Mudah Jer Kawal Darah Tinggi Di Rumah, Fahami Kaedahnya

January 04, 2021

BERDASARKAN
 statistik, hipertensi atau penyakit darah tinggi membabitkan kira-kira satu dalam setiap tiga orang dewasa Malaysia berumur 18 tahun dan ke atas.

Sebanyak 35.3 peratus menghidap penyakit berkenaan dengan bacaan 140/90 atau lebih tinggi.

Bagaimanapun, bagi setiap dua pesakit yang didiagnosis, ada tiga lagi pesakit yang kekal tidak didiagnosis dan tidak dirawat kerana penyakit tersebut dikatakan berkembang tanpa sebarang simptom, menyebabkan mereka berisiko untuk mendapat serangan jantung dan strok.

Meskipun dalam tinjauan OMRON Healthcare yang dijalankan baru-baru ini mendapati, 85 peratus daripada 504 responden telah memeriksa tekanan darah mereka tahun lalu, 42 peratus berpendapat, tekanan darah mereka tidaklah serius atau memerlukan pemantauan secara berkala.

Namun, dengan hipertensi yang semakin kerap melanda orang muda, penting untuk kita memahami betapa pentingnya memantau tekanan darah secara berkala.

Seperkara yang perlu ketahui, pesakit hipertensi didapati mengalami kesan yang lebih buruk akibat Covid-19 berbanding individu yang sihat.

Pakar Perubatan Perunding Dalaman, Hospital Columbia Asia, Dr Mohd Arifin Mohd Ali berkata, tekanan darah tinggi atau hipertensi adalah pembunuh senyap dan penyebab utama serangan jantung dan strok.

“Peluang seseorang untuk mendapat penyakit ini meningkat dengan usia dan dengan masalah kesihatan kronik yang sedia ada. Ini bermakna, jika seseorang menghidap diabetes, obesiti atau kolesterol tinggi, mereka lebih cenderung untuk mendapat penyakit ini.

Jika ada sejarah hipertensi dalam keluarga, mereka berdepan dengan peluang 50 peratus lebih tinggi untuk menghidap penyakit ini dan lebih berisiko mendapat strok, serangan jantung atau masalah buah pinggang terutama jika tekanan darah tidak dikawal dengan baik,” katanya yang juga Presiden Persatuan Hipertensi Malaysia (MSH).

Justeru, kata Dr Mohd Arifin, disebabkan kadar pesakit hipertensi kian meningkat dalam kalangan orang dewasa yang lebih muda, maka setiap orang dewasa perlu memantau tekanan darah mereka secara berkala bermula dari umur 18 tahun ke atas.

“Oleh kerana hampir 70 peratus orang dewasa Malaysia berisiko mengalami peningkatan tekanan darah dan hanya 37.4 peratus daripada pesakit yang dirawat mencapai tahap tekanan darah yang terkawal, kesedaran lebih besar menjadi kunci untuk mengurangkan kadar kelaziman hipertensi dalam masyarakat,” ujar Dr Mohd Arifin.

Buat semak diri dalam usaha untuk membantu mengenalpasti mereka yang berisiko tinggi, OMRON bekerjasama dengan MSH menghasilkan senarai semak diri yang mudah untuk menggalakkan orang ramai memeriksa tekanan darah dan mendapatkan nasihat mengenai cara mencegah atau merawat hipertensi yang tidak didiagnosis.

Pengarah Pemasaran Serantau, OMRON Healthcare Asia Pasifik, Alexis En berkata, di OMRON, pihaknya mempunyai visi yang dipanggil GEN 0 (Gen Sifar).

“Ia merujuk kepada generasi yang tidak ditentukan oleh usia, satu generasi yang bebas daripada serangan jantung dan (atau) strok.

Untuk maklumat selanjutnya, sila kunjungi
bit.ly/HypertensionSelfCheck
 untuk mengambil senarai semak diri dan laman web Persatuan Hipertensi Malaysia untuk penerangan lanjut tentang penyakit tekanan darah tinggi.

Anekdot

Cara mudah ringankan tekanan, kegelisahan:

1. Bersenam

Bersenam secara teratur dapat membantu mengurangkan tekanan dan kegelisahan dengan melepaskan endorfin dan meningkatkan kualiti tidur dan imej diri.
2. Pertimbangkan makanan tambahan.

Makanan tambahan tertentu dapat mengurangkan tekanan termasuk mengamalkan ashwagandha (sejenis herba), asid lemak omega-3, teh hijau dan lemon.
3. Aromaterapi.

Aromaterapi juga dapat membantu. Nyalakan lilin atau gunakan minyak pati untuk menikmati aroma yang menenangkan.
4. Kurangkan pengambilan kafein.

Kafein dalam kuantiti yang tinggi dapat meningkatkan tekanan dan kegelisahan. Bagaimanapun, ‘kepekaan’ seseorang individu terhadap kafein adalah berbeza-beza.
5. Menulis.

Membuat jurnal atau menulis segala yang terbuku dalam hati merupakan praktik yang disarankan kerana ia dapat membantu seseorang memberi fokus kepada perkara yang positif.
6. Mengunyah gula-gula getah.

Menurut beberapa kajian, gula-gula getah boleh membantu seseorang berehat. Ia juga dapat meningkatkan kesejahteraan dan mengurangkan tekanan.
7. Luangkan masa dengan rakan dan keluarga.

Mempunyai hubungan sosial yang kuat antara formula yang berkesan.
8. Ketawa.

Luangkan masa dengan menonton rancangan komedi atau bersama rakan-rakan yang mempunyai karakter kelakar.
9. Belajar mengatakan ‘tidak’.

Cuba jangan menerima atau mengambil tugasan di luar jangkaan untuk dikendalikan. Mengatakan tidak ada satu cara untuk mengawal tekanan.
10. Belajar untuk tidak menunda kerja.

Dengan ‘melangsaikan’ tugasan bermula di senarai teratas hingga bawah, dapat membantu mengatasi tekanan yang berkaitan dengan penundaan.
11. Ikuti kelas yoga.

Aktiviti itu dapat membantu menurunkan tahap hormon stres.
12. Amalkan praktis ketara sedar.

Antara kaedah yang dicadangkan adalah terapi kognitif berdasarkan perhatian, pengurangan tekanan berdasarkan perhatian, yoga atau bermeditasi.
13. Memeluk.

Sentuhan positif daripada pelukan, ciuman dan hubungan seks dapat membantu menurunkan tekanan dengan melepaskan oksitosin dan menurunkan tekanan darah.
14. Dengarkan muzik yang menenangkan.

Mendengarkan muzik yang disukai boleh menjadi kaedah yang baik untuk menghilangkan tekanan.
15. Bernafas secara dalam-dalam.

Bernafas secara dalam-dalam mengaktifkan tindak balas relaksasi. Ia juga meningkatkan sistem saraf simpatik lalu memberi isyarat kepada badan untuk kekal tenang.
16. Luangkan masa dengan haiwan kesayangan.

Menghabiskan masa dengan haiwan kesayangan antara praktis menyeronokkan bagi kebanyakan orang di seluruh dunia.

Dr. Mohd Arifin Mohd Ali

Consultant Internal Medicine Physician (Visiting)

Columbia Asia Hospital - Seremban
MBBS (Monash), MRCP (UK), AM (Malaysia), MBA (Australia), FRCP (UK), FNHAM

PDF and Online Articles:

Mudah jer kawal darah tinggi di rumah, fahami kaedahnya – SinarPlus, 6 December 2020

Artikel ini disiarkan oleh SinarPlus, 6 December 2020.

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Mudarat Kencing Berdiri

Mudarat Kencing Berdiri

March 17, 2020

AMALAN membuang air kecil berdiri dan duduk menjadi topik perbincangan hangat sejak tandas moden diperkenalkan pada abad ke-19.

Ini kerana semakin ramai lelaki memilih amalan kencing berdiri yang dianggap lebih mudah dan cepat tanpa perlu menanggalkan seluar bagi melepaskan hajat.

Ditambah pula semakin banyak mangkuk kencing berdiri disediakan di tandas awam dan ia menjadi pilihan pertama lelaki untuk membuang air kecil.

Di kebanyakan negara barat, posisi kencing berdiri adalah perkara biasa.

Berbeza di negara timur dan Asia, lelaki membuang air kecil dengan cara duduk serta mencangkung.

Kajian pengamal perubatan di Ayurveda Medical menjelaskan bahawa membuang air kecil secara berdiri adalah amalan tidak baik kerana boleh menjejaskan kesihatan lelaki.

Ketua Pegawai Perubatan Columbia Asia Hospital-Cheras Dr Mohd Fadhli Mohd Yusof berkata, keburukan membuang air kecil secara berdiri dapat dilihat daripada aspek kebersihan.

“Membuang air kecil dalam posisi berdiri boleh meningkatkan halaju air kencing yang ketara.

“Ini menyebabkan individu terbabit lebih mudah terkena percikan air kencing yang akan mengotorkan tubuh dan pakaian.

“Malah, tandas turut kotor dengan percikan air kencing berkenaan,” katanya.

Beliau berkata, daripada aspek kesihatan, kebanyakan mangkuk kencing tidak dilengkapi dengan punca air untuk tujuan mencuci kemaluan menyebabkan ramai tidak atau jarang mencuci kemaluan dengan bersih selepas membuang air kecil secara berdiri.

“Kemaluan yang tidak dicuci dengan bersih akan meningkatkan risiko jangkitan di kawasan kemaluan seperti kandidiasis (jangkitan fungus) dan balanitis (jangkitan pada bahagian kepala zakar),” katanya.
BOLEH melemahkan syahwat lelaki.

Menurutnya, posisi paling sesuai bagi lelaki membuang air kecil ialah duduk atau mencangkung.

“Pada kedudukan ini kedua-dua tapak kaki mencecah lantai, badan membongkok sedikit ke hadapan dan lutut dalam keadaan bengkok.

“Selain itu, dalam posisi ini, otot bahagian bawah abdomen, otot pelvis dan otot belakang badan berada dalam keadaan rehat yang maksimum,” katanya.

Sekumpulan penyelidik di Leiden University Medical Center, Belanda mendedahkan lelaki yang membuang air kecil secara mencangkung dapat mengosongkan pundi kencing mereka sepenuhnya.

Jelasnya, manakala membuang air dalam keadaan berdiri, otot pelvis berada dalam keadaan tegang dan ia menyukarkan air kencing keluar sepenuhnya.

Dr Mohd Fadhli berkata, setakat ini tiada kajian menunjukkan amalan membuang air secara duduk lebih baik berbanding berdiri bagi seorang lelaki sihat.

“Namun, bagi pesakit yang mengalami masalah gejala saluran kencing yang lebih rendah (LUTS) seperti pembengkakan kelenjar prostat, membuang air kecil dalam posisi duduk terbukti lebih baik daripada berdiri.

“Ini kerana, pada posisi duduk, otot-otot pelvis berada dalam keadaan rehat yang memudahkan pengeluaran air kencing dan sisa air kencing tidak tertinggal dalam pundi kencing,” katanya.

Menurut beliau, air kencing yang tertinggal dalam pundi kencing akan meningkatkan risiko mendapat jangkitan pundi kencing dan masalah batu karang bagi pesakit LUTS.

Dr. Mohd Fadhli Mohd Yusof

General Practice & Occupational Medicine

Columbia Asia Hospital - Cheras
MD (UKM), OHD (NIOSH)

PDF and Online Articles:

Mudarat Kencing Berdiri – Harian Metro, 15 Mac 2020

Mudarat Kencing Berdiri – Harian Metro, 15 Mac 2020

Artikel ini disiarkan oleh Harian Metro, 15 Mac 2020

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Mungkinkah Pejabat Anda Ada 'Sindrom Bangunan Sakit'?

August 27, 2020

“Pelik sungguh. Tadi bersin tak berhenti, mata pedih, kepala macam nak pecah, badan lesu. Sekarang dah hilang, " bisik hati penulis.

Apa yang penulis alami ini bukanlah yang pertama, malah sudah beberapa kali dan ianya berlaku sebaik sahaja kaki melangkah masuk ke bangunan yang satu itu. Keadaan penulis akan kembali sihat selepas beberapa jam beredar daripada bangunan berkenaan.

Penulis bawa berbincang dengan beberapa orang rakan dan akhirnya mencari-cari di internet lalu terjumpa “jawapan” di laman sesawang
http://www.myhealth.gov.my
 yang mungkin merungkai penyakit misteri yang penulis alami dan mungkin juga ramai lagi di luar sana.

Pernah dengar
Sindrom Bangunan Sakit
 (Sick Building Syndrome) atau SBS?

Lebih tepat, Pertubuhan Kesihatan Sedunia pada tahun 2008 menjelaskan SBS adalah keadaan di mana individu yang berada di dalam bangunan mengalami gejala serta rasa tidak selesa tanpa sebab yang jelas, Malahan, kajian yang dipaparkan di
https://www.who.int
 berkaitan kualiti udara menunjukkan, kualiti udara dalaman yang tidak baik (IAQ) adalah antara penyumbang kepada SBS.

Merungkaikan SBS yang dikaitkan dengan IAQ tidak baik yang sering dihadapi pekerja di Malaysia, Ketua Pegawai Perubatan dan Doktor Kesihatan Pekerjaan, Hospital Columbia Asia, Dr Mohd Fadhli Mohd Yusof menjelaskan sesiapa sahaja boleh mendapat SBS namun ia lebih terkesan kepada mereka yang menghabiskan banyak masa di dalam bangunan.

RISIKO UDARA DALAMAN TERCEMAR

Menurut Dr Mohd Fadhli, keadaan tersebut disebabkan oleh majoriti bahan unsur cemar antara udara persekitaran luar dan udara dalam bilik iaitu bahan cemar yang halus (PM), ozone (O3), nitrous diokside dan karbon monoksida adalah sama tetapi jumlah dan kepekatannya adalah lebih rendah berbanding udara dalam bangunan.

Penyumbang utama kepada kualiti udara dalaman tidak sihat ini berpunca daripada pengudaraan yang tidak baik dan kekurangan pengaliran udara segar dari luar.

Turut menjadi sebahagian faktor udara tercemar ialah sistem ventilasi dan penghawa dingin yang tidak selenggara dengan baik serta kadar kelembapan yang tinggi yang diakibatkan oleh kebocoran.

“Keadaan ini disebabkan oleh kehadiran kulat, bakteria, pengudaraan yang tidak baik dan kehadiran bahan kimia di dalam bangunan. Biasanya masalah ini didapati di bangunan lama yang tidak diselenggara dengan baik secara berkala," jelasnya kepada Bernama.

Memburukan keadaan, pendedahan dalam tempoh lama terhadap udara tercemar bukan sahaja memberi kesan kepada sistem pernafasan terutama individu yang mempunyai penyakit paru-paru kronik seperti asma atau Penyakit Pulmonari Obstruktif Kronik (COPD) malah boleh meningkatkan risiko angin ahmar, serangan jantung dan risiko sesetengah jenis kanser.

Dr Mohd Fadhli berkata, peningkatan risiko ini disebabkan bahan cemar yang halus, yang kurang daripada 2.5 micronmeter) yang berkemampuan untuk terapung di udara lebih lama dan apabila disedut, ia bukan sahaja boleh memberi kesan kepada paru-paru malah akan meresap ke dalam salur darah.

Lebih membimbangkan risiko juga menanti pekerja yang bertugas berjam-jam lamanya di bangunan lama memandangkan kondisi bangunan berusia itu sendiri mengalami proses degradasi atau penguraian sebatian kimia terutamanya bahagian siling, dinding dan cat.

“Bertambah buruk apabila bangunan lama tersebut mempunyai perabut lama yang dibuat menggunakan ‘pressed wood’,” katanya.

Bukan itu sahaja, asap tembakau, sebatian organik meruap yang dibebaskan oleh penggunaan pelarut dan ozon yang dibebaskan dari mesin fotokopi dan pencetak laser turut menjadi antara punca menyumbang pencemaran udara dalaman bangunan.

PENGHAWA DINGIN BERPUSAT TINGKAT RISIKO

Mengulas lanjut, Dr Mohd Fadhli juga tidak menolak penggunaan penghawa dingin berpusat yang menjadi pilihan utama majikan yang beroperasi di bangunan besar kerana kos lebih murah turut mengundang risiko kesihatan yang tinggi ke atas pekerja.

“Ada benarnya penggunaan penghawa dingin jenis unit asing lebih rendah risikonya berbanding penghawa dingin berpusat.

“Ini kerana, jika tidak diselenggara dengan berkala, penapis akan tepu dan tidak mampu untuk menapis sementara bahan pencemar pula akan masuk ke sistem pengudaraan am, yang sekali gus mencemarkan udara di dalam seluruh bangunan,” katanya.

Jika ini berlaku, tidak mustahil majikan terpaksa berdepan ketidakselesaan pekerja dan tahap kesihatan yang tidak menentu yang sekali gus menjurus kepada ketidakhadiran dan produktiviti yang rendah.

Meskipun penyakit disebabkan IAQ lemah ini majoritinya ‘under diagnose’ disebabkan pertindihan simptom dengan penyakit yang lain dan tiada trend yang jelas dari aspek kemasukan ke hospital namun masalah kesihatan yang paling ketara dikaitkan dengan IAQ ini adalah alahan, masalah pernafasan, kerengsaan mata, sinusitis, bronkitis dan jangkitan paru-paru.

“Malahan pendedahan berterusan terhadap udara tercemar kepada golongan berisiko pula mampu mengakibatkan serangan asma atau COPD yang teruk, meningkatkan kadar kemasukan ke hospital dan boleh menyebabkan kematian.

“Disebabkan itulah, penilaian kualiti udara dalaman perlu dilakukan setiap lima tahun bagi memastikan pekerja tidak terdedah kepada sebarang risiko kesihatan,” jelasnya.

Dari aspek gender pula, Mohd Fadhli menjelaskan, kajian yang diterbitkan pada tahun 2000 di Jerman yang membabitkan 1,500 responden, mendapati wanita mendapati SBS adalah dua kali ganda berbanding lelaki.

Dalam dalam kajian yang sama turut mendedahkan golongan pekerja lanjut usia mempunyai risiko yang lebih tinggi untuk mendapat SBS terutamanya lelaki. Pun begitu, faktor lain juga harus diambil kira iaitu merokok,” jelasnya.

PATUHI KOD AMALAN INDUSTRI

Meneliti Kod Amalan Industri bagi Kualiti Udara Dalaman yang diperkenalkan oleh Jabatan Keselamatan dan Kesihatan Pekerjaan (DOSH) pada 2010, ia secara jelas menetapkan garis panduan dan piawaian untuk melindungi kesihatan pekerja dan penghuni lain dari persekitaran dalaman atau tertutup yang menggunakan pengudaraan mekanikal atau penyaman udara.

Lebih menarik, paparan di laman sesawang
https://www.dosh.gov.my
 mengenai Kod Amalan Industri ini turut menggariskan julat yang boleh diterima bagi parameter fizikal tertentu bagi penggunaan penghawa dingin adalah 23 hingga 26 darjah celcius, 40-70 peratus bagi kadar kelembapan relatif manakala pergerakan udara ialah 0.15 hingga 0.50m/s (meter per saat).

Justeru, menjadi tanggungjawab majikan dan pekerja mematuhi peruntukan yang ditetapkan di bawah Seksyen 15 Akta Keselamatan dan Kesihatan Pekerjaan 1994 (OSHA) serta Seksyen 17 OSHA.

Ini bagi memastikan kesihatan kedua-dua pihak dilindungi daripada risiko kualiti udara dalaman yang tidak baik, yang sekali gus menjejaskan produktiviti mereka.

Bagaimana agaknya keadaan bangunan di mana anda bekerja?
Photo credit: Freepik.com

Dr. Mohd Fadhli Mohd Yusof

General Practice & Occupational Medicine

Columbia Asia Hospital - Cheras
MD (UKM), OHD (NIOSH)

PDF and Online Articles:

Mungkinkah Pejabat Anda Ada 'Sindrom Bangunan Sakit'? – Bernama.com, 25 Ogos 2020

Health Hazards Of Working In A ‘sick’ Building – Bernama.com, 25 August 2020

Artikel ini disiarkan oleh Bernama.com, 25 Ogos 2020

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Muscle Health - Dr Harjeet Singh [BFM - Podcast]

October 03, 2013

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon.

Healthy muscles matter - and not just for the Mr. Universe competition. They can also play a huge role in general health and disease prevention. Dr. Harjeet tells us more.

Listen to the podcast
here
.


Musculoskeletal Injuries in Adults and Children

July 21, 2023

Musculoskeletal injuries are common injuries that may occur everyday. Certain injuries are more common in certain age groups. This might be due to differences in the anatomy, physiology and the activities of people in this age groups.

Different risks and results

For children and teenagers, bones are immature. The weakest point of their growing skeleton is the growth plate. This is a necessary structure in every child and young person who continue to grow, making their bones more susceptible to injuries. Therefore, fractures around the wrist and elbow are more commonly seen in this age group following a fall.

High risk accidents that commonly happens to children will cause falls and fractures. Usually this tends to happen around the elbow and wrist because children are usually at play when this happens, such as falling at the playground’s monkey bar with one hand automatically reaching out to the ground to catch themselves. Sometimes this action can cause fractures of the forearm that occurs near the wrist joint.

Behaviour also determines the risk of injuries to a child. Between a child who is super active and a child who is timid and shy, chances are the former may experience falls more than the latter. As habit would have it, children and teenager are naturally more active. Their engagement in active play poses risk of injuries. Children with smaller sized bones are also more susceptible to injuries compared to a larger-sized child.

Teens, adults and the elderly

As for teenagers, they tend to get fractures from overused injuries with the most common part being the knee and foot. This can affect their growth plates along with bones, muscles, ligaments and tendons. When the growth plate is affected, it will need immediate treatment as this affects how the bone will grow in the future. If nothing is done after the injury, the bone may become crooked. It may even become shorter than the opposite limb.

When it comes to adults, the common injuries will usually involve vehicle accidents and sport injuries. As an adult, in urban areas especially, driving is something you do every day. The risks are always there especially if you are not a safe driver. Fractures and ligamentous injuries by far are the most common in accidents.

As for the elderly, they posses a reduced sense of balance and coordination that contributes to an increase in susceptibility to falls. More over, osteoporosis will result in the reduction of their bone density. This will make the bone more prone to fractures even when faced with trivial accidents such as a fall in the bathroom.

For example, a young man in his 20s who falls on his buttocks may get up, brush himself off and carry on walking. But a man who is in his 70s need only to slip on a slippery surface and suffer a serious fracture. These are osteoporotic fractures which happen among the older generation because their bones are porous and weak.

Prevention tips

Vigilance in supervising children during their activities will help in reducing these injuries. Being more cautious especially at the playground. For example, it is common for children to fall while playing monkey bar at the park.

To prevent injuries from happening to children, parents need to be more vigilant in supervising their children (even some teenagers need supervising!). Be more cautious at the park as they run around the playground, skating rink or football field. There have been many cases where children experience falls at the monkey bar thus causing fractures.

A home with young children needs to be child-proofed. Likewise, our elders. Provide a safe environment for them so as to eliminate risks of falling. Ensure floors and rugs are not slippery. The bathroom is one of the most dangerous areas in the house. Make sure the tiles are dry before walking in or use a non-slip mat to avoid slipping. If you have to walk in when tiles are wet, ensure you hold on to something for support like the sink or the towel rack. Also, avoid thick carpets to prevent an uneven surface which can be an accident risk too.

Other than road accidents, hobbies can become a risk too such as futsal, football, tennis and the likes. Of course, one must exercise but do not forget to warm up and play with the right technique and in the right attire, in order to minimise chances of injury. Don’t underestimate the importance of proper socks and shoes to cushion stomping action. Most importantly -- warm up before you start any form of sports.

This is a must!

Dr. Paisal Hussin

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Puchong
MBBS (UM), M Orthopedic Surgery (UM)

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My baby has abnormal ears

My baby has abnormal ears

April 15, 2011

Recently I had to counsel a young couple who just had the birth of their first child. Their baby was noted to have an abnormal ear on one side. Otherwise the baby was healthy and had no other medical problems.

The news of having a newborn baby with an abnormality is devastating for the parents. It is a normal reaction as one tries to cope with the fact that there is ‘something wrong’. It often takes time for the parents as well as the attending doctor to help the parents to accept the condition of their baby.
What is microtia?

Microtia is a condition when there is abnormal development of the outer ear that results in a small or underdeveloped pinna. It is a congenital condition that occur one in every 6,000 births. It occurs more often in boys than girls. It typically involves one ear but can occur in both ears. Patients may have narrowed or absent ear canal (canal atresia).

The hearing of the affected ear is reduced because of the abnormal ear canal. Usually the inner ear (cochlea) is normal. Hearing rehabilitation is important if both ears are involved.
What assessments are necessary at birth?

Microtia is not a life threatening condition. However it can be feature of a syndrome such as Goldenhar syndrome, hemifacial microsomia or Treacher Collins syndrome. The pediatrician will normally assess for any syndromic features and associated anomalies soon after birth.

The hearing of the affected ear is usually reduced because the structures in the middle ear can be affected as well. In children with unilateral microtia, hearing in the other ear is usually normal. However a hearing test must be done to confirm this. A baby with normal hearing in only one ear will usually develop speech and language as other babies with no hearing problems.

If both ears are affected, a hearing aid is fitted as early as possible. A bone conduction hearing aid is recommended and it is often worn on a headband in a very young child.
What is the management plan for the child?

If the initial assessments done at birth show that the microtia is an isolated problem and that hearing issues are resolved then the child’s developmental milestones should be normal.

A computed scan of the temporal bone (ear) is usually done when the child reaches 4-5 years old. This scan will show the status of the middle ear structures such as the ossicles and the size of the middle ear cavity. It will also show if there is cholesteatoma present. Cholesteatoma is accumulation of dead skin trapped within the absent ear canal. If cholesteatoma exists, the ENT surgeon would perform an ear exploration surgery to remove the cholesteatoma.
When is ear cosmetic surgery considered?

Ear (pinna) reconstruction is considered when the child is of school-going age. The child’s ear reaches adult size around the age of 6 years. Any surgery performed before this age will result in mismatched ears.

There are a few treatment options available for ear cosmetic surgery:

Ear reconstruction using rib graft

The pinna can be reconstructed using the patient’s rib cartilage as a graft. The rib cartilage is harvested and carved into the shape of the pinna before implanting under the skin. This surgery is usually performed at an older age around 10 years old to ensure adequate rib cartilage size. Ear reconstruction surgery is done in stages with 3 to 6 months apart between each procedure.

Prosthetic ears

The child can be fitted with false ear which can be fixed onto the skull through implants and fixtures. This surgery can be performed when the child is around 7 years old. The false ear is sculptured from a silicone material and colored according to the patient’s skin tone. The surgery is usually performed in 2 stages.
Is there surgery to improve the hearing?

Surgery to improve hearing is performed after the pinna reconstruction surgery is completed. The canal reconstruction surgery involves drilling out the bone to form a new ear canal and lining the canal with split skin graft. The hearing outcome of this surgery depends on the condition of the middle and inner ear structures. The ENT surgeon would advise if the patient is suitable for this surgery based on the CT scan images.
Dr. Mazita Ami

Consultant Ear, Nose, Throat- Head & Neck Surgeon

Columbia Asia Hospital- Bukit Rimau


My Child Has Not Started Talking

My Child Has Not Started Talking

August 20, 2020

I recently met a couple with a 2½-year old son who voiced out their concerns to me that their son has not started talking. He has not uttered a single comprehensible word and he only uses finger-pointing and gesturing for communicating. Other than this, he had an uneventful birth history, is a very active and energetic toddler with normal physical development, and has no symptoms to suggest any underlying illness. What could be the reason for this speech delay?

Before we start to discuss the possibilities, in this case, I would like to comment that children develop progressively on their own timeline. About 10 to 20 percent of two-year-olds, the majority being boys, are late to develop speech and language. Given time, most of them would catch up by three years old. There might not necessarily be a serious problem if a child seems to start speaking a bit later than others because he or she is a ‘late bloomer’. However, there are things that are typical for the common majority of children depicting what they can do at a certain age. For instance, a typical two-year-old will be able to speak up to 50 words in two or three-word sentences. The vocabulary of a three-year-old is certainly much higher with up to 1000 words. They can even tell short stories. Knowing what is normal helps to detect what is not.
Below are the common speech milestones in children:

Birth to five months:
Coos / Laughs / Cries / Giggles / Makes noise when talked to

Six to 11 months:
Babbles / Says first word / ‘Ma-ma’ or ‘Pa-pa’ / Repeats sounds

12 to 17 months:
Vocabulary of about 5 words / Can imitate simple words

18 to 23 months:
Uses two-word sentences / Vocabulary 50 words / Unclear pronunciation

Two to three years: Uses three-word sentences / Answers simple questions / Uses pronouns like ‘you’, ‘I’, ‘me’ / Uses descriptive words such as ‘happy’, ‘big’ / Strangers may not understand speech

Three to four years:
Identifies colors / Describes the use of objects / Expresses feelings and emotion / Strangers may understand what is said

A child may have speech delay if he or she is unable to fit in the common milestones. Most of the time they will catch up at a later age but it is important to not miss actual problems that cause speech and language delay. They include:

Hearing loss

Prematurity and development delay

Autism spectrum disorder

Learning disability

Neurological disorders – Cerebral palsy / Muscular dystrophy / Traumatic brain injury

Ankyloglossia or tongue-tie

Parental neglect or lack of stimulation

A suspected child with speech delay will be assessed for risk factors of having the conditions above. Questions will be asked on birth history, family history, speech and language capabilities, and developmental milestones. The child’s ears, mouth, palate, tongue, and the neurological system will also be examined. Depending on this initial screening, the child can be further subjected to audiological tests, referred to as an ear, nose & throat surgeon, speech-language pathologist, or a pediatric neurologist.

Audiological tests to assess the child’s hearing include Otoacoustic emissions (OAE), tympanometry, and brain stem evoked audiometry (BSER). If a child is found to have hearing loss, this is further categorized to type; conductive hearing loss or sensorineural hearing loss and severity of the hearing loss; mild to profound.
Treatment of speech delay will depend on the cause.
 If the developmental delay is merely speech with no other associated conditions, speech and language therapy may be the only treatment needed. It offers a good outcome especially when initiated early. Even when speech delay is caused by other additional factors, speech and language therapy by a trained therapist helps as part of an overall effective treatment plan.

When the speech delay is associated with other disorders as mentioned above, it is important to address those issues as well, in addition to speech and language therapy. These include treating the hearing loss, correcting mouth or tongue abnormalities, physical or occupational therapy, behavioral therapy and also treating underlying neurological disorders.

As parents, it is good practice to be observant of your children’s capabilities and developmental milestones. Equally commendable would be to encourage and nurture your child’s speech by the
methods
 below:

Talk to your child. Use proper words with good eye contact. Give your full attention.

Point or gesture to the objects as you describe or narrate.

Read together with your child. Tell easy to understand stories.

Be patient when talking to them. Explain things carefully using simple words.

Sing together simple songs or nursery rhymes.

Let them answer questions posed by other people instead of answering on their behalf.

Ask them questions with multiple answers and give them plenty of time to answer.

Allow your child to interact and play with children who have good speech and language skills.

As a closing note, your child’s speech delay might just be him or her being a ‘late bloomer’ but it can be caused by something else as mentioned above. Be vigilant. Bring your child to a medical practitioner preferably before three years old for an early assessment and intervention as this has proven to bear successful outcomes.

Dr. Mohd Adzreil Bin Bakri

Consultant ENT, Head & Neck Surgeon

Columbia Asia Hospital – Setapak
MBBCh BAO (Ireland), MRCS (ENT) (Edinburgh), M ORL-HNS (UM), CMIA (NIOSH), AM (Malaysia)

Make an Appointment

PDF and Online Articles:

My Child Has Not Started Talking – BabyTalk

This article first appeared in BabyTalk.

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My VISION Is Stolen!!!

My VISION Is Stolen!!!

July 03, 2017

Photo credit: stjameshospital.com
What is Vision?

SIGHT: sense faculty to see people and things around us.
Why is Sight Important?

Visual Acuity defines the clarity of the visual perception of an image. Vision can be lost at birth or during the lifetime painlessly or painfully for various reasons.

Pain in vision draws one’s attention to seek medical treatment.

Painless loss of vision is akin to termites silently causing destruction from the inside without initial symptoms. One common permanent loss of vision is Glaucoma.
When does GLAUCOMA occur?

Glaucoma is a condition where the optic nerve is damaged from increased intraocular pressure without us being aware.
Glaucoma damage is permanent and it is not reversible.

Aqueous humor controls the pressure inside the eyes to keep the eyeball firm. It is secreted in the ciliary body and passed through the pupil into the space between the iris and the cornea. Aqueous is drained through the Trabecular meshwork at the anterior chamber angle (Fig 1).

Fig 1. Cross Section of the Eye

Groups at Risk:

Male/female over 40

East-Asian/African American ancestry

Family history of glaucoma

People who have high eye pressure; either far-sighted or near-sighted; have an eye injury; taking steroid eye drops or orally; thinner central corneal thickness; thinning optic nerve; diabetes; migraines; hypertension or other health-related problems

World Health Organization (WHO) Eye Screening Recommendation
Glaucoma has no symptoms in early stages.

Many people are unaware of this silent but preventable blindness. Regular eye screening helps to detect this disease before vision is lost.
Glaucoma Screening for normal individuals:

Once in every 2 years for persons 40 years and above

Yearly for persons 50 years and above

Screen for intraocular pressure if immediate family is diagnosed with glaucoma

Full eye examination every 5 to 10 years if person is below 40 years with no known risk factors (American Academy of Ophthalmology)

Screening schedules for individuals at risk of glaucoma:

1 – 3 years for persons aged 40 – 50 years

1 – 2 years for persons aged 55 – 64 years

6 – 12 months for persons aged 65 years and above

How is Glaucoma treated?

Prognosis through medication and surgery to prevent further optic nerve damage is good.
Treatment Options

Glaucoma is usually controlled with eye drop medications. Used daily, the eye drops lower intraocular pressure by reducing the amount of aqueous fluid produced by the eyes or helps the fluid flow better through the drainage angle.

Laser surgery helps to drain the aqueous fluid from the eye. The various procedure types can be carried out in the ophthalmologist’s clinic or as outpatient in the surgical centre:

Trabeculoplasty
This surgery is for persons with open-angle glaucoma. The surgeon uses the laser to facilitate the drainage angle function better, in order for the fluid to flow out properly, thus reducing the eye pressure.

Iridotomy
This procedure is recommended for persons with angle-closure glaucoma. The ophthalmologist uses the laser to create a tiny hole in the iris allowing the fluid to flow towards the drainage angle.

Surgery

Trabeculectomy
The surgeon creates a tiny flap in the sclera and a bubble in the conjunctiva called a filtration bleb to drain the aqueous humor (Fig 2).

In the bleb, the fluid is absorbed by the tissue around the eye, hence lowering the eye pressure.

Fig 2. Trabeculectomy

Glaucoma Drainage Implant
- The ophthalmologist may implant a tiny drainage tube in the eye (Fig 3).

- It sends the fluid to a collection area called a reservoir.

- The surgeon creates the reservoir beneath the conjunctiva.

- The fluid is absorbed into nearby blood vessels.

Fig 3. Glaucoma Drainage Implant

Advisory Highlights

Team effort between patients and doctor

Adhere to doctor’s instructions

Visit the doctor every 3 – 6 months

Refer enquiries to consultant

Dr. Mohd Hassan @ Maung Maung Win

Consultant Ophthalmologist

Columbia Asia Hospital - Setapak


Myths About Breast Cancer and Why They Aren’t True

November 04, 2019

We are surrounded by tons of information about breast cancer – some good and some bad.

The Internet can be a huge help, but it can also cause a lot of confusion. While our family members and friends have the best intentions in giving information to protect us, not everything they say may be true.

Here are some of the common misconceptions or myths that we often come across:
Myth: If you do not have a family history of breast cancer, you are safe. You will not get it.
Truth
: Although family history of breast cancer is a significant risk factor for developing breast cancer, only 5-10% of breast cancer cases are inherited. The remaining 90-95% of cases are by chance. This simply means that if we do not have a family member with breast cancer, we are not spared from the disease.

As mentioned, the vast majority of patients with breast cancer have no family history, suggesting that there are many other factors involved in developing the disease.

Myth: Wearing an underwired bra causes breast cancer.
Fact
: The proposed theory for this myth is that wearing an underwired bra could restrict the flow of lymphatic fluid out of the breasts, causing a build-up of toxins within breast tissue, which then leads to the development of breast cancer.

However, research has found no evidence that any aspect of bra-wearing is associated with increased risk of breast cancer. You can keep wearing your bra, ladies!
Myth: Using underarm antiperspirants leads to breast cancer.
Fact
: There are rumours that underarm antiperspirants, especially those containing aluminium salts and other chemicals such as parabens, are absorbed into the lymph nodes and breast tissue, therefore increasing the risk of breast cancer.

Shaving is also believed to make things worse as the small cuts or nicks from shaving purportedly increase the rate of absorption of such chemicals. Some studies have shown that women who use aluminium-based underarm products have higher concentrations of aluminium in their breast tissues.

However, based on available literature, there is no evidence of a link between the use of antiperspirants and breast cancer.

Myth: Mammograms are unsafe because they give out too much radiation.
Fact
: The mammogram remains the gold standard for early detection of breast cancer.

There is often a misconception that a mammogram causes more harm than benefit as it involves high doses of radiation. However, modern mammography equipment is able to produce high quality breast images with low doses of radiation. The total dose for a standard screening mammogram is only about 0.4 miliSievert (mSv).

To put that number in perspective, we are typically exposed to an average of 3 mSv of radiation each year from background sources such as rocks and soil. There is no doubt that the benefits of early detection and early treatment of breast cancer far outweigh the possible harm from the very low dose radiation exposure by mammograms.

Myth: Only women develop breast cancer. Men do not get breast cancer.
Fact
: Although breast cancer commonly affects women, it does occur in men too. Sadly, there is lack of awareness among men and they are less likely to suspect that a lump in their breast could be cancerous. This causes a delay in seeking treatment.

In the presence of any suspicious breast lump in men, they should come forward quickly for assessment.
Myth: Consuming dairy products increase the risk of developing breast cancer.
Fact
: The association between dairy intake and breast cancer risk is often discussed. If we think about it carefully, assessment of dietary factors in relation to cancer risk is difficult and is affected by many potential biases.

For example, persons with high milk consumption may likely consume large amounts of meat or other high fat foods that could also contribute to an increased cancer risk. Therefore, it is difficult to completely separate the effects of milk or dairy products from other nutrients in order to assess the risk.

Another important question is whether the cow, which is the source of the milk has received any growth hormones, which could potentially increase the insulin-like growth factors that could in turn stimulate malignant cells to grow rapidly. Although several interesting hypotheses link dairy products and breast cancer, the available evidence does not support a strong association between these two.

Dr. Kiran Kaur D/O Amer Singh

Consultant General Surgeon

Columbia Asia Hospital – Klang
BSc (Hons) (Biomedicine) (UPM), MD (UPM), M Surgery (UM), Special Interest In Breast Surgery

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PDF and Online Articles:

Myths About Breast Cancer and Why They Aren’t True – The Star Online, 22 October 2019

Myths About Breast Cancer and Why They Aren’t True – The Star, 22 October 2019

This article first appeared in The Star, 22 October 2019

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Myths & Old Wives Tales About Pregnancy: Revealed

May 24, 2023

There are so many local myths and old wives tales about pregnancy. While some of them are entertaining, others can be downright harmful. Especially those that involve the mother and baby’s health and wellbeing.

We had a chat with Dr Victor Chin, a consultant obstetrician and gynaecologist at Columbia Asia Hospital, Cheras to help debunk some of these popular myths and old wives tales about pregnancy so that you can make informed decisions about you and your child’s health.

Myth 1: You should eat for two during pregnancy.

So, as far as I’m concerned, in pregnancy, it’s important to maintain a good nutrition intake and normal calorie intake. As long as you’re maintaining your regular diet, healthy diet along with proper supplements, that should be fine.

That should be enough and sufficient for both mummy and baby. So, you don’t really have to take extra or force yourself to eat much or eat for two. Eating for one person would be enough. Intake should also be according to the mother’s lifestyle as well.

Let’s say, she wants to exercise. Just light and gentle exercises; like brisk walking, some yoga. That should be fine. In terms of diet, just a regular diet, you know, less sugar, high protein, high fibre intake, that would be just sufficient.

On top of that, for the first trimester, add on things like folic acid, and you know, you have plenty of supplements available in the market that you can do your own survey. You don’t really have to force feed. A regular diet, your normal diet should be sufficient.

Myth 2: All bleeding during the first trimester means a miscarriage.

It depends on where the bleeding is coming from. So, in the female reproductive tract, we have the uterus, cervix and vagina.

If the bleeding is coming from the vagina or the cervix, it does not necessarily mean that you’re having a miscarriage. Of course, the chances of miscarriage during the first trimester are about 20 to 25%, which is quite common.

If you have any bleeding, especially if the bleeding is a fresh red colour, you might want to visit your doctor to get yourself checked.

There are some common cases of bleeding that may happen when you’re in your first trimester.

For example, if you have a polyp on the cervix, it can cause bleeding. Or if you have a cyst in the vagina which ruptures during the pregnancy, it can cause bleeding as well.

And of course, if you have a miscarriage, you can have bleeding. Certain pregnancy conditions such as ectopic pregnancy, it can manifest as early pregnancy bleeding.

So, it does not necessarily mean that you have a miscarriage. Having said that, being prepared for any potential pregnancy complication is important as it can help to minimise risk and ensure the best possible outcome for both mother and baby.

If you are in pain and bleeding, you should get to your doctor as soon as possible. But if the bleeding has stopped, for example, sometimes you might have some bleeding in the middle of the night. Or probably just brownish discharge.

This could be due to an infection. Or possibly a miscarriage. You can always contact your doctors, the next day to have yourself examined.

So, don’t panic. Just take it easy.

Myth 3: Being healthy guarantees a smooth pregnancy.

It depends on what is your definition for healthy.

Some girls, they might have underlying conditions. Like Polycystic Ovary Syndrome (PCOS). Or some people might not have had any medical examinations before.

So preferably, all women that are pregnant need to have proper blood tests and physical examinations before they call themselves healthy.

So how it works is usually at the very beginning of the pregnancy, we will triage a lady based on her risk factors.

For example, age, based on their family history, based on their previous history, we will triage them based on those risk factors.

Then we will categorise them based on low risk, medium risk or high-risk pregnancy.

So even though you are healthy, it’s always good to see your doctor earlier in the pregnancy stages to have all these things sorted out, and then you can have better planning for your pregnancy and a smoother pregnancy experience.

Myth 4: All mothers are blissful and happy after childbirth.

Childbirth is a tedious process. Giving birth is a labour.

You need to go through many long hours of pushing. You know, it’s physically tiring.

Then you have a newborn. And when the baby cries, you’ll be feeding the baby; then you get tired.

So, for the first few days, postpartum blues is very common.

Especially the first 2 to 5 days perhaps, and subsequently you might get mothers who fall into postpartum depression. So, these are the period where the mum needs to be well observed and well taken care of.

And that’s when your doctors, or your carers come into play.

Partners are very important as well. So, all the daddies out there, you need to keep an eye on your wife.

Dr. Victor Chin

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital – Cheras
MBBS (India), MRCOG (UK), Fellowship in Advanced Gynecologic Endoscopic Surgery (Australia)

Make an Appointment

PDF and Online Articles:

Myths & Old Wives Tales About Pregnancy: Revealed – Motherhood.com.my, 23 May 2023

This article first appeared in Motherhood.com.my, 23 May 2023.

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Nak Bersalin Anak Kembar, Ketahui Risiko Masa Process Kelahiran

September 14, 2018

Kandungan kembar adalah dalam kategori kandungan berisiko tinggi dan perlu dipantau doktor pakar sepanjang kehamilan dan kelahiran. Bagaimana untuk merancang kelahiran kandungan kembar?

Menurut Dr Sharina Mohd Razali, Pakar Perbidanan dan Sakit Puan, Columbia Asia Bukit Rimau mengenai persediaan yang perlu dilakukan dan proses kelahiran bayi kembar.

“Biasanya doktor akan berbincang dengan pesakit akan cara kelahiran dan menyarankan kaedah kelahiran yang sesuai situasi kehamilan. Kira-kira enam daripada 10 kandungan kembar akan lahir secara pembedahan caesarean,” kata Dr Sharina.

Idealnya kandungan kembar harus dipantau oleh pakar sakit puan dan seeloknya kelahiran di hospital yang mempunyai kemudahan seperti NICU ( Neonatal Intensive Care Unit) kerana kandungan kembar berisiko tinggi untuk bersalin awal.
Sejak dulu lagi, telah menjadi praktis biasa oleh semua pakar sakit puan untuk menggalakkan kelahiran secara normal sekiranya kembar pertama berada pada kedudukan kepala di bawah

Walaubagaimanapun, pakar-pakar mempunyai pendapat yang berbeza dan pakar di luar negara mungkin mempunyai pendapat berlainan tentang cara terbaik menyambut kelahiran kembar berdasarkan kajian yang dilakukan di negara berkenaan.
BOLEHKAH DILAHIRKAN SECARA NORMAL?

Kelahiran secara normal boleh dilakukan dengan syarat kandungan atau ibu tersebut adalah;

Kembar tidak lebih daripada dua dan bukan kembar bercantum/siam (conjoint twin).

Kedudukan bayi yang sesuai untuk kelahiran- kembar pertama mestilah berada dalam kedudukan kepala berada di bawah(kedudukan kepala kembar kedua begitu penting kerana kebanyakan masa kedudukan mereka akan berubah selepas kelahiran kembar pertama)

Ibu tidak mempunyai komplikasi tekanan darah tinggi yang berbahaya (pre eclampsia)

Ibu tidak mempunyai penyakit kronik yang lain seperti Penyakit Jantung

berat bayi melebihi 2kg

kandungan bukan pramatang

tiada komplikasi ‘growth restriction’ pada bayi (bayi terlalu kecil)

tiada growth discordant (satu bayi terlalu kecil berbanding dgn kembarnya)

kedua dua bayi sihat ( tiada Fetal compromise or abnormal

Sejarah kelahiran caesarean atau pembedahan lain ke atas rahim sebelum ini (kerana boleh meningkatkan risiko uterine rapture).

KELAHIRAN SECARA NORMAL BERISIKO

Kelahiran normal bagi kembar memerlukan kedudukan kepala bayi pertama di bawah.

Sekiranya kedua dua kepala bayi berada di bawah, bayi kedua akan dilahirkan pada kontraksi seterusnya selepas kelahiran bayi pertama

Sekiranya bayi kedua pula melintang ( prosedur External Cephalic Version (ECV) atau Internal Podalic Version (ICV) perlu dilakukan untuk menukar posisi menjadi songsang (breech)/ kepala dibawah(cephalic). ICV adalah sangat berisiko tinggi dan jarang jarang dilakukan pada masa kini.

Adalah penting untuk memastikan bayi berada dlm keadaan longitudinal/memanjang dan tidak melintang. Sekiranya bayi kekal melintang, bayi terpaksa dilahirkan melalui pembedahan Caesarean.

Namun, perlu diketahui kelahiran kembar secara normal haruslah dilakukan dengan kehadiran doktor pakar yg berpengalaman kerana banyak komplikasi boleh berlaku seperti cord prolapse (tali pusat terkeluar dan bayi boleh lemas) dan fetal distress (bayi lemas).
KESELAMATAN JANIN

Antara sebab utama doktor mengesyorkan ibu untuk melahirkan secara pembedahan caesarean ialah keselamatan kedua-dua bayi dan untuk mengelakkan keadaan retained second twin ( bayi kedua kekal dalam keadaan melintang) atau bayi kedua lemas kerana kesukAran memantau kedua dua bayi semasa dalam proses bersalin

Kontraksi rahim merupakan satu bentuk
stress
 kepada bayi dan boleh mengakibatkan bayi lemas.

Kadangkala adalah sukar untuk memantau (monitor) kembar kedua kerana kedudukannya yg mungkin berada dia belakang kembar pertama. Sekiranya ada kesukaran ini, sesetengah doktor pakar akan mencadangkan kelahiran secara pembedahan Caesarean
PEMILIHAN HOSPITAL MESTI MEMPUNYAI CIRI-CIRI INI

Selepas mengetahui akan risiko yang boleh berlaku dalam proses kelahiran maka, ibu bapa perlu bijak merancang lebih awal dan mempertimbangkan saranan daripada doktor. Antara perkara yang perlu dipertimbangkan dalam pemilihan hospital bersalin ialah;

Mengutamakan pemilihan hospital yang mempunyai kemudahan untuk ibu dan anak.

Mempunyai wad penjagaan neonatal yang mencukupi untuk menempatkan bayi yang kembar yang lazimnya lahir pada usia pramatang.

Bekalan darah yang mencukupi kerana kelahiran kembar mempunyai risiko tumpah darah sangat tinggi dimana rahim sukar untuk mengecut.

Jumlah pakar pediatrik yang mencukupi iaitu seorang bagi setiap bayi.

Mempunyai kemudahan teknikal yang mudah kerana kemungkinan pesakit memerlukan pembedahan caesarean secara kecemasan amat tinggi.

5 INFO MENGENAI KELAHIRAN KEMBAR

Bagi kandungan kembar tiga ke atas, mereka hanya boleh dilahirkan secara caeserean sahaja.

Biasanya bagi kandungan yang perlu dilahirkan secara caesarean, pembedahan akan dijadualkan pada minggu ke-3 hingga ke-37 atau lebih awal bergantung pada keadaan ibu dan janin dan juga bergantung kepada jenis kembar (monochorionic atau dichorionic)

masa untuk kelahiran kembar bergantung pada jenis kembar; seawal 32 minggu sekiranya kembar berkongsi plasenta dan berada dalam kantung amnion yg sama (monochorionic monoamniotic)

Kembar dua yang mempunyai dua plasenta berasingan dan berada dalam kantung amnion berbeza (selalunya boleh bersalin normal jika keadaan ibu sihat dan tiada komplikasi lain.Ini adalah jenis kembar yang paling kurang berisiko kerana kedua dua bayi mempunyai unit plasenta nya sendiri

Masalah ‘retained second twin’ boleh berlaku di mana bayi kedua terperangkap dalam rahim dengan keadaan songsang dan pembedahan caesarean kecemasan perlu dilakukan untuk menyelamatkan nyawa bayi.
Dr. Sharina Binti Mohd Razali

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Bukit Rumau
Artikel ini disiarkan oleh Majalah Pa&Ma, 14 September 2018
Click for Online Article:

Nak Bersalin Anak Kembar, Ketahui Risiko Masa Process Kelahiran - Majalah Pa&Ma, 14 September 2018


Nak Hamil Anak Pertama Tiada Masalah, Tapi Anak Kedua Susah Pula Nak Lekat

December 07, 2018

Kesukaran untuk anak kedua atau seterusnya sering dihadapi sesetengah pasangan. Anak pertama berupaya hamil dengan mudah, tetapi bila anak kedua, ketiga atau seterusnya, mama jadi sukar untuk hamil. Kenapa ye?

Ada yang mengadu kitaran haid tidak menentu walhal sebelum ini tiada masalah. Ada kala tiada haid, haid yang singkat dan ada waktunya haid keluar berketul-ketul. persoalannya adakah masalah kitaran haid ini yang menjadi punca sukar untuk mendapatkan cahaya mata?
“SECONDARY INFERTILITY”
ATAU MASALAH KESUBURAN SEKUNDER

Menurut Dr Norintan Zainal Abidin Shah, Pakar Perbidanan & Sakit Puan Hospital Columbia Asia Seremban,
keadaan ini sebagai
“secondary infertility”
atau masalah kesuburan sekunder.
 Ia berlaku apabila seseorang wanita mendapati dirinya sukar untuk hamil semula setelah mengalami satu atau lebih kehamilan atau keguguran.

Bagi mengesan punca, pasangan suami isteri perlu hadir sendiri ke klinik untuk mendapatkan pemeriksaan dan penyiasatan yang melibatkan ujian asas sebelum memberi ubat subur kepada pasangan yang bermasalah.

“Saya ingin menekankan bahawa haid yang tidak teratur bukan bermakna seseorang wanita itu tidak menghasilkan telur atau benih. Tetapi haid yang tidak teratur mungkin bererti telur atau benih yang dihasilkan adalah secara rambang sehingga menyebabkan pasangan sukar untuk menentukan bilakah waktu subur untuk mengadakan hubungan intim bersama suami,” kata Dr Norintan.

Sebanyak 33% pasangan lulus ujian kesuburan tetapi masih belum hamil dikenali sebagai
 unexplained infertility
.
GUNAKAN KIT OVULASI

Wanita yang menghadapi masalah untuk mengira atau menentukan hari subur bolehlah menentukan waktu subur menggunakan kit ovulasi yang asli untuk mendapatkan keputusan yang lebih tepat!

Jika kit menunjukkan anda tidak mempunyai ovulasi (waktu subur), doktor boleh melakukan pemeriksaan imbasan atau “
transvaginal ultrasound
” untuk memeriksa keadaan ovari dan memantau pengeluaran telur (
dominant follicle)
. Pemeriksaan mungkin kerap jika doktor ingin memastikan telur tadi berkembang dan seterusnya matang.
PERLU JALANI PEMERIKSAAN DARAH

Kegagalan untuk
menghasilkan sebiji
dominant follicle

memerlukan pemeriksaan darah yang dikenali sebagai
hormonal assay
 untuk memastikan pesakit sebegini tidak mengalami masalah-masalah seperti;

Polycystic ovarian syndrome
 (PCOS)

Hyper
atau
hypo-thyroidism

Hyperprolactinemia.

Doktor akan juga memastikan wanita terbabit tdiak menghidap kencing manis. Jika ada, ia wajib dirawat dan distabilkan sebelum cuba untuk hamil.
FIBROID, CYST & POLYP PENGHALANG HAMIL

Selain itu, masalah fibroid dan
ovarian cyst
 selalunya menjadi penghalang kehamilan.
Lebih-lebih lagi jika
ovarian cyst
 tadi merupakan
endometrioma
 atau endometriosis kerana ianya menurunkan kadar kesuburan kepada 20 hingga 30%

Manakala
endometrial polyp
 pula menyebabkan dinding rahim tidak sesuai untuk kehamilan
. Ujian
hysterosalphingogram
(HSG) untuk memeriksa salur Fallopian.

Jika kedua -dua salur Fallopian didapati tersumbat, pesakit akan dirujuk ke Unit IVF di Hospital yang mempunyai Unit Infertiliti. Namun sekiranya kedua-dua atau salah satu salur Fallopian normal tersumbat, ujian air maninya akan dilakukan kepada suami.
Dr. Norintan Zainal Abidin Shah

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Seremban
Artikel ini disiarkan oleh Majalah Pa&Ma, 7 December 2018
Click for Online Article:

Nak Hamil Anak Pertama Tiada Masalah, Tapi Anak Kedua Susah Pula Nak Lekat - Majalah Pa&Ma, 7 December 2018


Nak Mengandung Anak Pertama Mudah Tapi Anak Kedua Bertahun Cuba Susah Pula Nak Lekat

August 28, 2019

Kesukaran Untuk Anak Kedua Atau Seterusnya Sering Dihadapi Sesetengah Pasangan. Anak Pertama Berupaya Hamil Dengan Mudah, Tetapi Bila Anak Kedua, Ketiga Atau Seterusnya, Mama Jadi Sukar Untuk Hamil. Kenapa Ye?

Ada yang mengadu kitaran haid tidak menentu walhal sebelum ini tiada masalah. Ada kala tiada haid, haid yang singkat dan ada waktunya haid keluar berketul-ketul. persoalannya adakah masalah kitaran haid ini yang menjadi punca sukar untuk mendapatkan cahaya mata?

“Secondary Infertility” Atau Masalah Kesuburan Sekunder

Menurut Dr Norintan Zainal Abidin Shah, Pakar Perbidanan & Sakit Puan Hospital Columbia Asia Seremban, keadaan ini sebagai “secondary infertility” atau masalah kesuburan sekunder. Ia berlaku apabila seseorang wanita mendapati dirinya sukar untuk hamil semula setelah mengalami satu atau lebih kehamilan atau keguguran.

Bagi mengesan punca, pasangan suami isteri perlu hadir sendiri ke klinik untuk mendapatkan pemeriksaan dan penyiasatan yang melibatkan ujian asas sebelum memberi ubat subur kepada pasangan yang bermasalah.

“Saya ingin menekankan bahawa haid yang tidak teratur bukan bermakna seseorang wanita itu tidak menghasilkan telur atau benih.

“Tetapi haid yang tidak teratur mungkin bererti telur atau benih yang dihasilkan adalah secara rambang sehingga menyebabkan pasangan sukar untuk menentukan bilakah waktu subur untuk mengadakan hubungan intim bersama suami,” kata Dr Norintan.

Sebanyak 33% Pasangan Lulus Ujian Kesuburan Tetapi Masih Belum Hamil Dikenali Sebagai Unexplained Infertility.

Gunakan Kit Ovulasi

Wanita yang menghadapi masalah untuk mengira atau menentukan hari subur bolehlah menentukan waktu subur menggunakan kit ovulasi yang asli untuk mendapatkan keputusan yang lebih tepat!

Jika kit menunjukkan anda tidak mempunyai ovulasi (waktu subur), doktor boleh melakukan pemeriksaan imbasan atau “transvaginal ultrasound” untuk memeriksa keadaan ovari dan memantau pengeluaran telur (dominant follicle). Pemeriksaan mungkin kerap jika doktor ingin memastikan telur tadi berkembang dan seterusnya matang.
Perlu Jalani Pemeriksaan Darah

Kegagalan untuk
menghasilkan sebiji dominant follicle
 memerlukan pemeriksaan darah yang dikenali sebagai hormonal assay untuk memastikan pesakit sebegini tidak mengalami masalah-masalah seperti;

Polycystic ovarian syndrome (PCOS)

Hyper atau hypo-thyroidism

Hyperprolactinemia.

Doktor Akan Juga Memastikan Wanita Terbabit Tidak Menghidap Kencing Manis. Jika Ada, Ia Wajib Dirawat Dan Distabilkan Sebelum Cuba Untuk Hamil.

Fibroid, Cyst & Polyp Penghalang Hamil

Selain itu, masalah fibroid dan ovarian cyst selalunya menjadi penghalang kehamilan.
Lebih-lebih lagi jika ovarian cyst tadi merupakan endometrioma atau endometriosis kerana ianya menurunkan kadar kesuburan kepada 20 hingga 30%!

Manakala
endometrial polyp pula menyebabkan dinding rahim tidak sesuai untuk kehamilan.
 Ujian hysterosalphingogram (HSG) untuk memeriksa salur Fallopian.

Jika kedua -dua salur Fallopian didapati tersumbat, pesakit akan dirujuk ke Unit IVF di Hospital yang mempunyai Unit Infertiliti. Namun sekiranya kedua-dua atau salah satu salur Fallopian normal tersumbat, ujian air maninya akan dilakukan kepada suami.

Dr. Norintan Binti Zainal Shah

Consultant Obstetrics & Gynecologist

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

Make an Appointment

PDF and Online Articles:

Nak Mengandung Anak Pertama Mudah Tapi Anak Kedua Bertahun Cuba Susah Pula Nak Lekat – Majalah Pa&Ma, 24 Ogos 2019

Artikel ini disiarkan oleh Majalah Pa&Ma, 24 Ogos 2019

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Obstetrics & Gynecology
 in Columbia Asia?

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Need for Health Checks

Need for Health Checks

April 21, 2017

Being told you have a critical illness is devastating but there are approaches you can take in order to alleviate fear and anxiety. “My advise is – don’t wait for bad news. It is extremely important to go for regular screenings that can detect critical illness. The earlier you find out, the earlier you can respond…” Read on what our Medical Officers have to say about Health-Screenings.

Need for Health Checks – The Star, 20 April 2017
.


Neglected Injuries - Dr Harjeet Singh [BFM - Podcast]

April 23, 2014

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Whether through willful ignorance or wishful thinking, sometimes injuries get ignored. However that can cause serious long-term damage that would take more time and effort to fix than the original injury. Dr. Harjeet Singh, consultant orthopaedic surgeon, tells us more about this.

Listen to the podcast
here
.


No Burn, No Slim

No Burn, No Slim

April 20, 2022

Every living body needs energy to function. It is not just about the energy for jumping, dancing or running.

Even in-body activities such as protein synthesis, maintenance of body temperature, cardiac output, respiration, muscle functions, storage and metabolism of food sources, need energy.

You are what you eat

Did you know that more than 95 per cent of the food you eat provides your body's energy needs? Carbohydrates, protein and fat — these are dietary components that are sources of energy for your body.

While carbohydrates and fats are completely digested in the body, protein is only partially digested.

Whatever is undigested becomes excretion of urea and other nitrogenous products. Meanwhile, whatever is digested and absorbed from your gastrointestinal tract produces energy.

Whenever there is excess energy and unused at that, it is stored as adipose tissue. Adipose tissue is commonly known as body fat. It is found all over the body; under the skin as subcutaneous fat, wrapped around internal organs as visceral fat, in between muscles, within the bone marrow and in breast tissues. This leads to an increase in total body fat.

In short, if you don’t use the energy that you produce from your food intake, you gain weight. But with a little knowledge, you can strive for energy balance that will help you manage your weight better.

Start counting calories

The unit for measuring body energy is called kilocalories. For every gram of carbohydrate or protein digested, the yield is four kilocalories. However, for every gram of fat digested, the yield is around nine kilocalories. Plainly put, fatty foods are high in calories.

If you wish to manage your body weight, it is advisable to take note of your calorie count based on your food intake. With some discipline, counting calories can help you stay within your daily calorie requirement. This is called energy balance.

However, if your calorie count goes beyond your calorie requirement, you need to burn those extra calories (this is where exercise comes in), failing which, the unburnt calories will result in adipose tissues and settle in your body as fat.

Here is an example. If your required calorie intake is 1500 a day, this means you only need that much energy to get through your day. But, say you consume 2000 calories. Now, you have an excess of 500 calories. If you don’t burn 500 calories, you gain weight.

Nowadays, there are multiple apps to help you keep track of your energy expenditure. Not only can you note down your daily calorie intake, but you can also find out how many calories you burn from your physical activities.

If you are striving towards energy balance, monitoring the above details is a step in the right direction.

Burning energy round the clock

Did you know that even when you are at rest, your body still burns calories? Not as much as when you are active of course, but still, there is some in-body activity going on that relies on energy. Even breathing needs energy! Resting Energy Expenditure or REE is the amount of energy needed when we are at rest. It represents the calories required by your body during a non-active period. Your REE is influenced by age, sex, body weight, pregnancy, and hormonal status.

As you age, your metabolism slows down. The highest rate of energy expenditure per unit of body weight occurs during infancy and childhood but declines through adulthood.

For example, in your 20s, you may find that you can eat much and not gain much weight. But in your 50s, you may find it difficult to shed those extra pounds even when you eat less than before.

As a child, in-body activities work round the clock. There is a lot of energy that is going on inside a child’s body. The energy is being produced because the child is growing. But as the child grows older, they need more REE due to body physiology.

In adult life, the decline continues at approximately two per cent every 10 years because of a decline in lean body mass.

There is a significant relationship between energy expenditure and fat-free mass, body surface area, and body weight.

It is also interesting to note that females have a lower energy expenditure per unit of weight than males, because generally, females have a higher proportion of body fat.

Pregnancy increases energy expenditure to support fetal growth and the increase in maternal tissues.

Several hormones, including thyroxin, catecholamines, and insulin, also increase energy expenditure. Those who are obese also have a higher REE than those with normal weight.

Rich people problems

There are downsides to having easy access to rich foods (including fast food). Hence, body weight and obesity are rising in both developing and developed countries.

To maintain a stable body weight, your energy intake must match your energy expenditure in the long term for energy balance. If it far exceeds your energy expenditure, obesity becomes a risk.

Therefore, an understanding of the physiologic control of energy balance can be useful for designing interventions to tackle obesity worldwide.

As a summary, by increasing the use of energy received by doing physical activities, more people will start moving (literally!) to the regulated zone of energy balance. As a result, you will have better body weight control!

Nur Aiman Taslim Galli

Dietitian

Columbia Asia Hospital – Petaling Jaya

Make an Appointment

PDF and Online Articles:

No burn, no slim - the reality behind achieving a healthy body – Sinar Daily, 12 April 2022

This article first appeared in Sinar Daily, 12 April 2022.

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Dietetics & Nutrition
 in Columbia Asia?

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No More Jet Lag [Press Clipping]

No More Jet Lag [Press Clipping]

May 01, 2015

No More Jet Lag - HER WORLD Magazine, Issue May 2015
.


No Sleep Tonight

No Sleep Tonight

September 19, 2017

Do you feel sluggish all the time? Are the usual pick-me-ups not doing their magic? Find out what may be getting between you and a good night’s sleep.

No Sleep Tonight – Her World, Issue September 2017


Normalising the Need for Eye Surgery

Normalising the Need for Eye Surgery

March 16, 2020

Taking care of our eyesight is no easy feat as not everyone is blessed with 20/20 vision. However, as technology gets more advanced, many procedures can now be done to improve our eyesight. One of the many procedures available is vitreoretinal surgery.

Dr Ling Kiet Phang, consultant ophthalmologist at Columbia Asia Hospital - Iskandar Puteri, explains that vitreoretinal surgery is a group of procedures that are performed to treat eye problems involving the retina, macula and vitreous fluid. Procedures include vitrectomy, scleral buckling and intravitreal injection.

"One of the most common procedures is vitrectomy, where three micro-cannulas are inserted through the conjunctiva and sclera (white of the eye), to enable fine instruments to enter the eye," says Dr Ling.

Different eye conditions require different type of procedures. Dr Ling says that there are five major conditions that require patients to undergo a vitrectomy such as vitreous haemorrhage, retinal detachment, macular surface disease, intraocular inflammation and dropped lens from primary cataract surgery.

While it is normal for patients to be worried about the outcome of certain procedures, Dr Ling assures patients that the success rate for this surgery is relatively high. "Vitrectomy is a fairly routine surgery and can usually be performed safely as an outpatient procedure. With the improvements in surgical techniques and advancement in instrumentation, vitreoretinal surgery has evolved rapidly over past decades."

Other than the success rate, side effects as well as recovery time are also cause for concern for patients. Complications can include bleeding, infection, cataract and retinal detachment. Dr Ling says that while the success rate is high, the complications from vitrectomy are relatively unusual.
A vitrectomy can usually be performed as an outpatient procedure because of advancements in surgical techniques and instrumentation.

Dr Ling explains, "Bleeding inside the eye is not uncommon, especially in diabetic vitrectomy, but it mostly resolves itself. Infection in the eye (endophthalmitis) is rare but can give rise to serious loss of sight. Retinal detachment, which can happen within the first two months following vitreoretinal surgery, will require further surgery in order to repair it.

"Almost all patients develop cataract more rapidly than normal following this type of surgery. Following surgery, intraocular pressure (pressure within the eye) may rise, so you may require eye drops to control the pressure for a while."

In regard to the recovery time taken, Dr Ling says, "After surgery, your vision should gradually improve, but it may take up to six months or longer to regain ideal vision.

Depending on the additional procedures involved, most people are able to return to their daily activities after two to four weeks, but a full recovery often takes several months."

Dr Ling believes that many patients do not fully understand the cause of eye disease and consequences of delaying surgery, hence they worry they would become blind following the surgery.

His advice for patients who are hesitant about surgery is to bring their caregivers along to discussions with their surgeons. The patients and caregivers must be given the opportunity to receive all the information objectively and, if necessary, shown a video of the procedure the surgeon intends to perform. Vitrectomy is a low-risk procedure, but as with all procedures, talk to your doctor about what to expect before, during and after it is done.

Dr. Ling Kiet Phang

Consultant Ophthalmologist (Visiting)

Columbia Asia Hospital – Iskandar Puteri & Tebrau
MBBS (UM), MD (OPHTHALMOLOGY) (UKM)

Make an Appointment

PDF and Online Articles:

Normalising the Need for Eye Surgery – The Star, 8 March 2020

This article first appeared in The Star, 8 March 2020

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Ophthalmology
 in Columbia Asia?

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OBSTETRIC EPIDURAL FOR LABOR PAIN CONTROL

February 07, 2011

Almost all women experiences pain during the process of labor and delivery. In some societies, pain during labor is considered as natural phenomenon and should be tolerated by women. Some consider childbirth's uterine contraction as severe and need intervention. In one study, 60% of primiparae described labor pain as severe and intolerable, and another 30% experienced moderate pain. In comparison, 45% of multiparae describe it as severe, and 30% experienced moderate pain.

There are multi-factors that influence the intensity of pain during labor such as age and parity, frequency of uterine contraction, stage of labor, fetal size and presentation, as well as psychological factors.

Women who experience pain during uterine contractions in childbirth can have adverse physiological effects such as prolong stomach highly acidic contents emptying, hyperventilation, increase blood pressure, dis-coordinate uterine contraction and reduced placental perfusion. These adverse effects can be minimized by effective pain control.
WHAT METHODS OF PAIN RELIEF IS AVAILABLE?

Non-pharmacological methods which might reduce use of medication to ameliorate pain

Coping strategies and support such as prepared childbirth, support from a partner and midwives, calm breathing and massage during labor, aromatherapy, reflexology, water bath.

Transcutaneous nerve stimulation (TENS)

Acupuncture

Pharmacology methods which are commonly used

Entonox- a mixture of 50% nitrous oxide and 50% oxygen, which is breath through a mask. It is quick to act, but effect only last for a short while. It does not reduce the pain completely, and cause dizziness.

Intramuscular opiods injection which is usually injected by midwives. It takes about half an hour to work and last for a few hours. It can cause nausea and vomiting, drowsiness, and respiratory depression to the newborn.

Epidural analgesia is the most effective way of pain relief for labor pain. This procedure is performed by the trained anesthetists under aseptic technique.

OBSTETRIC EPIDURAL –PROCEDURES INVOLVED

First, an intravenous cannula will be inserted on the hand, in order to run intravenous drip. Then you have to sit bending forward. The anesthetist will clean the lower back with antiseptic. After identifying the point of insertion of epidural at the lower back, the anesthetist will inject local anesthetic into your skin, so that putting in the epidural needle does not usually cause much pain. An epidural catheter (a very thin tube) is then threaded through epidural needle to reach near the nerves in your spine. The epidural catheter is left in place when the needle is taken out so local anesthetic can be given via the epidural catheter to provide pain relief throughout the course of labor.
Figure 1: Image of epidural catheter and epidural needle
Figure 2: Site of epidural needle insertion
BENEFIT OF EPIDURAL ANALGESIA:

Epidurals provide better pain relief than any other treatment.

Generally do not affect the newborn such as respiratory depression.

Spinal analgesia can be given first in the technique called combined spinal-epidural analgesia for a quicker effect of pain relief.

Can be used to provide anesthesia if caesarean section is required.

POSSIBLE RISKS ASSOCIATED WITH EPIDURAL ANALGESIA:

Second stage of labor is longer.

Higher incidence of low blood pressure and itchiness.

May have leg weakness if higher concentration of local anesthetic is used.

May have difficulty in passing urine temporary.

Can develop headache which is usually self-limiting after treatment. This is caused by accidentally puncture of dural sac (bag with fluid that surround the spinal cord).

Dr. Tan Kok Hui

Consultant Anesthetist

Columbia Asia Hospitals- Cheras


Obstructive Sleep Apnea – The Not-So-Silent Killer

February 15, 2017

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

Snoring is a familiar experience afflicting both sufferers and their sleep partners (sometimes even beyond the bedroom!) and affects all of us at some point in our lives. While most see it as merely a social nuisance, which in itself can be a significant problem, there is a more sinister and dangerous condition linked to snoring.

Obstructive Sleep Apnea (OSA) is a condition where a sufferer stops breathing after a period of snoring due to the collapse of soft tissues in the upper airway, particularly in the oral cavity, throat and nose. This cessation of breathing is punctuated by a moment of arousal before the cycle of snoring and “choking” repeats itself. Throughout these events, the patient is not aware, but his or her partner is the one who would note such episodes.
SO WHAT’S THE BIG DEAL WITH OSA?

OSA is a serious medical condition which needs urgent attention and treatment. The repeated episodes of cessation of breathing, especially if left untreated, causes strain to the heart and lungs as well as denying the brain and body the sufficient oxygen and rest it needs. It can lead to early onset of hypertension and diabetes which then leads to heart disease and stroke. For men, OSA can also cause sexual dysfunction and impotence.

OSA too results in poor quality of sleep as sufferers rarely achieve deep sleep from the repeated arousals which causes tiredness and daytime sleepiness. This leads to poor work performance, mood swings, emotional irritation and increases the likelihood of motor vehicle accidents. The sleep disturbance snoring can put strain on bed partners relationship.
WHAT ARE THE SYMPTOMS OF OSA?

Apart from loud snoring, sleepiness and emotional issues highlighted earlier, patients often wake up at night to urinate. This is because the “lightness” of their sleep makes patients aware of their bladder contents during sleep which a non-OSA sufferer otherwise would not have. They too often complain of morning headaches, dry mouth and sore throat.
HOW IS OSA DIAGNOSED?

A sleep study or polysomnography is performed to confirm and diagnose OSA. It can be done in a hospital or, ideally, in the comfort of the patient’s bedroom as the test requires a minimum of six hours’ sleep. The Apnea-Hypopnea Index (AHI) is the key result from the sleep study which denotes the number of times one stops breathing (apnea) and experiences partial airway blockage (hypopnea) in an hour of sleep. An AHI of 5 or less is considered normal or insignificant; 5-15 mild OSA; 15-30 moderate OSA and 30 or more severe OSA. OSA is associated with a number of factors. Chief among them are obesity and craniofacial abnormalities such as a small or receding jaw.
ASSESSMENT

When a patient with OSA visits his or her doctor (usually an Ear, Nose and Throat Surgeon), a general physical examination is conducted particularly concentrating on the head and neck region. Things that a doctor will look for include obesity (measurement of Body Mass Index (BMI)), large neck circumference, teeth malocclusion, craniofacial anomalies, oral and nasal cavity obstructing structures such as large tonsils or nasal polyps and noisy breathing or stertor. In some patients with very severe OSA, their sleepiness is so pronounced that they may fall asleep during the consult! The doctor may perform an endoscopic examination called the Muller’s Manoeuvre using a flexible telescope to assess soft tissue collapse at various points in the nose and throat region.
WHAT ARE THE TREATMENT OPTIONS?

There is no one-fits-all treatment in OSA as the best treatment plan depends on the individual patient. In general, treatment of OSA can either be in the form of a Continuous Positive Airway Pressure (CPAP) or surgery. CPAP is a machine that forces air into the airway via a facemask, overcoming any physical airway obstruction, during sleep, therefore, delivering the necessary oxygen to the body. This is still considered the “Gold Standard” in treating OSA.

For a patient with obvious obstructive features in the airway like a broad soft palate, large tonsils or long uvula, surgery would be an option. This may include tonsillectomy, Cautery Assisted Palate Stiffening Operation (CAPSO), nasal surgery or even craniofacial surgery depending on the source of the problem. The effectiveness of surgery in OSA would be less in obese patients. A patient who is extremely obese (BMI of more than 40) will need to lose a significant amount of weight before any surgery could be considered. This can be done via strict diet on the advice of a dietician or bariatric surgery such as gastric banding or stapling. While undergoing such procedure and awaiting the desired results, a patient is usually put on CPAP to treat the sleep apnea before repeat assessment is done at a later time.
CONCLUSION

Obstructive Sleep Apnea is a lot more common than most people realise, as a lot of the time it is just passed off as a “snoring problem.” This condition is a lot more serious than it seems and needs urgent attention. Various treatment options are available, and new ones are being regularly introduced, but treatment should be tailored to the individual patient. Hence, an ENT Surgeon should always be consulted in such cases.
Dr. Iqbal Farim Rizal Wong

Consultant Ear, Nose and Throat Surgeon
Columbia Asia Hospital – Petaling Jaya

Obstructive Sleep Apnea – The Not-So-Silent Killer - InfoMed Malaysia, Issue 20, Jan – Mar 2017
.


Ocular Anatomy

Ocular Anatomy

June 23, 2015

The eyes are one of the most complex and highly specialized sensory organs in our body. It is about 1 inch in diameter and has a volume of about 3-4 cc. They are situated within the large bony sockets called orbital cavity. The cavity is formed by 7 bones namely maxilla, palatine, zygomatic, sphenoid, frontal, ethmoid and lacrimal bone.

The eye ball is located beneath the forebrain and above the maxillary sinus. Each eye has 6 muscles attach to it and is protected by the eyelids and the tough bony orbital rim.
Image credit: K. Holoski

It is very important that we take care of our eyes by practicing good eating habits and going for regular check-ups. Please do not take your eyes for granted as damage to the eyes can be permanent or irreversible. So, go for a comprehensive eye examination today.

The image below shows the 6 muscles attached to the eyes.(4 rectus muscle and 2 oblique muscle) which is responsible for the various eye movements.
Image credit: ultrasoundpedia.com

The image below shows the 7 bones forming the orbital cavity and the nerve openings.
Image credit: mjc.edu

Interesting facts about the eye:

The human eye sees in 576 megapixels.

There are over 2 million working parts in the eye.

The eye muscles are the most active muscles in the body.

80% of what a child learns is visual.

Dr Dinesh Kumar

Consultant Ophthalmologist
Columbia Asia Hospital – Petaling Jaya

Listen to the podcast
here
.


Once And For All, Here’s What You Need To Know About Vitamin C

August 18, 2017

We found out what the experts have to say about the micronutrient
Credit: ISTOCK

A few weeks ago, we read an interesting article on kidney stones and vitamin C by a colleague from Men’s Health USA, and decided to share it online. To our surprise, the topic generated a rather heated debate, especially on the “correct” dosage of vitamin C. To get a clearer picture, we spoke to three experts, covering the spectrum of
purpose, dosage and effect of vitamin C
.
How Much Vitamin C Should You Consume?

The first tell-tale sign of overconsumption is diarrhoea, according to Kong Woan Fei, dietitian from the Columbia Asia Group. Although the tolerable upper intake level for vitamin C is said to be 2,000mg Recommended Nutrients Intake, she says adults should not ingest more than
1,000mg
 to avoid health risks.

Like Kong, Yeoh Ee Ling, education manager of Fitness Innovations, says that 1,000mg of vitamin C supplementation is agreeable to the body.
Bottom line:
Consumption of 1,000mg of vitamin C supplementation is safe.
How About Vitamin C from Food?

Although the experts differ on the exact amount, it falls in the range of
70mg to 100mg
. “Recommended dietary allowance is 90mg for males and 75mg for females,” Yeoh says. However, Kong says 70mg of vitamin C is sufficient for adults up to age 90. As for Datuk Dr. Selvalingam Sothilingam, consultant urologist from
Columbia Asia Hospital - Cheras
, he suggests adults consume between 90g and 100mg of vitamin C from food.

All three experts agree that vitamin C supplementation is unnecessary if you have a balanced diet. Dr. Sothilingam, for one, doesn’t believe in it. “The vitamin C that you get from food is enough for your body. You don’t need high doses to boost your immune system and antioxidant levels,” he says. To ensure you get enough, you just need to know which foods contain high levels of vitamin C, he adds. Citrus fruit, broccoli, sweet potatoes and cauliflower, for example, are rich in the micronutrient.
Bottom line:
 Vitamin C supplementation is not necessary if you have a balanced diet.
Who Really Needs Vitamin C?

Nevertheless, some are advised to boost their intake. “If you don’t eat healthfully, that’s when vitamin C supplementation can benefit you,” Dr. Sothilingam says.

Vitamin C can’t boost your athletic performance though, but it is essential if you have a high-intensity training regime, Yeoh says. Those in a weight-sensitive category or on a low-calorie diet might also need supplementation, as their vitamin C consumption from food would be lower.
Bottom line:
 Vitamin C supplementation is recommended for those who are not getting enough of the micronutrient from food.
Will I Get Kidney Stones?

No and yes. Consuming excessive amounts of vitamin C doesn’t always cause
kidney stones
, but it does
increase their likelihood
, Dr. Sothilingam says. However, “typically, stone formation is
multifactorial
,” meaning it is determined by a combination of factors such as your genes, urinary system and diet, he adds.

If you’re worried about stones in your kidneys, Dr. Sothilingam advises
reducing your intake of sodium and purine
, which are found in food such as red meat, nuts and offal. Bodybuilders should also be cautious when taking protein supplements, as they are known to increase the risk of kidney stones.
Bottom line:
 There is no definitive evidence that consuming excessive amounts of vitamin C will cause kidney stones. However, some studies have found that consuming more than 1,000mg of vitamin C over a period of time will increase the risk.
The Misconceptions

Due to the successful marketing of vitamin C supplements, some Malaysians think that they need to do more to ensure they take enough of the micronutrient – going so far as to get regular vitamin C shots from clinics, Dr. Sothilingam says. “They claim it gives them a feel-good factor, but a lot of that might be due to a
placebo effect
.”

Meanwhile, Yeoh wants to debunk a common belief. “Most people think that vitamin C ‘cures’ colds.” In truth, it only serves as a
preventive
 measure, she explains.
Bottom line:
 Vitamin C is not a magic pill. It doesn’t treat colds; it can only make you less vulnerable to bugs.
Published in Men’sHealth, 3 August 2017
Click for Online Article:

Diet Men's Health, August 2017
.


Oncology - Breast Screening

Oncology - Breast Screening

October 10, 2015

Dr. Suhaila, Consultant Radiologist from Columbia Asia Hospital

Petaling Jaya shares about the importance on early detection for breast cancer.

Pink October - Early Detection Saves Lives – FEMININE Magazine, Issue October 2015
.


One is Nice, Two is Fun and Three is Crowded!

August 07, 2015

Having twins or multiple pregnancy seems to be the desire of most couples who undergone fertility treatment.

After all, most of us know normal, healthy twins, or read newspaper articles of families who are delighted with their twins or triplets following IVF treatment.

“Oh, I wish I had twins, I hope I have twins, why not have two at a time? “ pleading to their doctors.

What could be better than completing your family in one go, with twins or even more babies?

However the reality is that for many twins and triplets, life can be fragile and difficult.

Reproductive specialists are always being pressured by couples to put in more than 2 embryos during their IVF treatment. Putting in more embryos would result in higher pregnancy rate but the rate of higher order multiples such as twins and triplets also increases.

At present, about 1 in 4 IVF pregnancies lead to a multiple birth. This means that after IVF/ICSI, you are around 20 times more likely to have a multiple pregnancy than you would be if you have conceived naturally.

Women should understand that the human womb was created for just one baby.

Having two is fun but three is a crowd for a small womb.

Yes, we do understand that having twins or multiples are fun, but it is not without risks.

Compared to having one baby, twins and other multiples are more likely to have serious and even life threatening health problems.

The risks may involve both the mother and baby.

It can cause early or late miscarriage more than singleton. As a result of the miscarriage due to the twins occupying larger area of the uterus, it may results in heavy bleeding following the miscarriage. Most women with twins will end up with surgical procedure to evacuate the remaining tissues left in the uterus after a miscarriage.

Medical condition risks such as gestational diabetes and pregnancy induced hypertension tend to be higher in women with multiple pregnancies. Women with gestational diabetes will have the risk of sudden intra uterine death which can be devastating to women who has been waiting long to get pregnant.

Twins are five times more likely than single-birth babies to die within a month of birth. There are many reasons for this which includes being born prematurely i.e. born before the actual expected time, small size of the baby (low birth weight) and possibly birth defects which include cerebral palsy. Cerebral palsy is more likely found in premature babies.

Twins and other multiples are much more likely than single babies to be born early. According to statistics from the UK, 60% of all twins were born prematurely, compared to 11% of single babies. And 12% of these twins were born very prematurely i.e. before 32 weeks of gestation, compared to about 2% of single babies. Singleton babies are usually carried for about 40 weeks and tend to have normal birth weights.

At least half of twins are born before 37 weeks and with low birth weights, making them at high risk of serious health problems and death. Many are born before 35 weeks, when they often need neonatal care. Their birth weight is around 800–1000g less than singletons. Low birth weight may also results in hearing or vision loss.

Twins also have higher risk of anemia or low hemoglobin during pregnancy. Hemoglobin carries oxygen, and if the oxygen is low, it will affect the growth of the baby in the womb. The women will also have a higher risk of bleeding following delivery. Bleeding can also takes place before delivery.

Emotional risk tends to be higher in those with twins. It can be costly emotional roller coaster to go through IVF treatment but having premature babies can add to the psychological burden. Hence their post natal recovery can be slow leading to postnatal depression or post natal blues.

During birth, mothers of twins are more likely to require intervention, more likely to experience serious problems and more likely to die than mothers of singletons.

Caesarean is common among twin births. Most women would request for Caesarean as generally they would not like to go through the risk of normal labor .Other reasons as to why Caesarean increases is because of higher risk of placenta praevia(low lying placenta), malposition of the first twins such as breech and the presence of medical conditions such as gestational diabetes and pregnancy induced hypertension.

Screening for chromosomal anomalies such as Down’s syndrome can be difficult and challenging for obstetricians.

Screening is usually done by scan to check for the baby’s nasal bone and the thickness of the skin around the neck at around 11 to 13 weeks. At 14 to 18 weeks, screening can also be done using maternal blood. However interpretation of results usually tends to be difficult. For women who need further investigation such as amniocentesis, the risk of miscarriage is very much higher due to the procedure. The women may also face with ethical dilemma if only one of the twins is having Down’s Syndrome and the other twins is healthy. Terminating the Down’s Syndrome baby can also lead to miscarriage of the normal baby.

In identical twins who shared the same placenta, there is a 10% risk of twin to twin transfusion syndrome which can cause serious health problems and death. In this syndrome one of the babies received enough oxygen from the umbilical cord and the other one is being deprived of oxygen. The baby receiving less oxygen is because of less blood goes to the baby. This problem does not occur in non identical twins.

Women with twins or multiples especially first time parents should also consider the potential problem of bringing up twins in relation to financial burden, difficulty in breast feeding and the psychological impact. These issues could lead to long term impact to the couple leading to separation of family in the future which is often overlooked. These affect life with twins not just as babies but as they get older as well. Dividing care and attention between two children can be unexpectedly difficult.

Research shows that parents of singleton babies are more likely to enjoy family life and feel confident about parenting.

If women have twins or multiples, it is not the end of the world for you. You will need to have more checks with their obstetrician throughout the pregnancy. Even though the obstetric performance of twin women tends to be difficult, most of the time your obstetrician can manage and guide you to a healthy pregnancy resulting in healthy twins. For those with triplets or more you have the option of fetal reduction. This involves aborting one or more of the fetuses resulting in singleton or twins pregnancy. However this procedure is not without risks. It may cause miscarriage of all the fetuses.

One way of preventing multiple pregnancy is by going through a single embryo transfer. Surely by putting in one embryo can result in lower pregnancy rate. This disadvantage can be overcome by putting in a day 5 embryo called blastocyst instead of day 2 or day 3 embryos. The success rate of pregnancy following a single blastocyst transfer is always higher than a day 2 or day 3 embryos.

Multiple pregnancies can also lead to higher cost for health care provider. Twin pregnancies can cause tax payers millions of ringgit per year. This is due to increase hospitalization to prevent premature births, increase in intensive care for babies born prematurely and increase risk of lifelong disabilities like cerebral palsy in multiples.

Having multiples can be fun but understanding the risks is very important before you embark on IVF treatment. It is my hope that this article will guide you on deciding the number of embryos to be put into your womb during your treatment.
Dr Suhaimi Hassan

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


Orang Muda Pun Boleh Kena Kanser Kolon Kalau Masih Lakukan 6 Perkara Ini

November 02, 2020

Pernah tak anda rasa lesu, sakit perut yang teruk, muntah, hilang berat badan secara tiba-tiba atau berlaku sesuatu yang pelik pada corak pembuangan najis? Jangan ambil mudah, kerana inilah antara simptom kanser kolorektal!

Kanser kolon merupakan antara kanser yang biasa ditemui di Malaysia dan sebanyak
80%
 kes kanser ini di Malaysia didiagnos di kalangan mereka yang berusia
45 tahun ke atas!

Apa itu kanser kolorektal?

Kanser ini juga dikenali dengan nama kanser kolon atau kanser usus yang menyerang bahagian kolon, usus dan rektum (bahagian usus besar yang terlibat dalam pencernaan makanan dan pembuangan bahan kumuh).

Kebiasaanya bermula sebagai polip, iaitu bonjol kecil pada permukaan dalam usus yang kebanyakannya tidak berbahaya. Tetapi jika dibiarkan, akan membesar dan menjadi kanser.

Kanser kolon kebiasaannya menyerang mereka yang berumur 50 tahun ke atas, tetapi tidak bermakna golongan berusia seawal 40 tahun dan kanak-kanak bebas daripada
 pembunuh ke-2 di kalangan lelaki
, dan
 ke-3 di kalangan wanita
 di Malaysia ini!

Ada banyak sebab yang menjadi punca penyakit ini dan jangan tak percaya, golongan muda juga berisiko mendapat kanser kolon jika masih melakukan 6 perkara ini:

1. Tidur

Waktu tidur yang ideal antara 6 ke 8 jam, tetapi ada yang hanya tidur 3 ke 4 jam setiap hari. Bila tidur tak cukup, mulalah produktiviti semakin menurun dan kesihatan terjejas.

2. Kurang aktiviti fizikal

Sudahlah di pejabat lebih banyak duduk menghadap komputer, di rumah pula duduk menghadap fon... Nak buat aktiviti fizikal 60 minit sehari pun susah!

3. Diet tak sihat

Kurang makan sayur, buah dan bijirin. Banyak pula makan daging merah dan makanan tinggi lemak serta kurang serat. Anda juga digalakkan ambil herba kunyit yang tinggi antioksidan dan boleh menghalang proliferasi sel kanser.

4. Merokok

Merokok bukan sahaja merbahaya kepada perokok tetapi turut menjejaskan orang yang berada berhampiran. Perokok berisiko menghidapi pelbagai penyakit termasuk kanser peparu dan kolon.

5. Berlebihan berat badan

Bila makan tak jaga, mulalah berat badan meningkat dan tak terkawal. Bukan je kanser kolon, tetapi darah tinggi, kencing manis dan penyakit jantung mula bertandang.

6. Tak pantau kesihatan

Walaupun pada zahirnya nampak sihat tetapi kenalah lakukan pemeriksaan kesihatan dengan kerap mengikut saranan.

Selain pemeriksaan kesihatan secara berkala, anda boleh juga lakukan saringan awal untuk mengesan kanser kolon.
Ada beberapa tempat anda boleh lakukan ujian ini termasuklah di Columbia Asia Hospital.

Dengan adanya ujian saringan, anda boleh mengesan kanser lebih awal sebelum munculnya tanda dan simptom. Melalui ujian ini, polip boleh dibuang sebelum bertukar menjadi sel kanser. Ujian ini perlu dilakukan lebih awal sekiranya ada di kalangan ahli keluarga anda menghidap kanser kolon.

Dr. Venayagamurthy A/L Kanisan

Consultant General and Colorectal Surgeon

Columbia Asia Hospital - Cheras
MD (UKM), MS (General Surgery) (UKM), AM (Malaysia), CIMA (NIOSH), Fellowship in Colorectal Surgery (Australia & India)

Make an Appointment

PDF and Online Articles:

Orang Muda Pun Boleh Kena Kanser Kolon Kalau Masih Lakukan 6 Perkara Ini – Sinar, 17 Ogos 2020

Artikel ini disiarkan oleh Sinar, 17 Ogos 2020.

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 in Columbia Asia?

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Orthopaedic Surgery and Sports Medicine Review [BFM - PODCAST]

December 22, 2015

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

We take a look at some of the most interesting stories that Consultant Orthopaedic Surgeon Dr Harjeet Singh shared with us this year.

Listen to the podcast
here
.


Orthopaedics and Physiotherapy Part 1 - Dr Harjeet Singh [BFM - Podcast]

July 07, 2014

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Alisha Bajerai, Principal Physiotherapist

Two disciplines that work closely to get us back on track and moving right: orthopaedics and physiotherapy. We explore how they intertwine, where they philosophically diverge and converge - with Dr. Harjeet Singh, Consultant Orthopaedic Surgeon and Alisha Bajerai, Principal Physiotherapist.

Listen to the podcast
here
.


Orthopaedics and Physiotherapy Part 2 - Dr Harjeet Singh [BFM - Podcast]

August 05, 2014

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Alisha Bajerai, Principal Physiotherapist

Dr. Harjeet and Alisha are back to explain how their two disciplines (orthopaedics and physiotherapy) intertwine, especially when it comes to the specifics of injuries, ageing and healing.

Listen to the podcast
here
.