膝盖剧烈疼痛走不动怎么办?

膝盖剧烈疼痛走不动怎么办?

November 03, 2020

膝盖剧烈疼痛走不动怎么办?别怕，Columbia Asia Hospital 替你重新换个新的膝盖!让你恢复自由轻松行走

你们是否经常听见老人家抱怨自己膝盖不好，上下楼不方便，连蹲下捡个东西都痛不欲生?我们也偶尔会听见年轻人抱怨因运动过度等原因导致膝关节疼痛的困扰。

膝关节作为人体中最大、使用率最高的关节之一，出现故障的概率也是非常高的。大约有 25%的成年人经历过一次以上的膝痛。

频繁的上下楼、爬山和参加竞技体育如滑雪、打篮球等会增加膝关节磨损等风险，尤其是在肌肉不够强劲、柔韧的时候。长时间的负重行走(包括超重和肥胖)，会加速关节软骨的损伤。

此外，先前曾经受伤的关节，再次损伤的概率也会增加。

别担心!膝盖疼痛并不是绝症!Columbia Asia Hospital 将提供精密的人工膝盖移植手术，帮你脱离膝盖痛楚，自由自在走天下!

膝盖疼痛就一定要进行人工膝盖移植手术吗?

Columbia Asia Hospital 的医生建议，倘若出现，持续性的膝盖疼痛就应及时就医，医生会根据患者的膝盖受损情况提供不一样的医疗方式，如果膝盖受损还不太严重，医生会建议以打针或吃药的方式缓解疼痛。若患者的膝盖已经产生剧烈疼痛，医生则会建议进行人工膝盖移植手术，以解决患者的疼痛问题和恢复患者的行动能力。

什么是人工膝盖?

人工膝盖是由三个部分主成，即股骨，胫骨和髌骨组成。股骨部分是由金属构成，覆盖于大腿骨上;胫骨部分是由金属和塑胶所构成的，覆盖于胫骨上端;而髌骨部分则由塑胶所组成，覆盖于髌骨。如此，三个部分取代原来损坏的关节表面，便可发挥功能，让病人可以自由的行走活动。人工膝盖可以使用 15 年，其耗损程度因人而异。

人工膝盖移植手术该如何进行?

人工膝盖移植手术是以人工组件取代病變的膝關節，解決疼痛及行動受限的症狀。人工膝關節組件，即是為關節的彎曲或拉伸動作而產生。

人工膝盖移植手术恢复期长吗?

患者的恢复期一般应人而异，患者将会在手术休养两个星期后开始使用拐杖进行复健，重新学习使用新的膝盖行走。

人如果你有膝盖方面的烦恼， 请让 Columbia Asia Hospital 帮助你

Columbia Asia Hospital 所提供的人工膝盖移植手术，将会由专业又亲切友善的 Dr. Hazli 负责进行。医生在进行检查之前，都会与患者进行详细的讲解，以及了解患者的病情，确保患者了解整个疗程!

被膝盖疼痛问题搞得痛不欲生的你，可以尽早到 Columbia Asia Hospital 进行精密的检查，医生会在确认病情后告知你是否需要进行人工膝盖手术。别再抱怨犹豫了，早日结束膝盖疼痛，及早治疗换你往后的行动自由!

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

Dr. Hazli Sufian Bin Sulaiman

Consultant Orthopedic Surgeon

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

Make an Appointment

PDF and Online Articles:

膝盖剧烈疼痛走不动怎么办?别怕，Columbia Asia Hospital 替你重新换个新的膝盖!让你恢复自由轻松行走

这篇文章首次刊登在 2020 年 9 月 28 日的”JOHOR NOW 就在柔佛”

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Carbohydrates Myths

Carbohydrates Myths

October 29, 2014

Myth 1: Eating too much sugar causes diabetes
FACT:
 Diabetes is a common chronic disorder due to insulin resistance and/or insulin deficiency as well as increased hepatic glucose output. Type I diabetes caused by genetic and unknown factors that trigger the onset of the disease. Risk factors for Type II diabetes includes family history (immediate family member or relatives diagnosed with diabetes), aging ( more than 35 years old), high blood sugar (during an illness or pregnancy), overweight (with BMI more than 25kg/m-2 ) and physically inactive.

The American Diabetes Association recommends public to limit sugar sweetened beverages to help prevent diabetes. A diet high in calories from any source (e.g. sugar sweetener beverages) contribute to weight gain and being overweight does increase risk for developing type II diabetes.
Myth 2: Carbohydrates are bad for diabetes
FACT:
 Carbohydrate is part of healthy and balanced diet. Total carbohydrates percentage of 45%-60% of total energy is recommended. Every diabetes patient shall be advised on carbohydrate recommendation individually. Consuming carbohydrates within recommended serving size will not raise glucose level. At least 130g carbohydrates per day should be provided to ensure adequate intake of nutrients and to prevent ketosis.
Myth 3: Diabetes diet need to give up dessert and all the foods with simple sugar.
FACT:
 It is not necessary to give up all favourite dessert and simple sugar intake if the sugar count as part of total carbohydrates allowance. The key is to have small portion and on special occasion only. Modification of recipes is suggested e.g. to reduce sugar used, to replace sugar with sweetener or to add healthy ingredients like wholegrain.

By practising portion control and combined with exercise, it shall be safe to include sweets as part of carbohydrates counting.

Example for carbohydrates exchange for sugars:

Honey: 1 tablespoon level

Kaya: 3 tablespoons level

Sweets: 1-2 pieces

Brown sugar: 3 ½ teaspoons level

White sugar: 3 teaspoons level

Rose syrup: 3 ½ teaspoons level

Condensed milk: 2 tablespoons level

Cocoa/malt based powder: 1 ½ tablespoons level

Myth 4: Diabetes diet need to cut down rice intake totally
FACT:
 Carbohydrates counting is more important than type of carbohydrates. It is not necessary to cut down rice totally and replace with other starchy e.g. sandwiches because both contain carbohydrates.

Example for 1 serving size of carbohydrate (CHO):

Cooked rice, 1 bowl: 48g CHO

Chapatti, 1 piece: 47g CHO

Bread (white/wholemeal), 1 slice: 15g CHO

Biscuits (unsweetened), 2 pieces: 14g CHO

Potato, 1 medium: 16g CHO

Dhal (raw), ½ cup: 64g CHO

Low fat milk, 1 cup: 12g CHO

Skim milk powder, 4 tablespoons: 16g CHO

Myth 5: Diabetes diet need to cut down fruit intake
FACT:
 Fruits contain carbohydrates as well, so it needs to be count as part of carbohydrates intake.

Example of fruit serving size:

Apple/orange, 1 medium: 9g CHO (<1 serving of CHO)

Banana, 1 small: 9g CHO (<1 serving of CHO)

Star fruit, 1 medium: 11g CHO (1 serving of CHO)

Grapes, 8 small: 12g CHO (1 serving of CHO)

Guava, ½ fruit: 11g CHO (1 serving of CHO)

Watermelon/papaya, 1 slice: 11g CHO (1 serving CHO)

Mango, 1 small: 11g CHO (1 serving CHO)

Medical Nutrition Therapy Guidelines for Type 2 Diabetes Mellitus

Clinical Practice Guideline for Type 2 Diabetes Mellitus 2009

American Diabetes Association
Photo from: Freedigitalphotos.net


Career or Family…Which Options?

Career or Family…Which Options?

July 10, 2015

Beware ladies! There comes a point, in every childless woman’s life, when the larger world becomes very interested in your womb. Friends, family and mother-in-laws included inquire about your womb, asking why it is not being utilized, when it will be, or will it ever work? This is especially so in Malaysian community as we practice extended family system.

Today, forty-something mothers are more likely to be first-timers, and their numbers are rising. In the UK Office for National Statistics figures show that pregnancy rates for over forties have more than doubled in the past 24 years, with 14 conceptions per 1,000 women aged over 40 compared with six per 1,000 in 1990. The average age for a British woman to have her first child is 30, and 35 for university-educated women.

The trend in Malaysia is fast catching up with the UK statistics. Women made up of more than 50% of university graduates. Women above 38 years old made up about 15% of total antenatal clinic attendees.

It is a known fact that the older you are the less likely of you getting pregnant. A woman is born with her full supply of eggs but these naturally decline each month. Women do not make any new eggs like men producing new sperms forever.

A woman’s eggs are exactly as old as she is, so essentially as women age, so does your supply of eggs. So the quality of your eggs when you reach your 30’s and 40’s is significantly lower than it is in your 20s.This fact is not only true in natural cycle but also in IVF cycle.

In IVF, the process relies on the extraction of a large number of eggs from the ovaries. Younger women’s ovaries respond better to the drugs used to extract the eggs, and younger women’s eggs are more likely to be normal. As a result younger women’s IVF success rates are indeed much higher, 42 percent of those younger than 35 will give birth to a live baby after one IVF cycle, versus 27 percent for those ages 35 to 40. Many studies have confirmed how IVF success declines with age.

So how long can you wait to have a baby? For a career woman, there are always fundamental conflict between career ambitions and the hope for having a family. Do consider your fertility when making a decision about your career. However on the plus side, research indicates that “older” mothers usually have more solid marriages, command higher salaries and live longer than women who have their children in their twenties. These women almost invariably report that choosing to delay motherhood was the best choice they have made.

There need not be any right or wrong answer but you have to make a decision anyhow. There are only 3 options in making a decision. The first is to go for family with the risk of losing your higher career. The second is to go for career with the risk of losing the chance of having a family.

If you are focused on building your career but you know you want children someday, consider the third option. As you race up the career ladder pause for a moment to consider your fertility and give yourself the best chance of having it all hence balancing between your family and career.

Before making any decisions, you need to consider some facts on fertility. You must know your health status in relation to fertility.

To increase your chance of being pregnant in future, you need to lead a healthy lifestyle. This includes exercising regularly which will prevent you developing illness such as diabetes or thyroid problems at later stage when you decide to get pregnant. These diseases may impact on your future fertility.

Quitting drinking and smoking
 at early stage is very important choice you have to make. Smoking ages your eggs by around 10 years. So in your 20s you have the eggs of a 30 year old and by the time you are 30, you will have the eggs of a 40 year old. Research shows that cigarette smoking is responsible for approximately 13% of infertility worldwide and on average smokers requires twice the number of IVF cycles before they conceive.

Excessive alcohol intake disrupts the functioning of and damages the egg. It also impairs the body’s ability to absorb essential vitamins and minerals. So if you don’t stop taking alcohol, it will affect the quality of your eggs in future.

One of the most common causes of infertility is polycystic ovary syndrome. Those women with polycystic ovaries tend to be obese, having irregular period and excessive male hormones. Their ovaries will not usually ovulate leading to infertility. If you think you have polycystic ovaries, it is for your best interest to see your doctor before making any decision to delay pregnancy.

Your doctor may request you to do some basic test including blood test and ultrasound of your ovaries to confirm the diagnosis. Those with polycystic ovaries need help to get pregnant and sometimes delaying your pregnancy later may have serious impact on your future fertility especially if you do not reduce your weight.

Women with previous abdominal surgeries such as appendicectomy and bowel surgery need to inform their doctors. These operations can cause severe pelvic peritoneal adhesions leading to blockage of their fallopian tubes. Your doctor may request you to do an x-ray called HSG, to confirm the status of your fallopian tube. If your tube is confirmed blocked, the best alternative for pregnancy is to go through IVF treatment. Obviously this will have an impact on your decision to delay pregnancy as the success rate of IVF declined with age.

Women with gynaecological problem such as fibroid, ovarian cyst and endometriosis may also consider not to delay their pregnancy.

Women with uterine fibroid, usually presented with heavy and painful period. If the fibroid is found on the inside of their womb, it may cause difficulty to get pregnant and sometimes can cause recurrent implantation failure or miscarriage. Your doctor will advise you for surgery to remove your fibroid.

Women with endometriosis or cyst will usually have difficulty to ovulate and their fallopian tube may be blocked due to pelvic adhesions. These women may need long term treatment and follow up.

Women who are healthy may consider freezing their eggs if they do not want to “freeze” their career. This process involves the women undergoing ovarian stimulation just like IVF to produce eggs. Once enough eggs are available from the process, they are being frozen for future use. The advantage with this method is that the eggs frozen from younger women are better quality than the eggs produce when they decided to get pregnant at later stage. The main disadvantage with this method is that the eggs may not survive the freezing process. The women will then miss the opportunity to get pregnant when she decides so.

Women must also be made aware of the risk of pregnancy at older age. The risks include premature labor, hypertension, diabetes, small baby, premature labor, miscarriage and higher risk of chromosomal anomalies like Down’s syndrome.

Women must understand the risk of delaying pregnancy before deciding between career or family. Men do not have a biological clock. If the women decide to start their fertility clock later, they must make sure they are fit and healthy. They must also consult their fertility expert.
Dr Suhaimi Hassan

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


Caring For Your Health After A Miscarriage

November 09, 2021

Often, the utterance of the word ‘miscarriage’ is enough to make any mummy-to-be shudder. It is a most unfortunate and painful experience for any parent. And, it is more common than we think. If this has happened to any of you, don’t suffer in silence. Many have questions that may go unasked, yet it is most important for a woman to recover and take utmost care of her health after a miscarriage. Motherhood Story asks these questions for you and have an expert guide us through.

Dr Low Wea Haw, MBBS (West Indies) M. Obs & Gyn (UM)
,
a Consultant Obstetrician & Gynecologist at Columbia Asia Hospital, Setapak, helps us get through this difficult event by shedding some light on the topic of miscarriage, and how we can care for ourselves to have healthy and successful pregnancies going forward.

When is a pregnant woman most susceptible to a miscarriage?

Miscarriage can happen any time before the 22
nd
 week of pregnancy. However, it is most common to occur before 12 weeks of pregnancy.

What are some of the common triggers or reasons?

Miscarriage is common during pregnancy, and it may occur in about 10-20% of pregnancies.

There are some contributing risk factors to early pregnancy loss, such as:

Maternal age – the risk is increased as maternal age advances

Diabetes Mellitus

Infection/viral infection with fever higher than 38°C

Leading an unhealthy lifestyle, for example, smoking or binge alcohol intake

Multiple pregnancies

Being underweight or overweight

A patient with recurrent miscarriages (3 or more losses) will need further investigation and examination for its cause.

How is a miscarriage treated?

Miscarriage is treated according to the type of miscarriage, either it is missed, incomplete or complete miscarriage.

A missed miscarriage (the pregnancy/foetus is no longer alive) can be treated

Conservatively (waiting for spontaneous abortion in 1-2 weeks) if patient’s condition

(including emotion) is stable

Surgical or medical removal/abortion if patient’s condition is not stable, for example bleeding or having abdominal pain

An incomplete miscarriage requires surgical removal.

A complete miscarriage can be treated conservatively.

What can one expect of the recovery period?

Recovery period takes 1-2 weeks’ time. A patient could also be emotionally depressed during this period of time. Bleeding could last for 5 -7 days or there could be a risk of infection in the case of an incomplete miscarriage.

What happens to our body system after a miscarriage?

Our body system will undergo a process of hormonal changes from pregnancy state to non-pregnancy state, as if we go through a delivery.

For term delivery, the recovery will take 4-6 weeks, and a miscarriage may take 1-2 weeks. Some might experience breast tenderness/engorgement especially for those miscarriage that occurs after 16 weeks of pregnancy.

What care should we take after going through a miscarriage?

Family support and understanding from the husband (Tender Loving Care) to reduce the stress that we need to go through. A well balanced diet, good hygiene care, and well hydration will help in the recovery.

What are the implications and precautions to take for future pregnancies?

Not all miscarriage is preventable. However, you can improve the chance of a healthy pregnancy by:

Regular exercise

A well balanced diet

Reduce weight to normal range if overweight

Early and regular antenatal check-up

Reduce risk of infection by regular hand wash, avoid crowded area, and avoid contact with people who are sick

Consume folic acid pre-pregnancy, preferably 3 months prior to conceiving

Limit caffeine intake. Studies showed that drinking more than two caffeinated beverages a day increases the risk of miscarriage

Avoid known miscarriage risks such as smoking, alcohol, and illicit drug usage

When will it be a safe time to try to get pregnant again?

Usually we will say after the 1
st
 normal menses (post-miscarriage). However, that depends on whether the couple is ready for the next pregnancy, and should try to avoid pregnancy until you and your partner are prepared to cope with the anxiety of another pregnancy and possibly, another loss.

What is the risk of having a miscarriage again in future pregnancies?

The risk of miscarriage in subsequent pregnancy:

One previous miscarriage – risk at 20%

Two previous miscarriages – risk at 25-30%

Three previous miscarriages – risk at 40-45%

Is there any support group for women who suffer miscarriages?

Pregnancy loss support group
 and
Child bereavement support Malaysia may provide appropriate emotional support.

Having a sympathetic doctor will provide you with medical information as well as the support you require. Your doctor will also be able to reassure you, and lay your anxiety and fear about future pregnancies.

Dr. Low Wea Haw

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Setapak
MBBS (West Indies), M Obs & Gyn (UM)

Make an Appointment

PDF and Online Articles:

Caring For Your Health After A Miscarriage – Motherhood.com.my, 3 November 2021

This article first appeared in Motherhood.com.my, 3 November 2021

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 in Columbia Asia?

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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

January 16, 2018

Carpal tunnel syndrome (CTS) is a type of compressive neuropathy of upper limb. It is one of the common condition seen at orthopaedic clinics. Common presentations of pain, numbness and tingling sensation over hand can be due to carpal tunnel syndrome. This condition is caused when one of our main nerves to the hand, the median nerve is compressed at the level of our wrist.
Anatomy of Carpal Tunnel

Carpal tunnel is a passage or a tunnel at the level of our wrist. It is surrounded by the wrist bones at the base, and a strong tissue called transverse carpal ligament as its roof. Few structures pass through this carpal tunnel, which includes tendons which move our fingers and the median nerve. If the space or size of carpal tunnel is compromised, this will cause compression of the median nerve.
Image Credit: “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine

What Are The Symptoms of CTS

Common presentation is numbness and tingling sensation over the hand especially over the thumb, index, middle and ring finger. Initially, the numbness may present occasionally, but the frequency of numbness may worsen as it progresses.

Symptoms may be worse at night during sleep. This is because we tend to keep our wrist bent during sleep. Symptoms of numbness or tingling sensation can be aggravated when doing things which need us to flex our wrist, for example when holding a book or newspaper or even during driving. A lot of times, some relief is felt by shaking hands.

If left untreated, the symptoms may progress to muscle weakness where clumsiness is felt at hand. We may drop things frequently due to the weakness. In more severe cases, muscle wasting can be seen at the base of the thumb.
Symptoms of CTS

Feeling of numbness or “pins and needles” in the fingers and gets worse at night

Hand weakness

Swollen feeling in the fingers

Diffculty in gripping objects with the hand

Burning/tingling of the thumb, index and middle fingers

Diffculty making a fist

How is CTS Diagnosed

The doctor will ask you a series of questions about your symptoms and the progression. During the evaluation, the doctor will examine to confirm the diagnosis as well as assess the severity of it. Assessment of the sensation of the hand will be done as well as testing the motor power of the thumb and fingers.

Following doctor’s examination, a few investigations can be done to confirm the diagnosis further. The most common investigation done is nerve conduction study which measures the signals conducted by the median nerve over the forearm and hand. This can determine the severity of carpal tunnel syndrome. Other less commonly done investigations include electromyogram, x-ray and MRI.
What Are The Treatment Options?

It is important to start treatment early as the carpal tunnel syndrome worsens over time if left untreated. Initial treatment comprises of nonsurgical treatment. If early diagnosis is made and early treatment started, nonsurgical treatment generally gives good results.
Activity Modification

Activities and work that aggravates the symptoms need to be identified and modified. In general, an activity which keeps the wrist in the same position for a prolonged time, or activities which keep the wrist in exion/bend may worsen the symptoms. Use of computers/ laptops, power tools are among the common job activities that may worsen the symptoms Modification of the use of these tools as well as frequent rest or wrist exercises in between will benefit.
Braces

Braces are usually used for a couple of weeks depending on the severity and the rate of recovery. The braces are worn to keep the wrist in a neutral position or a more relaxed position for the wrist. Braces can be worn at any time especially important to wear it at night. In some cases, by wearing even during day at work will be useful.
Medication

Medication such as NSAIDs are often prescribed by the doctor. The medication reduces pain as well as it may relieve some of the symptoms of numbness by reducing the in ammation at the carpal tunnel.
Injection

Injection into the carpal tunnel is another method of nonsurgical treatment. Doctors usually inject a small dose of steroids. This may relieve the painful symptoms, but the effects are temporary.
Surgery

Surgery is normally recommended for patients with late presentation or for patients who did not improve with nonsurgical treatment. The surgery is known as carpal tunnel release. The purpose of the surgery is to relieve the compression of the median nerve, and this is done by cutting the transverse carpal ligament which forms the roof of the carpal tunnel.

There are two common surgical techniques for carpal tunnel surgery, the open carpal tunnel release, and endoscopic carpal tunnel release.

The surgery can be done as an outpatient or as a daycare procedure. It can be performed with general anaesthesia or local anaesthesia.

In open carpal tunnel release, a small incision is made over the palm. The ligament is cut under direct visualisation before the wound is closed.

In an endoscopic release, two smaller incisions are made. Visualising with the use of endoscope/camera the ligament is cut by a special knife.

In both methods, the outcomes are the same. You should discuss with your surgeon on the bene ts and risk of each technique.
Outcomes

The results of carpal tunnel release are generally good. Most patients recover well from their symptoms. In cases where surgery is done late, where there is permanent damage to the median nerve, the symptoms may not be relieved completely.

In rare occasions, recurrence of symptoms may occur which may require additional treatment or surgery.

Early detection and treatment are important. When treatment is started at early stages, the outcomes are good, and most symptoms are relieved.
Dr. Ramesh Naidu Applanaidu

Consultant Orthopedic Surgeon

Columbia Asia Hospital – Petaling Jaya
This article first appeared in InfoMed Malaysia, Issue 24, Jan - Mar 2018.

Carpal Tunnel Syndrome - InfoMed Malaysia, Issue 24, Jan – Mar 2018


CAST CARE OVERVIEW - For patients on a cast

February 07, 2011

You have been fitted with a cast or splint to protect your bone and reduce pain as you heal. It is important to take care of your cast or splint.
CAST CARE INSTRUCTIONS

Mild swelling of the injured area is common during the first few days. Swelling may make your cast feel tight initially. To reduce swelling, keep the cast above the level of your heart for 24 to 48 hours. This can be accomplished by resting it on pillows. Also, gently move your fingers or toes frequently.

Take your pain medicine as instructed. This allows for reduction of pain and also reduces the swelling.

Do not get the cast or splint wet. To bathe with a cast, cover the cast with a plastic bag and tape the opening shut. Even when covered with plastic, you should not place the cast in water or allow water to run over the area.

If the cast becomes wet, you can dry it with a hair dryer on the cool setting. Do not use the warm or hot setting because this can burn the skin.

Keep the cast clean and avoid getting dirt or sand inside the cast. Do not apply powder or lotion on or near the cast. Cover the cast when eating.

Do not place anything inside the cast, even for itchy areas. Sticking items inside the cast can injure the skin and lead to infection. Using a hair dryer on the cool setting may help soothe itching.

Do not pull the padding out from inside your cast.

WHEN TO SEEK HELP

If there are sore areas or a foul odor from the cast, cracks or breaks in the cast, or the cast feels too tight.

You develop swelling that causes pain or makes it so you cannot move your fingers or toes.

You develop tingling or numbness in the arm or fingers or toes.

Your fingers or toes are blue or cold.

You develop severe pain in or near the casted arm or leg.

Your cast becomes soaking wet.

Dr. Harjeet Singh a/l Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital- Bukit Rimau


Celiac Disease and Gluten Free Nutrition & Eating habits

May 20, 2015

Celiac disease is a lifelong inflammatory condition of the gastrointestinal tract that affects the small intestine. It is a heredity disease where T-cell-mediated immune response towards gluten is ingested by genetically predisposed people.

When people with celiac disease digest gluten (a protein found in wheat, rye and barley), their body will start to attack the small intestine because of its immune response.

It leads to damage on the villi that line the small intestine that promotes nutrient absorption and eventually leads to malabsorption of nutrients. Celiac disease can develop at any age after people start eating foods or medicines that contain gluten.
Signs and symptoms:

Frequent, foul-smelling stools that are pale and foamy

Diarrhoea

Irritability and distended abdomen

Easy fatigue

Pallor and anaemia

Weight loss

Vomiting

Celiac disease can lead to serious health complications if left untreated including dermatitis herpetiformis, osteoporosis, short stature and other autoimmune disorders.
Treatment:

The only treatment is lifelong adherence to a strict gluten-free diet. Gluten is a general name for the proteins found in wheat, rye and barley. Gluten acts as glue to hold food together.
Gluten-Free Diet:

Avoid gluten from wheat, rye, barley, brewer's yeast and triticale.

Foods that often not tolerated: cream soups, ice cream, malted, oatmeal, cereals, cakes, cookies, breads, baked goods, wheat starch, spaghetti, macaroni and other pasta.

Check food labels for thickening agents, flour thickeners, sauces, salad dressings, roux, food colouring, drugs and medications, vitamins and supplements. A product can be labelled as gluten-free if it does not contain wheat, rye, barley or their crossbred hybrids OR if it contains a gluten-containing grain or an ingredient derived from a gluten-containing grain that has been processed to less than 20 part per million (ppm) of gluten.

Choose naturally gluten-free grains and flours: corn, rice, tapioca, arrowroot, cassava, soy, potato, beans, sorghum, quinoa, millet and buckwheat.

Choose gluten-free products: gluten-free breads, gluten-free sauce etc.

Prevent cross-contamination with foods containing gluten during preparation. Separate utensils and equipment for both gluten-free and gluten containing foods is suggested. Wheat flour can stay airborne for many hours and may contaminate exposed preparation surfaces and uncovered gluten-free products.

When symptoms exists:

Start with low fibre diet because of flattening of the mucosa villi. Fibre intake can increase gradually as tolerated.

Dairy products should be avoided because risks of secondary lactase deficiency. Dairy products may reintroduced gradually after 3-6 months on diet treatment.
Dietary Supplement:

MCT (medium-chain triglycerides)

Water soluble vitamin (A, D, E and K) and B-complex vitamins

Iron>/li>

Calcium

Reference from:

MOH, 2012

Celiac Organization, US

Photocredit:

womenshealthmag.com

safereating.co.uk

sgihealth.com

crpud.net

nownhow.com

therootofhealth.com

rosannadavisonnutrition.com

glutenfreeeasily.com

udisglutenfree.co.uk


Cervical Cancer and its Prevention

Cervical Cancer and its Prevention

November 08, 2011

What is cervical cancer?

The cervix is the lower part of your uterus (womb). The cancer of this part of uterus is called cervical cancer. Cancer of the cervix (cervical cancer) is a serious but preventable disease. It is the third most common cancer among Malaysian Women.
What causes cervical cancer?

Since most of the all cervical cancers are caused by Human Papilloma Virus (HPV), any woman who has sex can get cervical cancer. Most women who’ve had sex have been exposed to HPV at some time in their life. Usually, your body’s immune system fights off the infection, and HPV goes away on its own. The women at highest risk for cervical cancer are women in whom infection with one of the high-risk types persists for years. Other risk factors for cervical cancer include smoking, multiple sexual partners and HIV infection.
HPV infection and how is it related with Cervical cancer?

HPV is a family of very common viruses that can cause cervical cancers, plus a variety of other problems like common warts, genital warts and plantar warts. HPV also causes cancers of the vulva, vagina, anus, and cancers of the head and neck. Women and men become infected with HPV types that cause cervical cancer through skin to skin especially during sexual contact and sexual inter course not necessarily has to happen. Most women will be exposed to HPV during their lifetime.

The most common cancer-causing types of the virus are 16 and 18. This is important to know because these two types alone cause about 70% of all cervical cancer. The cervical cancer vaccine protects against these two types 100% of the time.

An HPV infection rarely leads to cervical cancer. In most women, the cells in the cervix return to normal after the body’s immune system destroys the HPV infection. However, in some women, the HPV infection remains and causes changes in the body’s cells. If these abnormal cells are not found and treated, they may become cancer. Normally this progress can take from 10-20 years.
Do I have HPV infection?

In most cases, you won’t have any symptoms of an HPV infection. The only way to know if you have an HPV infection is to have a direct test for the virus which is performed right from the Pap test container or by using an additional swab at the time of the Pap test. The only way to tell if a high-risk HPV infection has caused the cells in your cervix to change is to have a Pap test. Signs of an HPV infection may appear weeks, months or years after the first infection, which is why it is important to have regular tests.
How to treat HPV?

Currently, there is no treatment for the virus. There are treatments for the cervical changes that HPV can cause. If your Pap and HPV tests show that cells in your cervix have changed, you should discuss treatment options with your doctor.

Girls and women age 9-45 can protect themselves from HPV and cervical changes related to HPV by getting the cervical cancer vaccine. There are two types of vaccines in the market. One is quadrivalent vaccine which consist of HPV strains of 16, 18, 11 & 6, this vaccine protects against the most common HPV that cause cervical cancer, genital warts and recent studies shows that it has protection against ano-genital cancers. The other vaccine is a bivalent vaccine with HPV strains of 16 & 18 which protects against cervical cancer. The quadrivalent is called Gardasil and is recommended from the age 9-26 years. The bivalent vaccine is called Cervarix and is recommended from the age 9-45 years.
What is a Pap test?

Screening tests can find changes in cervical cells before cancer develops. Changes in cervical cells before cancer develops are called dysplasia. Removing cells that have dysplasia can prevent cervical cancer. If left untreated, dysplasia can lead to cervical cancer. Screening tests can help prevent cervical cancer. Cervical cancer can be cured if it’s found at an early stage.
What should I do before a Pap test?

Don’t take the tests if you’re having your menstrual period.

Don’t douche for 2 days before the tests.

Don’t have sexual intercourse for 2 days before the test.

Don’t use tampons or birth control foams, jellies, or other vaginal creams or vaginal medicines for 2 days before the test.
When I should commence Pap test and till how long?

After 3 years of commencement of sexual activity every 1 or 2 years once and 3 yearly if 3 subsequent Pap test are normal. Once menopause you can do every 3 yearly and stop once 3 subsequent Pap test are normal with negative HPV DNA test.
What is the difference between Pap test and HPV vaccination?

These are two different prevention methods advocated for cervical cancer. HPV vaccination is called primary prevention whereby we are eliminating the most common risk factor that is HPV infection. So when there is no HPV infection then there are no cervical cell changes.

Pap test is to detect cervical cell changes at earliest stage as possible and do the necessary treatment. This is called secondary prevention.

However taking HPV vaccination does not give 100% protection against cervical cancer. We still recommend continuing Pap test at least biannually.
Conclusion and take away message

The single most important thing that a woman can do is to participate in a regular screening program. All women who are screened experience a dramatic reduction in the risk of cervical cancer compared to women who do not get tested. Make you appointment today!

Most cervical cancer is preventable. Early vaccination plus detection of abnormal cell changes with a Pap test are important. Cervical cancer is rare, and almost always prevented through regular screening and treatment of pre-cancerous changes.

At least 75% of women will have HPV at some point, but very few will develop cervical cancer. Most HPV infections are temporary and will go away on their own. An HPV infection that does not go away over a period of years might lead to cervical cancer.

The new screening options including liquid-based Pap tests and the test for high-risk HPV are important developments for women and their physicians. The HPV vaccine will prevent many Pap test abnormalities and most cervical cancer.

If you are a girl or woman between 9-45 years of age, you should be vaccinated against HPV. Remember, just because you have had the vaccine does not mean you should stop having Pap tests. Early vaccination and regular screening provides your best protection against cervical cancer.
Reference:

Cancer Institute,
www.cancer.gov

Saslow D,Castle PE et al ;American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors :CA Cancer J Clin 2007; 57:7-28 doi: 10.3322/canjclin.57.1.7 © 2007 American Cancer Society

Centers for Disease Control and Prevention (CDC);
http://www.cdc.gov/cancer/cervical/

Dr. RAMA KRSIHNA KUMAR

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital- Bukit Rimau


Cervical Myeloradiculopathy

Cervical Myeloradiculopathy

February 15, 2017

Article credit : InfoMed Malaysia, Issue 20, Jan – Mar 2017

Cervical myeloradiculopathy is the dysfunction of the cervical spinal cord (myelopathy) and nerve root (radiculopathy).
WHAT CAUSES THE DYSFUNCTION?

The dysfunction is usually due to compression of the spinal cord and nerve root. Compression can arise from facet osteophytes (overgrowth of bone), disc herniation (slip disc), ossification of posterior longitudinal ligaments (degenerative deposition of bone within ligaments). On rare occasion, the compression can be caused by tumours, infection and fractures of the vertebrae.
WHAT ARE THE SIGNS OF SYMPTOMS OF CERVICAL MYELORADICULOPATHY?

Patients with cervical myeloradiculopathy may complain of:

Heaviness in the legs or arms (myelopathy);

Inability to walk for long (myelopathy);

Difficulties in writing, buttoning or holding utensils/chopsticks (myelopathy);

Intermittent shooting pain to the arms and legs (radiculopathy); or

Urinary and bowel disturbance (myelopathy).

HOW DO WE DIAGNOSE CERVICAL MYELORADICULOPATHY?

The doctor would take a thorough history and do a physical examination. Common findings during a physical examination would be:

Hyper reflexia;

Clonus;

Babinski reflex positive;

Hoffman sign positive (flicking of the middle finger causes the thumb and index finger to flex); and

Inverse radial reflex positive (this reflex is demonstrated by tappingthe brachioradialis tendon; diminished reflex is noted along with a reflex contraction of the finger flexors.

HOW DO WE CONFIRM THE DIAGNOSIS OF CERVICAL MYELORADICULOPATHY?

The patient would be asked to do a cervical spine radiograph, and occasionally flexion and extension radiographs will be done to look for instability. Usually, a more detailed MRI scan would be done to determine the cause of the compression to the nerve root or spinal cord. An MRI would assist the surgeon in determining the best method to treat the condition.
HOW DO WE TREAT CERVICAL MYELORADICULOPATHY?

Myelopathy is a progressive condition. Unfortunately, this condition does not improve without decompressive surgery. The surgical procedure would relieve the compression on the spinal cord, and the surgeon may stabilise the spine with implants. However, radiculopathy does respond well to physiotherapy and analgesia. There is a small number of patient that may require surgery for radiculopathy.
WHAT ADVICE CAN I GIVE MY PATIENTS TO PREVENT NECK INJURIES?

Seven common tips to
prevent neck injuries
 are:

Keep finding the best pillow (if it’s not comfortable it’s not the best fit);

Sleep on your back, if it’s not possible, sleep on your side and ensure your head and body are in

alignment;

Keep your computer at eye level;

Perform neck stretching exercises;

Stop looking on your phone for long periods of time (resulting in

text neck);

Maintain a good posture; and

Carry weight evenly.

Dr. Manmohan Singh

Consultant Orthopedic Surgeon
Columbia Asia Hospital - Cheras

Cervical Myeloradiculopathy - InfoMed Malaysia, Issue 20, Jan – Mar 2017
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Chain of Survival

Chain of Survival

March 26, 2018

Would you know what to do if a loved one collapsed in front of you and showed no sign of life? If you find yourself in such a situation, it could mean the person’s heart has stopped beating and that he/she could be experiencing what doctors call sudden cardiac arrest (SCA). If you think that’s bad news, that’s only the half of it. Before you can fully absorb what’s happening, you have to spring into action because you have only four minutes to save the person’s life by performing cardiopulmonary resuscitation (CPR).

Almost everyone has heard of CPR. You would have heard it being discussed in school or probably seen someone perform the procedure on crime shows on TV. But the question is, do you know what it takes to save someone’s life with CPR?

In most SCA cases, proper application of this simple but vital skill could be the difference between life and death. Statistics indicate that about 80 per cent of SCA cases occur either at home or public spaces. In such a scenario, the person nearest to the victim is likely to be a relative, friend or passer-by with no medical expertise. But if the person present at the scene is able to perform CPR on the victim promptly, the latter’s chance of survival is significantly increased. Indeed, learning how to effectively administer CPR means you could one day save the life of a loved one.
Position hands over sternum and begin chest compressions while the second-aider sets up the AED machine. It’s always good to have someone on standby to take over chest compressions after two minutes.

Columbia Asia Hospital Malaysia consultant emergency physician and regional emergency services coordinator Dr Terence Leslie de Silva said SCA is a condition when the heart suddenly and unexpectedly stops beating. There are many causes of cardiac arrest, ranging from existing heart arrhythmia to being hit in the chest with a baseball. Regardless of the underlying condition, without CPR, most people experiencing SCA won’t survive, and with every minute CPR is delayed, the survival rate declines.

“CPR only works when the heart suddenly stops beating, most often because of a cardiac condition or heart attack. The heart’s function is to pump blood into vital organs such as the brain and kidneys, and in the case of a cardiac arrest, CPR is urgently needed to restore blood flow from the heart to the vital organs,” he continued.

By doing CPR, he added, the victim’s heartbeat is stimulated, restoring blood flow and oxygenation to the body’s system until medical professionals arrive at the scene. “Chest compressions force the heart to continue pumping, essentially serving as the electrical signal that keeps the heart beating.”
De Silva says time is of the essence when treating a cardiac arrest victim. — Photo from Columbia Asia

De Silva stressed that time is of the essence when treating a cardiac arrest victim. “Once the heart stops beating, the blood circulation stops and if not treated within four minutes, it will cause irreversible damage to the victim’s brain cells shortly after oxygen deprivation.”

Apart from that, de Silva said CPR helps to prolong any abnormal rhythm there is in the victim’s heart. “Most times, when people have a heart attack or SCA, the heart starts to brillate instead of beating in proper rhythm.”

He also pointed out that it’s because of this brillation that the Automatic External De brillator (AED) machine comes in handy when dealing with SCA cases.

“In many developed countries around the world, you can easily nd AED devices in airports, offices, shopping malls and public places all within a distance of four minutes,” he added.

De Silva explained that the AED machine is a life-saving equipment that goes hand in hand with CPR; it is used to jumpstart the heart in the event of SCA. “These portable shock devices automatically detect the abnormal heart rhythm and treat it through de brillation.”

Each machince is equipped with straightforward audio and visual commands, making it easy for any by stander to use.

Because SCA can occur to anyone at any time, de Silva said it is crucial for everyone to know how to correctly perform CPR.

In the past, some people were reluctant to perform CPR on a SCA victim because it involved mouth-to-mouth resuscitation, he noted. But the guideline for performing CPR changed in 2010, allowing those uncomfortable or who have not received proper training to attempt hands-only CPR until qualified paramedics arrive at the scene.

The sequence of basic life support as explained by de Silva
1. Danger

If someone appears to be unconscious, survey the area first and check for possible risks to the victim and yourself. Although it is best to begin CPR as quickly as possible, the first-aider needs to ensure that he will be safe while performing the procedure.
2. Response

Once you have approached the victim, determine if CPR is necessary by assessing the person’s responses. Ask loudly if the person is okay or gently shake the person to examine responsiveness. If there is no response, check for signs of life by assessing the victim’s pulse.

Place your finger two finger breadths away (either to the left or right) from the person’s Adam’s apple to feel the pulse. If there’s no pulse, call 999 and you’ll be directed to the medical emergency call centre where a doctor or paramedic will take you through the sequence of CPR while waiting for the ambulance to arrive. Meantime, ask if anyone in the area can provide you with an AED machine.
3. Circulation

Begin chest compressions. Place the heel of your dominant hand over sternum (the hard bone of the chest) – the midpoint between the epigastric region and the base of the neck – and put the other hand on top of the dominant hand. Keep arms straight and push the chest down about two inches deep. Try to do at least 120 compressions in two minutes.

Bear in mind that chest compression is a tiring procedure. Therefore, it’s good to have someone on standby to take over after two minutes.

Once the AED has arrived, stop the chest compressions, switch on the device and attach the pads on the patient’s chest.

The basic life support procedure also includes “Airway” and “Breathing” techniques which de Silva said are best left to qualified paramedics.
This article first appeared in Malay Mail, 22 March 2018

Chain of Survival – Malay Mail, 22 March 2018


Chef Fauziah bt Pakwan Chik's Q&A session complimented by a Heart Healthy recipe

September 08, 2014

Chef Fauziah bt Pakwan Chik

Head Chef from Columbia Asia Hospital- Setapak

Chef Fauziah has been working in the food industry for more than 13 years, with experiences in hospital environment for 4 years. Chef Fauziah shares with us her experiences in a brief Q&A session.
Question:
 What will you highlight as the biggest challenge(s) in enhancing inpatient meals in hospital?
Answer:
 There are great opportunities working in a hospital setting. However, with every job that we take, there are challenges. Some of the biggest challenges that I have faced while serving in this sector include:

Firstly, it was a common public mindset in judging hospital food does not taste good. These comments often apply in the therapeutic diet. Actually, we prepare food based on the type of diet requested and to change the mindset of people will need hard work and time.

Secondly, challenges in creating interesting and attractive menu, modifying and improvising it according to the type of diet requested.

Thirdly, challenges in ensuring food quality are up to standard. The food needs to be presentable, fresh and ensuring the food is at the right temperature before it is served to patients.

However, I am thankful for cooperation that I’ve received from the kitchen team, service staff and a Dietitian that has helped me along in this area.
Question:
 What will be the special dish that you would like to recommend?
Answer:
 I will recommend a Mexican dish, called Grilled Fish Fajitas. This menu is high in nutrient content and fiber and uses fresh ingredients. It’s so simple and easy to prepare without consuming too much time.
Question:
 Any special cooking instructions to prepare the dish?
Answer:
 This menu is simple. All you need to do is to marinate the fish, and grill it for about 5 - 6 minutes, shredding some fresh vegetables and preparing Guacamole and / or Tomato Salsa. It will take only about 10-15 minutes in total for preparation. The unique thing about this menu is the marinated fish, which requires little cooking oil. It also consist lots of vegetables for our fiber needs. Herewith, I will include a recipe for you to try at home.
Question:
 Can Diabetic patients enjoy this dish?
Answer:
 Yes. For Diabetic patients can limit the quantity of tortillas or substitute with whole grain flour tortillas. In addition, they can also add more variety of vegetables to get the maximum nutrient and fiber from this meal.
RECIPE

Grilled Fish Fajitas
Ingredients

Tortilla skin, 8 inch – 1 piece

Filling:

Dory fish, cut in finger strip – 100g

Cajun spices – 3gm

Paprika, powder – 2gm

Black pepper, crushed – 2gm

Lemon juice – 1 wedge cut

Olive oil – 2ml

Green and red capsicum, julienne – 10gm

Iceberg lettuce, julienne – 5gm

Reduced fat cheddar cheese, shredded – 5gm

Guacamole:

Avocado, mashed – 15gm

Garlic, minced – 2gm

Lemon juice – 2 wedges cut

Salt – 2gm

Tomato salsa:

Tomato, seedless, diced – 20gm

Coriander, chopped – 1gm

Onion, diced – 5gm

Method of Cooking:

For Filling

Marinate the fish with Cajun spice, paprika powder, black pepper and lemon juice. Place in chiller for 2 to 3 hours. Grill the fish with olive oil until golden brown.

For Guacamole

Mix the avocado (mashed) with garlic, lemon juice and salt

For Tomato Salsa

Mix tomatoes, coriander and onion together

Spread Guacamole on tortilla skin. Put all other ingredients on top of the tortilla skin (as per attached photo). Roll up the tortilla skin to enclose the filling.

Nutrient Content ( 1 serving )

Calories : 366kcal

Protein : 26gm

Fat : 13g (where 4gm of saturated fat)

Carbohydrates : 36gm

Fiber : 5g (~ 25% from *RNI Malaysia)
*Recommended Nutrient Intake (RNI)
Dietician’s comment: The chef choose fat free yogurt or reduced fat cheddar cheese in order to control total amount of fat. Using avocado and olive oil can increase the good fats (the monounsaturated kind).


Chicken Roulade with Roasted Pumpkin and Potatoes

March 02, 2017

Enjoying what you eat is one of life’s pleasures. Having diabetes should never hold you back from enjoying the foods you love or trying new foods. Diabetic patients can eat fine-dining food as well. All you have to do is to make your food healthier without losing out on taste. Try out these top tips for healthy eating.
1. Choose the right types of sugar

Sugar comes mainly from grains, fruits, beans, milk and vegetables. The natural sources are better choices because they are packed with important nutrients and fiber that might help you control blood sugar better. Remember, the key is to watch how much you eat at a time because even it is natural sugar, it would raise your blood sugar level.
2. Less salt

Always go for fresh and less processed ingredients. Processed foods are often very high in salt content. Try to eat more home-cooked meals as you can control the amount of salt in the recipe by reducing it to half or eliminating it completely and add other flavorings such as herbs and spices. Learn to enjoy real food and real flavors.
3. Switch to good fats and eat a healthy amount

Say yes to lean and white meat. Trim off all animal fat and skin before cooking because they can make your cholesterol high. Always choose low-fat or fat-free milk and dairy products. Anything flavored or sweetened such as chocolate milk is a big no.

Chef Mohd Izzat from Columbia Asia Hospital – Cheras would like to present a simple western dish that can be enjoyed by diabetic patients. Let’s get to know Chef Mohd Izzat a little better.

Q: Can you share with us your previous working experience before joining CAH-Cheras?
Chef Mohd Izzat:
 I was in the hotel industry for almost 15 years. I used to work in different hotels and restaurants and my last position was Western Sous Chef for banquets in Pullman Hotel.
Q: Why did you choose to join the hospital industry?
Chef Mohd Izzat:
 I decided to join the hospital industry because I wanted to gain more knowledge and improve my skills in preparing healthy foods.
Q: What dish will you be introducing to us today and why did you choose this dish?
Chef Mohd Izzat:
 Chicken Roulade with Roasted Potatoes and Pumpkin. I chose this dish because it is a healthy and complete meal for diabetic patients. It just takes around 30 minutes to prepare because the cooking method only involves steaming and searing on a hot plate. To maintain the freshness and crispiness of the salad, soak the salad in ice water for a few minutes.

Recipe
Chicken Roulade with Roasted Potatoes and Pumpkin

Serves 1

Ingredients:
Chicken Roulade

100g Skinless, boneless chicken breast

5ml Egg whites

4g Green capsicum (cut julienne)

4g Red capsicum (cut julienne)

Salt, to taste

Pepper, to taste

Mushroom sauce

5g Shitake mushroom

20ml Homemade chicken stock

3g Onion

2g Garlic

5ml Corn oil

Salt, to taste

Pepper, to taste

Mesclun Salad

Lolo Rosa salad

Butterhead salad

Frisee salad

Asparagus

Roasted potatoes and pumpkin

30g Pumpkin

1 medium size Potato

Method

Mince the chicken and mix it with the egg whites. Season with salt and pepper.

Lay the minced chicken flat on a plastic wrap. Place the capsicums in the middle of the minced chicken which has been flattened lengthwise.

Roll up the flattened mince chicken. Use the plastic wrap to help you tighten the roll, and tuck in the ends to hold in the filling.

Steam in the oven for 20 minutes. Remove the plastic wrap.

Add ½ tsp. of corn oil to the pan and heat on medium-high. When the pan is hot, add the chicken roulade to the pan and cook till brown. Cook until the roulades are cooked through, about 6 minutes.

When the chicken roulades are cooked, remove from the pan onto a plate, cover with aluminum foil to keep them warm.

Preheat oven to 180oC. Cut potatoes and pumpkin into wedges, roughly 2 inches wide and place them onto the tray. Roast for about 10 – 15 minutes.

Sauté onion and garlic in ½ tsp. hot corn oil over medium heat for 1 minute or until they turn golden brown. Add chicken stock and shitake mushrooms and cook 2 minutes or until thick. Spoon sauce over chicken and serve immediately.

Nutrient Content (per serving):

Energy (kcal) -
307

Carbohydrates (g) -
31

Protein (g) -
22

Fat (g) -
11

Sodium (mg) -
481

Dietary Fiber (g) -
2

Nutrition Tips:

Choose healthy ingredients. Use white meat instead of red or dark meat and lean meat instead of fatty meat. Trim off all animal fat and skin before cooking.

Cook using healthy methods. Steam instead of deep-frying.

Use a non-stick pan when browning the meat.

Control salt usage. When preparing home-cooked foods, you can reduce salt in the recipe by half or eliminate it completely and add other flavorings such as herbs and spices or garlic to compensate the taste.

Recipe prepared by:
Chef Muhammad Izzat Bin Ishak
Columbia Asia Hospital - Cheras

Nutrition information by:
Kong Woan Fei

Nor Alifah Binti Mokhtar, Food Service Coordinator
Columbia Asia Hospital


Child Friendly : Worm Infections

Child Friendly : Worm Infections

September 21, 2018

Dear Doctor,

IS de-worming still necessary for children these days? I remember being given deworming medicine as a child growing up in the seventies but I’m not sure whether it’s a requirement for children today. What would be the signs that a child is in need of de-worming?

Faridah Ibrahim, Petaling Jaya

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

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

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

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

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

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

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

Keep your toilet clean.

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

Always drink boil or filtered water.

Wash fruit and vegetables thoroughly in clean water.

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

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

Answers provided by Dr Lim Kok Chong, Consultant Pediatrician, Columbia Asia Hospital - Bukit Rimau.
Published in New Straits Times, 19 September 2018
Click for Online Article:

Child Friendly : Worm Infections
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Childhood Obesity Part 1 – Has it becomes an Epidemic?

July 21, 2012

The world-wide prevalence of obesity in childhood varies from 2.6-3.6% in Finland, 15% in the UK, 10.8% in the United States, 11.2-12.5% in Navajo Indian school children, 7.56 in Indian children, 16.1% in Singapore school children, 14.3% in Thailand, and about 7.8% in a local Malaysian study of school children in a rural area.

Obesity among children is literally an epidemic! Unless we get kids moving and teach them to enjoy healthy foods, the outlook for their long-term health is bleak. But we can change things.
What are the consequences?

Children who are overweight tend to grow up into adults who are overweight. They therefore have a higher risk of developing serious health problems in later life, including heart attack, stroke, type-2 diabetes, bowel cancer, sleep apnea and high blood pressure. The risk of health problems increases the more overweight a person becomes.

Being overweight as a child can also cause psychological distress. Teasing about their appearance affects children’s confidence and self-esteem and can lead to isolation and depression leading on to poor school performance.
Why are more children overweight?

Very few children become overweight because of an underlying medical problem i.e. either hormonal or neurological.

Children are more likely to be overweight if their parents are obese. If one parent is obese, there is a 50 percent chance that the children will also be obese. However, when both parents are obese, the children have an 80 percent chance of being obese. But genetic factors are thought to be less significant than the fact that families tend to share eating and activity habits.

In other words, most children put on excess weight because their lifestyles include an unhealthy diet and a lack of physical activity.

It is certainly easier than ever before for children to become overweight. High- calorie foods, such as fast food and confectionery, are abundant, relatively cheap and heavily promoted specifically at children.

Exercise is no longer a regular part of everyone’s day – some children never walk or cycle to school, or play any kind of sport. And it is not unusual for children to spend hours in front of a television or computer.
Dr. Margaret Kannimmel

Consultant Paediatrician

Columbia Asia Hospital-Setapak


Childhood Obesity Part 2 – what is the ideal weight?

July 22, 2012

Maintaining a healthy weight

What is a healthy weight for a child?

Parents may find it difficult to tell whether their child has temporary "puppy fat" or is genuinely overweight. In adults, a simple formula (the body mass index or BMI) is used to work out whether a person is the right weight for their height.

However, BMI alone is not an appropriate measure for children - it has to be used alongside charts that take into account the child’s rate of growth, sex and age - and is best interpreted with the help of your GP, health visitor, practice nurse or dietician (See Charts Attached).

Obesity is defined as an excessive accumulation of body fat. Obesity is present when total body weight is more than 25 percent fat in boys and more than 32 percent fat in girls.

A trained technician may obtain skinfold measures relatively easily in either a school or clinical setting. The triceps alone, triceps and subscapular, triceps and calf, and calf alone have been used with children and adolescents. Example, when the triceps and calf are used, a sum of skinfolds of 10-25mm is considered optimal for boys, and 16-30mm is optimal for girls.
Dr. Margaret Kannimmel

Consultant Paediatrician

Columbia Asia Hospital-Setapak


Childhood Obesity Part 3 – should I ask my child to go on a Nutrition & Eating habits?

July 23, 2012

Maintaining a healthy weight

Expert advice is that most children who are overweight should not be encouraged to actually lose weight. Instead they are encouraged to maintain their weight, so they gradually "grow into it" as they get taller. Children should never be put on a weight-loss diet without medical advice as this can affect their growth. Unregulated dieting – particularly in teenage girls – is thought to lead to the development of eating disorders such as anorexia and bulimia. No drug treatment has been proven effective in the treatment of weight problems in children. The good news is that all the evidence shows that it is much easier to change a child’s eating and exercise habits than it is to alter an adult’s.
Physical activity

Doctors recommend a gradual increase in physical activity, such as brisk walking, to at least an hour a day. Encourage walking to places such as school and the shops, rather than always jumping in the car. Suggest going to the park for a kick around with a football, or a game of rounders, cricket or frisbee. Visit a local leisure centre to investigate sports and team activities to get involved in. Make exercise into a treat by taking special trips to an adventure play park or an ice skating rink, for example. Involve the whole family in bike rides, swimming and in-line skating. When it is safe to do so, teach your child to ride a bike.
Reducing physical inactivity

"Physical inactivity" includes pastimes such as watching TV or playing computer games. These should be reduced to no more than two hours a day or an average of 14 hours a week. Encourage children to be selective about what they watch, concentrate only on the programs they really enjoy.
Dr. Margaret Kannimmel

Consultant Paediatrician

Columbia Asia Hospital-Setapak


Childhood Obesity Part 4 – he loves Mc.., what should I do?

July 24, 2012

A healthy well-balanced diet

Parents concerned about their child’s weight should encourage a variety of fresh, nutritious foods in his or her diet.

Starchy foods, which are rich in "complex carbohydrates", are bulky relative to the amount of calories they contain. This makes them filling and nutritious. Sources such as bread, potatoes, pasta, rice and chapatti should provide half the energy in a child’s diet.

Instead of high-fat foods like chocolate, biscuits, cakes and crisps, try healthier alternatives such as fresh fruit, crusty bread or crackers.

Try to grill or bake foods instead of frying. Burgers, fish fingers and sausages are just as tasty when grilled, but have a lower fat content. Oven chips are lower in fat than fried chips.

Avoid fizzy drinks that are high in sugar. One can of soda contains 9 teaspoons of sugar. Substitute them with fresh juices diluted with water or sugar-free alternatives.

A healthy breakfast of a low-sugar cereal (eg whole meal wheat biscuits) with milk, plus a piece of fruit is a good start to the day.

Instead of sweets, offer dried fruit or tinned fruit in natural juice. Frozen yoghurt is an alternative to ice cream. Bagels are an alternative to doughnuts.
Changes to eating habits

Try to set a good example with your own eating habits.

Provide meals and healthy snacks at regular times to prevent "grazing" throughout the day.

Don’t allow your children to eat while watching TV or doing homework.

Make mealtimes a happy occasion by eating as a family

Encourage children to "listen to their tummies" and eat when they are hungry rather than out of habit.

Teach children to chew food more slowly and savour the food. They will feel fuller more quickly and be less likely to overeat at mealtimes.

Do not keep lots of high-fat, high-sugar snack foods in the house.

Do not make outings for fast foods part of the weekly routine.

Try to get children involved in preparing food as this will make them more aware of what they are eating.

Do not use food to comfort a child – give attention, listening and hugs instead.

Avoid using food as a reward as this can reinforce the idea of food as a source of comfort. Instead of having a fast-food meal to celebrate a good school report, for example, buy a gift, go to the cinema, or have a friend to stay overnight.

When children who need to improve their eating habits are old enough, it may help them to keep a food diary, recording what and when they eat. It’s important to be aware of snacking "danger times" and find strategies to divert attention away from food, or towards a healthier option.

Studies show that breastfeeding a baby, even if only for a short period of time, may reduce the risk of obesity in later life.

Parents who enjoy a healthy diet with plenty of fresh fruit and vegetables set a good example for their children. As children grow older they tend to stick to the eating pattern that has been established at home.

Encourage physical activity as soon as they are able to walk steadily.
Dr. Margaret Kannimmel

Consultant Paediatrician

Columbia Asia Hospital-Setapak


Children and Posture

Children and Posture

July 17, 2020

Postural problems among children are on the rise. Picture: Designed by Racool_studio / Freepik.

Postural problems among children are on the rise but can sometimes result from parents interfering with natural milestones in infancy writes Dharvin Chalong Pillay

WHY does my child stand with his knees fully extended?

Why does my kid walk like a duck? My 2-year-old still walks on her toes. My boy falls frequently when he plays.

These are the few common questions and remarks I receive from parents.

Many parents are becoming more aware of their children's physical conditions. Postural deviations include conditions such as flat feet, hyperextended knees, excessive lumbar lordosis or thoracic kyphosis.

Postural deviation is a common problem and on the rise among children these days.

While parents may only notice these conditions in children from the age of two onwards, the source of these problems can be traced back to infancy.

Every infant goes through phases of gross motor milestones from the age of 0-3 months onwards.

A normal sequence starts from infants lifting their heads during tummy time to rolling from back to chest and chest to back, crawling on the belly followed by full crawling, sitting with support, sitting independently, standing with support, walking with support and finally walking independently and running and playing. It is during these phases of the child's development where the motor connection between muscles and joints integrate to form the necessary support and stability for posture.

Unfortunately, many parents tend to interfere with this natural process.

Postural problems among children are on the rise. Picture: Designed by Racool_studio / Freepik.

The natural phase of an infant's gross motor development is fundamental to prepare his physical body structure for the environment.

For example, if the infant does not experience the crawling phase completely, the possibility of a weak hip joint and under-developed muscular structure may occur.

Many parents cannot wait for their child to walk these days so they disrupt the development of natural milestones by getting their child to stand too soon or walk on his toes too early when the infant's muscles and joints have not fully developed the necessary strength and stability it needs.

Some parents place their children in baby walkers even before the child is ready to stand independently.

In the UK the Chartered Society of Physiotherapy (CSP) has already supported a ban on baby walkers because they disrupt the ability of children to develop their motor milestones completely.

EARLY RISK

If the foundation of your child's motor development is disrupted from the beginning, it will lead to a higher chance of postural deviations in the future.

Our body weight transfers through the hip-knee-ankle and our feet are the point of contact with the ground. The ankle joints are the weight bearing structure closest to the ground followed by the knee and hip. Hence, if our hip joint-muscles are not strong and stable, the weight transferred to the knee and ankle will be more than what the joint can tolerate, causing changes from ground up such as flat feet, knock knees and postural deviations throughout the body structure.

The modern sedentary lifestyle followed by high incidences of obesity and overweight are the primary contributing factors for increased postural deviations in children these days.

Excessive television and screen time, motorised transportation, fast food and lack of regular physical activity are the major contributors to poor physical conditions in our children, leading to an anatomical or biomechanical modification of the spine thus further leading to postural deviations of the body.

So, what is the solution? Play.

Since postural deviation is caused by muscular imbalance, the only solution to your child's condition is physical activity that retrains and strengthens the joint-muscular structures. Children are encouraged to play and be physically active to retrain their motor milestone phases through games and physical activity that challenges their bodies to redevelop and reintegrate its neural pathways so that muscles and joints regain their strength and stability.

For example, you may get your child to participate in activities that require him to crawl in order to retrain hip structures.

Playing on soft, uneven and different surfaces will also challenge the child's body to train the necessary sense of proprioception and develop stability for the body.

Crawling, climbing, squatting, running, jumping and hopping during outdoor play on grass and sandy areas are some of the best options to allow the child to experience various stimuli that will train him in balance, strength and agility.

Activities such as swimming (freestyle) weekly will also be great to train the posterior chain muscles that are responsible for keeping our bodies in an upright position.

Many parents invest in supportive devices such as foot arch support and back braces for their children in the hope that it will correct or even cure their child's postural deviation.

The reality is these devices will not work on your child's condition without exercise. The rule of thumb for muscles in the human body is "use it or lose it".

Dharvin A/L Chalong Pillay

Physiotherapy Manager

Columbia Asia Hospital – Petaling Jaya

PDF and Online Articles:

Children and Posture – New Straits Times, 6 July 2020

This article first appeared in New Straits Times, 6 July 2020.

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Children and Sports - Dr Harjeet Singh [BFM - Podcast]

October 25, 2011

Whether you're dreaming of moulding your child into the next sport superstar or just want to keep them healthy and fit, find out about the do's and don'ts of sport participation and fitness training for children, from Dr. Harjeet Singh, a Consultant Orthopaedic Surgeon.

Dr Harjeet will also advise on ways to optimise the benefits of sport for children, while reducing the risks.

Listen to the podcast
here
.


Choosing Your Embryos

Choosing Your Embryos

September 11, 2015

It is important in IVF to know how your embryos look like before you are able to choose them before transfer. By choosing the right one, it will increase your chance to get pregnant and reduce your risk of multiple pregnancies.
Only up to 60% of the embryos will reach day 5 stage (blastocyst).

An IVF cycle should result in the retrieval of mature eggs. The eggs will be allowed to settle for a few hours, then within the afternoon, it will fertilise with the sperm by either in vitro fertilisation (IVF) or intra cytoplasmic sperms insemination (ICSI). However, only up to 60% of the embryos will reach day 5 stage (blastocyst). The low rate of embryo development has 2 main causes i.e. a less than optimal culture environment in the lab dish and the inherent "weakness" of human embryos itself.

DAY 1 EMBRYO (24 HOURS)

After 24 hours, the embryo will still be a single cell with two-Pro-Nuclei (2PN). Only 80% to 90% of the fertilized eggs will turn into 2PN stage. Embryos are rarely transferred at this point because you cannot tell which embryos within the group will be the most likely to continue to grow properly.

DAY 2 EMBRYO (48 HOURS)

After 48 hours, the embryo should be 3 to 4 cells stage and the embryos can be transferred at this stage. However, if you have multiple embryos, your doctor would recommend you to let the embryos go to day 3. By allowing the embryos to go to day 3, only the healthy embryos will survive to day 3. Hence it might improve your chances of getting pregnant by the process of natural selection.

DAY 3 EMBRYOS (72 HOURS)

On day 3 the embryos should be between 6 to 8 cells. More than this range the embryos may be growing too fast, using up the energy stored by the eggs and therefore more likely burn out before they get the chance to implant. Slower than this range, the concern is that the embryos would not continue to divide at all.

DAY 5 EMBRYOS (BLASTOCYST)

The goal of in vitro fertilization and embryo culture is to provide high quality embryos which are capable of continued development and result in live births. However, under standard IVF culture conditions, only upto 60% of human embryos progress to the blastocyst stage after 5 days of culture. Sometimes your doctor may allow the embryos to go to day 6, which is called hatching blastocyst and never beyond day 6.

HATCHING BLASTOCYST ON DAY 6

Blastocyst transfer is ideal with highest pregnancy rate compared to day 2 or day 3 embryos. By giving an extra 2 days, it will result in better natural selections of the embryos. Furthermore, the blastocyst stage embryos should ideally be in the uterine cavity compared to day 2 or day 3 embryos which should be within the fallopian tube rather than the uterine cavity. The uterine lining is more receptive to the arriving embryo on day 5, which is similar to natural pregnancy.

However this may not be a fair comparison. Perhaps pregnancy rates would have been just as good transferring 3 embryos on day 3 versus 2 embryos on day 5? It is a fact that the more embryos you put in the higher is the success rate but the risk of multiple pregnancies are also higher.
Age should be taken into consideration when deciding day of transfer.

Doctors and laboratory staff will cite many factors when comparing day 2/3 transfer to day 5 (blastocyst) transfer. Age should be taken into consideration when deciding day of transfer. If you are more than 40 years old, it should always be a day 2/3 transfer. Also if you have few embryos, your doctor would also recommend day 2/3 transfers. When you have few embryos in your cohort, the risk of the embryos dying before you reach day 5 is high, resulting in no transfers at all. Culture media, where the embryos are kept, also play a part in the success rate. Poor culture media will result in death of the embryos.

Grading of the embryos are not only done based on the number of cells in an embryo. The other factor your embryologist would check would be the percentage of fragmentation of the dividing cells. As cells divide, they leave fragments behind and too many fragments suggest that cells may not be dividing properly. Higher fragmentations will result in poor quality embryos.

...the debate goes on. Good people can disagree. My advice would be to accept the day that your particular laboratory favours as long as you understand the process of your embryos growing in the laboratory. In this way, you will be maximizing your chances.
Dr. Suhaimi Hassan

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


Clean Up Your Act

Clean Up Your Act

June 01, 2016

Unlike the phrase "getting down and dirty", having sex shouldn't be unclean in any way. Read on for tips on how to make sure your next steamy session in fully enjoyable. Dr Haslina Sarkawi, Consultant Obstetrician and Gynaecologist, Columbia Asia Hospital - Bintulu shares on sexual hygiene.

Female Magazine, June 2016
.


给大肠照镜

给大肠照镜

March 28, 2019

给大肠照镜

大肠犹如人类体內的下水道，弯曲且凹凸不平。每天帮你的身体清走脏物和毒素，你曾否关心过它？用了几十年的肠道，是时候好好做个检查了！

3月是国际大肠癌醒觉月，今年的主题为「Don't Assume」，打著「別以为你年轻就不会患上大肠癌」的口號。美国大肠癌抗癌协会走访街头，发现许多人对「大肠癌」的瞭解並不深。明明是三大癌症之一，为何大眾对此的醒觉那么低？

林小姐才三十余岁，在排便时突然流出鲜血，她误以为是月事来潮並不加理会。下腹有些肿胀，她也放任不管，以为只是自己变胖了。一次突发性的腹部疼痛紧急入院，才发现自己患上第三期结肠癌。

肚子肿胀、排便出血，很多人的身体出现该症状时都以为只是单纯的胃胀风或便秘所致。根据马来西亚卫生部统计，国內常见的3种癌症包括乳癌（17.7%）、大肠癌（13.2%）及肺癌（13.2%）。男性当中，大肠癌是最常见的癌症。

人体大肠全长约1.5公尺，由盲肠、结肠和直肠组成。结肠可细分为升结肠、横结肠、降结肠、乙状结肠、直肠。大肠癌（Colorectal Cancer）则是指结肠或直肠的癌症。Columbia Asia外科及结肠手术专科医生杨元賡指：「结肠癌在华裔当中最为普遍，每10万人当中就有28名患者。」至於印裔及巫裔，分別为10万人中有14及11人患上大肠癌。好发年龄为50岁或以上，男性居多。
饮食习惯成关键

「大肠癌虽是大马常见癌症之一，但確诊时通常已经是末期，这可能是因为我国没有把大肠镜检查列入身体检查计划中，民眾对於大肠癌的醒觉意识较低。」然而，日本是大肠癌罹患率最低的国家，相信这关乎他们的生活及饮食习惯。大马人喜爱煎炸爆炒的烹调方式，或多或少也有所影响。

大肠癌可分为4期：第一期是大肠肠壁上长息肉，演化成肿瘤导致癌症。第二期是癌细胞侵入肠壁，第三期则是癌细胞扩散至淋巴系统。第四期大肠癌是癌细胞扩散到其他器官，如：肝臟、肺部、腹腔膜等等。「一般初期大肠癌病患若及早治疗，治癒率及存活率高达90%。第二和第三期病患的治癒率分別是80%及50%，第四期大肠癌的治癒率则少於5%。」杨元賡补充：「在第三及第四期大肠癌患者的数据显示，造成大肠癌的原因有基因突变和家族遗传病史；但有高达75%患癌原因不明。」

罹患癌症的危险因素可能与生活习惯有关，其中包含：摄取过多的红肉及加工肉品、抽烟饮酒、缺乏运动、肥胖、熬夜等等。隨著年龄增长也提高了罹患大肠癌的风险。大肠癌或可能带给患者腹部疼痛、肿胀的讯號，排便出血等较为明显的症状，但绝大部分人都会忽视这些症状，甚至有些病患的身体完全没有出现任何异常。

其实大肠癌是一种「表面疾病」，即是做简单的检查便可检验出来，但这项检验在马来西亚並不普遍。杨元賡建议50岁以上的人士应定期做大肠检查，可透过大肠內窥镜检查、血液检测、粪便筛检或电脑断层扫瞄进行大肠检验。其中，粪便筛检这非侵入性的检查最为容易，准確性达60%。
家族病史人士　儘早检验大肠

杨元賡表示，凡50岁以上的人士都建议进行大肠检测。家族里一等亲属关係当中曾有人患上大肠癌者，更应儘早检验。「假设你的亲人在40岁时患上大肠癌，那你本身应该在他確诊患病年龄的前5到10年进行检测，即30岁就要进行大肠检查，而非等到50岁后才检验。」

很多人逃避照大肠镜，有者听说那是苦不堪言的经验，有些人则觉得很尷尬羞耻。毕竟一条管子从肛门直通肠子，这感觉不是每个人都能够承受的。杨元賡表示，现在的医疗技术和仪器都相当发达，病患无需过於担心。「在进行大肠內窥镜检测前，医生会给予病人注射止痛和肌肉放鬆剂，病人也可以时刻反应给医生知道自身的感觉，期间可以改变姿势调整。」

「有许多病患过度担心而延迟做大肠检查，到最后確诊时已经是第三或第四期癌症。现实考量上，医药费会大大地提高；另一方面则是，就算有再多的钱，治癒率也降低了。」杨元賡指：「大肠癌几乎都是肠壁上的息肉开始演化成肿瘤而引起的，若在大肠镜检查时发现瘜肉，可提早切除。」大肠犹如一个下水道，人们用了几十年，理应给自己做个完善的检查，尽量避免患上大肠癌的任何可能性。
切除息肉去病灶

杨元賡坦言：「大肠癌初期是很容易治癒的，只要切除息肉並调理好生活作息即可。」「但若已经进入第三期或第四期大肠癌，则需通过手术切除肿瘤或患癌部位，进行化疗或电疗。这一切的治疗方案需由专业医疗团队来制定。」

在治疗大肠癌期间，病患有可能会面临一些生理上的变化。杨元賡说：「若是发病部位在直肠（靠近肛门部位），进行手术切除该部位后或可能需要依靠结肠造口（Ostomy Bag）收集排泄物。」抗癌期间，病患的生心理不免会受到影响，但杨元賡强调大肠癌患者应儘早接受治疗。病患和家属需与医疗团队配合，支持及协助病患抗病。
【致病因素】

透过第三及第四期结肠癌患者的数据显示，绝大部分患者患上癌症的直接因素不明：

5%基因病变

20%家族病史

75%不明原因

摄取过多红肉/加工食品

抽烟饮酒

缺乏运动

肥胖

熬夜等不良生活习惯

大马半岛5大常见癌症

男性：大肠癌、肺癌、鼻咽癌、前列腺癌、肝癌

女性：乳癌、大肠癌、肺癌、子宫颈癌、鼻咽癌
【常见症状】

许多大肠癌病患无明显症状，检测报告出来时为时已晚。但若本身或身边的人开始出现一下症状，建议儘早做大肠镜检查，以策安全。越早发现癌症，治癒率可大幅度提高。

腹部时常绞痛

肚子胀风

排便出血（血色为鲜红）

排便习惯改变

胃口变差

体重下降

肠道阻塞，无法排便

Dr. Yong Yuen Geng

Consultant General & Colorectal Surgeon

Columbia Asia Hospital – Setapak

PDF and Online Articles:

Colonscopy 给大肠照镜 - Oriental Daily, 28 March 2019

Colonscopy 给大肠照镜 - Oriental Daily, 28 March 2019

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Colorectal cancer

Colorectal cancer

February 01, 2012

Colorectal cancer is the second most common cancer in Peninsular Malaysia, the first among male and second among female. Worldwide, the incidence of colorectal cancer is increasing and it is still one of the leading health problems.

The exact cause of colorectal cancer is unknown, although some are hereditary in origin(inherited). However, it is widely accepted that it originates from the progression of some non-cancerous growth called adenomatous polyp which later on become cancerous over a period of a few years. Therefore, early detection and removal of these polyps can potentially prevent the development of colorectal cancer.

Some of the common symptoms of colorectal cancer are changed in bowel habit, sensation of incomplete bowel motion, weight loss and passing blood in the stools. However, one should not have a misconception that passing blood in stools is only due to piles because piles, being so common, can coexist with other more serious conditions like cancers, inflammatory bowel disease and ischemic bowel which require further assessment and investigations.

The benefit of screening for colorectal cancer is very strong and clear as it fulfills many criteria of a good screening i.e. colorectal cancer is one of the commonest cancers, it potentially improves the outcome of the disease if colorectal cancers are detected earlier, it is highly sensitive and the screening modalities are generally acceptable.

There are several ways of screening for colorectal cancers. These include stool occult blood tests, radio-imaging (x-rays) and colonoscopy. However, colonoscopy remains to be the final common pathway for all positive screening tests, i.e. if the screening test by a method other than colonoscopy turns out to be positive, the patient would be advised for colonoscopy and biopsy for confirmation of diagnosis. Colonoscopy detects and also removes adenomatous polyps at the same time and potentially stops the progression of polyps into cancers.

Once a diagnosis of colorectal cancer is made, the disease is usually further investigated for staging of the cancer. The mainstay of treatment is surgery and it may be combined with chemotherapy and radiotherapy depends on the stage and site of the colorectal cancer.

The good news about colorectal cancer is that it is potentially curable if detected early and potentially preventable if the adenomatous polyps are removed.
Dr. Yong Yuen Geng

Consultant General and Colorectal Surgeon Columbia Asia Hospital-Setapak


Columbia Asia: Small Is The New Big [BFM - Podcast]

October 25, 2012

Kelvin Tan the CEO of Southeast Asia for the Columbia Asia Group discusses its unique business proposition, bringing fast and efficient service and value-for-money treatment to residential areas in Malaysia.

He talks about how their hospitals are relatively smaller in comparison to other private hospitals and how this makes them run more efficiently and helps keep costs down. Columbia Asia's patients stay and average of only two days in their hospitals, due to advances in medical technology and non-invasive treatment. And with 10 medical facilities thoughout Malaysia already, Columbia Asia is bullish on expanding as Kelvin talks about their expansion plans.

Listen to the podcast
here
.


Common facts about cervical cancer unleashed: What every woman should know about cervical screening and cervical cancer

February 26, 2011

What are the common facts about cervical cancer

Cervical cancer is the second most common female cancer worldwide, (after breast cancer) and the second most common cause of cancer deaths amongst Malaysian women and in the Asia Pacific region. Worldwide, cervical cancer is the second most common cancer in women over 15 years of age. One woman in the world dies of cervical cancer every 2 minutes. About 500,000 women globally are diagnosed with cervical cancer with an average of 270,000 deaths a year.
What causes cervical cancer

Almost all (99%) cervical cancer is caused by the Human Papilloma Virus (HPV). HPV is spread mainly through sexual contact. There are over 100 identified types of HPV most of which are harmless and exhibit no symptoms. There are 15 cancer-causing types which can lead to cervical cancer; HPV 16 and 18 together cause more than 70% of all cervical cancers in Asia Pacific and worldwide. Cancer-causing HPV types 16, 18, 45 and 31 together account for over 80% of cervical cancer cases in Asia Pacific.
Who is at risk of cervical cancer

Sexually active women are at risk of being affected by cervical cancer or more commonly by the early stages of the disease i.e. cervical pre-cancer. Women at increased risk of developing cervical pre-cancer or cancer include women having several sexual partners, young women (less than 25 years of age and have had sexual intercourse at an early age of 16 years or less) or women having a male partner who has had several different sex partners.
How can pap smears reduce the risk of cervical cancer

Eighty percent of cervical cancer presents at an advanced stage when the cancer may be incurable. Hence, regular cervical screening by routine cervical or pap smear examinations allows cervical cancer and pre-cancer to be detected at an early stage when immediate treatments are more effective. Effective cervical cancer screening programmes in some countries, such as, in the United Kingdom, have dramatically reduced the incidence and death from cervical cancer.
What is a pap smear test and cervical cancer screening

Cervical cancer screening involves routine Pap smear tests aimed at women with no symptoms. It is currently recommended that every woman who has had sexual intercourse have regular Pap smear tests so that problems can be detected at an early stage and thus treated before they become a serious condition like cervical cancer.

The pap smear test is a simple painless test in which cells from the cervix and vagina are examined for any abnormalities that can lead to cancer. Fortunately, some early changes in the cervix can be seen long before cancer develops. Once these changes are treated, cancer can be prevented. It is important that the pap smear examination or test is done by a properly trained and experienced medical personnel as accurate visualisation of the cervix and an appropriate sample must be taken for assessment. Nowadays, there are many screening centres in Malaysia that offer pap smear tests and other screening tests but these test are unfortunately carried out at times by untrained or non-medical personnel and this can be detrimental to the woman.

Colposcopy is one way a gynaecologist can look at the cervix through a special magnifying device that allows the gynaecologist to find problems on the cervix that cannot be seen by the naked eye alone. It is a relatively painless procedure in which the cervix is examined under magnification after a mild vinegar-like solution (acetic acid) is applied to the cervix. Biopsies of abnormal areas are taken for further evaluation and treatment can be performed based on these results.
How do cervical cancer vaccines protect against cervical cancer

Currently, there are 2 vaccines available to prevent cervical cancer. Cervical cancer vaccine helps prevent but does not treat these diseases. However, it is not a substitute for routine Pap smears for cervical cancer screening. It is estimated that in the absence of vaccination, the vast majority of sexually active people will become infected by HPV virus in their lifetime. Many people who have HPV may not show any signs or symptoms, hence they may transmit the virus unknowingly.

Cervarix® cervical cancer vaccine provides nearly 100% protection against HPV types 16 and 18 associated pre-cancerous lesions. Cervarix® induces a stronger and more sustained immune response than the other vaccine. Cervarix with AS04 adjuvant system provides cross protection against infection of HPV 45 & 31, which are the third and fourth most common types found in cervical cancer globally. The primary vaccination course consists of three doses, given at 0, 1 and 6 months. Most importantly, it is not a substitute for routine Pap smears for cervical cancer screening.

Gardasil® the other vaccine available is a vaccine that helps protect against HPV types 6, 11, 16 and 18 which are associated with cervical cancer, precancerous changes of the cervix and vulva, and genital warts. Children and adolescents aged 9 years and above can receive Gardasil®. The vaccine works best when given to persons with no prior HPV contact although possible benefits can be derived in persons who may have had previous HPV exposure. It is given as an injection and a complete course consists of 3 doses where the 2nd and 3rd doses are administered 2 months and 6 months after the 1st dose respectively.

These vaccines help prevent but does not treat these diseases. Again, it is not a substitute for routine Pap smears for cervical cancer screening.
Dr. Sharad Ratna

General Obstetrician and Gynaecologist

Visiting Consultant Columbia Asia Hospitals


Common Foot Conditions in Kids

Common Foot Conditions in Kids

April 04, 2022

Children experience different kinds of foot problems similar to adults. These conditions show different characteristics where some may occur more frequently in children due to their active lifestyles and developing bodies.

For this episode of AskMeDoctor! we have Dr. Paisal Hussin, a Consultant Orthopaedic Surgeon from Columbia Asia Hospital – Puchong, who is also a father of three to help us explore more about this topic.

Q1: What are the most common foot problems in children?

Dr. Paisal Hussin
: The most common problems that often come stepping into our clinic are flat feet, viral warts and also ingrown toenails of big toes.

In fact, ingrown toenails occur in kids more compared in adults because of certain causes.

Q2: Do children also get warts and ingrown nails like us, adults?

Dr. Paisal Hussin
: Yes, as I’ve mentioned to you, these two conditions are actually one of the common foot problems. It can affect any age group.

So, we do also find that these problems also happen in children. There are a lot of reasons why it happens.

Ingrown toenails usually, happens because of some kinds of habits. When kids usually wear very tight shoes, the improper nail clipping; cut too short, not straight and crossed.

Or in kids, they usually have a kind of trauma to their big toe because of hitting, and stubbing.

Q3: Do foot conditions like flat feet cause serious health problems later?

Dr. Paisal Hussin
: Flat feet is actually a condition where the feet; the entire foot is touching the ground when you wear it bare.

It’s common in paediatric age groups, in children. This is because, at that time, their bones are not fully developed yet. Their ligaments are still flexible.

Studies have shown that about 40% of children at the age of 3-6 got a flat foot. But, this flat foot, the curve, the arch of the foot will start to develop after the age of six. Most children will have that kind of arch by the age of six.

But there are cases where children develop flat feet after the age of 6—maybe about 20% of them. But most of them, even the group of that 20%, rarely will cause any serious problem.

So, it’s quite common at an earlier age; they do have a flat foot but eventually, their body would develop the arch which is needed, later on.

Q4: What are the causes of these foot conditions and problems?

Viral Wart

Dr. Paisal Hussin
: Viral wart is caused by Human Papillomavirus (HPV). It’s a type of virus that is very common. It can grow anywhere in the parts of our body.

It happens through cuts or any abrasion/breakage on the skin and then starts to form viral warts. Kids are very active, that they easily got cuts here and there.

When they go off without shoes, walking and running around; these are some of the factors that make them more susceptible to getting this kind of thing.

Ingrown Toenails

And then for the ingrown toenails; it is a condition where your nails are poking the skin side to the nails or at the end of the nails. It just happens because of lots of other things. The most common ones are:

When people wear very tight shoes

Improper nail cutting

We try to get a very nice nail cutting, so you follow the oblique kind of cutting. That’s something you shouldn’t do. You should cut it straight, across.

Flat Feet

Flat feet, it is something more towards development. I would say most children will get it because of the ligaments and bones issues. They are quite flexible. The one that we worry about is the rigid part.

Not the flexible one. But usually, they happen in elderly times. It’s not happening in the young age group.

Q5: What are the treatments for these foot conditions and problems?

Dr. Paisal Hussin:

Flat Feet

It is basically something that you shouldn’t worry about. But sometimes your kids will complain about having pain. But what you can do is give medicine to ease the pain. Always start with something that is topical. Topical anti-inflammatory cream while you are massaging your child’s calf or foot. You can also ask them to stretch the ankle, knee and foot. Basically, it will stimulate the muscles that will make the muscles relax and the pain gets better.

Viral Warts

Tart with a topical bleaching agent, maybe a weak acid, like drops, the most common one that we use is salicylic acid. We drop it every day until the warts peel off. Sometimes, it’s not that easy, where they got multiple. If the warts get infected, you might need help from a dermatologist to freeze the warts. The dermatologist will use liquid nitrogen to freeze.

Ingrown nails

For this one, we should start with prevention by properly cutting your kid’s nails and using a proper non-tight footwear. You can look for signs of infection such as redness at the side of the nails (and most of the time, it will affect the big toe).

This indicates that the ingrown nails are getting serious and your kid may need to see a doctor. You can also see the changes in colour redness, swelling and when you palpate the toe, your kid is having pain. And then, in some cases, the pus will start coming out, which is very smelly and does not have a very nice odour.

Dr. Paisal Hussin

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Puchong

MBBS (UM), M Orthopedic Surgery (UM)

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PDF and Online Articles:

Common Foot Conditions in Kids – Motherhood.com.my, 28 March 2022

This article first appeared in Motherhood.com.my, 28 March 2022.

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