Understanding Tennis Elbow

Understanding Tennis Elbow

November 26, 2012

My elbow is killing me today! I often hear this from my patients and friends alike.

Most of them are weekend warriors and active at racquet sports. But it is not only them who complain, a fair share are non-sporting and a good number are homemakers.

Pain over the outer part of the elbow has been called several things. Most people call any pain in the region of the outer elbow Tennis Elbow. This is dangerous as not every painful condition over the outer part of the elbow is – Details of these other conditions at some other time.

Coming back to Tennis Elbow - Mind you, it doesn’t only happen in tennis players! The medical terminology is Lateral Epicondylitis and it is the most common of elbow injuries, typically occurring between the ages of 40 – 60 and affecting up to 3 percent of the population.
What is the Pathological Process?

Tennis elbow occurs when there is damage to the muscle and its tendon over the outer aspect of the elbow. The muscles, which run over the back of the forearm, are mainly attached to the outer part of the elbow. Theses muscles help to extend the wrist and fingers (movements which cause you to curl your wrists upwards and straighten your fingers)

Small tears (micro tears) form in the tendons and muscles, which control the movement of the forearm. These tears happen because the tendons do not stretch. Repeated stress strains the tendon causing it to fray in a similar way that a rope frays. This then causes a restriction of movement, inflammation and pain. As this area is prone to heal poorly with high chance of repeated injury, these micro tears eventually lead to the formation of scar tissue and calcium deposits. This tissue is of poor quality and is prone to further tearing, thus causing persistent pain and dysfunction.
What Causes Tennis Elbow?

The most common cause of tennis elbow is repeated injury due to over use. Any action which places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will tend to strain and overwork those muscles. Poor technique in sports increases strain on the involved muscles and will contribute to the condition, such as using ill-fitted equipment, like tennis racquets, golf clubs, work tools, etc. It is important to remember that these injuries don’t only occur in those involved in sports. Movements that predisposed to tennis elbow are:

Rotation of the elbow with a bent wrist such as using a screwdriver.

Gripping something strongly while rotating the wrist.

Hitting movements such as usage of a hammer.

Throwing movement that is not done smoothly (jerky).

There are also many other causes, like a direct injury - a bump or fall onto the elbow. Understand that poor levels of general fitness and conditioning will also contribute to the development of this condition
Signs and Symptoms

Pain is the most common and obvious symptom associated with tennis elbow. Pain is most often experienced on the outside of the upper forearm, but can also be experienced anywhere from the elbow joint to the wrist. Weakness, stiffness and a general restriction of movement are also quite common in sufferers of tennis elbow. Even tingling and numbness can be experienced.
Preventing Tennis Elbow.
WARM UP:
Thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the forearm area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.
STRETCHING:
Flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. Proper flexibility levels allow muscles to move and perform without being over stretched. Tight and stiff muscle on the other hand, may be pushed beyond their natural range of movement. This predisposes to injury.
STRENGTHENING:
Strengthening and conditioning the muscles of the forearm and wrist will also help to prevent tennis elbow.

Stretches for Prevention of Lateral Epicondylitis (Tennis Elbow) – These are to be done with controlled movements. The exercises should not be done if it brings about pain or causes more pain.

Lift your arms to about shoulder height and place your hands together in front of your chest, keeping your fingers together. Your fingers should be just under your chin. Lower your hands towards your waist and stop when you feel a mild stretch. Hold for 20 seconds and repeat 4 times.

Extend your arm out in front of you, palm down, and push your hand towards you with the other hand until you feel a stretch. Hold for 20 seconds.

Extend your arm out in front of you, palm up, and push your hand towards you with the other hand until you feel a stretch. Hold for 20 seconds.

Practice squeezing a tennis ball, holding the ball for a few seconds before releasing. Do this twice a day.

Place a rubber band around all of your fingers, including thumb, and practice opening your fingers against the rubber band. Do this twice a day.

Treating Tennis Elbow.

The occurrence of acute pain should bring about cessation of the initiating activity.

It is advisable to obtain a consult from an Orthopaedic Surgeon to obtain diagnosis. Not every painful episode over the lateral (outer aspect) of the elbow is due to tennis elbow.

The RICE protocol should be carried out for the first 24-48 hours. This involves R – Rest; I – Ice; C – Compression; E – Elevation. Usage of ice treatment should be done properly for best benefit (Use of Cold and Heat in Injury)

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. This begins with passive methods such as heat and ultrasound therapy and thereafter moves on to the preventive and rehabilitative phase once the pain control is good.

The ultimate aim of this phase is to regain and improve the strength, power, endurance and flexibility of the muscles and tendons that have been compromised.
Dr Harjeet Singh a/l Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital, Bukit Rimau


Usah Bergantung Susu Formula

Usah Bergantung Susu Formula

January 28, 2022

Mengandung buat kali pertama? Tahniah saya ucapkan. Sebagai seorang kaunselor laktasi, ingin saya berkongsi tentang kebaikan susu ibu. Ianya dapat menjalinkan ikatan yang mesra antara ibu dan bayi. Sentuhan yang dirasai antara ibu dan bayi ini mendatangkan perasaan kasih sayang, belas dan manja. Namun ramai juga ibu-ibu baru yang belum maklum sepenuhnya tentang kebaikan susu ibu atau mendengar maklumat yang tidak benar, lantas terlalu cepat membuat keputusan untuk memberi bayi mereka susu formula. Nanti dulu. Mari saya senaraikan antara perkara-perkara yang sering dikhuatiri seorang ibu tentang menyusu badan serta fakta yang harus dipertimbangkan.

Susu formula pun lebih kurang sama

Sama sekali tidak. Tahukah anda betapa kuatnya antibodi dalam susu ibu? Ia boleh melindungi bayi dari sebarang jangkitan kuman. Susu ibu juga dapat merangsang penglihatan dan menggalakkan pertubuhan yang sihat. Susu formula mungkin mengenyangkan tetapi khasiatnya berbeza jika dibandingkan dengan khasiat susu ibu. Tambahan lagi, menyusu badan bukan sahaja baik untuk bayi, malahan ibu juga dapat manfaat. Dengan menyusu badan, si ibu dapat mempercepatkan pengecutan rahim selepas bersalin, mengurangkan pendarahan dan membantu beliau untuk kembali ke bentuk badan sebelum mengandung.

Banyak belanja nak beli pam susu segala

Sebenarnya susu formulalah yang memerlukan perbelanjaan yang tinggi. Susu formula bayi bukan susu tepung biasa. Formulanya amat khusus untuk bayi yang baru lahir jadi sudah tentu harga pun bersesuaian. Itu belum lagi botol susu, berus, sabun, puting dan alat menyahkuman. Bila dijumlahkan setiap bulan, memang belanjanya agak tinggi. Susu ibu pula, selain sedia ada, bersih dan segar, ia dapat meringankan beban kewangan keluarga kerana tiada perbelanjaan diperlukan KECUALI pam untuk ibu menyusu yang bekerja.

Sakit belakang kerana asyik membongkok

Posisi penyusuan yang betul juga memainkan peranan dalam proses pengeluaran susu ibu. Posisi yang betul bukan sahaja membuat bayi selesa, malah ibu juga akan merasa selesa. Keselesaan ibu dan anak amat penting untuk pengalaman menyusu yang positif. Pegang bayi anda rapat dengan anda supaya badan bertemu badan. Pastikan kepala, leher dan badan bayi selari menghadap payudara ibu. Ampu kepala dan bahu bayi dengan lengan anda. Pastikan hidung bayi menghadap ke arah puting ibu supaya bayi dapat menghidu bau payu dara. Ini membuatkan bayi membuka mulut dengan lebih luas dan mula menyusu dengan lebih mudah.

Bagaimana untuk memastikan mulut bayi melekap dengan betul di puting ibu dan bayi minum dengan puas atau tidak? Pastikan mulut bayi terbuka luas, bibir bawah bayi melengkup keluar, dagu bayi menyentuh payudara ibu, serta sebahagian besar areola ibu berada di dalam mulut bayi dan harusnya kelihatan lebih banyak areola di bahagian atas (areola adalah kawasan yang berwarna gelap di sekeliling puting ).

Menyusu badan pun kena mengikut jadual

Bayi yang baru lahir tidak faham istilah ‘jadual’. Asalkan dia lapar, dia akan perlukan ibunya pada bila-bila masa. Ibu yang menyusu badan memang harus mengikut rentak bayi dan bukan sebaliknya. Satu lagi perkara; tiada had masa untuk setiap sesi penyusuan. Ketika menyusu, biarkan bayi menghisap sebelah payudara ibu dalam satu sesi penyusuan sahaja sehingga kenyang dan tertidur. Untuk ketahui jika bayi minum dengan betul dan puas, bayi akan kelihatan menelan dengan perlahan dengan hisapan yang mendalam dan kadangkala berhenti seketika. Ibu juga dapat melihat pipi bayi kembang-kembung ketika menyusu.

Susu mak tak banyak keluar, nak

Ini banyak dipengaruhi oleh makan dan minum si ibu. Pengambilan makanan buat ibu semasa tempoh penyusuan amatlah penting untuk penghasilan susu ibu yang optimum. Ibu perlu mengambil hidangan yang seimbang berpandukan piramid makanan. Ibu perlu memperbanyakkan pengambilan air sekurang-kurangnya lapan hingga 12 gelas sehari. Makan pelbagai jenis makanan yang kaya dengan protein, karbohidrat dan lemak supaya dapat menghasilkan susu yang berkhasiat untuk bayi. Tiada suplemen tambahan untuk memperbanyakkan pengeluaran susu ibu. Ibu perlu tahu bahawa teknik penyusuan yang betul boleh menggalakkan pengeluaran susu ibu yang lebih banyak.

Kalau dah sedawa maksudnya dah kenyang

Tepat sekali! Lagi satu tanda kenyang ialah bayi akan melepaskan sendiri payudara ibunya. Kelihatan mata bayi tenang dan otot muka bayi mengendur. Dapat dilihat juga ton otot bayi akan mengendur, genggaman tangannya dibuka dan tangan serta kakinya dalam keadaan rehat. Bayi tersenyum dan mengeluarkan bunyi kepuasan. Bayi juga akan kelihatan mengantuk dan ingin tidur.

Ibu yang memahami dan mendalami ilmu penyusuan susu ibu terutamanya dengan pakar laktasi ketika hamil, akan dapat menikmati betapa indahnya pengalaman menyusu susu ibu. Bukan sahaja ini amat baik untuk kesihatan ibu dan anak, ia juga merapatkan ikatan ibu dan anak. Dan akhir sekali, jangan lupa - untuk menggalakkan pengeluaran susu, ibu hendaklah sentiasa berfikiran positif!

Siti Shazzeela Shereen Md Isa

Lactation Counselor

Columbia Asia Hospital – Iskandar Puteri

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Usah Bergantung Susu Formula – Berita Harian, 22 Januari 2022

Artikel ini disiarkan oleh Berita Harian, 14 Januari 2022.

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Usah Meneran

Usah Meneran

January 07, 2019

Biarpun sembelit dan buasir bukan satu subjek yang selesa untuk diperkatakan, namun masalah itu sering membelenggu selain biasa 'menyerang' ibu hamil, lebih kerap daripada yang kita sangkakan. Masalah itu disebabkan perubahan hormon yang berlaku ketika hamil mendorong pergerakan usus yang agak perlahan hingga najis menjadi keras dan sukar membuangnya.

“Jangan pandang ringan jika berlaku sembelit, kesakitan dan pendarahan ketika proses membuang najis. Dapatkan segera bantuan daripada penyedia kesihatan terdekat untuk mengurangkan simptom dan merawat penyakit itu.”

Sembelit dan buasir sememangnya tidak dapat dipisahkan, malah sememangnya jika dibincangkan masalah pembuangan air, kedua-dua penyakit ini bersangkutan kerana sembelit yang keterlaluan mampu mengundang buasir.

Pakar Perbidanan dan Sakit Puan Hospital Columbia Asia Cheras Dr Norshida Brahim berkata, tindakan meneran ketika buang air besar boleh menyebabkan kerosakan kepada dinding dubur dan seterusnya mengakibatkan buasir. Menurutnya, penyakit itu tidak akan berlaku mendadak kerana prosesnya berlaku secara berperingkat. Tahap pertama barangkali hanya rasa gatal dan sakit, tetapi jika tidak dirawat ia akan mencapai tahap kronik hingga berlaku pendarahan ketika membuang najis. Tahap kedua katanya, usus besar menjadi luka dan usus terkeluar sedikit namun pada tahap ketiga saluran najis terkeluar tidak boleh dimasukkan semula selain kemungkinan trombosis (salur darah tersumbat) yang memerlukan prosedur pembedahan.
JANGAN abai masalah sembelit yang boleh mengakibatkan buasir.

"Buasir yang terkeluar dari dubur boleh menyebabkan sukar untuk duduk dalam posisi yang betul, andainya ia tersepit, bekalan darah ke saluran najis akan terhalang dan mencetuskan kesakitan berganda lalu ia memerlukan prosedur untuk menolak masuk semula ke dalam rektum.

"Ia bukan saja terjadi kepada wanita yang sedang berada pada peringkat akhir kehamilan, malah wanita selepas bersalin juga berpotensi untuk mengalami masalah sembelit dan buasir akibat tekanan yang dikenakan terhadap rektum," katanya.

Justeru katanya, ibu hamil perlu mendapatkan khidmat nasihat pakar sekiranya mengalami pendarahan ketika atau selepas membuang air besar. Doktor akan melakukan pemeriksaan dan diagnosis sama ada pendarahan berpunca daripada buasir atau penyakit serius lain sebelum memberi rawatan sepatutnya. Rawatan akan diberikan kepada pesakit buasir bagi menangani ketidakselesaan dan menghindari komplikasi lebih teruk.

“Ini penting kerana buasir mungkin membesar dan membahayakan ibu hamil jika dibiarkan tanpa rawatan. Buasir biasanya dirawat menerusi pengubahsuaian diet dan gaya hidup ibu hamil, pengambilan ubat-ubatan makan atau sapuan atau prosedur pembedahan.
PERBEZAAN usus besar sihat (kiri) dan mengalami buasir (kanan).

“Jangan pandang ringan jika berlaku sembelit, kesakitan dan pendarahan ketika proses membuang najis. Dapatkan segera bantuan daripada penyedia kesihatan terdekat untuk mengurangkan simptom dan merawat penyakit itu,” katanya.

Katanya, sembelit masih boleh menjadi masalah pada dua hingga tiga minggu selepas bersalin dan pada peringkat itu adalah penting untuk meminum air secukupnya serta memakan makanan berserat tinggi untuk memudahkan pembuangan air besar. Secara umumnya, pengambilan serat satu kaedah rawatan yang selamat, berkesan dan murah. Lebihkan pengambilan serat dalam pemakanan anda dengan makan buah-buahan, sayur-sayuran hijau dan bijirin bagi memastikan kelancaran proses pembuangan najis. Serat akan melembutkan dan meningkatkan saiz najis serta mengurangkan kebarangkalian pesakit meneran ketika membuang air besar. Keadaan ini seterusnya dapat mengurangkan tekanan pada dubur dan kejadian buasir dapat dielakkan.

Selain pengambilan makanan kaya serat, pengambilan air yang banyak, kurang pengambilan lemak, kerap bersenam, menjaga kebersihan dubur, kurangkan meneran dan sebagainya bagi mencegah dan merawat buasir. Buasir ketika mengandung sering bermula di peringkat akhir kandungan sehingga akhir waktu berpantang. Ada amalan berpantang yang menyarankan ibu untuk mengurangkan minum air dan mengelakkan memakan buah atau sayur-sayuran tertentu sekali gus mungkin akan mengakibatkan masalah buasir.

Oleh itu, mereka dinasihatkan untuk berhati-hati ketika berpantang dan mendapatkan nasihat dan rawatan doktor sekiranya mengalami sembelit atau simptom buasir ketika tempoh berpantang.

Dr. Norshida Brahim

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Cheras

PDF and Online Articles:

Usah Meneran – Harian Metro, 31 December 2018.

Artikel ini disiarkan oleh Harian Metro, 31 December 2018

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 Obstetrics & Gynecologist
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Vaccination For Kids

Vaccination For Kids

June 17, 2020

Photo credit: Freepik.com
An in-depth overview of vaccination, especially pneumococcal vaccination.

Vaccination for children is one of the most effective ways for parents to protect infants and children from potentially harmful diseases that can be serious and even deadly. Infants have natural immunity from their mothers in their earliest months. As that begins to wane, vaccines are given to take over and help keep babies from falling ill. In Malaysia, the vaccines are routinely offered to infants and children for free at the public health facilities. The Ministry of Health, Malaysia recommended schedule for vaccinations is as given in Figure 1.

Vaccines help protect children against diseases that their friends, playmates, classmates, and family members may introduce to them.

Figure 1
*
See table below for more information

Notes

Vaccines given at government health facilities:

Bacillus Calmette-Guerin (BCG), vaccine that gives protection against tuberculosis

DTaP is the combination of diphtheria(D), tetanus(T) and accelullar pertussis(aP)

DT is a booster dose which protects against diphtheria (D) and tetanus (T)

Hib is Haemophilus Influenza type B

MMR is the combination of Measles(M), Mumps(M) and Rubella(R)

MR vaccine provides protection against Measles (M) and Rubella (R). MR Dose 2 at 7 years old, until year 2022

JE is vaccine against Japanese Encephalitis. This vaccine is only provided in Sarawak

HPV is Human Papillomavirus. This vaccine is provided only for girls aged 13 years. Dose 2 is given 6 months after dose 1

VACCINATIONS MYTHS (
www.health.harvard.edu.my
)

MYTH

FACT

I'll catch the flu from the influenza

The injectable flu vaccine is not a live vaccine, so it cannot, in any way, transmit the flu virus.

The flu vaccine isn’t effective in older adults.

Each year, the flu vaccine formulation is based on predictions of which strains are most likely to circulate in the coming flu season. Other strains may enter the mix. But even if you catch a flu virus that wasn’t in the vaccination, the vaccine isn’t useless. It could make the infection less severe.

Vaccines contain mercury, which could make me sick.

According to the CDC, there is no evidence that the low doses of thimerosal, a mercury-containing preservative used in some vaccines, is harmful. If you’re still concerned, you can ask your doctor for a thimerosal-free flu vaccine.

Vaccines overload the immune system.

Considering that the immune system faces constant bombardment from microbes in the environment, the small amount of bacteria and viruses in one vaccination can barely be considered an assault. In fact, vaccines strengthen the immune system by arming it against infectious agents.

Older adults don’t need to be vaccinated.

The opposite is actually true. Among many older individuals, the immune system loses some of its ability to protect against infectious diseases even as they face an increasing number of chronic health conditions that can leave them more susceptible to infection.

IMMUNE SYSTEM

The body’s immune system helps protect against pathogens that cause infection. Most of the time, it’s an efficient system. It either keeps microorganisms out or tracks them down and gets rid of them.

However, some pathogens can overwhelm the immune system. When this happens, it can cause serious illness.

The pathogens most likely to cause problems are the ones the body doesn’t recognize. Vaccination is a way to “teach” the immune system how to recognize and eliminate an organism. That way, your body is prepared if you’re ever exposed.

Vaccinations are an important form of primary prevention. That means they can protect people from getting sick. Vaccinations have allowed us to control diseases that once threatened many lives, such as:

Measles

Polio

Tetanus

Whooping Cough

A healthy immune system defends against invaders. The immune system is composed of several types of cells. These cells defend against and remove harmful pathogens. However, they have to recognize that an invader is dangerous.

Vaccination teaches the body to recognize new diseases. It stimulates the body to make antibodies against antigens of pathogens. It also primes immune cells to remember the types of antigens that cause infection. That allows for a faster response to the disease in the future.

When the body responds to the vaccine, it builds an adaptive immune response. This helps equip the body to fight off an actual infection.

TYPES OF VACCINES

(US Department of Health & Human Services)
 There are several different types of vaccines. Each type is designed to teach your immune system how to fight off certain kinds of germs — and the serious diseases they cause. When scientists create vaccines, they consider:

How your immune system responds to the germ

Who needs to be vaccinated against the germ

The best technology or approach to create the vaccine

Based on a number of these factors, scientists decide which type of vaccine they will make.

There are 4 main types of vaccines:

Live-attenuated vaccines
 - use a weakened (attenuated) version of a virus or bacterium.

Inactivated vaccines
 - made from a virus or bacterium that is not living.

Subunit, recombinant, polysaccharide, and conjugate vaccines
 - take a structural component from a virus or bacterium that can train your immune system to attack this part of the germ.

Toxoid vaccines
 - come from a harmful chemical or toxin that is made by bacteria or viruses. Toxoid vaccines do not make you immune to the germ. Instead, they make you immune to the harmful effects from the toxin of a germ.

THE FUTURE OF VACCINES

Scientists are still working to create new types of vaccines. Here are two exciting examples:

DNA vaccines
 are easy and inexpensive to make - and they produce strong, long-term immunity.

Recombinant vector vaccines
 (platform-based vaccines) act like natural infection, so they're especially good at teaching the immune system how to fight germs.

InfoMed spoke with Dr. Tan Ru Wei, Consultant Pediatrician,
Columbia Asia Hospital - Klang
 on vaccination and specifically in relation to the pneumococcal vaccine for children. Also known as the pneumonia vaccine The pneumococcal vaccine protects against serious and potentially fatal pneumococcal infections.

Pneumococcal infections are caused by bacterium Streptococcus pneumoniae and can lead to pneumonia, septicaemia (a kind of blood poisoning) and meningitis. At their worst, the pneumococcal infections can cause permanent brain damage or even death.

Although the pneumococcal infection can affect anyone, babies, adults above 65 years old and children and adults with certain long-term health conditions, such as a serious heart or kidney condition are at higher risk of serious illness.

Are you looking for a vaccination program for your baby or kids ? Click here to find out more about our
pediatric services
 and
vaccination packages.

An Interview with Dr. Tan Ru Wei, Consultant Pediatrician - Klang

What’s the checklist of vaccines and the ages at which they should be ideally be given for kids?

Dr Tan Ru Wei:
 There is a National Vaccination Schedule published by the Ministry of Health, Malaysia. Majority of these vaccines will be completed by 18 months of age with some booster doses to be given at school going age. These include BCG; Hep B; 5-in-1 vaccine against Diphtheria, Tetanus, Pertussis, Polio, and Haemophilus Influenzae Type B; MMR that covers Measles, Mumps and Rubella. There are also some vaccines no included in the National Schedule but highly recommended, such as Pneumococcal vaccine, Rotavirus vaccine, Influenza vaccine, Meningococcal vaccine and Varicella vaccination. These vaccines are readily available in most private hospitals and GP clinics.

If you miss any of the vaccines at the recommended age, is it possible to catch up later in life?

Dr Tan Ru Wei:
 There are many reasons why vaccination needs to be postponed. The good news is other than Rotavirus vaccine that needs to be completed before 32 weeks of age, all other vaccines in the National Vaccination Schedule can be given later for catch up immunization. However, it is advisable to stick to the vaccination schedule as much as possible for optimal protection.

What is the primary reason for the vaccinations in the context of the present situation?

Dr Tan Ru Wei:
 Based on WHO estimation, globally 1 in 26 children die before the age of 5 in the year 2018. More than half of these deaths can be prevented or treated with simple, affordable interventions including vaccination, adequate nutrition, safe water and food, and appropriate care by a trained health care provider. The main purpose of vaccinations is to help our body build up immunity against some of the deadly childhood diseases.

Can you elaborate on the importance of pneumococcal vaccine (PCV) for babies?

Dr Tan Ru Wei:
 The bacteria pneumococcus can attack different parts of the body, leading to meningitis, pneumonia, bacteraemia, or otitis media. It can lead to brain damage, hearing loss and even death. It is recommended that infants receive at least three doses PCV within the 1st year of life, starting as young as six weeks of age to prevent pneumococcal diseases.

How does the pneumococcal vaccine work, and how do children respond to the vaccine?

Dr Tan Ru Wei
 PCV works by of the vaccine into the body to stimulate the normal immune system to produce antibodies that are directed against the bacterium. Children, in general, respond very well to the vaccine.

Can the PCV (vaccine) cause the disease they protect against?

Dr Tan Ru Wei:
 Short answer: No. Long answer: There are two types of pneumococcal vaccines. Pneumococcal conjugate vaccine (PCV) that is used for children, and pneumococcal polysaccharide vaccine (PPV) for adults. Both vaccines are inactivated or “killed” vaccine that does not contain any live organisms. They cannot cause the disease they protecta against.

SHOULD PCV be delayed or avoided completely for anymore and why?

Dr Tan Ru Wei:
 The only reason PCV should be avoided is when there is reported severe local reaction at the injection site from a previous does or reported a severe allergic reaction to a previous PCV does or one of the components of the vaccine. Vaccination can be postponed during an acute fever episode.

What are the side effects of the pneumococcal vaccine for kids?

Dr Tan Ru Wei:
Severe side effects are rare, common and short term side effects seen in children include soreness and redness on the injection spot and fever. Other possible side effects include reduced appetite, irritability, drowsiness.

The implications for not giving the PCV for kids?

Dr Tan Ru Wei:
Individually, children not vaccinated against pneumococcus are at higher risk of being infected by the bacteria. Whenthe pickup rate of a vaccine in a community, the incidence of the disease reduces significantly within the community. This will help those who are not able to receive the vaccine.

In the current situation of COVID-19 spreading, how or to what extent does the pneumococcal vaccine gives protection?

Dr Tan Ru Wei:
 To expect pneumococcal vaccine protect against COVID-19 is like taking antihypertensives to bring down the blood sugar. It just doesn’t work that way. The best way to prevent COVID-19 spread is to wash hands, avoid touching one’s face, wear mask and self-isolate if symptomatic, and cut down unnecessary travelling.

Please explain briefly on children’s flu vaccine?

Dr Tan Ru Wei:
 Flu vaccine is meant to protect the child against influenza viruses. There two major types of Influenza vaccine available. The Tetravalent vaccine that against 2 Influenza A virus and 2 Influenza B virus. The Trivalent vaccine which excludes 1 Influenza B virus. Everyone 6 months or older should get the flu vaccine. It is especially important for children from 6 months to 5 years old, or who have chronic underlying diseases such as asthma, heart conditions, HIV infection. Children who never received the vaccine before requiring a 2nd dose 4 to 6 weeks after the 1st dose. For continuing yearly protection, revaccination is required.

How does it work and does it help to build up the child’s immunity?

Dr Tan Ru Wei:
 Like PCV, Influenza vaccine uses inactivated viruses to induce an immune response to the antigens present on the virus. It is estimated to have an efficacy of 70 - 90%.

Once the flu vaccine is started, does it have to be given every year and why?

Dr Tan Ru Wei:
 Yearly vaccination is required because the flu virus changes constantly and rapidly. Every year WHO will review the flu vaccine formulation and update it to keep up with the changing flu viruses. Another reason is because our body’s immune response from vaccination declines over time, and yearly vaccination is needed for optimal protection.

How is the flu vaccine for children administered?

Dr Tan Ru Wei:
 There are two ways flu vaccination can be administered, either via injection or via nasal spray method. Recent studies show that nasal mist administration has a lower efficacy in flu prevention compared to a flu jab. Also, nasal spray uses a weakened form live virus as a vaccine, therefore is not suitable for immunocompromised patients. It is however a good alternative for parents and children who are anxious of getting a needle injection.

RECOMMENDED VACCINATIONS FOR KIDS:

Chickenpox (varicella) vaccine.

Diphtheria, tetanus, and pertussis vaccine (DTaP)

Hepatitis A vaccine (HepA)

Hepatitis B vaccine (HepB)

Hib vaccine.

Human papillomavirus (HPV) vaccine.

Influenza vaccine.

Measles, mumps, and rubella vaccine (MMR)

Dr. Tan Ru Wei

Consultant Pediatrician

Columbia Asia Hospital – Klang
MBBS (IMU), MRCPCH (UK), Pediatrics Bioethics (USA)

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PDF and Online Articles:

Vaccination For Kids - InfoMed Malaysia, Apr - Jun 2020

This article first appeared in InfoMed Malaysia, Apr - Jun 2020.

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Vaccinations Keep Your Child Safe

Vaccinations Keep Your Child Safe

February 10, 2023

Importance of vaccination for children

Diseases still persist today even if our healthcare system and hygiene standards have improved. While improved medical treatment and cleanliness standards decrease the development of diseases, they are insufficient to completely eradicate them. This is because the majority of infections spread through contact. The people who are most vulnerable to these diseases are our children.

When you are a new parent, the topic of childhood vaccinations or immunisations may seem overwhelming. The Child Development Centre (CDC), the American Academy of Pediatrics, and the American Academy of Family Physicians all propose vaccination schedules that cover around 13 different diseases.

Dr Margaret Kannimmel explains that by eradicating or significantly reducing harmful diseases that used to travel from child to child, vaccinations not only keep your child safe from devastating illnesses like polio, tetanus, and diphtheria but also keep other children safe.

A vaccination is a disease-causing bacterium that has been killed, rendered weak, or otherwise altered. When children are exposed to a disease in vaccine form, their immune system, which is the body’s germ-fighting machine, is able to build up antibodies that protect them.

Here is why vaccination is important for children:

Your baby is very vulnerable to infections

Protection offered through breast milk (maternal immunity) is not enough

Immunity through natural infection is risky. Children’s bodies cannot always fight off these diseases.

Your child can still catch a dangerous infection even though your child seems healthy and strong.

Childhood Immunisation is the most effective way to protect children.

Immunity will wane over time, so remember to get the boosters.

The Malaysian National Immunisation Programmed (NIP)

The National Immunisation Program (NIP) of Malaysia was initiated in the early 1950s. The Expanded Programme on Immunisation (EPI) of the World Health Organization (WHO) served as the model for our Malaysian NIP’s creation (EPI). The EPI urges all nations to immunise children against six illnesses. Our Malaysian National Immunisation Program (NIP), however, has increased protection against 13 important pediatric illnesses.
Diseases that the National Immunisation Programme (NIP) covers today:

Diphtheria

An infectious disease caused by bacteria that live in the mouth and throat of the infected person.

Haemophilus influenzaetype B (Hib)

A serious infection that mainly affects children under 5 years.

Hepatitis B

Infection of the liver by the Hepatitis B virus.

Human papillomavirus (HPV)

Most common sexually transmitted infection (STI) that causes cervical cancer which is the third most common cancer in women.

Japanese encephalitis (JE)

Infection of the brain caused by JE virus.

Measles

A highly contagious viral disease.

Mumps

A viral infection that is the most common cause of inflammation of the brain (encephalitis).

Pertussis – Whooping Cough

Highly contagious, with violent and persistent coughing that may cause a child to struggle to breathe and, turn blue (cyanosed).

Poliomyelitis (polio)

An infectious and incurable viral disease that attacks the nervous system.

Rubella

Also known as German measles that may cause abnormalities to the fetus.

Tetanus

Also known as lockjaw, caused by bacteria toxins that attacks the body’s nervous system.

Tuberculosis (TB)

A disease that commonly infects the lungs, but can also attack other parts such as the kidney, spine, skin, intestines and brain.

Pneumococcal

A bacterial infection caused by Streptococcus pneumoniae that can affect the lungs and other parts of the body.

Where can our children receive their vaccinations under the National Immunisation Programme (NIP)?

The National Immunisation Programme (NIP) vaccinations are provided free-of-charge at all government clinics across the country. They are also available at private clinics, where you may have to pay a small fee.

When does my child have to get these vaccines?

There is a National Immunisation Programme (NIP) schedule (see below). It is important to follow this schedule closely as doctors and other public health experts have worked hard to come up with the optimal vaccination schedule, affording the most complete and safest protection possible. It is not advisable to skip or delay vaccines, as this will leave the child vulnerable to disease.

Common childhood vaccines and their benefits

Because proof of immunisation is often a prerequisite for enrollment in school or day care, it’s important to keep your children up to date on their vaccines. The benefit of doing so is that your children will be protected from diseases that could cause them serious health problems. The recommended immunisations for children 0-6 years of age include:

Hepatitis B

Rotavirus

Diphtheria, tetanus, pertussis

Haemophilus influenzae type B

Pneumococcal

Poliovirus

Influenza

Measles, mumps, rubella

Varicella (chickenpox)

Hepatitis A

Meningococcal (for certain high-risk groups)

COVID-19

Additional recommended vaccines for children

There are currently 5 other vaccines that prevent diseases that can be deadly to children.

Chickenpox (varicella)

A highly contagious disease which causes fever and blistering skin.

Hepatitis A

Infection of the liver by the hepatitis A virus.

Influenza

A viral infection of the nose, throat and lungs.

Meningococcal disease

A bacterial infection of the lining of the brain and spinal cord that can lead to permanent disability.

Rotavirus

Causes vomiting and severe diarrhoea in babies.

Numerous of the immunisations described above offer protection against prevalent pediatric illnesses. Additionally, these advised vaccinations have the power to halt the spread of epidemics and disease. They are just as crucial to protecting your kids from diseases that can be prevented by vaccination as regular immunisations. Like the NIP, there is a recommended schedule for the best protection for our little ones. Your doctor will advise you on the appropriate timing of the vaccines.

Immunisation schedule

Risks and concerns surrounding vaccination?

Most people don’t have any serious side effects from vaccines. The most common side effects—like soreness where the shot was given—are usually mild and go away quickly on their own.

What are common side effects of vaccines?

The most common side effects after vaccination are mild. They include:

Pain, swelling, or redness where the shot was given

Mild fever

Chills

Feeling tired

Headache

Muscle and joint aches

Fainting can also happen after any medical procedure, including vaccinations.

Keep in mind that most common side effects are a sign that your body is starting to build immunity (protection) against a disease.

What about serious side effects?

Serious side effects from vaccines are extremely rare. For example, if 1 million doses of a vaccine are given, 1 to 2 people may have a severe allergic reaction.

Signs of a severe allergic reaction can include:

Difficulty breathing

Swelling of your face and throat

A fast heartbeat

A bad rash all over your body

Dizziness and weakness

Call your vaccination provider or your healthcare provider if you have any side effects that bother you or do not go away.

How to make an informed decision about vaccination for your child?

Vaccines protect against diseases

Different types of vaccines work in different ways to offer protection. With all types of vaccines, your body will remember how to fight that virus in the future. It typically takes a few weeks after vaccination for the body to build up that protection.

Strengthening your baby’s immune system

Immunity is the body’s way of preventing disease. Your baby’s immune system is not fully developed at birth which can put your baby at a greater risk for infection. Vaccines reduce your child’s risk of infection by working with the body’s natural defenses to help safely develop protection against disease.

Vaccine ingredients

Today’s vaccines use only the ingredients they need to be as safe and effective as possible.
All ingredients of vaccines play necessary roles
 either in making the vaccine, triggering the body to develop immunity, or in ensuring that the final product is safe and effective.

Some of these include:

Adjuvants
 help boost the body’s response to a vaccination. (Also found in antacids, antiperspirants, etc.)/li>

Stabilizers
 help keep a vaccine effective after it is manufactured. (Also found in foods such as Jell-O® and resides in the body naturally)

Formaldehyde
 is used to prevent contamination by bacteria during the vaccine manufacturing process. It resides in body naturally (more in body than vaccines). (Also found in environment, preservatives, and household products.)

Thimerosal
 is also used during the manufacturing process but is no longer an ingredient in any vaccine except multi-dose vials of the flu vaccine. Single dose vials of the flu vaccine are available as an alternative. No reputable scientific studies have found an association between thimerosal in vaccines and autism.

Dr. Margaret Kannimmel A/P Benson Fernando

Consultant Pediatrician

Columbia Asia Hospital - Setapak
MD (UKM), MRCP (UK)

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PDF and Online Articles:

Vaccinations Keep Your Child Safe – Baby Talk, 10 Feburary 2023

This article first appeared in Baby Talk, 10 Feburary 2023.

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Vaginal bleeding in early pregnancy

Vaginal bleeding in early pregnancy

March 02, 2011

This is one of the commoner presentations from my clinic besides the general antenatal workload.

The euphoria of early pregnancy (first trimester) is sometimes interrupted by symptom of vaginal bleeding. There is usually high anxiety level, which is only natural. This bleeding varies from brownish discharge to fresh red bleeding. This symptom can be associated with lower abdominal cramps. Most couple comes early for consultation. My assessment during this consultation is to attempt to ascertain the cause of vaginal bleeding and demonstrate pregnancy viability.

It is understandable that couple would want to know if ‘the pregnancy or fetus is alright’. However, there is no single clinical assessment, blood test or ultrasound feature that provides a reliable prediction of the pregnancy outcome following such event. The current treatment this condition remains empirical. Most doctors advocate bed rest and hormonal support, although the evidence is lacking.

On the contrary, it is not uncommon to find a cervical polyp as the source of vaginal bleeding. This condition can be treated with removal of the polyp to relieve the symptom. The pregnancy is usually left undisturbed.

Our clinical experience has shown that about half of the early pregnancies with complication of vaginal bleeding is associated with good prognosis. In these cases, the vaginal bleeding stop gradually over time and the pregnancy continues to term.
Early pregnancy vaginal bleeding is common and requires immediate medical attention

The joy of knowing that one is pregnant is often interrupted by feeling of bloatedness, poor appetite and nausea. Most women (50-90%) will have these symptoms during their early stage of pregnancy but gradually subside by the 14-16th weeks. Morning sickness, another name for this condition is coined due to the belief that these symptoms are commonly experience by pregnant mothers in the morning.

Hyperemesis gravidarum is associated with the rising pregnancy hormone (HCG, human chorionic gonadotrophin). Once the placenta is fully functional, the HCG hormone declines and hyperemesis improved. It does not affect the fetus but can be a challenging experience for most pregnant mothers. Besides the discomfort of nausea and bloated, medication is usually not necessary for most cases. Very rarely, severe hyperemesis is associated with liver (Wernicke’s encephalopathy) or kidneys (acute renal failure) complications. Looking at the bright side, hyperemesis indirectly indicates a healthy ongoing pregnancy. Only in a normal pregnancy, the HCG hormone will rise accordingly. On the contrary, women with missed abortion or failed pregnancy will not have a decline in the serum HCG level, which clinically manifest as regression of symptom.

I do not often prescribe anti-emetic drugs for my patients except if the hyperemesis is severe. I generally advise them to choose their food carefully, identify symptom triggers to avoid them, and take frequent but small snacks. There are also other alternative methods such as acupressure, acupuncture, taking ginger drinks and hypnosis but their effectiveness remains to be proven.
Embrace and welcome your pregnancy symptoms. They are challenging but mostly transient
Dr. Ng Soon Pheng

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital- Puchong


Vestibular Rehabilitation

Vestibular Rehabilitation

January 20, 2017

What is vestibular rehabilitation?

Vestibular rehabilitation is an exercise-based program, designed by a specialized physical therapist, to improve balance and reduce dizziness-related problems.
Who benefits from vestibular rehabilitation?

Patients who are typically referred for vestibular rehabilitation therapy are those diagnosed with dizziness, imbalance, vertigo, Meniere’s syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness and migraines. It can also benefit patients who have had a stroke or brain injury or whom are frequently fall.
How is dizziness defined?

Dizziness is defined as feelings of unsteadiness; wooziness (swimming feeling in head); lightheadedness; feelings of passing out; and sensations of moving, spinning, floating, swaying, tilting, or whirling (sensations known as vertigo).

These sensations can occur when standing still, lying down or when changing positions. The symptoms can last from seconds to minutes to days. For some people the symptoms are constant; others experience only short episodes of symptoms.
What causes dizziness?

Each year over 10 million patients visit a physician due to dizziness. It is the most common complaint among elderly patients but can occur in patients of any age.

Dizziness is generally not serious, but is often a sign of a mechanical problem. Dizziness can be due to an inner ear disorder, a side effect of medications, a sign of neck dysfunction, or it can be due to a more serious problem such as a brain or a heart problem.
Common symptoms that can be helped with vestibular rehabilitation include:

Dizziness or blurry vision with head movements

Neck tightness, stiffness and/or pain

Imbalance or the need to hold onto objects when walking

Headaches

Frequent falls

Generalized “dizziness, wooziness and foggy head” feelings

Vertigo/spinning

What type of recovery/outcome can I expect from vestibular rehabilitation?

Expected vestibular rehabilitation outcomes include:

Decreased fall risk

Decreased dizziness symptoms

Improved balance

Improved ability to stabilize vision/gaze

Increased body strength

Return to prior level of movement/function

Increase in confidence in ability to maintain balance

Improved neck motion, reduced symptoms

Vestibular Rehabilitation Therapy (VRT)

Vestibular rehabilitation therapy (VRT) is a form of physical therapy that uses specialized exercises that result in gaze and gait stabilization. Most VRT exercises involve head movement, and head movements are essential in stimulating and retraining the vestibular system. Vestibular rehabilitation therapy has been a highly effective modality for most adults and children with disorders of the vestibular or central balance system.

Do visit us for further clarification and for the treatment and exercises.

For appointment or any enquiries, please contact Columbia Asia Hospital - Seremban Physiotherapy Department at +606-603 3157.

References:

BSF Vestibular Rehab Exercises Journal

McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.

Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?

emedicine.medscape.com/article/883878

Meli A, Zimatore G, Badaracco C, De Angelis E, Tufarelli D. 2006. Vestibular rehabilitation and 6-month follow-up using objective and subjective measures


In Vitro Maturation (IVM) : A Cheaper And Safer Alternative To In Vitro Fertilization (IVF)

June 12, 2015

Since the birth of Louise Brown in 1978, in vitro fertilization (IVF) has advanced tremendously and has proven to be a very successful treatment for infertile couples. However, there are some drawbacks to this mode of treatment which may deter many women from treatment.

In vitro maturation (IVM) was first introduced by doctors in Denmark in the late 1990s. It is a revolutionary treatment technique developed to help couples with infertility problems which could potentially lead to cheaper and safer treatment compared to the conventional in vitro fertilization (IVF). To date there are about 400 babies who have been born worldwide using IVM compared with around two million by IVF.

Infertility involves 1 in every 7 couples after 1 to 2 years of trying to conceive. It can be due to male or female factor or a combination of both. Treatment differs and can be as simple as timed coitus or a more technological demanding process like the IVF.

The current IVF treatments use daily injections of medications to induce the development of multiple follicles in the ovaries in the hope of making the eggs mature faster within the follicles. Once the follicles are of appropriate size, the mature eggs within the follicles are harvested and then fertilised with sperm in the laboratory to create embryos.

IVM does not involve stimulation of ovaries by daily drugs injections. Only minimal medications are required. Therefore the eggs within the ovarian follicles are not mature. The immature eggs are harvested in a similar way to the IVF technique, and kept in the laboratory’s Petri dish for 24 to 48 hours until they are mature. Following maturity, the eggs are then fertilized by micro injecting sperm directly into them by a process called ICSI or intra cytoplasm sperm injection. Hence the eggs maturation happens in the laboratory rather than the ovaries. This is the basis of IVM treatment. Two or three days after fertilisation, the developing embryos are transferred to the mother’s womb. The treatment is also expected to be shorter than IVF.

In IVF, the ovaries are stimulated with medications such as gonadotrophins to increase the number of mature eggs. As result of this, there is high cost involved as the drugs are very expensive. The women require daily injection with the medications and frequent monitoring which can be a nuisance. There are potential side effect from the medications which can cause abdominal bloating, breast tenderness and mood swing. There is possible link to ovarian cancer which has not been quantified and may deter many women from having treatment.
Immature egg immediately after retrieval

Mature egg after 36 hours of culture

The most important well-recognised danger to the women undergoing IVF treatment is ovarian hyper stimulation syndrome (OHSS). The most severe form occurs in 1 % of women undergoing treatment especially those with polycystic ovary syndrome (PCOS). Those with ovarian hyper stimulation syndrome as results of daily injections with medications will produce too many eggs which may be associated with ovarian enlargement, abdominal distension, accumulation of fluid in the abdomen and blood in the body to be concentrated. These conditions if severe can be fatal. It is more likely to happen in young women with polycystic ovary syndrome (PCOS), a leading cause of infertility. Women with polycystic ovary syndrome (PCOS) are usually obese, have irregular menstrual cycle and infertile.

In IVM all the risks associated with IVF are being minimised. It is presently a useful procedure for two groups of women: those who are fertile, with normal cycles, who don't need stimulating hormones to help them to become pregnant, but who are undergoing IVF because their partners have impaired sperm, and for women with polycystic ovarian syndrome (PCOS) who are at an increased risk of developing ovarian hyper stimulation syndrome (OHSS) during IVF hormone treatment.

In IVF, one of the main factors affecting the success rate is the age of the women. This is likely to be the case in IVM. Generally women who are less than 35 years tend to respond better. The other important factor is the number of immature eggs collected. The more number of eggs collected, the more embryos are produced, and therefore the greater the choice of embryo selection for transfer. About 70% of the immature eggs retrieved will be successfully matured in the laboratory. But only 60% of the mature eggs, following fertilisation will develop into embryos.

The major disadvantage in IVM is its success rate which is only between 20 to 25%. This figure is very low compared to IVF which can be as high as 45%. However IVM is at the infant stage. When IVF started in the 1980s the success rate then was only 14%. Another major shortcoming with IVM is that the cultured mature eggs have hardened egg shells. As result of this, insemination can only be done by micro injection of sperm into the egg or ICSI. Finally the culture media use to nurture the eggs to maturity need to be improved. It is hope that by improving the culture media, the percentage of mature eggs per cycle of treatment would improve.

IVM is a potentially cheaper, shorter and a safer option of treatment for infertility. However, its usefulness is presently limited to only a few groups of patients. More research is needed to support its use. It’s now up to the scientists to explore this revolution in fertility treatment.
Summary:

IVF is more expensive than IVM. The cost of treatment ranges between RM15000 to RM18000 while IVM may cost only around RM5000 to RM8000 per treatment cycle.

All risks associated with IVF are less in IVM especially Ovarian Hyperstimulation Syndrome (OHSS).

IVM is a new technology and hence the success rate is low compared to IVF. More research is needed to support its use.

IVF will remain the mainstay of treatment for infertile couple while IVM may be suitable to certain groups.

Dr Suhaimi Hassan

Consultant Obstetrician, Gynaecologist and Fertility Specialist
Columbia Asia Hospital- Setapak


Waktu Hamil Jangan Hentam Makan Sampai Berat Naik Mendadak Boleh Kemurungan Lepas Bersalin

October 09, 2019

Masalah kenaikan berat badan yang berlebihan pastinya akan menyebabkan para wanita hamil ditegur oleh kakitangan klinik atau hospital. Pada waktu itu, kita akan mengimbas kembali, apakah yang kita makan semalam, atau sepanjang minggu itu? Kenaikan berat badan ketika hamil adalah sesuatu yang normal tetapi tidak boleh secara mendadak. Setiap ibu hamil boleh merujuk kepada carta berat badan yang ideal sepanjang mengandung. Ikuti penerangan lanjut tentang topik ini oleh Dr Norintan Zainal Shah, Pakar Obstetrik & Ginekologi dari Columbia Asia Hospital Seremban.

Sebelum kita semua panik, marilah kita lihat apakan kenaikan berat badan yang dianggap ‘normal’ ketika hamil. Kenaikan berat badan ketika hamil secara purata adalah 12 kilogram sepanjang kehamilan. Pun begitu, bagi wanita yang “underweight” iaitu BMI 18.5 atau kurang, anda boleh mengalami kenaikan berat badan sebanyak 20kg sepanjang kehamilan. Untuk wanita yang mengalami obesiti pula, (BMI lebih dari 30.0), anda hanya boleh naik berat badan sebanyak 5kg sepanjang kehamilan.

Naik Berat Badan Ikut Usia Kehamilan

Pada trimester pertama, keadaan ibu yang kurang selera atau mengalami loya menyebabkan kenaikan berat badan adalah minimum 1kg setiap bulan atau ada yang kehilangan berat badan.

Pada trimester kedua, berat badan akan naik 1kg setiap bulan. Jika berat badan tidak naik disebabkan masalah muntah yang berpanjangan, anda hendaklah berjumpa doktor untuk pemeriksaan lanjut (pastikan tiada masalah tiroid, masalah hati atau masalah usus/pankreas).

Pada trimester ketiga, berat badan selalunya naik 1.5 -2kg setiap bulan. Jika, berat badan naik lebih dari bacaan yang dinyatakan, pihak hospital atau klinik akan memastikan anda tidak mengalami masalah kencing manis, darah tinggi atau masalah pemakanan berlebihan.

Jika Berat Badan Naik Mendadak, Akan Dipantau

Ini bagi mengelakkan masalah seperti eklampsia, kematian ibu dan bayi (disebabkan oleh darah tinggi) atau masalah bayi yang obes, atau kematian bayi secara mengejut (disebabkan oleh masalah kencing manis sewaktu hamil). Biasanya doktor akan menasihatkan ibu supaya tidak makan berlebihan sehingga menyebabkan diri ibu dan bayi dalam kandungan menjadi obes.

Jika kita melahiran bayi yang mempunyai berat badan berlebihan, risiko yang kita alami adalah:

Proses kelahiran yang lama

Gagal untuk lahir secara normal dan perlu dibedah akhirnya

Penggunaan alat seperti vakum dan forsep bagi membantu kelahiran di mana bayi dan ibu boleh mengalami kecederaan.

Selepas kepala bayi keluar, bahu pula boleh tersangkut (shoulder dystocia) di mana otot, tulang dan urat saraf bayi boleh cedera dan kecederaan mungkin kekal! Otak bayi juga boleh mengalami kekurangan oksigen.

Setelah bayi dilahirkan, uri juga besar jika bayi puan besar. Dalam sesetengah kes, ia sukar dikeluarkan. Selepas uri keluar, rahim pula lambat mengecut dan boleh berlaku masalah tumpah darah.

Buat Rekod Kenaikan Berat Badan

Ibu mengandung seharusnya menyimpan rekod kenaikan badan. Dengan cara ini, anda akan peka dengan kenaikan berat badan. Beli mesin penimbang dan timbang berat badan dua kali sehari (waktu pagi dan malam sebelum tidur).

Campur berat badan anda pada hari itu dan bahagi dengan dua untuk mendapat purata berat badan. Simpan rekod berat badan selama seminggu dan kira puratanya.

Jika berat badan naik terlalu cepat ( lebih dari 0.5kg seminggu), makaa anda hendaklah menjaga pemakanan pada minggu seterusnya.

Masalah kenaikan berat badan yang berlebihan juga mempunyai kesan selepas bersalin. Di antaranya ialah masalah stres dan murung. Kesukaran untuk menyusu anak juga dikaitan dengan wanita yang obes selepas kelahiran bayi. Jika mengalami pembedahan caesarean, luka lambat baik, lebih mudah mengalami jangkitan dan lebih mudah dilanda masalah darah beku di kaki (deep vein thrombosis).

Kesimpulannya, jangan panik jika berat badan naik ketika hamil. Sebaliknya, simpanlah rekod berat badan anda sendiri. Jagalah pemakanan dan berjumpalah dengan pakar pemakanan jika perlu. Lakukan senaman setiap hari jika mampu. Ikutlah nasihat doktor kerana jika perlu, pemeriksaan untuk kencing manis dan darah tinggi akan dilakukan bagi memastikan keselamatan puan dan bayi dalam kandungan.

Dr. Norintan Binti Zainal Shah

Consultant Obstetrics & Gynecologist

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

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PDF and Online Articles:

Waktu Hamil Jangan Hentam Makan Sampai Berat Naik Mendadak Boleh Kemurungan Lepas Bersalin – Majalah Pa&Ma, 5 Oktober 2019

Ibu Hamil Akan Dipantau Jika Berat Naik Mendadak – Majalah Pa & Ma, Isu November 2019

Artikel ini disiarkan oleh Majalah Pa&Ma, 5 Oktober 2019

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Wanita Lebih Mudah Mendapat Penyakit Autoimun

February 25, 2020

Penyakit autoimun ini salah satu penyakit yang kurang diketahui umum dan masyarakat. Disebabkan itu ia kurang mendapat perhatian ramai. Namun begitu, kebiasaannya wanita lebih mudah mendapat penyakit autoimun jika dibandingkan dengan lelaki.

Pakar Perundingan Perubatan Hospital Columbia Asia Puchong, Dr. Muhammad Bin Shahruddin berkata secara umumnya penyakit autoimun ini adalah di mana badan manusia itu menghasilkan antibodi sendiri yang menyerang sel-sel badan atau organ manusia itu sendiri.

"Sepatutnya sistem keimunan dan antibodi kita ini adalah untuk menyerang penyakit seperti contohnya bakteria, fungus dan virus dari luar. Tetapi dalam kes penyakit autoimun ini, badan kita menghasilkan antibodi yang sama dan menyerang organ dalam diri sendiri. Ini kerana sistem imun badan tidak dapat membezakan sel atau tisu badan sendiri dan menganggapnya sebagai sel atau tisu asing"

Ada banyak jenis penyakit autoimun yang dikenalpasti setakat ini. Jumlah penyakit adalah lebih 80 jenis di dalam spektrum penyakit autoimun ini. Biasanya dalam sesuatu penyakit autoimun itu dari segi insidennya 80 hingga 90 peratus dihidapi oleh wanita.

Kenapa Wanita ?

Jelas Dr. Muhammad, kebiasaanya penyakit autoimun ini akan menyerang umur wanita yang sedang dalam jangka waktu subur.

"Contohnya di antara usia 15 hingga 45 tahun. Namun, ada juga kes yang melibatkan wanita berusia 45 tahun dan ke atas, tetapi ia jarang berlaku."

"Ia masih dalam kajian yang dilakukan oleh para saintis. Salah satu teori yang saintis terangkan adalah wanita ini sistem keimunannya lebih kuat sedikit daripada lelaki. Oleh itu dari segi jangkitan penyakit berjangkit, lelaki lebih senang mendapat kuman berbanding wanita."

"Mungkin juga disebabkan keimunan wanita itu lebih kuat daripada lelaki itu telah menyebabkan risiko mendapat penyakit autoimun lebih tinggi. Tetapi kebanyakan saintis mengatakan bahawa penyebab autoimun ini adalah kombinasi dari faktor genetik dan persekitaran."

"Selain daripada itu, penyakit autoimun itu juga berkait rapat dengan genetik. Sebagai contohnya jika ada ahli keluarga seperti ibu dan nenek menghidap penyakit autoimun, seorang wanita itu boleh mendapat penyakit yang sama."

"Bagi mengesan secara genetik, tidak ada ujian khusus yang boleh dilakukan. Secara asanya, bila doktor bertemu pesakit, dia akan bertanya sejarah penyakit yang menyerang keluarganya."

Genetik itu bukannya semestinya mendapat penyakit yang sama. Ia boleh menghidap penyakit dalam spektrum penyakit autoimun itu.

"Dalam penyakit autoimun ini, contohnya jika ibu menghidap penyakit tiroid, tidak bermakna anaknya akan mendapat penyakit tiroid. Ada kemungkinan jika ibu mendapat penyakit SLE, anaknya mungkin akan mendapat penyakit yang lain berkaitan dengan autoimun contohnya penyakit tiroid, psoriasis atau rheumatoid arthritis."

Jenis-Jenis Penyakit Autoimun Yang Menyerang Wanita

Apabila penyakit autoimun berlaku, antibodi ini akan menyerang organ tubuh badan yang tertentu.. Contoh-contoh adalah seperti berikut :

1-Sendi-sendi.

Sendi-sendi akan sakit dan membengkak. Contoh penyakit sendi ini adalah rheumatoid arthritis.

2-Systemic Lupus Erythematosus atau SLE

SLE ia boleh memberi kesan pada lebih dari satu organ dalam seluruh badan dan di antara jenis yang paling kerap di diagnosa. Ia akan menyerang sendi tetapi tidak seteruk rheumatoid arthritis. Ia juga boleh menyerang kulit sehinggakan kulit naik ruam-ruam, ruam-ruam pada muka, rambut gugur.

Paling teruk apabila SLE ini menyerang buah pinggang. Apabila buah pinggang telah diserang dan kita tidak dapat mengesannya terlebih awal, ia boleh menyebabkan kerosakan buah pinggang jika tidak dirawat.

SLE juga boleh menyebabkan serangan antibodi ke bahagian otak sekaligus menyebabkan radang otak.

3-Penyakit Tiroid

Penyakit tiroid lebih banyak menyerang wanita. Puncanya adalah antibodi menyerang organ tiroid. Dua jenis penyakit tiroid ini adalah Graves disease dan Hashimoto disease.

Graves disease berlaku apabila hormon tiroid berlebihan manakala Hashimoto disease berlaku apabila hormon tiroid terlalu rendah. Punca-punca berlaku adalah sama tetapi rawatan yang akan dilakukan adalah berbeza.

4-Penyakit Psoriasis

Penyakit psoriasis juga adalah penyakit autoimun. Ini berlaku apabila antibodi badan menyerang kulit sehinggakan kulit menggelupas. Cara untuk mengesahkan penyakit psoriasis ini adalah dengan mengambil sampel dan hantar ke makmal untuk diuji. Cara rawatan adalah untuk menurunkan sistem imum dengan rawatan tertentu oleh pakar kulit.

5-Immune thrombocytopenic purpura (ITP)

ITP ini adalah masalah darah. Apabla berlaku, antibodi menyerang platelet dan menyebabkan bacaan bilangan platelet menjadi rendah. Ia membuatkan seseorangan itu mudah lebam. Ia juga boleh menyebabkan pendarahan hidung dan pendarahan gusi.

Bahaya ITP ini pada ibu mengandung adalah jika bacaan platelet itu rendah, ia boleh menyebabkan pendarahan. Penyakit ITP ini biasanya dirawat oleh pakar hematologi (darah)

Selain dari penyakit yang disebut di atas, banyak lagi penyakit autoimun lain yang wujud. Contohnya
Celiac disease, Addison's disease, scleroderma, Myasthenia gravis dan Type 1 Diabetes mellitus.

Bagaimana Penyakit Autoimun Dikesan ?

Permulaanya, simptom-simptom tidak spesifik dan tidak jelas. Antaranya adalah seperti berikut :

1. Biasanya simptom-simpton itu akan bermula dengan rasa letih, lemah dan badan atau otot-otot rasa sakit.

2. Selepas itu kebiasaanya seseorang itu akan mula demam yang tidak tinggi (suhu badan 37.5 dan 37.8 Celsius). Tetapi demam ini agak lama dan berterusan lebih kurang seminggu hingga dua minggu.

3. Sendi-sendi juga akan rasa sakit dan bengkak. Sukar untuk bergerak sebaik bangun tidur pada waktu pagi.

4. Keguguran rambut yang berlebihan

Lakukan Pemeriksaan

Nasihat Dr Muhammad agar mereka yang menghidap simptom-simptom ini agar tidak menganggap simpton-simpton ini normal. Segeralah bertemu doctor bagi memeriksa apa sebenarnya yang berlaku pada tubuh anda.

Jelasnya lagi, sebaik bertemu doktor perubatan atau doktor pakar, pemeriksaan akan dilakukan. Antaranya :

- Doktor akan melihat simptom-simptom yang pesakit alami

- Doktor akan membuat pemeriksaan fizikal yang lengkap

- Doktor membuat ujian darah yang asas

Jika kemungkinan pesakit menghidap penyakit autoimun, doctor perubatan akan merujuk kepada doktor pakar yang berkaitan. Rawatan penyakit autoimun akan bergantung kepada gejala dan jenis penyakit tertentu.

Dr. Muhammad Bin Shahruddin

Consultant Internal Medicine Physician

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

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PDF and Online Articles:

Wanita Lebih Mudah Mendapat Penyakit Autoimun – Wanita Mingguan, 5 Februari 2020

Wanita Lebih Mudah Mendapat Penyakit Autoimun – Wanita Mingguan, 5 Februari 2020

Artikel ini disiarkan oleh Wanita Mingguan, 5 Februari 2020

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Wanita Obes Boleh Ke Hamil? Periksa Bacaan BMI Anda Sebelum Hamil

January 18, 2019

Berat badan memainkan peranan penting dalam kehamilan. Obesiti atau kegemukan akan mengundang pelbagai risiko yang tidak baik kepada diri dan kandungan. Dr Sharina Mohd Razali, Pakar Perbidanan & Sakit Puan Hospital Columbia Asia Bukit Rimau memberikan penerangan berkenaan perkara ini.

Wanita obes yang merancang untuk hamil boleh berjumpa pakar sakit puan atau
primary care physician
 untuk mendapatkan nasihat yang tepat berkenaan berat badan optimum dan cara hidup sihat yang perlu diamalkan. Kajian di Sweden mendapati penurunan berat badan sekurangnya 4.5kg boleh menurunkan risiko mendapat kencing manis semasa hamil sebanyak 40% pada kandungan yang seterusnya.
Bacaan BMI

Berat optimum yang perlu dicapai adalah BMI yang normal (BMI 18 – 24.9). BMI adalah berat dibahagi dengan ketinggian kuasa dua. BMI yang lebih daripada 25 adalah dalam kategori berat badan berlebihan dan BMI lebih daripada 30 ke atas adalah obes. Dalam pada itu, terdapat tiga kategori obesiti iaitu Kelas 1 (BMI 30-34.9), Kelas 2 (BMI 35-39.9) dan Kelas 3 atau
morbid obese
(BMI lebih 40).

Selain mencapai berat badan optimum dan mengikuti saranan pakar, wanita obes yang ingin hamil juga perlu melakukan beberapa perkara sebelum kehamilan agar kesihatan diri dan kandungan berada di tahap yang optimum.

Mengambil asid folik 5mg atau lebih setiap hari sekurang-kurangnya sebulan sebelum kehamilan dan diteruskan sehingga trimester pertama.

Mengambil Vitamin D sekurang-kurangnya 10mcg sehari sepanjang kehamilan dan diteruskan sehingga selepas kelahiran bayi dan sepanjang tempoh penyusuan susu ibu.

Menurunkan berat badan. Wanita disarankan menurunkan sekurang-kurangnya 5 – 7% dari berat asal untuk memastikan proses kehamilan yang sihat dan kurang berisiko.

Bahaya obesiti semasa hamil

Obesiti berbahaya kerana boleh mengundang pelbagai risiko buruk kepada si ibu dan bayi. Justeru ia perlu dicegah bagi mengelakkan berlakunya komplikasi.
Risiko kepada ibu

Keguguran secara berulang (
recurrent miscarriages
)

Diabetes semasa mengandung (
gestational diabetes
)

Praeklampsia iaitu tekanan darah tinggi semasa hamil yang merbahaya dan boleh mengakibatkan sawan, strok dan kegagalan organ-organ lain.

Venous thromboembolism
 iaitu darah beku pada salur darah yang boleh mengakibatkan kegagalan fungsi pernafasan dan membawa maut.

Kelahiran secara induksi.

Kelahiran secara pembedahan
caesarean
.

Komplikasi bius.

Jangkitan pada luka pembedahan
caesarean
 atau episiotomi.

Kesukaran memulakan penyusuan susu ibu.

Risiko kepada bayi

Stillbirth
tau bayi meninggal dalam kandungan.

Kecacatan kongenital seperti
spina bifida
dan jantung berlubang.

Kelahiran secara pramatang.

Macrosomia
iaitu bayi bersaiz besar.

Kematian neonatal.

Risiko bayi menjadi kanak-kanak obes dan mendapat penyakit metabolik.

Rintangan insulin

Kegemukan yang dialami oleh wanita bukan sahaja disebabkan oleh pengambilan diet yang tidak seimbang, malah ia juga disebabkan oleh ketidakseimbangan hormon seperti
Polycystic Ovary Syndrome
 (PCOS) yang menyebabkan rintangan terhadap insulin. Wanita hamil yang obes akibat faktor hormon ini perlu disaring dan dipantau bagi penyakit kencing manis semasa hamil
(gestational diabetes),
 praeklampsia dan perlu menjalani pemeriksaan antenatal dengan pakar sakit puan. Doktor yang memantau akan memberikan preskripsi metformin bagi mengurangkan risiko keguguran yang berulang
(recurrent miscarriage)
; iaitu salah satu komplikasi kehamilan bagi wanita berlebihan berat badan.
Saranan berat badan;
Kenaikan berat semasa hamil yang ideal

Berat badan di bawah paras ideal: 12.7kg – 18kg

Berat badan ideal: 11.3kg – 16kg

Berlebihan berat badan: 6.8kg – 11.3kg

Obes (semua kelas): 5kg – 9kg

Senaman

Mengawal berat badan semasa hamil dengan bersenam amat disarankan. Biarpun begitu, anda perlu memastikan senaman yang dilakukan haruslah jenis yang selamat. Bagi yang jarang melakukan senaman, anda boleh memulakan dengan senaman ringan seperti berjalan
(brisk walking).

Pada peringkat awal, senaman selama lima minit setiap hari sudah mencukupi tetapi haruslah konsisten dan dilakukan setiap hari. Tempoh senaman boleh ditambah lima minit lagi pada minggu yang berikutnya sehinggalah mencapai objektif untuk bersenam sekurang-kurangnya 30 minit sehari setiap hari.

Berenang juga merupakan contoh senaman yang baik untuk wanita mengandung kerana air boleh menampung berat badan wanita mengandung dan mengelakkan kecederaan pada otot dan sendi.
Tangani
emotional eater

Perasaan lapar menyebabkan kita perlu makan. Namun, ada kalanya kita akan makan kerana perasaan bosan, tertekan, merasa sunyi, rasa kosong daripada segi kerohanian, ketakutan malah juga kegembiraan!

Pada trimester ketiga kehamilan, emosi ibu bercampur baur dengan rasa tidak bersedia untuk bersalin, penat melayan kerenah anak yang lebih tua atau bimbang dengan apa yang bakal dihadapi dengan kelahiran bayi. Jadi, tidak hairanlah para ibu makan lebih sehingga menyebabkan berat badan jadi berlebihan.

Apabila makan melebihi jumlah yang sepatutnya dan berat badan naik mendadak, ibu akan mula risau dan akan mula beremosi. Ini seterusnya membuatkan para ibu makan dengan lebih lagi dan kitaran ini akan berterusan
(vicious cycle).
Bagi menghentikan masalah ini, ibu perlu mengenal pasti emosi manakah yang akan menyebabkan diri makan berlebihan.

Catat log makanan dengan menyenaraikan apa yang dimakan serta perasaan anda pada sebelum dan selepas makan.

Selepas seminggu kenal pasti emosi mana yang menyebabkan anda makan berlebihan dan catat .

Setelah mengenal pasti emosi tersebut (contohnya makan berlebihan apabila suami balik lambat) cuba atasinya dengan melakukan perkara-perkara yang boleh mengatasi emosi seperti bersenam, telefon ibu atau kawan untuk berbual, membuat Sudoku, membaca dan sebagainya.

Elak makan untuk dua orang

Wanita obes harus mengamalkan amalan pemakanan yang sihat dan seimbang. Jangan mengamalkan sikap ‘makan untuk dua orang’ kerana perlu mengehadkan kenaikan berat badan semasa mengandung. Keperluan tambahan pada trimester kedua dan ketiga hanyalah sebanyak 300 kalori (secawan susu rendah lemak dan sekeping sandwic!). Jadi para ibu haruslah makan mengikut keperluan kalori dan memastikan makan makanan sihat yang rendah lemak dan gula.

Kajian memang telah mendapati wanita obes yang mengandung akan melahirkan kanak-kanak yang obes juga. Saiz bayi yang besar semasa lahir berkait rapat dengan

kecenderungan mendapat penyakit metabolik pada usia kanak-kanak. Kajian yang dijalankan dalam kalangan kanak-kanak obes juga mendapati kebanyakannya mempunyai ibu yang obes. Jadi, penyakit ini bolehlah dikatakan penyakit keturunan yang akan diwariskan kepada generasi akan datang.

Dr. Sharina Binti Mohd Razali

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Bukit Rumau

PDF and Online Articles:

Wanita Obes Boleh Ke Hamil? Periksa Bacaan BMI Anda Sebelum Hamil - Majalah Pa&Ma, 18 Januari 2019

Artikel ini disiarkan oleh Majalah Pa&Ma, 18 Januari 2019

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Weekend Warriors

Weekend Warriors

April 25, 2012

Recreational athletes need to realise that more than anyone else, they need to take measures to prevent injuries from occurring.

AS we embark on our respective careers, sports and games, more often than not, take a backseat.

Eventually, we may start re-indulging in some sporting activity or other, albeit at an erratic pace and consistency.

This is when we turn into what is called the “weekend warrior”, a term referring to recreational athletes. However, the term recreational does not make us any less competitive than the younger athletes we play with or against.

Is this safe? The number of sporting injuries – both acute and overuse – are significantly skewed towards those who are recreational athletes. There are, however, ways not to add to these statistics and to continue enjoying your activities for the longest possible period.

First and foremost, we need to understand and accept the fact that our body is no longer as seemingly formidable as that of a teenager’s. Simple as it may seem, this is an essential fact to remember.

Secondly, understand that every facet of sports and games evolve with time. The trick is to get everything right from the outset:
Attire

Modern sport is flooded with state-of-the-art attire extolling better performance, often with absurd prices. The prudent action is to purchase attire that is comfortable and functional.

For example, runners should ideally wear breathable and lightweight attire, which allows cooling down of the body, particularly in humid weather. This need not be an expensive exercise.

Additionally, in any sport, it is best to invest in proper footwear – sport-specific is best. Having proper socks is equally imperative. Many a time, a lot of money is spent on the latest footwear, with scant attention to the socks worn with them – the difference is potential injury!

Additionally, be mindful that innerwear is as important as the outerwear.
Equipment

This is an elementary and crucial factor. The right equipment keeps you from harm’s way – those who play hockey without shin pads or a ball-guard will attest to this.

This is particularly pertinent in the older athlete who is less nimble in getting out of risky situations. The correct type of equipment, ie racquet, golf club or hockey stick will prevent both acute injuries and the more common injuries arising from overuse. This is particularly the case in recreational athletes.
Technique

Most weekend warriors think they have it all figured out. Whilst it is true that some of them might have been playing a particular sport for years, the techniques in most sports evolve as sports medicine brings about newer concepts in therapy and preventive strategies.

Even the playing surface has changed with the times.

Therefore, techniques have to be re-learnt. And when re-learning a particular technique, the trick is to break it down into small manageable steps and gradually moving on to the new technique as a whole. This is very effective in preventing injuries.
Intensity

Control the intensity of your exercise. Don’t try to keep up with the younger, more conditioned athlete. I promise you a visit to the clinic if you do this once too often.

This does not mean that the weekend warrior needs to just roll over and give in. It simply means that a prudent approach involving a more gradual increase in intensity and frequency can allow for a sport to be enjoyed for a longer period.

The idea is to enjoy the game and not injure yourself doing it.

Just to put a practical spin to this idea, in weightlifting, the oft-quoted protocol is increasing your load between 10-15% weekly. For the recreational athlete, it would be wise to keep this at 10% – you will ultimately get there too.
The play-rest cycle

Having a good play-rest cycle allows for adequate recovery. This is particularly effective in preventing overuse injuries, which occur during repeated activity of a body part, at non-maximal load. It is the frequency that causes the injury, and not the intensity of the load.

On the rest day, it is not necessary to stop exercising completely. However, it is advisable to carry out exercises that involve different muscle groups. This in turn introduces variety and fun in your activities.
Managing the day after sport

Particularly after a heavy session of sporting activities or exercise, the weekend warrior often complains of the body feeling sore the next day.

Soreness is a common consequence of sports and exercise. It is often said that one has to accept soreness as an inevitable part of exercising. It’s an indication that one has exercised well.

However, it is important to know that soreness after exercise usually eases off within 16-24 hours. If there is any soreness still felt thereafter, it means that you have potentially over-reached and over-exercised your current capabilities.

Here too, prevention is better than cure. Understand that the pre-exercise or pre-sport “warm up-stretching-game-warm-down” cycle allows for a gradual easing of the body into and out of exercise.

This prevents potential injury and eases recovery.

Furthermore, soreness can be negated by cryotherapy, post-exercise or post-sport. This can be via the use of custom-made icepacks, or simply, crushed ice placed in a plastic bag and wrapped in a moist towel.

Cryotherapy applications, two to three times for 20 minutes each time, every two hours, often helps in superficial joint injury in the shoulder, knee and ankle.

Stiffness felt on the morning after exercise is often relieved by the application of heat – often simply by a warm shower.
Know when to seek help

The weekend warrior, like other athletes, often understimates the severity of an injury. Signs that necessitate early medical attention include:

The inability to bear weight on the injured part.

Inability to move a joint through its whole range of motion comfortably.

Feeling of joint instability.

Severe swelling of the body part.

Persistent pain in spite of resting, particularly with use of pain medications.

Like any other sports participant, the recreational athlete aims to enjoy his/her sport, while at the same time, hoping to avoid injury. It is best to “listen” to the signs shown by one’s body.

For example, playing through pain is never a good idea. Stop-ping when tired is often a safe decision.

Heeding such simple rules allow for the enjoyment of a sport or activity, for as long as one wants.
Dr Harjeet Singh is a consultant orthopaedic surgeon. This article was contributed by Columbia Asia Hospitals, which are participating in the Star Health Fair today at the Mid Valley Exhibition Centre, Kuala Lumpur. They will be at booths A023, A024, A026 & A027 in Hall 1. The inaugural Star Health Fair 2012 is organised by The Star, with Great Eastern Life as the event’s partner. It will be held in Halls 1 to 3 of the exhibition centre from 10am to 7pm, and admission is free.

Dr. Harjeet Singh Puran Singh

Consultant Orthopedic Surgeon

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

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Weight Loss

Weight Loss

July 23, 2018

LOSING WEIGHT IS A MIND GAME.

CHANGE YOUR MIND CHANGE YOUR BODY.

When it comes to losing weight, we have been told time and time again to eat right and exercise regularly.

From following a healthy diet plan to working out regime, those who want to lose weight try every possible plan in order to get a fitter body. But often, we miss on some basic yet important things which might also affect our weight loss journey.

Our team of experts consists of certified personal trainers, fitness coaches, doctor and image consultant shares tips and advices to help us with the weight loss journey in improving the diet, streamlining the workouts and shedding weight the healthy way.

Topics being covered in this issues :

Tips For A Healthy Body Towards Body Wellness

Lean Meal Recipes for Weight Loss

All You Need To Know About Insulin Resistance

Back into Shape With Smoothies

Kurangkan Berat

Yoga Untuk Mengurangkan Berat Badan

Weight Loss Workout – Work Your Way Towards Your Ideal Weight With these Specific Moves

Planning a Successful Wellness Programme

Make A Difference e-Magazine – Issue 3, Weight Loss edition


Weight-Loss Readiness Assessment

Weight-Loss Readiness Assessment

August 01, 2014

A positive attitude and self-motivation can determine whether you will be successful on weight loss, weight gain or weight maintenance. Below are questions to assess if you are ready for weight loss program.

How would you describe your own body shape?

Underweight

Normal weight

Overweight

I am ready to cut down my carbohydrates intake to achieve weight lost

Yes

No

I am ready to cut down my weight as soon as possible

Yes

No

I know what is my appropriate weight lost goal

Yes

No

I am ready to increase my physical activities levels

Yes

No

I will give up if the weight not coming down after

1 month

3 months

6 months

never

I shall withhold my weight lost plan when stressful or vacation

Yes

No

I am ready to change my unhealthy eating habit for lifelong

Yes

No

I believe that weight loss can solve all my health problems

Yes

No


WFH: Avoid Posture Related Strain and Injury

November 30, 2021

The Covid-19 pandemic has profoundly changed our working life. In an effort to minimise physical contact among individuals and prevent transmission of infection, many companies have implemented work-from-home (WFH) policies as a way for businesses to continue to run without the need to go to the office.

Malaysia started implementing this around March last year and despite the recent exponential containment of Covid-19 cases, WFH is still very much in fashion.

For some employees, WFH is probably a first for them in their career.

Work-related musculoskeletal (MSK) injuries are injuries associated with workplace risk factors.

They include repetitive strain or overuse injuries. For example, lifting heavy items can cause neck and back pain.

For those who spend a great deal of time on computers (or laptops, tablets, video display units), work-related neck or back pain is a common problem.

There is no denying that the increased usage of these devices is our cultural adaptation to the convenience of new technology.

Getting It Right

The home environment is likely to be faulty in many aspects compared with the office. In particular, the absence of ergonomic office furniture at home may impede the adoption of a healthy posture and may promote the onset of MSK injuries like neck pain and back pain.

Working in a sedentary position for prolonged periods increases the risk of neck pain and/or low back pain. This is not surprising, considering that spine pain is one of the most frequent health problems in the working-age population worldwide.

A comfortable workplace at home may help in preventing MSK injuries. The average adult sits nine hours a day during work. Research has shown that adding bouts of standing works better for your back and neck.

Give yourself a break every 30 minutes. Walk around, make a cup of coffee, stretch your legs. Just get up and move.

If you are sitting all day, it is obvious that muscles will get weak and tight. Transitioning from sitting to standing while working may be helpful.

Slouching over your laptop or lying down while typing is also damaging to your neck and lower back. This is especially so when your 15-minute online meeting turns into an hour.

To avoid this, it is advisable to choose a chair which supports your back and is comfortable to sit on. If you are sitting too far forward, you are arching your back. Too far back and you are slouching.

The chair must be adjustable in height so that both feet are well-placed and supported on the ground. In the absence of a height-adjustable chair, the use of a footrest is advised. The use of non-ergonomic equipment may increase neck or back pain.

Do The Necessary

Adjustments to the computer monitor or computer screen may also be required. It must be at an appropriate eye level so as not to force a persistent head tilt.

Good lighting at your worktable is equally important. Position a steady table or floor lamp nearby if natural light is not easily accessible. Poor lighting will cause you to crane your neck and strain your eyes.

However, adapting to all these preventive measures may be easier said than done. Please remember that some cases of neck and low back pain may be a medical emergency.

If you experience any of these symptoms, please seek medical opinion immediately:

New weakness or tingling in the arms and legs

Numbness in the buttock area with a shooting pain down your thigh

Pain that wakes you up at night

Urinary or faecal incontinence

If you are working from home during this pandemic, try to make the best of the situation. It might not be the same as before, but human beings are good at adapting to changes.

Do some adjustments to your home environment to allow for a more conducive and comfortable workspace. Your body and mind will thank you for it.

Work-From-Home Ergonomics

Get The Right Chair

Invest in a good office chair with proper armrests. The chair should allow for ideal seating, enabling your feet to rest flat on the floor with your hips and knees at or slightly greater than a 90-degree angle.

If your feet aren't flat on the floor, use a footrest or a box or book to get the same effect.

Don't Stray

Avoid working on the couch or armchair in your living room even if it seems more comfortable.

If you have no other option, use pillows/cushions to provide back support and ensure you work in an upright position.

Adjust

An external monitor (one that is separate from your laptop) is more ideal for display. It should be placed about an arm's length away with the top of the monitor at or below eye level. Use a book or box to elevate the monitor, if needed.

Adjust blinds or curtains at your workstation to help reduce screen glare.

Increasing font size on your screen may decrease eye strain.

If using an external mouse, maintain a neutral (straight) wrist posture.

Photo credit: Freepik.com

Dr. Hazli Sufian Bin Sulaiman

Consultant Orthopedic Surgeon

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

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PDF and Online Articles:

WFH: Avoid posture related strain and injury - New Straits Times, 16 November 2021

This article first appeared in New Straits Times, 16 November 2021.

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What Are Gallstones?

What Are Gallstones?

February 28, 2016

Gallstones comprise cholesterol stones, pigment stones and ‘mixed stones’, which are stones comprising different ratios of pigment and cholesterol. Photo: Wikimedia Commons

The gallbladder is a pear-shaped organ intimately related to the liver and the digestive tract in form and function.

It serves as a reservoir of bile, which is a vital body fluid produced in the liver and flows through the bile ducts to the intestines.

As bile is continuously secreted, excess bile flows passively into the gallbladder. At variable intervals – usually when food is ingested – the gallbladder actively contracts to squirt its contents into the intestines through the bile ducts.

Gallstones are tricky customers. Certainly, not all gallstones are the same. Scientifically, they comprise cholesterol stones, pigment stones and “mixed stones”, which are really what they sound like, i.e. stones comprising different ratios of pigment and cholesterol.

Pure pigment stones are rare. Cholesterol stones, however, are very common. They make up the vast majority of gallstones and are responsible for the largest share of the problem.

As such, let me limit this discussion to these stones.

Cholesterol is essential to life. In the human body, it is produced in cells. Ingested cholesterol, from eating meat or animal products such as butter, cheese and lard, is also absorbed into the body.

Excess cholesterol is excreted in a complex manner, but mostly by the liver cells through bile.

Cholesterol is dissolved in bile and is further concentrated in the gallbladder by the absorption of water. The longer bile is retained in the gallbladder, the more concentrated it becomes.

The gallbladder empties itself under the influence of hormones such as cholecystokinin and secretin, which are released on the ingestion of foods.

Due to factors that are still not clear, for some people, the process of gallbladder contraction becomes inefficient over time. This leads to the stagnation of bile, which then becomes too viscid, leading to the formation of cholesterol particles.

Eventually, these particles coalesce to form stones. As such, it is the diseased gallbladder that gives rise to gallstones.

While this is true, there is no doubt that many underlying factors predispose to gallstone formation and conspire to provide the ideal environment for this phenomenon.

Obesity, a diet rich in animal products (which include not just meat and poultry, but dairy products and lard as well), hormonal changes in women as they approach menopause, crash diets and excessive vitamin supplementation, among others, have been implicated in the formation of gallstones.
Natural history of gallstones

Precipitation of cholesterol in bile will, in time, coalesce to form stones.

Stone size and number vary greatly – for the most part, they are between 0.5-2cm in size.

In some, these stones come to partially obstruct the outlet channel of the gallbladder, called the cystic duct. Attempts by the gallbladder to empty its content against this resistance triggers biliary colic, which are episodes of upper abdominal discomfort that often follow a meal.

Repeated episodes cause the gallbladder wall structure to thicken, pushing the stones up against the cystic duct. Stone impaction at this site is likely to cause severe, unrelenting pain.

The end result of gallstone formation will be chronic cholecystitis – the irreversible state of a diseased gallbladder that has lost the ability to perform its functions and becomes the source of chronic pain.

This process takes a variable amount of time. For many, this process is so slow, they remain pain-free throughout their natural lives. As such, it is entirely possible that one may have gallstones that never really cause any symptoms.

In fact, there is ample evidence to suggest that if one is diagnosed with gallstones and has no symptoms, it is much more likely than not they will remain asymptomatic for the rest of their lives.

For others, the disease process continues more quickly.

In a small number, about 2%, serious life-threatening complications arise.

Among these include acute cholecystitis, acute cholangitis and acute pancreatitis.

The association between gallstones and cancer of the gallbladder is controversial, in that while only a tiny number of patients with gallstones develop cancer, the vast majority of patients with gallbladder cancer have gallstones.
Treatment of gallstones

Gallstones that are found incidentally and cause no trouble, are best left alone.

Large studies have shown that fewer than 20% of these will ever give rise to symptoms. Serious complications are even less likely.

In certain groups of people however, one must be cautious, for example, those with chronic haemolytic anaemias like thalassaemia.

Medical treatment of gallstones has not proven to be very useful in the long term. There is evidence that ursodeoxycholic acid, a bile component found in both humans and bears, can promote dissolution of gallstones.

The treatment may well work, although it is costly and has been associated with long-term side effects.

Unfortunately, the gallstones often recur with cessation of treatment.

Anecdotal and online reports of treatments to expel gallstones, the gallbladder “flush” or “cleanse”, which aims to cause a strong contraction of the gallbladder to force out the stones through the bile ducts by oral ingestion of a large amount of fatty acids such as olive oil or apple sauce, are not supported by clinical evidence.

The treatment for troublesome gallstones is surgery. Surgical removal of the gallbladder (called a cholecystectomy) is curative.

This can be performed with either laparoscopy or a more traditional “open” incision, depending on the clinical circumstances.

This procedure has been carried out since the 18th century, when it was proven that the gallbladder was not essential for life.

However, the procedure should not be taken lightly.

Potential side effects exist for cholecystectomy and these are more likely when the operation is carried out hastily.

Nevertheless, for the person who suffers recurrent episodes of pain due to gallstones, surgery remains the most effective option for relief. It also protects the patient from life-threatening complications that may arise as a result of gallstones.
Complications of gallstones

These complications are rare, but when they occur, they can be serious and frightening.

Acute cholecystitis is a condition where the gallstones relentlessly obstruct the gallbladder, triggering an infection. The pain is continuous and made worse by fever.

Prompt surgery provides the best results in this situation, although it is technically challenging (as opposed to surgery in elective and less pressing circumstances).

The pancreas is a gland that is involved in the production of digestive enzymes. It is also closely related to the gallbladder and bile ducts.

Gallstones can migrate down the bile duct and obstruct the pancreas, leading to pancreatitis.

Pancreatitis is a painful condition that has an unpredictable course – although the majority of patients recover completely, serious complications have led to fatal outcomes in a few.

Early cholecystectomy is advised to prevent recurrence.

Gallstones can also obstruct the bile ducts, giving rise to jaundice. Jaundice is a yellow discolouration of the skin and the whites of the eyes.

It is a frightening symptom, especially if it occurs over a short time. Jaundice is frequently accompanied by intense itching and a deep darkening of the urine, which is often described as tea-coloured.

Treatment for this complication is less straightforward as it can be coupled with a dangerous infection. Laparoscopic bile duct clearance and cholecystectomy are an effective treatment where the expertise exists.

Clearing the bile duct using an endoscope, followed by surgical removal of the gallbladder later to prevent recurrence is another option.

Gallbladder cancer is a rare type of cancer, which is also associated with gallstones.

It is found incidentally in one percent of patients undergoing surgical removal of the gallbladder for gallstones.

The incidence may be even higher in persons known to be at higher risk. If removed while in the early stages, gallbladder cancer can be cured. At later stages, the disease is not treatable.

Gallstones are a frequent cause of discomfort and early treatment is very effective. The symptoms are upper abdominal discomfort and flatulence related to rich, fatty meals.

A healthy lifestyle can be preventive. When in doubt, consult a doctor. Prompt treatment can avoid needless complications.
Dr. Haritharan Thamutaram

Consultant General & Hepatobiliary Surgeon
Columbia Asia Hospital – Petaling Jaya
See our Press Clipping:

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The Star Online, 28 February 2016

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Vernacular National Paper Tamil Thanthi, 27 March 2016