Poached Seabass With Cauliflower Puree

Poached Seabass With Cauliflower Puree

June 21, 2016

In a survey conducted by the Academy of Nutrition and Dietetics, parents ranked highest as nutrition role models by kids below 12. However, the majority are unaware that their children look up to them to develop a healthy lifestyle.

Here are some tips to boost a child’s nutrition knowledge:

Try new healthy foods or recipes regularly.
 A lot of parents choose to cook what their children love the most because the children refuse to try new food. This will limit the child to explore more food variety. The tip here is to try and modify the new food and present it using different cooking methods. Parents should never give up trying to introduce new healthy food to their children even if they reject it the first time.

Let the kids serve themselves and learn food preparation.
 The Nutrition Society of Malaysia encourage parents to cook together with their children. Food experts encourage parents to bring their children grocery-shopping as well. Thus, parents can teach their children how to read nutrition labels and understand better the healthy ingredients from different food groups.

Chef Mahmor Abas from Columbia Asia Hospital - Iskandar Puteri presents a simple dish that can be prepared by kids under parental guidance and supervision.

Q: Share with us your experience in cooking with children.

Chef Mahmor:
 From my tenure in the hotel industry, I have experience participating in kids cooking classes whereby we teach children how to prepare simple dishes. I also enjoy spending time cooking at home with my kids.
Q: How safe is it for kids to be cooking?

Chef Mahmor:
 It is safe as long as they are well-supervised by adult to ensure their safety.
Q: What dish will you be introducing to us today?

Chef Mahmor:
 Poached seabass with cauliflower puree. This is a healthy recipe. It only takes around 20 minutes to cook.
Q: In its preparation, which cooking method is involved?

Chef Mahmor:
 Poaching is the main cooking method for this dish. Poaching means submerging food in liquid (stock) in low temperature (relatively low temperature compared with simmering and boiling).

Recipe

Poached Seabass with Cauliflower Puree

Serves 10

Ingredients:
Poached Seabass

½ medium Carrot

½ stalk Celery

½ medium Zucchini green

1 tablespoon Olive oil

½ teaspoon Fennel seed

½ teaspoon Parsley, chopped

3 cups Water

4 pieces Seabass fillet (approximate 120gram per fillet)

Lemon juice, to taste

Salt, to taste

Pepper, to taste

Method

Cut vegetables into cubes.

Heat oil in sauce pan. Add vegetables and season with salt and pepper.

Cover and cook for 5 minutes over low heat.

Remove vegetables from pan and set aside.

Add water to sauce pan. Season with salt and pepper and boil for 8 minutes over low heat.

Add seabass into pan. Simmer for 6 minutes over low heat. During cooking, turn seabass once.

Put back the vegetables into the pan for 2 minutes (before seabass is fully cooked).

Remove the cooked seabass from pan (the seabass is cooked when flesh feels firm to touch). Sprinkle with lemon juice and serve with vegetables.

Puree of Cauliflower

1 small Cauliflower

1 ½ cup Potatoes, mashed

3 tablespoons Unsalted butter

2 tablespoons Low fat milk

Salt, to taste

Pepper, to taste

Method

Remove and discard outer leaves from cauliflower. Wash and cook the whole cauliflower in salted boiling water (core side down). Cook for approximate 15 minutes depending on size.

Remove cauliflower and drain the water. Divide into large florets and force through sieve into bowl.

Place pureed cauliflower into sauce pan and cook on very low heat for 3 minutes.

Add mashed potatoes, unsalted butter and low fat milk. Season with salt and pepper. Mix well and serve together with seabass.

Nutrient Content (per serving):

Calorie (kcal) -
303

Protein (g) -
27

Fat (g) -
15

Carbohydrates (g) -
15

Sodium (mg) -
203

Fibre (g) -
3

Recipe prepared by:
Chef Mahmor Bin Abas
Columbia Asia Hospital - Iskandar Puteri

Nutrition information by:
Kong Woan Fei

Dietitian
Columbia Asia Hospital


Polycystic Ovary Syndrome (PCOS) in a Nutshell

January 06, 2021

What is it?

Polycystic ovary syndrome (PCOS) is the most common hormone abnormality of reproductive-aged women, occurring in up to 10% of such individuals. It is characterized by excess production of the testosterone, menstrual irregularity when ovulation does not occur and enlarged ovaries containing multiple small follicles. These ovaries lined up on the surface of the ovaries, which appears like a “pearl necklace.”

What causes it?

The exact cause of PCOS is unknown. It is more prevalent among family members than in the general population, suggesting that genes can influence the development of PCOS. One study in Sweden had shown that daughters of women with PCOS are five times more likely to have it too. Lifestyle, including diet and exercise, also affects the severity of PCOS. Weight gain can worsen both reproductive and metabolic abnormalities.

What are the signs and symptoms of PCOS?

There are several combinations of signs and symptoms that may be accounted for in the diagnosis of PCOS, resulting in different phenotypes for the same syndrome.

Some have minimal signs/symptoms, while others may experience several of them. It can vary widely which may include irregular menses, excess body and facial hair, overweight or obesity, acne, darkening or thickening of the skin on the neck and armpits as well as scalp hair loss.

How to diagnose?

There is no single test that can diagnose PCOS. It is based on a combination of clinical findings such as medical history, physical examination, ultrasound findings of the ovaries, as well as blood investigations. Currently, health professionals are using the Rotterdam criteria to diagnose PCOS.

Complications of PCOS?

Women with PCOS have a hormonal imbalance and metabolism problems that can affect their overall health and appearance. It can cause a woman difficulty in getting pregnant. She also has a higher risk of miscarriage and developing diabetes mellitus and hypertension during pregnancy.

Women with PCOS also at increased risk of development of metabolic syndrome with its associated risks of heart disease and stroke. They are also at risk of mood disorders such as depression, anxiety and eating disorders. The hormone imbalance also increases the risk of endometrial cancer (cancer of the inside lining of the uterus).

What happens if PCOS is left untreated?

If PCOS left unchecked or untreated, those women are at higher risk of developing:

Type 2 diabetes mellitus, especially if women are overweight (BMI>25). Even if the BMI is normal, a woman with PCOS should be screened for diabetes if age is more than 40 years old, has a personal history of gestational diabetes, or has a family history of diabetes. PCOS is classified as a nonmodifiable risk factor for type 2 diabetes. Insulin resistance that occurs in PCOS leads to compensatory hyperinsulinemia, which in turn increases ovarian androgen synthesis by direct ovarian actions and by stimulating Luteinizing Hormone secretion. Insulin resistance also induces dyslipidemia, therefore increase the risk for diabetes mellitus and cardiovascular disease.

Non-alcoholic fatty liver disease: Recent studies indicated that PCOS is associated with lowgrade chronic inflammation and that women with PCOS are at increased risk of non-alcoholic fatty liver disease.

Endometrial cancer: The hormone imbalance also increases the risk of endometrial cancer (cancer of the inside lining of the uterus). Low level of progesterone that occur in PCOS, causing unopposed estrogen stimulation of endometrium resulting in endometrial hyperplasia and cancer.

Sleep apnoea: The prevalence of sleep apnoea is increased in obese women with PCOS. Hyperandrogenism and insulin resistance are positively associated with obstructive sleep apnoea in PCOS.

Mood disorders such as depression, anxiety and eating disorders.

Overall, the health risks associated with PCOS is lifelong.

Does PCOS affect pregnancy?

One of the features of PCOS in anovulation, i.e. failure of the follicular/ovum development. This can result in difficulty in getting pregnant. She also has a higher risk of miscarriage and developing diabetes mellitus and hypertension during pregnancy.

Is PCOS linked to other health issues?

Yes definitely! For those women less than 50 years old with PCOS, they are at an increased risk for cardiovascular disease. Maybe because they are more likely to be overweight and have high blood pressure and diabetes compare to those without PCOS. However, for those above 50 years old, there was no difference in terms of risk of cardiovascular disease.

What are the treatments of PCOS?

There is no cure for PCOS, and it does not go away on its own. The overall goals of therapy of women with PCOS include the mitigation of hyperandrogenic symptoms, management of metabolic abnormalities and reduction of risk factors for type 2 diabetes and cardiovascular disease, prevention of endometrial hyperplasia, planning and obtaining a safe pregnancy if desired, and improving general well-being and quality of life. These goals are ideally achieved by a multidisciplinary team providing patient-centered care.

Lifestyle modification is the key to managing PCOS in an overweight woman. Even a modest weight loss can improve symptoms. Knowing the right types of foods to eat together with exercise can bring down insulin levels and can help with weight loss. Diet and exercise are also important for cardiovascular health and improve mood.

Metformin, an Insulin sensitizer has long been used in women with PCOS to counteract the Insulin resistance and its sequelae. Also, combined oral contraceptive pills to decrease the androgens level as well as for endometrial protection.

The latest research of PCOS?

Few studies had shown that women with PCOS have a lower level of Vitamin D. Therefore, it is recommended that women with PCOS be given a Vitamin D supplement that may decrease chronic inflammation associated with PCOS.

Improved PCOS symptoms correlate with gut bacteria. It was noted that women with PCOS have less diverse gut bacterial composition. Studies in the mouse model have shown improvement in PCOS symptoms with exposure to healthy gut bacteria. Therefore, prebiotics and probiotics may be used as part of treatment for women with PCOS.

Having said that, a lot more research is needed to understand this disease further and to improve the treatment outcome.

Dr. Khairiah Binti Seman

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital - Klang
MBBS (Australia), MMed (Obs & Gyn)(USM)

Make an Appointment

PDF and Online Articles:

Polycystic Ovary Syndrome (PCOS) in a Nutshell – InfoMed Malaysia, Issue 35, Oct - Dec 2020

This article first appeared in InfoMed Malaysia, Issue 35, Oct - Dec 2020.

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跟着自己节奏走 产后减重在于持续非速成

跟着自己节奏走 产后减重在于持续非速成

May 17, 2022

孕妇体重的增加范围需取得平衡，过多或过少都不好。其实这些重量不全都是到了胎儿身上，也不是大众所想像的单纯变胖或脂肪增加，而是身体在做准备，以便帮助孕妇和胎儿健康安全度过整个孕期、分娩和哺乳期。一般上，处于正常BMI范围的女性，整个孕期增加大约11.5至16公斤最为理想，即平均每月增加1.6公斤。

“怀孕期间体重增加是必然的，然而我们不时能看见‘明星怀孕只胖4公斤！’或‘艺人怀孕只胖肚子四肢仍纤细！’等新闻，那么孕妇的体重增加多少才是正常的呢？

事实上，孕妇体重适当地增加很重要，这是为了帮助身体度过妊娠期所做的准备，太多或太少都不妥。数据显示，只有大约三分之一孕妇达到医学建议的体重标准，其他则是过多导致肥胖，不然就是过少或完全没有增重。

我们主要以孕前的身体质量指数（Body Mass Index，BMI）计算。处于正常BMI范围（18.5至24.9）的女性，整个孕期增加大约11.5至16公斤最为理想，即平均每月增加1.6公斤。若本身体重过轻（BMI低于18.5），则可以接受孕期时增多一些，大约12.5至18公斤。孕前体重为过重（BMI介于25至29.9）或肥胖（BMI在30以上）者，则建议体重增加控制在7至11.5公斤，以及5至9公斤。

双身子须吃双倍分量？

大多数人会说孕妇是‘双身子’所以需要吃双倍分量，事实上不太正确。许多孕妇在孕早期（0至13周）会有恶心和呕吐等症状，由于食欲不振，吃得也不多。等到体内荷尔蒙的改变趋向稳定，她们就会感到肚子饿或食欲增加，突然开始吃得很多，体重就迅速上升。此时她们往往会担心自己胖得太快了，或许还会想要减肥，但是请别忘了自己在一开始是几乎没有增重的。

孕妇体重的增加会因孕早期、中期和晚期有所不同。在怀孕的首3个月，他们不需要额外增加热量摄入，保持和孕前一样就可。到了孕中期（14至26周），每日需要增加大约350大卡，到了孕晚期（27至40周）则可以酌情增加约450大卡。

因此，孕妇体重的增加范围需取得平衡，过多或过少都不好。其实这些重量不全都是到了胎儿身上，也不是大众所想像的单纯变胖或脂肪增加，而是身体在做准备，以便帮助孕妇和胎儿健康安全度过整个孕期、分娩和哺乳期。

在这期间，孕妇的乳房会增加约0.5 至 1.5 公斤，这些增加的乳腺和脂肪组织都是为母乳喂养做准备。其次，原本如一颗乒乓球大小的子宫也会随着胎儿长大而变大，大约增加1公斤。别忘了胎盘大约会占0.5至1公斤，而羊水大约1公斤，若是怀有双胞胎则会有两个羊水池，那么重量就会多出许多。

血容量增易水肿

由于孕期荷尔蒙变化，孕妇的血容量会增加大约1.5至2公斤。或许大家也听过孕妇提及小腿浮肿等，水肿现象在妊娠期非常常见，而这些液体可能有1至1.5公斤。最后，有大约2至4公斤的重量是身体贮存的脂肪（fat storage）。

以上种种再加上大约三四公斤的胎儿，就可粗略计算出孕妇所需增加的体重。任何超出身体所需的重量，会引发肥胖症，而这将令糖尿病、高血压或其他并发症等风险提高。

骨盆底肌松弛 漏尿子宫脱垂

从女人到母亲，总是要面临许多身体变化，有一些则可能是永久性的。

举例而言，支撑子宫、膀胱和肠的骨盆底肌肉（pelvic floor muscles）本是非常强的肌肉，而怀孕期间它需要支撑胎儿、增大的子宫和羊水，长期的承重和拉长可导致骨盆肌松弛，导致产后一些漏尿问题。若有多次怀孕而没有将时间间隔开来，就可能会造成产后的子宫脱垂。

另外，怀孕后女性荷尔蒙的分泌增加，会促进乳腺发育，为哺乳做准备，胸部会变得比较饱满。结束哺乳期后，一些乳腺和组织会转化成脂肪而没有消失，因此她们的内衣可能需要大一个罩杯。

盆骨开身形变宽

不得不提的便是皮肤扩张纹（stretch marks），或是一般人认知的妊娠纹。生产之后，这些皮肤上暗色的疤痕会渐渐随着时间变浅变细，但不会完全消失。

不仅如此，她们的体型也不会完全恢复如初，因为怀孕时肋骨腔通常会变宽，分娩时盆骨（pelvic bone）会打开一些，以便胎儿能够顺利出来。因此，许多女性会发现在生了孩子之后，就算瘦下来也很难穿上以前的一些紧身衣，这就是因身形变宽了一些。有时，鞋码也会变大一号。

自然产Vs剖腹产

产后减重不易有许多因素，其中一个是生活方式的改变，在孕期维持的饮食习惯很难一下子改变。

另外，产后子宫收缩是每名母亲都会遇到的生理现象；若是自然产，会阴可能会撕裂或进行会阴切开术。因此，她们会经历许多生理变化，可能有子宫痉挛或疼痛等症状，所以绝对不可勉强在生产后马上开始运动减重。

一般上，自然产后运动可以是渐进式的，从轻微的步行、伸展运动开始。在欧洲国家，妈妈们其实会将新生儿绑在身上一起到公园慢走，同时能与其他新手妈妈一起交流，起到鼓励的作用。不过，本地主要遵循坐月子习俗，因此妈妈和新生儿都是被保护起来的，没有见到其他人，这在文化上有些不同。

可选择固定式脚踏车

若是剖腹产，则需要面临更长的复原期。她可以慢走或进行伸展运动，但是需要根据自身状况去进行。一些低冲击（low impact）运动如游泳、瑜伽应该是无碍的。若要尝试其他或提升强度，建议咨询自己各自的医生，以评估是否会对身体造成伤害。

另外，固定式脚踏车（stationary bike）也是挺不错的选择，能够增强肌力和帮助减重。只是在产后有伤口或缝线的人，起初会感到比较不舒服。总的来说，产后减重胥视个人身心状况和意愿，用适合自己的步伐前进就好。一般上产后12周就可以从低冲击运动迈入中等强度运动。

勿以明星作对照

现今的新闻不时报导名人或明星们产后瘦身迅速，不一会儿就在幕前展现出窈窕的身材，被赞‘生完像没生过’等。这些产后瘦身话题，或多或少都让辛苦生下孩子的女性倍感压力，甚至会开始认为自己不够好、不够努力，所以瘦得不够快，产生负面情绪。

其实妈妈们千万别因此感到压力，保持良好的状态与身材是明星的工作需求，她们减重的方法有时非常激烈，或是饮食上控制得非常严格，不像我们普通人比较轻松一些，偶尔可以‘偷吃’一些不健康的食物。

说来也是挺遗憾，不仅是我们国家，世界许多地方都将苗条和漂亮视为完美。然而，身材苗条和脸蛋漂亮并不意味着一个人在健康方面一切都好。我曾见过不少身材瘦小女性有许多健康问题，因此不应将苗条视为一个标准。

拼瘦身诱产后忧郁

怀孕是一趟美丽的旅程，每个人的经历不一，所以不要以某某人作为自己的对照。与其让过程变得‘竞争性’，不如去享受这个过程，因为心理健康也至关重要。有时，女性产后想要迅速瘦身恢复产前自信心，或是认为这是社会的标准等，最终承受了巨大压力，这样一来非常容易进入产后忧郁。

丈夫本身也应该明白这个事实，给予妻子最大的支持。快速减重不是产后最重要的事情，回归健康生活和饮食习惯，从中计划正确和可持续性的减重更为重要。女性在产后需要应对的事情太多了，因此我们要经常告诉他们，按照自己的节奏来就好，照顾好生理和心里健康优先，不要急着将自己套入以前的某件紧身裙。

另外，市面上存在许多宣称有瘦身效果的产品，有些甚至是没有准证的，我曾见过许多人尝试而得到并发症。其实最佳减重方法是改变生活方式，控制饮食和运动，不在于速成，而是在于持续。因此，请享受怀孕、产后以及哺乳的过程，想要减重，跟着自己的节奏进行即可！

产后减重2问：喂母乳 每天耗500大卡

问1：诞下婴儿当天，孕妇体重会骤降吗？

答：除了胎儿本身大约三四公斤的重量，羊水流失和胎盘分离分别占1公斤，子宫也会缩回至原本大小，加起来大约是六七公斤左右，这些是分娩之后会马上减少的重量。之后身体至少需要6周让荷尔蒙恢复至孕前状态，因此母亲们的水肿现象会逐渐缓解，体重慢慢下降。至于其他的脂肪组织不会自然消失，需要一些时间和努力。

问2：母乳喂养有助于减重？

答：母乳喂养有着许多好处，医学上建议6个月以下的婴儿完全喂母奶，之后可以持续哺乳并搭配副食品，母亲可以持续哺乳长达2年。对婴儿而言，这是最为佳的营养来源。母乳中有很多不同的抗体，因此可以减少婴儿感染的风险。研究证实，母乳喂养的孩子，日后发生第II型糖尿病的风险降低，IQ水平也比较高。

对母亲而言，哺喂母奶时身体会分泌催产素（oxytocin），因此可以帮助子宫收缩、减少产后出血，更快帮助子宫回复产前状态。不仅如此，哺乳让母婴之间有更多亲密接触机会，过程中愉悦时光能够降低产后忧郁的风险。长期下来，母亲罹患了卵巢癌、乳癌、高血压、糖尿病和关节炎的风险也降低。

除了节省奶粉钱，更棒的是母乳喂养可以每天额外消耗500大卡。当然，前提是母亲的饮食需要均衡，这样的话哺乳对于减重有一定的帮助。
**温馨提醒：文章与广告内提及产品、服务及个案仅供参考，不能作为看诊依据，须以医生的意见为主。

Dr. Vijayaletchumi Thandayathany

Consultant Obstetrician & Gynecologist, Maternal Fetal Medicine (Visiting)

Columbia Asia Hospital - Seremban

MBBS (India), MOG (UKM), Fellowship in Maternal Fetal Medicine (Malaysia & India)

Make an Appointment

PDF and Online Articles:

跟着自己节奏走 产后减重在于持续非速成 – 医识力, 星洲网

这篇文章首次刊登在2022年5月4日的《医识力, 星洲网》

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Post-Scoliosis Surgery Rehabilitation

Post-Scoliosis Surgery Rehabilitation

January 24, 2022

In severe cases of scoliosis, surgery may be the only way to prevent the patient's spinal curvature from getting worse. Spinal fusion surgery, while generally effective, is a major operation from which it typically takes months to fully recover. Here is some advice for those who are about to undergo this surgery. After Day One of surgery, try walking slowly with or without walking aids, wear a rigid back brace while walking and try to walk frequently as it helps with post-surgery healing.

Now, for the smaller details. If you are a caregiver of a child who has just had this surgery, here are some rehabilitation steps you can do at home:

Let’s do breathing exercises

After spinal surgery, your breathing is usually slower. The breaths you take now aren’t as deep as your normal breaths, risking complications such as pneumonia. Note that breathing exercises can improve your breathing pattern.

First sit in a comfortable position or lie flat on your bed. Relax your shoulders. Put one hand on your chest and the other on your stomach. Breathe in through your nose, making your stomach expand. Make sure your stomach is moving outward while your chest remains relatively still. Purse your lips, press gently on your stomach, and exhale slowly through your mouth.

Watch your sleeping positions

To sleep on your back, try elevating your upper back, shoulder, and head with supportive pillows. Also, placing a pillow or rolled-up blanket under your knees will help relieve pressure after the back surgery. Try keeping your arms on your sides. Placing them under or over your head may seem like a comfortable position but it adds additional pressure to your back and shoulders. If you prefer to sleep on your left or right side, it is recommended to change sides ever so often to enhance your spine’s alignment.

Exercising in bed

Yes, it’s possible and it is effective! For post-spinal surgery patients, these moves will get your blood flowing even while you are recuperating in bed.

Ankle pumps

Move your ankles up and down, clockwise and anticlockwise for 30 repetitions in each direction. This will help to improve blood flow and prevent your legs from swelling.

Heel slides

Lying on your back, bend one knee slowly to your chest as much as you can and then straighten it back to its original position. Alternate sides.

Free movements for upper limb

Move your shoulder up and down, side raise, bend your elbow and straighten back, and move your wrist and fingers to prevent limitation in movements.

Pelvic tilt

Lie on your back with knees bent and hands resting below the ribs. Tighten abdominal muscles to squeeze ribs downwards and towards the back. Be sure not to hold your breath.

Straight Leg Raise

Lie on your back with one leg straight and one knee bent. Tighten abdominal muscles to stabilise your lower back. Slowly lift leg straight up about six to 12 inches and hold for one to five seconds. Lower leg slowly. Repeat 10 times.

Don’t bend, lift or twist

Never bend your back. If need be, you can bend from the knees and hips but not from your back. For the first two weeks after surgery, avoid lifting anything heavier than 2kg (check with your doctor as this number may differ from patient to patient). Some common household items can also pose weight risks like a full laundry basket, vacuum cleaner, or even a 2-litre bottle of milk. One more thing that you should not do is to twist your spine. Sometimes we don’t even realise it but simple tasks such as reaching for something behind you require a twist of the spine. That motion will have to be restricted during recovery.

Three months after surgery

You should be able to carry out these exercises by now. If in doubt, check with your medical professional.

Wall squats

While leaning on the wall, slowly lower your buttocks until thighs are parallel. Tighten thigh muscles and return. Repeat 10 times and hold for 10 seconds each time.

Pelvic bridging

Lay down on the floor and slowly raise your buttocks off the floor while keeping your stomach tight. Slowly release your back to the floor. Repeat 10 times and hold for 10 seconds each time.

Superman

Kneel on all fours. Tighten the stomach and raise the right leg and opposite arm to a 180-degree position. Keep your trunk rigid.

Piriformis stretches

Cross your right leg on top of your left. Gently pull other knee toward chest until you feel a stretch in the buttock area.

Single knee to chest

Lie down on your back. Bend one knee upwards and then pull it towards your chest. Alternate sides. Use hands only to support this position.

Hamstring stretches

Supporting the right thigh behind the knee, slowly straighten your knees until a stretch is felt in the back of the thigh.

Calf stretch

Stand with the right foot back with your leg straight. Forward leg bent and keeping heel on floor. Lean into wall until a stretch is felt in the calf.

Quadriceps stretch

Kneeling on the right knee, slowly push the pelvis down while slightly arching the back until a stretch is felt on the front of hip.

Tips to lifting safely

Keep a wide base of support.

Squat Down
, bending at the hips and knees only. If needed, put one knee to the floor and your other knee in front of you, bent at a right angle (half kneeling).

Keep good posture.
 Look straight ahead, and keep your back straight, your chest out, and your shoulders back.

Slowly lift
 by straightening your hips and knees (not your back). Keep your back straight, and don't twist as you lift.

Hold
 the load as close to your body as possible, at the level of your belly button.

Use your feet
 to change direction, taking small steps.

Lead with your hips
 as you change direction. Keep your shoulders in line with your hips as you move.

Set down
 your load carefully, squatting with the knees and hips only

Getting out of bed safely

When lying on your back, never lift your head and upper back to sit up in or get out of bed. Keep your arms to your sides. First bend your knees. Pull your abdomen in and breathe as you roll onto your side keeping your knees, hips and shoulders moving as one unit. Keep your abdomen pulled in and use your hand and elbow to raise your upper body as you carefully place your legs over the side of the bed in one motion. Sit on the edge of the bed for a moment or two before you stand up to avoid blood rushing to your head and making you feel giddy.

Kalaimanan Tarmalinggam

Physiotherapist

Columbia Asia Hospital - Klang

PDF and Online Articles:

Post-Scoliosis Surgery Rehabilitation – Natural Health, Vol. 124, November/December 2021.

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

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Pregnancy Acne [Press Clipping]

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December 01, 2014

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Pregnancy and Systemic Lupus Erythematosus (SLE)

January 30, 2011

Fast facts

Fertility is usually normal in SLE, although disease activity and certain drugs can contribute to menstrual disorders.

Planning before pregnancy is important.

The patient should have no signs or symptoms of SLE and be taking no medications for at least six months before she becomes pregnant.

As SLE can flare during pregnancy, it is important for the patient to be under a doctor’s care during pregnancy.

Although pregnancy in systemic lupus erythematosus (SLE) is considered high risk, most women with SLE carry their babies safely to the end of their pregnancy. However, it must be stressed that planning before pregnancy is important. Ideally, a woman should have no signs or symptoms of SLE and be taking no medications for at least six months before she becomes pregnant.
Problems during pregnancy

It is important for the mother with SLE to be under a doctor’s care during pregnancy as frequency of flares is slightly higher in pregnant than in non-pregnant SLE patients, especially during the second and third trimester, and most commonly after the delivery of the baby. This is due to changes in hormonal levels during pregnancy, i.e., increased estrogen level. Kidney flares tend to pre-dominate while musculoskeletal flares seem to decrease. Prompt treatment will help to keep the mother healthy.
Some points to note:

Women with SLE have a higher rate of miscarriage and premature births compared with the general population.

Women who have anti-phospholipid antibodies are at a greater risk of miscarriage in the second trimester because of their increased risk of blood clotting in the placenta.

SLE patients with a history of kidney disease have a higher risk of pre-eclampsia (hypertension with a build-up of excess watery fluid in cells or tissues of the body).

Pregnant women with SLE, especially those taking corticosteroids, are also more likely to develop high blood pressure, diabetes, hyperglycemia (high blood sugar), and kidney complications, so regular care and good nutrition during pregnancy are essential.

It is advisable to have access to a neonatal (newborn) intensive care unit at the time of delivery in case the baby requires special medical attention

Monitoring during pregnancy
 In women with stable kidney disease before the pregnancy, the pregnancy does not jeopardize kidney function in the long term. However, SLE kidney disorder may manifest for the first time in pregnancy. Doctors must take note that lupus flares may be difficult to diagnose during pregnancy since many of the features may also occur in normal pregnancy.

Monthly follow-ups are best done in combined (obstetric and medical) clinics. History and physical examination remains the mainstay of monitoring disease activity in pregnancy. Early control of disease activity is essential. Initial assessment involves:

testing for anti-ro and anti-la antibodies

testing for anti-phospholipid antibodies for those with past pregnancy losses.

Management of lupus pregnancy

Medications which can be used during pregnancy are:

aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) which are used in the relief of joint or muscle pain. NSAIDs other than aspirin should be avoided in the second and third trimester.

anti-malarials such as plaquenil which is useful for those with skin and joint disease.

low-dose prednisolone. As pregnancies should be planned only when the disease is under control, most patients are already be on low-dose prednisolone by the time they become pregnant. As there are certain risks of gestational diabetes and hypertension, doctors should try to keep the prednisolone below the 10mg daily level.

In the event of a lupus flare, intravenous methylprednisolone can be used. However, cyclophosphamide should be avoided because of its association with birth defects.
Decision to terminate the pregnancy

Doctors take into consideration the following factors:

is the mother’s health likely to deteriorate irreversibly if pregnancy continues?

is the baby likely to grow better delivered than in the womb?

Maternal complications are more often pregnancy related than lupus related. Vaginal or caesarian section is an obstetric decision. Specific lupus issues rarely determine the delivery route, though they may upgrade urgency for operation.
Post-partum period

it is advisable to continue steroid medication for two to three months after the post-partum period (six weeks after delivery) if there was active SLE throughout the pregnancy. Care should be taken as flares are most frequent in the second and third trimester and the post-partum period. It would be useful to alert the neonatology staff about the new mother’s anti-ro and anti-la status.
Breast feeding

SLE patients can breastfeed. Generally very little steroid is transmitted to breast milk, especially when the patient is on low-dose prednisolone. The neonatal effect of using 20mg prednisolone daily or less is insignificant. The exposure of the baby to steroids can be further minimized by breastfeeding just prior to taking the prednisolone. Anti-coagulants such as heparin are safe, while cytotoxics such as cyclophosphamide are not safe.
Neonatal lupus

This is a rare disorder that can occur in newborn babies in which auto-antibodies in the mother’s blood called anti-ro and anti-la are thought to have the potential effect of skin rashes and to injure fetal heart conduction tissue. There are usually skin rashes during the first to third months after birth, which disappear without treatment after about six months. In those rare cases (less than 2%) where there is congenital heart block, the condition is usually irreversible and the baby may require a pacemaker.
Anti-phospholipid syndrome

A syndrome characterized by “sticky blood” was described by Dr Graham Hughes in 1983, and is associated with the presence of circulating antibodies against phospholipids. Two tests are usually requested – anti-cardiolipin antibody and lupus anti-coagulant. The major features of anti-phospholipid syndrome are:

vein thrombosis, i.e. Arm vein thrombosis, thrombosis in the eye, leg vein thrombosis, and thrombosis of the veins of the brain.

arterial thrombosis, i.e. Leg artery clots or heart attack.

recurrent miscarriage

Other features are low platelet count, blotchy skin rash, migraine, and positive blood tests for anti-phospholipid antibodies.

For patients with anti-phospholipid syndrome, pregnancy loss is most typically in the second trimester. Treatment is with aspirin plus heparin. Heparin is stopped at the time the patient goes into labor but is resumed after delivery. The greatest thrombotic risk to mother is during the post-partum period.
Childhood

Although there are few long-term follow-up studies of children born to SLE mothers, there seem to be very little risk of SLE in the children born to patients. Male children seemingly had more learning disabilities compared with female children.
Conclusion

Successful pregnancy is now achievable by women with SLE. You do not have to deny yourself the happiness of being a mother, but be aware of the situation and take special care during and after your pregnancy. Be sensible and follow your doctor’s advice as to when it is safe to get pregnant.
Dr. Pagalavan Letchumanan

Consultant Physician & Rheumatologist

Columbia Asia Hospital- Nusajaya


Pregnancy - Do's and Don'ts

Pregnancy - Do's and Don'ts

December 21, 2012

Hi congratulations if you are pregnant or just delivered and wish you best of luck if you are trying to conceive.

I would like just share a few tips on common issues which you should know during this period. Hopefully it will be helpful for you.
Do’s

See your Doctor early in fact the best time to see is during pre-pregnancy period. The doctor will look at your present state of health and do some basic examinations. Continue regular checks during pregnancy up to delivery and post-partum 6 weeks.

Start Folic Acid as soon as you planned to get pregnant as this 5mg tablet can prevent skull and spine defects in baby.

Eat healthy and balanced diet-consume adequate amount of water, take enough vegetables, fruits along with your routine meal.

Please take pregnancy supplements as per your care provider’s advice. These supplements are given to meet the increase demand during your pregnancy especially iron, calcium ,Vitamin C, B complex etc. Please do not take iron and calcium with milk/tea/coffee as the certain ingredients in this reduce their absorption. Try to take it before bed time or early morning 1/2-1hr before breakfast.

Continue exercises at moderate levels. Stretching exercises like yoga are very useful during pregnancy and they are many centers offering Yoga during pregnancy in Malaysia.

You can climb stairs and continue to do routine activities in early pregnancy. None of these activities will cause miscarriage as you fear. Your pregnancy is well protected and it is shocks prove as long it’s a healthy pregnancy.

You can travel by car, air and ship during pregnancy as long as you are fine. Air travel is restricted maximum up to 36 weeks (except for mom’s who had premature delivery previously up to 28weeks) and be cautious to go in the ship if you have severe morning sickness in early pregnancy as sea sickness will aggravate the condition.

Certain common medications like panadol/paracetamol/flu medicine like piriton/certain antibiotics are classified as relatively safe and can be taken if in need. So please do not hesitate to take if your doctor prescribes for you. However self-medication is not recommended at all during pregnancy.

You can continue to work during pregnancy. Certain work conditions like working in X-ray departments, Chemical factories, cement factories and physically strenuous and challenging works are prohibited.

Driving is allowed and please wear seat belt all the time. It’s advisable to have chauffeur, car pool yourself or use public transport in late third trimester.

Don’ts

Avoid tobacco, alcohol, too much of caffeine during pregnancy all of these are related with untoward effects in pregnancy.

No self-medication without consulting your doctor. Especially in first 3 months of pregnancy as your baby's organs are forming now. Even your supplements like multi-vitamins, iron and calcium is recommended after 2 months.

Please be careful with your herbal products like herbs, herbal teas, ginseng, and other stuff during pregnancy. Similar to most of the allopathic drugs, even these herbal products do not have proper evidence or proof of safety during pregnancy. In fact some moms who have taken these products tend to bleed excessively during delivery.

Avoid Stress and tension. This is one of the main culprits which attack your physical body in surprising ways. For example, in pregnant women, stress can cause variety of pains, insomnia, and even lead to preterm or low birth weight. Not only will it cause a lot of stress in you but also on the people surrounding you. So please be relaxed and enjoy your pregnancy.

Do not handle cat or cat litters as the cat might transmit Toxoplasmosis which causes birth defect to your fetus.

Please be careful with food like nasi lemak, nasi kandar, roti canai, fast foods or any rich food like too much of chocolate/cheese etc. All these food can cause indigestion, bloatedness, reflux and gastritis as your digestion is slower during pregnancy.

No raw food, no raw egg, be careful of certain fish like shark, mackerel, tuna and etc which may contain high levels of mercury.

Please avoid all the extra supplements like spirulina and others. Not enough is known about the use of blue-green algae during pregnancy and breast-feeding. Stay on the safe side and avoid. Please stick to your doctor’s recommendation. Look for FDA aproval or ministry of health approval for pregnancy in any herbal supplements.

Please do not take excessive levels of 'ikan haruan essence’ or other products like 'gamat', etc. for healing purposes, some of them create bad keloids. Please maintain in moderations.

Consumption of herbal alcohol products like Dome/Yomeishu during post-partum period is not recommended but some of the traditional old folks will insist during confinement period. As a general rule, it takes 2 hours for an average woman to get rid of the alcohol from 1 standard alcoholic drink. So remember stick to 1 standard glass ~ 30ml and drink immediately after breast feeding and next feeding should be after 3-4 hrs. Another way is to express your milk and keep for next subsequent feedings before taking these drinks.

.....and before I end, a small quote for moms who are going to deliver soon..

Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth. -Virginia Di Orio…..Wish you best of luck..
Dr. Rama Krishna Kumar

Consultant Obstretics and Gynecologist

Columbia Asia Hospital-Bukit Rimau


Preparing For the Unexpected

Preparing For the Unexpected

May 09, 2023

Pregnancy can be nerve-racking, for both first time mums and experienced mums. You may be constantly wondering if everything is going as it should.

Childbirth may come with many surprises, and not all of them pleasant.

So it’s so important to prepare yourself physically and mentally for what could possibly happen. As well as learn how you can reduce your risks.

Preparing for birth also means preparing for the unexpected.

We sat down with Dr Sundar Gugan, visiting consultant obstetrician and gynaecologist at Columbia Asia Hospital, Petaling Jaya, to talk about pregnancy—preparing for the unexpected.

Here are some things every expecting mother should know about the unexpected risks and symptoms of pregnancy, as well some fool-proof tips on how to navigate them.

Q1: Who is at risk for pregnancy complications? And do we all have the same risk?

Anyone can be at risk of complications during their pregnancy, but your risk is higher if you have chronic medical conditions or you have some illness prior to pregnancy.

Some examples of health conditions or diseases that may cause complications during pregnancy are diabetes or cancer.

Also, some people have high blood pressure, hypertension, prior to pregnancy while others develop it during pregnancy. This can cause the baby to not get enough blood.

Kidney problems, epilepsy, anaemia and other factors that may increase the risk of pregnancy complications include being older than 35, being younger than 20, smoking cigarettes, drinking alcohol, and taking illicit drugs.

Of course, being pregnant with multiple babies like twins, triplets or more. And those who have a history of repeated miscarriages.

Being over- or underweight also increases pregnancy risk. Obesity, BMI more than 30 and anorexia, which is BMI less than 20.

So maybe while pregnancy is a natural and normal process, it does come with risks for some women.

And every woman is different and may have varying degrees of risk for pregnancy complications depending on their health status, age and other factors like the doctor mentioned just now.

Q2: What are the most common complications of pregnancy?

Here are some common complications during pregnancies. The first is ectopic pregnancy, a condition where the fertilised egg implants outside the uterus.

Miscarriage is also a big pregnancy complication. It is a loss of pregnancy in the first 20 weeks. It occurs about 10% of the time, about one in five pregnancies.

There is also hyperemesis gravidarum, which is a severe form of nausea, vomiting in pregnancy.

It can cause severe dehydration, lean body weight loss and causes electrolyte imbalance and it could be quite catastrophic, actually.

Of course, congenital disorders.

If your doctor suspects the foetus has a health issue or a congenital disease, you’re at higher risk for complications during the pregnancy.

This may mean you need additional monitoring and your baby needs special care after birth.

Another one is preeclampsia is a blood pressure problem which occurs after 20 weeks of pregnancy.

It occurs about 10% of people who develop this during pregnancy. It’s more common with people who already have high blood pressure prior to pregnancy.

Gestational diabetes, is another one, which is a type of diabetes which occurs during pregnancy.

It happens because the pregnancy hormone makes it harder for the body to metabolise the blood sugar. So usually you would be given a sugar screening test during your pregnancy.

Other things include infections, viral and bacterial infections can complicate pregnancy, like urinary tract infection, which can cause preterm labour. There’s also group B Streptococcus which can cause infection to the baby.

There’s also sexual transmitted infection which also causes preterm labour and infection to the baby and such.

And of course, we call the Torch Infection which is like toxoplasma, rubella, cytomegalovirus and herpes which causes congenital infections for the baby.

Vaginal bleeding which could be either heavy or excessive bleeding during pregnancy. That is an emergency and that one you need to see your doctor immediately if such happens.

Placenta increta. So the increta is when the placenta is embedded deeply into the uterine tissue and it’s very difficult to come out after the delivery and causes severe bleeding and sometimes, we need to remove the womb to arrest the bleeding.

And the worst part of the placenta increta spectrum is called percreta.

And percreta actually the placenta invades not only into the uterine tissue as well, it goes to the adjacent tissue like bladder, bowel and such.

And not only does it might require the removal of the womb but there might be injury to the bowel and bladder and such.

Preterm labour, which is a delivery before the age before your gestational age before 37 weeks.

This can cause a problem for your baby because the baby might be born with a lower birth weight and slightly underdeveloped organs, depending on the gestation.

Oligohydramnios, which is actually like a low level of amniotic fluid because the baby is swimming inside the amniotic fluid.

And if it’s less, it of course causes risk of premature birth or iatrogenic birth because we might consider delivering earlier as well polyhydramnios, which is the other version of it where there’s more a lot of excessive fluid.

Also causes preterm birth as well.

And the most sinister of all is amniotic fluid embolism. It has a very high mortality rate that means it causes a higher amount of death and usually we kind of diagnose it much later.

So basically, what happens is the debris from the amniotic fluid or the foetus goes into the maternal circulation and causes cardiovascular collapse. It’s almost immediate and sudden.

Depression, anxiety and extreme sadness during pregnancy and mainly after post-delivery. It is overwhelming and can affect a baby’s development and the family.

Anaemia can be bad because the haemoglobin, which is the low level which we call anaemia, it carries oxygen throughout very important parts of your body.

So, it needs to be corrected. And the usual cause of it is iron deficiency. So it can be corrected with the supplementation of iron or injection, now what we have.

In Malaysia, we should be looking out for other anaemia such as thalassemia. Yes, that’s a problem because the haemoglobin kind of dies much faster than usual. So that’s another cause.

It’s so important for mums to recognise disease symptoms and seek help as early as possible.

Q3: Can pregnancy complications cause a premature birth? What are the health effects on premature babies?

Premature birth is a birth which is a baby being born before 37 weeks of pregnancy.

Some health problems can raise the risk of premature birth such as problems with the uterus, cervix, sometimes we call it cervical incompetence or placental issues.

Some infections like we talked about earlier and many of the amniotic fluid and lower genital tract.

Ongoing health problems such as high blood pressure or diabetes also could be the cause of premature delivery or iatrogenic premature delivery. This means we facilitate the delivery for some issues.

And of course, injuries or trauma to the body sometimes can cause premature delivery as well.

Babies born prematurely may have more health problems at birth and later in life than babies born at full term because their organs did not have enough time to fully develop.

The baby might have some issues which includes breathing problems because the lung is not fully developed so they can’t breathe properly, they need assistance.

Feeding difficulties, sucking, taking in the milk and of course, higher risk of developing cerebral palsy, vision problems, hearing problems.

Premature babies also need to spend some time in the newborn intensive unit called the NICU.

Premature baby stays in the NICU until the organs develop enough to stay alive by themselves without medical support.

And some babies need to be in the NICU for weeks or months until they can breathe on their own, eat by their own mouth and feed themselves and maintain their body temperature and body weight.

Babies born preterm are also at risk of developmental delays and that can affect their behaviour and ability to learn.

Finding and treating health problems as early as possible can help premature babies lead to healthier lives. I do know many parents who had premature babies that grew up to be healthy and happy.

Thanks to advances in medical care, even babies born prematurely are more likely to survive and thrive today than ever before.

Babies that are born prematurely are required to stay in the hospital’s newborn intensive care unit (NICU) to receive medical treatment until they are well enough to go home.

Q4: Do all premature babies go through caesarean section?

In some cases, premature babies can be delivered naturally, but it depends on the circumstances and gestation age of the baby.

For a premature labour baby before 37 weeks of pregnancy, your doctor will evaluate the situation to determine the safest method of delivery for both mum and the baby.

In some cases, if the baby is in a good position, which is basically what we call cephalic when the baby’s head is down and the cervix is fully dilated, a vaginal delivery is possible.

In other cases, an emergency caesarean section may be recommended for preterm births.

If there are such medical reasons, such as there are concerns for the safety of your baby, and there’s a life threatening emergency for you or your baby.

If your labour is not progressing normally and there are complications, such as bleeding during the labour, severe preeclampsia, the high blood pressure.

Those are some of the reasons why we might end up doing the caesarean section.

Q5: Is it possible to prevent pregnancy complications? If so, how?

There are several steps that can be taken to prepare for pregnancy complications.

Of course, seeking prenatal care early and regular prenatal care can help to identify and manage any potential complications.

It is important to attend all the appointments and to communicate very openly with your healthcare provider about any concerns of your symptoms that you may experience.

Maintaining a healthy lifestyle, eating a healthy diet, exercising regularly, and avoiding harmful substances such as tobacco or alcohol or illicit drugs can help to reduce risk of complications.

Educating yourself. Learn about the signs and symptoms of pregnancy complications such as preeclampsia, gestational diabetes, preterm labour; this can help you to recognise when to seek medical attention.

Building a support system. Having a very supportive partner, family members and healthcare team can make a big difference in managing complications, navigating the challenges that may arise during pregnancy.

Remember, while it is important to be aware of the risk of pregnancy complications and take steps to prepare, it is also important to focus on the positive aspect of pregnancy and enjoy this special time in your life.

Dr. Sundar Gugan A/L Santhana Dass

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital – Petaling Jaya
MD (UPM), MRCOG (UK), Diploma in Minimal Invasive Surgery

Make an Appointment

PDF and Online Articles:

Why You Shouldn’t Play it Cool When it Comes to Heatstroke – Motherhood.com.my, 9 May 2023

This article first appeared in Motherhood.com.my, 9 May 2023.

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Preventing Digital Eye Strain

Preventing Digital Eye Strain

July 30, 2016

Time to take a closer look at the all-inclusive digital age and the resulting computer vision syndrome. The twenty-first century is an era of electronic gadgets. New products are introduced into the market from time to time. Due to the extensive use of modern gadget, many studies have been conducted to address the concern of the safety of Video Display Terminals (VDT) on our health. Dr. Dinesh Kumar Ramesh Chandra, Consultant Ophthalmologist Columbia Asia Hospital – Petaling Jaya shares on preventing digital eye strain.

InfoMed Malaysia, Issue 18, July – September 2016
.


Preventing Injury While Keeping New Year’s Resolutions - Dr Harjeet Singh [BFM - Podcast]

January 21, 2015

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

In the rush to fulfill New Year's resolutions of hitting the gym, it can be easy to forget about the protective measures one needs to take to keep safe. Here’s Dr. Harjeet Singh with a friendly reminder.

Listen to the podcast
here
.


Problem With Your Sinus

Problem With Your Sinus

February 03, 2020

A blocked nose and facial pain are common symptoms of rhinosinusitis.

On a rainy day in Kuala Lumpur, a lady in her early 30’s, looking very tired and stressed out, came to my clinic, complaining of a blocked nose for the past two weeks, which disturbed her daily activities.

She also complained of a severe headache over her forehead and cheek region, making it difficult to concentrate on her work. She felt a lot of thick mucus behind her nose and throat, which was difficult to clear, causing her to frequently clear her throat and cough in an attempt to remove it.

These symptoms became more apparent when she was lying down and sleeping at night, as well as during prayer time when she bent forward.

She had sought multiple medical opinions and treatments, however, her symptoms were not fully resolved.

She had had infections like this in the past, but never quite so severe with such persistent symptoms.

I personally hate having a blocked nose as it disturbs my work.

I can’t concentrate when my nose is blocked as I have to breathe through my mouth, which makes my throat dry and uncomfortable.

I’d just recovered from a common cold, which lasted about 10 days. It was the worse experience I have ever had.

Because of the nose block, I couldn’t sleep well at night. My symptoms were similar to those of the lady above.

My patient and I were suffering from acute rhinosinusitis – a common condition also known as resedung in Bahasa Malaysia.

Caused by inflammation

Our symptoms are related to the inflammation of the paranasal sinuses (which surround the nose or nasal cavity) and nasal mucosa, leading to swelling of the turbinates (soft tissue that projects into the nasal cavity from its walls) and increased mucus production.

These are the major contributions to the blocked and “running” nose in acute rhinosinusitis.

The inflammatory changes in nasal mucosa lead to the congestion, and inefficient drainage and ventilation, of the paranasal sinuses.

Rhinosinusitis affects one in eight adults, making them miss work or decrease their productivity.

The stagnation of mucus in the sinuses may lead to bacterial infection if treatment is not given.

This may result in headache, facial pain, thick yellowish or greenish mucus, and fever.

Sinusitis refers to inflammation in the paranasal sinuses, while rhinitis refers to inflammation in the nasal mucosa.

The term “rhinosinusitis” – a combination of rhinitis and sinusitis – is preferred to “sinusitis”, as inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa.

Acute rhinosinusitis lasts less than four weeks, whereas symptoms lasting more than 12 weeks are classified as chronic rhinosinusitis.

Recurrent acute rhinosinusitis occurs when a patient has four or more episodes of rhinosinusitis a year, without persistent symptoms in between.

A patient has complicated rhinosinusitis when the inflammation has spread outside the paranasal sinuses and nasal cavity at the time of diagnosis (e.g. affecting the nerves, eyes or other soft tissue).

I am frequently asked by patients, “I catch colds quite frequently, but this is the worst cold I’ve ever had, is there any particular reason for this?”

There are certain conditions that may contribute to the severity of the rhinosinusitis.

These include a family history of rhinosinusitis; asthma, especially in the presence of chronic rhinosinusitis with nasal polyps; allergies; chronic bronchitis; chronic rhinitis; a personal history of acute rhinosinusitis; gastroesophageal reflux; sleep apnoea and adenotonsillitis.

People with these conditions are also prone to having recurrent rhinosinusitis.

A common infection

Rhinosinusitis poses a major health problem. Its effect on quality of life, productivity and finances are substantial.

It affects one in eight adults and accounts for close to 16 million doctor visits per year.

In Asia, the infection rates reported in Korea, China and Singapore are 7%, 8% and 2.7% respectively.

The direct cost of managing acute and chronic rhinosinusitis exceeds US$11 billion (RM45.2 billion) per year, not including the cost from lost productivity, reduced job effectiveness and impaired quality of life.

More than one in five antibiotics prescribed for adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy.

An accurate diagnosis and management contribute to improved treatment outcome and reduce the financial burden of the disease.

Although it is a common illness, rhinosinusitis presents a number of diagnostic and management challenges to doctors.

Its diagnosis is usually based on symptoms, supported by diagnostic imaging or nasal endoscopy, which is difficult to access in primary care clinics because of limited radiological and endoscopy facilities.

The most common cause of acute rhinosinusitis is a viral infection associated with the common cold, which is usually self-limiting in nature (will improve by itself).

Supportive care with medications to alleviate the symptoms are the main aim of treatment. Antibiotics are not necessary.

However, distinguishing between acute viral rhinosinusitis related to colds and influenza-like illnesses from bacterial infection is a frequent challenge to the primary care doctor or general practitioner (GP).

A thorough history-taking and clinical examination are important to reach the diagnosis.

As a general guide, symptoms that last less than 10 days are likely to be viral in origin.

Acute bacterial rhinosinusitis is diagnosed when the symptoms and signs of acute rhinosinusitis – greenish or yellowish nasal discharge with blocked nose and/or facial pain/pressure/fullness – persist without improvement for at least 10 days.

Anterior rhinoscopy can be done in primary care when acute rhinosinusitis is suspected.

However, it has limited value in diagnosing chronic rhinosinusitis, compared to nasal endoscopy, due to its limited visualisation of the nasal cavity.

Nasal endoscopy allows the doctor to better see problems in the nose, like anatomical variations, mucosa inflammation, polyps and nasal discharge.

In recurrent rhinosinusitis, the doctor may test for allergies and immune function, as well as look for nasal polyps.

Radiographic imaging is unnecessary if the diagnostic criteria for acute rhinosinusitis are met.

The most common imaging study done to evaluate the paranasal sinuses is a CT (computed tomography) scan, supplemented by an MRI (magnetic resonance imaging), if complications are suspected.

Treating the symptoms

Most patients will seek treatment at the GP’s clinic, and the majority will recover completely.

The aim of treatment is to reduce the severity of the symptoms and prevent complications.

In viral rhinosinusitis, treatment is usually symptomatic with medicines for fever and pain.

Antibiotics should only be given when acute bacterial rhinosinusitis is diagnosed.

If the symptoms worsen or fail to improve with the initial treatment seven days after diagnosis or worsens during the initial treatment, the doctor should reassess the patient to confirm acute bacterial rhinosinusitis, exclude other causes of illness and detect complications.

If that is the case or if there is any doubt, a further evaluation like nasal endoscopy and imaging should be done.

Surgery may be required in certain situations, when complications arise, such as involvement of the eye or brain, and in the case of failed optimal medical treatment.

The aims of surgery are to reduce the inflammation and improve the delivery and effectiveness of intranasal medications.

Dr. Gan Chon Chean

Consultant ENT Surgeon

Columbia Asia Hospital – Petaling Jaya
MBBS (India), M ORL – HNS (UM), CMIA (NIOSH), AM (Malaysia)

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PDF and Online Articles:

Blocked Nose All The Time? That 'Cold' May be a Sinus Infection– The Star Online, 8 January 2020

Problem with your sinus? – The Star, 5 January 2020

This article first appeared in The Star Online, 8 January 2020

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Proses Bersalin Yang Sangat Lama Punca Bahu Bayi Tersangkut! Ibu Hidap Kencing Manis Golongan Berisiko

January 19, 2019

Bahu bayi tersangkut ketika kelahiran
(shoulder dystocia)
 ialah antara masalah kecemasan yang boleh berlaku ketika kelahiran. Ikuti penerangan Dr Sharina Mohd Razali, Pakar Perbidanan & Sakit Puan Columbia Asia Bukit Rimau.

Bahu bayi tersangkut ketika kelahiran ia adalah keadaan di mana kepala bayi yang telah lahir tetapi bahunya tersangkut pada tulang pubis ibu. Sekiranya berlaku, doktor perlu melakukan langkah kecemasan tambahan (
additional manouvres)
 untuk membantu melepaskan bahu bayi yang tersangkut pada tulang pubis tersebut.

Kebanyakan masa bahu bayi boleh dilepaskan tanpa sebarang masalah tetapi dalam beberapa kes bahu tersangkut ini kadangkala boleh menyebabkan masalah kepada bayi seperti patah tulang bahu, kecederaan pada saraf dan kekurangan oksigen
(birth asphyxia)

Masalah ini boleh berlaku dalam 1 dalam 150 kelahiran (0.7%) dan lebih kerap berlaku pada ibu-ibu yang menghidap penyakit kencing manis semasa mengandung. Hakikatnya ia sangat sukar diramal.
Golongan berisiko tinggi

Oleh sebab ia sukar diramal ketika hamil, ibu-ibu yang perlu memahami siapa yang berisiko tinggi untuk mengalami bahu bayi tersendat ketika kelahiran. Dengan ini perlu mengambil langkah awal serta persediaan mental dan fizikal.

Sejarah bahu bayi tersendat ketika kelahiran sebelumnya

Ibu yang menghidap kencing manis

Bayi yang besar dan ibu menghidap kencing manis

Indeks jisim tubuh ibu lebih dari 30

Kelahiran secara paksa (induksi)

Proses bersalin yang sangat lama

Kelahiran menggunakan
 ventouse
 atau forseps

Kes kecemasan

Bagi kes kecemasan di mana ia terjadi tanpa jangkaan atau dikenali sebagai
obstetric emergency
, pakar sakit puan dan bidan yang bertugas akan memberikan rawatan segera. Sekiranya berlaku bahu bayi tersendat semasa proses kelahiran,
red alert
 akan dimulakan untuk mendapat bantuan dari pasukan perubatan. Ibu akan diminta berhenti meneran untuk mengelakkan kecederaan lebih teruk pada bayi.

Doktor pakar perbidanan dan bidan akan meminta ibu membengkokkan paha dan lutut ke arah perut ibu bagi menambah ruang vagina supaya bahu bayi boleh dilepaskan dari tulang pubis ibu. Ini dipanggil Mc Roberts
manouvre
.

Sekiranya
manouvre
 pertama gagal, langkah seterusnya ialah doktor pakar akan menekan pada bahagian abdomen ibu iaitu pada atas tulang pubis bertujuan untuk menolak dan melepaskan bahu bayi yang tersangkut.

Andai
manouvre
 kedua gagal, doktor akan masukkan tangan dala vagina dan cuba menolak bahu bayi dan cuba melepaskan bahu bayi yang tersangkut. Guntingan episiotomi akan dilakukan sekiranya belum dibuat untuk memudahkan
manouvre
tersebut di atas.

Akhir sekali sekiranya semua gagal ibu mungkin akan disuruh menelangkupkan badan
(on all four hands and legs)
 kerana ini juga boleh membantu melepaskan bahu bayi.

Ibu menghidap kencing manis

Masalah bahu bayi tersangkut ini sukar dielakkan kerana sukar diramal. Cara yang boleh dilakukan untuk mengelakkannya ialah dengan adalah ambil langkah berjaga-jaga jika ibu mempunyai risiko terutamanya ibu yang menghidap kencing manis. Bersalin secara induksi boleh mengelakkan masalah ini. Elakkan sama sekali kehamilan yang terlebih tempoh bagi ibu yang mempunyai kencing manis. Doktor selalunya akan mencadangkan bersalin melalui pembedahan
Caesarean
 jika berat bayi melebihi berat normal iaitu 4kg. Walau bagaimanapun risiko bahu tersangkut masih boleh berlaku pada bayi yang mempunyai berat kurang dari 4kg lebih-lebih lagi jika ibu menghidap diabetes

Dr. Sharina Binti Mohd Razali

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Bukit Rumau

PDF and Online Articles:

Proses Bersalin Yang Sangat Lama Punca Bahu Bayi Tersangkut! Ibu Hidap Kencing Manis Golongan Berisiko - Majalah Pa&Ma, 19 Januari 2019

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

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Puasa Bukan Tiket Mudah Untuk Kurus

Puasa Bukan Tiket Mudah Untuk Kurus

June 02, 2021

PADA bulan Ramadan, lazimnya ramai di antara kita memasang impian untuk menurunkan berat badan.

Ia disebabkan jadual pola pemakanan kita jauh berubah berbanding pada hari-hari biasa.

Kita hanya bersahur dan 12 hingga 13 jam selepas itu, barulah kita berbuka puasa.

Namun demikian, ramai yang hampa matlamat berkenaan tidak tercapai.

Lebih mengecewakan, ada sesetengah individu merungut bahawa berat badan mereka menjadi semakin bertambah sebaik tamat bulan puasa.

Di manakah silapnya dan apa yang tidak kena?

Bagi mendapatkan jawapan, SinarPlus mengajukan persoalan itu kepada Pakar Pemakanan, Hospital Columbia Asia, Iskandar Puteri Johor, Yap Pau Lin.

Ujar Pau Lin, berat badan seseorang sama ada semakin naik atau turun adalah bergantung kepada jumlah pengambilan tenaga atau kalori sepanjang hari.

“Jika jumlah makanan yang dimakan semasa hari berpuasa sama seperti hari-hari biasa, berat badan pasti akan kekal sama.

“Sebaliknya, jika jumlahnya berkurang, tetapi mereka menikmati makanan tambahan seperti snek, kuih-muih, buah-buahan, pencuci mulut dan minuman bergula atau mengandungi susu selain lauk-lauk yang berlemak juga akan meningkatkan jumlah kalori,“ jelasnya.

Akhirnya, berat badan akan kekal sama atau kadangkala akan semakin bertambah!

Stor glukosa

Menerangkan lebih lanjut, pakar pemakanan itu berkata, semasa berpuasa, glukosa atau gula dalam darah akan berkurangan disebabkan ia telah digunakan sebagai sumber tenaga pertama untuk sel-sel dan organ-organ badan berfungsi.

“Jika gula dalam darah tidak mencukupi untuk membekalnya ke organ-organ badan, otak akan terus memberi isyarat kepada hati yang berfungsi sebagai stor untuk glukosa. Hati kemudiannya berperanan untuk membekalkan gula ke dalam darah dan pada masa sama dihantar ke organ-organ lain,“ katanya.

Proses itu sekali gus menyaksikan tubuh badan akan tetap berfungsi seperti biasa walaupun seseorang tidak menjamah sebarang makanan.

Beritahu Pau Lin lagi, selepas berbuka puasa dan bersahur, gula akan ditambah semula ke dalam stor hati.

“Jadi, makan makanan yang seimbang dan mencukupi pada dua waktu tersebut (berbuka dan sahur) sangat penting sepanjang Ramadan.

“Namun, bagi sesetengah individu yang menghidapi penyakit kencing manis, sistem badan mereka yang mengawal dan membekal glukosa tidak sensitif seperti orang biasa. Justeru, pemantauan lebih rapi oleh pesakit kencing manis kena lebih teliti,“ ujarnya lagi.

Daripada fakta yang dihuraikan itu, jelas Pau Lin, sememangnya puasa selama sebulan tidak menjamin seseorang itu boleh kurus.

“Silapnya cuma satu iaitu kaedah memilih makanan yang kurang tepat,“ katanya.

Dalam pada itu, ramai yang seolah-olah ‘menuding jari’ tentang kepelbagaian makanan di Malaysia yang telah membuatkan ramai rambang mata.

“Ia tidak salah, tetapi kecenderungan orang ramai yang lebih gemar memilih sajian berminyak, berlemak dan mengandungi gula yang tinggi.

“Cara memasak juga lebih kepada kaedah menggoreng, menggunakan santan, kerisik, krim, mentega atau marjerin. Ditambah dengan sos yang sememangnya mempunyai kalori yang tak diperlukan oleh badan.

“Orang ramai kena peka dan tahu, makanan dan minuman yang mengandungi gula tinggi akan merencatkan diet kita. Gula putih, gula perang, madu, susu pekat, sirap, coklat atau krim melimpah dalam setiap masakan, semuanya tidak berapa elok jika berlebihan,“ tegasnya.

Sekiranya kuantiti menu yang diambil dalam kuantiti yang besar juga meskipun tidak mempunyai kalori yang tinggi, boleh menyumbang kepada masalah berat badan.

Senam sebelum sahur

Ujar Pau Lin, bukan tidak boleh langsung menyentuh makanan yang lazat yang sedia terhidang di depan mata, namun semuanya perlu dikawal.

Berikut panduan yang terbaik bagi mengawal saiz hidangan seperti yang disyorkan oleh pakar berkenaan:
i) Elak sediakan atau membeli makanan secara berlebihan.

Rancang setiap menu yang ingin dimakan dan memadai menikmati juadah bersaiz yang kecil.
ii) Amalkan konsep suku-suku separuh.

Praktikkan amalan suku pinggan makanan berkanji, suku pinggan makanan protein dan separuh pinggan sayur-sayuran dan buah-buahan. Selain itu, letakkan makanan dalam pinggan sebelum mula makan dan elak menambah makanan.
iii) Tentukan masa dan jumlah untuk makan makanan sampingan.

Hadkan masa untuk menjamah snek, makanan ringan atau buah-buahan. Elakkan juga kekerapan mengunyah snek selepas iftar.

Adakah senaman yang konsisten pada bulan puasa dapat memberi berita gembira kepada mereka yang mahu turunkan berat badan?

Menjawab pertanyaan itu, Pau Lin berkata, terdapat beberapa pilihan waktu yang dicadangkan.

Berikut adalah perinciannya:
1. Senaman awal pagi selepas matahari terbit.

Baik: Badan akan berasa lebih cergas untuk waktu pagi.

Buruk: Jika bersenam selepas sahur, badan menggunakan kalori daripada makan sahur. Oleh itu, badan akan mengalami kekurangan tenaga sepanjang hari jika senaman berlebihan dilakukan.
2. Senaman lewat petang sebelum berbuka.

Baik: Membantu untuk membakar lemak berlebihan kerana badan menggunakan sumber daripada lemak jika gula dalam darah dan hati tidak cukup untuk membekal tenaga semasa bersenam.

Buruk: Mengalami masalah kurang tenaga semasa senaman, berasa pening atau menyebabkan gula dalam darah berkurangan jika senaman berlebihan dilakukan.
3. Senaman waktu malam selepas berbuka.

Baik: Menggunakan kalori daripada makanan yang dimakan ketika berbuka puasa. Senaman yang dilakukan akan mengelakkan kalori berlebihan disimpan sebagai lemak dalam badan dan lebih bertenaga untuk buat senaman yang berintensiti lebih tinggi.

Buruk: Jika seseorang terus bersenam selepas berbuka puasa, proses itu akan mengganggu penghadaman makanan.

“Daripada semua itu, saya sarankan seseorang bersenam sebelum sahur atau dua hingga tiga jam selepas berbuka puasa selama 30 hingga 40 minit, selain memberi fokus kepada senaman yang berintensiti rendah ke sederhana seperti joging, zumba ringan, berbasikal dan lain-lain."

“Namun, jangan lupa minum air yang mencukupi iaitu antara lapan hingga 10 gelas atau 2 hingga 2.5 liter dalam sehari,“ pesannya.

Tidur selepas sahur

Sementara itu, Pakar Pembedahan Am dan Pembedahan Saluran Gasto-Usus Atas, Hospital Gleneagles Kuala Lumpur, Dr Yeap Chee Loong mempunyai perspektifnya sendiri.

Ketika diwawancara SinarPlus, beliau menyentuh tentang tabiat tidur selepas bersahur.

“Tidur selepas sahur sangat tidak digalakkan kerana akan memberi kesan dan bakal membahayakan kesihatan.

“Ini kerana makanan memerlukan masa selama dua hingga empat jam untuk melalui proses pencernaan. Jika seseorang memilih untuk tidur dalam tempoh masa itu, proses pencernaan akan terganggu, begitu juga dengan penyerapan nutrien.

“Makan makanan yang telah dimakan ketika sahur juga tidak mampu menghasilkan tenaga yang diperlukan tubuh,“ tambahnya.

Selain itu, terdapat beberapa kesan sampingan lain. Antaranya adalah:
i) Risiko kegemukan.

Tidur selepas makan akan mendorong kepada peningkatan berat badan.

“Lebih-lebih lagi jika makan makanan bergoreng, berlemak dan manis lebih pada hari biasa. Makanan itu semua akan menyebabkan tubuh badan tidak dapat mencerna dengan baik dan nutrisi makan yang dimakan akan berkumpul menjadi lemak pada tubuh,“ jelas beliau.
ii) Cepat lapar.

Bukan itu sahaja, amalan tidur semula selepas sahur akan menjadikan makanan yang dimakan itu tidak dapat diproses dengan sempurna.

“Sebahagian besar nutrien akan bertukar ke simpanan lemak dengan amat cepat. Ini akan membuatkan seseorang itu merasa lapar dengan cepat seawal jam 10 pagi,“ beritahunya.
iii) Gangguan kepada saluran pencernaan.

Posisi berbaring sewaktu tidur juga boleh menyebabkan gangguan kepada proses pencernaan makanan.

“Masalah refluks esophagitis boleh berlaku dan ini amat merisaukan yang mana bahagian bawah esophagus boleh terdedah kepada pengaliran asid perut.

“Keadaan itu secara tidak langsung akan mengganggu proses pencernaan makanan tidak dapat dilakukan dengan sempurna ketika tidur,“ katanya.

Sebagai seorang doktor prihatin, pakar pembedahan itu berpesan kepada semua umat Islam agar jangan sesekali meninggalkan sahur.

“Kesannya, ia akan merangsang kepada tahap metabolisme rendah sehingga waktu berbuka tiba,“ ujar beliau.

Misi Mohd Ikbar turunkan berat badan gagal

HANYA dua minggu sahaja, berat badan Mohd Ikbar Muhaimin Ahmad, 28, bertambah sebanyak 3 kilogram.

Kata Mohd Ikbar, beliau sangat terkejut melihat transisi itu kerana dirinya memang memasang matlamat mahu menurunkan berat badan sempena Ramadan yang mulia ini.

Kalau diikutkan berat asalnya adalah 77 kilogram dan misinya mahu turun kepada 70kg.

“Saya memang berhajat mahu kurus sedikit pada bulan puasa ini, tetapi sebaliknya yang berlaku,“ katanya ketika dihubungi SinarPlus baru-baru ini.

Pun demikian, Mohd Ikbar mengakui tentang kesilapan tabiat pemilihan makanannya ketika berbuka dan bersahur.

“Saya makan umpama tiada hari esok. Saya akan membeli kuih-muih, roti, aneka nasi dan air di bazar pada setiap hari. Saya seboleh-bolehnya akan menghabiskan makanan tersebut. Bimbang membazir,“ ujar lelaki yang berasal dari Ipoh, Perak itu.

Apabila bersahur pula, beliau akan mula makan pada pukul 4 pagi.

“Seusai itu, saya akan tidur seketika sementara menunggu masa untuk menunaikan solat Subuh dan bersiap ke tempat kerja,“ tambahnya.

Melihat kepada rutin itu, Mohd Ikbar mengakui, pendekatan yang dilakukannya bukan sahaja tidak betul, malah memudaratkan kesihatan dan misinya untuk kurus pasti tidak akan tercapai.

“Selepas mendapat nasihat daripada rakan sekeliling, pada minggu-minggu terakhir ini, saya cuba untuk mengubah corak pemakanan dan gaya hidup Ramadan saya.

“Pertama sekali, saya akan elak minum air manis. Selain itu, saya cuba terapkan dalam diri agar bersederhana dalam apa sahaja dilakukan terutama ketika menikmati makanan,“ katanya.

Yap Pau Lin

Dietitian

Columbia Asia Hospital – Iskandar Puteri

PDF and Online Articles:

Puasa Bukan Tiket Mudah Untuk Kurus – SinarPlus, 2 Mei 2021

Artikel ini disiarkan oleh SinarPlus, 2 Mei 2021.

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Puasa Ibu Hamil

Puasa Ibu Hamil

May 24, 2019

SETIAP kali tibanya Ramadan timbul kebimbangan dalam kalangan ibu hamil untuk berpuasa kerana memikirkan tentang kemudaratan yang bakal dialami terhadap bayi dikandung jika mereka melaksanakan ibadah tersebut.

Menurut Pegawai Dietitik Hospital Columbia Asia Cheras, Nurul Atilia Abdullah, berpuasa tidak akan mendatangkan kemudaratan kepada bayi jika ibunya mengamalkan pemakanan yang mengandungi nutrisi mencukupi. Makanan yang diambil ibu hamil perlu mempunyai tiga elemen penting iaitu karbohidrat kompleks, protein dan fiber yang mesti diambil semasa bersahur, berbuka puasa dan sebelum tidur atau ketika moreh.

“Lazimnya saya cadangkan mereka mengambil karbohidrat kompleks seperti nasi putih, nasi perang atau makanan yang mempunyai fiber tinggi seperti oat untuk memberi tenaga berpanjangan sepanjang berpuasa,’’ katanya.

Nurul Atilia juga mewajibkan ibu hamil yang hendak berpuasa agar bersahur kerana dibimbangi jika tidak berbuat demikian akan memudaratkan bayi kerana tidak memperoleh tenaga dan nutrisi mencukupi.

Oleh itu, ibu hamil yang sukar menjamah nasi atau makanan berat ketika bersahur digalakkan mengambil susu kurma kerana minuman ini mempunyai zat pemakanan yang seimbang iaitu fiber dan karbohidrat daripada oat dan kurma serta protein daripada susu.

“Sama ada bersahur atau berbuka puasa, susu kurma boleh diambil oleh ibu hamil normal atau yang menghidap diabetik cuma jangan ditambah gula,’’ katanya.

Beliau juga menasihatkan ibu hamil bersahur dalam tempoh setengah jam atau satu jam sebelum imsak bagi membina ketahanan diri semasa berpuasa selain tidak terlalu aktif.

“Tidak bersahur akan menyebabkan mereka cepat penat dan memberi kesan bukan sahaja pada diri mereka juga ibadah yang dilakukan sepanjang Ramadan. Apapun jika mereka tidak boleh meneruskan berpuasa lebih baik mereka berbuka. Jangan memaksa diri kerana mereka telah diberi kelonggaran dalam melaksanakan ibadah ini,’’ katanya.

Nurul Atilia tidak menggalakkan ibu hamil minum kopi dan teh atau apa-apa minuman berkafein ketika bersahur kerana akan menyebabkan tubuh mengalami dehidrasi.

“Minuman berkafein menyebabkan ibu hamil kerap membuang air kecil sekali gus mengurangkan air dalam badan,’’ katanya.

Beliau juga menggalakkan ibu hamil di peringkat trimester kedua (15-29 minggu) dan ketiga (30 minggu ke atas) agar mengambil juadah lengkap terutama juadah utama selain susu kerana semasa tempoh tersebut bayi sedang membesar dan memerlukan tambahan kalori.

Kalori yang perlu ditambah pada kehamilan peringkat trimester pertama ialah 90 kalori dan sebanyak 270 kalori semasa trimester kedua manakala trimester ketiga, ibu hamil perlu menambah sebanyak 470 kalori. Ibu hamil yang menghidap kencing manis digalakkan mengambil banyak sayur-sayuran dan buah-buahan namun tidak digalakkan mengambil buah-buahan lain jika telah mengambil tiga biji kurma semasa berbuka puasa.

Kata Nurul Atilia, tiada halangan bagi ibu-ibu berkenaan mengambil air kosong bercampur madu ketika berbuka puasa namun tidak dibenarkan ditambah kurma sebaliknya mereka boleh memilih salah satu daripada manisan tersebut untuk berbuka puasa.

“Ada ibu hamil yang mengalami kencing manis tidak dibenarkan untuk makan kerana bimbang paras gula naik namun mereka lupa bayi dalam kandungan memerlukan nutrisi daripada ibu mereka. Sebab itu ibu-ibu ini perlu makan, tidak boleh ditinggalkan,’’ kata beliau.

Nurul Atilia Abdullah

Dietitian

Columbia Asia Hospital – Cheras

PDF and Online Articles:

Puasa Ibu Hamil – Utusan Melayu, 12 May 2019

Puasa Ibu Hamil – Utusan Melayu, 12 May 2019

Artikel ini disiarkan oleh Utusan Melayu, 12 May 2019

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Pulled Elbow – The wailing child with no fracture

February 17, 2012

With the school holiday on, I thought this topic would be appropriate.

The pulled elbow occurs in children following a peculiar type of mechanism to the injury.

It usually involves a tug to the elbow of a child – which usually happens when the caregiver – parent/nanny is trying to prevent the child from falling or preventing the child from crossing the street.

The child classically holds the elbow straight or slightly bent and particularly resists movement at the affected elbow. This often mimics a fracture at the elbow.
What happens?

The elbow joint consists of 3 bones – the arm bone, the humerus; the two forearm bone, the radius and ulna. The forearm bone is linked at the elbow by the annular ligament and it is the slipping of the head of the radius from this ligament which brings about the condition.
Treatment

A good history – if classical and clinical evaluation is all that is required for a diagnosis. Often an x-ray is not necessary. I request for an x-ray to rule out a fracture around the elbow if the examination of the child me doubt the diagnosis of a pure pulled elbow – this usually is the case if the elbow is unduly swollen.

Manipulation is done in the clinic-emergency room. If done correctly - with reduction of the radial head, the child is comfortable within minutes and often starts using the limb. It is therefore important to review the child after 15-20 minutes. An arm sling is often used but often unnecessary with the child often discarding it within hours.
Credit – Images from Netter’s Atlas of Orthopaedics
Dr. Harjeet Singh a/l Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital-Bukit Rimau


Punca Najis Berdarah Dan Rawatan Sesuai Untuk Atasinya

March 19, 2018

Pernahkah anda mengalami masalah najis berdarah? Apakah yang dimaksudkan dengan najis berdarah dan bagaimanakah cara untuk merawatnya? Dr Rosliza Ghazali, pakar bedah di Hospital Columbia Asia, Klang kongsikan punca najis berdarah dan cara untuk rawatinya.

Menurut Dr Rosliza, najis berdarah adalah tanda pesakit mengalami masalah usus. Pendarahan mungkin disebabkan daripada usus besar atau dubur. Sebahagian besar gejala najis berdarah adalah disebabkan masalah yang tidak serius seperti buasir dan ‘anal fissure’ (luka pada dubur) di mana rawatannya adalah asas dan tidak kompleks.

Tambah Dr Rosliza lagi, masalah najis berdarah ini tidak boleh dipandang ringan kerana ia boleh menjadi tanda penyakit usus yang merbahaya seperti kanser usus. Mendapatkan rawatan awal untuk kanser usus adalah penting untuk penyembuhan sepenuhnya. Berikut adalah fakta mengenai najis berdarah.
Punca Najis Berdarah

Buasir (haemorrhoids) – pembengakkan saluran darah di bahagian anus (lubang dubur)

Luka pada dubur (anal fissure)

Diverticular disease- dinding usus yang lama membentuk poket kecil di sepanjang dinding usus besar.

Colitis – keradangan usus yang disebabkan kuman atau masalah kronik (ulcerative colitis)

Polip – Ketumbuhan pada dinding usus.

Kanser usus.

Tanda Amaran Lain Untuk Penyakit Usus Besar Selain Najis Berdarah.

Sembelit atau cirit birit yang berpanjangan.

Najis berlendir atau berwarna hitam

Pemeriksaan Yang Akan Dilakukan Oleh Doktor.

Pemeriksaan pada bahagian abdomen (perut) untuk merasa ketumbuhan/benjolan.

Pemeriksaan di bahagian dubur untuk melihat sekitar lubang dubur dan warna najis.

Pesakit Yang Memerlukan Rawatan Lanjutan

Berusia 40 tahun ke atas

Mempunyai sejarah keluarga yang pernah menghidap kanser usus

Pernah melalui pemeriksaan awal tanpa menemui sebab sakit

Jenis Ujian Lanjutan Yang Diperlukan

Colonoscopy/Sigmoidoscop- Skop ini dalah sejenis alat berbentuk tiub yang mudah lentur. Di hujung tiub, dilengkapi kamera bagi membolehkan doktor melihat di dalam usus besar untuk mencari punca pendarahan.

Artikel ini disiarkan oleh Jelita – 1 March 2018
Click for Online Article:

Punca Najis Berdarah Dan Rawatan Sesuai Untuk Atasinya – Jelita, 1 March 2018


Punca Pengsan Ketika Senaman

Punca Pengsan Ketika Senaman

October 06, 2022

Baru-baru ini kita dikejutkan dengan pemergian Mejar Dr Mohd Attaful Uzair, abang kepada pelakon dan pengacara Uyaina Arshad. Arwah merupakan seorang doktor tentera. Kalau kita perhatikan tubuhnya, beliau tegap, aktif bersukan dan tidak obes. Sungguhpun begitu, arwah rebah ketika berbasikal.

Apabila saya menghubungi Uyaina, diketahui bahawa arwah ayah mereka pernah pengsan tiga kali ketika bersukan, dan meninggal dunia tidak lama kemudian pada usia yang muda juga.

Ini mungkin sesuatu yang dianggap pelik. Bukankah seseorang yang aktif bersukan itu sihat? Kenyataannya, bersukan juga boleh mendatangkan pelbagai komplikasi. Saya akan jelaskan dengan lebih lanjut tentang punca-punca pengsan atau rebah ketika bersukan.

Hyponatremic Dehydration (Dehidrasi Akibat Kekurangan Garam)

Ini yang paling kerap mengakibatkan seseorang itu rebah ketika bersukan. Secara umumnya, kita semua maklum bahawa apabila bersukan, seseorang akan berpeluh. Peluh mengandungi air dan garam. Apabila seseorang berpeluh dengan banyak, tahap garam yang keluar dari tubuh adalah tinggi. Bila tubuh kekurangan garam, ia tidak dapat berfungsi secara biasa. Seterusnya, segala fungsi dalam badan terhenti lantas menyebabkan seseorang itu pengsan. Sekiranya kandungan garam terlampau rendah hinggakan jantung tidak boleh berfungsi secara normal, individu akan rebah, nafasnya akan terhenti dan jantungnya berhenti berdegup.

Antara tanda-tanda awal seseorang itu mengalami ‘hyponatremic dehydration’ adalah seperti berikut:

Rasa dahaga yang amat sangat

Mulut kering

Seakan tiada air liur/tidak dapat meludah

Pening-pening lalat

Sekiranya anda mengalami gejala demikian ketika bersukan, pastikan anda berhenti rehat, minum air dan pertimbangkan jika anda masih bertenaga untuk meneruskan aktiviti tersebut atau tidak. Untuk mengelakkan situasi begini, pastikan anda minum air secukupnya sebelum dan ketika bersukan.

Strok Haba (Heat Stroke)

Ketika bersukan, tubuh akan menghasilkan haba yang banyak. Sepatutnya tubuh kita berupaya menyingkirkan haba secara efektif untuk mengekalkan suhu badan yang normal. Namun, apabila keadaan tidak mengizinkan, contohnya cuaca terlampau panas atau pakaian terlampau ketat atau tertutup, badan akan mengalami dehidrasi dan gagal menyingkirkan haba. Akibatnya, tubuh akan mengalami kenaikan suhu secara tinggi dan mendadak yang akan menyebabkan strok haba.

Antara simptom awal adalah:

Pening

Muntah-muntah

Keliru/tidak boleh fokus

Pengsan

Untuk mengelakkan strok haba, pastikan anda memakai pakaian yang sesuai yang membenarkan aliran udara. Elakkan bersukan jika cuaca terlampau panas.
Masalah Jantung

Ramai yang berasa mereka tiada masalah jantung. Persoalannya, adakah mereka pernah membuat saringan jantung? Masalah jantung bukan hanya melibatkan saluran darah tersumbat. Masalah jantung yang menyebabkan seseorang itu rebah secara tiba-tiba ketika bersenam boleh berpunca dari:

Ritma (rhythm) jantung yang tidak normal

Contohnya, pelakon Uyaina sendiri mempunyai masalah Supraventricular Tachycardia. Masalah ini hanya boleh dikesan dengan ujian ECG. Adakalanya ECG juga tidak mampu mengesan masalah ini kecuali dijalankan selama 24 hingga 48 jam. Ini dipanggil Holter Monitor Test.

Otot atau struktur jantung tidak normal

Contohnya Dilated Cardiomyopathy. Ini adalah satu keadaan di mana otot jantung lebih besar dari biasa, akibat faktor genetik. Sekiranya ada ahli keluarga yang meninggal secara mengejut pada usia muda, ianya mungkin diakibatkan oleh masalah ini. Doktor akan membuat ujian scan (imbasan) jantung untuk memeriksa otot jantung. Di Instagram Uyaina, beliau pernah bercerita tentang salah satu injap jantungnya yang tidak normal. Ini hanya boleh dikesan melalui scan oleh pakar. Biasanya seseorang itu tidak menyedari keadaan ini kecuali ia pernah pengsan, atau sering rasa berdebar ketika bersukan.

Saluran jantung tersumbat

Ini ialah sesuatu yang biasa berlaku terutamanya jika seseorang itu menghidap diabetes, darah tinggi, kolesterol tinggi atau kombinasi antara tiga. Pasti ramai yang berasa mereka tiada masalah ini tetapi pernahkah diperiksa?

Tiga dari 10 orang penduduk di Malaysia menghidap darah tinggi, tetapi 50 peratus dari mereka tidak menyedarinya. Ini yang menjadi punca utama insiden rebah secara tiba-tiba.

Walaupun anda berusia muda dengan berat badan yang bersesuaian, dan tidak menghidap sebarang penyakit tiga serangkai (kencing manis, tekanan darah tinggi, penyakit jantung koronari) serta tiada penyakit ini dalam sejarah keluarga, risiko untuk menghidap penyakit darah tinggi atau kolesterol tinggi zaman sekarang tetap tinggi.

Ini akibat gaya hidup masa kini di mana stres menjadi sebab utama tekanan darah tinggi. Pemakanan juga menjadi satu faktor penyakit. Tabiat makan yang tidak dikawal, contohnya gemar makanan segera dan makanan berkalori tinggi, boleh mengakibatkan kolesterol tinggi di kalangan masyarakat muda.

Selain dari itu, kehidupan di bandar, bekerja sepanjang masa, tiada masa untuk bersenam; ini semua boleh menyebabkan kencing manis, kenaikkan berat badan dan banyak masalah lain walaupun pada usia muda.

Seeloknya kita mengambil tindakan segera dengan menjalankan pemeriksaan kesihatan menyeluruh, terutamanya jika anda gemar bersukan.

Tidak apa kalau anda belum bersedia untuk menerima sebarang rawatan. Yang penting, anda mengenali tubuh anda.

Sekiranya anda sedar anda berkolesterol tinggi, ataupun tahap kencing manis atas pagar, anda akan ada motivasi lebih tinggi untuk memulakan gaya hidup sihat. Malahan, dari segi perubatan, langkah pertama dalam mengawal kolesterol atau kencing manis adalah usaha pesakit sendiri, dan tidak bergantung kepada ubat semata-mata.

Dr. Malar Santhi A/P Santherasegapan

Medical Officer

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

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Cardiology
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Queries On Colic

Queries On Colic

October 19, 2017

Colic is a common albeit exasperating condition characterised as excessive crying or fussing in babies who are otherwise healthy and thriving. It affects both baby boys as well as baby girls equally. The most telling sign of colic is the crying and it’s most likely to begin in the late afternoon or early evening although they can occur at any time of the day or night. Dr. Phang Yuk Jean, Consultant Pediatrician at Columbia Asia Hospital – Klang shares on her answers on the queries.

Queries On Colic – Baby Talk, Issue October 2017


Questions, anyone?

Questions, anyone?

March 27, 2017

Got a questions that you’re either too shy or embarrassed to ask? Here are the answers from the experts from different fields to your curious questions about having children, smell during cycle, visiting gynecologist. menopause, health-screening and so on.

Questions, anyone? – Her World, Issue March 2017
.


Ramadan: Berat Badan Turun Atau Naik?

Ramadan: Berat Badan Turun Atau Naik?

April 30, 2020

Sudah menjadi rutin setiap tahun, umat Islam diwajibkan berpuasa, selain memenuhi tuntutan syariat, ia memberikan pelbagai manfaatnya termasuk dari segi kesihatan tubuh.

Bagaimanapun, puasa anda lebih sempurna kepada tubuh jika tahu yang betul, selain dapat bertahan tempoh yang lama.

Apabila berpuasa, tahap glukosa akan berkurangan. Oleh itu, tubuh akan beralih ke glikogen yang tersimpan di dalam organ hati untuk membantunya mengeluarkan glukosa.

Ini adalah simpanan rezab tenaga glukosa untuk bertahan selama 18 hingga 24 jam.

Dalam keadaan kekurangan glukosa ini, ada juga otot yang turut terproses menjadi glukosa. Bergantung kepada keadaan kesihatan seseorang, proses ini boleh jadi berbeza-beza.

Mereka yang berpenyakit seperti diabetes akan terkesan dengan cara lain.

Oleh sebab itu, golongan ini disarankan untuk mendapat nasihat pakar perubatan sebelum berpuasa.

Walaupun badan menggunakan glukosa semasa kita berpuasa pada waktu siang, pengambilan kalori yang tinggi semasa berbuka puasa akan menyebabkan kurangnya impak kepada penurunan berat badan.

Malah, sesetengah individu mengalami peningkatan berat badan pada bulan puasa. Ini kerana jumlah kalori seharian melebihi jumlah sepatutnya.

Ini berikutan kepelbagaian jenis makanan berkalori tinggi yang dihidang ketika berbuka.

Ciri-ciri makanan berkalori tinggi ialah:

Makanan yang mengandungi santan, marjerin yang banyak.

Makanan yang digoreng.

Makanan yang tinggi kandungan gula (bukan gula asli dari sumber makanan)

Makanan yang ditumis dengan minyak yang banyak.

Jika berat badan anda pada tahap yang sesuai dan anda ingin kekalkan begitu, anggaplah pengambilan kalori pada Ramadan sama seperti pengambilan kalori pada hari biasa.

Sahur seperti makan tengah hari, iftar seperti makan malam dan snek waktu malam seperti sarapan. Hati-hati dengan kuih-muih serta air manis kerana ini boleh meninggikan jumlah kalori anda dengan ketara.

Mengawal saiz hidangan ialah cara terbaik untuk menjaga kalori dan menikmati hidangan berbuka puasa.

Hidratkan badan setiap waktu

Meminum air sedikit-sedikit selepas berbuka puasa sehingga sahur adalah lebih praktikal daripada meminum air yang banyak sekali gus.

Apabila kita minum dengan kerap walaupun sedikit, kandungan air bertahan lebih lama untuk hidrasi badan.

Jika kita minum dengan banyak sekaligus, hasilnya akan terbuang kerana kekerapan membuang air kecil.

Tips

Sediakan sebotol besar air yang tidak berperisa untuk dihirup sepanjang waktu selepas berbuka puasa. Contohnya, air ais yang ditambah lemon, pudina atau teh hijau tanpa ditambah gula.

Kurangkan minum kopi atau air yang mengandungi kafein kerana ianya akan membuat kita kerap buang air kecil. Ini akan menyukarkan tubuh untuk menyimpan air bagi tujuan hidrasi.

Baik buruk senaman pada Ramadan dan strategi senaman.

Bagi yang memilih untuk meneruskan aktiviti senaman sepanjang bulan puasa, terdapat beberapa pilihan masa yang boleh dipilih berdasarkan kesesuaian setiap individu. Setiap pilihan mempunya kelebihan dan kekurangan yang tertentu.
1. Bersenam awal pagi – selepas matahari terbit

Pro

Dapat sumber tenaga dari snek sebelum tidur dan makanan sahur

Con

Kurang membantu untuk recovery process bagi tenaga dan rehydration berikutan puasa sepanjang hari.

Tips

Pilih makanan yang tinggi kandungan sodium sewaktu sahur untuk membantu hidrasi dan liquid retention.

Makan selambat yang boleh pada waktu sahur.

Pilih makanan rendah Glycemic index dan tinggi serat bagi membolehkan bekalan tenaga glukosa digunakan secara perlahan-lahan oleh tubuh.

Pilih casein protein yang dihadam secara perlahan untuk membekalkan badan dengan sumber protein berpanjangan selepas senaman. Contoh: 'low fat' Greek yogurt dan makanan berasaskan tenusu.

1. Bersenam lewat petang sehingga waktu berbuka

Pro

Dapat bekalan nutrisi terus untuk 'recovery process' selepas bersenam dan sepanjang malam.

Con

Kurang nutrisi semasa dan sebelum senaman

Tips

Elakkan bersenam semasa cuaca panas

Makan makanan tinggi karbohidrat semasa berbuka bagi menggantikan glukosa yang digunakan semasa senaman.

Makan protein (minimum 20g) yang mudah dihadam semasa berbuka, dan sumber protein berkualiti tinggi sepanjang malam dan sahur keesokannya.

1. Bersenam di waktu malam, dua hingga tiga jam selepas berbuka

Pro

Dapat bekalan nutrisi penuh untuk sebelum, semasa dan selepas senaman.

Con

Berkemungkinan mengganggu waktu tidur berikutan masa hadaman yang sempit di waktu malam.

Tips

Elakkan makan berlebihan ketika berbuka. Makan sekadar perlu dan kawal pengambilan snek.

Makan sedikit jumlah karbohidrat semasa senaman untuk tenaga berterusan. Contoh: Jus buah tanpa gula tambahan, susu rendah lemak atau roti disapu peanut butter.

Terapi nutrisi bekas pesakit COVID-19

Mereka yang pulih dari COVID-19 dan tidak lagi di hospital, tumpuan kini adalah untuk membekalkan tubuh dengan nutrisi melalui kandungan kalori yang mencukupi serta protin untuk meningkatkan sistem imuniti.

Bioavailability protein yang tinggi membantu tubuh untuk membina sel dan otot. Untuk yang sudah berumur, keperluan protin adalah lebih tinggi kerana proses penuaan dan proses baik pulih.

Bagaimanapun, nasihat terapi nutrisi perubatan yang khusus diperlukan untuk individu yang berpenyakit sedia ada seperti Penyakit Buahpinggang Kronik. Sumber protin yang baik adalah daging lembu tanpa lemak, ayam tanpa kulit, ikan, tempeh, tofu, telur, susu rendah lemak dan keju.

Untuk meninggikan sistem imuniti dalam badan, lebihkan jenis sayur dan buah-buahan. Warna sayur-sayuran yang berbeza mengandungi vitamin dan antioksida yang juga berbeza.

Vitamin C membantu untuk sistem imuniti. Tubuh kita tidak dapat menghasilkan Vitamin C. Oleh itu, amat penting untuk mendapatkan Vitamin C melalui sumber makanan. Ia akan perbaiki sel, memudahkan menyembuhan luka dan melawan radikal bebas yang mencerobohi tubuh badan.

Lihat jadual di bawah untuk pengambilan Vitamin C yang sesuai mengikut jantina dan kadar umur (dari Recommended Nutrients Intake For Malaysia 2017).

UMUR LELAKI PEREMPUAN

1-330mg/sehari30mg/sehari

4-630mg/sehari30mg/sehari

7-935mg/sehari35mg/sehari

10-1865mg/sehari65mg/sehari

19-6570mg/sehari70mg/sehari

>6570mg/sehari70mg/sehari

BUAH/SAYUR-SAYURAN JUMLAH VITAMIN C

½ biji jambu batu 228 mg

1 biji limau mandarin24 mg

1 potong betik150 mg

1 biji kiwi135 mg

1 sudu makan perahan lemon atau limau nipis5 mg

100g bayam56.4 mg

100g cekur manis136 mg

100g bak choy60 mg

100g kangkong48.3

100g ulam raja65 mg

100g lada benggala112 mg

100g bunga kobis42.6 mg

100g lobak merah53 mg

Amalkan pengambilan sekurang-kurangnya dua hidangan buah dan tiga hidangan sayur setiap hari. Ini untuk memastikan keperluan vitamin dan serat dapat dipenuhi bagi menyokong sistem ketahanan badan disamping membantu rasa kenyang lebih lama dengan kalori yang rendah.

Nurullatifah Fauzan

Dietitian

Columbia Asia Hospital - Petaling Jaya

PDF and Online Articles:

Kegunaan Kalori Dalam Tubuh - Berita Harian, 25 April 2020

Ramadan: Berat Badan Turun Atau Naik? - Berita Harian Online, 25 April 2020

Artikel ini disiarkan oleh Berita Harian, 25 April 2020

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Ramdhan Al-Mubarak – How Far Should the Children Be Involved

June 30, 2016

Muslims are required to fast during the month of Ramadhan. Fasting means to abstain "completely" from foods, drinks as well as performing acts which break “fast”. Muslim children are not required to fast for Ramadan until they reach the age of maturity (puberty). However, parents are encouraged to educate their children in this holy month. How far the children should go when it comes to fasting?

Ramdhan Al-Mubarak Sejauhmanakah Penglibatan Anak-anak Kita Di Bulan Ini - Mami Baby, Issue June 2016
.


Rawat anak hiperaktif [Press Clipping]

Rawat anak hiperaktif [Press Clipping]

November 14, 2012

See our Press Clipping:

Harian Metro,

14 November 2012

Harian Metro,

14 November 2012


Rawat Segera Rabun Kanak-kanak

Rawat Segera Rabun Kanak-kanak

September 25, 2019

Berdasarkan laporan Pertubuhan Kesihatan Sedunia (WHO), menjelang tahun depan - dijangka 2.56 bilion penduduk dunia menghidap rabun jauh (miopia), peningkatan dua kali ganda daripada jumlah 1.8 bilion penghidap sekarang. Melalui Kajian Penyakit Mata Pediatrik Segamat, Johor (SEGPAEDS-Disember 2017) melibatkan 1,287 kanak-kanak prasekolah mendapati sebanyak 12.5 peratus daripada mereka (161 kanak-kanak) mempunyai masalah penglihatan dan daripada jumlah itu, 61 peratus daripadanya mempunyai masalah pada kedua-dua mata.

Pakar Mata Hospital Columbia Asia, Dr. Palanyraj Naicker berkata, rabun terbahagi kepada tiga kategori selain miopia, terdapat hiperopia (rabun dekat) dan astigmatisme (silau) namun dalam kalangan kanak-kanak, miopia dan astigmatisme merupakan rabun yangsering dialami malah ada yang menghidap kedua-dua penyakit mata itu. Tegas beliau, masalah rabun dalam kalangan kanak-kanak merupakan isu penting yang memerlukan rawatan segera pada usia awal bagi mengelakkan mereka mengalami penyakit mata malas (ambliopia).

Jika kanak-kanak terbabit disahkan mengalami ambliopia, penggunaan cermin mata tidak akan dapat membantu penglihatan pesakit sehingg tahap maksimum atau sempuma, sekali gus boleh mengehadkan potensi kanak-kanak dan mengurangkan keyakinan diri mereka malah jika dikesan pada tahap serius, rawatan amat sukar dilakukan.

Dalam pada itu menurut Dr. Palanyraj, masalah miopia boleh berlaku secara perlahan-lahan namun jika terlalu pantas maka miopia menjadi lebih tinggi sehingga menimbulkan pelbagai masalah seperti saraf mata terlekang (retnal detachment) iaitu saraf retina tertanggal daripada belakang mata dan memerlukan pembedahan serta merta untuk memperbaiki kedudukan saraf terbabit.

Selain itu, masalah lain termasuklah kemerosotan makular (macular degeneration) iaitu perubahan pada saraf dalam mata yang boleh

menyebabkan gangguan penglihatan kekal yang teruk selain masalah katarak iaitu isu yang lazimnya dihidap oleh individu berusia lebih 50 tahun tetapi boleh juga berlaku pada individu berusia 30 hingga 40-an.

"Bagaimanapun jika miopia meningkat terlalu pantas, pesakit akan disaran memulakan ubat titis khas (Atropin) untuk memperlahankan peningkatan miopia bagi tempoh setahun sehingga dua tahun namun keputusan untuk memberi ubat tersebut hanya akan dibuat selepas pesakit menjalani ujian saringan bagi mengesahkan miopia dihidap benar-benar terlalu tinggi atau sedang meningkat pada kadar yang terlalu cepat," ujarnya.

Kata beliau, antara simptom miopia dalam kalangan kanak-kanak ialah mereka sering menonton televisyen dan memegangbukupadajarak terlalu dekat, selalu membuat kesilapan semasa menyalin nota, kerap menggosok mata dan mengecilkan mata untuk melihat sesuatu, juling (berlaku di peringkat mata malas), akan memaling muka untuk melihat sesuatu, keputusan peperiksaan sekolah merosot dan kerap sakit kepala.

Faktor genetik kemungkinan besar menjadi punca kanak-kanak mengalami rabun namun risiko untuk mereka menghidap rabun adalah lebih tinggi jika ibu atau bapa menghidap masalah rabun dan risiko bertambah tinggi jika kedua-duanya mengalami masalah tersebut.

Selain itu, katanya, terlalu banyak aktiviti dalam rumah dan kurang aktiviti di luar rumah boleh menyebabkan rabun terutama jika kanak-kanak lebih banyak menghabiskan masa dengan gajet seperti telefon bimbit dan komputer selain terlalu banyak membaca kerana tumpuan terhadap objek terlalu dekat menyebabkan otot mata tegang.

Menurut Dr. Palanyraj untuk merawat miopia, penyakit itu perlu dikesan di peringkat awal justeru pemeriksaan mata perlu dilakukan terhadap bayi pada usia enam bulan sehingga 12 bulan dan seterusnya pada usia tiga tahun dan sebelum memulakan persekolahan.

Pemeriksaan mata yang dilakukan di peringkat permulaaan persekolahan untuk mengesan rabun dianggap terlalu lewat. Malah beliau mendapati di peringkat ini terdapat ramai kanak-kanak berumur antara tiga sehingga empat tahun telah menghidap masalah rabun malah ada yang terpaksa memakai cermin mata dengan kuasa kanta dalam lingkungan tinggi..
Faktor Rabun Dalam Kalangan Kanak-kanak

Faktor genetik kemungkinan besar penyebab rabun. Risiko lebih tinggi jika ibu atau bapa mempunyai masalah rabun atau kedua-duanya mengalami masalah tersebut.

Menuggu sehinga pelajar berusia tutjuh tahun untuk melakukan pemeriksaan mata pertama terlaly lewat.

Tabiat menatap gajet sehingga tertidur akan menyebabkan mata mengalami keletihan.

Terlalu banyak aktiviti dalam rumah boleh menyebabkan rabun terutama jika kanak-kanak menghabiskan banyak masa dengan gajet selain terlalu banyak membaca.

Cahaya matahari boleh membantu untuk memperlahankan miopia dan melihat objek jauh di luar rumah juga membantu otot dalam mata untuk berehat.

Ibu bapa perlu memastikan anak mereka yang menghidap rabun sentiasa memakai cermin mata.

Amalkan 20-20-20 Rule. Selepas 20 minit j membaca atau menggunakan komputer. lihat objek yang jauh 20 kaki (enam meter) selama 20 saat untuk ' membolehkan otot mata berehat.

Galakkan kanak-kanak bermain di luar rumah sekurang- -kurangnya dua jam sehari.

Dr. Palanyraj Naicker

Consultant Ophthalmologist

Columbia Asia Hospital – Cheras
MBBS (India), M Ophthalmology (UM)

Make an Appointment

PDF and Online Articles:

Rawat Segera Rabun Kanak-kanak - Utusan Malaysia, 22 September 2019

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Ophthalmology
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