An Associate Professor Shares How the Role of the Pharmacist Has Evolved Over the Years

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR WONG PEI SE
School of Pharmacy
International Medical University (IMU)

This year, the theme of the World Pharmacists’ Day is Pharmacy strengthening health systems. In light of this, we’re pleased to have Dr Wong Pei Se joining us to share her thoughts on the role of community pharmacists in our healthcare system.

MALAYSIANS ARE CONSULTING PHARMACISTS MORE THEN EVER

In 2015, the National Survey on the Use of Medicines (NSUM) found that only 5% of the respondents would consult a pharmacist on health problems.

Just 6 years later, in 2021, it was reported that Malaysians on average visited community pharmacies 31 times a year. This is comparable to the average in developed countries such as Australia, the US, and the UK!

This could be spurred by the growing awareness of the role of a pharmacist as a result of the COVID-19 pandemic. That was when people began to rely more on their pharmacist for information and guidance on the use of medications, sanitizers, masks, and more to stay safe and healthy during the pandemic.

Even then, many Malaysians may still overlook how the pharmacist behind the counter can be a reliable first stop for medical and general health advice, beyond the scope of the pandemic.

GUIDANCE & EDUCATION ON GENERAL MINOR AILMENTS

“Community pharmacists can help manage minor ailments, give advice and help to educate the public on different aspects of ailments and treatments available,” says Dr Wong Pei Se.

She adds, “Pharmacists are also able to guide customers onto the right medical path – when you are not sure whether you need to see a doctor, or even which doctor you need to see.”

THE BIGGEST ROLE OF A PHARMACIST

No, it’s not to sell medications and over-the-counter products!

The biggest role a pharmacist can play in their community is to support healthy living and self-care in that particular community. They are in an optimal position to help members of the community prevent or reduce their risk of illnesses as well as to stay healthy through basic health advice on exercise regimes, good nutrition, and health supplements.

Dr Wong explains further: “We want to intervene before people get a heart attack, before a stroke, before diabetes leads to kidney problems. These are things that we can manage at the community level so that people don’t end up going to the hospital.”

To that end, many pharmacies provide screening and monitoring services for blood pressure, sugar and cholesterol levels.

Although there are many devices that can be used at home, this service is an alternative for those who are not willing to invest in a device or who are just not comfortable self-administering these tests.

The availability of these services is convenient for people that are unable or unwilling to make a trip to a hospital or clinic.

People also don’t have to delay their monitoring for months as they wait for their follow-up appointments at a clinic or hospital.

CONVENIENCE & ACCESS

Ultimately, people find pharmacies easily accessible and hence very convenient. After all, as Dr Wong shares, there were over 3,000 pharmacies in Malaysia—you can find 1 every 5 to 10 km in urban areas.

Furthermore, there is hardly any need to for registrations or making an appointment in advance.

“The consultation is free when you just need to ask a few questions, or if you are unsure of the medical severity of your condition; these are factors that make a big difference,” says Dr Wong.

As an example, Dr Wong brings up that many people with skin problems such as acne are more likely to visit a pharmacy first. In such a situation, the pharmacist can guide these people through the many options of skincare available and also advise them to visit a doctor if the situation warranted it.

“Pharmacists have become a very accessible primary care service provider,” says Dr Wong. “When clinics are overcrowded and when there is an unexpected burden on the system, pharmacies can help to optimize a healthcare system.”

SO, WHAT’S IN THE FUTURE FOR PHARMACISTS IN MALAYSIA?

In the past few years, digital platforms have been pushed to the fore by the pandemic and pharmacies have not been left out of this technological leap.

“During the lockdowns, pharmacies started doing deliveries and digital health platforms became a very common communication method,” says Dr Wong.

During the pandemic, it was common for long-time customers of a pharmacy to send messages over WhatsApp to ask for advice as well as to place orders products ahead of time for convenient pick-ups or deliveries. This trend continues beyond COVID-19 and has contributed further to the convenience of the consumer.

On a bigger scale, personalized medicine and pharmacogenomics are trends that are moving the industry forward.

Personalized medicine allows for a patient’s treatment to be tailored to their unique genetic makeup, lifestyles and health conditions. Therefore, such treatment is optimized to be most effective and appropriate for them as each individual.

Pharmacogenomics looks into how one’s individual genetics affect the effectiveness of medicine. “It studies how our different genetics will affect how and when you should take a particular medicine, how it is absorbed into your body, how it interacts with your body, the side effects that you may have,” explains Dr Wong.

However, pharmacogenomics is not something that can be done across the board, as pharmacogenomic tests are costly and are available only for certain treatments, for example cancer.

CHALLENGES IN THE WAY INTO THE FUTURE

The perception of certain members of the public can be a significant hurdle that pharmacists will need to overcome.

“The pharmacy is seen as a business. There is a perception that pharmacists only want to sell their products: People feel that the more I talk to you, the more you will want to sell me things,” Dr Wong explains as a reason as to why some people still remain reluctant to engage a pharmacist.

Privacy is also a big issue. Unlike at the clinic, a pharmacy doesn’t have private consultation rooms. This could hinder people from asking more personal issues. “If you have a very private question and you see ten people ahead of you, you probably wouldn’t want to ask it,” muses Dr Wong.

Nonetheless, Dr Wong reiterates that the community pharmacist still holds a unique position of being part of the community. Being privy to certain lifestyles and habits of the neighbourhood, the pharmacist has unique insight on the community as well as the opportunity to build relationships and walk together with their customers not just through sickness, but in health.

IMU Professor Shares How Evolving Role of Pharmacists Can Lead to Better Medicine Safety

WORDS PROFESSOR ONG CHIN ENG

FEATURED EXPERT
PROFESSOR ONG CHIN ENG
Dean of School of Pharmacy
International Medical University (IMU)
UNSAFE MEDICATION PRACTICES AND MEDICATION ERRORS A LEADING CAUSE OF INJURY AND AVOIDABLE HARM 

Globally, the cost associated with medication errors has been estimated at USD42 billion every year.

Furthermore, throughout the world each year, adverse drug events—harm resulting from medication use —cause billions of visits to hospital emergency departments.

LEARNING ABOUT MEDICATION SAFETY CAN REDUCE AND EVEN PREVENT THE RISK OF HARM FOR YOU AND YOUR LOVED ONES

Errors can occur at different stages of the medication use process. These include but not limited to patient receipt of the incorrect prescription (such as receiving the wrong drug or the correct drug but at the wrong dosage), harmful drug-to-drug interactions, errors in the drug preparation or delivery, and inappropriate or overprescribing of certain drug groups such as opioids.

Medication errors can also occur as a result of weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages. These issues can affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death.

ENSURING THE SAFE PRESCRIBING AND DISPENSING OF MEDICATION TO PATIENTS

In conjunction with World Pharmacist Day on 25 September, it is a timely reminder to the pivotal role of this healthcare provider in safeguarding the proper and safe use of medicines.

Pharmacists ensure that patients not only get the correct medication and dosing, but that they have the guidance they need to use the medication safely and effectively.

However, as healthcare providers with expertise and focus on medications, there is an opportunity for the pharmacists to expand their role as patient safety leaders, working with patients and other providers to improve patient care outcomes and prevent medication errors.

While traditionally pharmacists have been perceived as ‘behind the glass’ dispensing medications, in the changing healthcare landscape they are increasingly seen as critical partners in the multi-disciplinary care team addressing complex patient needs.

Particularly in response to the recent COVID-19 pandemic, there are some clear opportunities for hospital and community pharmacists to assume a greater role in pressing patient safety issues, access to medications, medication adherence, readmission reductions, and medication safety.

Pharmacists have a unique expertise and knowledge base that can support improvements in medication error rates and play a critical role in the reporting process, such as providing appropriate feedback to providers. This may result in improved prescribing practices and greater teamwork as well as improving pharmacist confidence and feeling of self-worth in the care team.

ANTIMICROBIAL STEWARDSHIP (AMS) PROGRAMMES

Antimicrobial resistance is a growing public health threat and inappropriate use of antimicrobials (including antibiotics, antivirals, and antifungals), has further aggravated the resistance.

Pharmacists have an important role within AMS programmes, including developing and managing antimicrobial guidelines; reviewing individual patient regimens to optimize therapy; educating healthcare staff on the appropriate use of antimicrobials; and monitoring and auditing outcomes.

Pharmacists are central to the delivery of education on stewardship to healthcare professionals, patients and members of the public. Pharmacists are also key healthcare educators in the community, as they are often the first point of contact for the public and have a responsibility to be a source of information and education on antimicrobial use and resistance.

AMS programmes have been proven effective at improving clinical outcomes, reducing adverse events, and reducing resistance. Given the success of the AMS model, pharmacist role in other medication stewardship programmes may increase.

PHARMACISTS OFFER UNIQUE SKILLSETS TO ADVANCE PAIN AND OPIOID STEWARDSHIP PROGRAMMES

Other therapeutic areas, such as glycaemic control and thrombotics, may also be suitable targets for future programmes.

As evidence continues to demonstrate the success of stewardship programs, medication stewardship could become a central aspect of the pharmacists’ role in ensuring patient safety.

COUNSELING SERVICES AND COMMUNICATION ON POTENTIALLY UNSAFE MEDICATION COMBINATIONS

Increasing medication reconciliation by the community pharmacist following hospital discharge has the potential to reduce adverse events, reduce patient hospital readmissions, and even reduce the risk of death.

PROVISION OF LONG-TERM CARE

From a healthcare policy and care delivery standpoint, there is an ever-increasing focus on providing long-term care as a means of increasing the quality and safety of care. As patient care delivery evolves from episodic to longitudinal, organizations will restructure to care for patients across the continuum.

This evolution will reinforce the need for team-based care to ensure care coordination, patient safety, and optimal patient outcomes. Pharmacists play a great role in supporting a transition to longitudinal patient care and can serve to enhance pharmacist patient safety services.

Central to this longitudinal care is the home medication review (HMR) process. The intent of the HMR is to support the quality use of medicines and assist minimizing adverse drug events by helping patients to better understand and manage their medicines through a medication review conducted by a pharmacist in the home.

An HMR is a collaborative process between the referring doctor (referrer), pharmacist, patient, and where appropriate, a carer.

Currently, there are 3 HMR services provided by Malaysian government hospitals and health clinics, namely neurology/stroke, psychiatry, and geriatrics.

During the HMR interview process, the pharmacist will aim to improve the patient’s understanding of the medicines.

After the initial interview, the pharmacist will produce a HMR report that outlines the findings. This report aims to improve the referrer’s understanding of how the patient is using the medicines and provide recommendations that will assist the referrer and patient in developing a medication management plan.

If clinically indicated, up to two follow-up services can be conducted, with a focus on the resolution of medication-related problems identified at the initial interview.

DIGITAL HEALTH & TELEPHARMACY

Digital health and telepharmacy have gained increasing importance in the delivery of health care, largely due to COVID-19 pandemic.

There are some innovative models of telepharmacy services aimed at optimizing and improving access to pharmacy care, resulting in improved patient safety and outcomes.

Such innovative technology improves access and affordability for consumers, breaks down geographical barriers to accessing pharmacy services and medicines, and empowers pharmacists to manage medication risks for consumers.

The use of digital health records, electronic prescriptions, and real-time prescription monitoring, for example, provides ample opportunities for pharmacists to ensure the safe and quality use of medicines.

THE FUTURE

As the topic of medication error is continually pushed to the forefront of patient safety initiatives, the role of pharmacists will continue to evolve. This will broaden the opportunities pharmacists have to become integral change makers in the reduction of adverse events and improvement of healthcare safety.

Institut Kanser Negara Introduces Use of AI in Lung Screening

WORDS LIM TECK CHOON

In conjunction with the 10th anniversary of Institut Kanser Negara’s (IKN), the institute announces its collaboration with AstraZeneca Malaysia to introduce artificial intelligence (AI) X-ray technology into early lung screening.

This effort is part of Projek Saringan Awal Paru-Paru (SAPU), and IKN is the first government institution in Malaysia to implement this technology.

Vinod Narayanan, Country President of AstraZeneca Malaysia, and Dr Puteri Norliza Megat Ramli, Deputy Director of Institut Kanser Negara. Click on the image for a larger, clearer version.
THE SIGNIFICANCE OF THIS MILESTONE
  • Lung cancer is one of the most common cancers in Malaysia.
  • It accounts for about 19 deaths per 100,000 population in the country.
  • 80% of patients are diagnosed at stage IV, when the cancer has spread to other body parts and treatment becomes complex with poorer chances of a good outcome.
  • Hence, early screening crucial to facilitate early diagnosis and treatment for people with lung cancer.
IMPROVING ACCESS OF MALAYSIANS TO AI X-RAY TECHNOLOGY 

The introduction of AI technology in government hospitals and clinics will allow a wider part of the population to benefit from more precise lung screening at lower, affordable costs.

Dr. Mohd Anis Haron @ Harun, the Director of Institut Kanser Negara reiterates that early screening can improve the chances of survival, especially when it comes to lung cancer.

“This consequently can alleviate the high financial cost of cancer on our national healthcare system,” he adds.

What Do You Know about Alzheimer’s Disease? Find Out from a Geriatrician!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR TEH HOON LANG
Consultant Geriatrician
Sunway Medical Centre

21 September is World Alzheimer’s Day. We’re pleased and really appreciative of the fact that, in conjunction with this day, Dr Teh Hoon Lang has graciously shared her insight on Alzheimer’s disease with us.

IS DEMENTIA THE SAME THING AS ALZHEIMER’S DISEASE?

Dr Teh explains that:

  • Dementia is a complex brain function impairment set that interferes with daily life.
  • Alzheimer’s disease is a common type of dementia.
  • It is a progressive brain disorder characterized by the buildup of abnormal proteins in the brain.
  • This buildup will lead to a gradual decline of memory, thinking, and reasoning skills.
  • This condition will get worse over time.
An overview of Alzheimer’s disease. Click on the image to view a larger, clearer version.
  • According to some studies, over 8.5% of Malaysians aged 60 and above have dementia, with a higher prevalence among women.
  • However, note that Alzheimer’s disease and other forms of dementia can also occur to people at a younger age. They should not be considered as merely ‘old people’s disease’.
WE SHOULD BE VIGILANT & KEEP AN EYE OUT FOR EARLY SIGNS

According to Dr Teh, symptoms of dementia can be mild and hence overlooked.

“Many people may assume these symptoms as part of the normal ageing process,” she adds.

COMMON EARLY SIGNS OF DEMENTIA (OF WHICH ALZHEIMER’S DISEASE IS ONE TYPE)
  • Recent memory loss, such as being unable to recall recent events or appointments.
  • Difficulties in planning and carrying out tasks or solving problems such as following a recipe, managing their finances, or managing their own medicines.
  • Difficulty in completing familiar tasks such as cooking, driving or using appliances.
  • Confusion about time and/or place—they may lose track of the date, time, or where they are. They may also get lost in familiar places.
  • Trouble understanding visual images and spatial relationships. This can manifest as difficulties in understanding maps, following directions, judging distances, determining the size of objects, etc.
  • Problems with languages, such as difficulty finding the right words or using the wrong words during a conversation.
  • Frequently misplacing things and losing the ability to retrace steps.
  • Decreased or poor judgement. They may make poor decisions, such as giving away large sums of money or insisting on driving when they are no longer fit to drive.
  • Withdrawal from work or social activities that they used to enjoy. They may also become isolated and avoid interacting with others.
  • Changes in mood or personality such as becoming depressed, anxious, or irritable. They may also experience personality changes, such as becoming more passive or withdrawn.
CERTAIN FACTORS CAN INCREASE ONE’S RISK OF DEVELOPING ALZHEIMER’S DISEASE & OTHER FORMS OF DEMENTIA

Dr Teh shares that common risk factors include:

  • Sedentary living—not getting regular physical activity.
  • Smoking and/or excessive alcohol consumption.
  • History of head injuries.
  • Infrequent social contact and isolation. This can lead to depression, a risk factor. Thus, we, especially the elderly, are encouraged to stay socially active no matter our age.
  • Less or low levels of education in early life, as this can affect cognitive reserve—the ability of the brain to maintain our cognitive function and withstand deterioration and damage.
  • Obesity, especially during one’s mid-life.
  • High blood pressure or hypertension.
  • Diabetes, primarily type 2 diabetes.
  • Hearing impairment or individuals with hearing loss. Hearing aids may help reduce this risk.
WHY EARLY DETECTION IS CRUCIAL

Any damage to the brain is irreversible; there is no way to treat or undo the damage.

“It is important to see a doctor for an assessment as soon as possible, as early diagnosis and treatment can help to prevent or delay irreversible brain damage,” Dr Teh states.

HOW ABOUT SCREENING FOR ALZHEIMER’S DISEASE?

“According to guidelines, routine cognitive screening isn’t recommended for everyone, it’s only recommended to screen people at risk,” Dr Teh shares.

She adds, “However cognitive screening is not 100% accurate, hence, it’s crucial to educate the public about the early warning signs of dementia.”

Furthermore, some conditions may resemble dementia, such as vitamin B12 deficiency and hypothyroidism, and these can be reversed by early treatment.

INNOVATIONS OF THE PHARMACEUTICAL INDUSTRY IN DEVELOPING A TREATMENT FOR ALZHEIMER’S DISEASE

In other news, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has released a video highlighting the challenges and advances made by the pharmaceutical industry in finding means to slow the progression of Alzheimer’s disease. Have a look!

For more information, visit the IFMPA (link opens in a new tab).

IMU Opens the First Free Student-Led Dietetics & Wellness Clinic in Malaysia

WORDS LIM TECK CHOON

The International Medical University (IMU) recently opened the doors of the IMU Student Dietetics and Wellness Clinic. It had its official launch on 19 September 2023.

HIGHLIGHTS OF THE LAUNCH

HealthToday had the opportunity to meet the staff of the clinic as well as Professor Dr Winnie Chee, the Pro Vice-Chancellor Academic of IMU, to find out more about the clinic.

We are greatly indebted to them for their time and their willingness to provide answers to the following questions!

WHAT SERVICES ARE AVAILABLE AT THE CLINIC?

It offers many services comparable to other dietetics clinics. However, the clinic offers these services free of charge.

Individualized Meal Planning

It can be challenging to navigate through various foods to plan the right meals for one’s optimal health and maintenance of one’s ideal body weight.

 The staff of this clinic can meet with an individual and their loved ones to help design personalized daily meals based on the individual’s health status, their food preferences, and other factors.

Given that a healthy, balanced diet is key to good management of chronic diseases such as type 2 diabetes, high blood pressure, and more, this service will be especially helpful to those with these conditions.

YOU MAY FIND INIVIDUALIZED MEAL PLANNING HELPFUL IF YOU HAVE THE FOLLOWING:
  • Overweight or obesity
  • Gout
  • Diabetes
  • High blood pressure
  • High blood cholesterol
  • Chronic kidney disease
  • Anaemia
  • Irritable bowel syndrome (IBS)
  • Gastroesophageal reflux disease (GERD)
  • Chronic or long-term gastritis
Body Composition Analyzer

This is a series of non-invasive tests to measure a person’s fat mass and muscle mass.

These tests are also a good way to find out whether the person is at risk of not getting enough nutrients to maintain good health and proper functioning of the body (malnutrition).

A student dietitian can advise the individual accordingly based on the test results.

To register for your free session, click here. The link opens in a new tab.

Public Talks and Workshops

Members of the public can attend educational talks, cooking demonstrations, and more—free, of course!

They can follow the social media of the clinic (see below) to stay updated on upcoming talks and other public events.

WHERE IS THIS CLINIC?

It’s located at the International Medical University building at the following address:

Student Dietetics & Wellness Clinic
Level LG at the International Medical University
126 Jalan Jalil Perkasa
57000 Bukit Jalil
Kuala Lumpur

Opening hours: Monday to Thursday, 10.00 am to 4.00 pm during the final year dietetics practicum semesters.
Check the social media of the clinic (see below) for the latest updates.

Find the clinic on Google Maps

Do I Have to Travel to the Clinic Personally to Obtain Its Services?

Since the clinic has just opened its doors, for the time being only face-to-face consultation is available.

There are plans for telehealth services in the future, however. Interested parties can follow the social media of this clinic (see below) for future updates.

SO, IT’S A CLINIC STAFFED BY STUDENTS?

Yes, it’s a student-led diet clinic is a clinic managed and run by final year dietetics students.

These students are supervised by registered dietitians that are part of the IMU staff and they work in close collaboration with the public and communities in the surrounding area in Bukit Jalil and beyond.

Professor Dr Winnie Chee proudly tells us that while the clinic was conceptualized by the IMU School of Health Sciences, the enthusiastic students were responsible for all the planning, resources, programmes, and marketing of the services, as well as quality monitoring and management of the day-to-day operations of the clinic.

Wait, So Are These Students ‘Real’ Dietitians?

Don’t worry, these are final year dietetic students under the Bachelor of Science (Hons) Dietetics with Nutrition programme under the School of Health Sciences at IMU.

Therefore, they possess the necessary knowledge to help their clients.

What they lack is real world experience, which will be provided by this clinic. It will give these students training and experience on how to set up and manage a dietetics clinic as well as to instill in them an entrepreneurial mindset—thus making them more well-rounded dietitians when they graduate!

Throughout it all, every session will be supervised by a clinical educator, who is a registered dietitian.

If a medical emergency were to occur, the person will be directed to relevant healthcare professionals at IMU Health that are just nearby.

Hence, you don’t have to worry about receiving ‘inferior’ advice and help from this clinic!

HOW DO I MAKE AN APPOINTMENT?

Just fill in the online form found on their Facebook page.

HOW LONG IS EACH SESSION?

It can vary on a case-by-case basis.

Typically, the first session may take up to 1 hour. During this session, you may be asked to go through some simple, non-invasive tests and be asked about your medical history, current dietary preferences, etc.

Subsequent sessions—also free—may take about 30 minutes. The clinic will follow-up with you during these sessions to monitor your progress. If you’re having difficulties following your new meal plan, the staff will offer advice and help to get you back on track.

STAY CONNECTED WITH THE CLINIC
Facebook | Instagram

Experts Explain Why Thumb Sucking Can Be a Damaging Habit for Children Over 5

WORDS DR NIK MUKHRIZ NIK MUSTAPHA & DR MOHD AMIR MUKHSIN ZURIN ADNAN

FEATURED EXPERTS

DR NIK MUKHRIZ NIK MUSTAPHA
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
DR MOHD AMIR MUKHSIN ZURIN ADNAN
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
5 QUICK FACTS ABOUT THUMB SUCKING
  1. Thumb-sucking—a repetitive behaviour of sucking the thumb—is one of the behaviours referred collectively as non-nutritive sucking habits (NNSH).
  2. This behaviour has the potential to adversely affect the dentition, occlusion, and facial structures.
  3. It is prevalent among young children, particularly girls, and its occurrence tends to decrease with age. Approximately 70% to 80% of children exhibited this habit before the age of 5, with the incidence reducing to 12.1% and 1.9% beyond the age of 7 and 12, respectively.
  4. Interestingly, a higher percentage of mothers with thumb-sucking children had received some college education in comparison to mothers of children that don’t have this habit.
  5. It was also reported that the prevalence of thumb-sucking was least common among children that had favourable breastfeeding opportunities.
THUMB-SUCKING COMFORTS & SOOTHES INFANTS

The thumb-sucking reflex is one of the first sophisticated patterns of behaviour in infants, appearing around the 29th week of age.

Such reflex is considered normal, harmless, and comforting.

It helps infants to fall asleep easier as well as provide a sense of comfort, happiness, and security when they feel distressed.

COMMON FACTORS, EMOTIONS & SITUATIONS ASSOCIATED WITH A BABY’S THUMB-SUCKING HABIT
  • Fatigue.
  • Boredom.
  • Hunger.
  • Anger.
  • Fear.
  • Excitement.
  • Tooth eruption.
  • Insufficient sense of satisfaction.
  • Physical and emotional stress.
WHAT STARTED OUT AS AN EMOTIONAL COPING MECHANISM CAN BECOME A HABIT WHEN THE CHILD IS OLDER

Because thumb-sucking is a comforting coping mechanism, a child may eventually develop a strong attachment to this habit that persists at an older age.

This is the point at which problems begin to arise.

There is a direct link between the destructive effects of thumb-sucking habit and the intensity, frequency, and duration of the habit.

Having the habit for a short period will not leave much of an impact on the child.

However, continuous thumb sucking more than 6 hours daily often lead to the development of significant destructive outcomes.

Abnormal Pattern of Teeth Formation

The constant pressure and sucking motion exerted by the thumb on the teeth may interfere with a child’s normal path of tooth eruption and cause teeth to shift unnaturally. The position of the thumb within the oral cavity determines the pattern of the deformity.

A study has indicated that the incidence of tooth misalignment (malocclusion) is 3 times higher among children that exhibit thumb-sucking behaviour and other unhealthy oral habits, compared to those who do not have any such habits.

Asymmetrical Open Bite

The child’s front upper and bottom teeth do not come in contact when biting. This is usually worse on the side that the digit is sucked.

In turn, this may interfere in biting, speech, and to some extent, prevent closing of the lips.

Asymmetrical Facial Appearance

The narrowing of the palate associated with strong buccal musculature contraction and low position of the tongue can lead to the development of a posterior crossbite.

This can potentially impede the establishment of a proper bite and cause the jawbone to shift to one side, resulting in an asymmetrical facial appearance.

Increased Overjet

The tongue may push the upper front teeth forward, resulting in a ‘sticking out’ appearance while the lower front teeth is backward. The combination of these movements will result in an increased horizontal gap between the upper front and lower front teeth, a condition referred to as increased overjet.

Children with an increased overjet usually are at a greater risk of dental trauma due to the prominence of the teeth.

Speech Difficulties

Pronouncing certain words using tip of the tongue may be difficult, often with the child developing a lisp.

Skin Problems

Prolonged thumb sucking can cause skin irritation, cracked skin, and callus formation along the thumb.

Fingernail infection and eczema of the thumb may also develop.

WHEN SHOULD PARENTS BE CONCERNED ABOUT THEIR CHILD’S THUMB SUCKING?

The American Dental Association recommends intervening before a child turns 4 or, at the latest, by the time the permanent front teeth are about to erupt at the age of 5.

If the habit continues into the mixed dentition stage, past the age of 6, problems with the position of teeth might occur.

These problems can still self-correct and the child experience normal tooth growth if the habit is stopped by the age of 7.

After this age, the positions of the child’s teeth become more established and self-correction is less likely to occur. Complex orthodontic treatment is needed at this stage.

Hence, parents should aim to help their child stop the habit as early as possible, such as during preschool.

HOW TO WEAN YOUR CHILD OFF THUMB SUCKING
Psychological or Behavioural Approaches

Identify triggers. Determine the situations or times that would most likely drive your child to suck their thumb. By identifying these triggers, you can redirect their attention or provide them with alternative forms of comfort.

Positive reinforcement. Celebrate your child’s thumb-free moments. Consider setting up a reward system like a sticker chart that allows your child to visualize their progress and earn treats for sustained periods without thumb-sucking.

Communicate. Engage your child in age-appropriate discussions about thumb-sucking. Help them understand why they need to stop, while at the same time addressing any of their anxieties that lead them to suck their thumb.

Use visual reminders such as a band-aid on their thumb or a colourful bracelet on their wrist as a visual cue to remind them not to suck their thumb.

Distraction and substitution. Help your child find alternative ways to comfort themselves or keep their hands busy. Offer items like a soft toy, a soothing blanket, or even a stress ball. Keeping their hands occupied can divert attention away from thumb-sucking.

Seek professional help. If your child’s the thumb-sucking habit persists despite your efforts, consider consulting a child psychologist or counsellor. They can help identify any underlying emotional or psychological issues contributing to the habit and provide appropriate guidance.

Non-orthodontic Strategies

Thumb guards are devices that fit over the thumb and make thumb-sucking less enjoyable.

Other forms of physical barriers that can be used include bandages and gloves, but parents will have to monitor the child as these barriers can be easily removed by the child.

Taste-based deterrents. Apply bitter-tasting products to the child’s thumb as an immediate and often effective deterrent.

Orthodontic Strategies

Palatal crib is a dental appliance attached to the upper teeth. It prevents the thumb from comfortably resting against the roof of the mouth. Dentists often recommend the use of this appliance if the child’s thumb-sucking habit is causing dental issues.

Bluegrass appliance is designed to redirect thumb-sucking behaviour. It includes a roller or bead that the child can play with using their tongue, instead of sucking their thumb. Over time, this can help break the habit.

Quad-helix with crib attachment is recommended for more severe dental complications arising from prolonged thumb-sucking. This device corrects dental misalignments while curbing the thumb-sucking habit.

Why Counsellors Won’t Give You Advice & Aren’t Supposed To

WORDS FAITH FOO

FEATURED EXPERT
FAITH FOO
Director of ABRI Integrated Mental Health
Registered & Licensed Counsellor
Certified EMDR Therapist
Certified Coaching & Mentoring Professional
Website | Facebook | X | YouTube

Most people going for counselling expect the counsellor to provide tangible answers or give ‘quick fixes’ to their problems.

They seek specific, concrete solutions for whatever issues that are troubling them, such as:

“What should I do?”

“Can you tell me if I should get a divorce?”

The response from the counsellor would always be: “Giving advice is not part of my job”.

WHAT?!!

Confused, disappointed, and possibly a little frustrated, most people would wonder then what their counsellor does anyway.

Well, we are used to seeking advice from our family, friends, or colleagues. So, it is understandable why clients may see an opportunity to ask their counsellor for advice.

This expectation is often reinforced by the portrayal of counsellors and therapists in the media, especially on TV and film. Because of this, many clients enter a counsellor’s office expecting the counsellor to be an expert in knowing what the client should do in any given situation.

THE TRUTH ABOUT THE COUNSELLOR’S JOB

Counsellors don’t know what the best option in any given situation would be.

This is because there is no one-size-fits-all solution.

Also, from an ethical standpoint, counsellors are not allowed to advise clients.

I DON’T GET IT. THEN WHAT AM I PAYING THE COUNSELLOR FOR?

Giving advice is easy. It takes nothing but the audacity to give it. Some people can back that audacity up with genuine insight, but many can’t.

How many people in your life have given you advice? Of the good advice you’ve received, how many have helped you? How much have you taken and applied?

For example, you know that you should not be in an abusive relationship.

Then, someone says: “You should leave the relationship.”

Can you do it on your own?

If you never develop trust in yourself, you can fall into a pattern of taking someone else’s bad advice over your own insight.

This leaves you vulnerable to bad advice from bad people. This can lead to more problems to overcome!

This is where the counsellor comes in: to help you explore your ‘stuck-ness’—to help you understand why you can’t overcome your problem.

Once you know the ‘why’, then the ‘how’ will come.

In all of this, your counsellor truly and sincerely doesn’t know the best option for your situation.

THIS IS BECAUSE THEY’RE NOT YOU

There’s a school of therapy called humanistic, person-centered, or Rogerian therapy that holds this as one of its core principles: you are the expert of your own life.

The founder of that school of therapy, psychologist Dr Carl Rogers, believes that counsellors or therapists act as collaborators that engage in active, respectful partnership with their clients.

They don’t ‘figure you out’—they help you figure yourself out.

That said, counsellors do have some expertise. They have an understanding and knowledge of how the mind works, how people tend to get in their own way, and how human relationships work.

What counsellors do, then, is combine their expertise with their clients’ insight and knowledge about themselves.

  • The counsellor will point out certain patterns that they notice in clients thinking or behaviour, to help them figure out where they came from.
  • The counsellor will collaborate with their client on a plan for how to change the client’s pattern. It’s only through this active collaboration that we can help clients solve problems, address issues, and grow as a person.

As much as your counsellor knows about you, there’s a lot they don’t know too—something that they always keep in mind.

Hence, good counsellors refrain from giving advice, as they are very aware that they may end up you some really bad advice!

SO, WHAT CAN A COUNSELLOR DO FOR ME?

Counsellors will help you build your problem-solving muscles by reasoning through things with you, but our focus is on helping you deal with the symptoms or emotional issues that short-circuit your problem-solving process.

To address the issues that hold you back, you might have to delve into your past.

But the one thing you’ll always have to do is learn how you’re getting in your own way. You might be caught up in depressed or anxious thoughts, the shadows of trauma, or hurtful words others have said to you.

For counselling to work, you must uncover and disconnect the dots—the points where your brain uses irrational thoughts, painful memories, or impulsive reactivity to lie to you and lead you astray.

Doing so can help you heal the wounds that have damaged or limited your perspective or sense of self.

As you overcome what once gave you doubt and pain, you knock down the obstacles that once stood between you and your intuition—your deep inner knowing of what to do.

HENCE, COUNSELLING IS MORE THAN JUST GIVING ADVICE

It’s a collaborative effort between the counsellor and the client.

As a counsellor, we want to help you break the cycle that keeps you trapped in an unhappy situation.

We want to help you get better at making your own decisions and finding your own answers.

We want to help you gain the confidence and capability to decide for yourself.

A Consultant Urologist Talks about Kidney Stones & How They Affect Children & Younger Adults

WORDS DR GOH ENG HONG

FEATURED EXPERT
DR GOH ENG HONG
Consultant Urologist
Prince Court Medical Centre

Kidney stones are formations that develop in the kidney.

The process of stone formation often begins with a blood flow issue. Such issue causes a small crystal to start to grow and eventually transforms into a stone—a kidney stone.

Kidney stones. Click on the image for a larger, clearer version.

There are typically a few types of kidney stones, with calcium stones being the most prevalent.

NOW, HOW DO THESE STONES FORM IN THE URINARY TRACT?

There are several factors contributing to their formation.

  • Structural abnormalities along the kidney tract.
  • A malfunction in the body, leading to a higher risk of stone formation in the urine.
  • Lifestyle choices.
  • It’s essential to consider the presence of other concurrent medical conditions. For instance, diabetes and cholesterol can contribute to stone formation as well.
KIDNEY STONES ARE INCREASINGLY MORE COMMONLY DIAGNOSED AMONG YOUNGER PEOPLE?

I can’t provide an exact prevalence, but it’s evident that kidney stones are becoming more frequently diagnosed in young people, especially young women.

There are several reasons contributing to this trend.

  • Improved medical care leads to more regular check-ups that detect the presence of kidney stones.
  • Modern lifestyle, characterized by the consumption of fast and convenient foods. Such processed foods tend to be high in salt content, a known risk factor for stone formation. Moreover, sugary beverages, processed drinks, and excessive sugar consumption also contribute to the risk of stone formation.

In the case of young women, several additional factors may play a role.

  • Many of them desire to maintain a lower body weight, which leads them to adopt special diets that may lack proper balance. This imbalanced diet can contribute to stone formation.
  • Their busy lifestyles and work commitments may result in reduced water intake and holding in of urine for extended period of time (finding a restroom can become inconvenient). This inadequate hydration can also lead to stone formation.
OTHER INTERESTING POSSIBLE RISK FACTORS OF KIDNEY STONES AMONG YOUNGER PEOPLE
  • Climate change. Rising temperatures lead to increased dehydration. While outdoor activities and games are encouraged, inadequate water intake during these activities can contribute to stone formation.
  • Antibiotic misuse. The direct role of antibiotics in the formation of kidney stones remain uncertain. They may affect the formation of kidney stones indirectly, probably by causing issues related to nutritional absorption in the gut.
SYMPTOMS OF KIDNEY STONES

Kidney stones can present in various scenarios. For instance, some patients may exhibit symptoms like pain, bleeding, or fever when the stone obstructs the urinary tract, causing an infection.

Alternatively, kidney stones may be detected early in some fortunate cases, while these stones are still small, and hence there are no significant issues.

So, the manifestations of symptoms of kidney stones can vary.

POTENTIAL CONSEQUENCES AND COMPLICATIONS OF UNTREATED KIDNEY STONES

The stone might not cause any significant issues to the person’s quality of life if it is quite small.

However, the kidney stone may block the ureter—the passage in which urine is expelled from the body—creating a ‘traffic jam’ that leads to kidney swelling.

If left untreated, this blockage can lead to pain, infections and even kidney failure.

KIDNEY STONES MAY COME BACK OR RECUR IF ONE’S DIET IS NOT PROPERLY MANAGED

While water intake is often emphasized in relation to kidney stones, it is essential to consider other factors as well, such as salt and sugar intake.

Without proper diet management, there is a high chance of recurrence of 50% in 5 years, with some patients experiencing kidney stone formation again only 5 years after their initial operation.

This is also true for children. There is always a risk of kidney stone recurrence, especially if their diet is not properly managed.

Additionally, if a child has any structural or functional body issues that have not been adequately addressed by the doctor, it can also contribute to recurrent kidney stones.

HENCE, SPECIAL ATTENTION IS NEEDED FOR CHILDREN THAT HAVE EXPERIENCED KIDNEY STONES

They should undergo thorough medical assessments to rule out any body structural defects or functional problems that could lead to stone formation.

Proper management and monitoring are also essential.

TIPS TO REDUCE THE RISK OF KIDNEY STONE FORMATION
  • Adopt a healthy lifestyle. This is crucial. It involves maintaining a balanced diet, controlling one’s body weight, engaging in regular exercise, and managing blood sugar and cholesterol levels.
  • Drink an adequate amount of water daily as it helps in both hydrating the body and flushing out stones.
  • Avoid or limit foods that are high in sugars and salt.

The Haze Is Back, and Here’s How You Can Protect Your Lungs

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KOW KEN SIONG
Respiratory, Internal Medicine, and Interventional Pulmonology Consultant
Sunway Medical Centre
WHAT, THE HAZE IS BACK?
  • The API readings for September 2023 showed alarming levels of fine particulate matter.
  • Experts predicted that the haze would persist until October.
  • Dry and monsoon seasons will further increase the risk of forest fires and haze during this period.
WHY SHOULD YOU BE CONCERNED?

Dr Kow Ken Siong tells us: “Fine particulate matters in the haze less than 2.5 microns in diameter, though often short-term, can leave a lasting impact, especially when inhaled.”

  • Short-term exposure can result in acute bronchitis symptoms like cough, phlegm, chest tightness, breathlessness, and lethargy.
  • Long term or chronic exposure can lead to respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and lung cancer.
  • Air pollution, including haze, is linked to premature deaths, infections and various diseases, with chronic respiratory illnesses ranked the third-leading cause of death globally in 2019.
  • In Malaysia, nearly 20% of hospitalizations in government hospitals and over 12% in private hospitals are due to the abovementioned respiratory diseases!

He adds that:

  • Vulnerable groups such as children, the elderly, and those with pre-existing conditions (such as asthma and cardiovascular diseases) face higher risks of worsening pre-existing chronic lung conditions, increased the risk of lung cancer, and frequent bronchitis episodes.
  • Individuals without prior health issues may develop upper respiratory symptoms and become more susceptible to viral infections.
DR KOW’S TIPS TO PROTECT YOURSELF AGAINST THE HAZE
  • Staying indoors as much as possible, especially in areas where the air pollution index is unhealthy.
  • Keep doors and windows closed to prevent indoor air pollution.
  • Use high-quality air purifiers with high efficiency particulate air (HEPA) filters, especially when natural ventilation is limited.
  • Use N95 masks for prolonged outdoor exposure, to filter out potentially harmful fine particulate matter that may be harmful.
  • Stay hydrated throughout the day.
  • Stay informed and seek medical advice. Monitor air quality through official sources, limit outdoor activities during the haze, and seek professional medical advice if experiencing lung or heart symptoms.
  • Self-medication, particularly with inhalers, is discouraged as it may lead to unwanted side effects.

Worried about Infertility? A Fertility Specialist Offers 5 Important Advice

WORDS DR AGILAN ARJUNAN

FEATURED EXPERT
DR AGILAN ARJUNAN
Consultant Obstetrician & Gynaecologist and Fertility Specialist
evelyn Fertility & Women Specialist Clinic
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Infertility, a condition affecting millions of couples worldwide, remains a complex and emotionally challenging issue today.

The inability to conceive a child naturally has profound implications for individuals and couples, leading to feelings of frustration, sadness, and even societal stigmatization.

In Malaysia, the fertility rate is continuously declining. The fertility rate in 2023 is 1.924 birth per woman, a 0.88% decline from 2022.

Even though the topic of infertility has been written and spoken widely for many years, I noticed that many couples still face dilemmas in their fertility journey. In this article, I will highlight 5 things that you need to know about infertility.

DO YOU BELIEVE THAT YOU SUFFER FROM INFERTILITY?

Before you start worrying that you have infertility, you need to carefully assess your trying-to-conceive or TTC circumstances.

In general, a couple would suspect they might have infertility after consistently trying to conceive for about a year or at least about 6 months if the female partner is more than 35 years of age. The key factor in this time frame is that the couple has been able to perform unprotected intercourse during her fertile window.

When a couple is suffering from painful vaginal intercourse (vaginismus) or erectile dysfunction, they are not necessarily infertile.

For these couples, pregnancy has not happened yet simply because there is no chance for the sperm and egg to meet for fertilization to occur.

In my experience, couples in these circumstances have a very good chance to get pregnant, provided that there are no other major infertility factors.

When the female partner has an irregular period cycle, especially those with polycystic ovarian syndrome (PCOS).

A woman will have an irregular period cycle when the ovulation of her egg is erratic or irregular.

For example, if she ovulates later than 2 weeks after the start of her period cycle, say about 3 weeks, her next period likely will start 5 weeks after the current period cycle.

Usually, period starts about 2 weeks after ovulation. However, if her ovulation does not follow any pattern at all, it becomes nearly impossible to know her ovulation date or commonly known as fertile window.

Thus, these couple are not actually facing infertility but merely could not identify their fertile window.

Once the woman’s ovulation is induced with acceptable regularity, her chances to get pregnant are pretty good.

However, if you are suffering from PCOS, please discuss your condition with a fertility specialist.

ARE YOU DOING THINGS CORRECTLY?

Once a couple has recognized that they are facing infertility, they can be overwhelmed with many suggestions on what to do. The internet is flooded with many such posts, some from a reliable source and some are not.

Your first step should be to choose a fertility clinic and start your basic fertility tests.

Attend the session together, not the female partner first and the male partner later.

Basic tests should include a semen analysis for the male partner, an egg reserve test, a pelvic ultrasound scan, and probably a fallopian tube patency test (hysterosalpingography) for the female partner.

An egg reserve test can be done via an ultrasound scan to count the antral follicles count. It can be supplemented with a blood test called anti-Mullerian hormone (AMH). It is important for two reasons:

  • It helps to determine the order of priority of treatment options. When the egg reserve is low, the couple might opt for an in-vitro fertilization (IVF) straight away or perhaps decide to do intra-uterine insemination (IUI) once or twice and continue with an IVF without much delay.
  • The egg reserve helps you and your fertility specialist to manage your fertility journey timeline more effectively. If your egg reserve is low even when you are younger, it is probably wise to start your IUI or IVF treatment earlier than later. However, if your egg reserve is good and you are young, your fertility doctor might try simpler options such as ovulation induction and timed sexual intercourse.
WILL HORMONE TESTS HELP YOU?

The answer to this question lies in your own fertility history.

Many traditional hormone tests such as follicle stimulating hormone (FSH), luteinizing hormone (LH), and ‘day 21’ serum progesterone blood tests are not helpful to many young women. In a healthy, young woman with a regular period cycle and normal egg reserve, I do expect these tests to be normal. It does not necessarily add any valuable information.

However, some hormone tests are needed based on your clinical history, such as tests for thyroid function, serum prolactin, and serum insulin levels.

Rarely, a genetic test is needed for couples with recurrent miscarriages or for a male partner with zero sperm count (azoospermia).

WHAT ABOUT THE MALE PARTNER?
The male partner is equally as important as the female partner.

Although only a semen test is required for the male partner, it does not mean he contributes little to the success of the infertility journey. After all, 50% of the embryo is contributed by his DNA!

In my opinion, the first fertility test that needs to be done is a semen analysis. This test may provide valuable information about his fertility status and provide the fertility specialist with enough time to improve male infertility while at the same time focusing on the female partner.

I will do a semen analysis for all male partners regardless of their medical history. This is because there are no symptoms of male infertility. Seemingly healthy and well-built men may have azoospermia.

If a men’s semen analysis is normal, does that mean everything is okay with him? The answer is no.

A semen analysis does not necessarily indicate the actual quality of his fertility health.

For example, a cigarette smoker’s semen analysis results may be normal, but his sperm DNA fragmentation test—which look for the amount of damage to the DNA in his sperm—may indicate that there is higher damage to the genetic material carried by his sperm cells. The higher the DNA damage, the higher the likelihood of infertility and even miscarriage rate.

Thus, men should remember to take care of their general health and stop or reduce activities that may impair their fertility because there is no one test that can accurately assess their fertility health.

IS IVF THE ONLY SOLUTION?
An overview of the IVF process. Click for a larger, clearer image.

Over 40 years of IVF treatment performed globally had led to over 8 million babies born worldwide. It is more common in countries like Denmark.

However, IVF is not the only option to get pregnant.

The first logical step is to try to identify the root cause of your infertility. Once this is done, take the necessary steps to make improvements which may help increase your chances of natural conception. However, in one-third of couples, there is no obvious cause of infertility found.

If there is no major or obvious infertility factor and the fertility tests are normal, the couple could start with an intra-uterine insemination (IUI) at least twice before considering an IVF treatment.

A word of caution: IUI could be the first treatment option for many couples, but the treatment choice should be tailored to your own fertility history, age factor, and financial capability.

IVF treatment could be the first option for couples suffering from bilateral blocked fallopian tubes or severe male factor infertility.

You should consider IVF as the first option if your egg reserve is low or if the female partner is older.

Ultimately, there is no clear and straightforward algorithm for determining the choice of fertility treatment.

In many instances, the choice is done based on financial burden rather than scientific factors.

CLOSING WORDS

I hope this article will help you at least do a preliminary assessment of your own fertility status and help you plan your fertility journey effectively to save time and money. The journey towards parenthood is not an easy path but definitely rewarding.