Common Kids Foot Problems

Common Kids Foot Problems

January 19, 2023

Flat feet

Also known medically as pes planar, or pes planovalgus.

Appearance – a low or no arching on the middle aspect of the foot.

Most common foot condition seen in growing children – reported to be as high as 77.9%

2 main types: rigid type and flexible type – depending on whether the medial arch reconstitutes with toe walking and big toe extension.

Flexible type (more common) – usually harmless, self-limiting and resolves over time.

Symptoms – usually asymptomatic – noticed by parents when child standing, or children might complaint of mid foot pain or rarely, shin pain.

Treatment – mainly observation. If symptomatic with foot pain, they might require extra biomechanical foot support, bracing and physical therapy to help correct the alignment while the child is growing.

In the more severe one, further assessment e.g., Xray and computer tomography (CT) scan will be helpful to rule out rigid flat foot.

Rigid flat foot (less common) – usually cause by tarsal coalition (abnormal connection of two or more bones at the back of the foot – tarsal bone).

Surgery might be required in the rigid flat foot, or flexible flat foot that doesn’t respond to conservative management with symptoms disruption normal daily activity.

In toeing / out toeing

In normal circumstances, our toe points outwards 5-10 degree when we walk.

When the toes point inward, it is known as in-toeing.

When the toes point outward excessively, it is known as out-toeing.

In/out-toeing is another common foot condition seen in children.

It is caused by an abnormal rotational profile in the lower limb. The abnormality could arise in the hip joint, calf, or more distally at the feet.

Usually require further assessment by an orthopedic surgeon to determine the cause of the abnormal toeing gait.

Symptoms – mostly asymptomatic, other than the abnormal gait observed by the parents during walking. More severe forms might present with frequent falling, especially when the child starts engaging with more vigorous physical activity, eg running.

Investigation – Xray of the lower limb, including hip, knee and foot. CT scan is important to measure rotational profile of the lower limb.

Management – targeted towards the underlying cause. However, they are mainly conservative with observation and parental education.

Simple lifestyle modification, prevent the child from sitting in “W” position, which could worsen in-toeing.

Stretching and physical therapy

Surgical operation is rarely required, only in the patients that has exhausted conservative management, with a persistent or progressing deformity that is symptomatic and affecting their daily functioning.

Heel pain

Also known as Sever’s disease, or calcaneal apophysitis.

Commonly seen in children between age 7-14, especially in children that are active in sports, e.g. running and jumping sports.

It happens because of inflammation at the junction between the heel cord (Archilles tendon) and the heel bone (calcaneum), caused by repetitive stress or microtrauma on this growing area.

Presentation:

Pain at the heel

Toe walking or a limping gait

Redness, swelling and tenderness over the heel region

Pain exaggerated after an exercise or physical activity

Management is mainly supportive, with stretching of heel cord, or ice compression after sport activity. Children can also use heel padding to ease their heel pain. Activity modification, eg stopping sports for a short period of time, is sometime required in the more severe cases. Anti-inflammatory medication is helpful to control acute symptoms.

It’s a self-limiting condition that gets resolved after skeletal maturity and closure of the physis (growing part in a bone).

Ingrown toenails

Known medically as onychocryptosis. In Malay it’s known as Cagu.

It’s a condition where the corner of the nail is grown into the skin.

Might be associated with secondary infection.

Incidence has been reported to be around 2.5 – 5%

Almost exclusively affecting the big toe. Ingrown toenail of the lesser toes is less common.

Present as pain, redness, swelling of the toe, and in more severe cases, pus discharge if secondary infection sets in .

Causes:

Cutting the nail too short, or with rounded edge

Tight socks

Improper shoe wear

Trauma

Non infected ingrown toenail can be managed with conservative measures – correcting nail trimming technique, comfortable footwear with more room for the toes.

nfected toenails may require surgical intervention to remove half or the whole offending nail, to clean the infected tissue and ablate the side of the nail plate to avoid recurrent.

Antibiotic is also usually needed in infected ingrown toenail.

Importance of early detection and treatment of foot problems:

Although most foot problems in children are self-limiting, without proper monitoring and timely intervention, they can progress into permanent deformity later when these children grown into adulthood. This could lead to an abnormal walking gait due to the abnormal foot and lower limb biomechanics.

What to pay attention to:

New onset pain and swelling involving the foot.

Abnormal walking pattern (gait), e.g., limping, walking tip toe, refusing to walk (in younger age group like toddlers).

Abnormal lower limb altitude.

Asymmetrical wear pattern of the child’s shoe.

Dr. Low Weng Kong

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Seremban
MD (USM), M Orthopedic Surgery (UM), Fellowship in Advanced Musculoskeletal Trauma (Malaysia)

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PDF and Online Articles:

Common Kids Foot Problems – Baby Talk, 19 January 2023

This article first appeared in BabyTalk, 19 January 2023.

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Orthopedics
 in Columbia Asia?

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Complementary & Alternative Medicine for Sports Injuries

October 12, 2015

Photo credit:
www.bfm.my
Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Over the past 10 years, the sports medicine community has increased the use of non-operative treatment for musculoskeletal injuries. We explore Massage, Relaxation Techniques, Injectables & Acupuncture as a complementary approach to sports injuries.

Listen to the podcast
here
.


Contact and Collision Injuries

Contact and Collision Injuries

November 25, 2015

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

There are many ways sports and physical injuries can happen – including overuse and poor technique – but perhaps none is more graphic that injuries caused from impact and contact trauma. The most common are head, neck, shoulder and knee injuries. Consultant Orthopaedic Surgeon, Dr Harjeet Singh, walks us through what we need to know about these injuries.

Listen to the podcast
here
.


Corporate Wellness

Corporate Wellness

September 24, 2018

EMPLOYEE HEALTH - CARING FOR OUR MOST PRECIOUS RESOURCE

The prevalence of non-communicable diseases (NCDs), especially cardiovascular disease, diabetes and cancer, is on the rise in Malaysia. Modifiable risk factors such as sedentary lifestyle, poor diet and excess body weight are having a large effect on the risk of NCDs. A 2012 study in the journal Population Health Management found that employees who consume unhealthy diets were 66 percent more likely to experience a loss in productivity than their counterparts who regularly consumed fruits, vegetables and whole grains.

The majority of the world population is in the working-age group. This group spends most of their waking hours at workplaces. Achieving healthy eating habits and reaching physical activity goals are virtually impossible. Worksites, which are communities with their own social networks and infrastructure, can provide opportunity to deliver messages that encourages healthy eating behaviours.

Well-designed worksite-based health programmes have shown positive impacts on employee health. Environmental changes that support low-cost, healthy food choices, places for physical activity and group-based health education classes have been demonstrated as components of successful worksite interventions.

Topics being covered in this issues :

Tips on How Employees Can Eat Healthy Foods and be Active at Work

Fit to Function

Menangani Stres Di Tempat Kerja Dengan Yoga

Exercise at The Workplace

Healthy Meal Preps

A Healthy Workplace

Weight Management Programmes at Workplace

7 Healthy Habits That Make Your Workplace Awesome!

Corporate Wellness

Reconnecting You To An Active Life

Make A Difference e-Magazine – Issue 4, Corporate Wellness edition


Couples with difficulty to conceive

Couples with difficulty to conceive

March 05, 2011

Doctor, is it true that subfertility is more common nowadays?

This question is commonly posed to me during my consultation with couples seeking treatment for fertility. The figure quoted for prevalence of this problem is 1 in every 7 married couple. However, there is no local data available (at least that I can recall). Doctors are seeing more subfertility cases because

Better access to fertility treatment,

Increased patient awareness,

Couple delaying childbirth and

Higher prevalence of lifestyle disease.

When to seek treatment?

The probability of pregnancy for a healthy couple is 30% per month. This is known as fecundity rate. This low figure is just to show that men are poor reproducer. Despite this low pregnancy rate, most couple with regular unprotected sexual intercourse (2-3 times a week), should be able to conceive within a year. Fertility is influenced by age, duration of subfertility, presence of poor sperm count and past history of pregnancy. It is important for couple to seek treatment after 1 year of trying to conceive but sooner if they have the following problem.

Women aged more than 35years.

Irregular menstrual cycle.

Previous history of Endometriosis, pelvic infection.

Poor sperm count.

Difficulty to conceive- seek treatment early!!
Dr. Ng Soon Pheng

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital- Puchong


Covid-19: Kuman Tak Akan Merebak Selagi Tangan Kita Tak Sentuh Muka

June 02, 2021

SEJAK kebelakangan ini, kita dapat melihat wabak pandemik Covid-19 kian kembali mengganas dan sangat menakutkan lebih-lebih lagi dengan kemunculan varian-varian baharu.

Setiap hari kes positif yang dicatatkan sangat membimbangkan. Sudah beberapa hari menjangkau angka empat digit.

Buktinya, semalam sahaja, Malaysia telah mencatat 6,976 kes. Hari ini tak tahu lagi berapa jumlah kesnya.

Jika diamati, data-data tersebut sangat menggusarkan semua orang dan tidak mustahil akan meningkat saban hari.

Pun demikian, apa yang pasti pematuhan kepada prosedur operasi standard yang disarankan seperti memakai pelitup muka dan menjaga jarak mampu memutuskan rantaiannya.

Namun, ada aspek penting yang perlu diberi perhatian terutamanya ketika berada di kawasan sesak dan memerlukan anda memakai pelitup muka.

Baru-baru ini, doktor di Jabatan Kecemasan Hospital Columbia Asia Cheras, Dr Malar Santhi Santherasegapan melalui Facebooknya memberi saranan kepada orang ramai agar tidak menyentuh kawasan muka kerana ia boleh menjadi laluan kepada penularan virus Covid-19.

Bagi mengelakkan hal itu, beliau turut menggesa orang ramai agar sama sekali tidak memandang mudah aspek kebersihan tangan terutamanya selepas mendapatkan barangan keperluan asas di pasar raya atau kedai-kedai lain.

“Ingat, jangan sesekali menyentuh muka atau betulkan pelitup muka selepas menyentuh barang-barang yang dibeli di pasar raya tersebut.

“Ia kerana kuman yang terdapat pada tangan itu sangat mudah merebak di kawasan berkenaan,” jelasnya.

Pada masa sama, Dr Malar turut memberitahu kuman wabak pandemik itu yang berada pada tangan tidak akan memberi penyakit selagi ia tidak mendekati mana-mana laluan termasuk pada permukaan muka.

“Ada sesetengah orang, mereka sangat takut untuk duduk di atas kerusi atau bimbang menyentuh meja.

“Sebenarnya, jika terkena dekat belakang badan mahupun bahu sekalipun, ia (kuman) masih kekal di situ. Lama-kelamaan ia akan mati,” beritahunya lagi.

Oleh itu, pesan Dr Malar, selagi tidak mencuci tangan dengan bersih atau menggunakan cecair pembasmi kuman, jangan sesekali menyentuh permukaan muka masing-masing. Bahaya!

“Sebab itu saya juga memang tidak akan sentuh muka saya selagi tidak cuci tangan."

“Jadi, sangat penting informasi ini untuk disebarkan kepada orang ramai,” tambah beliau lagi.

Namun, jika kebarangkalian untuk menyentuh permukaan muka itu masih tinggi, nasihat Dr Malar, pakailah pelindung muka (
face shield
).

“Ingat, pastikan tangan dibasuh dengan bersih terlebih dahulu sebelum menyentuh permukaan muka tau!,” katanya menerusi satu sesi live tersebut.

Dr. Malar Santhi A/P Santherasegapan

Medical Officer

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

PDF and Online Articles:

Covid-19: Kuman Tak Akan Merebak Selagi Tangan Kita Tak Sentuh Muka – SinarPlus, 24 Mei 2021

Artikel ini disiarkan oleh SinarPlus, 24 Mei 2021.

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儿童冠病疫苗接种

儿童冠病疫苗接种

March 21, 2022

Columbia Asia（民都鲁）医院儿科专科医生刘运原医生认为，让儿童接种疫苗是有必要的，多数严重的冠病确诊病例都是没有疫苗保护。

Omicron “温和” 或疫苗之功

刘运原医生说，尽管很多人认为，奥密克戎比较 “温和” 不那么致命，但这未必是其特性，很大可能是与我国高疫苗接种率有关，让我们有一定保护力。

他以我国情况为例，因感染冠病进人第三组别至第五组别入院治疗病例中，有74%病例是未接种疫苗及施打加强针。这也显示多数严重的病例，都是没有疫苗保护。

刘运原医生昨日接受星洲日报脸书直播访问时说，许多家长对孩子需要接种冠病疫苗都有所顾虑，不过，不管是辉瑞或科兴疫苗，都有一定保护力，只是取决于家长对哪一种疫苗较有信心。

技术有20年历史 • 辉瑞降染病潜在风险

刘运原医生解释，辉瑞是属于信使核糖核酸（mRNA）疫苗，虽然很多人指这是新技术及疫苗，其实它并不像大家想的那么新，此技术已有约20年历史。在美国历史上最严格的安全检测计划下，美国己有数亿人接种mRNA疫苗。

“越来越多证据表明，冠病疫苗接种好处超过了已知和潜在风险。”

刘运原医生说，信使核糖核酸疫苗的优势是，接种后没有感染该病的潜在风险、高效、可以快速被身体使用，产生保护作用。同时，可以更容易且快速大量在实验室生产，而不是在卵子或其他哺乳动物细胞中培育。

他说，信使核糖核酸疫苗的缺点是容易降解，所以必须包裹在纳米脂肪粒子中（Nano fat particles），及必须在非常低的温度下存储。

大规模接种数据显示．科兴安全性有保证

刘运原医生也说，科兴疫苗属灭活性疫苗，卫生部是3月3日在第370次药物管制局会议上，有条件批准用手5至11岁儿童。

他解释，我国是根据智利卫生部对疫苗有效性评估作为参考数据。根据智利卫生部对200万名6岁至16岁儿童接种科兴疫苗，所发布儿童接种冠病疫苗有效性评估结果，在6至11岁儿童方面，有症状感染的保护效果为76%，对住院病例的保护效果为87.6%。

“在结合智利的研究结果和在儿童人群中数亿剂次的大规模接种，确认了中国科兴冠病疫苗的安全性。”

刘运原医生说，全世界使用最多的危病疫苗是阿斯利康（AZ）疫苗，共有181个国家使用，随后是辉瑞，共有154个国家使用，而科兴疫苗则有47个国家在使用。

儿童没有接种，患心肌炎几率高

儿童没有接种危病疫苗，确诊冠病后引发心肌炎的几率，比接种疫苗后出现心肌炎几率来得更高。

对于许多家长担心接种后出现心肌炎，刘运原医生解释说，心肌炎不是接种疫苗后才会出现的状况。

“心肌炎是常见疾病，症快是胸口痛、喘及累，这通常发生在青少年时期，包括感染流感也会造成心肌炎。根据报告，流感造成心肌炎的巴仙率高达10%。”

每100万剂仅1心肌炎病例

刘运原医生说，根据新加坡针对心肌炎发生的几率数据显示，在每100万剂疫苗接种，可能会出现一宗心肌炎病例。但若是确诊冠病，在每100万名确诊者中，就有450人会有心肌炎。这个数据一目了然，可以看到那一个情况比较严重，即没有接种疫苗确诊引发心肌炎的风险，是相对比接种后出现心肌炎来得高。

他说，心肌炎病例可以快速康复，只是需要休息及一些药物的帮助下就可康复。

儿童参与辉瑞临床试验

刘运原医生说，任何疫苗在接种前都会进行临床研究，当一个疾病严重至会导致死亡及传染速度快，甚至造成严重并发症及后遗症，就必须开始研发疫苗及需要接种疫苗。

他理解许多父母对孩子接种疫苗感到担心，甚至不让孩子接种及保持观望态度。

不过，他说，美国辉瑞疫苗在临床武验过程，获得超过2000名5至11岁儿童参与，一部分接种辉瑞疫苗及一部分进行生理盐水试验。试验发现疫苗功效为90.7%，保护功效主要是住院率。这也刊登在最具权威的英格兰医学杂志内。

根据辉瑞试验显示，12岁至15岁保护力是100%，及16岁至64岁保护力是90.6%，相对来说，疫苗保护力还是很高。研究所发现的副作用，第一剂主要是局部疼痛（70%）、严重疲劳（0.9%）、头痛（0.3%）及 发冷（0.1%）；第二剂则是发（8.3%）。

他说，副作用一般为轻度或中度，并可在24小时至48小时内消退，也无心肌炎、心包炎及过敏反应。如今，美国己有超过1亿人接种辉瑞疫苗。

儿童确诊倍增4全5倍 • 奥密克戎危害更大

对儿童而言，奥密克戎变异毒株比德尔塔（Delta）毒株更具危害性，这也是为何我国儿童确诊病例比过去1个月倍增4至5倍！

刘运原医生表示，根据卫生部数据显示，我国儿童确诊病例在1个月前只有3000至4000宗病例，但如今却暴增4至5倍。其中，0至4岁儿童一个月前病例是1476宗，本星期病例达到1万零84宗；5岁至11岁儿童一个月前病例是3374宗，本星期病例达到1万5712宗。

他说，从数据上来看可以发现，倍增非常迅速，也说明奥密克戎对儿童来说更严重。

儿童住院率增4至5倍

刘运原医生说，这种情况不仅发生在我国，美国数据也显示，儿童住院率比德尔塔增加4至5倍。

他说，根据美国数据统计，在德尔塔病毒下，每10万人有1.8人住院，而在奥密克戎期间，儿童住院率在每

10万名儿童中，有7.1人住院。显然，奥密克戎变异已成为全球最普遍的流行毒株，传播能力较其他变异毒株强。

〝奥密克戎变异毒株来袭前，95%儿童确诊病例属轻度或中度。主要因素是儿童一般都比较容易感染伤风感冒，这些季节性伤风及感冒会带给他们一定免疫力和保护力，包括应对冠病病毒。”

疫苗仍有保护效果

刘运原医生说，儿童的呼吸系统还没有完全发育，如鼻窦及气道，及儿童较少慢性疾病。因此，儿童是相对性的保护群体，在冠病毒株未变异前较难入侵儿童身体，这也是为何儿童病例在这之前较不严重。

尽管如此，他说，奥密克戎毒株对现有疫苗并未完全出现免疫逃逸，现有疫苗仍有一定保护效界。 虽然其预防感染的能力有所下降，但仍末发现重症率和死亡率上升，及不影响主流检测试剂的检测敏感性。

“奥密克戎可能导致住院率变高，但重症及死亡率仍保持。

人们对数据已麻木

刘运原医生说，两年前疫情爆发后，每个人都认为疫情非常严重，人心惶惶，死亡率高及传播很快。经过两年时间，人们对数据已感麻木。

他说，大马确诊数据平均每日在2万至3万宗，累计病例超过300万宗，死亡病例超过3万3000宗，我国死亡率仍保持在0.9%至1%间。不过，他提醒人们，冠病仍是非常严重约疾病。

刘运原医生引述日本采用超级电脑计算传播率发现，奥密克戎是德尔塔病毒的1.5倍。即使维持2公尺的社交距离，只要不戴口罩交谈15分钟，感染德尔塔病毒的几率为40%，而感染奥密克戎的几率高达60%。

“尽管卫生部长指，我国每100万人口中，只有600至700人确诊，相较邻国每100万人口有超过2000人确诊，我国疫情还不算严重。不过，我国疫情虽看似不严重，但我们都知道，很多人确诊后并没有呈报，否则数据将远远比现在数据更高。”

新病毒株比奥密克戎更危险

刘运原医生说，日本实验室的新实验表明，新发现的BA.2可能比奥密克戎毒株更危险，具有导致严重疾病的特性，基本传染数是奥密克戎原始毒株的1.4倍，传播量比奥密克戎高30%.

“根据世界卫生组织，BA.2毒株已在74个国家和美国47个州被发现，因此，奥密克戎不会是冠病最终变异株。”

1岁以下更要小心 • 儿童有症状或需入院

刘运原医生表示，儿童确诊冠病后，即使是属于第2组别的轻微症状，包括出现发烧及感冒等，也需高度注意或需入院观察，尤其是小于6个月或1岁以下的儿童更要小心。

“若儿童确诊后，持续高烧38.5度、无法进食或脱水、持续呕吐及腹污、嗜睡、很累、不活跃及出现癫痫，就必须入院观察及治疗。

冠病确诊病例分为5组别，第1组别属无症状、第2组别轻微症状、第3组别肺部感染、第4组别肺部感染及需氧气，以及第5组别肺部感染及需呼吸辅助器。

接种后有副作用须就医

刘运原医生说，一般成人确诊后，只有进入第3组别，即出现肺炎、呼吸急促，血氧低于95%才需入院治疗。但儿童情况不同，即使属于第2组别，如发烧及感冒，有时候也需要住院。

在谈到儿童接种疫苗时，他说，儿童接种疫苗后出现副作用分轻微、中度及严重，轻微副作用包括发烧、疼痛、发红及疲劳；中度副作用包括头疼、肌肉疼痛、关节疼痛、恶心、怕冷及淋巴腺肿胀；严重副作用，包括胸痛、喘、累、全身无力、心跳加速、晕眩、脸部肿胩及严重红瘆。

“一旦出现严重副作用就必须就医，而中度的就因人而异。中度副作用可在家吃退烧药，若症状可在24小时内得到纾缓就不需送院，否则就需去医院观察。”

接种后应避免激烈运动

刘运原医生说，至今我国已将近100万名儿童接种疫苗，截至目前没有出现严重副作用，只有2、3人需要住院并已出院。

“儿童接种疫苗后，应观察至少15分钟，主要看有没有严重敏感反应。若要减少注射部位的疼痛和不适，可用干净凉爽的湿毛巾贴服注射处。若要减少发烧引起的不适，可服用药物、多喝水及穿着轻便。

他提醒家长，儿童接种疫苗后应避免激烈运动2星期，最主要是避免发生心肌炎及心包炎。

点击此处
观看录制的Facebook直播。

Dr. Thomas Lau Yun Guan

Consultant Pediatrician

Columbia Asia Hospital - Bintulu

MBBS (UM), MRCPH (UK), GDip (Family Practice Dermatology, S'pore)

Make an Appointment

PDF and Online Articles:

没有疫苗变重症 • 刘运原：儿童必须接种

儿童没有接种 • 刘运原：患心肌炎几率高

儿童确证倍增4至5倍 • 奥密克戎危害更大

1岁一下要更小心 • 儿童有症状或许入院

这篇文章首次刊登在2022年3月13 日的《星洲网》

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Dangers Of Outside Food

Dangers Of Outside Food

August 17, 2021

Foodborne viruses have long been recognised as a growing concern to the food industry and can potentially become a serious public health issue. The Hepatitis A virus is responsible for most food-related outbreaks worldwide. Foods with high risks of contamination of Hepatitis A include shellfish, oysters, and fresh produce such as salads, fruit and vegetables.

Transmitted through faeces

Restaurant food remains a common source of Hepatitis A as the virus often finds its way into restaurants through the people who work in these restaurants who themselves are infected with the virus. Hepatitis A is transmitted via faecal-oral transmission. This means that the virus is transmitted via food or water that has been contaminated by an infected person who probably handled the food/water without washing their hands after going to the bathroom. What is particularly troubling is the fact that infected individuals can transmit the virus up to two weeks before they themselves exhibit any symptoms, meaning that they often transmit the virus before they are even aware that they are infected.

Chefs, cooks, kitchen staff and other employees in a restaurant that handle food and beverage, can easily pass the virus through food, drinks, dishes, glasses, and utensils that are used by patrons of the restaurant. Strict hand hygiene such as thorough handwashing after using the bathroom and wearing gloves when handling food are key factors in preventing the spread of these viruses. It is also important for diners at a restaurant to practise good hygiene too to protect themselves from becoming ill. Steps such as washing their own hands before eating and after visits to the restroom are good habits to have.

The average time from exposure to onset of symptoms is about 28 days with a relative range of 15 to 50 days. Hepatitis A begins with symptoms of fever, reduced appetite with poor oral intake, nausea, vomiting, diarrhoea, and generalised malaise. At onset or within a few days following initial symptoms, an individual may note jaundice which is yellowish discoloration of the eyes and skin. Additionally, they may find they have dark-coloured urine or light-coloured stools. They may also experience abdominal pain and tenderness. Examination by a doctor may reveal that their liver and/or spleen are enlarged.

Once infected, no reinfections

There is no specific treatment for Hepatitis A. All measures of managing this infection are purely supportive. Hepatitis A infection is self-limiting as it may last for several weeks with relapsing symptoms. However, full recovery is expected although symptoms may persist on and off for a few weeks before the patient fully recovers.

Individuals who work at restaurants, grocery stores and supermarkets who have been diagnosed with Hepatitis A should be excluded from work for at least two weeks after their onset of symptoms. If they had experienced jaundice, they should not return to work for at least one week after the onset of jaundice. Once an individual has recovered from Hepatitis A, they cannot be reinfected. They are immune for life and do not continue to carry the virus.

Course of action

According to the World Health Organization, the most effective way to prevent Hepatitis A infection is to improve sanitation, practise proper handwashing techniques and ensure clean and hygienic handling of food. Avoid sharing food, cutlery and drinks with other people. Avoid eating raw or undercooked shellfish. When travelling, particularly in places with poor sanitation, drink bottled water and avoid food that might have been prepared using contaminated water.

Hepatitis A immunoglobulin is a drug that contains antibodies against the Hepatitis A virus. This drug can be taken within two weeks of exposure to the virus. It is around 85 percent effective but its effects are temporary and may last up to only three months.
Hepatitis A vaccination
 is still the preferred choice for prevention. Vaccines against Hepatitis A are available as inactivated single antigen vaccines or in combination with the Hepatitis B vaccine. Hepatitis A vaccines do not cause any severe reactions, and the benefits of vaccinating yourself and your family outweigh any risks. The best thing to do is to consult a
physician
 on your options for vaccination.

Dr. Harpreet Kaur A/P Harnam Singh

Consultant Internal Medicine Physician

Columbia Asia Hospital – Tebrau
MBBS (IMU), MRCP (UK), AM (Malaysia)

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PDF and Online Articles:

Dangers of Outside Food - News Straits Times, 22 July 2021

This article first appeared in New Straits Times, 22 July 2021

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Delicious & Diabetic-Friendly Malaysia Breakfasts Recipes

December 02, 2015

In line with Columbia Asia Diabetes campaign focusing on healthy eating for World Diabetes Day 2015, our chefs from Café Columbia worked closely with our dietitian to reinterpret Malaysian favourites and recipes so that the output is a diabetic-safe meal plan without compromising taste. Recipes from the Columbia Asia Master Chef Challenge 2015 and other healthy recipes have been compiled into a booklet.

Delicious & Diabetic-Friendly Malaysian Breakfasts
.


Demi Mahu Melakukan Perubahan Hannah Pilih Jadi Jururawat

February 18, 2020

Hannah Fong suka berinteraksi dan bertemu dengan orang ramai. Malah ketika kecil, apabila cikgu bertanya apakah cita-citanya, jawapan Hannah sudah pastilah jururawat, kerjaya yang diimpikan.

Sebab itu, setelah tamat pengajian peringkat sekolah menengah, Hannah telah memilih kerjaya sebagai jururawat. Siapa sangka kerjaya pilihannya ini bukan sahaja mendekatkan Hannah dengan masyarakat tetapi ia turut membantunya cemerlang dalam pekerjaannya.

Wanita berusia 45 tahun ini berpengalaman luas dalam bidang kejururawatan. Kerjaya dalam bidang kejururawatan juga telah membawanya berkhidmat ke serata hospital swasta di Kuala Lumpur dan Singapura. Jawatan yang dipegangnya ketika di hospital-hospital tersebut juga tidak kurang hebatnya.

Bermula sebagai seorang jururawat biasa, kerjayanya telah berkembang, antaranya pernah menjadi Pengajar Jururawat, Jururawat Perbidanan dan Pengurus Jururawat. Di hospital tempatnya berkhidmat kini, iaitu Columbia Asia Puchong, Hannah berjawatan Chief of Nursing atau Ketua Kejururawatan.

Tanggungjawabnya amat berat namun Hannah tidak pernah merasakan itu satu beban. Dia seronok dengan tugasyang diamanahkan kepadanya itu.

"Tugas saya kini merangkumi segala-galanya berkaitan perkhidmatan dan penjagaan yang diberikan oleh jururawat kepada pesakit yang mendapat rawatan di hospital ini.

"Walaupun saya tidak lagi dapat melakukan tugasan sebagai jururawat kerana dengan jawatan yang diberikan ini, saya tidak ada lagi masa untuk mengurus dan merawat pesakit. Namun begitu saya masih boleh melawat dan melihat pesakit yang ada di hospital ini.

"Saya berpuas hati dengan jawatan yang saya pegang sekarang kerana saya boleh melakukan perubahan. Kuasa untuk mengubah itu amat besar. Saya boleh melakukan perubahan bagi memastikan pesakit dapat dirawat dengan baik. Paling penting, saya boleh menambah baiksesetengah hal berkaitan penjagaan pesakit oleh jururawat. Ujarnya.

Dengan jawatan yang dipegang itu juga telah membolehkan Hannah untuk mengetuai pasukan di bawah seliaanya.

Kebolehan untuk mengetuai adalah amat bermakna dan memberi kepuasan dalam diri saya terutamanya apabila semua orang dalam arah yang sama dengan saya dalam memastikan penjagaan pesakit dapat dilakukan dengan baik." Tambahnya lagi.

Berpegang Pada Janji

Untuk menjadi seorang jururawat yang cemerlang, seseorang itu perlu berpegang pada janji. Ini adalah pesan Hannah kepada semua jururawat di mana sahaja mereka berada.

"Kalau janji hendak buat, kena buat. Tak kira apa pun. Kadangkala apabila kita mahu melakukan sesuatu tetapi menjangkaui kebolehan diri, kita perlu cari jalan melakukannya. Cuba dekatkan diri dengan orang yang ada pengalaman untuk belajar mencari jalan penyelesaian.

"Dalam bidang kejururawatan, ia memerlukan kerjasama berpasukan yang mantap. Ini kerana di hospital bukan hanya jururawat sahaja yang ada, malah pelbagai bidang kerja ada di hospital. Oleh itu jururawat perlu berkerjasama dengan semua pihak." Jelas Hannah.

Pesannya lagi, kalau seseorang itu tidak ada sikap suka kepada orang ramai, janganlah pilih kerjaya sebagai jururawat.

Jururawat perlu ada sikap suka membantu orang lain dan perlu banyak berkorban demi mahu membantu pesakit yang memerlukan. Sekali lagi saya ingatkan, salah satu perkara penting mengenai kerjaya jururawat ini adalah diri perlu bersedia untuk berkhidmat kepada orang ramai." Tegasnya.

Tambah Hannah lagi, sikap sabar juga perlu ada dalam diri seorang jururawat kerana setiap hari mereka akan berjumpa dengan pelbagai perangai dan kerenah orang sakit. Tanpa kesabaran sudah pasti akan menyukarkan lagi kerja jururawat itu setiap hari.

Sasaran Hannah dalam kerjayanya adalah untuk membina pasukan yang mampu melakukan kerja sebaik mungkin.

Pengalaman dan ilmu dalam bidang kejururawatan sentiasa dijadikan panduan ketika berkhidmat.

"Saya berpuas hati dengan jawatan yang saya pegang ini kerana saya boleh melakukan perubahan. Kuasa untuk mengubah itu amat besar. Saya boleh melakukan perubahan bagi memastikan pesakit dapat dirawat dengan baik..." Hannah sentiasa memastikan setiap jururawat di bawah seliaannya melakukan kerja dengan baik.

"Peranan saya sudah lain kerana saya berada di barisan kepimpinan. Saya tidak boleh kerja 24 jam seminggu. Oleh itu saya perlu membentuk satu pasukan pertengahan yang kuat untuk membantu saya menguruskan perkhidmatan kejururawatan di sini." Ulasnya.

Walau sibuk dengan kerja dan tanggungjawab di hospital, Hannah tidak pernah lupa untuk menjaga dirinya sendiri.

"Rehat dan tidur adalah cara saya menghilangkan stres. Saya cuba mengamalkan gaya hidup seimbang dalam hidup bagi memastikan diri saya sentiasa sihat dan bertenaga untuk melakukan kerja yang saya suka ini." Akhiri Hannah.

PDF and Online Articles:

Demi Mahu Melakukan Perubahan Hannah Pilih Jadi Jururawat – Mingguan Wanita, Februari 2020

Artikel ini disiarkan oleh Srikandi, 1 Februari 2020

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Developing A Champion Sportsperson

Developing A Champion Sportsperson

January 19, 2017

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Want your child to be a star athlete? Find out how on this month's edition of sports medicine, Dr Harjeet Singh speaks about development of athletes from the ground up. He is joined by a former national and development coach.

Listen to the podcast
here
.


Dexamethasone: The Lee Chong Wei Story - Dr Harjeet Singh [BFM - Podcast]

November 25, 2014

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

National sporting hero Dato' Lee Chong Wei has recently made headlines and broken hearts by failing a drug test. What was the drug they found though, and does it really constitute cheating? Dr. Harjeet Singh, consultant orthopaedic surgeon, offers his perspective.

Listen to the podcast
here
.


Diabetes

Diabetes

November 19, 2015

In conjunction with World Diabetes Day, Dr Jalal from Columbia Asia Hospital – Bukit Rimau shares about Diabetes on the symptoms, types of diabetes, sugar intake as well as preventive steps with the listeners of Sinar FM.

Listen to the podcast
here
.


Diabetes in Children [BFM - Podcast]

Diabetes in Children [BFM - Podcast]

November 07, 2013

As of 2010, an estimated 285 million people had diabetes, with this number expected to double by 2030, mostly in Asia and Africa. How much of this burden is being borne by children, and how do the symptoms and treatment differ from childhood to adulthood? We get two separate perspectives from Dr. Izzurina Bashah Mohamed Ibrahim and Ambreth Kaur, parent of 10-year-old diabetic patient, Veena.

Listen to the podcast
here
.


Diabetic foot

Diabetic foot

November 26, 2011

The current incidence of diabetes in Malaysian is about 23 percent - 1 in 5 Malaysian is a diabetic - this does not include the numbers undiagnosed.

Diabetes affects multiple organ systems - even the musculoskeletal system is not spared. The feet in particular are at risk increasing the potential for infection, gangrene and limb loss - amputation. Diabetes may cause nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection.

Amputations reduce mobility and increase morbidity and mortality rates. To put it simply, having an amputated limb increase the risk of having other problems due to reduced ambulatory capacity and does reduce lifespan.

As always, prevention is better than cure and there are simple preventive measures to reduce chance of diabetic foot infection.

First -
Have good sugar control
. This has always been a key need and will always be so.
Inspect your feet daily
 - Easy to do but most don’t. Check for cuts or blisters - this may indicate areas suggesting ill-fitting footwear. Skin redness and swelling are also areas for concern particularly if the area of redness does not blanch with pressure. Always give your nail and the spaces between the toes a good look - these are usually the initial sites of infection. Don’t forget the skin of the sole. Using a hand mirror simplifies looking at the bottom of your feet. Get worried and do see your doctor if things don’t look normal.
Clean and wash feet with lukewarm water
 - Keep in mind that diabetics have reduced sensation over the feet due to nerve damage. Test water temperature either by dipping the points of your elbow in or ask someone else to do this. Keep your feet clean by washing them daily. Be gentle - wash them using a soft cloth or sponge. Ensure that you dry the feet well after wash.
Moisturize your feet
 - Use a moisturizer daily to keep dry skin from itching or cracking. But DON’T moisturize between the toes - this could cause a fungal infection.
Nail care
 - Cut nails straight and not in a curve. Never cut them too short. This can cause in growing nails with possible infection and worse. Cut them straight across and file the edges.
Corns and Calluses
 - Please don’t self treat these conditions. You are not the doctor - I am.
Wear clean, dry socks
 - I qualify this with this additional important instruction - change your socks daily. Ideally use cotton socks. Synthetic sock usually are less breathable. Avoid tight bands and thicker kinds of socks, which usually fit poorly. An ill fitting sock will cause shear and make your feet prone to injury
Shake out your shoes before wearing them
 - Diabetics may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.
Avoid walking barefoot
 - Try practicing this even at home. Wear a soft shoe or slipper. You will be able to avoid unnecessary injury.
Don’t smoke - Duh….
 Smoking restricts blood flow and slows healing
Get periodic foot exams
 - Get regular input from your friendly Orthopaedic Surgeon on foot care with periodic updates and assessment.
Dr. Harjeet Singh a/l Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Bukit Rimau


A diabetic Nutrition & Eating habits menu

December 18, 2014

Recipes and write-up by the team from Café Columbia Seremban (left to right: Abu Hashim Bin Abdul Malik, Khairul Fahmi Bin Jomino, Nur Zaitie Binti Md Rais, Chef Ravindran a/l Mathavan, Food Service Manager- Mr. Gunaraj a/l Sivalingam, Rafidah Binti Azid, Food Service Coordinator- Ms. Chua Kai Jia, Haryatie Binti Ibrahim, Jayanthi a/p Arumugam)

Many Diabetes patients often ask the Dietitian during their counselling sessions what is Diabetic food? We would like to emphasize that a diabetic patient can still enjoy his food as long as he follows the Dietitian’s advice on food recommendation. Café Columbia Seremban team has prepared a sample menu for a diabetic patient, supplemented with advice from their Dietitian.

SAMPLE ONE DAY MENU

(1500 kilocalories per day which 45% comes from carbohydrates)

Breakfast

Mango Oat Smoothie (serving for 1)

100g mango

3 tablespoons oat

100ml low fat milk/skimmed milk

Preparation method: Blend all ingredients well.

As a quick start for the day, we suggest to have 1 glass of Mango Oat Smoothie and 2 slices of wholemeal bread with thin spread for mid-morning. Oat and wholemeal bread can increase the total fibre intake and substituting full cream milk with low fat milk/skimmed milk can reduce the total fat intake.

Lunch

Malaysia Fusion Pasta (serving for 1)

1 cup spaghetti (cooked)

50g chicken breast

1 tablespoon chili powder

10g dry chili

30g bell pepper

30g mushroom

30g broccoli

30g onion

Cooking method: Stir-fry all the ingredients with canola oil on a non-stick pan.

Our Chef designed a special dish - Malaysia Fusion Pasta. Whole wheat spaghetti is suggested for its high fibre content. The colour variety for vegetables adds to enhance the nutrition, presentation and taste of this dish.

Tea Time

Chanadal Pancake (serving for 1)

60g chanadal (soaked and drained)

20g spinach (chopped)

30g carrot (grated)

30g onions

2-3 piece curry leaves

½ teaspoon green chili (chopped)

Cooking method: Mix all ingredients and pan-fry on a non-stick pan.

Most local kuih are high in sugar or fat. We would like to introduce Chanadal Pancake which is neither high in carbohydrates nor fat.

Dinner

Columbia Heart Healthy Chicken Skewer (serving for 1)

Heart Healthy Chicken Skewer

90g cube chicken breast

10g bell pepper

Coarse black pepper and salt to taste

Dressing

½ whole red bell pepper

Coarse black pepper, sugar and salt to taste

Cooking method: Marinate the cube chicken breast with black pepper and salt. Put the cube chicken breast and bell pepper into satay stick. Bake them in the oven. As for the dressing, blend the whole red bell pepper. Sauté it on a non-stick pan and add some black pepper, sugar and salt to taste.
Vegetarian Fried Brown Rice

1 cup brown rice (cooked)

20g bell pepper

20g baby corn

<20g cauliflower

1 whole egg

Cooking method: Stir fry all the ingredients using a non-stick pan.

We introduce the Columbia Heart Healthy Chicken Skewer which is served with vegetarian fried brown rice, mix salad and one serving of fruit (e.g. 1 small apple/ 1 small orange/ 1 slice of papaya) as a complete nutrition set.

Supper

Light snack can be introduced before sleep e.g. one glass of warm low fat milk. There is no one prefect food. It is important to have a variety of foods but to take into consideration on portion size. People with diabetes can enjoy food with their friends and family. The diabetic only needs to make smart food choices and do menu planning.


Diabetics, watch your eyes [Press Clipping]

November 20, 2012

See our Press Clipping:

New Straits Times,

20 November 2012


Diet Rendah Kalori Tidak Sihat

Diet Rendah Kalori Tidak Sihat

July 31, 2019

Formula Hendak Cepat Kurus Ganggu Sistem Kimia Badan

“Kajian juga membuktikan batu karang hempedu adalah penyakit yang diwarisi dan tidak bolen dihalang pembentukannya"

Dr Khairul Izan Mohd Ghani @ Mamat, Perunding Pembedahan Am

Amalan diet dengan mengambil makanan berka-lori rendah untuk meng-hilangkan berat badan dengan cepat akan meng-ganggu sistem kimia dalam badan.

Ini menyebabkan pundi hempedu kurang mengecut, sekali gus mendedahkan risiko menghidap batu karang hempedu.

Perunding Pembedahan Am, sebuah hospital swasta, Dr Khairul Izan Mohd Ghani @ Mamat, berkata kebanya-kan orang terutamawanita terlalu obses untuk mem-peroleh bentuk badan yang cantik dengan mengamalkan diet makanan rendah kalori.

Beliau berkata, pengam-bilan kalori yang rendah daripada sepatutnya boleh mengundang padah dan mudah dijangkiti batu karang hempedu.

Katanya, walaupun penyakit ini sering dihidapi wanita berusia dan memiliki tubuh yang berisi, namun terdapat wanita seusia 20 ta-hun pernah menghidapinya. Malah, wanita lebih berisiko dua kali ganda berbanding lelaki.

"Kajian juga membuktikan batu karang hempedu adalah penyakit yang diwarisi dan tidak dihalang pembentukan-nya," katanya kepada BH.

Gangguan Genetik

Terdapat laporan di Amerika Syarikat, mengatakan banyak enam peratus dalam kalangan lelaki dan sembilan peratus daripada kalangan wanita ber-hadapan masalah berkenaan.

Manakala di Itali pula, kajian mendapati banyak 18 peratus daripada kalangan wanita dan 9.5 peratus lelaki mengalami batu hempedu.

Dr Khairul Izan berkata, ada ketikanya batu karang hempedu terlepas daripada pundi hempedu lalu masuk ke pankreas melalui duktus yang boleh mengakibatkan komplikasi pankreatitis, sekali gus mengancam nyawa.

"Simptom duktus hempedu tersumbat ialah kulit kekuningan dan kawasan mata menjadi putih (jaundis), air kencing berwarna gelap, demam berlarutan dengan keadaan pesakit menjadi panas dan sejuk berpanjangan.

"Kesan ini boleh dilihat dan dirasai secarajelas, pesakit perlu mendapatkan rawatan segera jika gejala berkenaan berterusan hingga menjejaskan keselesaan mereka," katanya.

Ujian Darah Kesan Jangkitan

Beliau berkata, memandang-kan batu karang hempedu sukar dikesan menerusi simptom awal, ia boleh dike-tahui menerusi ujian ultrasound atau imbasan tomografi berkomputer.

"Ketika pemeriksaan jaundis, pesakit akan menjalani ujian darah bagi mengesan sebarang jangkitan, tahap en-zim pankreatik atau hati yang tidak normal serta bilirubin berlebihan," katanya.

Katanya, bagi merekayang menghidapnya, mereka boleh mendapat rawatan menerusi prosedur pembedahan lapa-roskopik kolesistektomi atau pembedahan terbuka bagi mengeluarkan pundi hempedu.

"Manakala rawatan bukan pembedahan, pesakit di-berikan pil garam hempedu (ubat ursodial - Actigall) bagi melarutkan batu kolesterol.

"Begitu juga dengan terapi gelombang bunyi (litotripsi gelombang kejutan extracorporeal), bertujuan meme-cahkan batu-batu berkenaan. Bagaimanapun, keadaan itu dikhuatiri boleh kembali ter--bentuk, melainkan menerusi pengambilan ursodial," katanya..

Simptom Awal Batu Karang Hempedu:

Rasa senak kronik - pesakit mengalami mual, origin, kembung perut dan sakit pada abdomen; Kesan sakit 15 hingga 30 minit, ada kalanya lebih satu jam.

Bermula pada bahagian tengah dan kanan abdomen hingga menular ke belakang atau bahu kanan;

Serangan tidak menentu hingga bertahun.

Loya dan muntah, ada kalanya demam panas.

Dipanggil 'gallstone'- disebabkan pengumpulan kolesterol, kalsium, garam bilirubin dan bendasing jangkitan parasitatau bakteria di dalam hempedu.

Batu karang hempedu berkolesterol - berwarna kekuningan Batu karang berpigmen - berwarna coklat hitam atau gelap.

Terbentuk kerana banyak bilirubin akibat mengalami sirosis, jangkitan trek biliari dan anaemia;

Saiz batu karang hempedu sekecil sebutir pasir atau sebesar bola golf.

Dr. Khairul Izan Mohd Ghani

Consultant General Surgeon

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

Make an Appointment

PDF and Online Articles:

Diet Rendah Kalori Tidak Sihat – Berita Harian, 27 Julai 2019

Artikel ini disiarkan oleh Berita Harian, 27 Julai 2019

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Do Healthy Kids Need Vitamins & Supplements?

March 20, 2023

Adequate nutrition intake is important for kids due to growth and development. On top of that, having a balanced nutrition helps in preventing health conditions such as malnutrition and overweight.

Are vitamins and supplements necessary for healthy children?

Kids are able to obtain adequate nutrients from their daily food intake. Therefore, vitamins and supplements are supposed to be given to children who have symptoms or diagnosed with vitamins deficiency. However, kids who are not taking balanced meal will tend to have inadequate nutrients. For examples, those kids are like picky eaters, having irregular meal intakes, having digestive health conditions or having food restrictions due to allergies.

Besides, kids who are on vegetarian or vegan diet tend to be lacking in iron, vitamin B12, zinc and calcium. Thus, vitamins and supplements are suitable to be given to kids in the categories mentioned. Children can take vitamins and supplements to boost their immune system and appetite. Besides, studies found that more than 50% of Malaysian children do not obtain adequate calcium and vitamin D as suggested in Recommended Nutrients Intake (RNI) Malaysia. Therefore, calcium and vitamin D supplements can be given to children who do not take dairy products and vegetables daily.

Vitamins & Supplements Deficiency and Overdose in Children

Nutrients

Benefits

Effect of Deficiency

Effect of Overdose

Vitamin A

For healthy eye, growth, development and immune system

Eye, skin, growth issues

Severe headache, blurred vision and dizziness

Vitamin B complex

Helps in energy production, promote cell health and appetite

Fatigue, nausea, anemia

Lost feeling in limbs, nervous system damage and live

Vitamin C

Antioxidant that protect cells, improve iron absorption

Scurvy, aneamia, bleeding gums

Diarrhea, nausea, gastric discomfort, increase rick of kidney stones

Calcium and Vitamin D

Essential for bone health and growth

Rickets, weak bones/ nails, muscle cramp, confusion

Kidney stones, bone pain, muscle weakness

Iron

For growth, development and essential in blood production

Anemia, fatigue, poor concentration

Bloody vomit/ stool, gastric discomfort

Zinc

Helps in immune system and metabolism

Growth retardation, loss of appetite, impaired immune system

Bloody diarrhea, gastric discomfort

Probiotics

For gut health, constipation, diarrhea and immune system

Not available

Bloating, infection in critically ill child (depends on individual)

Prebiotics

Work together with probiotics, suitable for kids who does not take adequate fruits and vegetable daily

Constipation, colic

Bloating, intestinal discomfort

Nutrients

Benefits

Effect of Deficiency

Effect of Overdose

Vitamin A

For healthy eye, growth, development and immune system

Eye, skin, growth issues

Severe headache, blurred vision and dizziness

Vitamin B complex

Helps in energy production, promote cell health and appetite

Fatigue, nausea, anemia

Lost feeling in limbs, nervous system damage and live

Vitamin C

Antioxidant that protect cells, improve iron absorption

Scurvy, aneamia, bleeding gums

Diarrhea, nausea, gastric discomfort, increase rick of kidney stones

Calcium and Vitamin D

Essential for bone health and growth

Rickets, weak bones/ nails, muscle cramp, confusion

Kidney stones, bone pain, muscle weakness

Iron

For growth, development and essential in blood production

Anemia, fatigue, poor concentration

Bloody vomit/ stool, gastric discomfort

Zinc

Helps in immune system and metabolism

Growth retardation, loss of appetite, impaired immune system

Bloody diarrhea, gastric discomfort

Probiotics

For gut health, constipation, diarrhea and immune system

Not available

Bloating, infection in critically ill child (depends on individual)

Prebiotics

Work together with probiotics, suitable for kids who does not take adequate fruits and vegetable daily

Constipation, colic

Bloating, intestinal discomfort

Vitamin A

Benefits

For healthy eye, growth, development and immune system

Effect of Deficiency

Eye, skin, growth issues

Effect of Overdose

Severe headache, blurred vision and dizziness

Vitamin B complex

Benefits

Helps in energy production, promote cell health and appetite

Effect of Deficiency

Fatigue, nausea, anemia

Effect of Overdose

Lost feeling in limbs, nervous system damage and live

Vitamin C

Benefits

Antioxidant that protect cells, improve iron absorption

Effect of Deficiency

Scurvy, aneamia, bleeding gums

Effect of Overdose

Diarrhea, nausea, gastric discomfort, increase rick of kidney stones

Calcium and Vitamin D

Benefits

Essential for bone health and growth

Effect of Deficiency

Rickets, weak bones/ nails, muscle cramp, confusion

Effect of Overdose

Kidney stones, bone pain, muscle weakness

Iron

Benefits

For growth, development and essential in blood production

Effect of Deficiency

Anemia, fatigue, poor concentration

Effect of Overdose

Bloody vomit/ stool, gastric discomfort

Zinc

Benefits

Helps in immune system and metabolism

Effect of Deficiency

Growth retardation, loss of appetite, impaired immune system

Effect of Overdose

Bloody diarrhea, gastric discomfort

Probiotics

Benefits

For gut health, constipation, diarrhea and immune system

Effect of Deficiency

Not available

Effect of Overdose

Bloating, infection in critically ill child (depends on individual)

Prebiotics

Benefits

Work together with probiotics, suitable for kids who does not take adequate fruits and vegetable daily

Effect of Deficiency

Constipation, colic

Effect of Overdose

Bloating, intestinal discomfort

How to ensure that your child is getting enough nutrition through their diet?

Take meal on time, avoid skipping meals

Take balanced meal and adequate protein portion using Malaysian Healthy Plate (quarter quarter half)

Take dairy products daily such as milk (2 glasses a day)

Increase intake of wholegrain products, choose wholegrain cereal, oat biscuit, etc

Add on healthy snacks by choosing fruits, vegetable chips, yoghurt, cereal, blended fruits sorbet, etc

Reduce on fast food, processed food, sugary beverages and high calorie snacks

Expose to sunlight (15-30 minutes, 2-3 times a week) or do more outdoor activities for bone health

Yap Pau Lin

Dietitian

Columbia Asia Hospital - Iskandar Puteri

Make an Appointment

PDF and Online Articles:

Do Healthy Kids Need Vitamins & Supplements? - BabyTalk

Vitamins for Kids – BabyTalk, March 2023

This article first appeared in BabyTalk.

Look for
 Dietetics and Nutrition
 in Columbia Asia?

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Do You Have A Bladder Problem?

 Do You Have A Bladder Problem?

April 14, 2016

If you think urinary incontinence affects only older women, think again. Bladder control issues affect younger and active women too.

Women's Weekly, 14 April 2016
.

Women's Weekly, 14 April 2016
.


Do you really know me? An anesthetist’s ramblings

February 23, 2011

As an anesthesiologist or more famously known as anesthetist or even "mah sui", we are behind the scene all the time. Even my spouse wasn't aware what I really do until she came to the operation theatre and saw with her own two eyes what I really do.

My friend once asked me, after you give the "bius", what do you do? "So easy la your work", he lamented. Then, comes the anesthetists fee. Why do you have to charge so much? These question even comes from doctors who have left the clinical side for so long they have forgot what its feel like to be responsible for another person's life.

Yes, that is how a true anesthetist feels. We are holding the responsibility of guarding your life when you are vulnerable and unable to do it yourself. More accurately called perioperative physicians, anesthetist will take you through the whole process of pre (before), intra (during) and post (after) operation.

Before you go for an operation, you need to be assessed whether you are in good health or not. This will affect the risk of your operation from low to high risk. Basically going for an operation under General Anesthesia is like undergoing a high level of strenuous exercise and we want to know whether your heart will be able to withstand this stress.

Yes, when you are older your heart will be less able to withstand this stress and puts you at a higher risk of getting a heart attack during the operation. Also the type of operation is important in determining whether it is high risk for you or not. The field of anesthesia has evolved from using chloroform to using more safe and short acting gases that facilitates earlier recovery and faster return to normal activities.

To make you anesthetized, it is not a "one for all" drug. Each patient has their own dose at which they become unconscious without falling into the "deep end". Yes, every drug is poison! Only the dose determines whether it is medicine or otherwise.

The real work starts here. Contrary to popular belief, it's not all over for anesthetists once you are asleep. This is when you are at your most vulnerable point. Your breathing pathway will be blocked and you will be paralyzed to facilitate the surgery. We will put in a tube for the breathing and ensure that you are getting enough oxygen by use of machines that breathes for you. We will monitor your blood pressure and make sure that it is enough to pass the oxygen to the whole body. All this is done while making sure that you are fully unconscious and your brain not aware of what is happening. Don’t forget painkillers for good pain relief without compromising your breathing later.

Surgery is over! Now the whole process needs to be reversed and you need to be brought back as close as possible to the condition you were before the surgery. The tube for breathing is taken out; the gases that are going in are stopped so you regain consciousness. Drugs that reverse the effect of paralysis are given. Of course there will be residual effects. In some cases their care even is extended in Intensive Care because of their poor medical condition or major operation.

All goes well and you wake up in recovery. More pain killers are given until you are pain-free before sent back to the ward.

All in a day's work!
Dr. Mohamed Asri B Kader Ibrahim

Consultant Anaesthetist

Columbia Asia Hospital- Bukit Rimau


Doctor, I missed my period!!!

Doctor, I missed my period!!!

March 04, 2011

This is a common presentation to my clinic. My response will depend on the age of my patient and her intention. She is most probably pregnant or one who is approaching menopause. It could also be some drug (medication) side-effect. There are also other gynae causes for ‘missed period’, which I will write some time later.

Working as an O&G specialist in Puchong, with a relatively young and growing population, pregnancy is still the commonest diagnosis for “missed period”. For this group of women, they come to confirm their pregnancy. Many have come with prior positive test on the urine pregnancy kit. A pelvic ultrasound scan will normally bring glow and joy to these mothers to be.

Most women will come with their spouse, especially if this is their first child. The concerned husband will listen attentively as the excited mom shares her early pregnancy symptoms. I usually let them to clear their doubts, proceed to discuss the 9- month journey towards becoming the super “Mom & Dad” and not forgetting the long list of do’s and don’ts during this critical time.

My most important message is that during the first 3 months (first trimester), the fetus develops rapidly. It is the most vulnerable period as it is prone to malformation caused by teratogen (factors that derail fetal development). Although most women will sail through this period without any untoward incident, some may encounter vaginal bleeding. The first three months is a critical time to determine if the pregnancy will continue or otherwise. The would-be “Mom and Dad” leave my clinic with feelings of joy, and ready to brave through the sea of uncertainty.
Early Pregnancy, a time of sheer joy & uncertainty
Dr. Ng Soon Pheng

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital- Puchong


Doktor Kongsi 12 Tips Meneran Masa Bersalin

December 28, 2018

Meneran adalah satu kemahiran yang perlu ada semasa proses kelahiran. Meneran dengan betul membantu mempercepatkan proses bersalin serta boleh mengelakkan pelbagai komplikasi kepada ibu dan bayi.

Mungkin ramai ibu yang tertanya-tanya cara meneran dengan betul bagi melicinkan proses kelahiran bayi. Ada yang keliru cara teran dan meneran pada muka menyebabkan rasa penat dan bayi tidak dapat dikeluarkan dengan efisien. Bayi yang hampir dikeluarkan pun boleh distress kerana terlalu lama di saluran peranakan.

Bagi ibu baru atau pertama kali melahirkan secara normal, ia mungkin agak sukar. Tambahan lagi setelah bergelut dengan kontraksi yang semakin kerap dan lama, ibu boleh jadi keliru! Oleh itu bimbingan & nasihat daripada perawat dan petugas perubatan perlu dipatuhi.

Dr Sharina Mohd Razali, Pakar Perbidanan & Sakit Puan, Columbia Asia Bukit Rimau berkongsi tentang
cara meneran bersalin yang betul. Katanya cara yang betul ialah seperti meneran ketika membuang air besar.

“Para ibu perlu menghindari teran pada muka kerana ia cara yang salah dan boleh menyebabkan anda berasa cepat penat. Ini adalah kesilapan yang sering kali terjadi terutamanya bagi ibu pertama kali yang tidak mempunyai pengalaman bersalin normal.”
12 TIPS CARA MENERAN SEMASA BERSALIN

Angkat kepala
sehingga dagu mencecah dada.

Mata memandang
ke arah perut.

Tangan
pegang pergelangan kaki.

Elakkan mengeluarkan suara
ketika meneran. Simpan tenaga untuk meneran

Jangan sesekali angkat punggung
 agar luka tidak melibatkan dubur.

Tarik nafas dengan dalam dan
teran seperti keadaan membuang air besar.

Pastikan anda
tidak mengeluarkan nafas dengan kuat.

Teran sekuat – kuatnya selama yang boleh (selama
10 saat sekiranya boleh).

Rehat dan relaks ketika tiada kontraksi
. Basahkan bibir dengan air dengan bantuan suami.

Curi nafas
 dan teruskan meneran di setiap kontraksi.

Dengar arahan
 jururawat dan doktor

Elakkan menjerit
– jerit supaya pembaziran tenaga dapat dielakkan.

POSTUR BADAN

Postur badan perlu dipastikan sesuai supaya memudahkan ibu untuk meneran. Caranya ialah dengan;

Berbaring dengan keadaan kedua belah kaki terbuka luas.

Kedua-dua kaki dilipatkan sedikit ke belakang.

Bahagian belakang akan ditinggikan bahagian sedikit.

Cuba pegang pada tumit atau meletakkan kaki pada penyokong besi yang disediakan.

BEREHAT UNTUK MENGELAKKAN PEMBAZIRAN TENAGA

Proses meneran memerlukan tenaga. Anda disarankan
berehat sebelum proses bersalin aktif
untuk mengelakkan pembaziran tenaga.
Berjalan-jalan di sekitar wad
 boleh dilakukan sekiranya ia bertujuan untuk menenangkan fikiran dan mengurangkan tumpuan kepada perasaan sakit.

Sesetengah pakar perbidanan juga berpendapat berjalan semasa proses awal bersalin boleh membantu mempercepatkan proses bersalin kerana tekanan kepala bayi pada serviks.
Kurma boleh dijadikan snek semasa dalam proses kelahiran.

AMBIL SNEK RINGAN BAGI MEMBERIKAN TENAGA

Anda dibolehkan mengambil snek ringan sebelum masuk ke dewan bersalin. Antara
snek yang boleh diambil ialah seperti roti, minuman berkhasiat dan buah-buahan seperti pisang. Makanan ringkas dan berkhasiat diambil dalam kuantiti yang kecil sebagai mengalas perut dan membekalkan tenaga untuk meneran.

Menurut Dr Sharina, kenyataan mengenai ibu yang ingin bersalin tidak dibenarkan adalah tidak benar sama sekali kecuali pada kes yang telah dijadualkan melahirkan menerusi pembedahan secara elektif. Manakala sepanjang masa di dewan bersalin, ibu diberikan air dalam kuantiti sedikit seakan-akan seperti membasahkan bibir dengan air untuk mengelakkan kehausan
ELAKKAN MENERAN TERLALU AWAL

Ibu perlu mengelakkan diri dari meneran terlalu awal iaitu sebelum bukaan serviks 10sm kerana ia boleh menyebabkan ibu berasa penat dan memberikan stres berlebihan kepada bayi. Meneran terlalu awal juga boleh menyebabkan serviks terkoyak.
PEKA ARAHAN PETUGAS PERUBATAN

Dengar dan sentiasa peka kepada arahan yang diberikan oleh doktor dan jururawat yang bertugas. Teran apabila disuruh dan tahan apabila tidak perlu teran. Hal ini penting kerana doktor atau jururawat hanya akan memberi arahan teran setelah memantau kontraksi menerusi bacaan CTG dan keadaan bayi.

AWAS! Menghembus nafas dengan kuat semasa meneran akan menyebabkan anda jadi cepat letih. Jika anda mempunyai masalah pernafasan seperti asma, beritahu doktor atau jururawat yang bertugas. Jangan lupa bawa ubat-ubatan seperti
metered dose inhalers.

Sumber:
Jangan Main-Main Ambil Selusuh, Sakit Kontraksi Boleh Jadi Berganda-Ganda, Bayi Pun Berisiko Lemas. Doktor Ini Jelaskan Kenapa
Dr. Sharina Binti Mohd Razali

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Bukit Rumau
Artikel ini disiarkan oleh Majalah Pa&Ma, 28 December 2018
Click for Online Article:

Doktor Kongsi 12 Tips Meneran Masa Bersalin - Majalah Pa&Ma, 28 December 2018


Doktor Terangkan 7 Risiko Kandungan Overdue

January 19, 2019

Jangan abaikan perihal berkaitan usia kandungan. Kandungan melepasi tarikh jangkaan bersalin atau overdue perlu diberikan perhatian ekstra & perlu dirujuk ke hospital segera. 7 Risikonya ini boleh menyebabkan impak besar kepada bayi & ibu.

Usia kandungan melepasi tarikh jangkaan bersalin memang mendebarkan para ibu. Tentunya kerisauan akan bermain di fikiran, memikirkan tentang diri dan tertanya-tanya bagaimana keadaan bayi, mudaratkah situasinya?

Dr Sharina Mohd Razali, Pakar Perbidanan & Sakit Puan Columbia Asia Bukit Rimau berkongsi info bahawa keadaan hamil
overdue
ini banyak berlaku.

Hanya kira-kira 5% sahaja ibu yang melahirkan tepat pada tarikh jangkaan. Tarikh jangkaan bersalin biasanya ditentukan oleh doktor atau jururawat 40 minggu daripada tarikh hari pertama haid ibu yang terakhir. Ada juga keadaan di mana tarikh jangkaan ditentukan berdasarkan ujian imbasan bagi kes ibu yang mempunyai kitaran haid tidak teratur.

"Sekiranya anda mencapai usia kehamilan 41 minggu, anda akan diarahkan untuk ke hospital oleh doktor yang merawat. Doktor akan menyemak semula tarikh haid yang terakhir dan melakukan pemeriksaan kedudukan bayi dan saiznya. Selain itu, bukaan serviks juga diperiksa untuk melihat sama ada ia sudah bersedia untuk proses kelahiran," kata Dr Sharina.
BAHAYA KANDUNGAN LEBIH TEMPOH / OVERDUE

Bagi kehamilan yang melepasi minggu 40, ibu dan bayi berisiko untuk berhadapan berhadapan dengan pelbagai masalah seperti berikut;

Bayi mati dalam kandungan.

Fetal distress
 di mana bayi menunjukkan reaksi seperti degupan jantung yang perlahan dan kurang pergerakan.

Meningkatkan risiko bayi untuk mengalami Sindrom Aspirasi Mekonium yang boleh menyebabkan bayi tertelan najis selepas minggu ke40.

Air ketuban yang berperanan untuk melindungi bayi semakin kurang isi padunya.

Ibu berisiko untuk mengalami trauma semasa proses kelahiran kerana kemungkinan bayi perlu dilahirkan menggunakan alat bantu seperti vakum atau forseps kerana saiz bayi yang besar.

Intraparum hypoxia
 di mana bayi mengalami kekurangan oksigen.

Risiko bahu bayi tersangkut semasa kelahiran atau
shoulder dystocia
. Ini disebabkan oleh saiz bayi besar.

KENAPA SERING MENGALAMI OVERDUE

Menurut Dr Sharina, kehamilan yang melepasi tempoh jangkaan bersalin atau overdue ini banyak terjadi kepada wanita hamil yang mempunyai ciri-ciri ini;

Ibu tidak pasti tarikh hari pertama haid terakhir sebelum hamil.

Kehamilan pertama.

Ibu mempunyai sejarah
overdue
 sebelum ini. Jadi tidak hairanlah jika seorang ibu mengalami beberapa kehamilan yang
overdue.

Hamil bayi lelaki.

Ibu mempunyai berat badan berlebihan.

Bayi mempunyai kecacatan secara biologi yang menyebabkan kekurangan hormon kortisol pada bayi yang melambatkan proses bersalin. Mereka juga berisiko untuk mengalami masalah kekurangan oksigen semasa kelahiran
(intrapartum hypoxia)
.

CADANGAN SEKIRANYA IBU MENGALAMI OVERDUE

Indius pada 41 minggu.

Membrane sweeping
daripada minggu ke 38 ke atas.

PERCEPATKAN KELAHIRAN

Selain daripada membuat ujian imbasan dan memeriksa bukaan, doktor juga akan melakukan prosedur membrane sweep yang bertujuan untuk mencetuskan kelahiran.

Ia selalunya dilakukan semasa pemeriksaan bukaan di mana jari akan dimasukkan pada serviks dan perlahan-lahan ia digerakkan dalam bentuk pusingan bagi memisahkan membran kantung bayi dengan rahim.
Membrane sweep
 jika dilakukan dengan betul akan merembeskan hormon prostaglandin yang mencetuskan kelahiran dalam masa 48 jam.

Selain
 membrane sweep
, berjalan kaki juga boleh mencetuskan kelahiran. Ia menggalakkan proses kelahiran bagi kandungan yang sudah mencapai usia 40 minggu. Ini kerana pergerakan membantu kepala bayi untuk memasuki pelvis.

Dr. Sharina Binti Mohd Razali

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Bukit Rumau

PDF and Online Articles:

Doktor Terangkan 7 Risiko Kandungan Overdue - Majalah Pa&Ma, 19 Januari 2019

Artikel ini disiarkan oleh Majalah Pa&Ma, 19 Januari 2019

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 Obstetrics & Gynecologist
 in Columbia Asia?

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Clues Us In On Down Syndrome

Clues Us In On Down Syndrome

November 10, 2021

One of the many concerns of mummies-to-be is the off-chance of having a Down syndrome baby. It’s an understandable fear that each mother has especially if it’s something that’s in an unknown territory for us.

So, Motherhood Story got in touch to chat with Dr Lee Kok Fung, a Consultant Paediatrician at Columbia Asia Hospital – Seremban, to help us understand better about Down syndrome in kids.

Q1. What is Down syndrome and what causes it?

Down syndrome is by far the most common and best-known chromosomal disorder in humans and the most common cause of intellectual disability. It is primarily caused by trisomy of chromosome 21.

Q2. What are the types of Down syndrome and the percentage that they occur?

There are three types of Down syndrome:

Trisomy 21

Trisomy 21 means there’s an extra copy of chromosome 21 in every cell. This is the most common form of Down syndrome (95%).

Mosaicism

Mosaicism occurs when a child is born with an extra chromosome in some but not all of their cells. People with mosaic Down syndrome tend to have fewer symptoms than those with trisomy (21.2%).

Translocation

In this type of Down syndrome, children have only an extra part of chromosome 21. There are 46 total chromosomes. However, one of them has an extra piece of chromosome 21 attached (3%).

Q3. How is prenatal screening or diagnosis done, and when should a pregnant mother do so?

Screening tests have no risks of miscarriage, but can’t determine with certainty whether a foetus is affected.

There are 3 types of screening tests for Down syndrome: the combined first trimester screening, the non-invasive prenatal testing (NIPT), and the second trimester maternal serum screening.

Combined First Trimester Screening

The combined first trimester screening test is done between 9 weeks and 13 weeks (plus 6 days) into the pregnancy to calculate the chance of a number of abnormalities, including Down syndrome. It is safe for both mother and baby.

A computer is used to combine results from 2 tests: A blood test, done between 9 and 12 weeks into the pregnancy, looks for hormonal changes that can suggest there is a problem with the baby’s chromosomes.

An ultrasound scan, done at 12 to 13 weeks into the pregnancy, measures the thickness of fluid behind the baby’s neck, called the nuchal translucency. This is often larger in babies with Down syndrome. These results, combined with the mother’s age, show the chance of Down syndrome.

Non-invasive Prenatal Test

It involves a simple blood test that analyses DNA from the baby that has passed into the mother’s bloodstream. The test is done after 10 weeks and is more than 99% accurate for Down syndrome.

Second Trimester Screening

Sometimes called a maternal serum screen (MSS) or ‘triple test’, it is done between 14 and 18 weeks into the pregnancy. It is usually offered to women who missed the combined first trimester screening test. It involves a blood test to look for hormones that could indicate the baby has Down syndrome or other diseases such as neural tube defect.

Diagnostic Tests

Diagnostic tests, on the other hand, are extremely accurate at identifying certain abnormalities in the foetus, but carry a small—generally less than 1 percent— risk of miscarriage.

Chorionic villus sampling (CVS)

A needle, guided by ultrasound, is inserted through the mother’s abdomen to take a sample of cells from the placenta. These are tested for missing, extra or abnormal chromosomes. The procedure is done between 11 and 14 weeks of pregnancy. It is not painful and takes about 20 minutes. The risk of miscarriage is less than 1 in 100.

Amniocentesis

A needle, guided by ultrasound, is inserted into the mother’s abdomen, to take a sample of amniotic fluid. This is tested for missing, extra or abnormal chromosomes. This procedure is done between 15 and 18 weeks of pregnancy. It is not painful and takes about 20 minutes. The risk of miscarriage is also less than 1 in 100.

Percutaneous umbilical blood sampling (PUBS, or cordocentesis)

Your doctor will take blood from the umbilical cord and examine it for chromosomal defects. It’s done after the 18th week of pregnancy. It has a higher risk of miscarriage, so it’s performed only if all other tests are uncertain.

Q4. What makes a woman high risk for a Down syndrome baby?

Occurrence is strongly dependent on maternal age. The incidence of this syndrome at various maternal ages is as follows:

15-29 years – 1 case in 1500 live births

30-34 years – 1 case in 800 live births

35-39 years – 1 case in 270 live births

40-44 years – 1 case in 100 live births

Older than 45 years – 1 case in 50 live births

Because of the higher rate of delivery among younger generation, we did see more Down syndrome in young couple.

Q5. How can one prevent Down syndrome during pregnancy?

There’s no way to prevent Down syndrome. If you’re at high risk of having a child with Down syndrome or you already have one child with Down syndrome, you may want to consult a genetic counsellor before becoming pregnant.

Q6. What are other health conditions or risks that are associated with Down syndrome?

Down syndrome is generally associated with increased risk of all health conditions, namely cardiovascular system, central nervous system, endocrine system, hematology system.

A higher risk in congenital heart disease

A higher risk in central nervous system: spine instability, higher chance of dementia in adulthood

Endocrine system: congenital hypothyroid, higher chance of diabetes and obesity in adulthood, obstructive sleep apnea

Hematology: easier to get infection such as ear infection, higher chance to have leukemia

Q7. How will these conditions be tested or detected for?

We will have a checklist to follow during follow up for a child with Down syndrome and will involve multiple discipline team to monitor, from general paediatrician (usually the coordinator), cardiologist, endocrinologist, speech therapist, occupational therapist, etc, according to the patient’s condition. If a red flag is encountered, then further investigation will be carry out.

A Down syndrome child requires life-long monitoring. Once a patient reaches 18 years old, the care will be transferred to the adult physician and family physician.

Q8. In what other ways does down syndrome affect a child’s life?

Heart defects. About half the children with Down syndrome are born with some type of congenital heart defect.

Gastrointestinal (GI) defect

Immune disorders

Sleep apnea

Obesity

Spinal problems

Leukemia

Dementia

Social: Down syndrome children are generally friendly and cheerful. However, the stigma from society may cause pressure to the child and family as well.

Q9. What is the average life expectancy in someone with Down syndrome?

The lifespan for people with Down syndrome has improved dramatically in recent decades. In 1960, a baby born with Down syndrome often didn’t see their 10th birthday. Today, life expectancy for people with Down syndrome has reached an average of 50 to 60 years.

Q10. Do babies with Down syndrome need extra care?

Yes, from prenatal, neonatal, infancy, toddler, childhood, teenager to adulthood, even. People with Down syndrome are living longer and richer lives now more than ever. Though they can often face a unique set of challenges, they can also overcome these obstacles and thrive.

Building a strong support network of experienced professionals and understanding family and friends is crucial for the success of people with Down syndrome and their families.

In Malaysia, there are multiple support groups and NGOs that provide support to the child and family.

Dr. Lee Kok Fung

Consultant Pediatrician

Columbia Asia Hospital – Seremban
MD (USM), MRCPCH (UK), M Pediatrics (UM)

Make an Appointment

PDF and Online Articles:

Dr. Lee Kok Fung Clues Us In On Down Syndrome – Motherhood.com.my, 5 November 2021

This article first appeared in Motherhood.com.my, 5 November 2021

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 in Columbia Asia?

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Drink Four Cups of Coffee A Day

Drink Four Cups of Coffee A Day

September 19, 2018

An expert shares whether we should actually take heed of this new-found claim.

In the first half of the year, researchers claimed that drinking three cups of coffee a day has some health benefits. A few months after, a study done by German researchers found that drinking four cups a day would not only help lower the risk of cardiovascular diseases, but also improve eyesight. Nurullatifah Fauzan, a dietician at Columbia Asia Hospital, Seremban, expounds on both these views.
Addressing the matter

Firstly, we need to look at the bigger picture, seeing as we are all unique and one size rarely fits all. Nurul cautions to “keep in mind that further research is still needed to evaluate the direct correlation (between coffee and its cardiovascular benefits). Also, several other factors such as the extra calories from syrup, sugar, and creamer consumed together with coffee can affect the overall health outcome.”
Healthy habits

A healthy way of consuming coffee is to make conscious decisions about the food you’re pairing it with. “As an example, if you’re having a pastry with your cup of coffee, try to reduce the amount of calories in the coffee by adding low-fat milk instead of regular milk. Pass on the whipped cream, and sweeten it with an artificial sweetener or granulated sugar rather than flavoured syrup. This way, you can keep track of the amount of sugar consumed,” Nurul advises. She also points out that according to a small study, consuming caffeine six hours prior to bedtime has disruptive effects on sleep.
Playing It Safe

“Caffeine in coffee has various degrees of effect on each individual depending on the tolerance, amount, and type of coffee consumed,” Nurul explains.
Nurullatifah Fauzan

Dietitian

Columbia Asia Hospital - Seremban
This article first appeared in Her World, Issue September 2018

Should You Ever Self-Diagnose - Her World, Issue September 2018


Drugs in Sports and Sports Injuries - Dr Harjeet Singh [BFM - Podcast]

January 31, 2012

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

What drives accomplished, talented athletes to take the illegal quick fix of steroids and other performance enhancers, and what are some of the potential long-term effects of usage on the body? Dr. Harjeet Singh, consultant orthopaedic surgeon, untangles the complicated web of drug use in sports, exploring the three main areas: therapeutic, recreational and ergogenic.

Listen to the podcast
here
.


Early Detection and Prompt Treatment

Early Detection and Prompt Treatment

October 16, 2018

BREAST cancer is one of the scariest and most frequently diagnosed cancers among women worldwide. Therefore, there is a need to spread awareness of how risk factors, regular screenings, early detection and prompt treatment come into play in the survival rates of breast cancer patients. Risk factors are factors that increase your chance of developing breast cancer.
Dr Kiran Kaur Amer Singh, consultant general surgeon with special interest in breast surgery
 at
Columbia Asia Hospital – Klang
, divides risk factors into two types: nonmodifiable and modifiable risk factors.
Non-modifiable risk
 factors are factors that cannot be changed, which include gender, family history of breast cancer and being a carrier of the BRCA1 and BRCA2 gene mutation. Hitting puberty early (below 12 years old) and menopause later in life (after 55 years old) increase one's risk of developing breast cancer as well. “Early menarche and late menopause cause prolonged lifetime exposure to endogenous ovarian hormones, that is, oestrogens.

The longer the exposure, the higher the breast cancer risk,” says Dr Kiran.
Modifiable risks
 come down to lifestyle choices such as sedentary habits, alcohol consumption, smoking and even long-term intake of exogenous hormones in the form of oral contraceptive pills or hormone replacement therapy after hitting menopause. Not bearing children, full-term pregnancy after the age of 30 as well as not breastfeeding increase the risk further. According to Dr Kiran, “Non-modifiable risks cannot be changed. However, risks may be lowered for some patients. For example, prophylactic mastectomy can be performed to lower breast cancer risks in BRCA gene mutation carriers. “In terms of modifiable risk factors, leading a healthy lifestyle, regular exercise and maintaining a healthy weight will not only reduce risks of breast cancer but also its recurrence in survivors. “Limiting the amount of alcohol consumed and cessation of smoking are also important.”

She shares that although family history of breast cancer is a significant risk factor, only 5% to 10% of breast cancer cases are inherited. The remaining 90% to 95% of cases are sporadic. This means that individuals who do not have a family member with breast cancer are not spared from the disease. Therefore, it is essential for women to participate in breast cancer screening programmes and undergo mammogram or ultrasound if recommended so that immediate action may be taken should they be diagnosed.

Dr Kiran adds, “Thanks to breast cancer research over the years, treatment has come a long way, significantly improving the survival rate and prognosis especially for patients with early-stage breast cancer. “There has been advancement in
surgical techniques
 as well as
adjuvant treatments
, which are now widely available. “We have moved towards breast conserving surgery (lumpectomy) and sentinel lymph node biopsies for suitable patients with early-stage breast cancer. “This means that it may no longer be necessary to remove the entire breast as lumpectomy can be offered with equally good outcome. The idea of surgery is to completely resect the tumour with negative margins, followed by appropriate adjuvant therapy.” Adjuvant therapy helps to reduce risk of recurrence after surgery. Types of adjuvant therapy available include chemotherapy, radiotherapy, hormonal therapy and targeted therapy. However, not all patients will benefit from these treatment modalities. Treatment offered is based on stage of disease, type and grade of tumour, patient’s general health condition, hormone receptor status and other factors.

Addressing the issue of patients seeking treatment only during the later stages of cancer, Dr Kiran believes that education and awareness are the best course to take to alleviate patients’ fears. “Fear of losing one’s breast is common. Therefore, patients should be made aware that if they undergo
mastectomy
 for breast cancer, there are options for creating a new breast. “
Breast reconstruction
 generally falls into two categories: implant-based reconstruction and flap (autologous) reconstruction using the patient’s own tissues. “In this region, the challenge that we face is beliefs. Many patients strongly believe in alternative medicine as the mainstay for cure of breast cancer, and that causes the delay in coming forward for treatment. “The problem of stigma is also common, which creates a significant barrier to medical care. Some don’t even tell their family members about the disease,” she explains.

She adds that other factors that may contribute to the reluctance in coming forward for
screening programmes
 and treatment are the potential cost and misconceptions surrounding breast cancer. “One common misconception is that the radiation of mammogram causes more harm than benefit. This is not true. Mammogram exposes patients to low-dose radiation and the benefit definitely outweighs the harm,” says Dr Kiran. It is only with the eradication of such beliefs that we can see an increase in early detection and survival rate of breast cancer.
Early detection saves lives
.

For more information, call 03-3346 7999.
Dr. Kiran Kaur D/O Amer Singh

Consultant General Surgeon

Columbia Asia Hospital – Klang
This article first appeared in The Star, 14 October 2018

Early Detection and Prompt Treatment – The Star, 14 October 2018


Eat Your Way To Fabulous Skin

Eat Your Way To Fabulous Skin

April 01, 2016

A healthy and wholesome diet can affect the appearance and condition of your skin. Dr. R. Muthulaksmi, Consultant Dermatologist of Columbia Asia Hospital shares that as a rule of thumb, you should maintain a balanced diet, drink sufficient water, exercise regularly and have enough sleep to keep you complexion bright and well nourished.

HER WORLD Magazine, Issue Apr 2016
.


Eating and Living Well for Healthy Bones

July 02, 2015

Photo credit:
www.bfm.my
Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

As we age, we worry about osteoporosis and breaking our bones that turn more brittle with time. Yet it turns out that osteoporosis has its roots in our childhood. Today we learn about ways to grow and develop healthy bones and joints with Dr Harjeet Singh, consultant orthopaedic surgeon.

Listen to the podcast
here
.


Eklampsia: Benarkah Ia Datang Secara Tiba-tiba

March 17, 2020

Eklampsia bukanlah hal biasa yang terjadi kepada ibu hamil. Satu hal yang perlu diketahui, elakkan penyebab-penyebab yang boleh mengakibatkan eklampia ini ketika hamil. Jangan terlepas pandang kerana ia boleh mengakibatkan kehilangan nyawa. Dr. Norintan Zainal Shah, Pakar Perunding Obstetriks & Ginekologi, Hospital Columbia Seremban berkongsi apakah itu eklampsia.

Eklampsia merupakan serangan sawan akibat tekanan darah tinggi ketika hamil. lanya amat serius kerana ibu boleh mengalami pelbagai masalah termasuklah kerosakan organ seperti otak, hati dan ginjal. Eklampsia juga menyebabkan pendarahan, koma, strok dan maut. Anak di dalam kandungan juga boleh mengalami masalah pramatang dan maut. Eklampsia boleh berlaku kepada sesiapa sahaja tanpa mengira usia, bangsa dan lokasi.

Elak Hipertensi

TMasalah eklampsia ini bermula dengan masalah tekanan darah tinggi atau hipertensi ketika hamil. Terdapat tiga kumpulan pesakit darah tinggi ketika mengandung ini iaitu hipertensi yang telah sedia ada sebelum hamil, masalah hipertensi yang bermula setelah hami (selepas kandungan berusia 20 minggu) dan pra-eklampsia. Penyakit hipertensi dalam ketiga-tiga kumpulan ini perlu dikawal dan diubati kerana jika tidak, eklampsia atau sawan, akan datang mendadak.

Di antara tiga kumpulan hipertensi di atas, kumpulan pra-eklampsia adalah yang paling bahaya kerana ia kerap diikut dengan sawan. Pelbagai kajian dijalankan untuk memahami mengapa pra-eklampsia boleh berlaku tetapi para doktor masih belum dapat menemui sebab yang nyata. Apa yang diketahui setakat ini adalah pra-eklampsia bermula dengan masalah dalam pembentukan dan perkembangan uri dari awal kandungan, diikuti dengan masalah radang dan kerosakan endothelium sepanjang kehamilan. Secara amnya, masalah pra-eklampsia dikatakan mula berlaku apabila bacaan tekanan darah ibu yang hamil tadi mencecah 140/90mmhg dan kehadiran protein dalam air kencing yang melebihi 0.3gram/24jam.

Namun, bacaan tekanan darah 140/90mmh tidak semestinya tepat untuk semua wanita. Apabila wanita hamil mendapati tekanan darah pada lawatan pertama di klinik antenatal adalah rendah (contohnya 90/60mmhg), mereka boleh juga mendapat masalah pra eklampsia jika bacaan diastolik (60mmhg) meningkat melebihi 15mmhg dan bacaan sistolik (90mmhg) meningkat sebanyak 30mmhg. Ini bererti, pra-eklampsia boleh berlaku apabila bacaan tekanan darah adalah 120/75mmhg!

Bagi kehadiran protein dalam air kencing pula, pemeriksaan air kencing di klinik antenatal selalunya menggunakan dip stick dan keputusannya ditulis sebagai negative trace, 1+, 2+, 3+ dan 4+ atau solid. Jika keputusan dip stick untuk air kencing didapati 2+ atau lebih, pesakit akan dimasukkan ke dalam wad obstetrik untuk rawatan pra-eklampsia.

Jika gagal mengenalpasti wanita-wanita hamil yang mengalami pra-eklampsia, maka wanita tersebut menghadapi risiko yang tinggi untuk mendapat sawan eklampsia. Jangkamasa pra-eklampsia menjadi eklamspsia adalah amat cepat! Malah, apabila serangan eklampsia berlaku, ianya merupakan satu situasi kecemasan yang amat mencabar dan sukar dirawati.

Golongan Berisiko

Kumpulan wanita hamil yang berisiko tinggi untuk mendapat pra eklampsia dan eklampsia perlulah berjaga-jaga. Antara kriteria mereka:

Usia belasan tahun/40 tahun ke atas.

Mengandung kali pertama.

Pernah mengalami pra-eklampsia/eklampsia dalam kandungan sebelumnya.

Mempunyai saudara, adik-beradik atau ibu yang pernah mengalami pra-eklampsia.

Mengalami obesity dengan BMI>30.

Wanita yang sudah pun mengalami hipertensi dan kencing manis sebelum hamil.

Wanita yang mengalami kandungan kembar atau molar (uri besar).

Simptom-simptom eklampsia perlu dikenal pasti. Jika ada yang mengalami simptom berikut, segeralah ke hospital serta merta untuk mendapatkan pemeriksaan tekanan darah dan air kencing. contohnya:

Sakit kepala

Pening

Kabur mata

Pandangan bercahaya/silau

Sakit tengkok

Loya atau muntah

Sakit ulu hati

Rasa kurang sihat

Walaubagaimanapun, ramai juga pesakit pra-eklampsia dan eklampsia yang tidak mempunyai apa-apa simptom atau gejala. Ini menyukarkan doktor untuk menghalang eklampsia menyerang pesakit secara tiba-tiba!

Jenis Rawatan

Bagi mereka yang berisiko terdapat pelbagai saranan, tip dan juga mitos untuk mengelakkan wanita hamil dari diserang eklampsia. Antaranya adalah:

Kalsium

Kajian menyarankan ibu yang beriso tinggi mengambil pil kalsium 1.5- 2.0gram setiap hari.

Aspirin

Low-dose aspirin 75mg juga didapati membantu untuk mengelakkan pra-eklampsia. Ada pendapat yang menyarankan low dose aspirin dimulakan ketika usia kandungan 12 minggu.

Ubat Tekanan Darah Tinggi

Semua ibu hamil yang mempunyai masalah darah tinggi hendaklah mengambil ubat secara berdisiplin. Ubat seperti methyldopa misalnya sudah lama digunakan dan selamat untuk ibu dan anak.

Magnesium Sulphate (MGS04)

Mgso4 adalah pilihan terbaik bagi masalah pra-eklampsia. la mengelakkan serangan sawan eklampsia. la juga digunakan untuk mengubati pesakit yang telah diserang sawan eklampsia.

Kelahiran Bayi

Dalam kes pra-eklampsia yang serius, bayi akan dilahirkan walaupun belum ada tanda-tanda ibu akan bersalin. Jika bayi belum matang, doktor akan menyarankan kelahiran bayi untuk menyelamatkan ibu.

Selepas Kelahiran

Penggunaan ubat diteruskan bagi mengawal masalah hipertensi. Jika pesakit gagal mengambil ubat, serangan sawan eklampsia boleh berlaku sewaktu tempoh pantang selepas bersalin.

Rehat Di Rumah

Cadangan rehat di rumah untuk mengelakkan pra-eklampsia belum terbukti lagi.

Mengurangkan Garam Dalam Diet

Ini adalah cara hidup sihat tetapi belum terbukti boleh mengelakkan pra-eklampsia.

Vitamin C, D dan E

Setakat ini, belum ada bukti kukuh yang menunjukkan vitamin-vitamin ini dapat mengelakkan masalah pra-eklampsia.

Kesimpulannya, jika anda hamil dan mempunyai masalah darah tinggi, pastikan puan mendapat rawatan segera. Jika terdapat protein dalam air kencing, pastikan ianya bukan pra eklampsia. Jika ada gejala atau simptom yang disebut di atas, awasilah bacaan tekanan darah. Sikap berjaga-jaga serta rawatan rapi dari hospital amatlah penting untuk mengelakkan eklampsia menyerang secara tiba-tiba.
Photo Credit: Freepik.com

Dr. Norintan Binti Zainal Shah

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital – Seremban
MBBCh BAO (Ireland), LRCP & SI (Ireland), MMed (Obs & Gyn) (USM)

Make an Appointment

PDF and Online Articles:

Eklampsia: Benarkah Ia Datang Secare Tiba-tiba? – Majalah Pa&Ma, 1 Mac 2020

Artikel ini disiarkan oleh Majalah Pa & Ma, 1 Mac 2020

Looking for
Obstetrics & Gynecology
 in Columbia Asia?

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Eksema Tiada Ubat Penyembuh Tapi Ada Cara Untuk Merawatnya

March 17, 2020

Ekzema adalah simptom keradangan dan kegatalan kulit. Ekzema yang paling biasa dihidapi oleh anak kecil atau orang dewasa dikategorikan dermatitis atopik (atopic dermatitis), atau ekzema atopik (atopic eczema). Dr Kartini Farah Rahim, Pakar Perunding Dermatologi, Avisena Women's & Children's Specialist Hospital menjelaskan secara terperinci tentang simptom dan cara rawatan yang betul bagi penyakit ekzema.

Biasanya bagi bayi ia bermula dengan mendapat bintik-bintik merah di pipi dan kadang kala berair. Bayi juga akan kelihatan tidak selesa dan menggeselkan mukanya. Ada juga bintik-bintik merah di kawasan kulit yang lain.

Ciri-ciri ekzema atopik ini adalah gatal dan bintik merah kecil. Jika digaru, ruam boleh menjadi kasar, berair dan tebal. Kebiasaannya ruam terdapat pada muka, kulit kepala, leher dan kawasan pelipat siku dan lutut bayi.

Risiko lebih tinggi jika ada sejarah alahan pada bayi atau keluarganya sama ada asma, resdung dan ekzema atopik.

Apakah Masalah Yang Boleh Boleh Dihadapi oleh Bayi Ekzema Atopik?

Kulit pedih apabila luka digaru dan susah tidur lena kerana gatal.

Kerap menangis dan murung kerana tidak selesa.

Kenapa Ekzema Atopik Terjadi?

Masalah gen yang diwarisi contohnya mutase gen filaggrin. Ini menyebabkan kurangnya daya tahan kulit untuk menghalang bahan uaran masuk ke dalam kulit dan kelembapan mudah meruap keluar menyebabkan kulit kering.

Sistem imun bayi yang tidak matang.

Masalah persekitaran

Ekzema tidak boleh berjangkit dan bukan disebabkan kurangnya kebersihan diri.

Bagaimana Boleh Menghindari Dari Ekzema Berlaku Semula?

Cari pencetusnya. Setiap bayi mempunyai pencetusnya yang unik yang boleh berbeza dengan bayi yang lain. Contoh penecetus adalah jangkitan bakteria, hama rumah, debunga, haiwan peliharaan, pemakanan, perubahan cuaca, stress dan asap rokok.

Contohnya:

Faktor hama habuk dalam rumah adalah salah satu sebab yang paling kerap mencetuskan eczema. Gunakan penyedut habuk yang mempunyai penapis HEPA, menukar cadar katil dengan kerap dan tidak menggunakan karpet dan alat mainan berbulu.

Hindarkan bayi dari terlalu panas dan berpeluh atau terlalu sejuk dan kering udaranya. Ikhtiarkan cara untuk mengurangkan stress bayi.

Dapatkan nasihat doktor dan pakar nutrisi jika ingin berpantang makan.

Makanan yang kebiasaannya menyebabkan tercetusnya eczema adalah susu lembu, telur, soya, gandum, kekacang dan makanan laut.

Berjumpa dengan doktor untuk mengetahui jika bayi memerlukan ujian alahan.

Kawal Bayi Dari Menggaru

Menggaru akan merosakkan permukaan kulit dan secara langsung memudahkan bahan alahan dan kuman masuk ke dalam kulit. Usahakan supaya kulitnya kurang gatal.

Tip Mengurangkan Gatal Ekzema:

Pakai pelembap yang sesuai dengan kerap dan guna pembersih yang bebas sabun.

Sibukkan bayi dengan aktiviti yang boleh mengalihkan perhatian.

Pakai pembalut atau sarung fabrik yang lembut dan elastik untuk melindungi kawasan kulit berekzema daripada tergaru dan mengekalkan kelembapan kulit, contohnya Tubifast.

Potong kuku jari pendek supaya tidak melukakan kulit jika tergaru.

Sapu ubat yang mengandungi mentol untuk mengurangkan kegatalan.

Memakai pakaian yang diperbuat daraipada kain kapas yang lembut, ringan dan menyerap peluh.

Lapkan peluh terutama di kawasan pelipat kerana peluh boleh menyebabkan kegatalan.

Apakah Rawatan Untuk Ekzema?

Ada pelbagai cara untuk merawat ekzema dengan baik, walaubagaimanapun ianya tiada ubat penyembuh. Masalah ekzema ini boleh berulang-ulang apabila ada pencetusnya. Berita baiknya adalah lebih 60% kanak-kanak akan pulih dengan sendiri ekzemanya apabila dia meningkat remaja.

Rawatan Ekzema:

Penyapuan pelembap adalah rawatan yang paling penting dalam mengawal masalah ekzema.

Krim atau minyak steroid dan calcineurin inhibitor adalah cara rawatan penting untuk mengawal keradangan dengan cepat dan berkesan.

Jika ekzema menjadi teruk seperti berair, bergelembung air, bengkak, bernanah dan berbau, sila bawa anak ke klinik pakar kulit untuk diperiksa kemungkinan memerlukan ubat antibiotik.

Pembalut fabrik elastik (wet wrap) (Lumur pelembap, sapu ointment, wet wrap. Tahan 4 jam.)

Kebaikan Wet Wrap

menyejukkan kulit

meninggikan kelembapan kulit

mengurangkan gatal

menghalang dari tergaru

Bagaimanakah Penggunaan Wet Wrap (Teknik Pembalut Basah)?

Gunakan pembalut yang ada di pasaran atau mana-mana stokin lembut dan selesa di pakai.

Langkah

Sapu pelembap dahulu

Sapu steroid lembut (jika perlu) dan tunggu beberapa minit

Balut lapisan basah

Balut lapsian kering

Pelembap Mana Sesuai Untuk Bayi Saya?

Pelembap yang sesuai dapat menghindari ekzema berulang semula. Oleh itu, sapuan pelembap mestilah menjadi satu rutin.

Ada pelbagai jenis pelembap di pasaran dan pemilihan pelembap bergantung kepada tahap kekeringan kulit, cuaca dan kesesuaian bayi dengan isi kandungan pelembap itu.

Secara amnya kulit ekzema adalah kering dan perlu pelembap yang berminyak dalam kuantiti yang banyak untuk meliputi seluruh kawasan berekzema. Sapuan pelembap perlu diulang dengan kerap apabila kulit menjadi kering semula.

Pilih jenis pelembap mengikut kesesuaian cuaca. Contohnya pelembap yang kurang berminyak berbentuk krim, sesuai digunakan di waktu panas. Sapu pelembap yang jenis berminyak waktu malam atau udara kering contohnya jika pasang penghawa dingin.

Produk yang tinggi kandungan minyaknya seperti 100% petroleum jelly melembapkan kulit dengan lebih lama dan sesuai digunakan untuk kulit yang sangat kering.

Kulit bayi boleh mendapat alahan kepada kandungan pewangi, pewarna dan pengawet oleh itu sebaiknya pilih pelembap yang khas untuk kulit bayi sensitif.

Dr. Kartini Farah Rahim

Consultant Dermatologist (Visiting)

Columbia Asia Hospital – Cheras
MBBCh BAO (Ireland), MRCP (UK), Diploma in Dermatology (Glasgow), Advance Master in Dermatology (UKM)

Make an Appointment

PDF and Online Articles:

Eksema Tiada Ubat Penyembuh Tapi Ada Cara Untuk Merawatnya - Majalah Pa&Ma, 1 Mac 2020

Artikel ini disiarkan oleh Majalah Pa&Ma, 1 Mac 2020

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Dermatology
 in Columbia Asia?

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Elak berusaha separuh jalan [Press Clipping]

November 12, 2012

See our Press Clipping:

Harian Metro,

12 November 2012


Empowering Man

Empowering Man

August 25, 2015

Even with the advanced state of healthcare today, some men suffer from all kinds of health issues, including sexual disorders.

Empowering Man – The Star - Your Health, 25 August 2015
.


An Endocrinologist Talks About the Thyroid Gland & The Butterfly Effect

May 12, 2023

You are sitting at your work desk, but you can hardly get any work done properly. You struggle to curb the trembling in your fingers.

Sweat trickles down your back. You wonder why it feels this warm despite the air-conditioning blowing at maximum speed.

You swear that you felt a missing beat from the normal pace of your heartbeat. It just feels like there was just something weird with your heartbeat.

Your friends have been complimenting you about how much weight you have lost, but you have a voracious appetite and you keep eating.

Your mercurial mood swings have kept them and other people around you at a distance.

With all these going on, you just could not help thinking, are all these closely related to your scanty and irregular menses? Or is it part and parcel of that smooth neck swelling at your neck and your protruding eyes?
You’re not going crazy—It could be your thyroid gland

If you had experienced any of the symptoms mentioned above, you may have a condition known as
hyperthyroidism
 or
thyrotoxicosis
.

This is a result of
high levels of thyroid hormone
, also known as thyroxine, circulating in your blood levels.

Sitting at the neck and resembling a butterfly, the thyroid gland secretes and stores thyroxine, the hormone that plays a vital role in maintaining your daily metabolism and other bodily functions.

Normally, the levels of the thyroxine hormone are kept in check by your body’s mechanism called homeostasis, with any alterations resulting in compensatory responses in your body.

When this mechanism fails, then the rising thyroxine hormone levels will eventually lead to the symptoms mentioned above.

The most common cause of hyperthyroidism is a ‘grave’ one

Graves’ disease
 is one of the most common causes of hyperthyroidism.

In this disease, the tyroxine stimulating hormone-receptor antibodies stimulate the thyroid gland to produce and release high levels of thyroxine into the blood levels.

People with Graves’ disease have
smooth neck swelling
 often accompanied by
protruding and swollen eyes
 as well as
skin problems
 such as hives.

This affliction often plagues
women within the reproductive age
, especially if they have other autoimmune diseases or family members with autoimmune thyroid diseases.

Toxic nodules

Another cause of hyperthyroidism is the presence of thyroid tissue that
independently and uncontrollably releases thyroid hormones
 into the blood stream.

Known as toxic nodules, this disease is more common in the
older population
, especially those with past history of iodine deficiency.

There can be just a single toxic nodule or multiple toxic nodules in the neck area, giving the appearance of an
uneven neck swelling
.

At times the neck swelling can be large enough to cause
difficulties in swallowing or breathing
.

Other possible causes of hyperthyroidism

Other rarer causes include acute infection of the thyroid gland or side effects of certain medications.

It is important to see a doctor when you think you have hyperthyroidism

If left untreated, chronically high levels of thyroid hormones may result in
irregular fast beating
 of the heart and subsequently
heart failure
.

This may also result in
excessive bone mineral loss
 that can give rise to
osteoporosis
.

Sometimes, patients with hyperthyroidism may develop a severe life-threatening condition known as a
thyroid storm
 if they are down with other acute medical condition such as a chest infection or heart attack.

A visit to the endocrinologist can be helpful if you think you may have hyperthyroidism, as sometimes the symptoms may be very vague in the early stages.

On top of a clinical assessment, a
blood test
 is necessary to evaluate the thyroid function and confirm high levels of thyroid hormone in the blood.

Aside from that, further tests such as antibody level testing, ultrasound of the neck, or even a radioactive iodine scan are required to determine the exact cause of hyperthyroidism.

The right management plan can vary according to the different causes of hyperthyroidism

For instance, patients with Graves’ disease may recover after 18 months of medical treatment. However, patients with toxic nodules usually require life-long medications to control their thyroid hormone levels. In such cases, other options such as surgery and radioactive iodine therapy can be considered.

Dr. Kang Waye Hann

Consultant Internal Medicine Physician & Endocrinologist

Columbia Asia Hospital - Puchong
MD (UNIMAS), MRCP (UK), Fellowship in Endocrinology (Malaysia)

Make an Appointment

PDF and Online Articles:

An Endocrinologist Talks About the Thyroid Gland & The Butterfly Effect – HealthToday, 12 May 2023

This article first appeared in HealthToday, 12 May 2023.

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 Internal Medicine
in Columbia Asia?

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