What To Do if Someone Experiences Heatstroke

June 01, 2023

As parts of the world, including Malaysia and other parts of Southeast Asia, continue to experience extremely hot weather, it’s important to safeguard yourself against the dangerous and potentially life-threatening condition known as heatstroke.

There are two types of heatstroke: classic and exertional. Classic heatstroke typically affects those who aren’t physically active, and is usually caused by exposure to hot and humid conditions.

In contrast, exertional heatstroke typically affects athletes or individuals who perform physical activities in hot environments. It occurs when the body generates heat faster than it can dissipate, leading to an increase in core body temperature.

The older adult population and adults with comorbidities make up the highest proportion of fatalities. This is because as people age, their bodies become less able to regulate temperature and adapt to heat stress.

Additionally, older adults may have chronic medical conditions or take medications that can interfere with their body’s ability to regulate temperature, making them more susceptible to heatstroke.

Infants and younger children are also at risk, especially of classic heatstroke. This is because their bodies have a higher ratio of surface area to mass, which means they absorb heat more quickly.

Their thermoregulatory system is also not fully developed, which makes it harder for them to release heat effectively.

Additionally, they have a smaller blood volume in comparison with their body size, which limits their ability to conduct heat and leads to a buildup of heat in their bodies.

Lastly, they have a lower perspiration rate, which makes it harder for them to cool down through sweat evaporation.

Emergency measures

When dealing with someone who has heatstroke symptoms, swift action is necessary to prevent further harm.

Here are some steps that can be taken:

Transfer the person to a cooler area – if possible, a place with shade or air conditioning.

Help the person remove any excess clothing that could trap heat.

Decrease their body temperature by using a fan; applying a cool cloth or ice pack to their neck, forehead, armpits, and groin; or spraying them with cool water.

Hydrate the person by giving them water or other fluids to drink, but avoid beverages that contain alcohol or caffeine as these can dehydrate the body.

If the individual’s symptoms do not improve or they become unconscious, seek emergency medical assistance immediately.

Recovery

Recovery from heatstroke depends on the severity of the condition and the timeliness of treatment. Mild cases can often be treated effectively with rest and rehydration, and individuals usually recover fully without any long-term effects.

However, more severe cases can lead to permanent organ damage, in which case the recovery process may take longer. In some instances, rehabilitation may be necessary to help individuals regain lost physical or cognitive abilities.

Additionally, those who have experienced heatstroke are at an increased risk of developing it again in the future. As such, it is important to follow your doctor’s instructions for recovery and prevention.

With proper treatment and care, most individuals can fully resume normal activity. However, it is essential to avoid heatstroke recurrence by keeping hydrated, avoiding prolonged exposure to hot environments, and taking breaks from physical activities during hot weather.

Dr. Syed Farid Almufazal Bin Syed Salim

Consultant Emergency Physician & Head of Emergency Department

Columbia Asia Hospital - Seremban
MBBS (UK), MMed (Emergency Medicine) (UKM)

PDF and Online Articles:

What To Do if Someone Experiences Heatstroke – Free Malaysia Today, 10 May 2023

This article first appeared in Free Malaysia Today, 10 May 2023.

Think you or someone else may be experiencing heatstroke?

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What to Do When You Can't Find Flu Vaccine

February 03, 2020

The influenza vaccine is updated yearly, in August and September. This is comforting to know, as Columbia Asia Hospital – Setapak Consultant Internal Medicine Physician and Neurologist, Dr. Tan Wee Yong, affirms that the best way to avoid contracting influenza is to get the vaccine yearly.

However, currently it has been a challenge to keep up with vaccine requests from the public in light of the increasing number of influenza cases in the country. So, what does one do in the meantime? “You can boost your own immune system by drinking lots of water, and eating more fruits and vegetables,” says Dr Tan, “But the most important and obvious thing to do is to strengthen your personal hygiene habits.”

It may seem like furious OCD behavior but this is a time when the cliché “better be safe than sorry” can be stressed upon with conviction. “Wash basins are not available everywhere but you still have to have clean hands all the time if that is possible. So apart from applying the handwashing technique of scrubbing your palms, back of your palms, interlacing your fingers, scrubbing them clean — make it a habit of carrying a small bottle of hand sanitizer wherever you go and use it frequently,” advises Dr Tan. He also calls for members of the public to start wearing a proper mask. “Imagine you are on board a train crammed with other passengers. You need to be aware of the risk you are taking every time you inhale in that environment.”

How Contagious is Influenza?

Influenza is a highly contagious disease transmitted by air droplets by people who talk, sneeze and cough. Did you know that an infected person can spread it to another person who is standing six feet away? That’s how easily this current situation can get out of hand.

Taking precautions goes both ways. As much as you don’t want to contract influenza from others, others do not want to contract it from you either. Regardless of whether one carries the influenza virus or not, if you need to cough or sneeze, there are ethics to be adhered to such as covering your mouth and turning your head away from people.

“Some people believe in air purifiers to keep influenza at bay, but there has not been much evidence of their efficacy. The disease is spread by droplet from a person to a person, even in clean air surroundings,” says Dr Tan.

In some people, the risk of infection is much higher. Because of their low immunity than the average person, children under five and adults above 65 as well as pregnant women and those with chronic diseases may get a more serious infection. “Those in the high-risk group may take a longer time to recover compared to others. They may also get a secondary infection which will require additional treatment including oxygen support and antibiotics,” says Dr Tan.

Dr. Tan Wee Yong

Consultant Internal Medicine Physician and Neurologist (Visiting)

Columbia Asia Hospital – Setapak
MD (UKM), RCP (UK), MMed (Internal Medicine) (Singapore), Fellowship in Neurology (Malaysia) (Australia), CMIA (NIOSH)

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PDF and Online Articles:

What to do When You Can't Find Flu Vaccine – Her Inspirasi, 23 January 2020

This article first appeared in Her Inspirasi, 23 January 2020

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 Neurology
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What Does Your Period Blood Colour Mean?

October 08, 2019

There are a variety of factors that affect the color of menstrual blood, including hormonal activity, the age of the blood, and infection. Your period may be used as a vital health sign. Anything from the length of your cycle to the textures and colors you see may indicate something important about your health.

You may see colors of blood ranging from black to bright red, brown to orange.

Although most colors can be considered “normal” or “healthy,” others may be a reason to see your doctor.
Black

This color is related to brown blood, which is old blood. Black blood is usually blood that’s taking some extra time to leave the uterus.
Brown

Is typically a sign of old blood. The blood has had time to oxidize, which is why it’s changed hues from the standard red.

When your flow is slow, the blood may take longer to exit your body. When blood stays in the uterus longer, it may become brown in color. The blood may also be leftover from your last period.
Dark Red

The deep color may simply mean that the blood has been sitting in the uterus for a while but hasn’t oxidized to the point of turning brown.

You may also see this color blood toward the end of your normal menstrual period as your flow slows.
Bright Red

Your period may start with bright red bleeding. This means that the blood is fresh and is flowing quickly. Your blood may stay this way your whole period or may darken as your flow slows.
Pink

Your blood may appear pink in color at the beginning or end of your period, especially if you’re spotting. This lighter shade likely indicates that the blood has mixed with your cervical fluid, diluting its hue.
Orange

When blood mixes with cervical fluid it may also appear orange. As a result, you may see orange discharge for the same reasons you see pink discharge.
Gray

Seeing gray or off-white discharge is a reason to call your doctor. Gray blood is associated with: Infection

This hue may indicate that you have an infection brewing, like bacterial vaginosis. Other signs of infection include:

fever

pain

itching

foul odor

Dr. Mohd Suhaimi Hassan

Consultant Obstetrics & Gynecologist & Reproductive Medicine

Columbia Asia Hospital – Setapak
MD (UKM), MRCOG (UK), MRCP (Ireland), DRCOG (UK)

Make an Appointment

PDF and Online Articles:

What Your Period Blood Colour Says About Your Health - Female Magazine, 26 September 2019

This article first appeared in Female Magazine, 26 September 2019

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Obstetrics & Gynecology
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WHAT IS ELECTROTHERAPY?

WHAT IS ELECTROTHERAPY?

February 03, 2011

Electrotherapy is a drug free, non-invasive and non-addictive treatment option. The use of electrical current in this modality of treatment may surprise you but you can rest be assured that it is safe and has been in use since 1855. Electrotherapy delivers small, pulsating current to muscles and nerve endings. This current causes repeated muscle contraction and relaxation. Such stimulation allows the involved muscles to strengthen, relax and thus relieves pain.
THEREUPETIC USES OF ELECTROTHERAPY

Pain management

Treatment of neuromuscular dysfunction

Improvement of strength

Improvement of motor control

Retards muscle atrophy

Improves local blood circulation

Improves range of joint mobility

Induces repeated stretching of contracted soft tissues

Tissue repair

Enhances microcirculation and protein synthesis to heal wounds

Restores integrity of connective and dermal tissues

Acute and chronic edema

Accelerates absorption rate

Improves blood vessel permeability

Increases mobility of proteins, blood cells and lymphatic flow

Peripheral blood flow

Accelerates absorption rate

Induces arterial, venous and lymphatic flow

TYPE OF ELECTROTHERAPY
1. TENS

TENS stands for Transcutaneous electrical nerve stimulation. (Transcutaneous simply means through the skin)

Electrodes applied to the skin deliver low voltage, intermittent stimulation to superficial nerves causing transmission of pain signals to be blocked and release of endorphins. Endorphins are naturally occurring pain-killers within the body.
2. ULTRASOUND

Ultrasound is a high frequency sound wave. These waves vibrate tissues deep within injured areas, creating heat that draws blood flow into the affected tissues. The tissues then respond to the influx of healing nutrients and the repair process thus begins.

Treatment is given with an ultrasound head that is moved gently in strokes or circles over the injured area. It lasts just a few minutes. The procedure may be performed in combination with a topical anti-inflammatory drugs or gels.
3. INTERFERENTIAL

Interferential therapy is the application of two medium frequency current to produce a low frequency effect.

It is based on the principle of interference as a result of which a beat frequency is produced.

Paired electrodes are lined up on the skin of the injured area. This results in current flow between each pair of electrodes. The flowing current obstructs the transmission of pain at the spinal cord level. Additionally, this process focuses on delivering electrical current to the damaged tissues while minimizing its effect on cutaneous nerves.
ELECTROTHERAPY MAY BENEFIT THOSE SUFFERING FROM:

Chronic Pain

Post Herpetic Neuralgia

Stump Neuroma & Phantom Limb Pain

Trigeminal Neuralgia

Chronic Neck Pain

Chronic Backache

Chronic Leg Pain

Post – Operative Pain

For example Cholecystectomy, Menisectomy

Rheumatoid Arthritis

Osteoarthritis

Dupuytren’s Contracture

Tennis elbow

Golfer’s elbow

Supraspinatus Tendinitis

De Quervain’s Tenosinovitis

Bicipital Tendinitis

Subdeltoid Bursitis

Subacromial Bursitis

Metatarsalgia

Plantar Fascitis

Calcaneal Spur

Muscle Strain

Ligament Sprain

Adhesion of structures around joints

Tenosinovitis

Tendon / muscle contracture

Dr. Ramnan Jeyasingam

Chief of Medical Services

Columbia Asia Extended Care Hospital


What everyone should know about Pressure Sores

February 03, 2011

Risk factors for pressure sores:

Advanced age – the skin loses its elasticity as one ages

Immobility

Incontinence and exposure to moisture

Malnutrition and dehydration

Reduced ability to sense discomfort and change body posture frequently

Areas that are prone to pressure sores are depicted below:
Prevention of Pressure sores:

In general, pressure sores can be prevented by observing the following:

Pressure relief – using devices like Ripple Mattresses and Low Memory Foam Cushions.

Frequent change of position, preferably every 2 hours

Preventing exposure to moisture, such as frequent diaper changes or temporary use of urinary catheters and colostomy bags.

Maintenance of proper nutritional and hydration status.

Treatment of coexisting conditions such as Anemia or Diabetes.

Maintaining a high index of suspicion and actively looking for pressure areas to commence early treatment.

Treating Sores:

Treatment of pressure ulcers depend on it stage and the presence of other complications. It is best left in the hands of medical professionals who have sufficient experience in managing these problems. At times, surgical intervention and the use of antibiotics may be required as a life saving measure.

Always remember, pressure sore can be life threatening and prevention is less complicated than treatment.
Dr. Ramnan Jeyasingam

Chief of Medical Services

Columbia Asia Extended Care Hospital


What is a Heart Attack?

What is a Heart Attack?

September 28, 2020

Our heart is the most important organ in the human body as this organ pumps relentlessly from the day that we are born and doesn’t stop beating even when we are asleep. In fact, our heart pumps about a million barrels of blood in an average lifespan. Therefore, the heart is like the engine of the human body. If anything goes wrong with the heart, all the other organs will also be affected.

The prevalence of heart disease in Malaysia is ever increasing. What used to be a disease of the elderly is now seen much earlier. Nowadays, Malaysians in their 20’s and 30’s are suffering from heart attacks. Heart disease is still the number 1 killer in Malaysia. Almost 1 in every 4 deaths is caused by heart disease. On average, about 140 persons for every 100,000 people will suffer from a heart attack during their lifetime.

The risk factor for heart disease can be divided into non-modifiable and modifiable risk factors. The non-modifiable risk factors are age, sex and family history. The modifiable risk factors are namely diabetes, hypertension, smoking, hyperlipidaemia and obesity.

The typical symptoms of a heart attack are left sided or central chest pain, nausea, sweating, left arm pain and jaw pain. However, some patients like those with diabetes may not have chest pain and only have difficulties in breathing. Women are another group that often doesn’t have the typical symptoms, and they often present with epigastric pain.

What actually happens during a heart attack? Our heart has 3 main blood vessels that supply blood to the heart muscle with a diameter between 2.5 to 4mm. A diseased blood vessel can slowly get narrowed over time due to atherosclerosis. In an acute myocardial infarction, the atherosclerotic plaque ruptures and the blood that normally flows within the lumen of the blood vessel is exposed to the lipid rich contents of the atherosclerotic plaque. This causes the blood to form a clot and thus occludes the flow of blood within the blood vessel. Once this happens, the heart muscle cells will start to die and the heart will become weaker until it finally fails to pump blood.

Time is of the Essence

Heart attacks can occur at any time, but they usually occur in the early hours of the morning. This is due to our Circadian rhythm. During a heart attack, time is of the essence. Every second that passes results in millions of heart muscle cells dying and the heart getting weaker. Therefore, the most important thing to do if one is suspected to have a heart attack is to call 999 to get to the nearest hospital with 24-hour primary angioplasty.

It is important to emphasise here that not all hospitals provide 24-hour primary angioplasty and that only thrombolysis may be done. Primary angioplasty has been proven to be superior to thrombolysis. Columbia Asia Hospital – Iskandar Puteri is one of the hospitals which have been offering 24-hour primary angioplasty since July 2018. Led by Interventional Cardiologist, Dr Dhanan Umadevan, Columbia Asia’s catheterization laboratory is staffed around the clock on standby to provide emergency treatments to patients with acute heart attack. For more information and enquires, please call 07-233 9999.

Consult with our
heart specialists
 today for more advice and any concerns related to cardiovascular health
Photo credit: Freepik.com

Dr. Dhanan Umadevan

Consultant Cardiologist

Columbia Asia Hospital - Iskandar Puteri
MD (USM), MRCP (UK),, Interventional Cardiology IJN (Mal), CBCCT (USA), OHD NIOSH (Mal)

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PDF and Online Articles:

What is a Heart Attack? – The Iskandarian, 17 September 2020

This article first appeared in The Iskandarian, 17 September 2020.

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Cardiology
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What is Febrile Seizure?

What is Febrile Seizure?

April 10, 2017

Photocredit : YouTube

In simple terms, a febrile seizure or convulsion is a seizure caused by fever. It occurs when there is a sudden rise in body temperature, usually a fever above 38⁰C. This can be due to a viral or bacterial infection in the body. Febrile seizures usually occur on the first or second day of fever and affects children aged 6 months to 6 years of age. Studies in Western Europe quote a figure of 3 to 4% of children, less than 5 years old, experiencing febrile seizures.
How does a febrile seizure present itself?

The child will usually lose consciousness and does not respond to calls. His eyes might roll backwards and he might look blue or red in the face. He might have stiffening or jerky movements of his limbs. Some children might wet themselves during a seizure episode. Seizures usually last for less than 5 minutes and abort spontaneously. After a seizure, the child will usually feel sleepy for some time.

Photo credit: snotty-noses.com

What should I do when my child is having a febrile seizure?

First, don’t panic! It is indeed a horrifying experience for parents to witness their child having a seizure but parents must remain calm.

Note the time the seizure starts and put the child in recovery position – lying by his/her side with head slightly tilted to the back. This is to prevent the child from swallowing or aspirating his vomitus and to maintain the airway.

It is important not to put anything in the child’s mouth, including parents own fingers. The child will not choke or swallow their tongue. If the seizure lasts more than 5 minutes, or if another seizure occurs shortly after the 1st episode, the child should be brought to the nearest hospital.
How do we treat febrile convulsion?

Most of the time, febrile convulsions last less than 5 minutes and does not require any treatment. However, in the rare occasion that seizure lasts more than 5 minutes, doctors might give medication to stop the seizure.

All children having had seizures should visit the doctor as soon as possible for a proper examination in order to get a proper diagnosis and rule out serious infections such as meningitis.

Photo credit: hello-sehat.com

Will my child develop febrile seizures again after experiencing the first episode? Will he develop epilepsy when he grows up?

Thirty percent of children who have had febrile seizures can develop a second episode of febrile seizures when they have another febrile illness. Risk factors for recurrence include family history of febrile seizures, onset aged less than 18 months, lower temperature or shorter duration of fever at onset of seizure.

The risk of developing epilepsy (seizures occurring in the absence of fever) is 2 to 7%, which is similar to the risk of epilepsy in normal children population.
Can I prevent my child from developing febrile seizures?

Febrile seizures usually occur on the first or second day of the seizure. Despite popular belief, giving regular antipyretics (fever medication such as paracetamol and ibuprofen) does not reduce the number of febrile seizures. Research also showed that medication such as oral diazepam or phenobarbitone does not prevent febrile seizures.

References:

http://patient.info/health/febrile-seizure-febrile-convulsion

http://patient.info/doctor/febrile-convulsions#ref-8

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Febrile-Seizures-Fact-Sheet#3111_8

http://www.nhs.uk/conditions/Febrile-convulsions/Pages/Introduction.aspx

http://www.rch.org.au/kidsinfo/fact_sheets/febrile_convulsions/

Paediatric Protocols for Malaysian Hospitals 3rd edition

Dr. Kenneth Looi Chia Chuin

Consultant Pediatrician
Columbia Asia Hospital - Cheras


What is Sarcoma?

What is Sarcoma?

July 30, 2021

Sarcomas represent only 1% of the total burden of malignancy in the population, and because of their rarity are not commonly encountered by members of the medical profession. Indeed, most members of the public will not even be aware they exist.

What type of cancer is Sarcoma?

A sarcoma is a type of cancer that starts in tissues of mesenchymal cell origin, quite similar to adenocarcinoma which is from glandular cells, and squamous cell carcinoma from epithelial cells. Bone and soft tissue sarcomas are the main types of sarcoma. Soft tissue sarcomas can originate virtually from any form of soft tissue, like fat, nerves, wall of blood vessels, deeper layers of skin and so on. So they are very varied in origin, behavior, and can be found in any part of the body.

What are the different types of Sarcoma?

• Angiosarcoma develops from the cells that make up the walls of blood vessels

• Bone sarcoma is a cancer that starts in the bone

• Chondrosarcoma originates from cartilage

• Ewing's sarcoma also from bones, and most common among younger age group

• Fibroblastic sarcoma from fibrous tissues eg muscles, tendons, ligaments

• Gastrointestinal stromal tumours (GIST) arise from some specialized cells of the smooth muscle of the stomach or intestines.

• Liposarcomas, which develop in fatty tissues

• Leiomyosarcomas, which originate in smooth muscles

• Rhabdomyosarcomas, which start in skeletal muscles

• Synovial sarcomas, which start in tissues that surround joint

• Dermatofibrosarcoma forms in the tissue under the skin, commonly found in the trunk or limbs.

Sarcomas are extraordinarily heterogeneous, comprising more than 70 distinct histological subtypes, with additional layers of biologic variability as a result of differences in genetic complexity and driver molecular mutations. There is also particularities in clinical factors such as age of onset and anatomic site of affliction.

What is the most common type of Sarcoma in Malaysia?

Soft tissue sarcomas are by far the most common. Osteosarcomas (sarcomas of the bone) are the second most common, while sarcomas that develop in the internal organs, such as the ovaries or lungs, are diagnosed least frequently.

Is Sarcoma hereditary?

They are usually acquired during life rather than having been inherited before birth, but can also arise in the setting of a recognized heritable cancer predisposition syndrome. E.g. neurofibromatosis, Li Fraumenis syndrome, etc.

What causes Sarcoma?

They occur mainly due to DNA mutations, which are usually acquired during life. Many of these acquired mutations may result from exposure to radiation or cancer-causing chemicals. In many cases, they occur for no apparent reason.

Where does Sarcoma usually start in the body?

In general, they occur throughout the body, but depending on the type, there is a predilection for certain sites eg you’ll find angiosarcoma occurs most commonly on face and scalp, but can also affect skin, liver, breast, and spleen tissue; whereas Ewings sarcoma and osteosarcoma most commonly affects long bones, GIST tumours will affect mostly the stomach and intestine.

How aggressive is Sarcoma, how fast does it spread and is it deadly?

"Agressiveness" is a very subjective term that may not best describe sarcomas. Firstly, sarcomas in general are quite rare & hard to detect and diagnose early. For a cancer patient, it is more dangerous to have a news of being diagnosed with sarcoma rather than carcinoma. This is due not only because of its rarity, but also due to the fact that sarcomas have widely variable behavior pattern, and progression and subsequent treatment may be influenced by variety of factors.

Some of these factors are grade, stage, and cancer biology in-toto, as determined by their molecular and gene profile characteristics (intrinsic). Sometimes they can be extremely aggressive, especially in a situation where the patient may have been compromised by poor immune status, age, co morbid conditions, “bad genes”, and location of the cancer (extrinsic factors).

In these situations the sarcomas can invade neighbouring tissues, and have high metastatic potential through the genes that determine their migration, invasiveness and angiogenesis. On the other hand, they may be more indolent and have a fairly good outlook, even if diagnosed very late.

Is Sarcoma a ‘silent killer’ (no symptoms) If not, what are the symptoms?

In comparison to aggressive cancers like ovarian cancer, which are indeed “silent killers”, sarcomas tend to grow and spread relatively slower. Delayed diagnosis is usually because the symptoms and signs are masked by the slow growth, absence of pain, being unable to feel them due to deep seated location, and other doctor-asociated and socioeconomic factors. However the high grade tumours can spread quickly to lymph nodes and through lymphatic and vascular channels.

What does a Sarcoma lump feel like? Is it like a breast cancer lump which is hard and defined?

A sign of adult soft tissue sarcoma is a lump or swelling in soft tissue of the body. A sarcoma may appear as a painless lump under the skin, often on an arm or a leg. Sarcomas that begin in the abdomen may not cause signs or symptoms until they get very big.

Soft tissue sarcomas are hard to spot, because they can grow anywhere in your body. Most often, the first sign is a painless lump. As the lump gets bigger, it might press against nerves or muscles and make you uncomfortable or give you trouble breathing, or both.

How is Sarcoma diagnosed?

A diagnosis of sarcoma is made by a combination of clinical examination by a doctor and imaging tests. Soft tissue sarcomas are hard to spot, because they can grow anywhere in your body. Most often, the first sign is a painless lump. It is confirmed by the results of a biopsy of the mass or lesion detected clinically. There is unfortunately no salvia, urine, stool or blood tests that can be used to diagnose a sarcoma. Tissue samples, obtained from either a biopsy or from an excised tumor, must be analyzed by a skilled pathologist who specializes in these rare cancers in order to render a diagnosis of sarcoma & histological sub type.

What treatment options are available for Sarcoma patients, and how effective are they?

Best treatment for sarcoma, is surgery if in early stage, or if it is of low grade (not likely to spread to other parts of the body). Most people diagnosed with a soft tissue sarcoma are cured by surgery alone.

More aggressive sarcomas are harder to treat successfully. It is more likely to be cured if all of the cancer can be removed by surgery. Those that are high grade and larger than 2 inches (5 cm) are often treated with a combination of surgery and radiation therapy. Radiation therapy or chemotherapy may be used before surgery to shrink the tumor and make removal easier. Hence the importance of multidisciplinary/multimodal treatment strategies in treating sarcomas.

What is the survival rate of sarcoma patients?

The overall 5-year survival rate for sarcoma is 65%. About 60% of sarcomas are found as a localized sarcoma. The 5-year survival rate for people with localized sarcoma is more than 80%.

Can we prevent ourselves from developing sarcoma?

At this time, there's no known way to prevent this cancer. The only way to reduce risk some soft tissue sarcomas is to avoid exposure to risk factors like radiation, certain chemicals like herbicides, dioxin, etc, whenever possible. Still, most sarcomas develop in people with no known risk factors. And for those people needing radiation therapy, there's usually little choice, but to accept the small but significant risk. It may also be a new norm in the future to know one’s genetic predisposition, eg whether there is a link with conditions such as neurofibromatosis, Li-Fraumenis syndrome, retinoblastoma gene. But for the moment, there are not a lot of genetic tests to accurately predict one’s risk of sarcomas.
“It appears to be too rare a condition to worry about cost effective screening and detection strategies”
.

Can Sarcoma be cured completely?

Sarcomas can be cured, as with most cancers, if patients present at an early stage, when surgical resection is feasible. If you look at the survival rates, you will notice the difference in survival based on stage. However there are other factors that determine the outcome, very important of these are grade of tumour, histological type of sarcoma, site of tumour, age and overall health, and so on. Quality of treatment also appears to play an important part, especially in the more advanced stages, as those that tend to do well are those that have access to multimodality treatment strategies.

Overall the 5 yr survival rate is about 65%

EER Stage

5-Year Relative Survival Rate

Localized

81%

Regional

57%

Distant

16%

All SEER stages combined

65%

Dr. Jayendran Dharmaratnam

Consultant Clinical Oncologist (Visiting)

Columbia Asia Hospital - Bukit Rimau
MBBS (India), FFR.RCSI (Radiotherapy) (Ireland)

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What It Takes To Be A Midwife

What It Takes To Be A Midwife

October 19, 2017

Being a nurse, they say, is not for everyone. When you’re working in a labour ward, the wellbeing of mothers and their newborns are in your hands and that’s quite a responsibility to take on. Royani Binti Hj Singsan, 39, has been involved in midwifery services for the past 19 years. She started her career at Columbia Asia Hospital - Puchong and stayed on. Here’s her story.

What It Takes To Be A Midwife – Baby Talk, Issue September 2017


What is Mortality & Morbidity?

What is Mortality & Morbidity?

July 02, 2011

More famously called M&M in the field of medicine. Mortality is self-explanatory, morbidity is complications that occur to patients whether small or big. This is something that we should always evaluate to ensure our standards are upheld and harm to the patients are minimized. The Hippocratic Oath does say Do No Harm to the Patients and I believe this is something that the doctors should believe deeply. Whatever our actions should reflect this oath that we took.

However despite the best intentions some side effects or complications do occur maybe due to the patients’ pre-existing medical condition or the complexity of the surgery. Recently one of my patients had quite a bad sore throat and it made me think. We need to make people more aware of the common complications that can and do occur. I’ll talk about anesthesia since that’s what I do.

With modern advances in medications, monitoring technology, and safety systems, as well as highly educated anesthesia providers, the risk caused by anesthesia to a patient undergoing routine surgery is very small. Mortality attributable to general anesthesia is said to occur at rates of less than 1:100,000. Minor complications occur at predicable rates, even in previously healthy patients. The frequency of anesthesia-related symptoms during the first 24 hours following ambulatory (daycare) surgery is as follows:

Vomiting - 10-20%

Nausea - 10-40%

Sore throat - 25%

Incisional pain - 30%

Again, pain is not well controlled as we would like them to be. It has a whole list of complications attached to it. We’ll save it for another day. Nausea and vomiting can be minimized with good hydration and use of good prophylactic anti-emetics (a bit expensive but worth all the pennies) such as ondansetron. Sore throat can be minimized if we minimize the use of endotracheal tubes (the plastic tubes that help you breathe during anesthesia). To do this we need to adhere to the fasting guidelines. As a conclusion I think to have a pleasant anesthesia, we both need to play our part. And please, no smoking at least 24 hrs before anesthesia, you’re just multiplying your risks by a factor of 10 if you do.


What a Pain! [Press Clipping]

What a Pain! [Press Clipping]

January 01, 2014

Health Smarts, pp. 124-129; Expert panel from CAH is Consultant Obstetrician & Gynecologist, Dr. Haw Wan Lye.
See our Press Clipping:

Her World,

January 2014

Her World,

January 2014

Her World,

January 2014

Her World,

January 2014

Her World,

January 2014

Her World,

January 2014

Her World,

January 2014


What To Do When You Get Gamer's Thumb From Too Much Gaming

December 06, 2022

In the early 1980s, playing video games would require you to go to the arcade, but with the advancement of technology, video game screens got smaller and became wonderfully portable, which was great for gamers.

Fast forward to the 21st century and you don’t even have to step out of bed to play video games.

Mobile phones allow you to download games any time, anywhere with just the tap of a finger.

There is no doubt that gaming can be a fun distraction or hobby, or even a competitive sport in the form of esports.

However, there are health risks that can come from too much gaming.

Try playing a video game on your mobile phone or using a controller for a few hours straight, and you will notice that you will start having sore thumbs.

This repetitive stress injury to the thumb is called “gamer’s thumb” or de Quervain tenosynovitis of the thumb.

It is an inflammation of the tendons located over the base of the thumb, running up to the wrist and forearm.

Patients will typically experience:

Pain and swelling below the thumb

A grip that is painful or weak

Tenderness around the thumb and wrist region

Pain that radiates up to the forearm and thumb, and

Wrist pain that worsens with every movement.

Of course, there are other factors that can cause de Quervain tenosynovitis.

These include carrying heavy bags or lifting a baby, playing sports like golf or racket sports, or even playing the piano.

Basically, it can happen with repetitive wrist and hand movements.

Just think about the amount of use the thumb goes through while you scroll or text, or play video games on the mobile phone.

Simple prevention tips

As overuse of the thumbs is the main cause of gamer’s thumb, there are preventive measures you can take to ease the pain and prevent it from worsening.

Most importantly, take frequent breaks from your mobile phone or playing video games.

Also, shorten the time period of using your mobile phone or playing video games.

Do some stretching exercises for your thumbs and wrists.

In the event that the pain and swelling occurs so often that it gets in the way of your daily activities, then it is time to get it checked by a qualified doctor.

Once the diagnosis is consistent with gamer’s thumb or de Quervain tenosynovitis, we will advise the patient to rest and reduce the amount of time they spend on their mobile phone and/or playing video games.

Topical analgesics or creams can be applied, as well as an ice pack over the affected thumb and wrist.

Oral painkillers can be prescribed.

The thumb and wrist area can be splinted or braced to rest them.

A qualified occupational therapist can also create a treatment plan involving exercises that will increase the mobility of your thumb and reduce the pain.

If the swelling and pain are severe, a corticosteroid injection to the affected area will drastically reduce those symptoms.

As a final resort, surgery can be done to relieve the pain.

Such surgery involves cutting the sheath around the tendons to allow more room for it to move more freely.

Like many other activities that have both benefits and harm, moderation is key.

Education is also important in preventing injuries.

Simple advice like taking breaks and stretching can make a huge difference.

Limit your number of hours spent in front of the screen and engage in healthier activities like exercising or socialising in the real world, instead of the virtual world.

It is important for us to integrate the real world into our lifestyle, which should include plenty of sleep, a healthy diet and exercise, rather than letting the game become your life.

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:

Hadoken! Adoh pain! What to do when you get gamer's thumb from too much gaming – The Star, 21 August 2022

This article first appeared in The Star, 21 August 2022.

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What You Eat Affects Your Pregnancy Outcome

December 19, 2022

There is a saying “you are what you eat”. From preconception to antenatal period, what you consume can potentially affect your pregnancy outcome.

Pre-pregnancy folic acid

Folic acid is the synthetic form of folate, which is a naturally occurring B vitamin. Folate helps make DNA and other genetic material. It is especially important in prenatal health.

Studies show that consuming 400mcg of folic acid per day can reduce risk of neural tube defect by more than 70%.

The two most common types of neural tube defects are anencephaly and spina bifida. Anencephaly is a serious birth defect in which parts of a baby’s brain and skull do not form correctly. Almost all babies born with anencephaly will die shortly after birth. Spina bifida is a serious birth defect in which a baby’s spine does not form correctly and can result in some severe physical disabilities.

Every woman who is capable of becoming pregnant should get 400 mcg of folic acid every day.

There are three ways women can get enough folic acid. They can choose to:

Take a vitamin supplement containing 400 micrograms of folic acid daily, or

Eat a fortified breakfast cereal daily which contains 100% of the recommended daily amount of folic acid (400 micrograms).

In addition, increase consumption of foods fortified with folic acid (e.g., "enriched" cereal, bread, rice, pasta and other grain products) in addition to consuming food folate from a varied diet (e.g., orange juice and green vegetables).

Say no to alcohol consumption during pregnancy

Alcohol in the mother’s blood passes to the baby through the umbilical cord. Alcohol use during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical, behavioral, and intellectual disabilities. These disabilities are known as fetal alcohol spectrum disorders (FASDs).
Children with FASDs might have the following characteristics and behaviors:

Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)

Small head size

Shorter than average height

Low body weight

Poor coordination

Hyperactive behavior

Difficulty with attention

Poor memory

Difficulties in school (especially with maths)

Learning disabilities

Speech and language delays

Intellectual disability or low IQ

Poor reasoning and judgment skills

Sleep and sucking problems as a baby

Vision or hearing problems

Problems with the heart, kidney, or bones

There is no known safe amount of alcohol use for mothers during pregnancy or while trying to get pregnant. There is also no safe time for alcohol use during pregnancy. All types of alcohol are equally harmful, including all wines and beer. FASD is preventable if the baby is not exposed to alcohol before birth.

No Smoking during pregnancy

Tobacco use during pregnancy increases the risk of preterm birth, low birth weight, and birth defects of mouth and lips.

E-cigarettes and other tobacco products containing nicotine (the addictive drug found in tobacco) are not safe to use during pregnancy. Nicotine is a health danger for pregnant women and developing babies. It can damage a developing baby’s brain and lungs. Also, some of the flavorings used in e-cigarettes may be harmful to a developing baby.

Maintain normal body weight before pregnancy

Obesity is a strong risk factor for any pregnant woman.

Obesity is associated with increased risks of almost all pregnancy complications:

gestational hypertension

preeclampsia

gestational diabetes mellitus

delivery of large-for-GA infants

higher incidence of congenital defects (heart defect, neural tube defect)

Thromboembolism

Miscarriage

Yet, most obesity cases are modifiable risk factors for pregnancy via lifestyle changes. A healthy pre-pregnancy weight can be achieved via regular exercise and diet control.

Remember, you are what you eat! By consuming a proper diet, and maintaining a negative calory balance, weight loss is possible.

A negative calorie balance state occurs when you burn more calories than you take in.

Obese women also have higher chances of developing Type 2 Diabetes Mellitus which itself can increase the risks of congenital fetal anomaly.

In summary, a lifestyle modification is hard for the majority of people, but once you can deliver a healthy baby, all your effort is worthwhile.

“Stay fit! Stay healthy! Healthy mum, healthy baby!”

You do your part, and the rest, let your obstetrician guides you through your wonderful pregnancy journey.

Dr. Soon Khai Cherng

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital – Miri

MD (Russia), MRCOG (UK) (Malaysia)

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PDF and Online Articles:

Maternal Nutrition: Things Mums Need to Know – The Borneo Post, 18 December 2022

Maternal Nutrition: Things Mums Need to Know – The Borneo Post, 18 December 2022

This article first appeared in Borneo Post Online, 18 Dec 2022.

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What You Need To Know About Hypertension

July 11, 2023

Hypertension (HPT) or high blood pressure, is a well-known silent killer. Defined as consistent high blood pressure (BP) with systolic blood pressure above 140 mmHg and/or diastolic blood pressure above 90 mmHg. Diagnosis is made when the elevated blood pressure is recorded on two separate visits two weeks apart, at the very least.

It is one of the most common non-communicable diseases alongside Type 2 Diabetes Mellitus.

Prevalence increases significantly with age although nowadays there is an increase in diagnosis in younger age groups. Studies show that almost 50% of patients are unaware of them having HPT and only about 40% of patients on treatment achieve the target BP. In Malaysia, the prevalence of HPT in people aged 18 years and above is around 35 to 40 per cent!

Risk factor of heart diseases

Hypertension is one of the main risk factors for cardiovascular disease especially stroke and heart disease. An early diagnosis leads to optimal treatment to prevent unwanted complications and in turn, reduce the rate of mortality or death.

Primary HPT is also known as essential HPT. This constitutes more than 90 per cent of all cases of HPT diagnosis. The causes are multifactorial and associated with genetic or a family history of HPT. Apart from advanced age as a major risk factor, obesity and environmental stress also play important roles in increasing risks of HPT.

Essential hypertension can be present in both a benign state, in which onset is gradual and prolonged. Or in a malignant state, where the onset of abrupt and short dramatic BP increases. Without urgent intervention, the latter can be fatal.
Secondary hypertension

Secondary hypertension results from an identifiable cause such as hormonal or endocrine diseases, kidney disease or heart conditions. This makes up the five to 10 percent of prevalence for hypertension diagnosis. Thus in these diseases, treatment of the underlying disease will be able to control patients’ blood pressure.

Stage of hypertension

Classification*

Systolic (mmHg)

Diastolic (mmHg)

Prevalence in Malaysia³

Optimal

<120

and

<80

30.7

Normal

120 - 129

and/or

80-84

25.3

At Risk

130 - 139

and/or

85-89

18.6

Hypertension

Stage 1 (Mild)

140 - 159

and/or

90-99

17.3

Stage 2 (Moderate)

160 - 179

and/or

100 - 109

5.7

Stage 3 (Severe)

≥180

and/or

≥110

2.4

Isolated Systolic Hypertension

≥140

and

<90

11.2

Classification: Optimal

Systolic (mmHg)

<120

and

Diastolic (mmHg)

<80

Prevalence in Malaysia³

30.7

Classification: Normal

Systolic (mmHg)

120-129

and/or

Diastolic (mmHg)

80-84

Prevalence in Malaysia³

25.3

Classification: At Risk

Systolic (mmHg)

130-139

and/or

Diastolic (mmHg)

85-89

Prevalence in Malaysia³

18.6

Hypertension: Stage 1 (Mild)

Systolic (mmHg)

140-159

and/or

Diastolic (mmHg)

90-99

Prevalence in Malaysia³

17.3

Hypertension: Stage 2 (Moderate)

Systolic (mmHg)

160-179

and/or

Diastolic (mmHg)

100-109

Prevalence in Malaysia³

5.7

Hypertension: Stage 3 (Severe)

Systolic (mmHg)

≥180

and/or

Diastolic (mmHg)

≥110

Prevalence in Malaysia³

2.4

Hypertension: Isolated Systolic Hypertension

Systolic (mmHg)

≥140

and

Diastolic (mmHg)

<90

Prevalence in Malaysia³

11.2

Table 1-A Classification of Clinic Blood Pressure Levels in Adults

HPT is known as the silent killer because, usually there will be no significant symptoms especially at the early stages. As the disease advances and blood pressure increases, without treatment patients will start to develop symptoms such as headache, fatigue, dizziness, palpitations, flushing and blurring of vision.

Upon diagnosis the treating doctor will perform routine blood and urine tests, electrocardiogram (ECG) and if needed chest X-ray. These are to see the extent of hypertension, organ damage and also screening of other associated diseases.

In some cases especially with borderline HPT, non pharmacologic therapy can be considered for first line treatment of hypertension such as sodium restriction, weight loss for overweight individuals, exercise, caffeine restriction and cessation of smoking and/or alcohol.

In patients with hypertension, weight loss is shown to be one of the most beneficial to reduce BP. A 3-4 kg reduction would achieve improvement of systolic BP 4-5mmHg. WHO recommends reduction of salt intake less than 5g per day (one teaspoon salt) in assisting BP control.

In patients with excessive environmental stress, relaxation and breathing techniques are also shown to be beneficial. If these lifestyle modifications fail then the patient will eventually require medications.

Pharmacological treatment primarily involves the usage of a variety of anti hypertensive methods, which work using different pathways in the human body. There are few different groups of medications to treat hypertension. Often than not patients will require a combination of 2 or 3 medications to achieve good BP control in trying to reduce complications and ultimately mortality.

After starting medications, the next step is to treat the blood pressure to reach the target goal. Aim to achieve the target within 3-6 months.

<80 years old target <140/90

>80 years old target <150/90

High risk individuals target <130/80

Regular follow up is needed and intervals will be individualised according to risk, blood pressure and control, plus types of medications used. Once BP is well controlled, a follow up is recommended at least every 6 months.

One of the common myths of HPT is that once you are subjected to medications, it has to be continued lifelong. In fact in patients with very good BP control, doctors can consider to titrate down the medications and in some cases stop it completely, especially if aggressive lifestyle modifications can be made. Of course some criteria is needed in this category, such as, patients in stage 1 HPT should have good BP control at least for more than 1 year, besides continuing and maintaining a healthy lifestyle.

However we can’t avoid some common complications of uncontrolled hypertension that can lead to death including coronary heart disease, congestive heart failure, ischaemic or hemorrhagic stroke and kidney failure. These events will usually affect the patient greatly in terms of quality of life. Another important complication from long standing uncontrolled HPT is retinopathy or hypertensive eye disease causing blurred vision. Thus, it is also recommended for hypertensive patients to undergo eye screening.

In summary, a blood pressure check at every opportunity is highly recommended. Anyone above 18 should at least have 1 (one) BP recorded. People with higher risks such as family history of HPT and obesity need more frequent monitoring. The usage of electronic blood pressure devices is acceptable. Blood pressure measurement has to be optimum including using the right cuff size and must be done in a relaxed manner.

Home blood pressure monitoring in high risk and hypertensive patients is highly recommended as this will help the treating doctor in managing hypertension better. Early diagnosis of hypertension is very important as this allows early treatment and control of blood pressure. This will reduce the number of patients with acute or long term complications and make our nation a healthier one, besides reducing the economic burden in the health system.

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:

What You Need To Know About Hypertension – Natural Health

This article first appeared in Natural Health.

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What You Should Know About Female DNA

What You Should Know About Female DNA

March 30, 2020

Can you use your DNA as an excuse for your thoughts and behaviour? Find out what our expert shares about the female and male DNA.
What makes us a woman? The simple answer would be — our ‘female’ DNA. Unfortunately, like many other things in life, nothing is simple. Least of all what we make of our DNA.

Back to basics

Firstly, let us ponder on that word, ‘female’. This word could be used for both ‘gender’ and ‘sex’. The female gender refers to the feminine characteristics which are mostly influenced by society. The female sex however is biologically determined. However, the terms sex and gender, for both male and female are usually used interchangeably.

Human beings are made of cells. All cells except for reproductive cells, have 46 chromosomes. Those 46 chromosomes are arranged in pairs hence we have 23 pairs in each cell. Out of the 23 pairs, 22 are called autosomes and the last pair is called sex chromosomes.

Life with one less X

The X and Y chromosomes are sex chromosomes. They determine a person’s sex. We were taught in our secondary school that men are XY (written as 46XY), women are XX (written as 46XX). Research suggests that some female babies can be born with a single X (45X) instead of two. They are known as Turner Syndrome. A baby who has Turner syndrome usually grow up with a short stature, with a heart shaped face, has webbing of her neck, possibly has a heart lesion and elbow deformities as well as a poorly developed gonadal/reproductive tract.

A fetus can also have only one Y, without an X chromosome (45Y). However, this genetic combination is not compatible with life. Clearly the X chromosome is needed for survival.

Females with a Y

Some fetuses are born with more than one sex chromosomes. These are called sex polysomies, for example 47XXX. These babies will grow up to be tall females with normal mental development (unfortunately the extra X does not make one a Superwoman!).

There are also fetuses born with 47XXY. Even though the baby has a pair of X chromosome, the baby external appearance is of a male baby. This is because, the presence of the Y chromosome act as the main inducer for the male appearance (also known as the male ‘phenotype’). Another example will be an individual with 48XXXY, who will also have a male phenotype due to the presence of a Y chromosome.

Male at birth

Klinefelter’s Syndrome refers to 47XXY. Even though they are born as male babies, as they grow older, their testes will not be well developed and there will be no production of sperm. The extra X chromosome is said to cause them to have less facial hair, less muscle mass and grow to be tall with breasts, broad hips and long legs.

In addition to all those genetic variations above, there are some males born 46XX. This is due to the translocation of a tiny section of Y chromosome onto the 46XX individual. Presence of the tiny section of Y chromosome is responsible for the development of testes in the embryo/fetus! Later, section of the Y chromosome will induce the external appearance of a male.

Two sexes in one body

Inversely, there are also some females born as 46XY. This occur because the Y chromosome suffer some mutation, hence fails to induce embryonic testes, as a result ovaries will develop instead! There are some individuals born with 46XY because they cannot respond to the hormone “testosterone” produced by their testes, as a result they will have all or some external appearance of a woman despite the male genes. This is known as ‘Androgen Insensitivity Syndrome’.

When an individual has both male and female sexual organs, they are known as hermaphrodite. Hermaphrodite: this word comes from two names of Greek God and Goddess, Hermes and Aphrodite. Theoretically, when cell divisions occur in the fetus, it is possible to have both cells of 46XX and 46XY in the same fetus. This is what they call mosaicism. As a result, the individual will have both male and female ‘apparatus’. Sadly, hermaphrodites are usually infertile, and thus they cannot impregnate themselves.

It’s never straightforward!

Clearly sex is complicated, yet beautiful. Gender, in my mind, is the perfect example of nature versus nurture. All these amazing variations of combinations of the sex chromosomes humbly show us the infinite diversity of life. Always remember that not all females are XX and not all males are XY. Each of us are being influenced by our own unique internal genetic materials and the orchestra of hormonal balances as well as many external developmental and environmental factors.

Dr Norintan Zainal Shah is a consultant obstetrician and gynecologist at
Columbia Asia Hospital – Seremban

Dr. Norintan Binti Zainal Shah

Consultant Obstetrician & Gynecologist

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

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PDF and Online Articles:

What You Should Know About Female DNA - HerInspirasi.com, 4 March 2020

This article first appeared in HerInspirasi.com, 4 March 2020

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What You Should Know About Tuberculosis (TB)

April 21, 2021

Tuberculosis (TB) is the leading cause of death related to infectious diseases worldwide. According to the World Health Organisation (WHO), it is estimated that TB is responsible for 8.6 million new cases in 2014 and approximately 1.5 million deaths. Locally, TB is rampant, with an incidence rate of about 80 patients in 100,000 population.

The main route of transmission of TB is airborne. When a person is infected with TB, a disease of the lungs, whenever he coughs, speaks, or sneezes, the TB germs are spread into the surrounding air. A nearby person becomes infected by means of breathing in the TB bacteria. The bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain if the person is immunocompromised.

Most commonly, a TB patient’s lungs are affected. Symptoms include coughing that lasts three or more weeks, coughing up bloody sputum, chest pain, or pain with breathing or coughing, unintentional weight loss, fatigue, fever, drenching night sweats and decreased appetite. Fifteen to 20 per cent of TB can also affect other parts of your body, including your kidneys, spine, guts or brain. When TB occurs outside your lungs, organ-specific symptoms may be the presenting complaints. For instance, TB of the gut may bring about chronic diarrhoea, and tuberculosis in your kidneys might cause blood in your urine.

If someone is suspected to have TB or has come into contact with a TB patient, they should go to their doctor or local health department for tests. There are two tests that can be used to help detect TB infection: a TB skin test or TB blood test. The skin test is the one that is most often used to detect TB. A small needle is used to put a testing material called tuberculin, under the skin. In two to three days, you return to your health care worker who will check to see if there is a reaction to this test. In some cases, a TB blood test is used to test for TB infection. This blood test measures the reaction of a person’s immune system against the germs that cause TB.

A diagnosis of pulmonary TB can be reached when the patient displays a typical clinical presentation, classical chest x-ray changes and positive sputum (phlegm that is coughed up from deep in the lungs) smears for TB which are Acid-Fast Bacilli (AFB). Generally, a clinician collects phlegm samples for three consecutive days to smear for AFB. This practice has a sensitivity of TB detection approximately 70 per cent when the culture-confirmed TB disease is the reference standard. To tell if someone has TB disease, other tests such as chest x-ray and a sample of sputum sent to culture the deadly bugs, may be needed.

People with TB need to promptly seek treatment, know how to take their TB drugs properly and complete the full course of medicines prescribed. Commonly, the treatment involves taking four medications for six months. It is vital to understand that if TB patients stop taking the drugs prematurely, they can fall sick again. If they do not take the drugs correctly, the germs that are still alive may become resistant to standard drugs or difficult to treat in the future. In addition, they need to fulfil all their doctor appointments. They also need to know how to make sure that they do not pass TB on to other people during their first few weeks of treatment, or until their doctor says they are no longer contagious by observing cough etiquette and respiratory hygiene.

Cough etiquette means that you cover your mouth with a tissue when you cough or sneeze. It is prudent to seal the tissue in a plastic bag, then dispose it into a bin. If you do not have a tissue then you should cough or sneeze into your upper sleeve or elbow. You should not cough into your hands. You should wash your hands after coughing or sneezing.

A TB patient should wear a face mask during the infectious period as it can mitigate the spread of Mycobacterium tuberculosis (the bacteria responsible for TB) from the patient to other people. The face mask plays a vital role in capturing huge moist particles near the mouth and nose of the patient, preventing the germs from being released into the surroundings.

It is advisable for patients infected with TB in the early phase of the disease to sleep alone in a separate, adequately ventilated room, if possible. Avoid using public transport and stay home from work, school, or other public places where large numbers of people gather, minimise social gatherings or interactions and use a fan or open windows to circulate fresh air.

As the common maxim goes, prevention is better than cure. The first step to halt the transmission of TB from one adult to another is identifying people with active TB, and then curing them through the provision of drug treatment. With proper TB treatment, someone with TB will very swiftly not be contagious hence can no longer spread TB to others.

Another crucial armamentarium in the fight against TB is the Bacillus Calmette-Guerin (BCG) vaccine, which was invented in the 1920s. It is one of the most widely used vaccine of all current vaccines. It has inoculated more than 80 per cent of all new-born children and infants in countries where it is part of the national childhood immunisation programme. Although it has been proven to protect children against the disseminated forms of TB, it occupies a lesser role in interrupting transmission among adults.

We also need to ensure certain susceptible individuals who have conditions that make the body weaker and difficult to fight off the TB bacteria to stay away from TB patients as much as possible. These high-risk group includes people with HIV infection, illicit intravenous drug users, babies and young children, elderly people, people with certain medical conditions such as diabetes mellitus, certain types of cancer, and being underweight.

If you are infected but untreated, you can end up with such complications as lung function damage, systemic spread of the bacteria to other parts of your body causing bone pain, meningitis, kidney or liver malfunction. In worse case scenario, mortality can befall the untreated patients.

In conclusion, TB is not only contagious and deadly, but also highly preventable and curable. Heightened public awareness in early detection, treatment, and a diligent completion of the full course of treatment, following the do’s and don’ts when infected, it is possible to curb the transmission of TB thus leading the way forward to a TB-free society in the future.

Dr. Cheong Kuan Loong

Consultant Gastroenterologist & Hepatologist

Columbia Asia Hospital - Puchong
MBBS (UM), M.Med (Int. Med.) (UM), Fellowship in Gastroenterology (Mal)

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PDF and Online Articles:

What You Should Know About Tuberculosis (TB) - Natural Health, Vol.118, March 2021

This article first appeared in Natural Health, Vol.118, March 2021.

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麻醉手术醒来后，你会经历什么？

麻醉手术醒来后，你会经历什么？

October 11, 2021

很多人听说过“麻醉”却不了解它，特别是病人一听见麻醉就很害怕自己一睡不醒，可是我们却没想过麻醉醒来之后会有什么感觉？！到底病人在麻醉手术醒来后，当麻醉效果渐渐消失，你会经历什么？

几乎每一台手术都需要麻醉医生全程参与，包括手术前、手术中以及手术后。麻醉主要分为三大类：全身麻醉 (General Anesthesia，简称GA)、局部麻醉 (Local Anesthesia，简称LA) 以及区域麻醉 (Regional Anesthesia)。它们的主要功能及目的是为了达到以下3 点：

✔ 让病人短暂失去意识

✔ 失去移动能力

✔ 阻断疼痛的感觉

全身麻醉:
 可以成功达到以上3种要求。

区域麻醉:
 如半身麻醉，或者肢体麻醉，病人还是在清醒或半清醒 (药物辅助) 的状态，只是丧失了移动能力和没了疼痛的感觉。

局部麻醉:
 主要是麻醉较小的身体部位如手指或某皮肤部位，让其丧失疼痛的感觉，移动能力也可能被减少。

麻醉后对身体的副作用？

芙蓉哥伦比亚医院的
麻醉科顾问医生——张凯钦医生
透露，除非病人有特殊的疾病，否则一般上的麻醉风险是极低的。

而很多没有动过手术的人大部分都不知道，在全身麻醉手术过后，一旦病人醒来通常会感觉轻微的副作用，比如头痛、头晕等症状。再加上多数的病人在禁食的情况下接受麻醉，然后又经历了一段漫长的手术过程 (手术时间可能很短，也可能长达数小时)，所以当病人恢复意识当儿，也可能出现恶心的情况。

再者，在特殊的情况下麻醉师有时不但需要用药让病人失去知觉、意识，有些人就连呼吸也可能需要用“麻醉机器”来进行呼吸辅助。在这个情况下，医生就会在病人的喉咙置入导气管，因此这一位病人也可能在清醒后感觉喉咙微痛。

若出现一些常见症状：如意识暂时性受影响、判断能力减低和反应不敏捷，请卧床休息数小时。

若病人进行日间手术，回家后出现任何紧急事故，需要寻求最近的医疗帮助，可立即拨电999！

麻醉后的注意事项？

一般情况下，在进行全麻手术后，病人大概需要 45 至 60分钟才会恢复意识。区域或局部麻醉后，一般人需要 4 至 6个小时，让麻醉的身体部位逐渐从局部慢慢恢复到完全正常的状态。一般视乎麻醉药的时效，也在于药物的种类和份量。当麻醉效果渐渐消失后，你的伤口自然会开始感到轻微的疼痛，这也是正常的。

这时候，主治医生通常会为病人配上适当的止痛药。若是病人还是持续感觉非常的疼痛，麻醉医生就会提供疼痛治疗服务。出院后，病人可以依据本身的身体状况，然后依照医嘱处方服药。

如果麻醉区的知觉尚未恢复，建议尽量卧床休息。

如双脚感觉无力、使不上劲，请尽可能让家人帮忙搀扶。

恢复知觉后若身体的疼痛感持续增加，请在医生的指导下服用止痛药。

由于麻醉作用，患者可能会在手术后的12小时内出现恶心、呕吐和头晕的症状。建议采取姿势如平卧、站立和正确的坐姿，并重复这些姿势。

麻醉后的进食注意事项？

建议禁食禁水最少4~6个小时以避免在半清醒状态出现呕吐情况。

当病人在神志完全清醒下，建议可以饮用少量的白开水或果汁。

避免进食一些甜点类食品，或是辛辣、油腻和难以消化的食品。

建议一开始以少量流质和清淡易消化的食物为主。

如感觉身体不适，如出现恶心、呕吐、低血压等，建议病人立即卧床休息。

若长时间不能进食或严重呕吐，需要告诉医生给予适当的治疗。

Dr. Chong Kai Chin

Consultant Anesthesiologist

Columbia Asia Hospital – Seremban
MD (UNIMAS), M Anesthesiology (UM)

PDF and Online Articles:

麻醉手术醒来后，你会经历什么？ - 健康时尚杂志

这篇文章首次刊登在《健康时尚杂志/GoodHealth Magazine》

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What's Hot and Hyped in Injury Care and Prevention - Dr Harjeet Singh [BFM - Podcast]

June 13, 2012

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

From hip replacements to kinesiology tape, there are a multitude of ways in which the medical industry and orthopaedics continue to accelerate, adapt and innovate. Dr. Harjeet Singh dissects some of what's hyped up in injury care and prevention today and gives his take on where the industry is headed and what doctors need to do to keep up.

Listen to the podcast
here
.


When diabetes strikes the young [Press Clipping]

January 22, 2013

New Straits Times - The number of diabetes cases among adolescents and children is growing. Nadia Badarudin gets some tips on its management.

See our Press Clipping:

New Straits Times,

22 January 2013

New Straits Times,

22 January 2013


When Teenagers Get Arthritis

When Teenagers Get Arthritis

January 25, 2022

When you hear the word ‘arthritis’, young people rarely come to mind. But did you know that arthritis also happens to children? Children suffering from arthritis can be as young as six months to 16 years old. Although arthritis happens more among adults, one in every 1k children in the there are many children who suffer from it that makes this topic worth addressing.

Arthritis, first and foremost, is an inflammation, swelling and irritation of the synovial (pronounced: suh-no-vee-ul) membrane which lines the joints such as the knees or knuckles. When it becomes inflamed, fluid is produced. The joints become stiff, swollen, painful and warm to the touch. Over time, the inflammation in these joints can damage the cartilage and bone.

The title of this article, Juvenile Idiopathic Arthritis, is not just about arthritis among teenagers. The word
‘Idiopathic’
 is a medical term doctors use to describe a disease that has no known causes.

Although that may be the case, Juvenile idiopathic arthritis is the most common kind of arthritis among children and teenagers. Children usually find out they have this disease between the ages of six months and 16 years. You also might have heard JIA being referred to Juvenile Rheumatoid Arthritis or JRA.

What Happens When Someone Has JIA?

Those with JIA may have pain and stiffness that can change from day to day or from morning to afternoon. These symptoms come and go. When the condition becomes more active and the symptoms worsen, it's known as a ‘flare-up’.

Juvenile Idiopathic Arthritis often causes only minor problems, but in some cases, it can cause serious joint damage or limit growth. Although JIA mostly affects the joints and surrounding tissues, it can also affect other organs like the eyes, liver, heart, and lungs.

JIA is a chronic condition, meaning it can last for months and years. Sometimes the symptoms just go away with treatment, which is known as
remission
. Remission may last for months, years, or a person's lifetime. In fact, many teens with JIA eventually enter full remission with little or no permanent joint damage.

Types of JIA

There are seven types of JIA:

Systemic JIA
 affects the whole body. With this type of JIA, someone may have high fever that often increases in the evenings and may suddenly drop to normal temperature. During the onset of fever, the patient may feel very ill, pale or develop a rash. The rash may suddenly disappear and then just as quickly reappear. The patient's lymph nodes might become enlarged. Eventually many of the body's joints are affected by swelling, pain and stiffness.

Oligoarthritis
 affects four or fewer joints. A person will notice pain, stiffness or swelling, often in the knee and ankle joints. Sometimes oligoarthritis gives someone an inflammation of the iris (the colored area of the eye) that's known as
iridocyclitis
,
iritis
, or
uveitis
.

Polyarticular arthritis, rheumatoid factor negative
 is a kind of JIA that affects more girls than boys. A person will have swelling or pain in five or more joints. The small joints of the hands are usually affected as well as the weight-bearing joints like the knees, hips, ankles, feet, and neck. In addition, a person may have a low-grade fever, as well as bumps or nodules on parts of the body subjected to pressure from sitting or leaning.

Polyarticular arthritis, rheumatoid factor positive
 is the type of JIA that is most like adult arthritis. This is one of the least common types of JIA, but it carries a higher risk of joint damage.

Psoriatic arthritis
 is when a person has both psoriasis and arthritis.

Enthesitis-related arthritis
 usually affects the lower joints (like the ankle) and the spine. Kids with this type of arthritis also may have
juvenile ankylosing spondylitis
  if joints of the lower back are inflamed. Arthritis that is accompanied by inflammatory bowel disease (like Crohn's disease and ulcerative colitis) also falls into this category of JIA.

Undifferentiated arthritis
 is a doctors’ terminology when someone's arthritis doesn't fit into any of the above categories or falls into more than one of the six categories described above.

What Causes JIA?

Although doctors don't yet know exactly what causes JIA, scientists are researching it. Experts do know that JIA happens because of problems with a person's immune system.

When the immune system isn't working properly, which is something that happens with JIA, it has difficulties telling the difference between the body's own tissues and damaging germs. This confusion causes the immune system to attack and damage the body's healthy tissues. That is what causes the kind of inflammation that goes along with JIA.

JIA isn't contagious.
 You can't catch it from someone else or pass it along to another person the way you might a cold or other infections.

What Do Doctors Do?

It's not always easy for doctors to diagnose JIA right away. Juvenile Idiopathic Arthritis itself can have lots of different symptoms. Some infections, like Lyme disease, have similar symptoms akin to JIA. So doctors will want to rule out any other possibilities before deciding on a JIA diagnosis.

If a doctor suspects a patient has JIA, he or she will ask about the person's symptoms. He will also find out if others in the family have had arthritis, and then carry out a complete physical examination to look for joint swelling, eye problems, and rashes. A doctor may also do blood tests and X-rays. In some cases, doctors may use a needle to take a sample of synovial fluid from a person's joint.

Sometimes, a doctor might need to see a patient for several months to determine the particular type of JIA the person has.

How Is JIA Treated?

When JIA is diagnosed early and treated appropriately, it can usually be managed effectively. There is no cure, but there are many doctors who can help ease the symptoms of JIA and prevent or limit damage to joints.

For some people, taking medications like ibuprofen or naproxen can help reduce inflammation. Some patients need to take a weekly medication called methotrexate. Newer medications — such as etanercept, adalimumab, abatacept, and tocilizumab — can keep the immune system in check and control the disease far better than what was possible a few years ago. For arthritis flare-ups, doctors may also use medicines called corticosteroids (like prednisone), but they try to limit these to avoid side effects.

Physical therapy exercises that improve flexibility and the use of heat can help people with JIA control symptoms. It is rare that joints get damaged in a person's teens, but surgery can repair damaged joints if needed.

Living With JIA

If you have JIA, it may be hard to get out of bed during some mornings. Periods of inactivity, like sleeping for eight hours, can be followed by stiffness.

It may be tempting to roll back into bed and sleep the day away, but that can make things worse. Even though you may feel lousy sometimes, gentle movements can help you feel better. Just as runners, bodybuilders, and other athletes do stretching exercises to warm up,
gentle massaging and stretching can help soothe the muscles and ligaments around sore joints.

Once a person is up and moving, the discomfort usually lessens.
 Exercise can help keep full motions in your joints and strengthen your muscles and bones. A physical therapist can help you plan an effective exercise program to do at home.
Proper nutrition can improve anyone's overall health.
 A dietitian can help you to understand the basics of a healthy diet. For example, when your symptoms flare up, you might feel sick and unable to eat as much. A dietitian can help you find foods that have a higher nutritional value to make up for having a poor appetite.

A positive mental outlook is just as important as exercises and a healthy diet.
If you feel depressed or angry, talk to someone who can support you.
  Tell your parents, your doctor, or a friend about how you feel. It may also help to do simple things that we often take for granted. For example, each day try to do something that you enjoy and makes you happy.

Most teens with JIA do the same activities as other teens — go to schools, hang out with friends, and stay active physically, academically, and socially. Learning more about JIA and taking change of your medical care can help some people feel more in control, too.

Your doctor and other medical professionals are there to support you and help you manage the condition so that it has the least possible impact on your life.

Dr. Gunaseelan A/L Ponnusamy

Consultant Orthopedic Surgeon

Columbia Asia Hospital – Tebrau
MD (Indonesia), Doctor of Orthopedic & Traumatology (UKM), CMIA (NIOSH), Special Interest in Spine Surgery (Korea) & Pain Intervention (India)

Make an Appointment

PDF and Online Articles:

Juvenile Arthritis: When Teenagers Get Arthritis – Natural Health, Vol. 124, November/December 2021.

This article first appeared in Natural Health, Vol. 124, November/December 2021.

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Who are we - the Radiologists?

Who are we - the Radiologists?

February 28, 2011

Many patients have visited Imaging Department of the hospital for various imaging procedures. Some of the patients left the department without encountering us. Some of the patients know the existence of a radiologist when an ultrasound or interventional procedures were being performed on them. Some are really concerned about us for dealing with daily radiation.

In Imaging Department, there are several working groups of people to provide a complete set of radiological services. These include the radiologists, the radiographers and the nurses.

Radiologists are medical doctors (MDs) or doctors of osteopathic medicine (DOs) who specialize in diagnosing and treating diseases and injuries using medical imaging techniques, such as X-Rays, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Nuclear Medicine, Positron Emission Tomography (PET), and Ultrasound.

Radiologists graduate from accredited medical schools, pass a licensing examination, and then go on to complete a residency of at least four years of unique post-graduate medical education in, among other topics:

Radiation safety and protection

Radiation effects on the human body

Appropriate performance and interpretation of quality radiological and medical imaging examinations

Radiological procedures are medically prescribed and should only be conducted by appropriately trained and certified radiologists.

We play a Key Role in Your Health by:

Acting as an expert consultant to your referring physician (the doctor who sent you to the radiology department or clinic for testing) by aiding him or her in choosing the proper examination, interpreting the resulting medical images, and in using test results in your care.

Treating diseases by means of minimally invasive, image-guided surgery (interventional radiology).

Correlating medical image findings with other examinations and tests.

Recommending further appropriate examinations or treatments when necessary, and conferring with referring physicians.

Directing radiology technologists (personnel who operate the equipment) in the proper performance of quality exams.

We have the Right Training, Knowledge, and Experience

When your referring doctors tell you they have reviewed your studies, what they usually mean is that they have reviewed the radiology report and gone over the study with your radiologist.

We must remember that good health care is a team effort from the family doctors, to the nurses, to the radiologists. And while the radiologists may not be the star quarterback, they are certainly taking one for the team.

The radiographers (radiologic technologists) are the ‘backbone’ of Imaging Department. They run the X-ray equipment and work directly with the patient and radiologist. A radiologist needs a good quality set of images provided by radiographers for interpretation. The radiologic nurse usually develops and manages a care plan to help patients understand procedures and, later, recuperate from the procedures. This may also include working with a patient's family. The nurse can perform examinations or carry out preventive health measures within the prescribed guidelines and instructions of the radiologist. Often, a radiologic nurse will assist during examinations or therapy.

Computers and the digital world have influenced the science of Radiology bringing it to what it is today. Storage of digital images is undertaken by a picture archiving and communication system (PACS).
Dr. Wong Soon Li

Consultant Radiologist

Columbia Asia Hospitals- Bukit Rimau


Why isn't my child talking?

 Why isn't my child talking?

April 20, 2023

“Why isn’t my child talking yet?” is a question that voices panic and concern. When other children can already hold simple conversation with mummy and daddy, you struggle to get any words from your little one. Before we get into the details of speech delay in children, let’s take a look at the basics.

The definition of speech and language

Speech is how we say sounds and words, using the mouth, lips and tongue. It includes articulation. For example, we need to be able to say the “r” sound to say "rabbit" instead of "wabbit.” Using our vocal folds and breath, we also use the frequency of our voice to produce sounds that are loud, soft, high-pitched or low-pitched.

Fluency matters too. This has to do with the rhythm of our speech. Stuttering is an example of what can happen when you have a problem with speech rhythm.

Most importantly is the language we speak to refer to the words we use, and how we use them to share ideas. Language addresses what words mean. Some words have more than one meaning. For example, ‘star’ can be a bright object in the sky or someone famous. Language also allows new words such as ‘friend’, ‘friendly’ or ‘unfriendly’ with each on denoting different meaning. It is how we put words together. For example, in English we say, “Lisa walked to the new store,” instead of, “Lisa, walk, store, new,”.
Common speech milestones of a child

Before a child reaches one year old, he should be able to coo and babble. It is also normal for a toddler to mimic different sounds and words he hears, much to the amusement of parents who have no idea yet of what is being said. The child would also use gestures to communicate such as waving and pointing. When you call his name, he would turn around to look at you. He would understand names of common items like 'ball', 'milk or 'shoe’.

Between one to two years old, toddlers should be able to follow simple instructions, identify a few body parts, use single words consistently, starts using some two-word phrases like ‘no milk' or ‘mommy go’. They can also ask simple questions such as ‘what is that?’. When they reach two to three years old, they can follow two-step instructions like ‘take the book and give it to daddy’. They would also understand concepts. They use two- to three-word utterances like 'daddy shoe blue’. They understand simple questions.

At three to four years, they can identify colors. They can also use four to five-word utterances. They can answer 'where' questions. Most importantly, their speech is easily understood by listeners who are unfamiliar with the child’s speech. Upon reaching four years and above, they can follow longer and more complex instructions. They can even tell a simple story, and use conjunctions such as 'and', 'but', 'so', in order to connect phrases and sentences.

Red flags for speech and language delay

Speech and language delay is when a child is unable to reach speech and language milestones as expected. If you refer to the milestones mentioned above, you can see if your child’s language milestone development tallies. There are certain occurrences that should raise an alarm for concern, other than not showing an interest in communicating.

No babbling by 12 months.

Does not respond to his/her name by 12 months.

Does not use gestures like waving ‘bye bye’ or shaking head for ‘no’ by 12 months.

Does not point to objects or pictures when asked to, by 17 months.

No first words by 18 months.

Does not understand basic commands by 18 months.

No word combinations by 24 months.

Causes of speech delay

There are several causes for speech delay in children. They can be related to Global Developmental Delay where a child takes a longer time to reach certain development milestones compared to other children their age. This may include learning to walk or talk, movement skills, learning new things and interacting with others, socially and emotionally. If the child has Autism Spectrum Disorder, Down Syndrome or Cerebral Palsy, or hearing impairment, he or she would most likely experience a delay in speech development.

Another reason for speech delay is excessive screen time. Long hours of being on the phone or tablet tend to create a breakdown in two-way communication resulting in poor parent-child interaction. The child may also imitate cartoon-like speech, prefers using gestures rather than talking, and seemingly obsessed with visual lightings and sounds.

Stimulate language in your child

Experts use four types of language stimulation to help with speech delay. Here are some examples for you to emulate:
1. Self-talk

Whenever you are engaged in an activity, describe your actions by using short and simple sentences. For example, “Mummy is cooking.” or “Daddy is eating biscuits.”
2. Parallel Talk

This is a reverse of the above where you describe the actions your child is doing. Likewise, use short, simple and easy-to-understand sentences, such as “You are kicking a ball.”, or “Aishah is drinking milk.”.
3. Repetition

Repeat what your child says. For example, when your child points to a car, you can reiterate by saying, “Yes, that is a car.” Or, if he points to a bird in the sky, you can say, “Yes, that is a bird.”.
4. Extension

Build your child’s vocabulary by adding on suitable words to what he or she says. For example, when your child says, ‘teeth’, you can add on by saying “Brush teeth.” Or if he or she says ‘water’, you can add on “You are drinking water.”.

Seeking the help of a speech therapist

The job of a speech therapist is to provide clinical services for speech, language, communication, feeding and swallowing problems. The experts use play activities during therapy which is literally an acronym for:
P - People Skills

People skills are about requesting, asking permission, taking turns, sharing, negotiating, and discussing.
L - Language Skills

These consist of new vocabulary and concepts, as well as sequence and narrative skills, and the ability to follow simple to complex commands.
A - Attention

This requires attention to details and information; hence it focuses on listening skills, following instructions and rules.
Y - Youthful Imagination

Children’s brains are stimulated to create endless ideas and stories.

Wong Yee Ling

Speech Language Therapist

Columbia Asia Hospital – Bintulu

PDF and Online Articles:

Speech Delay in Children: Issue Beyond Sounds, Languages – Borneo Post, 9 April 2023

This article first appeared in Borneo Post, 9 April 2023.

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Why Reading In The Toilet is Bad For You

May 13, 2019

Sitting on the toilet for a prolonged period of time is no good news.

Do you have the habit of spending more time than needed when you’re in the toilet because you’re too caught up on that gossip or news column on your phone? You’re not alone – reading in the toilet is a popular habit, but it isn’t necessarily good for you. We spoke to Dr Venayagamurthy Kanisan, consultant general and colorectal surgeon at Columbia Asia Hospital, and he explained to us how you should only reserve the time at the cubicle for two purposes.
Focus on your Number 1 and Number 2

“Your body needs to be conditioned in such a way that when you see the toilet, it is only for urination or defecation. The process of defecation in controlled by nerves and muscles. If someone focuses on gadgets instead of the act of defecation, it may result in in-coordination of the pelvic floor muscles which can result in a prolonged defecation or excessive straining. Time spent in the toilet should only be around 10 minutes,” Dr Venayagamurthy shared.
Detrimental to your health

Dr Venayagamurthy added that “sitting too long on the toilet also exerts excessive pressure on the blood vessels, muscles, tissues, and nerves in the anal region. This leads to engorgement of the anal cushions in the anal canal, resulting in haemorrhoids. Besides that, it can weaken the pelvic muscles and lead to rectal prolapse (lower part of large intestine protruding out of anus). Other possible complications include hernia (due to prolonged straining) and exacerbation of varicoceles (bag of veins in the testicles).

So, focus on toilet matters when you’re in the toilet. The reading and scrolling can come later!

Dr. Venayagamurthy A/L Kanisan

Consultant General and Colorectal Surgeon

Columbia Asia Hospital - Cheras

PDF and Online Articles:

Why Reading In The Toilet is Bad For You - Herinspirasi May 8, 2019

This article first appeared in HerInspirasi.com, 8 May 2019

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Why You Shouldn’t Play it Cool When it Comes to Heatstroke

May 26, 2023

This serious and life-threatening condition occurs when the body’s temperature regulation system is overwhelmed by heat.

The recent deaths of two children in Kelantan from heatstroke has prompted the health ministry to send out warnings, driving home the fact that Malaysia’s high temperatures cannot be taken lightly.

A serious medical condition that requires immediate attention, heatstroke occurs when the body’s temperature regulation system is overcome by heat. Symptoms may include:

A high body temperature above 40°C;

Rapid heartbeat;

Rapid or laboured breathing;

Headache, dizziness or lightheadedness;

confusion or disorientation;

Nausea or vomiting;

Seizures; and/or

Loss of consciousness.

Emotional sensations such as anxiety and agitation, and a sense of being overwhelmed can also occur due to the body’s response to high temperatures. Failure to treat heatstroke could lead to organ damage or be fatal.

That said, it can sometimes be difficult to differentiate between someone who is simply hot and sweaty, and someone who is experiencing heat exhaustion.

With the latter, one’s body temperature typically rises above 40°C. The skin might feel dry and hot, causing sweating to stop altogether.

In contrast, those who are merely exerted usually continue to perspire, and are unlikely to experience the symptoms above.

Treatment and severity

In mild cases, heatstroke is often treated effectively through rest and rehydration. The individual usually recovers without any long-term effects.

But in more severe instances, damage to the body’s organs and tissues can be permanent, leading to long-term health complications. For example, heatstroke could cause damage to the brain, resulting in cognitive impairment, memory problems, and difficulties with coordination and movement.

It may also cause damage to the kidneys, liver, and heart, leading to organ failure and other serious complications.

The duration of sun exposure that leads to heatstroke varies depending on factors such as the overall temperature and humidity, as well as the individual’s age, health, and physical wellbeing.

There is no set amount of time for how long someone needs to be out in the sun to get heatstroke. It could develop within just a few hours of exposure to high temperatures and humidity, especially if the person is performing strenuous activity.

As some individuals may be more susceptible than others, it’s crucial to take precautions such as wearing light clothing, using umbrellas or taking breaks in shaded or cool areas, and drinking lots of water.

Indoor risks

Heatstroke can occur indoors, too, especially during extended periods when the outdoor temperature is very high. Indoor temperatures can rise to the point that it is equal or greater than outside, especially in buildings with poor ventilation or no air conditioning.

As such, individuals who spend prolonged periods indoors – especially the elderly, infants, and those with chronic health conditions – are also at risk of heatstroke. In large cities, those who live in high-rise buildings with inadequate ventilation and no air conditioning are vulnerable during heatwaves.

Furthermore, certain indoor activities, such as cooking in a hot kitchen, using hot tubs or saunas, or working in high-temperature environments, increase the risk of heat exhaustion.

To avoid heatstroke while indoors, use fans or air conditioning, or open windows to increase ventilation. Do note, however, that the latter could result in hot air from outside coming into the room.

Again, wear appropriate clothing, try to keep cool by using a cold compress, and stay hydrated by drinking plenty of fluids even if you don’t feel thirsty.

Dr. Syed Farid Almufazal Bin Syed Salim

Consultant Emergency Physician & Head of Emergency Department

Columbia Asia Hospital - Seremban
MBBS (UK), MMed (Emergency Medicine) (UKM)

PDF and Online Articles:

Why You Shouldn’t Play it Cool When it Comes to Heatstroke – Free Malaysia Today, 9 May 2023

This article first appeared in Free Malaysia Today, 9 May 2023.

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Why You So Fat Ah?

Why You So Fat Ah?

May 14, 2016

Malaysia is the fattest nation in Southeast Asia, a situation that's bound to have far-reaching implications for all areas of life. Find out the truth behind the pandemic and how to keep your health in check.

Men's Health, May 2016
.

Men's Health, May 2016
.


Women and Fitness - Dr Harjeet Singh [BFM - Podcast]

March 15, 2012

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

While we covered some ground in our last interview with Carolyne Anthony, Dr. Harjeet Singh, consultant orthopaedic surgeon offers a different take on women and fitness, discussing the physiological differences between men and women and why some results will necessarily be different.

Listen to the podcast
here
.


Worm Infections

Worm Infections

June 19, 2018

WORM infections are very common and spread easily. They often don’t have symptoms and are often under-reported. There are different types of worm infections. Pinworms are a common kind that affect young children. Hookworms, roundworms and whipworm infections are also common. Children get worms when they come into contact with infected soil in playgrounds or during outdoor play. When they put their hands into their mouth such as for thumb sucking, the worms or eggs will go into their intestine. Touching pets or their excrement infected with worms is another common way to get worm infestation.

Very often, a worm infestation does not show symptoms or the symptoms may be so slight and gradual that they are overlooked. It is one of the leading causes of stomach ache in children. Depending on the type of worm infection and the severity of the infections, a child with worms may have some common signs or symptoms, like a sore tummy, weight loss, loss of appetite, irritability, nausea or vomiting, itching or pain around the anus. Very rarely if there are many worms, there can be blockage of the intestines.

If left untreated, they can become severs, as the worms can lead to intestinal bleeding. This can then lead to malnutrition, weight loss and complications like anaemia. Infected children then become more vulnerable to illness, as their immune systems are damaged. If the condition persists, the worm infection can also harm the infected child’s physical and intellectual development, delaying growth and affecting cognitive function, especially if it results in anaemia and malnutrition.

The treatment of worm infection is quite simple and often involves a course of anti-parasitic medicine. Don’t buy over-the-counter medicines or herbal remedies, as some anti-worm medicines may be unsuitable for children less than 2 years old. You may also be tempted to try alternative medicines like herbal remedies but there isn’t any evidence proving their effectiveness. It is best to obtain professional advice from your physician.

The World Health Organisation recommends that preschool children receive regular deworming treatments every six months after they turn one.

Here are a few things you can do to keep your child safe from worm infections:

Always ensure that your child plays in a clean, dry area.

Keep your toilet clean.

If your child is old enough, teach him to wash hands after going to the toilet every time.

Always drink boil or filtered water.

Wash fruit and vegetables thoroughly in clean water.

Cook meat and fish thoroughly till there are no raw bits.

You can always speak to your doctor for more information and the required treatment.

Answers provided by Dr Lim Kok Chong, consultant paediatrician, Columbia Asia Hospital — Bukit Rimau.
Published in New Straits Times, 5 June 2018

Worm Infections – New Straits Time, 5 June 2018


Your Essential Office Snacks

Your Essential Office Snacks

June 02, 2016

While you are busy with back to back meetings or stressed out over a big project, keep your body and brain fuelled with these healthy eats.

Your Essential Office Snacks - HER WORLD Magazine, Issue Jan 2016