areas of the body are immune to exercise. No matter how many miles we run, sit-ups we do, weights we lift, or laps we swim, the fat remains, unless it is removed—with liposuction.

Liposuction is appropriate for large, disproportionate hips, buttocks, thighs, the abdomen and "love handles", as well as fat deposits on arms, back, knees, sides, and under the chin. Very often, many different areas can be treated during a single operation.
Is Liposuction safe?

Liposuction is a relatively safe surgery when performed within the safe limits. However, even large volume liposuctions have been performed safely without complications. Liposuction should be safely performed in a hospital setting by an experienced plastic surgeon.
The Surgery

Surgery begins with a tiny incision inconspicuously located in a natural skin fold or crease in an area to be treated. Next, a salt water/anaesthetic solution is injected through a micro cannula.

During surgery, the doctor moves the micro cannula back and forth under the skin. With the help of a high pressure suction machine, the unwanted fatty deposits are removed permanently and the desired shape is created.
After surgery

After surgery a tight-fitting garment must be worn over the area. This will help your skin shrink and conform smoothly to the new shape of your underlying tissue. You will be up and around in a day or two after surgery but strenuous activities should be restricted the first week or two. For several days after surgery you may experience mild discomfort and stiffness, which can usually be controlled by medication. Some patients experience numbness or discomfort for varying periods of time.

Your scars will be barely noticeable and will soon seem to disappear. To help your skin shrink properly, we will provide you with an appropriate garment which is to be worn for several weeks. If you had skin dimpling (cellulite) before surgery, you will still have it afterward, but it may be somewhat improved. Expect some swelling and bruising which will subside within a few months. Sometimes the skin may have an uneven or slightly rippled effect. The final body contour after liposuction may take between 3 to 6 months to be noticeable. This is due to the swelling in the tissues, and by wearing the garment continuously the final result will be apparent in the due course of time. Occasionally, permanent sagging of the skin happens when the amount of fat removed exceeds the ability of the skin to shrink. Overweight patients who have localized areas of fat removed must be willing to accept a greater chance of contour irregularities and less than ideal skin redraping in exchange for improving the way they look in clothing.
Dr. A. ANANDA DORAI

Consultant Plastic Reconstructive Aesthetic Surgeon

Columbia Asia Hospital - Bukit Rimau
Image Source: howstuffworks.com


Long Term Care Options for the Elderly and Severely Disabled [BFM - Podcast]

May 27, 2009

Long Term Care Options for the Elderly and Severely Disabled - Dr Ramnan Jeyasingam.

Listen to the podcast
here
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Long-term Healthcare for Aged

Long-term Healthcare for Aged

October 31, 2017

Photo credit : thinkhealth.priorityhealth.com

MALAYSIANS are living longer going by figures from the department of statistics. The population is expected to live up to an average of 74.8 years this year compared to 74.3 years in 2011.

To top that, life expectancy is also increasing, where men and women are expected to live another 15.0 and 17.1 years respectively. It is also estimated that the ageing population will increase to 7.2% by the year 2020 and 14.5% 2040.

Malaysia’s growing ageing population also means there is an urgency to address the need for long-term care, especially for those who, in the august of their lives, are affected by illness and become infirmed or disabled.

Long-term care or chronic care refers to a continuum of medical and social services that support the needs of patients living with chronic medical conditions or severe disabilities that affect their ability to go through their daily routines without physical help and support from others.

This refers to a person’s basic daily self-care activities such as toilet hygiene, continence, mobility, dressing, bathing and eating.

It also includes continuous medical monitoring and timely intervention when medical complications are detected early.

Apart from medical services, long-term care also requires skilled nursing and rehabilitation services.

Generally, it can be broadly categorised into:

Institutionalised care which includes:

a) inpatient admission to hospitals which provides skilled nursing care (also known as skilled nursing facility); and

b) nursing homes;

Community care. This includes:

a) adult daycare centres; and

b) hospices; and

Informal care, defined as home care by family and friends, with the support of visiting nurses, visiting physical therapists and visiting doctors. In severe cases, full-time nursing services and domestic workers are employed to help out with home care. This option is gaining popularity as patient care is carried out within the setting of the patient’s home.

Demand for Long-Term Care

Our medical and healthcare services are comprehensive overall and are mainly geared towards acute care services and short-term hospitalisation.

Where long-term care needs are concerned, the estimated demand for them is complicated because it involves extensive data collection on the prevalence of medical diagnoses and the limitations in functional abilities of the patients involved.

But due to the increase in the aging population and growing number of non-communicable diseases, there is a definite need for them.

The following scenario well describes a typical situation ― A 60-year-old man with diabetes and high blood pressure sustains a massive stroke and is admitted to an acute care facility. After a week’s stay in hospital, he is discharged. However, the patient also suffers from physical disabilities as a result of the stroke. He experiences weakness in his arms and legs, and needs assistance in his daily self-care.

It is estimated that 10 per cent of stroke patients succumb immediately to the disease. The remaining 50-60 per cent continue to live with disabilities. This is where long-term care comes in.

Apart from stroke, other chronic diseases in the elderly that typically require long-term care include advanced dementia, advanced Parkinson Disease, severe brain injury, spinal cord injury and other debilitating neurological conditions, terminal cancers (some patients are also channeled to hospices) and pathological fractures.

Younger adults may also seek or require extended care for conditions such as traumatic brain injury, where some of these patients remain in a vegetative state with variable outcomes.
Financial Impact and Cost of Long-Term Care

The cost of long-term care is difficult to estimate because data on it is still scarce. However, in general, the financial charges depend on a few factors, such as:

Complexity of patient’s illness or disability;

Cost of certain consumables such as diapers and milk;

Sudden change in patient’s medical condition or sudden acute illnesses; and

Use of certain medications for patient.

However, the future holds promise for a more holistic and integrated view of healthcare delivery. What will affect the demand will be factors like the impact of population increase, changes in medical diagnoses and treatment, healthcare delivery, lifestyle and behaviour patterns of patients.

A point to ponder, future generations of the elderly and disabled are likely to be different— they’d be better educated, are more health conscious than today’s population.

One could argue then that there will be an increased life span but no change in the onset of illness, requiring longer care as more people live long enough to develop disabling conditions.

The opposite view would be that improved treatment or prevention of disabling conditions would lessen long-term care needs independent of the death rate.

However, even under an optimistic scenario, the overall demand for long-term care will still rise signiﬁcantly because of the steady increase in the elderly population.
Published in Malaymail, 19 October 2017
Click for Online Article:

Long-term Healthcare for Aged – Malaymail, 19 October 2017
.


Looking after young eyes [Press Clipping]

September 02, 2012

See our Press Clipping:

The Star,

2 September 2012


Lower Back Pain [BFM - Podcast]

Lower Back Pain [BFM - Podcast]

June 04, 2015

Photo credit:
www.indianexpress.com
Dr Ahmad Norshahrid Zahari, Consultant Orthopaedic & Spine Surgeon, Columbia Asia Hospital - Petaling Jaya.

You wake up, you stretch and get out of bed, then you spend the rest of the day sitting at your desk and in traffic jams. Well, you might actually be lying on a bad mattress, sitting with poor posture and putting unnecessary strain on your back. All of which can lead to lower back pain.

Find out more about what causes lower back pain and when you need to seek medical help with Dr Ahmad Norshahrid Zahari, Consultant Orthopaedic & Spine Surgeon from Columbia Asia Hospital - Petaling Jaya.

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Lupus organ damage: What is damaged in Asian patients?

February 23, 2011

Assessment of organ damage has become the standard outcome measure for morbidity and mortality in patients with lupus. Ethnicity is thought to be a marker for genetic, environmental, behavioral, and other variables that may affect disease outcomes.

Previous studies suggest that Asians residing in western countries had significantly higher prevalence of damage compared with Whites. In contrast, studies performed in Chinese, Korean and Arab patients showed that the overall prevalence of damage and the most commonly involved organs (neuropsychiatric and musculoskeletal) were similar to Whites. Compared with their Asian counterparts, Pakistani and Jewish patients appeared to have a higher prevalence of damage, most likely secondary to longer disease duration. Chinese patients had an increased prevalence of premature gonadal failure, whereas patients residing in western and southern Asia had more skin damage.

When compared with Whites, Asian patients had more renal damage but less ocular and cardiovascular damage. Risk factors associated with organ damage in Asian lupus patients included older age, higher disease activity, and the use of cyclophosphamide and steroids. Further investigations into other determinants such as genetic predisposition, socioeconomic factors, prevalence and severity of disease manifestations, and treatment, is needed in order to understand the variation in damage accrual in lupus patients from different ethnicities.
Dr. Kuan Woon Pang

Consultant Physician & Rheumatologist

Columbia Asia Hospital- Bukit Rimau


Mak Ayah! Lengkapkan Perlindungan Maksimum Imunisasi Dalam Proses Tumbesaran Anak

December 02, 2020

Di dunia ini, kita wujud berdampingan dengan pelbagai jenis bakteria dan virus. Kebanyakkan mikroorganisma ini tidak mendatangkan kemudaratan namun ada yang berpotensi untuk sebaliknya. Vaksin memainkan peranan untuk mencegah penyakit berjangkit seperti polio, batuk kering dari merebak dan menjangkiti kita.

Vaksin mengandungi bakteria/virus atau komponennya yang telah dilemahkan atau dimatikan. Apabila diperkenalkan ke badan, ia akan merangsang sistem imun/pertahanan kita untuk bertindak dan mengenal pasti bakteria/virus ini sebagai ancaman, dan membina antibodi yang bersesuaian untuk memusnahkannya. Antibodi yang dibina ini akan bertindak sebagai memori pertahanan badan untuk melawan jangkitan yang serupa pada masa depan.

Golongan yang patut dilindungi dengan pemberian vaksin adalah golongan bayi dan kanak-kanak yang berisiko tinggi kerana sistem imun mereka masih tidak matang. Contohnya, vaksin BCG diberi kepada bayi selepas lahir untuk mencegah tuberculosis (batuk kering). Kerajaan mewajibkan pengambilan vaksin seperti yang disenaraikan dalam Jadual KKM di bawah.

Sumber:
www.myhealth.gov.my

Terdapat juga vaksin tambahan/pilihan seperti pneumococcal, meningitis, Hepatitis A, influenza, varicella (cacar air), dan rotavirus yang boleh didapati di kemudahan perubatan swasta.

Terdapat sesetengah vaksin memerlukan lebih daripada satu dos untuk memberi perlindungan maksimum (batuk kering, diptheria, tetanus) manakala ada sesetengah vaksin pula hanya memberi perlindungan untuk tempoh terhad (contohnya, tetanus) maka booster dos diperlukan. Adalah sangat penting untuk melengkapkan siri vaksin untuk memastikan perlindungan maksimum. Cuba untuk mematuhi jadual immunisasi yang ditetapkan dan jika sekiranya terpaksa ditunda, digalakkan untuk mengambil immunisasi secepat mungkin.

Vaksin, seperti semua ubat-ubatan, berkemungkinan mendatangkan kesan sampingan. Bukan dikatakan semua yang mengambil vaksin akan mendapat kesan sampingan tetapi jika ada, biasanya adalah ringan seperti demam dan sakit pada tempat suntikan yang boleh sembuh dengan cepat.

Charis Yap

Pharmacy Manager

Columbia Asia Hospital - Puchong

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Mak Ayah! Lengkapkan Perlindungan Maksimum Imunisasi Dalam Proses Tumbesaran Anak – Mingguan Wanita, 20 Ogos 2020

Artikel ini disiarkan oleh Mingguan Wanita, 20 Ogos 2020.

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Management of Atrial Fibrillation

Management of Atrial Fibrillation

February 20, 2013

Atrial fibrillation is one of the most common arrthymia encountered. It presents as a totally irregularly irregular rhythm. Causes of AF are-

Thyrotoxicosis

Mitral valvular heart disease

Chest infection

COPD

Hypertension

Ischemic heart disease

Constrictive pericarditis

A SD-secundum.

Basic cardiac physiology required to understand AF better. 1) Atrial contraction contributes 20 % of cardiac output. Thus with onset of AF, there is loss of 20% of left ventricular systolic function which may result in cardiac failure in patients with pre-existing compromised LVF. 2) Left ventricular filling occurs during diastole. The duration of diastole is inversely proportional to ventricular rate, thus in AF with rapid ventricular rate, the diastolic phase is short and LV filling is impaired. One cardiac cycle may not fill enough to generate a radial pulse. It may require 2 or 3 consecutive cardiac cycles to give a radial pulse. This explains the concept of pulse deficit, whereby in AF the apex beat, is more than the radial pulse. 3) Ventricular rate in AF is reflected clinically by the apex beat and not the radial pulse.

AF manifests as palpitations, giddiness, cardiac failure and thromboembolic phenomenon like stroke.AF may be classified as paroxysmal, persistent or permanent. As the intention is to discuss basic principles of management, the various classes would not be elaborated on. The dispute over rate control over rhythm control is ongoing. Previously, it was thought that everyone with AF should be given one chance for cardioversion (Quote Prof Chu Pak Lau of Hong Kong University). Following the result of AFFIRM (AF follow up investigation of rhythm management), it was shown that rate control or rhythm control have no difference in outcome. The benefit of restoring sinus rhythm is nullified by the adverse effect of antiarrthymic drugs. It is therefore acceptable to leave AF alone and focus on ventricular rate control and thrombophylaxis.Cardioversion is still needed for symptom control if persist despite well controlled ventricular rate.

Acute management of AF depends on time of presentation and haemodynamic state. If patient is haemodynamically unstable like hypotensive with very rapid ventricular response, there is no dispute that immediate electrical cardioversion is mandatory. If presentation is less than 48 hours of onset, if one feels cardioversion is needed, it can be done safely without fear of thromboembolism.However if presentation is more than 48 hours; option is limited for cardioversion then must be done electively with prior anticoagulation for at least 1 month. Alternatively, a transoesophageal echo may be done to rule out LAA (left atrial appendage) thrombus prior to cardioversion.

Ventricular rate control may be by beta- blockers, digoxin or nondihydropyridine calcium blockers like verapamil or diltiazem.My preference is beta blockers to digoxin as beta-blocker can control exercise induced tachycardia whereas digoxin is only good for resting tachycardia.

Thrombophylaxis is traditionally with vitamin K antagonist, warfarin.The thromboembolic risk is determined by CHADS2 score which include factors of age(>75 years), diabetes mellitus, hypertension, cardiac failure and history of ischaemic stroke. Those with CHADS2 score of 2 or more are advised anticoagulation.Warfarin is notorious for having a narrow therapeutic window and requires regular monitoring of INR.Interaction with other drugs and food restrictions must be considered. New anticoagulants are available like dabigatran which is a direct thrombin inhibitor and rivaroxaban which is a factor Xa inhibitor. These new agents are convenient in that it requires no blood monitoring. The drawback is that we are unable to track compliance.

Other invasive interventions like RF ablation restores sinus rhythm in AF patient (MANTRA-PAF trial).AV nodal ablation prevent the atrial impulse from reaching the ventricles. After AV node is ablated, the ventricle will beat at a slow rate and a permanent pacemaker has to be inserted.
Dr. Ng Butt Chin

Consultant Physician


Management of Chronic Renal Failure

Management of Chronic Renal Failure

February 09, 2013

Definition- Chronic renal failure or CKD (chronic kidney disease) is defined as renal dysfunction which is irreversible unlike acute renal failure. Causes of CKD include DM, analgesic abuse, chronic glomerulonephritis, hypertension, polycystic kidney, medullary cystic kidneys etc.

CKD is a continuum ranging from stage 1 which is the earliest stage to stage 5 which is also referred to as end stage renal failure (ESRF).Diagnosis of CKD is based on history like history of DM, analgesic abuse, obstruction like renal stones supported by renal imaging like renal ultrasound and blood test of urea, creatinine and estimation of GFR.When seeing a patient for first time, it is important to always assume it is acute renal failure until proven otherwise. This requires repeat test like blood test. It is advisable that patient be referred to a nephrologist for initial workout to confirm the diagnosis and rule out any reversible factors which may be contributing to the kidney failure. Once this is done, patient may be followed up by his regular doctor. When he approaches advanced renal failure, he should be referred back to the nephrologist for counselling and prepare for renal replacement therapy. It is to be noted that not all CKD patients will reach ESRF.A proportion of them dies before reaching the terminal state and the major cause of mortality in CKD patients are cardiovascular events. Patients should preferably be followed up by a particular doctor who keeps track of his regular blood results like creatinine and urea. Over a period of time, based on the test results, a rough prediction of when ESRF occurs can be made.Meanwhile, treatment is conservative including lifestyle, dietary modification and medications.

A low protein diet of 0.8-1 gram/kg/day is advised. Low protein diet slows progression of renal failure by reducing intraglomerular pressure. Malnutrition with low albumin level on the other hand must be avoided, as hypoalbuminaemia is a predictor of increased mortality.

Nephrotoxic drugs like NSAID and traditional medicine must be avoided. I have encountered patients who insisted on seeing sinsehs who assure them that they can be cured and dialysis is not necessary. It is difficult if not impossible to convince them otherwise. Nevertheless, it is our responsibility to explain to them so they can at least make an informed choice. When patient is oliguric, salt and water need to be restricted.

Activation of vitamin D occurs at the liver and kidneys. Impaired activation of vitamin D causes renal osteodystrophy.Phosphate retention is another factor. To reduce the phosphate level, phosphate binders are used. Commonly used are CaCO3 which binds phosphate and is also a source of calcium. Newer agents like lantanum carbonate are much more expensive. When a patient reaches stage 3 of CKD, addition of vitamin D analogues will suppress SHPT (secondary hyperparathyroidism).

Hypertension must be treated aggressively as hypertension accelerates renal damage. The aim is to bring down the BP with whatever drugs.ACEI/ARB are shown to have effects beyond BP lowering in proteinuric renal disease. One has to be aware of its hyperkalaemic effect and effect in lowering GFR.

CKD is recognised to predispose to coronary heart disease and all risk factors must be addressed. The usual principle applies. Stop smoking, exercise, and loose weight. Treatment of dyslipidaemia in CKD is now advocated following the result of SHARP (study of heart and renal protection) which shows that treatment with simvastatin and ezetimide in CKD patients reduces mortality from cardiovascular disease and strokes. Reduced dosage of statins may be considered.

In DM, tight glycaemic control slows renal dysfunction. My preference is to use insulin, though oral hypoglycaemics like second generation sulphonylurea are claimed to be safe in renal impairment, albeit in reduced dosage. It is important to ensure that tight glycaemic control should not be at the expense of frequent hypoglycaemia which is deleterious. In certain groups like in advanced age with multiple co morbid conditions like CHD stroke and is not expected to live long, a certain degree of allowance is necessary as tight control is of not much benefit.

Erythropoietin produced by kidneys stimulate RBC production and lack of this hormone contributes to anaemia of CKD.A high proportion of patients with CKD are also deficient in iron, and iron supplements or haematics are routinely given unless contraindicated like in thalassaemia or carrier state. Correction of anaemia has been shown to improve quality of life, exercise tolerance and cardio respiratory function. Use of erythropoietin may be started in the predialysis stage. Various preparations are available. Some are given 2x or 3x per week. Some are given once a month.

When the patient is approaching ESRF, he should be referred to a nephrologist for counselling on the various options. Family members are to be involved. The options available are haemodialysis, peritoneal dialysis i.e. continuous ambulatory peritoneal dialysis (CAPD) and renal transplant. Patients at advanced age with multiple complications like retinopathy, neuropathy, CHD and cerebrovascular disease generally have poor outcome inspite of dialysis. In this group it is justified to advise against dialysis but to opt for conservative management i.e. to optimise medical treatment and allow nature to take it’scourse.For those who opt for dialysis even for CAPD,it is imperative that long before the expected onset of ESRF,at least 6 months, they should be referred for the construction of an arteriovenous fistula(AVF).This is usually done by a urologist or a vascular surgeon. An AVF takes time to mature, at least a month or longer. Diabetic patients with vasculopathy take much longer to mature and even need repeat construction. The advantage of having an AVF on standby is that anytime haemodialysis is required, there is no worry of vascular access. Patients who have not reached ESRF may occasionally be admitted for acute on chronic renal failure precipitated by events like sepsis, dehydration, ingestion of nephrotoxic drugs. A period of temporary dialysis is required. An AVF will save the patient and the doctor the hassle of having to insert an internal jugular catheter for temporary vascular access
Dr. Ng Butt Chin

Consultant Physician