The Lowdown of HFMD

The Lowdown of HFMD

September 19, 2018

ENTEROVIRAL
 vesicular stomatitis, the medical term for hand, foot and mouth disease (HFMD), is a common infection in children and one that can affect any child regardless of demographic and logistic differences. Lately in Malaysia, there has been an outbreak of HFMD cases in major pandemic proportions.
Causes

HFMD is caused by the coxsackie virus of the enteroviral group of virus that belongs to the Picornaviridae family, which includes poliovirus. The most common virus is the one that is causing HFMD Coxsackie A followed by Enterovirus 71. The Picornaviridae virus thrives in human body secretions such as saliva and stool.
Symptoms

The most common symptoms are fever and a general feeling of being unwell (less active and lethargic).Within 24 to 48 hours of fever, skin manifestation is noted on the extremities (around the mouth, hands, palms, feet and soles) and ulcers in the oral cavity (tongue and palate). Fever can start at a low grade but commonly, it spikes up to 40 degrees especially in the first 24 hours. The skin manifestation is commonly flat and discoloured spots or bumps. The skin manifestation is not itchy but for some children, it can be painful thus their refusal to bear weight (stand and walk) if the abundance of lesions are on their feet and soles. The mouth ulcers would result in a refusal to swallow, hence the drooling and inability to tolerate either liquid or solid intake orally.
How HFMD spreads

The HFMD is mainly transmitted through nasopharyngeal secretions, which are directly in contact with virus particles of the body secretions, especially the saliva of an affected child. It can also be transmitted through faecal-oral transmission due to poor hand hygiene after coming in contact with the stool of an affected child. Therefore, it is common for outbreaks to take place in nurseries, playschools or classrooms. Another example of how HFMD can spread to other children is through direct contact with contaminated saliva from swimming pools and playgrounds.
Diagnosis

The only laboratory method to diagnose HFMD is through viral detection from infected secretions but this process is tedious, expensive and slow in getting results. The main diagnostic tool is the clinical features of the skin rash and oral ulcers. The doctor can easily diagnose HFMD based on a clinical assessment.

A good history can also help in diagnosis especially if a child has been in contact with an affected child.
Treatment

The mainstay of treatment is to ensure adequate hydration. This means the child should be able to drink fluids and still be able to pass urine. Reduction in solid intake is not a major concern, though.

Other symptomatic treatments include antipyretic, topical drop or cream for oral ulcers. On occasion, if the symptoms are florid (red or flushed complexion), some clinical centres advocate intravenous antiviral. Topical cream is not needed for the skin rash as this has proven to be ineffective to treat the HFMD skin rash. We should totally avoid administering antibiotics as the illness is due to a viral infection.

Admission to the ward is mainly for intravenous hydration, when a child shows a reduction in intravascular volume, such as tears and urine.
Prevention

The main prevention method is to ensure good hygiene especially of the oral cavity. No vaccines are available to date despite the 2015 vaccine for Enteroviral 71 which was implicated, but there has been no further development since. Prevention of contact with affected children should be put in place if outbreaks occur. Avoid going to nurseries when this happens.
What should parents do

As parents, we would want our children to be as healthy as they can be. Ensuring good hygiene is crucial such as practising oral hygiene, taking frequent baths and avoiding crowded areas such as swimming pools and playgrounds.

Bring your child to the doctor if the child shows symptoms of HFMD. Make sure your child is able to drink healthy fluids while waiting to be treated at the clinic. Parents should provide adequate hydration including cold milk. Also check the presence of urine by checking the child’s diapers. Poor hydration will reduce urine output.

Antipyretic (drug to reduce fever) can be given to the child but due to the difficulty in swallowing because of the pain, administrating suppository via rectal antipyretic is another option. Parents should not worry if the child refuses to eat. Hydration and fluid intake are more important than food intake. Do note that having your child hospitalised for intravenous hydration to boost appetite is not useful. Intravenous hydration is mainly to rehydrate due to loss of fluid and not because of the child’s refusal to eat. The application of topical (localised) oral gels or creams which help to heal oral ulcers can help accelerate the increase of oral fluid intake.

Avoid unnecessary treatments like skin creams and antibiotics as these measures are of no effect and may even cause side effects. Administering multivitamins to increase appetite is also not indicated and unnecessary.

Currently, the Ministry of Health (MOH) has authorised hospitals to inform MOH regarding cases of HFMD so that the ministry can pin down the source.

Dr. Khairul Zaman Omar

Consultant Pediatrician

Columbia Asia Hospital – Setapak
This article first appeared in Malaymail, 9 August 2018

The Lowdown of HFMD – Malaymail, 9 August 2018

Click for Online Article:

The Lowdown of HFMD – Malaymail, 9 August 2018


The Management of Placenta Previa in Pregnancy 如何降低胎盘前置的风险

November 25, 2016

In a normal pregnancy, the placenta attaches itself to the front, side, back or upper part of the uterine cavity. As the uterus expands from week to week during pregnancy, the main parts of the placenta will grow upwards. However, Placenta Previa will form if the placenta remains too low or blocks the cervix after 28 weeks of pregnancy. Bleeding during pregnancy, hypoxia, premature delivery and other adverse effects from Placenta Previa are not to be taken lightly.

How much does a mother-to-be understand about Placenta Previa? And how to better manage Placenta Previa during pregnancy? Dr. Nicholas Lim Lye Tak, Consultant Obstetrics & Gynecologist, Columbia Asia Hospital - Petaling Jaya shares with you on the management of placenta previa in pregnancy.

Mombaby Magazine, Issue October 2016
.


The Many Ways Diabetes Affects Your Eyes

October 15, 2018

Diabetes can affect the eyes in many ways. Diabetic retinopathy affects blood vessels in the light-sensitive tissue called the retina that lines the back of the eye.

It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness in adults.

This condition usually develops in anyone who has poorly controlled type 1 or type 2 diabetes.

Diabetic eye diseases also include cataract and glaucoma:

Cataract: Adults with diabetes are two to five times more likely than those without diabetes to develop cataract. It also tends to develop at an earlier age.

Glaucoma: Certain types of glaucoma are associated with elevated pressure inside the eye. In adults, diabetes nearly doubles the risk of glaucoma.

All forms of diabetic eye disease have the potential to cause severe vision loss and blindness.
Diabetes can affect many different organs in the body.

Types of diabetic retinopathy

There are three types of diabetic retinopathy:

Non-proliferative retinopathy is an early form of the disease, where the retinal blood vessels leak fluid or bleed.

Macular oedema is a swelling of the macula, caused by the leakage of fluid from retinal blood vessels. It can damage central vision.

Proliferative retinopathy is an advanced form of the disease and occurs when blood vessels in the retina disappear and are replaced by new fragile vessels that bleed easily. This can result in a sudden loss of vision.

One might not have symptoms in the early stages of diabetic retinopathy. It usually affects both eyes.

As the condition progresses, symptoms may include:

Spots or dark strings floating in your vision (floaters).

Blurred vision.

Fluctuating vision.

Impaired colour vision.

Dark or empty areas in your vision.

Vision loss.

What causes diabetic retinopathy?

Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy.

It can cause blood vessels in the retina to leak fluid or haemorrhage (bleed), distorting vision.

In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina.

Diabetic retinopathy may progress through four stages:

Mild non-proliferative retinopathy

Moderate non-proliferative retinopathy

Severe non-proliferative retinopathy

Proliferative diabetic retinopathy (PDR).

At this advanced stage, growth factors secreted by the retina trigger the proliferation of new blood vessels, which grow along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye.

The new blood vessels are fragile, which makes them more likely to leak and bleed.

Accompanying scar tissue can contract and cause retinal detachment – the pulling away of the retina from underlying tissue, like wallpaper peeling away from a wall. This can lead to permanent vision loss.

The risk of developing diabetic retinopathy can increase as a result of:

Duration of diabetes – The longer one has diabetes, the greater risk of developing diabetic retinopathy.

Poor control of blood sugar level.

High blood pressure.

High cholesterol levels.

Pregnancy.

Smoking.

Diabetic retinopathy and diabetic macular oedema are detected during a comprehensive dilated eye exam that includes:

Visual acuity testing.

Pupil dilation – allowing a physician to examine the retina and optic nerve.

Optical coherence tomography (OCT) – Scanning of the nerve fibre layers.

A comprehensive dilated eye exam allows the doctor to check the retina for:

Changes to blood vessels.

Leaking blood vessels or warning signs of leaky blood vessels, such as fatty deposits.

Swelling of the macula (DME).

Changes in the lens.

Damage to nerve tissue.

Complications of diabetic retinopathy

Complications can lead to serious vision problems such as:

Vitreous haemorrhage – The new blood vessels may bleed into the clear, jelly-like substance that fills the centre of eye.

If the amount of bleeding is small, one might see only a few dark spots (floaters).

In more severe cases, blood can fill the vitreous cavity and completely block vision.

Retinal detachment – The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye, which will cause severe vision loss.

Glaucoma – New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up.

Blindness – Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.

In proliferative diabetic retinopathy, fragile new blood vessels grow along the inside surface of the retina and into the vitreous gel, which are likely to leak and bleed. Accompanying scar tissue can contract and cause retinal detachment, which can lead to permanent visionloss.

Preventing diabetic retinopathy

Regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.

Manage your diabetes. Make healthy eating and physical activity a part of your daily routine.

Take oral diabetes medications or insulin as directed.

Monitor blood sugar level. You may need to check and record your blood sugar level several times a day.

Keep blood pressure and cholesterol under control.

Stop smoking. Smoking increases the risk of various diabetes complications, including diabetic retinopathy.

Pay attention to vision changes.

Treating diabetic retinopathy

Vision lost to diabetic retinopathy is sometimes irreversible. However, early detection and treatment can reduce the risk of blindness by 95%.

Because diabetic retinopathy often lacks early symptoms, people with diabetes should get a comprehensive dilated eye exam at least once a year.

People with diabetic retinopathy may need eye exams more frequently, and women with diabetes who become pregnant should have a comprehensive dilated eye exam as soon as possible.

Additional exams during pregnancy may be needed.
Early diabetic retinopathy
 – If one has mild or moderate non-proliferative diabetic retinopathy, one may not need treatment right away.

However, the eye doctor will closely monitor the eyes to determine when you might need treatment.

Work with a diabetes doctor (endocrinologist) to determine if there are ways to improve diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.
Advanced diabetic retinopathy
 – If one has proliferative diabetic retinopathy or macular oedema, one will need prompt surgical treatment.

Photocoagulation, also known as focal or grid laser treatment, can stop or slow the leakage of blood and fluid in the eye.

During the procedure, leaks from abnormal blood vessels are treated with laser burns. It is usually done in an eye clinic.

Panretinal photocoagulation, also known as scatter laser treatment, can shrink abnormal blood vessels.

During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar.

Some loss of peripheral vision or night vision after the procedure is possible.

In vitrectomy, a tiny incision is made in the eye to remove blood from the middle of the eye (vitreous), as well as scar tissue that’s tugging on the retina.

It’s done in a surgery centre or hospital using local or general anaesthesia.

The eye doctor may also suggest injecting medication into the vitreous of the eye.

These medications, called vascular endothelial growth factor (VEGF) inhibitors, may help stop growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels.

The doctor may recommend these medications, also called anti-VEGF therapy, as a stand-alone treatment or in combination with panretinal photocoagulation.

All the above treatments slow or stop the progression of diabetic retinopathy, but it’s not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.
Dr Angela Loo Voon Pei is a consultant ophthalmologist and vitreoretinal surgeon. This article is courtesy of Columbia Asia Hospital.
Dr. Angela Loo Voon Pei

Consultant Ophthalmologist & Vitreoretinal Surgeon (Visiting)

Columbia Asia Hospital – Petaling Jaya
Click for Online Article:

The Many Ways Diabetes Affects Your Eyes – The Star, 8 October 2018
.


The Spread of TB

The Spread of TB

September 19, 2017

Tuberculosis (TB) is extremely contagious and outbreaks can occur in crowded environments. With a recent outbreak reported in the country, find out what tuberculosis does to the body and how you can prevent is from taking more lives.

The Spread of TB – Her World, Issue September 2017


The Truth About Back Pain

The Truth About Back Pain

January 26, 2022

If you have lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-going children can have back pain.

Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout can also cause back pain.

There are two types of back pain:

Acute
, or short-term back pain that lasts a few days to a few weeks.

Chronic back pain
 is defined as pain that continues for 12 weeks or longer. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms in a span of one year.

What causes lower back pain?

Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. Some examples of mechanical causes of low back pain include:

Congenital

Skeletal irregularities
 such as scoliosis (a curvature of the spine), lordosis (an abnormally exaggerated arch in the lower back), kyphosis (excessive outward arch of the spine), and other congenital anomalies of the spine.

Spina bifida
 which involves the incomplete development of the spinal cord and/or its protective covering. This can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.

Injuries

Sprains
 (overstretched or torn ligaments),
strains
 (tears in tendons or muscle), and spasms (sudden contraction of a muscle or group of muscles).

Traumatic Injuries
 from playing sports, car accidents, or a fall that can injure tendons, ligaments or muscles, causing the pain, as well as compress the spine and cause discs to rupture or herniate.

Degenerative problems

Intervertebral disc degeneration
 which occurs when the otherwise rubbery discs wear down as a normal process of aging and lose their cushioning ability.

Spondylosis
 is the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.

Arthritis or other inflammatory disease in
 the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.

Nerve and spinal cord problems

Spinal nerve compression, inflammation and/or injury

Sciatica
 (also called radiculopathy), caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica may feel shock-like or burning low back pain combined with pain through the buttocks and down one leg.

Spinal stenosis
, the narrowing of the spinal column that puts pressure on the spinal cord and nerves

Spondylolisthesis
, which happens when a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column

Herniated or ruptured discs
 can occur when the intervertebral discs become compressed and bulge outward

Infections
 involving the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis

Cauda equina syndrome
 occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.

Osteoporosis
 (a progressive decrease in bone density and strength that can lead to painful fractures of the vertebrae)

Non-spine sources

Kidney stones
 can cause sharp pain in the lower back, usually on one side

Endometriosis
 (the build up of uterine tissue in places outside the uterus)

Fibromyalgia
 (a chronic pain syndrome involving widespread muscle pain and fatigue)

Tumors
 that press on or destroy the bony spine or spinal cord and nerves or outside the spine elsewhere in the back

Pregnancy
 (back symptoms almost always completely go away after giving birth)

What are the risk factors for developing low back pain?

Anyone can have back pain. Factors that can increase the risk for low back pain include:

Age:
 The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease.

Fitness level:
 Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.

Weight gain:
 Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.

Genetics:
 Some causes of back pain, such as ankylosing spondylitis (a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine), have a genetic component.

Job-related factors:
 Having a job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. Working at a desk all day can contribute to pain, especially from poor posture or sitting in a chair with not enough back support.

Mental health:
 Anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.

Backpack overload in children:
A backpack overloaded with school books and supplies can strain the back and cause muscle fatigue.

How is low back pain diagnosed?

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.

Tests include:

Blood tests

Bone scans

Discography

Electrodiagnostics
 :

Electromyography (EMG)

Evoked potential studies

Nerve conduction studies (NCS)

Diagnostic imaging tests
 allow specialists to see into the body without having to perform exploratory surgery. Imaging includes:

Computerized tomography (CT)
 can show soft tissue structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors.

Magnetic resonance imaging (MRI)
 creates a computer-generated image of bony structures and soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumor, inflammation, disc herniation or rupture, or pressure on a nerve is suspected

X-ray imaging
 can show broken bones or an injured or misaligned vertebra.

Myelograms

How is back pain treated?

Acute back pain
usually gets better on its own. Acute back pain is usually treated with:

Medications
 designed to relieve pain and/or inflammation

Analgesics
 such as acetaminophen and aspirin

Non-steroidal anti-inflammatory drugs
(
NSAID
s) such as ibuprofen and naproxen may be sold over the counter; some NSAIDS are prescribed by a physician

Muscle relaxants
are prescription drugs that are used on a short-term basis to relax tight muscles

Topical pain relief
such as creams, gels, patches, or sprays applied to the skin stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.

Heat and/or ice
may help ease pain, reduce inflammation, and improve mobility for some people

Gentle stretching
(not vigorous exercise) upon advice by your healthcare professional

Exercising, bed rest, and surgery are typically not recommended for acute back pain.

Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain.

Step 1: Early treatments

Medications
may include:

Analgesics and NSAIDS

Opioid drugs
prescribed by a physician (opioids should be used only for a short period of time and under a physician’s supervision, as opioids can be addictive, aggravate depression, and have other side effects)

Anticonvulsants
—prescribed drugs primarily used to treat seizures—may be useful in treating people with sciatica

Antidepressants
such as tricyclics and serotonin, and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain (prescribed by a physician)

Self-management
:

Hot or cold packs

Resuming normal activities
as soon as possible may ease pain; bed rest is not recommended

Exercises
that strengthen core or abdominal muscles may help to speed recovery from chronic low back pain. Always check first with a physician before starting an exercise program and to get a list of helpful exercises.

Step 2: Complementary and alternative techniques include:

Acupuncture
is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them (by twisting or passing a low-voltage electrical current through them), which may cause the body to release naturally occurring painkilling chemicals.

Transcutaneous electrical nerve stimulation
(TENS) involves wearing a battery-powered device which places electrodes on the skin over the painful area that generate electrical impulses designed to block or modify the perception of pain

Physical therapy
programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combination with other interventions

Spinal manipulation and spinal mobilization
are approaches in which doctors of chiropractic care use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements.

Spinal injections
include:
Trigger point
 injections can relax knotted muscles (trigger points).

Epidural steroid injections,
 Pain relief associated with the injections tends to be temporary and the injections are not advised for long-term use.

Radio frequency ablation
 involves inserting a fine needle into the area causing the pain through which an electrode is passed and heated to destroy nerve fibers that carry pain signals to the brain.

Step 3: More advanced care options

Surgery

When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:

Vertebroplasty and kyphoplasty

Spinal laminectomy

Discectomy and microdiscectomy

Foraminotomy

Nucleoplasty

Radio frequency denervation,
 destroys part of the target nerves and offers temporary pain relief.

Spinal fusion
is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws.

Artificial disc replacement
is an alternative to spinal fusion for treating severely damaged discs.

Interspinous spacers
are small devices that are inserted into the spine to keep the spinal canal open and avoid pinching the nerves.

Rehabilitation programs

The programs are designed to help the individual reduce pain and reliance on opioid pain medicines. Programs last usually two to three weeks and can be done on an in-patient or out-patient basis.

Can back pain be prevented?

Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back.

Recommendations for keeping one’s back healthy:

Exercise regularly to keep muscles strong and flexible. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.

Maintain a healthy weight and eat a nutritious diet with sufficient daily intake of calcium, phosphorus, and vitamin D to promote new bone growth.

Use ergonomically designed furniture and equipment at home and at work. Make sure work surfaces are at a comfortable height.

Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. Put your feet on a low stool or a stack of books when sitting for a long time.

Wear comfortable, low-heeled shoes.

Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.

Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.

Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.

Dr. Gunaseelan A/L Ponnusamy

Consultant Orthopedic Surgeon

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

Make an Appointment

PDF and Online Articles:

Pain in the back – The Star, 5 December 2021

This article first appeared in The Star, 5 December 2021.

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Orthopedic
 in Columbia Asia?

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Therapeutic Ultrasound (UST)

Therapeutic Ultrasound (UST)

January 20, 2017

What is Ultrasound?

Ultrasound is an inaudible high frequency vibration that is converted from electrical energy which passes through crystals in the transducer head. Ultrasound can be used as a diagnostic modality and for treatment purposes.

Therapeutic ultrasound is one of the most commonly used and well accepted electrotherapy modality in treating various musculoskeletal conditions.

Ultrasound therapy is usually used with the help of a coupling media. The coupling media, such as water, oil or gel prevents reflection of the ultrasonic wave away. It also allows easy movement of the transducer onto the skin, thus prevents friction and allows more evenly-spread penetration.
Some of the effects of ultrasound are:

Decreases soft tissue inflammation (example: tendonitis, bursitis)

Increases tissue extensibility

Enhances scar tissue remodelling

Decreases localised pain

Improves soft tissue healing

Reduces soft tissue swelling (edema)

Improves blood flow around the tissue

Reduces muscle spasms

Ultrasound therapy is usually set at a frequency of 1MHz or 3Mhz. 1Mhz is usually used for deeper penetration (3cm-5cm), while 3Mhz is usually set for superficial penetration (1cm-2cm). Ultrasound can be used in either continuous or pulsed mode for a duration of 5 to 8 minutes.

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

References

American Physical Therapy Association

(A Survey of Therapeutic Ultrasound Use by Physical Therapists Who Are Certified Specialists)(2016) 87 (8): 986-994

Oxford Journals, Medicine & Health, Rheumatology

(Rheumatology)(2001) 40 (12): 1331-1336


腰酸背痛3大常见原因

腰酸背痛3大常见原因

November 16, 2020

你在日常生活中是否也时不时发出这样的“哀嚎”？腰酸背痛如今已不再是上了年纪的长辈们的”专利”，数据显示，80%的人一生中会经历至少一次腰酸背痛，而且还有年轻化趋势呢！若你也面对腰酸背痛的困扰，先别急着找“谷歌医生”，不如让 Columbia Asia Hospital - Iskandar Puteri 驻院骨科医生—崔伟杰医生了解常见的3个腰酸背痛原因吧！

#破解迷思: 一起向骨科专科崔伟杰医生了解腰酸背痛3大常见原因, 除了肌肉拉伤原来还可能是…

ABOUT BACKACHE

不说你不知，腰酸背痛常见的3大原因有这些！

崔医生先后在马来亚大学获得医科学士和骨科硕士专业，随后曾到新加坡接受半年的脊椎骨科训练，并每年根据政府规定接受培训。拥有20年骨科专科经验的他说，腰酸背痛是现代普遍的病症，虽然80%的人曾经历腰酸背痛，但当中90%的患者只要休息就会痊愈，只有少部分人需要药物和手术治疗。据他观察，现代人腰酸背痛常见的3个原因包括：

【原因 ①：肌肉拉伤】

很多人以为腰酸背痛是脊椎问题，但其实急性肌肉或韧带拉伤才是最普遍原因，例如生活中我们经常习惯性地错误姿势、运动过度或搬重物等，都会造成脊椎周围韧带与肌肉急性扭挫伤。另外，长时间的肌肉和韧带慢性劳损也会诱发脊椎周围肌肉痉挛。这个原因造成的腰酸背痛以年轻人、运动者、需搬重物职业者居多。若放任不管，就会变成反复发作的慢性病。

▲ 案例分享：印度舞舞蹈老师长期扭头，导致颈椎椎间盘突出(红圈处)。

【原因 ②：椎间盘突出 / 骨刺 / 骨质疏松】

除了腰酸背痛，你是否偶尔觉得手脚麻痹呢？那你可能有椎间盘突出问题！椎间盘位于两节脊椎之间，用于活动时吸收震动，但长时间的姿势不良或搬重物会造成椎间盘压力过大而向外突出。崔医生说，在下背疼痛的病人中，椎间盘突出占很大比例，且以年轻人为主。“椎间盘突出可不是背痛那么简单，若突出的椎间盘压迫到神经线，会造成手脚麻痹。”

若是老年人，椎间盘老化和脊椎过度负荷会产生骨刺，续而压迫周围的神经造成坐骨神经痛。另外，停经后的女性因荷尔蒙减少造成骨质流失，骨折机率会高出许多。若沒有适当治疗，会形成慢性背部疼痛、驼背甚丧失行动能力。

▲ 案例分享：十几岁的少年容易因椎间盘(黑色部分)突出而背痛。

椎间盘突出和骨刺造成的疼痛十分相似，一般可通过年龄分辨。还有一个方法是，椎间盘突出是无时无刻在痛，但通过休息、吃药或物理治疗则情况会好转；骨刺的症状，则是在清晨起床时腰背部特别酸痛僵硬，但起床活动后会获得缓解。

【原因 ③：疾病】

女性若觉得下腹隐隐作痛类似经期的感觉，并伴有分泌物产生就得注意了，因为这可能是骨盆腔发炎初期的信号！若不及时到妇产科治疗，便会因此下背疼痛喔~男士们也得注意，常见于你们的输尿管和肾结石会让你觉得腹股沟疼痛，并逐渐转移到背部，并伴随一阵阵痉挛痛感、频尿和血尿情况。若你出现以上症状，建议到泌尿科治疗。 癌症方面，崔医生说一般骨头出现癌细胞是从其它地方的癌细胞扩散，因此当骨头发现癌细胞时通常已很难治愈。他举出前几天刚碰到的一个案例：一名妇女因背痛向他问诊，经检查才发现那名妇女已患有乳癌第四期，癌细胞扩散至脊椎才导致她背痛。尽管从医20多年，但面对这样的病患，崔医生仍难掩哀怜之情。

ABOUT: ORTHOPEDIC

持续腰酸背痛请咨询专业医生，骨科医生问诊范围还包括这些…

看完上面3个常见原因，你是否正在扶着自己的腰，寻思自己腰酸背痛的原因呢？崔医生建议，若病患经休息和吃药后，腰酸背痛情况仍不见缓解，最好寻求专业医生判断。医生会通过询问病史和活动性测试等，通过排查做出临床诊断，再配合 X-ray、CT Scan 和 MRI 去找出原因。

除了腰酸背痛，骨折、创伤、关节、运动受伤、小儿科、脊柱 (脊椎创伤、退化) 和肿瘤等，都属于骨科医生的诊疗范围，而在 Columbia Asia Hospital - Iskandar Puteri，骨科还有 Dr. Yoga Raj 和 Dr. Aswadi Mohd Ariff 另外2名医生，因此崔医生笑言这个科室汇集了三大民族。为了提供全方位服务予病患，医院也提供其他医疗服务，如图像诊断、身体检查、临床化验和住院等。

ABOUT: COLUMBIA ASIA HOSPITAL

柔佛首间分行位于
ISKANDAR PUTERI
，现代化医疗环境与专业医生获认可

作为一间国际知名私人医院，
Columbia Asia Hospital
 于1996年进驻大马，目前全马设有13间分行，而2010年于 Iskandar Puteri 设立的这间分行正式柔佛第一间。10年来，这间综合性私人医院除了颇具名誉的骨科、神经科和妇产科，
Columbia Asia Hospital - Iskandar Puteri
 还设有耳鼻喉头颈科、泌尿科、心脏科、小儿科等共11个科室，共有24名专科医生、9名客座医生和5名驻院医生在这里问诊。这里占地22000 sq. ft.，共有135张床位并预计会在明年增加至168张床位。

Columbia Asia Hospital 于2017年获得马来西亚健康品质局认可，且曾获得 BrandLaureate 全球最佳品牌奖 (健康与私人医院组别)，足见其现代化的医疗设施、医术高超的医生和训练有素的护士获得认可。位于Iskandar Puteri 的这间 Columbia Asia Hospital 维持一贯风格，空间宽敞、干净、明亮，装潢犹如高级酒店，更没有任何“药水味”，完全跳脱我们对于医院的传统印象。另外，这里距离几个新兴住宅区如 Nusa Idaman、Horizon Hills、Educity、SiLC、Ledang，距离新山市区约20分钟，相当方便。

Dr. Chooi Wai Kit

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Iskandar Puteri
AM (Mal), MBBS (Mal), Master of Orthopedic Surgery (Mal)

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PDF and Online Articles:

腰酸背痛3大常见原因

这篇文章首次刊登在2020年10月19 日的 ”新山生活誌 / JB City Guide”

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Thyroid Health

Thyroid Health

January 22, 2021

There are many different types of thyroid disorders which may affect either its structure or function. Generally, there are five common thyroid disorders. The first is hypothyroidism which happens when there is insufficient amount of thyroid hormone production.

Then there is Hyperthyroidism which signifies an excessive amount of thyroid hormone production. Next comes Thyroid nodules which are abnormal lumps or masses within the thyroid gland. Goiter is also a common thyroid disorder. It is an enlargement of the thyroid gland, regardless of cause and may be associated with hypothyroidism, hyperthyroidism or normal thyroid function.

Last of all, thyroid carcinoma or more commonly known as thyroid cancer.

Who are at risk?

Thyroid disease can affect anyone from infants to the elderly but there are several factors that put one at a higher risk of developing thyroid disease. This includes those who already have a family history of thyroid disease or a personal history of autoimmune disorder, also those who are taking medicine that is high in iodine such as amiodarone plus those who have had treatment for a thyroid condition or thyroid cancer (thyroidectomy or radiation). What makes the risk even higher is if you are a woman and especially so if you are above 60.

Symptoms of thyroid disorder

So how do we know if you have a problem with your thyroid? That really depends on the type of thyroid condition you have. If you have palpitations, heat intolerance, experience weight loss, lethargy, menstrual disturbance, subfertility, hand tremors, nervousness, irritability and diarrhea, you may have hyperthyroidism.

However, if you experience weight gain, poor concentration, feel sleepy, experience bloating, menstrual changes, cold intolerance, constipation, hair loss, coarse dry skin and hair as well as memory loss, you may have hypothyroidism. The best thing is to check with a medical professional such as a neurologist in order for you to determine your diagnosis.

Diagnosing thyroid diseases

In addition to a thorough medical history investigation and physical examination, there are specific tests to diagnose thyroid disorders. First and foremost is a blood test and a special one too, called Thyroid Function Test (TFT). This test measures levels of thyroid hormones. Another test is the Thyroid Stimulating Hormone (TSH) which utilises your hyroid autoantibodies affecting the anti- thyroglobulin (anti Tg), anti-thyroperoxidase (anti-TPO) and TRAb (TSH receptor autoantibodies).

Imaging can also determine thyroid symptoms. The ultrasound scan of the thyroid gland is commonly used when thyroid nodules or enlargements are present. Another option is the thyroid uptake scan, carried out to evaluate the function of thyroid nodules comprising either ‘hot’ or ‘cold’ nodules. ‘Hot’ nodules are hyperfunctioning nodules. ‘Cold’ nodules do not produce excess hormone and can sometimes represent cancer. Finally, the enterologist can order a fine needle aspiration and a biopsy. This is to obtain a sample of cells or tissues from the thyroid gland for further examination by a pathologist.

Thyroid diseases: long-term or short-term treatment?

In most cases, thyroid disorders can be well-managed with medical treatment. Only some conditions may need radioactive iodine therapy (RAI) or surgery. The duration of treatment will depend on any particular disease of the thyroid.

Synthetic thyroid hormone is given to replace the inadequacy of thyroid hormone in hypothyroidism. Antithyroid drugs are given to block the excessive production of thyroid hormone in hyperthyroidism. Radioactive iodine therapy is given when hyperthyroidism is not controlled with medications. Surgery is also an option if thyroid carcinoma is confirmed or the enlarged thyroid gland is causing obstruction to the adjacent structures.

Common causes and prevention of thyroid diseases

Common causes of hypothyroidism are Hashimoto’s thyroiditis and other types of thyroidism such as postpartum thyroiditis and acute thyroiditis. The common causes of hyperthyroidism are Graves’ disease, toxic multinodular goiter, solitary toxic nodule, excessive iodine consumption and the likes.

There are no specific precautions or steps to take to avoid getting thyroid disorders. Still, for those who have hyperthyroidism, it is recommended to avoid food and drinks that contain caffeine as this can worsen symptoms. The doctor will also advise you to consume food with low iodine content. You can take calcium and vitamin D supplements for bone health if you don’t take foods rich in calcium. For those who have hypothyroidism, it is recommended to take iodine-rich foods. And last but not least, avoid alcohol consumption and smoking!

Dr. Rohaya Abdul Razak

Consultant Internal Medicine Physician

and Endocrinologist (Visiting)

Columbia Asia Hospital - Taiping
MBBS (UM), M Internal Medicine (UM),

Fellowship in Endocrinology (Malaysia)

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Tips dan info penyakit diabetis [Sinar fm - Podcast]

November 14, 2014

Dr. Abdul Rahman Mohamad (Columbia Asia Group Medical Director) & Dr. Feisul Idzwan Mustafa (Public Health Physician)

Dengarkan podcast SINAR fm untuk mengetahui tips dan info penyakit diabetis di Malaysia serta kesedaran tentang penyakit tersebut dengan kerjasama Columbia Asia sempena Bulan Diabetes Antarabangsa dan Hari Diabetes Sedunia.

Columbia Asia

Listen to the podcast
here
.

Columbia Asia - Sambutan Hari Diabetis Sedunia

Listen to the podcast
here
.

Manfaat dari Tabung Walk For Cure 2014

Listen to the podcast
here
.

Pesakit Diabetis "Type 1"

Listen to the podcast
here
.

Statistik Pesakit Diabetis

Listen to the podcast
here
.

Tahap kesihatan rakyat Malaysia

Listen to the podcast
here
.

Faktor penyakit Diabetis di kalangan kanak-kanak

Listen to the podcast
here
.

Aktiviti dan pemakanan di kalangan kanak-kanak

Listen to the podcast
here
.


Tips Penjagaan Kaki

Tips Penjagaan Kaki

January 25, 2012

Para pesakit kencing manis mempunyai risiko lebih tinggi untuk mendapat jangkitan kuman (yang kadangkala boleh menjadi serius dan mengancam nyawa), terutamanya ke atas anggota badan yang sering terdedah seperti kulit, tangan dan kaki.

Risiko jangkitan ini akan menjadi lebih tinggi sekiranya pesakit-pesakit tersebut mengalami keadaan kebas pada anggota terbabit akibat kencing manis yang tidak terkawal, lantas mendedahkan mereka kepada kecederaan kulit dan anggota yang tidak disedari dan seterusnya mengundang pelbagai bentuk jangkitan sekunder (secondary infection). Lebih menakutkan lagi apabila jangkitan tersebut merebak dan menyebabkan pesakit kehilangan anggota yang terlibat (amputasi, gambar).

Bagaimanakah cara untuk mengelakkan kecederaan dan seterusnya jangkitan pada kaki? Berikut adalah beberapa tips mudah bagi menjaga kaki kita daripada mendapat kecederaan tanpa kita sedari :

Jagalah
tahap gula
 dalam darah anda – ini sangat penting, kerana tahap kencing manis yang tinggi akan menjadikan jangkitan kuman sukar dikawal.

Periksalah kaki anda
setiap hari
 dan awas terhadap kewujudan lepuh-lepuh (blisters), luka (tidak kira berapa kecil saiznya), kemerahan pada kulit, dan tanda bengkak. Gunakan cermin bagi memeriksa kulit pada tapak kaki dan kawasan lain yang terlindung.

Gunakan
kasut yang selesa dan sesuai
 sewaktu berjalan di luar, dan pakailah stokin yang bersih bagi menyerap kelembapan berlebihan pada kulit kaki di dalam kasut. Pakailah kasut yang lebar hujungnya (large toe-box, gambar) bagi mengelakkan jari kaki terkepit di dalam kasut yang akan mengurangkan aliran darah dan menambah risiko kecederaan pada jari kaki. Elakkan penggunaan selipar kerana bahagian kaki akan terdedah kepada benda-benda tajam yang mungkin mencederakan kulit kaki. Jangan berjalan 'kaki-ayam' di luar rumah.

Basuhlah kaki setiap hari
 dengan air yang bersih (!!! jangan gunakan air panas) dan laplah kaki sehingga kering selepas dibasuh. Elakkan dari menggunakan sabuh atau pencuci yang bersifat menghakis (corrosive) kerana ianya akan melukakan kulit kaki. Jangan lupa mengeringkan kulit di antara jari kaki yang mungkin mengundang jangkitan kulat sekiranya dibiarkan lembap selepas dicuci.

Sapulah losyen
 pada kulit kaki bagi memelihara kelembapan dan mengelakkan rekahan (ini adalah gi mereka yang mempunyai kulit yang sentiasa kering dan merekah).

Potonglah kuku kaki
 dengan berhati-hati seminggu sekali dan jangan memotongnya terlalu pendek bagi mengelakkan kecederaan pada lapisan kulit berdekatan kuku. Mintalah pertolongan orang lain sekiranya penglihatan anda tidak begitu jelas. Gunakan pemotong kuku yang sesuai (nail-clippers) dan bukannya pisau bagi mengelakkan kecederaan pada kulit anda sewaktu kuku dipotong.

Elakkan berjalan di kawasan yang
terlalu panas
 (contohnya di kawasan pantai) atau
terlalu sejuk
 (contohnya lantai simen yang sejuk) tanpa alas kaki yang sesuai.

Amalkan
senaman regangan kaki dan jari
 selalu terutama sewaktu berehat di rumah. Ini bagi menggalakkan aliran darah yang lebih berkesan ke anggota-anggota tersebut.

Pergilah
berjumpa doktor anda dan jalanilah pemeriksaan kaki secara berkala
 dengan doktor anda.

Dr. Mohd Nizlan Mohd Nasir

Consultant Orthopedic and Arthroscopic Surgeon

Columbia Asia Hospital- Setapak


Tips for Staying Healthy During the Lockdown Period

March 24, 2020

Our immune system is complex and involves numerous defense mechanisms. Proper hygiene practice and following the advice issued by the government are the main steps in avoiding infection. A balanced diet and adequate fluid/water intake may help you protect yourself during this lockdown.

1. Prepare simple meals at home with the guide of the Healthy Plate concept which provides essential amount of energy, protein, vitamins and minerals that the body needs.

2. Avoid binge-eating and snacking on unhealthy snacks. Practice constant meal timings as you are free to plan a proper mealtime at home.

3. Ensure enough water intake to stay hydrated. The Recommended Nutrient Intake for Malaysia is six to eight glasses (1.5L to 2.0L) a day.

4. Reduce fast food and processed food intake to prevent consumption of excessive sodium and fat.

5. Reduce gravy intake or eliminate the gravy from canned foods if you have no other options. For example, only take the fish out of canned sardines and prepare the sauce with fresh tomatoes and onions.

6. Reduce salt. Use herbs and spices instead. Also, reduce your oil intake. Restrict sugar and alcohol consumption too.

7. Avoid a sedentary lifestyle. Do simple exercises in your home compound.

8. Don’t waste food. Prepare meals according to demand. Don’t share food off your plate with family members. Don’t even share your cutleries or utensils.

A Balanced Diet

According to Malaysia Dietary Guidelines, a balanced diet is defined as a diet that combines foods with a proper balance of nutrients including fruits, vegetables, grains, meat and dairy. We cannot depend on only one superfood or supplement to help our immune system. In fact, we need to have a complete and balanced diet to strengthen it.

Protein

During this lockdown period, please do ensure that you have enough protein sources such fish, poultry, lean meat, seafood, soy products (tofu and tempe, for instance) as well as beans/lentils. Protein is needed for cell and tissue repairs/regeneration. Indirectly, this secures our immune system mechanism. This is especially for mucous membrane regeneration which produces immune cells as the body’s first line of defense. An example of a sufficient protein intake is one palm-sized meat/chicken/fish or one piece of tofu (200g) per main meal is suggested for generally healthy people (those without kidney diseases).

Carbohydrate

Eat adequate rice and other cereal products (preferably wholegrain) and tubers because carbohydrate is our main source of energy in daily life. The basis for most meals should include unrefined cereals or minimal intake of processed cereals and grains (whole grain or whole meal), where fortified cereals and grains are recommended (Malaysia Dietary Guidelines, 2010). Thus, an appropriate amount of carbohydrate is essential to sustain our daily life’s needs.

Fruits and Vegetables

Fruits and vegetables provide vitamins and minerals that are needed to secure our immune system, including Vitamin A, B, C, D and E. Iron and zinc that play an essential role in our immune system are commonly found in food from animal sources.

The Vitamins

Vitamin A
 is found abundantly in spinach, broccoli, carrots, potatoes, bell peppers, liver, cod liver oil as well as vegetables and fruits that are dark yellow and orange in colour. Vitamin A is also needed to strengthen the immunity barrier as it is involved in mucous secretion and the organ protective lining (epithelium) formation that defends against pathogen invasion especially for both respiratory tract and intestine mucus layer. On top of that, vitamin A is also needed to form blood cells (macrophage) required in the immune system (Huang , Liu , Qi, Brand, & Zheng, 2018).

Other vitamin sources are
Vitamin B6
 in eggs, lean meat, seafoods;
Vitamin B9
 in soy and soy product;
Vitamin B12
 in yogurt and cheese.
Vitamin B
 helps in regulating immune responses in terms of cell production differentiation and the activation of white blood cells (Mikkelsen, Stojanovska, Prakash, & Apostolopoulos, 2016).
Vitamin C
 is well-known for its antioxidant properties. This helps in boosting the immune system. Vitamin C supports the outer layer of our protective surface against pathogens. It promotes the oxidant-scavenging activity of the skin and supports various cellular functions of the immune system (Carr & Maggini, 2017). Vitamin C is common in citrus fruits, guava and dark green vegetables.
Vitamin D
 is derived from sun exposure. Dietary vitamin D is found in mushrooms, potatoes, salmon, mackerel, sardines, eggs and dairy products. A Vitamin D deficiency will increase susceptibility to infection as the vitamin D receptor is expressed on immune cells (Aranow, 2011).
Vitamin E
 in found in vegetable oils such as sunflower, safflower, corn and soybean oil, and nuts such as almonds, peanuts and hazelnuts/filberts. It is another powerful antioxidant that has the ability to modulate the host’s immune functions. It helps in the differentiation of immature immune cells in thymus (Moriguchi & Muraga, 2000).

The Minerals

Iron
 which is heme-iron from animal-sourced foods including liver, red meat and egg yolk, is important to prevent anemia. Anemia depreciates the body’s immune system (Viana, 2011). Meantime, iron can also have direct effects on the growth of microbial pathogens as it is part of the component of the innate anti-microbial defense mechanism (Cherayil, 2010).
Zinc
 is rich in shellfish, red meat, eggs, liver and nuts. It is an antioxidant and anti-inflammatory nutrient. Studies show that proper zinc supplementation decreases oxidative stress markers and the generation of inflammatory cytokines (Prasad, 2008). Zinc deficiency leads to a negative impact of the immune cells.

Bibliography

Aranow, C. (2011). Vitamin D and the Immune System.
Journal of Investigative Medicine
, 881-886.

Carr, A., & Maggini, S. (2017). Vitamin C and Immune Function.
Nutrients
.

Cherayil, B. (2010). Iron and immunity: immunological consequences of iron deficiency and overload.
Archivum Immunologiae et Therapiae Experimentalis
.

Huang , Z., Liu , Y., Qi, G., Brand, D., & Zheng, S. (2018). Role of Vitamin A in the Immune System. Journal of Medical Medicine. Mikkelsen, K., Stojanovska, L., Prakash, M., & Apostolopoulos, V. (2016). The effects of vitamin B on the immune/cytokine network and their involvement in depression.
Maturitas
, 58-71.

Moriguchi, S., & Muraga, M. (2000). Vitamin E and Immunity.
Vitamins and Hormones
.

Prasad, A. (2008). Zinc in Human Health: Effect of Zinc on Immune Cells.
Molecular Medicine
, 353-357.

Viana, M. (2011). Anemia and infection: a complex relationship.
Revista Brasileira de Hematologia e Hemoterapia
, 90-92.

Adeline Wong Kai Chii

Dietitian (Visiting)

Columbia Asia Hospital - Miri

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Track & Field

Track & Field

March 29, 2017

Photo credit:
dailytrackpic.wordpress.com
Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Consultant Orthopaedic Surgeon Dr. Harjeet Singh returns for his monthly show on sports medicine and orthopaedics. This month, he focuses on athletics. Most professional track and field athletes specialise in only a small number of disciplines. Traditionally, the title of the World's Greatest Athlete has been given to the person who wins the Olympic decathlon - which combines foot races, throwing and jumping disciplines. Is that still accurate in modern sports?

Dr. Harjeet Singh Puran Singh

Consultant Orthopedic Surgeon

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

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Podcast:

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新冠疫情期间，该如何安全旅行？

新冠疫情期间，该如何安全旅行？

July 18, 2022

随着我国政府逐渐放宽新冠防疫政策，世界各国逐步放开旅游限制，停滞已久的旅游业也随之重启。这也是广大旅游爱好者所期盼的一天，疫情后，你想去哪里？提醒大家，一定要记得防疫三件套：口罩、洗手液、消毒喷雾，你准备好了吗？

你准备好了吗？

在这个与病毒共存的时候，请一定要确保你的旅游计划是万无一失的。首先，随身携带个人防护用品如口罩、消毒喷雾和消毒洗手液已经是一个共识，但也要确保你带的用品是足够应付旅游的天数的。此外，在确定你的计划前，请务必评估自身的状态。倘若身体有任何的不适，请等到身体恢复了才旅行。一定要谨记身体的健康才是最重要的。

我适合旅行吗？

高风险人群如慢性肺病患者、心脏病患者、肾脏病患者、肝脏类患者、糖尿病患者、高血压患者、过度肥胖患者和免疫功能低下的人群都是相对风险较高的人群。除此之外，60岁以上的人群也属于高风险的人群。如果你是符合以上的高危人群，而且还没接种全剂量的疫苗，那么是非常不建议旅行的。

自驾旅游会比乘搭飞机和火车安全吗？

想必很多人都会觉得自驾旅行会比乘搭飞机和火车还来得安全。出乎意料的，根据2020年9月MIT斯隆管理学院教授阿诺德•巴内特先生阐述的数据显示，一位乘客坐在满座的飞机上感染上新冠病毒的几率为0.03%。如果是在隔一个座位的状况下， 一位乘客感染上的几率是0.02%。也就是说，乘搭飞机感染病毒的几率是意外的小的。

遗憾的是，至今也还没有关于自驾旅游感染病毒的完整数据。因此，自驾旅行是否比乘搭飞机还危险依然是个未知数。

当然，在驾车旅行的时候，请避免疲劳驾驶并在精神充足的状态驾驶以降低车祸发生的几率。此外，防范措施也是必不可少的。在中途的暂时停留的地方，比如：加油站和休息站等，都要维持勤洗手、戴好口罩的习惯。

如何降低在飞机上感染新冠病毒的风险？

有些飞机会装置高效灰尘(HEPA)的空气过滤系统以快速的清理飞机里的病毒和细菌，从而最大限度的减少了任何潜在的传染可能。但是，基于飞行的整个路程都是处于一个密封的空间，在飞行途中感染上病毒的担心也是无可厚非的。因此，自身的防疫措施还是要做好的。

除了基本的勤用酒精消毒双手和随时戴好口罩，登上飞机后就尽量避免触摸周围，包括自己的脸。

假如没有任何需要摘下口罩的理由，就绝对不要摘下。当然，排队如厕和上下飞机的时候，也一定要与其他乘客保持距离。

在外更安全的用餐

因在外用餐而不幸感染上新冠病毒的案例不计胜数。为此，大多数的人都是选择在家自行烹饪或者点送外卖。然而，难得出门旅行，在外用餐的情况是在所难免的。对此，建议你可以选择室外用餐，或者较为通风的餐厅。

也请牢记，尽量选择少人的酒店餐厅或宴会厅。如果是在室内的用餐的话，良好的通风系统的餐厅和人数较少的情况才是相对理想、安全的。当然，最理想的状况还是减少外出的用餐，被感染的风险更可以大大的减低。（编辑提醒：记得要使用公筷公勺！）

总结来说，严格的执行个人的预防措施是最重要的。保护好自己，也是保护他人的方法。

尽可能避免摘下口罩，尤其在人群里面。

与别人保持至少1米的身体距离。

打开窗户或维持通风的室内空间。

避免封闭或拥挤的室内空间。

勤消毒并清洗双手。

Dr. Chong Pei Wen

Consultant Internal Medicine Physician

Columbia Asia Hospital - Petaling Jaya

MBBS (AIMST), MRCP (Ireland)

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速看！新冠疫情期间，该如何安全旅行？- 健康时尚杂志

这篇文章首次刊登在《健康时尚杂志/GoodHealth Magazine》

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Traveler’s Diarrhoea

Traveler’s Diarrhoea

April 01, 2015

Traveler’s diarrhea (TD) is usually caused by enterotoxigenic bacteria or viruses or protozoa from contaminated food or water. It can be happened at any time while traveling and even after returning home.

According to the Centers for Disease Control and Prevention (CDC), both cooked and uncooked foods are a concern on high risk destinations such as certain countries in the continent of Asia and Africa. Risky foods include raw or undercooked meat and seafood and raw fruits and vegetables. Tap water, ice and unpasteurized milk and dairy products can be increased risk too.

Symptoms: diarrhoea (often with blood and mucus), intestinal rumbling, abdominal cramp, fever, nausea, vomiting and malaise.
Dietary recommendation:

Prevent dehydration. Extra amounts of clear liquids should be taken during the acute stages. Oral rehydration therapy solutions may be useful.

Reduce irritation and inflammation of the gastrointestinal tract. Provide no irritating and low fibre food such as rice, bread, potatoes, plain crackers and banana.

Ensure food and water supplies are clean to prevent reinfection.

use safe bottled water for drinking and brushing teeth

wash hands before eating using antiseptic gel or hand wipes

avoid ice in drinks

do not eat raw vegetables or salads, raw fruits or unpasteurized dairy products

avoid street foods where unhygienic conditions are present

discard cooked foods that are left more than 2 hours at room temperature

Reintroduce fibre once tolerated to restore bowel motility. May include probiotic such as yogurt with live cultures to improve gut function.

Reference from: Centers for Disease Control and Prevention (CDC), Nutrition and Diagnosis-Related Care

Photocredit: travelreadymd.com


Treatment of Frozen Shoulder

Treatment of Frozen Shoulder

March 28, 2012

As this condition involves inflammation with subsequent thickening and scarring of the shoulder capsule (the tissue which envelopes the joint), the main problem that most patients face is stiffness of the affected shoulder. Almost all movements will be restricted and their daily activities will be disturbed bythis limitation in movement. Overhead activities (wiping the windows, combing hair, playing racket sports) will be difficult and, in the early stage, painful. The patients will also find it difficult to wash or scratch their own back, and strapping bras for ladies will be a nightmare.

After a careful evaluation and after ruling out other causes, the Doctor will usually start the treatment by thoroughly explaining the condition - it is very important for patients to realize that frozen shoulder is a SELF-LIMITTING condition, meaning that the condition will improve by itself after a period of time even without treatment. Nevertheless, certain situations will need to be treated by surgical means, as will be described later.

Treatment starts with physical therapy (range of motion exercises). This is the mainstay or the gold standard in all frozen shoulder conditions. Physical therapy ensures that the patient will continue to move the joint despite having a painful shoulder. This is particularly important in the second stage of this condition where the stiffness will be at its maximum and even though the pain is subsiding. Passive stretching of the joint in all directions using the opposite limb is done 3-4 times a day, every day. Assistive devices such as a towel, table or wall, and a broom- or walking-stick could also be used to provide maximum effect (see picture).

Pain can be treated by heat therapy, or analgesics usually prescribed by the treating doctor. This is often unnecessary unless the pain is unbearable and is very much disturbing daily activities. Long-term intake of analgesics is often discouraged.

In conditions where the stiffness cannot be overcome even with frequent stretching exercises, manipulation of the shoulder (where the surgeon will 'break' the thickened capsular tissue by forced movement under general anesthesia) is an option. Often a surgery is not needed after this procedure, unless the stiffness is persistent. In this rare instance, the surgeon will perform an arthroscopic capsular release whereby the thickened capsule is divided under direct vision (using an arthroscope - see picture below).
An arthroscopic image of the divided capsule (white tissue on the top right area) exposing the underlying muscles (red color).

Please visit your Orthopedic Surgeon for further information on this condition.
Dr. Mohd Nizlan Mohd Nasir

Consultant Orthopedic and Arthroscopic Surgeon

Columbia Asia Hospital-Setapak


Trekking and Hiking - Dr Harjeet Singh & Alex Laevaert [BFM - Podcast]

April 30, 2015

Photo credit:
www.bfm.my
Dr Harjeet Singh, Consultant Orthopaedic Surgeon and Alex Laevaert, Asian Trail Explorers

More and more urbanites are putting on trekking shoes and venturing into the forests and hills, pacing the trails for a sports adventure in the outdoors. But is trekking for everyone, and is there a difference between hiking and trekking? We learn more about the health aspects of hiking and trekking as from consultant orthopaedic surgeon Dr Harjeet Singh and Alex Laevaert, experienced hiker and trekker.

Listen to the podcast
here
.


Trust Your Gut

Trust Your Gut

June 19, 2018

DURING celebrations such as the upcoming Hari Raya, it is not uncommon to see antacids being passed around after everyone is done feasting. Bloating, abdominal discomfort and difficulty breathing after meals may be a normal thing for you, but it could be a sign of a more serious problem.

Dyspepsia, commonly known as indigestion, is a chronic disorder of sensation and movement (peristalsis) in the upper digestive tract. It can cause abdominal and upper gastrointestinal (GI) tract discomfort, especially after a meal.

According to a study in Alimentary Pharmacology & Therapeutics, the prevalence of this disorder is around 20% in Malaysian adults, whether due to heavy chilli intake, use of analgesia or chronic illness.

“A lot of people with this problem will not seek medical treatment because it is a self-limited condition, which means that it resolves spontaneously with or without specific treatment,” says Dr Cheong Kuan Loong, consultant physician, gastroenterologist and hepatologist at Columbia Asia Hospital, Puchong.

“In 25% of patients, we can identify a structural, metabolic or biochemical defect that causes dyspepsia. The remaining 75% have functional dyspepsia.

Functional dyspepsia is difficult to treat and control due to the lack of apparent symptoms and underlying causes.”

Some conditions that can lead to or exacerbate functional dyspepsia are:

Gastric dysmotility
 – A group of conditions that includes delayed or rapid stomach emptying after meals and subsequent satiety issues, hypermotility, gastric arrhythmia and impaired gastric accommodation (in males).

Visceral hypersensitivity
 – Bloating is sometimes painful, but some people find it more painful than others. A lower pain threshold when it comes to bloating, a condition called visceral hypersensitivity, could signify digestive problems.

Bacterial infection
 – Helicobacter pylori has been identified as a possible cause of functional dyspepsia. It could also be a reason for gastric dysmotility or contribute to smooth muscle dysfunction.

Psychosocial dysfunction
 – Dyspepsia has been associated with generalised anxiety disorder, amnesia and depression. Patients with these conditions regularly report feeling nauseous or having GI discomfort during periods of high stress.

Dr Cheong says, “Patients who come in with gastric problems are classified by age. If a patient is more than 60 years old, an upper endoscopy with gastric biopsy is performed. Younger patients only need an endoscopy if they display four important symptoms.”

These symptoms are:

Clinically significant weight loss, which is defined by a 5% to 10% weight loss over a six- to 12-month period.

Overt GI bleeding that is characterised by vomiting blood or passing tarry stools

More than two alarm features Rapidly progressive alarm features

Alarm features for GI tract problems are:

Difficulty swallowing

Painful swallowing

Unexplained iron-deficient anaemia

Persistent vomiting

Palpable mass in the abdomen

Palpable lymph nodes

Family history of cancer in the upper GI tract

According to Dr Cheong, antacids are not a cure-all and should not be treated as such. Proper diagnosis and medication are needed, especially in cases of persistent gastrointestinal problems.

If drug therapy is not effective, he says doctors may put their patients through less popular treatments such as psychotherapy or gastric emptying studies.

People can develop dyspepsia no matter their age. However, if GI tract problems occur at a later age, caution should be exercised by consulting a physician because these problems could indicate cancer, peptic ulcer disease or other organic problems.

For more information, call 03-8064 8688.
This article first appeared in The Star, 3 June 2018

Trust Your Gut – The Star, 3 June 2018


Tumpah Darah Lepas Bersalin Bukan Hal Biasa-Biasa

November 12, 2018

Kes kematian ibu selepas melahirkan anak bukanlah hal biasa yang boleh dipandang ringan oleh ahli keluarga. Disebabkan itulah orang-orang lama selalunya menasihatkan ibu berpantang supaya ditemani suami atau ahli keluarga ketika berpantang.

Sepanjang 42 hari selepas dilahirkan, ibu yang baru melahirkan anak mudah terdedah dengan pelbagai risiko yang mampu mengundang bahaya sehingga menyebabkan kematian mengejut. Antara salah satu sebab kematian dikalangan ibu melahirkan anak adalah tumpah darah.

Menurut Dr Norintan Zainal Shah daripada Hospital Columbia Asia, kes kematian ibu selepas 42 hari bersalin diklasifikasikan sebagai “late maternal death”.
Punca Kematian Ibu

Banyak masalah yang menjadi punca kematian ibu selepas bersalin. Antara salah satu penyebab yang utama adalah masalah tumpah darah ketika bersalin.

Masalah tumpah darah selepas bayi dilahirkan dikenali sebagai post-partum hemorrhage (PPH). Sebanyak 25 peratus kes Maternal Mortality ratio atau MMR disebabkan oleh PPH ini.

Kes-kes tumpah darah berlaku kerana rahim tidak mengecut atau masalah uri yang dikeluarkan (selepas kelahiran bayi) tidak lengkap.

Ibu yang melahirkan bayi di rumah mempunyai risiko yang dilaporkan 3 hingga 5 kali lebih tinggi untuk mengalami PPH. Mereka yang mengandungkan bayi kembar atau berganda juga lebih berisiko untuk mengalami PPH.

Para wanita yang mengandungkan anak ke 6 atau lebih dari itu, juga mengalami risiko PPH. Walau bagaimana pun, risiko tumpah darah atau PPH ini boleh dikurangkan dengan cara ini:

Mengamalkan perancangan keluarga agar tidak hamil lebih dari 5 orang.

Melahirkan bayi anda di hospital-hospital besar.

Elakkan memilih untuk bersalin sendiri

Oleh itu, bagi ibu yang mengandung anak pertama terutamanya harus mendapatkan informasi lebih mengenai hal ini. Tambah ilmu dan ketahui pendarahan bagaimana samada normal atau berlebihan sehingga mengundang risiko dan bahaya pada nyawa.
Dr. Norintan Zainal Abidin Shah

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Seremban
Artikel ini disiarkan oleh Majalah Pa&Ma, 12 November 2018
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Tumpah Darah Lepas Bersalin Bukan Hal Biasa-Biasa - Majalah Pa&Ma, 12 November 2018


Tumpah Darah Penyebab Kematian Ibu Bersalin Di Malaysia

November 05, 2018

Masalah tumpah darah selepas hamil dikenali sebagai
post partum hemorrhage
 (PPH). Ia adalah sebab utama ibu hamil meninggal dunia di Malaysia. Nak elakkannya, boleh lakukan 10 perkara yang dicadangkan ini.

Menurut Dr Norintan Zainal Abidin Shah, Pakar Perbidanan & Sakit Puan Columbia Asia Seremban, kes seperti Ros ini boleh dielakkan dengan beberapa langkah berikut;
SEBELUM HAMIL

Pastikan tahap
hemoglobin melebihi 11.5g%. Wanita yang kekurangan darah lebih berisiko untuk mengalami PPH.

Pastikan ujian
pelvic ultrasound.
 Jika mempunyai fibroid, ia menyebabkan kesukaran untuk rahim mengecut dan seterusnya boleh berlaku PPH.

Pastikan t
iada masalah seperti kencing manis dan darah tinggi sebelum hamil.
 Wanita yang mempunyai masalah darah tinggi dan kencing manis berkemungkinan besar perlu bersalin secara indius. Proses indius boleh menyebabkan rahim sukar mengecut selepas bersalin lalu menyebabkan PPH.

SEMASA HAMIL

Pastikan membuat
a
ntenatal booking
 di hospital yang mempunyai kemudahan tabung darah.

Pastikan anda
memantau tahap hemoglobin
. Disiplin dalam memakan zat besi, folik asid, Vitamin C dan B kompleks. Kesemua vitamin ini perlu untuk pembentukan hemoglobin di dalam tubuh.

Pastikan bayi tidak terlalu besar.
 Jika besar, air ketuban banyak dan ini boleh menjadi penyebab PPH.

Jika pada akhir kehamilan, doktor berpendapat bersalin melalui casearean adalah terbaik, maka ikutilah nasihat doktor.

SETELAH BERSALIN

Pastikan anda memantau darah nifas ketika berpantang
. Jika banyak, berketul-ketul sehingga basah ke kain, terus ke hospital. Tidak kira ia awal pagi atau tengah malam. Tindakan pantas boleh menyelamatkan nyawa. PPH boleh berlaku bila-bila masa walaupun sudah pulang ke rumah.

Anda perlu dapatkan
 rawatan dari hospital secepat mungkin
 apabila mengalami masalah tumpah darah selepas bersalin. Jika lambat, anda akan mengalami perubahan dalam darah di mana ia tidak boleh berhenti daripada berdarah (DIVC) yang boleh berakhir dengan maut.

PPH juga lebih kerap berlaku kepada
wanita yang hamil terlalu rapat atau terlalu ramai.
 Bincanglah dengan doktor mengenai cara-cara merancang keluarga. Suami juga bertanggungjawab menjaga nyawa isteri. Jadi, kerjasama adalah perlu dalam hal ini.

Dr. Norintan Zainal Abidin Shah

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Seremban
Artikel ini disiarkan oleh Majalah Pa&Ma, 5 November 2018
Click for Online Article:

Tumpah Darah Penyebab Kematian Ibu Bersalin Di Malaysia - Majalah Pa&Ma, 5 November 2018


Tumpuan Rawatan Untuk Penyakit Kronik

Tumpuan Rawatan Untuk Penyakit Kronik

June 17, 2020

Berikut ialah beberapa cadangan kepada pesakit sekiranya mengalami masalah kesihatan selain simptom Covid-19.

Untuk pesakit kronik
 Contohnya seperti kencing manis , sakit jantung dan sakit buah pinggang , sila pastikan anda mempunyai bekalan ubat yang mencukupi. Hubungi doktor anda untuk bertanya tentang kesesuaian untuk menangguhkan temujanji. Dapatkan bekalan ubat melalui pos ataupun pandu-lalu.

Untuk pesakit hemodialisis

 Mereka dikehendaki untuk menghadirkan diri 3 kali seminggu seperti biasa untuk menjalankan dialisis. Pemantauan tanda – tanda batuk , deman dan sebagainya. Sekiranya terdapat tanda-tanda sakit atau demam, beritahu kepada pusat dialisis. Jaga kesihatan dan kebersihan anda. Pulang ke rumah terus selepas rawatan hemodialisis.

Untuk pesakit yang mengalami sakit yang ringan
Contohnya seperti selesema dan sakit kepala, cuba makan ubat
dan rehat dengan mencukupi. Sekiranya sakit tidak bertambah baik, sila mendapatkan rawatan daripada klinik atau hospital yang berdekatan.

Untuk pesakit yang mengalami keadaan yang tidak bertambah baik
Walaupun dengan ubat dan rehat atau pun berada dalam keadaan yang serius seperti sakit dada, sesak nafas , kaki bengkak, koma, sakit perut yang serius – mesti datang ke hospital. Sekiranya anda tidak tahu sama ada keadaan anda memerlukan rawatan di hospital atau tidak, anda boleh menelefon doktor yang anda kenali untuk mendapatkan nasihat

Photo credit: Freepik.com

Dr. Tee Shin Kuan

Consultant Internal Medicine Physician & Nephrologist

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

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Tumpuan Rawatan Untuk Penyakit Kronik - Berita Harian, 13 Jun 20200

Artikel ini disiarkan oleh Berita Harian, 13 Jun 2020

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ULSER PEPTIK – Apa yang anda perlu tahu

ULSER PEPTIK – Apa yang anda perlu tahu

February 01, 2011

Tidak lama dahulu, tanggapan normal yang dikaitkan dengan punca ulser terjadi adalah stres dan memakan terlalu banyak makanan pedas.

Ulser peptik merupakan luka terbuka yang terdapat di bahagian dalam lapisan perut, bahagian atas usus kecil atau esofagus. Simptom yang paling biasa bagi ulser peptik adalah rasa sakit.

Tidak lama dahulu, ulser peptik dikatakan berpunca daripada cara seseorang itu menjalani kehidupannya. Tetapi kini, para doktor telah membuat penemuan bahawa punca kebanyakan ulser di perut dan bahagian atas usus kecil (duodenum) adalah jangkitan kuman atau medikasi dan bukannya stres atau diet. Ulser esofageal juga boleh terjadi dan lazimnya dikaitkan dengan refluks asid perut.

Ulser mempunyai nama yang berbeza bergantung kepada lokasinya:

Ulser gastrik.
 Ulser peptik ini terjadi di dalam perut anda.

Ulser duodenal.
 Ulser ini terdapat di dalam bahagian pertama usus kecil anda (duodenum)

Ulser esofageal.
 Selalunya, ulser esofageal ini terdapat di bahagian bawah esofagus. Ianya sering dikaitkan dengan penyakit refluks gastroesofageal (GERD).

Ulser peptik adalah satu penyakit yang biasa dialami oleh kebanyakan orang. Yang eloknya, rawatan ulser ini mengambil masa hanya selama beberapa minggu.
Tanda-tanda dan simptom-simptom

Rasa sakit seakan terbakar merupakan simptom biasa bagi ulser peptik. Rasa sakit ini disebabkan oleh ulser dan ianya bertambah sakit lagi apabila asid perut terkena kawasan ulser. Rasa sakit ini mungkin:

dirasai di mana-mana kawasan dari kawasan pusat ke bahagian tulang dada

mengambil masa daripada beberapa minit ke beberapa jam

menjadi lebih teruk apabila perut anda kosong

mengembang pada waktu malam

boleh dikurangkan sementara rasa sakit itu dengan memakan berbagai makanan yang akan menjadi penampan kepada asid perut atau dengan mengambil ubat yang mengurangkan asid.

datang dan pergi untuk beberapa hari atau minggu

Adakalanya, ulser akan menunjukkan tanda-tanda atau simptom-simptom seperti:

muntah darah – seakan kemerahan atau kehitaman

darah pekat di dalam najis atau najis yang kehitaman atau seakan tar

rasa mual atau muntah-muntah

kehilangan berat badan yang tidak diketahui puncanya

sakit dada

Punca-punca

Walaupun stres dan makanan pedas pernah dikaitkan sebagai punca ulser peptik, kini, para doktor telah mendapat tahu bahawa punca kebanyakan ulser berpunca daripada bakteria yang berbentuk ‘cockscrew’
Helicobacter pylori (H.pylori)
.
H.pylori
 tinggal dan bercambah di dalam lapisan mukus yang menyelaputi dan melindungi tisu-tisu di dalam perut dan usus kecil.
H.pylori
 jarang mendatangkan sebarang masalah. Tetapi, adakalanya ia akan mengganggu lapisan mukus, menginflamasikan serta menghakis tisu-tisu pencernaan yang akan menghasilkan ulser. Satu sebab hal ini terjadi adalah mereka yang mempunyai ulser peptik telahpun merosakkan lapisan di dalam perut atau usus kecil – menyebabkan mudah bagi bakteria menceroboh dan menyerang tisu-tisu tersebut.
H.pylori
 merupakan satu jangkitan gastrointestinal yang biasa. Di Amerika Syarikat, terdapat 1 dalam 5 orang di bawah 40 tahun dan separuh daripada mereka yang berumur lebih daripada 60 tahun telah dijangkiti bakteria ini. Walaupun cara
H.pylori
 merebak tidak begitu dikenalpasti, ia mungkin disebarkan melalui sentuhan intim seperti ciuman. Selain daripada itu,
H.pylori
 juga boleh disebarkan melalui makanan dan minuman.

Walaupun jangkitan
H.pylori
 merupakan punca yang paling biasa bagi ulser peptik, tetapi ianya bukanlah satu-satunya punca penyakit ulser terjadi. Lain-lain punca atau faktor-faktor yang boleh memburukkan lagi keadaan ulser itu termasuklah:

Penggunaan ubat mengurangkan sakit.
 Dadah anti-inflamasi bukan steroid (NSAIDs) boleh merengsakan atau menginflamasikan lapisan di dalam perut dan usus kecil. Terdapat medikasi yang boleh diperolehi melalui prekripsi dan di kaunter farmasi. NSAIDs bukan prekripsi termasuklah aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve) dan ketoprofen (Oridus KT). Untuk mengelakkan masalah pencernaan, anda dinasihati mengambil NSAIDs selepas makan.

NSAIDs menghalang penghasilan enzim (siklosigenase) yang menghasilkan prostaglandins. Bahan seakan hormon ini membantu melindungi lapisan perut anda daripada tercedera secara kimia dan fizikal. Tanpa perlindungan ini, asid perut boleh menghakis lapisan tersebut dan menyebabkannya berdarah serta menjadi ulser.

Merokok.
 Nikotin yang terkandung di dalam tembakau meningkatkan tahap kepekatan asid di dalam perut dan ini akan meninggikan risiko anda menghidapi ulser. Merokok juga boleh memperlahankan pemulihan sewaktu rawatan ulser.

Pengambilan alkohol secara berlebihan.
 Alkohol yang diambil secara berlebihan juga boleh merengsa dan menghakis lapisan mukus di dalam perut anda serta meningkatkan jumlah asid perut yang dihasilkan. Walaubagaimanapun, samada faktor ini merupakan satu-satunya punca yang menyebabkan ulser atau samada faktor-faktor lain harus wujud seperti bakteria
H.pylori
 atau medikasi lain yang menyebabkan ulser seperti NSAIDs.

Stres.
 Walaupun stres sahaja bukanlah satu-satunya punca ulser peptik, tetapi ianya merupakan faktor yang menyumbang kepada penyakit ulser. Stres akan memburukkan lagi simptom-simptom ulser peptik dan dalam beberapa kes, mampu melengahkan proses perawatan. Anda mungkin akan mengalami stress disebabkan situasi yang mengganggu emosi anda, surgeri atau trauma fizikal seperti kes kebakaran atau kecederaan teruk yang lain.

Bila anda perlu mendapatkan nasihat pakar doktor

Ulser bukanlah merupakan sesuatu penyakit yang anda boleh rawati secara sendirian tanpa pertolongan doktor. Walaupun antasid atau ubat penyekat asid yang boleh didapati di kaunter farmasi, ianya boleh mengurangkan kesakitan yang dialami dan kelegaannya adalah sementara. Jika anda mempunyai simptom-simptom ulser, sila berjumpa doktor anda. Dengan bantuan kepakaran doktor, anda boleh mendapatkan kelegaan daripada sakit ulser dengan serta-merta dan pulih sepenuhnya.
Penyaringan dan diagnosis

Pada mulanya, doktor anda mungkin melakukan sinar-X di bahagian atas gastrointestinal (GI) yang menunjukkan esofagus, perut dan duodenum. Sewaktu sinar-X dilakukan, anda akan menelan cecair metalik berwarna putih (barium) yang akan melapisi trek pencernaan anda dan menunjukkan lokasi ulser yang dialami dengan lebih jelas. Sinar-X di bahagian atas GI ini mampu mengesan beberapa ulser walaupun tidak semua ulser yang dialami.

Endoskopi mungkin perlu dilakukan jika keputusan sinar-X itu menunjukkan kemungkinan terdapatnya ulser itu atau jika doktor anda telah pun melakukan endoskopi terlebih dahulu. Dalam prosidur yang lebih sensitif ini di mana satu tiub panjang dan berongga dengan kamera di hujungnya dimasukkan secara perlahan-lahan ke dalam tekak dan esofagus ke dalam perut dan duodenum anda. Dengan instrumen ini, doktor boleh melihat bahagian atas trek pencernaan dan mengenalpasti ulser. Jika terdapat ulser, doktor anda akan mengambil sampel tisu kecil (biopsi) berhampiran lokasi ulser. Sampel-sampel ini diperiksa di bawah mikroskop untuk memastikan ianya bukan kanser. Biopsi juga boleh mengesan
H.pylori
 dalam lapisan perut anda.

Selain daripada biopsi, terdapat 3 ujian lain yang boleh memastikan punca ulser yang dialami adalah berpunca daripada jangkitan
H.pylori
:

Ujian darah.
 Ujian ini memeriksa kehadiran antibodi
H.pylori
. Tetapi kekurangan ujian ini adalah adakalanya ia tidak boleh membezakan dedahan luka di masa lepas ataupun jangkitan yang baru berlaku. Selepas bakteria
H.pylori
 dibasmikan, anda mungkin masih mempunyai keputusan positif buat beberapa bulan.

Ujian pernafasan.
 Prosidur ini menggunakan atom karbon radioaktif untuk mengesan
H.pylori
. Mula-mula, anda dikehendaki menghembuskan nafas ke dalam beg plastik kecil dan ikat beg plastik tersebut ketat-ketat. Kemudian, minum segelas kecil air yang jernih dan tidak berperisa. Cecair itu mengandungi karbon radioaktif sebagai sebatian (urea) ayng akan dipecahkan oleh
H.pylori
. 30 minit kemudian, anda dikehendaki menghembuskan nafas anda sekali lagi ke dalam beg plastik kedua dan ikat beg plastik tersebut ketat-ketat. Jika anda dijangkiti
H.pylori
, sampel nafas anda yang kedua akan mengandungi karbon radioaktif dalam bentuk karbon dioksida.

Jika anda mengambil medikasi yang dikenali sebagai pam perencat proton, adalah penting untuk anda berhenti mengambil ubat tersebut 3 hari sebelum ujian pernafasan dilakukan kerana medikasi tersebut boleh mengganggu keputusan ujian.

Kelebihan ujian pernafasan ini adalah ia boleh mengawas keberkesanan rawatan yang digunakan untuk membasmikan
H.pylori
, mengesan waktu apabila bakteria telah dibasmikan. Melalui ujian darah, kadangkala antibodi
H.pylori
 juga boleh dikesan dalam masa satu tahun atau lebih selepas jangkitan itu hilang.

Ujian antigen najis. Ujian ini memeriksa kehadiran
H.pylori
 di dalam sampel najis. Ianya amat berguna dalam mendiagnosis jangkitan
H.pylori
. Ia juga mungkin berguna untuk mengawas samada sesuatu rawatan itu berjaya atau tidak.

Komplikasi

Jika tidak dirawat, ulser peptik mungkin menyebabkan berlakunya perdarahan dalaman dan boleh mengakibatkan lubang di dinding perut atau usus kecil anda, lantas meletakkan anda pada risiko jangkitan serius di kaviti abdomen (peritontis). Ulser peptik juga akan menghasilkan tisu parut yang boleh menyekat laluan makanan melalui trek pencernaan dan menyebabkan anda terasa kenyang dengan mudah, muntah-muntah dan hilang berat badan.
Rawatan

Disebabkan kebanyakan ulser berpunca daripada bakteria
H.pylori
, doktor-doktor menggunakan kaedah bercabang 2 iaitu:

membunuh bakteria

mengurangkan tahap keasidan dalam sistem pencernaan untuk melegakan rasa sakit dan mempercepatkan penyembuhan.

Untuk melakukan kedua-dua langkah tersebut, ia memerlukan sekurang-kurangnya 2 atau kadangkala 3 hingga 4 daripada medikasi berikut:

Antiobiotik.
 Beberapa antibiotik yang digabungkan mampu memusnahkan
H.pylori
. Dan kebanyakan medikasi adalah efektif. Walaubagaimanapun, untuk memastikan rawatan itu efektif, adalah penting untuk anda mematuhi arahan doktor secara teratur. Lazimnya, antibiotik yang diarahkan untuk rawatan
H.pylori
 termasuklah amoxicillin (Amoxil), clarithromycin (Biaxin) atau metronidazole (Flagyl). Beberapa syarikat farmaseutikal telah menggabungkan pakej yang mengandungi kombinasi dua antibiotik dengan penyekat asid atau agen cytoprotectif khas untuk merawat jangkitan
H.pylori
. Kombinasi kedua-dua rawatan ini dijual di bawah nama Prevpac dan Helidac. Anda perlu mengambil antibiotik tersebut selama satu hingga dua minggu, bergantung pada jenis dan bilangannya. Selalunya, medikasi lain yang diarahkan bersama antiobiotik ini diambil untuk jangkamasa yang lebih lama.

Penyekat asid.
 Penyekat asid juga dikenali sebagai penyekat histamine (H-2). Ia mampu mengurangkan jumlah asid hidroklorik yang dibebaskan ke dalam trek pencernaan serta mengurangkan sakit ulser dan menggalakkan penyembuhan. Penyekat asid berfungsi dengan menghalang histamine daripada mendekati reseptor histamine. Histamine merupakan satu sebatian yang terdapat di dalam tubuh anda. Apabila penyekat asid tersebut bertindak dengan reseptor histamine, reseptor-reseptor ini mengisyaratkan sel-sel yang merembeskan asid di dalam perut untuk membebaskan asid hidroklorik. Penyekat asid yang boleh didapati secara prekripsi atau di kaunter farmasi adalah medikasi seperti ranitidine (Zantac), famotidine (Pepcid) dan Cinetidine (Tagamet).

Antasid.
 Doktor anda mungkin memasukkan antasid ke dalam pengambilan ubat anda. Antasid boleh diambil sebagai tambahan kepada penyekat asid atau untuk menggantikan penyekat asid tersebut. Tanpa mengurangkan rembesan asid, antasid meneutralkan asid yang terdapat di dalam perut dan boleh memberi kelegaan dengan segera.

Pam perencat proton.
 Satu cara lain untuk mengurangkan asid di dalam perut ialah dengan menutup ‘pam-pam’ di dalam sel-sel yang merembeskan asid. Pam perencat proton ini mengurangkan asid dengan cara menyekat pam-pam kecil ini daripada bertindak. Ini termasuklah prekripsi medikasi omaprazole (Prilosec), lansoprazole (Prevcacid), rabeprazole (Aciphex) dan esomeprazole (Nexium). Dadah pantoprozole (Protonix) boleh diambil secara oral atau intravena di hospital. Pam perencat proton juga boleh merencatkan kehadiran
H.pylori
.

Agen cytoprotective.
 Medikasi-medikasi ini boleh melindungi tisu-tisu yang melapisi perut dan usus-usus kecil anda. Ini termasuklah prekripsi medikasi sucralfate (cerafate) dan misoprostol (Cytotec). Contoh agen cytoprotective bukan prekripsi adalah seperti bismuth subsalicyclate (Pepto-Bismol). Di samping melindungi lapisan dalam perut dan usus anda, persediaan bismuth seakan merencatkan aktiviti
H.pylori
.

Jika
H.pylori
 tidak dikesan di dalam sistem anda, kebarangkalian ulser anda berpunca daripada NSAIDs – dadah anti-inflamatori bukan steroid – yang mana anda patut berhenti mengambilnya jika boleh; atau asid refluks (ulser esofageal). Dalam kedua-dua kes, doktor anda akan mengurangkan tahap keasidan dengan menggunakan penyekat asid, antasid atau pam perencat proton. Dan kemungkinan besar anda juga dikehendaki mengambil dadah cycloprotection.
Ulser-ulser yang gagal disembuhkan

Peptik ulser yang tidak dapat disembuhkan setelah dirawat dikenali sebagai ulser refraktori. Terdapat beberapa sebab kenapa ulser gagal disembuhkan walaupun setelah mendapatkan rawatan. Salah satu sebabnya adalah pesakit ulser tidak mengambil medikasi mengikut arahan yang diberikan oleh doktor. Sebab yang lain adalah terdapat beberapa jenis
H.pylori
 yang ‘tahan’ kepada antibiotik. Faktor-faktor lain yang boleh mengganggu proses pemulihan termasuklah penggunaan tembakau, alkohol atau NSAIDs. Namun demikian, ada ketikanya punca masalah ini adalah secara tidak disedari di mana ramai yang tidak menyedari medikasi yang mereka ambil mengandungi NSAIDs.

Dalam beberapa kes, ulser refraktori mungkin terjadi akibat daripada:

Penghasilan asid perut secara berlebihan seperti yang terjadi di dalam sindrom Zollinger-Ellison

Jangkitan lain selain daripada
H.pylori

Penyakit pencernaan yang lain, termasuk Crohn’s atau kanser

Rawatan untuk ulser refraktori termasuklah faktor penyingkiran yang akan mengganggu proses penyembuhan, bersama sukatan medikasi ulser yang lebih kuat. Kadangkala, medikasi tambahan diperlukan. Sugeri untuk membantu menyembuhkan ulser adalah perlu hanya apabila ulser tidak menunjukkan sebarang tindakbalas terhadap rawatan dadah yang agresif.
Penjagaan diri

Sebelum
H.pylori
 dikesan, doktor kerap menasihati mereka yang menghidap ulser untuk makan makanan yang terkawal dietnya dan mengurangkan stres dalam kehidupan mereka. Kini, memandangkan faktor pemakanan dan stres telah dikenalpasti sebagai bukan punca utama ulser, ianya tidaklah begitu penting. Walaubagaimanapun, sementara ulser itu sedang dalam proses penyembuhan, anda dinasihatkan untuk mengambil berat tentang pemakanan dan mengawal stress anda. Stres mungkin menambahkan asid dan melambatkan pencernaan. Ini menyebabkan makanan dan asid pencernaan kekal di dalam perut dan usus anda untuk jangkamasa yang lebih lama. Jika stres yang dialami agak serius, ia akan melambatkan penyembuhan ulser.

Selain daripada itu, doktor anda mungkin akan mencadangkan langkah-langkah berikut:

Berhenti merokok.
 Merokok akan mengganggu lapisan yang menyelaputi perut anda dan menyebabkannya lebih mudah untuk ulser merebak. Selain daripada itu, merokok juga boleh meningkatkan kandungan asid di dalam perut.

Hadkan atau elakkan alkohol.
 Penggunaan alkohol secara berlebihan boleh merengsakan serta menghakis lapisan mukus di dalam perut dan usus anda lalu menyebabkannya inflamasi dan berdarah.

Elakkan dadah anti-inflammasi bukan steroid (NSAIDs).
 Jika anda kerap menggunakan pil penahan sakit, anda digalakkan menggunakan acetaminophen (Tylenol, dll)

Mengawal refluks asid.
 Jika anda menpunyai ulser esofageal yang kerapkali dikaitkan dengan refluks asid, anda boleh mengambil beberapa langkah untuk membantu refluks asid. Ini termasuklah elakkan makanan pedas dan berlemak, elakkan berbaring selepas makan untuk sekurang-kurangnya 3 jam, tinggikan bahagian kepala katil anda dan kurangkan berat badan anda. Dengan mengelakkan diri daripada merokok, minum alkohol dan NSAIDs akan membantu anda mengawal refluks asid.

Dr. Abd Hamid Mat Sain

Consultant Surgeon

Columbia Asia Hospital - Seremban


Understanding Cardiac Arrest: What it is, What causes it, and How do you act on it?

May 03, 2023

What is Cardiac Arrest?

Cardiac arrest is a life threatening medical emergency when our heart suddenly stops beating. It requires immediate intervention like Cardiopulmonary Resuscitation (CPR). One of the main functions of the heart is to pump the blood that contains oxygen to be delivered to all the cells, tissues and organs. When cardiac arrest occurs, there is no blood flow to our vital organs like our brain. Brain cells will start to die off within 4min if CPR is not performed after cardiac arrest. The longer the brain is without oxygen, the risk of permanent damage to the brain is higher.

What are the prevalence of Out of hospital Cardiac Arrest in Malaysia?

According to a research published by PATOS in 2015, these are some of the findings:

The witnessed cardiac arrest contributes about 47% compared to non-witness cardiac arrest
(45%)
.

The bystander CPR is only
22.6%
.

The average age of the cardiac arrest patient in Malaysia is
57
 years old.

The prevalence is more in males about
71%
.

22.6%
 of them are patients with risk factors of heart diseases.

The survival rate of patients discharged from hospital is only
0.5%
.

What causes Cardiac Arrest?

There are several known factors that can contribute to sudden cardiac arrest like coronary heart disease, abnormal heart rhythm(arrhythmias), cardiomyopathy, hereditary condition like Brugada syndrome, drug abuse and also risk factors like hypertension, hyperlipidaemia, smoking and others.

How do you know that the person is having a Cardiac Arrest?

Cardiac arrest can occur suddenly with or without warning. Below are some of the symptoms or signs that might indicate that the person is suffering from Cardiac Arrest:

Sudden loss of consciousness

Absence of breathing

Absence of pulse or heartbeat

One of the main risk factors to cardiac arrest is due to Acute Coronary Syndrome. There are also some warning signs that might indicate the person is having Acute Coronary Syndrome like:

Chest pain or discomfort

Shortness of breath

Nausea or vomiting

Profuse sweating

There is also some atypical presentation of Acute Coronary Syndrome especially in the older population, female and diabetic patients. These patients might not be having chest pain but may present:

Upper abdominal pain

Shortness of breath without chest pain

Profuse sweating without chest pain

Nausea and vomiting without chest pain

Non-specific symptoms like lethargy or back pain

How do you approach a cardiac arrest patient?

Currently, the American Heart Association (AHA) recommends “Hand Only CPR” for a lay person provider. It is a 2-step approach. This 2-step approach is the simplified version of CPR that can be performed by anyone without the need for mouth to mouth breathing.

Step 1
: Call for Emergency Medical Services

The first step is to call for help. If you witness a person collapsing or find someone unresponsive, call Malaysia Emergency Response System or
999
 immediately.

Step 2
: Start Hands-Only CPR

Once you have called for help, start hands-only CPR. Place the heel of one hand in the centre of the chest. Next, place the other hand on top of the first hand and interlock your fingers. Then, start pushing hard and fast on the person’s chest. The recommended rate of compression is at least 100 to 120 compression per min. The compression needs to be continued until the person starts breathing or the EMS arrives and takes over.

How to prevent cardiac arrest?

Unfortunately, the majority of sudden cardiac arrest cases cannot be identified in advance. The best way to prevent is:

Recognise the signs and symptoms of impending cardiac arrest and Coronary Heart Disease.

Annual health check-up or cardiac assessment if you have the risk factors. There are several modalities of investigation that can be done for screening of coronary heart disease such as stress test and CT scan of the heart.

Adopt a healthy life style that includes a balanced diet, adequate sleep and exercise.

Stop smoking and vaping.

Proper follow up with your doctor.

What can we do more in the society to improve the survival rate of out-of-hospital cardiac arrest?

Teaching Hands-Only CPR in primary school. In Japan, hands-only CPR is a compulsory topic taught in primary school. Malaysia can also adapt this topic into their syllabus.

Have Automated External Defibrillation (AED) available in public places for example in all sports centres, condominiums and offices.

Make it compulsory to have CPR and AED taught to all company employees as part of their Human Resource Training.

Tax relief for those who have attended a Basic Life Support Course.

Dr Jonathan Yeap Han Hsiung

Consultant Emergency Physician and Head Of ER

Columbia Asia Hospital - Petaling Jaya
MD (India), M Med (Emergency Medicine) (UM), FISQUA, AMM

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Cardiology
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Understanding men's health [Press Clipping]

July 22, 2014

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The Star,

22 July 2014


Understanding Peripheral Arterial Disease (PAD)

August 20, 2020

Peripheral Arterial Disease (PAD) can cause claudification, which is fatigue or heaviness in the leg muscles. These muscles affect the thighs, calves, and buttocks. People experiencing this symptom may have a hard time walking, climbing stairs, riding a bike, or performing other activities.

PAD affects not only how well you live but also how long you may live. You may find that that you can’t walk as far or for as long as you used to—and that’s frustrating—but if you have PAD, you are also at greater risk for having a heart attack and stroke

Approximately 160,000 to 180,000 of the estimated 18 million Americans with PAD will undergo a limb amputation as a result of PAD-related condition this year, resulting in lower quality of life, high medical costs, and shorter life expectancy

Peripheral arterial disease or PAD is a common circulatory problem that limits the blood flow to your limbs. One of the symptoms of such a disease is a pain in your legs when walking. This disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up in your arterial walls and reduce blood flow.

While this situation is common with the heart, this could also cause a problem in the lower limbs when blood flow is restricted in certain areas. People who suffer from diabetes, hypertension, and high cholesterol has a higher risk of developing atherosclerosis.

Sign & Symptons

While most of the patients with PAD have mild or no symptoms, some may have leg pain when walking (claudication). Some of the common symptoms may include painful cramps in your hip, thigh or calf muscles after certain activities, such as walking or climbing the stairs. You may also experience hair loss or slower hair growth on your legs. The legs may have a weak pulse or no pulse at all. Either foot could feel cold or change color/darkens. Furthermore, there can be sores or ulcers on your toes, feet or legs that won’t heal; these are diabetic foot ulcers. In men, a symptom of PAD could also be erectile dysfunction.

Complications

Failure to recognize and treat the disease may likely result in serious consequences such as Critical limb ischemia (CLI), which may result in gangrene possibly requiring amputation of the affected limb. It could also result in sepsis – non-healing ulcers especially in diabetics who are more prone to infection.

Diagnosis

When you experience some of the symptoms, your doctor may perform the following tests to confirm the diagnosis; ankle-brachial index, duplex ultrasound, CT angiography, and invasive angiography.

Treatment Options

There are two main objectives in treating peripheral arterial disease. Firstly, to manage the symptoms by increasing blood flow to the affected limb. This will reduce the progression of gangrene thus salvaging the limb from the risk of amputation. Secondly, to stop the progression of atherosclerosis throughout the body to reduce risks of heart attack and stroke.

Depending on the severity of your condition, your doctor may initiate medications to optimize blood sugar, blood pressure, and cholesterol control. He may also recommend angioplasty, an invasive procedure whereby a balloon and/or stent is inserted into the blood vessel to restore blood flow to the affected limb. Last of all is the option of a bypass surgery which is open surgery to create a graft bypass to the occluded/narrowed blood vessel.

Dr. Alan Koay Choon Chern

Consultant Interventional Cardiologist

Columbia Asia Hospital – Taiping
MD (UPM), MRCP (UK), FSCAI (USA), Fellowship in Caridiologist (Malaysia), Fellowship in Endovascular Intervention (IJN)

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PDF and Online Articles:

Understanding Peripheral Arterial Disease (PAD) – Natural Health

This article first appeared in Natural Health.

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