Author: Chit Ko Ko Oo

An Infection Called Listeriosis

May 8, 2022 Return

Words Lim Teck Choon

Bad Bacteria

The bacteria responsible for listeriosis is Listeria monocytogenes. People get infected by eating food contaminated with these bacteria.

What are the Symptoms to Watch Out For?

This is the tricky part, as symptoms may vary from one person to another.

Most people experience mild symptoms. Those who are most vulnerable to the more serious consequences are listed below – people in these groups should see a doctor for proper diagnosis and treatment as soon as possible if they suspect that they have a case of listeriosis.

Be Very Careful if You Are:

Pregnant, as listeriosis may lead to miscarriage, stillbirth, premature birth and potentially life- threatening infection in the newborn.
Newborn or over 65 years old and/or have weakened immune system, as listeriosis may lead to severe infections of the blood and the brain, with potentially life-threatening consequences.

Careful with These Foods!

Raw milk

Raw milk may contain not only L monocytogenes – other types of potentially harmful microorganisms may be present as well!
Drink only pasteurized milk – check label on milk to be sure.
Refrigerate milk at 5°C or below.

Cheese, yoghurts and ice creams made from raw milk

Always check the label to make sure that the product uses pasteurized milk.

Melons

The recent Australian outbreak is caused by eating contaminated melons.
After cutting a melon, eat or refrigerate right away. Don’t leave it in room temperature to be contaminated!
When refrigerating, make sure that the temperature is below 5°C. Don’t keep for more than a week.

Raw sprouts (alfalfa, clover, radish, bean sprouts, etc)

Cook sprouts thoroughly; avoid eating raw or lightly cooked ones.
Note that rinsing alone will not remove harmful bacteria.

Processed meats (hot dogs, burger patties, pâtés, cold cuts, etc)

Cook until the internal temperature is 75°C or higher before eating.
Refrigerate opened packages for not more than one week, while unopened packages should not be kept longer than two weeks.

REFRIGERATION TIP

Keep these “high risk” foods refrigerated separately from other foods to avoid contamination. Also, always check to make sure that the fridge is 5°C or below while the freezer should be 0°C or below.

Breaking Depression’s Spiral

May 8, 2022 Return

Words Lim Teck Choon

Paul Jambunathan
Consultant Clinical Psychologist & Senior Lecture

Decoding Depression

Depression = Cannot Cope?

Some people experience depression because they are unable to cope with life-changing events, such as financial problems, unemployment, broken relationships, the passing of a loved one and more. Of course, most people will be affected by such events, but people with depression will experience symptoms that will prevent them from functioning normally, and this will persist for a longer period of time than normal.

Other Medical Conditions Can Cause Depression Too

Do you know that our mood can be affected by the levels of certain hormones in our body? Specifically, our thyroid, adrenal and pineal glands, as well as the glands in our sex organs produce hormones that have links to our mood. Therefore, it is possible that any medical problems involving those glands can give rise to depression. In such cases, these problems will have to be addressed in order to help the person overcome his or her depression.

The Depression Gene

Research suggests a strong possibility of a depression gene that can be passed on from parent to children, leaving these children more at risk at developing depression. If you have family members who developed depression, you should be more aware of the symptoms and get help if you have them, as well as practice good stress management techniques (there are books that can offer advice and tips on this). You should also get enough sleep and be physically active every day to keep your spirits up.

As You Can See, Depression Is Not Simply Because You Are Weak

Depression can be an inability to cope with life’s many stresses and pressures, or it could also be a result of a medical condition, or perhaps even a hereditary condition. Or, it could be caused by a combination or all of these factors! Therefore, if you believe that you may have depression, don’t be ashamed. Seek help from a qualified mental health professional instead.

Do You Have Depression?

Mr Jambunathan points out that, according to the latest (fifth) edition of The Diagnostic and Statistical Manual of Mental Disorders (the authoritative reference used by mental health professionals worldwide), someone is diagnosed as suffering from depression if he or she shows at least five of the following symptoms for nearly every day.

Depressed Mood
Feels irritable most of the day, nearly every day for more than two weeks. The person may appear sad, empty or tearful to the people around him or her.

Lack of Interest
The person shows decreased interest or pleasure in most activities, including activities that he or she previously enjoyed, most of each day.

Significant Weight/Appetite Change
Medically, a weight change of five percent (gain or loss) may be an indication of depression.

Change in Sleeping Habit
Some people may have problems falling asleep (insomnia), while others may sleep more excessively than normal (hypersomnia).

Fatigue
The affected person seems listless and lacking in energy most of the time, often showing little inclination to snap out of the mood.

Guilt
The person feels an excessive or inappropriate amount of guilt over a past incident that triggered the depression. He or she may also feel helpless to change a situation, or feel that he or she is worthless to the people around him or her.

Lack of Focus
He or she has a reduced ability to concentrate or think, and is also indecisive.

Suicidal Thoughts
The thought of death or suicide frequently runs through his or her mind, along with ideas of how to carry them out.

Getting Closer to Happiness

Who to seek help from?

There are different types of mental health professionals, and it will be good to know what they can (and cannot) do to help you.

Counselors are generally the ‘front line’ mental health professionals. They are trained to offer support and counseling to people with emotional problems.
Clinical psychologists have at least a Masters degree in clinical psychology. They can offer the services of a counselor as well as more specialized services such as cognitive behavioural therapy (CBT).
Psychiatrists are medical specialists who are better equipped to help people with more serious mental disorders such as schizophrenia and depression. Because they are medical doctors, they can prescribe medications when the need arises.

Mr Jambunathan says that it is perfectly fine to visit a counselor first. If the counselor believes, after assessing you, that you require the more specialized services of a psychologist or psychiatrist, he or she will refer you to the right person. “Often, you may also be requested to get a full medical check-up,” he adds, explaining that this is necessary to rule out any medical conditions that may be contributing to your depression. If such conditions exist, they will have to be looked into first.

Not Sure Where to Get Help?

Mr Jambunathan stresses that it is important to turn to qualified mental health professionals for help. Unfortunately, there are certain unscrupulous people who pose as counselors or psychologists, and they will do more harm than good. If you are unsure as to where to find legitimate mental health professionals, you can start at the following places:

Counseling services: Malaysian Mental Health Association at http://mmha.org.my/resources/directory-of-councelling-services/
Psychiatrists: Malaysian Mental Health Association at http://mmha.org.my/resources/directory-of-psychiatric-services-in-malaysia/
Another listing of psychiatrists: Malaysian Psychiatric Association at http://www.psychiatry-malaysia.org/listcat.php?cid=28&all=Y

Confidentiality Guaranteed

Don’t worry about people finding out that you are depressed. Mr Jambunathan assures that mental health professionals will not divulge your status to anyone (even your employer and partner) without your explicit permission. If you have any concerns about confidentiality, you can voice them out – most mental health professionals are used to (and even expect) such a discussion and thus, they will be glad to address your concerns.

What Are The Sessions Like?

Often, the client dictates the pace and nature of the session. The number of sessions depends on the client’s progress and the severity of his or her condition. For clinical psychologists such as Mr Jambunathan, sessions involve listening to the client and asking thought-provoking questions in order to empower the client into finding the determination and drive to make the necessary steps to overcome his or her depression.

Empower Yourself

Mr Jambunathan emphasizes that your recovery will be smoother if you take steps to empower yourself. Firstly, learn more about depression – the causes, the symptoms and the options available to overcome your condition. The knowledge will allow you to be more confident in making educated decisions when it comes to your recovery.

Furthermore, don’t hesitate to ask for second or third opinions if you have doubts about an initial diagnosis, and feel free to ask to be referred to another mental health professional if you are uncomfortable with the one you are currently seeing. Most mental health professionals will be happy to accommodate your request for a second opinion or referrals to another colleague; they will not take it personally, don’t worry!

In the second part of this series on depression, we look at anti-depressant medication and whether they are effective at treating depression. Look out for it in the following issue.

One Step Closer to Happiness

May 8, 2022 Return

Words Lim Teck Choon

Assoc Prof Dr Amer Siddiq Amer Nordin

Consultant Psychiatrist

Universiti Malaya Specialist Centre

All About Antidepressants

Wait… medications?

Yes, sometimes medications are helpful in overcoming moderate-to-severe depression. Dr Amer explains that these medications, called antidepressants, are prescribed by psychiatrists, who are medical doctors specializing in mental healthcare or psychiatry.

Malaysia Has Good Psychiatric Care

Some of us may not know this, but Malaysia actually offers some of the best psychiatric care in this region. Dr Amer points out that many of the commonly prescribed and effective antidepressants used worldwide are available in Malaysia. Therefore, people with depression can find a good level of medical care in both government and private hospitals. It is only a sad kind of irony that awareness of both depression and its treatment is not widespread enough, causing a number of people with depression to either deliberately or unknowingly miss out on getting treatment.

Thus, if you suspect that you have depression or you believe someone close to you has this condition, Dr Amer gently recommends that you seek appropriate advice and help from a qualified mental health professional. The earlier the treatment, the better are the chances of recovery.

5 Things to Know about Antidepressants

Dr Amer stresses that antidepressants are not the be all and end all of depression management. They work to reduce the symptoms of depression instead of curing the condition, and are only prescribed when necessary. Some people with depression may be able to overcome it without any need of medication at all.
It may take a couple of weeks before you see the beneficial effects of the antidepressant you are taking. If you believe that you are not getting better even after taking the medication, don’t be too quick to assume that it does not work. Instead, talk to your psychiatrist about your options.
It is, however, possible that certain antidepressants don’t work on you. The psychiatrist will prescribe another type after he or she has performed the necessary evaluation to confirm that your current medication is ineffective.
Take your medications based on the recommended dosage and frequency, and do not stop without consulting your psychiatrist first. Some people stop on their own when they believe that they are getting better, and as a result, their depression comes back, sometimes more severely than before.
Avoid drinking alcohol or taking illegal drugs while you are on medication. Some people believe that the ‘high’ from alcohol or drugs helps them feel better, but research has shown that these substances actually negate the benefits of your medications and can even worsen your depression.

How Antidepressants Work

There are different types of antidepressants available, and each type has its own unique ways of reducing the symptoms of depression. Generally, however, they all work by influencing the way the brain works.

Our brain cells, or neurons, form a closely connected network called the brain circuit. All information is passed from one neuron to another, carried by substances called neurotransmitters. There are many different types of neurotransmitters, and some of them carry information that affect our mood – for example, serotonin, dopamine and norepinephrine.

Generally, antidepressants help reduce the symptoms of depression by interrupting the transmission of specific neurotransmitters that trigger a depressive mood. Some work on a single neurotransmitter, while others may work on two or more.

The type of antidepressants prescribed depends on the symptoms and severity of your depression, other health conditions already present and whether you are pregnant or breastfeeding. Sometimes, a psychiatrist may prescribe a combination of two antidepressants for enhanced beneficial effects. If the need arises, additional medications such as mood stabilizers, anti-anxiety medications or antipsychotic medications may also be prescribed to help you better manage your symptoms.

Also, if you experience bothersome side effects, your psychiatrist may switch you to a different kind of medication. If you are also on medications for other health conditions, you should share them with your psychiatrist, as there is a possibility that these medications can react with an antidepressant to create potentially dangerous complications.

But Aren’t Antidepressants Addictive?

No, not at all, says Dr Amer. Some patients experience withdrawal-like symptoms when they stop taking antidepressants, but this is not a sign that they are addicted to those medications. Rather, it is more likely due to the body needing some time to adjust once the medication is stopped, especially if it is stopped abruptly. These symptoms usually go away on their own. If you experience bothersome side effects, you should let your psychiatrist know. He or she will either offer options to address these side effects or switch you to another type of antidepressant.

Is It True that Taking Antidepressants Will Ruin My Sex Life?

Because antidepressants work by calming your mood and reducing your anxiety, one possible unwanted side effect is that you also become too ‘calm’ to respond in intimate situations. Some people (both men and women) find that their libido is decreased. There are men who also experience erectile dysfunction, while women may experience discomfort during sex due to reduced lubrication. Delayed orgasm may also be experienced by both men and women.

Fortunately, this does not mean that your sex life is ruined if you are on antidepressants. Sometimes these side effects go away on their own, after your body has become used to the medication. If they persist, there are ways to manage these symptoms, such as reassessing the dosage or, if you anticipate having an intimate moment with your partner, taking your antidepressants only afterwards. Switching antidepressants might also be an option if the above doesn’t work.

Don’t stop your medication because it is affecting your sex life, as this may cause your depression to worsen. Instead, talk to your psychiatrist about the issue; he or she will be able to help you in this matter.

Don’t Give Up!

Medication alone is often not enough to help the person overcome his or her depression. Overcoming depression is a day-to-day process, often requiring a lot of energy and focus. Recovery may not be as quick as the person wishes, and in the meantime, he or she may experience broken relationships, loss of jobs and other heartbreaking disappointments.

In such situations, some people may become overwhelmed and feel that they will never become better. They choose to give up instead, thus succumbing to their depression.

It does not have to be this way. While depression is often portrayed as a lone person’s struggle, Dr Amer points out that the road to recovery is often easier with support from the people around that person.

This is why, while he respects a patient’s desire for confidentiality, Dr Amer would advise the patient to let at least one trusted person in on the fact that he or she is trying to overcome depression. This person can provide a listening ear and a shoulder to cry on when the going gets tough for the patient. Additionally, that confidante is welcome to ask for advice from the patient’s mental health professional if the need arises.

Furthermore, support can be obtained from various support groups (either in real life or online at places such as Facebook and Reddit) as well as from various non-profit organizations dedicated to helping people with depression and other mental issues heal.

When the World Shuts You Out, We Are Still Open

That is the motto and rallying cry of the Befrienders, a nonprofit organization established to provide emotional support to those in need. If you need someone to talk to, call the Befrienders at 03-7956 8144 or 7956 8145
(they are available 24 hours a day) or email sam@befrienders.org.my. You can also arrange for face-to-face support by calling the numbers above.

Healing A Hurt Heel

May 8, 2022 Return

Words Dr Au Yong Pui San

The plantar fascia is a thick fibrous band of tissue that stretches from the inner underside of the heel bone to the base of the toes. It provides support to the arch of the foot.

When there is too much stress to the plantar fascia, it can become inflamed, thickened and swollen, causing pain on the heel or along the arch of the foot. This condition is called plantar fasciitis (pronounced fash-ee-ai-tis).

The condition is commonly associated with overuse and usually occurs slowly. Typically, the usual complaint will be pain at the heel, especially upon waking up in the morning and taking the first step out of bed. Similarly, there will be pain in the heel during the first step after a period of prolonged immobilization (for eg, sitting in a car for a long journey or after a movie marathon).

Early in this condition, the pain eases after walking around but if it is left untreated, the pain worsens and lingers throughout the day.

WHAT CAUSES IT?

Some people are more prone to developing this condition, such as those with high body mass index, are flat footed, have overpronation of the feet and very tight calves (typical of people who do not stretch on a regular basis and people who love wearing high heels).

In the more athletic population, especially runners, common predisposing factors that may lead to the road of prolonged pain and (most times debilitating) discomfort of plantar fasciitis are:

Poor running biomechanics (or running form), where there is over pronation of feet and/or too much heel strike during running gait. This places a lot of stress onto the plantar fascia leading to irritation and inflammation.
Poor choice of footwear, where a person uses the wrong type of footwear for his or her foot type or body type, or there is inadequate support from the footwear. For larger sized runners who are just starting to enter the fascinating world of running and road racing, picking a pair of shoes with enough cushioning and support is important. With the minimalist types of running shoes still in vogue, a sudden change to shoes with low heel-to-toe drop without adequate adaptation to the shoes will place a high amount of stress to the plantar fascia.
Tight calves from inadequate stretching (or none!). Stretching post run is highly recommended if not pivotal to the prevention of many overuse injuries, including plantar fasciitis.
Weak calves, just like tight calves, are also contributing factors to developing plantar fasciitis. A lot of runners feel that running is the only exercise necessary to build muscles in the legs, thus forgoing strengthening exercises.
Running surfaces also play a role. Running on tar roads and cemented sidewalks (which unfortunately most runners do) leads to high impact on foot strike landing which leads in turn to higher stress on the plantar fascia.
The dreaded “too’s”, which is too much, too soon, too often. Sudden increment in mileage without adequate rest will most often lead to unwanted aches and pains. One of them very likely could be plantar fasciitis.
Speedwork and hill repeats. Related to “too much, too soon and too often”, adding on too much speedwork and hill repeats can also lead to heel pain.

WHAT CAN I DO?

If you experience such heel pain and it is causing you much grievance when you run, there are a few things that you can do to ease the discomfort and return to running in a timely fashion.

First, you need to make sure it really is plantar fasciitis. There are other ailments that can mimic plantar fasciitis, especially in the non athletic population. The best way to confirm the diagnosis (after your doctor goes through your medical history and physical examination) is to do an ultrasound scan of the plantar fascia, which should show that the fascia is visibly thickened and swollen. An x-ray may show heel spurs but that rarely is the cause of heel pain. There are many people with heel spurs that do nat have heel pain, just as there are many people with heel pain that do not have heel spurs.

If you are a runner and had committed the above causal factors that may have led to plantar fasciitis, then correcting them is the first step to reducing your likelihood of heel pain.

Icing after a run, walk or even prolonged standing.
Using proper footwear with adequate cushioning and support. You may consider inserting silicone insoles to reduce the pressure on the heels or insoles that help reduce flat footedness.
Stretching of both the plantar fascia and your calves. Rolling the painful foot over a tennis ball or a golf ball helps to stretch the plantar fascia and may provide a lot of relief upon your first step out of bed. Ideally, this is done the moment you wake up.
Strengthening of intrinsic foot muscles and calf muscles. The stronger the muscles, the better you are at preventing re-injury.
Adding softer running surfaces such as a rubberized track, grassy field or less technical trail to your routine.
Pulling back on the mileage up to 50 percent and taking a break on speedwork and hill repeats, while letting the pain ease off. Once the pain resolves, you can add the mileage back slowly (key word: slowly). Cross training (for eg, cycling, swimming, aqua-running) can be a great option to maintain cardiovascular fitness while easing off pressure on the foot.

Other treatments that can be done include:

Soft tissue therapy (or myofascial release therapy) can be performed on the plantar fascia, calf muscles, hamstrings and glute muscles.
Night splint worn during sleep to keep the plantar fascia (and calf muscles, to some degree) stretched throughout the night.
Taping of the plantar fascia and the calf muscles.
Topical and/or oral analgesia. (However, these are not recommended to be taken when exercising.)

If all the above conservative management does not help, your options are:

Corticosteroid injection, ideally done under ultrasound guidance to prevent injecting directly into the plantar fascia. Corticosteroid, while useful in reducing inflammation quickly, can weaken the plantar fascia and may cause it to tear or rupture especiallyin the athletic population. With ultrasound guidance, the corticosteroid will be injected along the surface of the fascia.
Surgery, only in stubborn or difficult cases where there is still pain but all conservative management efforts have been tried to no avail. Note that surgery is not ideal for the athletic population. HT

The Truth About Cats & Dogs

May 8, 2022 Return

WORDS LIM TECK CHOON

How hard is it to raise a dog or a cat? Well, it’s as easy as raising a beloved child – just give all the TLC your heart is capable of, throw in a heap of patience, sit through moments of exasperation when you realize that your little one can get out of hand and a big smile when, in the end, you realize that you will not change any second of the experience – as all the ups and downs are worth it.

HealthToday catches up with Dr Goh Kim Siang, a veterinary surgeon, who touches on a few things that everyone should know before adopting a pet.

THE SECRET HISTORY OF PETS

Humans are the only creatures in this world that keep pets. One of the earliest evidences was the remains of a human cradling a puppy found in what is now Israel, dating back to 10,000 BC.

TRUTH #1

YOUR KIDS AREN’T THE BEST PEOPLE TO DECIDE WHETHER YOU SHOULD ADOPT A PET.

Veterinary surgeon Dr Goh Kim Siang shares that companionship is one of the greatest benefits of having a pet. “For many people, just seeing their pet approach them for a rub or cuddle when they come home from work can be a good antidote to the stress they experience earlier in the day,” he says. He adds that older people may find a pet’s companionship beneficial in staving off loneliness.

“THE KID WANTS A PET!” IS PROBABLY NOT A GOOD REASON TO HAVE ONE.

Just as Mom and Dad will not have another baby just because their kid wants a sibling, it is not a good idea to adopt a pet because of a child’s whim. Dr Goh points out that children will be children – they may get bored easily or become fascinated by something else quickly. They may also eventually decide that having a pet is no fun and they don’t want it anymore.

Dr Goh goes on to say that the ultimate decision to have a pet lies with the grown-ups. After all, like it or not, the care and feeding of the pet will ultimately fall onto them. “Having a pet is a lifelong responsibility,” he emphasizes.

DR GOH’S CHECKLIST FOR PET OWNERS-TO-BE

Does your residence have ample space for the pet to live comfortably in, move around and answer the call of nature?
Can you and are you willing to allocate the time and effort every day to feed the pet, bond and communicate with it and, in the case of a dog, take it out for some exercise?
Can you afford and are you willing to invest money in nutritious foods, vaccinations, medical check-ups and treatments and more for your pet?

If you hesitate to say YES to any of the above, you may not be ready to adopt a pet yet. Let’s think a bit more about the matter, perhaps even talk to a veterinarian or another responsible and loving pet owner to find out more about what being a pet owner is like.

BLACK PETS NEED MORE LOVE

Do you know that there is a National Black Dog Day in October? The day was created because statistics showed that, in the US, black or dark-furred dogs are often not picked for adoption. Hence, pet shelters, pet welfare organisations and dog lovers all came together to spread the word that a black dog is no less lovable and loyal compared to dogs of other colours. Also, black-furred dogs can be truly adorable, as evidenced by the Black Dogs Project (caninenoir.tumblr.com)!

TRUTH #2

TRAINING GIVES DOG OWNERS & THEIR FURBABIES A GOOD START IN THEIR RELATIONSHIP.

Research has found supporting evidence that training helps to establish a stronger, more harmonious bond between a dog and its owner. According to Dr Goh, it is especially important for adopted dogs which may have experienced abuse in the past – training will teach them to interact peacefully with humans.

WELL, HOW DOES TRAINING BENEFIT MY DOG AND ME?

Your dog and you do not speak the same language. In fact, you and your dog are of entirely different species, so it’s very likely your dog doesn’t think or see the world the same way as you.

Training helps both you and your dog bridge these differences, so that the two of you can develop a system of communication via simple words (“Sit!”, “Come!”, “Stop!”, etc) and touches.

Here are just some of the benefits from such improved communication:

Your dog will learn which behaviour is acceptable and which isn’t. This will help your dog to react properly to unpredictable changes and situations that it will come across in real life.
It teaches your dog how to interact peacefully with other people as well as with other dogs.
You and your dog gain a better understanding of one another. You don’t have to scold or punish your dog often, and your dog will flourish in a less stressful and more loving environment. In the long run, this will promote a stronger bond between you and your dog.

GREAT! BUT I CAN TRAIN MY DOG MYSELF… RIGHT?

Dr Goh advises against this. While there may be books and YouTube videos for those who wish to train their dogs themselves, dogs are like babies. They have their own mind and can react in ways that are different from what’s demonstrated in those books and videos! Hence, what works for one dog may not work as well or even at all for another.

An experienced trainer who has trained many dogs of different personalities and temperament, on the other hand, may know a trick or two to deal with dogs that like to break the rules.

TRAINING IS NOT ABOUT SHOWING THE DOG YOU ARE

In the past, it was commonly believed that you need to establish a firm dominance over your dog to ensure good behaviour and loyalty. However, these methods tend to emphasize punishment over reward, and they often do not work on dogs with already problematic behaviour.

These days, evidence from research on pet behaviour has generated a shift from this ‘I’m the boss!’ style of training to one that emphasizes positive reinforcement and mutual respect between dog and owner. Dr Goh recommends seeking a trainer that adopts such an approach, as this approach has a higher likelihood of success in promoting good communication and stronger affection between the dog and its owner.

TRUTH #3

CATS & DOGS NEED BALANCED AND NUTRITIOUS MEALS AS WELL AS EXERCISE AND MEDICAL CHECK-UPS.

THE FACTS ON FOOD

You can easily purchase nutritionally-complete pet foods from stores or the veterinarian’s clinic to meet your pet’s nutritional needs. However, Dr Goh shares that there are a few things to take note of when picking the right brand for your pet:

Like human foods, pet foods have nutritional information panels (NIPs) on their package. Look at them before buying and take note of the sodium and fat content. Pick ones that have less of these.
Also, check the ingredient list. Ideally, cat and dog foods should have some source of animal protein and fat. You can identify these sources by the presence of ingredients such as beef, chicken, turkey, etc.
If you are unsure or are confused by the numbers and jargon on the food packages, you can always ask for advice or clarification from a veterinarian.

How about cooked foods? Dr Goh shares that it is increasingly common these days for pet owners to prepare their own homemade meals for their cats and dogs. In fact, November 1 is National Cook for Your Pets Day in the US! There are recipes available online for pet owners who wish to go down this route. You can check with your pet’s veterinarian if you have concerns about allergens, nutritional content, etc.

Just no table scraps, please. These are almost always foods with all the nutritious parts already eaten. It is best to delegate the table scraps to the waste bin instead of your pet’s food bowl.

ENERGIZE WITH EXERCISE

You are advised to be physically active for at least 30 minutes every day to maintain a healthy weight and keep the body functioning at tip-top condition. Also, daily physical activity helps to reduce risks of non- communicable diseases such as diabetes, high blood pressure and more.

Cats and dogs can develop these health problems too, especially if they become overweight. Hence, they also need to be physically active every day!

Cats are more independent in nature. Dr Goh points out that they usually get their exercise during their daily rounds around and outside the house.

On the other hand, dog owners often need to allocate some time to take their furbabies out for their daily workout. Dr Goh recommends a 2-3 km walk around the neighbourhood, a simple but enjoyable exercise that allows both dog and human to get their daily workout.

A MEDICAL CHECK-UP ONCE A YEAR

Just like humans, dogs and cats also can develop cancer, high blood pressure and other diseases. Most of these diseases can be treated or managed more successfully when detected early. Hence, Dr Goh recommends bringing your cat or dog to the vet’s clinic for a medical check-up once a year. HT

Perfect Skin For The Holidays

May 8, 2022 Return

Dr Ch’ng Chin Chwen

Consultant Dermatologist

WORDS: HANNAH MAY-LEE WONG

Well, there is no such thing as perfect, but with some tender loving care (and the help of a skin specialist), we can certainly make improvements to our complexion.

We all want to look our best during the holiday season. But how do we do that when we all have different skin qualms? This month, consultant dermatologist Dr Ch’ng Chin Chwen provides some tips about some of the most common skin troubles we face and how to fix the problem.

ACNE

SHOULD WE SQUEEZE?

It depends on the type of acne you have and whether the acne is matured. Generally, there are two types of acne:

Non-inflammatory acne

Also known as comedones or more commonly referred to as blackheads and whiteheads. It is best not to squeeze or pick these. Anti-acne medications are able to dissolve them. Be careful though; comedones typically do not leave scars, but forcefully squeezing them might cause scarring.

Inflammatory Acne

These include pustular and cystic acne. If you have pustular acne and it is matured and ready to pop, I would recommend extracting it, but make sure your hands and equipment are clean or sterile. Cystic acne is more severe and would normally require oral medication to treat. Furthermore, some larger cystic acne may need to be injected with a low dose of steroids to reduce inflammation and to shrink it. This way, scars are less likely to form. Pustular and cystic acne tend to leave scars if not treated properly.

FOOD WITH HIGH GLYCAEMIC INDEX (SUGARY FOODS AND BAD CARBS) AGGRAVATE ACNE.

HOW DO WE TREAT ACNE?

For mild cases of acne, topical anti-acne gels and creams are effective. These come in the form of antimicrobials, topical retinoids, azelaic acid and others. Some products contain AHA and BHA which can help dissolve comedones. With these products, you’ve got to be patient because it takes a few weeks for improvements to be seen. When applying topical products, I would not advise people to only dot the product on the pimples. It is better to apply a thin layer onto the entire face to prevent new ones from popping up.

Oral medication for acne includes oral antibiotics, synthetic retinoids and hormonal treatment (for women). However, more and more dermatologists are steering away from these options, particularly antibiotics and hormonal treatment. Previously, doctors would first prescribe antibiotics to acne patients for three to six months to try. If it doesn’t work, they upgrade to other treatment options. But on top of the unwanted side effects of long-term use of antibiotics, doctors found that when the patients stopped taking them, the acne came back. Hormonal treatment is a good option for women, especially those with polycystic ovary syndrome (PCOS) which also causes acne. However, the side effects of hormone treatments include bloating, weight gain and water retention. Retinoids are considered the gold standard of acne treatment, but are not suitable for women of childbearing age because retinoids can pass through the placenta and cause neural tube defects.

Physical methods to treat acne are gaining popularity. These include light-based therapy, laser treatment, chemical peels and radiofrequency. Each method works differently, but they all share the common aim of shrinking the sebaceous glands that cause acne. For me, creams and oral medications are still the first line treatments, and physical methods are used as adjunct treatments.

ANY FOODS WE SHOULD AVOID?

Food with high glycaemic index (sugary foods and bad carbs) aggravate acne. It’s best to avoid them when having a breakout.

HOW DO WE DEAL WITH ACNE SCARS AFTER A BREAKOUT?

If you get pigmentation which appears immediately after a breakout, these will fade eventually on its own. Scars that are protruding (keloid scars) will need procedures such as low- dose steroid injections to get rid of them.

Those with scars that are sunken (for example, ice pick scars), can opt for the chemical reconstruction of skin scars (CROSS) technique. This procedure involves trichloroacetic acid being dotted into scarred areas to smoothen them. Box scars or uneven skin can benefit from fractional ablative laser treatment. This involves a dermatologist dotting small injuries onto the scarred skin, so that the area will heal with a reduction of scarring.

WRINKLES

WHY DO WE GET WRINKLES?

Ageing is a natural and inevitable process, and unfortunately, we get wrinkles as we age. Intrinsically and genetically, our cells continuously multiply throughout our lifetime. As this happens, our telomeres shorten and we accumulate cell damage as we go along. Extrinsically, environmental factors like sun exposure makes you age faster. Collagen begins to break down after 15 minutes of being in the sun. People who smoke will also age faster and develop fine lines.

IS IT POSSIBLE TO PREVENT WRINKLES?

There are two types of wrinkles: dynamic wrinkles are those that appear when your face muscles move, and fine lines are those that are there even if there is no movement.

People with less facial expression tend to get less dynamic wrinkles. But if you really want to slow down wrinkle formation, having a healthy lifestyle is the best way to go about it. Diligent sun protection helps too. In terms of products, retinol or retinoids and antioxidants are key ingredients that slow down the appearance of fine lines. You can’t completely prevent wrinkles from forming, but you can slow down the process.

WHAT ARE OUR OPTIONS FOR LESSENING THE APPEARANCE OF WRINKLES?

You could opt for botulinum toxin injections – these are most effective for lessening dynamic wrinkles. For fine lines, you can use retinoids or retinol products, or you can go for laser treatments or chemical peels which stimulate collagen production.

Lines that are very deep are called fixed lines. These initially appear as dynamic lines, but over time they become fixed and are there even when you don’t smile or frown. To lessen these, you would need fillers. Wrinkles can also appear due to sagging, especially when you lose weight. People who have these will benefit from skin tightening procedures and fillers.

PIGMENTATION

WHY DOES SKIN PIGMENTATION APPEAR?

There are many kinds of pigmentations, caused by various factors. Freckles occur due to genetic reasons. Solar lentigo is caused by accumulated years of sun exposure. Melasma is a little more complicated. It can appear due to emotional factors such as stress but can also be caused by hormonal factors and excessive sun exposure. Some people call melasma a mask of pregnancy because women can get it when they are pregnant.

HOW DO WE PREVENT IT?

No matter the cause of pigmentation, the best way to prevent them is sun protection. Freckles, melasma and solar lentigo all darken and worsen when exposed to the sun.

HOW DO WE LIGHTEN SKIN PIGMENTATION?

Again, sun protection. If you protect your skin from the sun enough, it will lighten with time since the skin has the ability to self-repair. If you feel your skin needs some extra help, there are products and procedures that can lighten pigmentation.

Bleaching creams have hydroquinone in them, but I wouldn’t advise to use these long-term because you might get side effects like developing a greenish/bluish tint to the skin (it happens if you use too high of a concentration for too long). Another key ingredient that works is arbutin. It is safe to use as long as your skin is not allergic.

Alternatively, you can go for laser treatments or chemical peels to lighten your skin tone. All these treatment options must be followed by sun protection because freckles and pigmentation can potentially reappear again.

HOW MUCH SUN PROTECTION DO WE NEED?

Get a broad-spectrum sunscreen that protects against UVB and UVA. Textbooks will tell you that you’ll need SPF of at least 30 or 35, but that’s based on a measurement of 2g per cm2 (that’s a thick layer). Most people do not apply that much due to the white cast it gives and it might not feel very comfortable on the skin.

I would advise people to get as high an SPF as they can afford. You are not going to get the exact level of SPF labelled on the bottle. For example, if you apply SPF 35, you might get 7 in actuality.

NO MATTER THE CAUSE OF PIGMENTATION, THE BEST WAY TO PREVENT IT IS SUN PROTECTION

Don’t forget to apply on areas like the ears, neck, hands and toes. Also, note that each application does not protect you for long hours. Guidelines say if you are indoors, you should re-apply every two hours, and if you are outdoors, every hour. Although you have sunscreen on, it’s still important to seek shade especially when the sun is strong. Wear a wide-brimmed hat and large sunglasses for more protection. If you’re worried about vitamin D deficiency, you can always get it from food such as salmon or vitamin supplements.

REDNESS

WHY DO SOME PEOPLE GET REDNESS?

The reason for redness on the skin depends on whether a person has any pre-existing conditions. People can get redness due to acne, eczema or rosacea. Rosacea generally does not get enough awareness in Asia. It is characterized by facial flushing with redness, visible blood vessels, rough skin or even acne-like eruptions, which is why when acne appears on mature skin, we always need to make sure it is not rosacea. People with rosacea tend to get flushes of redness especially when they are hot or eat spicy food.

Other uncommon causes of redness on the skin include photosensitivity – certain people cannot tolerate sunlight and whenever they get exposed, they get red. Some autoimmune diseases like systemic lupus erythematosus (SLE) can cause redness too.

WHAT CAN WE DO TO MAKE IT GO AWAY?

It is important to get the diagnosis right, and then to treat accordingly. If you get lots of redness on your skin and you’re concerned, it’s best to consult a dermatologist. HT

What Determines Our Fertility?

May 8, 2022 Return

WORDS PANK JIT SIN

Dr Eeson Sinthamoney

President-Elect

Obstetrical and Gynaecological Society of Malaysia (OGSM)

The most accurate gauge of a woman’s fertility is the anti-Müllerian hormone (AMH) levels in the body and not her age, says fertility expert Dr Eeson Sinthamoney.

The AMH test is a simple blood test which determines a woman’s fertility as it is a marker for ovarian reserve—an important consideration for women who are planning their pregnancy or struggling with infertility.

For women planning to delay motherhood, the AMH test is also helpful as they can determine their fertility and gauge how many fertile years they have ahead of them and be well- informed in decisions involving parenthood.

AMH testing is also important in those seeking fertility treatment as it is a good gauge of a woman’s response to ovarian stimulation, which is the first step towards in vitro fertilization (IVF). “If AMH levels are within the normal range, the ovaries are more likely to react more positively to stimulating drugs and more eggs are likely to be retrieved, often resulting in a higher IVF success rate,” Dr Eeson explains.

“We used to have to send our samples overseas to test for AMH levels, hence the reason we didn’t use it very often,” he adds. He goes on to explain that nowadays, the AMH test is available locally and at a relatively cheaper cost.

AMH TESTING IN A TIME OF FALLING FERTILITY RATE

Dr Eeson said Malaysia’s national fertility rate has dropped to an all-time low, as reported by the 2017 Vital Statistics Report of the Department of Statistics (DOSM).

“It is widely believed by the professional community that the infertility rates have also increased. Women are born with around two million eggs and these continue to decrease throughout their lives,” says Dr Eeson.

The risk of egg abnormality also increases with age and above the age of 45, there is 100 percent certainty of egg abnormality.

Dr Eeson points out that it was common for women to have their first child at the age of 17 or 18 a few decades ago. Now, more women are delaying childbirth to focus on establishing their careers, thus more and more are starting families in their late 20s and well into their 30s.

“Over the past 5 years, I have seen more and more women in their early 30s come to me to find out about how they can plan ahead so that if they decide to delay parenthood, their chances are not diminished. Whatever the reason for the delay, they may still want to experience motherhood, and the AMH test helps them match their career and parenthood goals,” he elaborates. HT

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What Are The Latest Updates On Diabetes?

May 8, 2022 Return

WORDS PANK JIT SIN

Think you have heard everything there is to know about type 2 diabetes? Given the ongoing research on this disease, it is very likely that there is some latest news that you may have missed out on. Last November 2018, medical experts from all over the world gathered in Kuala Lumpur for the 12th International Diabetes Federation Western Pacific Region (IDF-WPR) Congress and 10th Asian Association for the Study of Diabetes (AASD) Scientific Meeting. We are fortunate to be among the attendees, and we are pleased to share with you four important updates that were discussed during these events.

Dr Martalena br Purba

Dietitian

UPDATE 1: PLANT-BASED DIET SUPPORTS BETTER BLOOD GLUCOSE CONTROL AND IMPROVES OVERALL HEALTH

Plant-based proteins and a balanced diet can help in diabetes management.

The increase in consumption of calorie-dense foods which include fast foods, meats and other animal fats, as well as highly-refined grains and drinks loaded with refined sugar, are dietary choices contributing to the rising rates of obesity around the world.

As most people know by now, diabetes is closely linked to obesity and type 2 diabetes is more prevalent among people who eat more fat and animal-based foods.

A LOW-FAT PLANT-BASED DIET IS LINKED TO MANY BENEFITS

Didn’t your parents tell you to eat your vegetables? They may not have told you the reasons, but studies have shown that populations eating a plant-heavy, low-fat diet have less risk of heart disease, hypertension, type 2 diabetes, osteoporosis, kidney stones and gallstones; lower death rates from heart conditions, fewer intestinal disorders, and less incidence of certain cancers.

Not necessarily vegetarian

Plant-based diets here are not necessarily vegan or vegetarian in nature, but rather rich in plant- based foods. Animal proteins can be replaced with plant proteins such as tempeh and other soy- based products and legumes. Carbohydrates can come from fruits, vegetables and nuts while calcium and other nutrients can be sourced from dairy and eggs.

DIETARY GUIDELINES FOR PLANT-BASED DIETS

The American Diabetes Association (ADA) and the US Academy of Nutrition and Dietetics (AND) recently recommended a well- balanced, plant-based diet as part of diabetes nutrition. These guidelines recommend carbohydrates intake from legumes, whole grains, vegetables and dairy products, with an emphasis on nutrient-dense, high-fiber, low-glycaemic load foods. In short, plant-based diets are consistent with these diets.

Plant-based diets are indirectly beneficial for blood sugar control because they contain less saturated fatty acids. When taken over a long term, plant- based diets result in lower free- fatty acid levels and lesser fat accumulation thus leading to a reduction in diseases associated with free fatty acids, which includes heart failure, metabolic syndrome, and more.

Professor Lee In-Kyu

President of Korean Diabetic Association Department of Internal Medicine Kyungpook National University Daegu, South Korea

UPDATE 2: DIABETES IS LIKELY TO INCREASE THE RISK OF CANCER

According to current scientific research, it seems to be true. Type 2 diabetes is closely linked to obesity and obesity increases the risk for cardiovascular diseases (which includes mainly heart disease and stroke), muscle and bone diseases; and cancers. Obesity related cancers include breast, endometrial, ovarian, colorectal, pancreatic, renal, liver and gallbladder cancer.

Although the reasons for this link have not been thoroughly identified, it is thought to be related to hyperinsulinaemia (excess insulin), hyperglycaemia (high blood sugar) and inflammation. On a more scientific note, there’s a link between energy metabolism of our cell’s powerhouse, the mitochondria, and how it’s altered in cancer cells. This alteration is induced by starvation, nutrient deficiency, long-term high-fat diets and can be found in patients with obesity and diabetes.

According to the American Institute for Cancer Research, after smoking avoidance, maintaining a healthy weight is the most important thing we can do to prevent cancer. Our National Health and Morbidity Survey states that as of 2016, 30 percent of Malaysians are overweight and 17.7 percent of them are obese. This means 30 percent of the population are at increased risk of the cancers listed above.

WHAT CAN WE DO TO REDUCE THE RISK?

The answer seems quite universal. A healthy diet, physical activity and weight management – the core of a healthy lifestyle – not only improve type 2 iabetes outcomes, but also reduce the risk of cancer.

Some diabetes drugs are associated with reduction in cancer risk. Metformin, for example, is a first-line drug in the treatment of type 2 diabetes. The drug has been around for many years and is widely used on its own or in combination with other antidiabetic medications. Metformin use has been linked to lower risks of cancer, and a study in 2010 revealed that it could lower the risk by up to 30 percent.

Insulin, on the other hand, has a somewhat volatile reputation, with some studies linking it to an increased risk of cancer while some claim it does not raise any cancer risks. However, the benefits of insulin use in type 2 diabetes far outweigh its cancer risk, which is minimal, if any. Cancer risk should not be a major factor in choosing between available diabetes therapies for the average patient. Only for selected patients with very high risk of cancer occurrence or for recurrence of specific cancer types, should these issues require more careful consideration.

Patients should seek appropriate cancer screenings as recommended for their age and sex ie, colon and prostate cancer for men above 50.

Dr Andrea Ban Yu-Lin

Consultant Respiratory Specialist Head of Respiratory Unit

Universiti Kebangsaan Malaysia Medical Centre

UPDATE 3: OBESE OR OVERWEIGHT PEOPLE WITH DIABETES ARE PRONE TO HAVE OBSTRUCTIVE SLEEP APNOEA, WHICH SHOULD BE TREATED.

OSA: NOTHING TO DO WITH THE OFFICIAL SECRETS ACT!

Obstructive Sleep Apnoea (OSA) is a dangerous condition which is expected to affect more people in the near future, in tandem with the obesity epidemic. This makes it necessary for effective and acceptable treatment options to be available.

OSA is a condition where a person stops breathing frequently during his or her sleep. This results in interrupted sleep and subsequently a host of other diseases. Diagnosis is a challenge as the current criteria requires overnight monitoring of sleep-disordered breathing. This means a person suspected of OSA will need to register to a sleep clinic and have special monitoring equipment (a polysomnography) fixed on him or her. As can be expected, the diagnosis itself can be expensive.

Lack of sleep is associated with excessive daytime sleepiness and an increase in workplace and driving accidents. Sleep fragmentation also affects glucose balance in the body and in rats, this leads to increased fat deposition, insulin resistance and hyperglycaemia via increased cortisol and oxidative stress.

There’s more! OSA is also associated with increased risk of hypertension (high blood pressure), atrial fibrillation (uneven heartbeat) and even stroke! In other words, OSA is a recognized independent risk factor for cardiovascular and metabolic disorders.

WHAT ARE THE RISK FACTORS?

OSA is more common in males with a prevalence of 24% versus only 9% in women. It is thought that men tend to store more fat around the neck, hence the increased likelihood of airway blockage which is responsible for snoring and intermittent stoppage of breathing.

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WHAT ARE THE AVAILABLE TREATMENT OPTIONS?

Sleep on your side. As the soft tissue at the back of the throat is responsible for blocking one’s airway, sleeping on the side or belly may help alleviate sleep apnoea. Lose weight! As obesity is one of the main causes of snoring and OSA, it makes sense that by losing weight, one would be able to rectify the problem. A 10% weight loss predicts a 26% reduction in apnoea-hypopnoea index (a measurement of the severity of sleep apnoea). Conversely, a 10% increase in weight is associated with a six-fold increase in chances of developing moderate-to-severe OSA.

There’s a machine called the continuous positive airway pressure (CPAP) which forces low pressure air into the nose at night to help with breathing and to prevent hypoxia. The downside of this treatment is some persons may not like the discomfort of having a mask over their face as they sleep. A newer version called the bilevel positive airway pressure (BiPAP) machine works in the same fashion.

Should all else fail, surgery is also an option. Various surgical therapies are available, and these should be discussed with a specialist. Among available procedures are radiofrequency ablation, mandibular advancement, palatal implants and tracheostomy.

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AS OBESITY IS ONE OF THE MAIN CAUSES OF SNORING AND OSA, IT MAKES SENSE THAT BY LOSING WEIGHT, ONE WOULD BE ABLE TO RECTIFY THE PROBLEM.

Associate Professor Barakatun Nisak Mohd Yusof

Department of Nutrition and Dietetics Universiti Putra Malaysia

UPDATE 4: A DIET HIGH IN FAT AND/OR LOW IN CARBS MAY NOT NECESSARILY BE BENEFICIAL

WHAT’S THE RATIONALE BEHIND LOW-CARB DIETS FOR PEOPLE WITH T2DM?

Carbohydrates in the diet raise blood sugar levels, and because diabetes is defined by high blood sugar levels, it makes sense to minimize carbohydrates in the diet.

A high-carbohydrate diet leads to constantly high blood sugar levels, which in turn leads to a constant high demand of insulin. As a result, cells in the body become insulin resistant. The positive feedback loop creates an environment in the body where high glucose and high insulin levels circulate in the blood but due to insulin resistance, the person is still hungry.

What’s high and what’s low?

Low-fat diets are usually synonymous with high carbohydrate content, while a very-low-carbohydrate diet is synonymous with high-fat or high-protein (ketogenic) content.
A very-low-carbohydrate or ketogenic diet only allows for 5% to 10% of daily energy intake to come from carbohydrates.
A low-carbohydrate diet consists of less than 26% carbohydrates.
Moderate carbohydrate diets range from 26% to 45% carbohydrates.
A typical Asian diet consists of 45% to 60% carbohydrates. In the Asian context, a high-carbohydrate diet is one that consists of more than 65% carbohydrate intake.

We’ve heard many people talk about the benefits of low-carbohydrate diets. The evidence seems to swing from one end to another. BUT DO LOW-CARB DIETS REALLY WORK?

According to a study named PURE, which was published in 2017, the intake of high carbohydrate was associated with a higher risk of mortality. The study found that fat intake had no effect on cardiovascular disease or death.

Later in 2018, the Atherosclerosis Risk in Communities (ARIC) study revealed a U-shaped association between percentage of energy from carbohydrate and all-cause mortality. What this means is if too little (less than 40%) or too much (more than 70%) of our daily diet is from carbohydrates, the risk of death increases.

SOUNDS LIKE SOMETHING WE’VE HEARD BEFORE?

Yes, balance is the key. The ARIC study found that carbohydrate intake of between 50% and 55% of daily energy intake pose the least risk in terms of deaths. Also, definitions of moderate intake differ in Asian and Western settings, as Asians take more carbs in general.

But wait! The type of protein and fat plays a role, too. The type of non-carbohydrates ie, the fats and proteins consumed as part of the daily dietary intake also plays a big role in determining the risk of death. For instance, if the bulk of protein and fats come from animal sources then there is an increased risk of death.

Conversely, if the bulk of protein and fats are derived from plant and unsaturated sources then they become beneficial for health, and thus, result in a reduced risk of death. HT

Protect Them Against Pneumonia

May 8, 2022 Return

Words Hannah May-Lee Wong

Datuk Dr Zulkifli Ismail

Consultant Paediatrician & Paediatric Cardiologist

Dr Aminah Bee Mohd Kassim

Public Health Physician

Dr Hishamshah Mohd Ibrahim

Paediatrician

World Pneumonia Day falls on the 12th of November every year. In November 2018, Immunise4Life hosted an educational programme to raise awareness on the importance of vaccination as prevention against pneumonia.

Consultant paediatrician Datuk Dr Zulkifli describes pneumonia as a serious lung disease whereby the alveoli in the lungs become filled with fluid or pus, which would cause difficulty in breathing. “Pneumonia is an infection that affects the parenchymal (the functional) part of the lungs. It affects the little globules at the end of the respiratory tract called the alveoli. When there is infection, inflammation occurs and when that happens, the cells swell up causing fluid build-up. Fluid in the lungs will hamper the transfer of oxygen from the air that we breathe to the capillaries around the alveoli, and this causes difficulty in breathing,” he explains. Common signs and symptoms of pneumonia include cough, difficulty breathing, rapid heartbeat, fever, shivers and chest pain.1

Public health physician, Dr Aminah adds that pneumonia is spread through air-borne droplets emitted by infected people when they cough or sneeze.

MORE THAN THE DISEASE

Other than suffering an infection, it is not uncommon for those struck with pneumonia to spend weeks at the hospital. Not only do parents have to deal with sky high medical bills, if a child gets pneumonia, his or her parents would have to take time off work. Furthermore, if the child is admitted to the ICU (intensive care unit), he also runs the risk of getting another infection from spending time at the ICU.

The cost of the vaccine depends on where you go to get it. On average, it is RM250 to RM300 per dose, and a child (depending on age) will need up to four doses. “In total, the vaccines would have cost just above RM1000 for four doses that a child typically needs. It is the most effective way of preventing pneumonia.” Dr Zulkifli adds, “When the vaccine was introduced in Malaysia in 2007, 3% of the birth cohort were vaccinated. The good news is that numbers have been increasing. Now 15% to 18% of children are vaccinated.”

WHO IS AT RISK?

Dr Zulkifli explains that anybody is prone to get infected if they are exposed to a high enough dose of bacteria or virus. That said, there are a few groups of people who are more susceptible to contracting pneumonia, namely:

Those who have underlying medical conditions like having congenital or acquired immunodeficiency, sickle cell disease, pulmonary disease, chronic heart disease, chronic renal disease, diabetes and more.
Children younger than the age of two and the elderly older than 65.
Certain ethnic groups are more predisposed to getting pneumonia. These include Asian, Black, Hispanic and Native American people.
Children who are looked after outside home (at a nursery or day care) for at least four hours a week and are in the presence of at least two children other than siblings.

WHAT CAUSES PNEUMONIA?

“Pneumonia is mostly caused by viruses. The common ones are: influenza virus, respiratory syncytial virus (RSV), measles virus and chicken pox virus. Bacterial causes include Streptococcus pneumoniae and Haemophilus influenzae type B (Hib). But in terms of pneumonia-associated mortality (death) rates, the numbers are higher with those cases caused by bacteria. This means, vaccines against pneumococcus is important,” Dr Zulkifli explains.

“Across the world, most deaths associated with pneumonia occur in the Southeast Asian region (where Malaysia is) and Western Pacific Region. But you’ll find that deaths caused by pneumonia has been decreasing from the year 2015.” Dr Zulkifli continues, “Compared with other Asian countries such as Indonesia, the death toll in Malaysia is low. This is not because we don’t see a lot of cases of pneumonia. Malaysia has been seeing good survival rates due to the health seeking behaviour of Malaysians and the good accessibility of health centres across Malaysia, from where patients can be referred to a tertiary health centre.”

Pneumonia is a health issue not to be taken lightly. It is the third leading cause of death among children under five in Malaysia, just behind deaths cause by delivery complications and congenital malformation.

HOW CAN WE PREVENT PNEUMONIA?

“Exclusive breast feeding for the first six months would give some protection to the child. Taking care of the environment where the child spends time is important too,” says Dr Zulkifli. Haze, indoor pollution and indoor smoking aggravate pneumonia.

He adds, “The practice of hand washing with soap and water prevents spread of disease. If possible, limit your child’s exposure to other children. This doesn’t mean your child should not play with other children. But be careful and watch who they play with. Make sure they play with kids who do not have a cough or running nose. Adequate nutrition is also important to ensure good health of a child.”

Vaccines are among the most effective means of preventing disease, disabilities and death in infants and children. Measles, pertussis and invasive Hib disease for example, had a reduction of 99-100% after vaccinations for those diseases were introduced.

Dr Zulkifli explains, “the pneumococcal vaccine is now being used in 142 countries in the world. In the US, when the vaccine was introduced in the year 2000, there was a 94% reduction of contracting pneumonia in children under 5 who received the vaccine. At the same time, what was not expected was that there was a 65% reduction of invasive pneumococcal disease in the elderly (older than 65 years) who were not vaccinated. This is the indirect effect of vaccination known as herd immunity. When you vaccinate the children, the elderly get protected because there are less circulating bacteria around.”

HOW DOES PNEUMONIA AFFECT YOUNG CHILDREN UNDER FIVE?

Younger children are particularly more vulnerable to complications of pneumonia. Paediatrician Dr Hishamshah remarks: “Treating pneumonia in young children can be complex. The disease can progress rapidly, and patients may require oxygen, intravenous therapy to deliver strong antibiotics and possibly surgery to drain their lungs. If lungs failure occurs, we will need to put them on a ventilator machine to enable them to breathe.”

He adds, “A small percentage may end up with chronic lung disease, which requires long term management and may impact quality of life down the road. The impact and burden not only falls on the child who is infected with pneumonia, it affects the parents and the hospital where the child is admitted. All of this can be prevented.”

THE TYPES OF VACCINATIONS AVAILABLE

There are conjugate and polysaccharide type vaccines for pneumonia. The polysaccharide vaccines will protect a person from 23 types of pneumococcal bacteria, while the conjugate will cover 10 or 13 serotypes. The conjugate vaccines can be given to children less than two years of age, while the polysaccharide is suitable for those older than two years old.

Dr Zulkifli adds “The polysaccharide vaccine will not prevent carriage, which means you may still carry the bacteria in your nasopharynx and you can transmit it. Whereas the conjugate vaccine does prevent carriage, which is why we see that indirect effect in the elderly when the children are vaccinated.” He continues, “The pneumococcal conjugate vaccine (PCV) confers life-long protection from the Streptococcus pneumoniae bacterium, which is the leading cause of severe pneumonia in children under five years old, accounting for one-third of deaths due to pneumonia, globally.”

Dr Aminah says the Hib, MMR and DTaP vaccines are already part of Malaysia’s National Immunisation Programme and are free of charge for infants. These vaccines protect against Hib, measles and pertussis. However, she encourages parents to talk to their doctors and consider vaccinating their children against influenza, chicken pox and pneumococcus. These would optimize their protection against vaccine-preventable pneumonia. HT

Reference: www.nhs.uk/conditions/pneumonia/

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“Eeeuw, My Baby Has Diaper Rashes!”

"Eeeuw, My Baby Has Diaper Rashes!"

May 8, 2022 Return

Words Pank Jit Sin and Lim Teck Choon

Dr Leong Kin Fon

Paediatric Dermatologist

Patches of bright red skin on the buttocks, thighs and genitals… many parents will be familiar with such a sight in their babies as diaper rash is a common condition among babies that regularly wear diapers. Also called perianal dermatitis, diaper rash can cause a baby to fuss and cry (especially when someone touches the diaper area) and alarm the parents.

This month, paediatric dermatologist Dr Leong Kin Fon offers a look into what causes diaper rash and how we can keep our little ones free from this annoying condition.

WHAT CAUSES DIAPER RASHES, ANYWAY?

There are a few possible causes that parents should take note of.

The baby’s own stool. Dr Leong shares that a baby’s stool contains high amounts of protease, an enzyme that helps in the digestion of protein. Protease can also irritate a baby’s skin, which is thinner and more sensitive than an adult’s. This is why diaper rash is more prone to break out when a baby experiences frequent bowel movement or has diarrhoea.

Tip! Vaseline and zinc oxide cream can help protect a baby’s intact healthy skin from irritation. For babies who are prone to developing diaper rash, parents may consider the use of diaper rash prevention creams that contain protease enzyme inhibitors which keep the protease in a baby’s stool from irritating the skin and vitamin E which helps to support the healing of damaged skin.

Diapers that are too tight. When a baby’s diapers are too tight, the diaper material can rub against the skin each time the baby moves. This constant rubbing can lead to rashes forming on the affected areas of the skin. Also, tight diapers reduce the airflow into the diaper region, causing that area to stay moist. A moist environment will encourage bacteria and yeast to grow and irritate our baby’s skin.

Tip! Make sure our baby’s diapers fit comfortably without being too snug or too loose.

Constant use of wet wipes. Babies do as they please, and much to many parents’ exasperation, this behaviour also applies to doing a number one or two at the most inconvenient moments. In such a moment, wet wipes can come in handy. However, Dr Leong cautions against overusing them, as wet wipes tend to contain preservatives that can cause allergic reaction on a baby’s skin.

Tip! “Wet wipes are no replacement for water and soap,” he clarifies.

OTHER GENERAL TIPS TO KEEP DIAPER RASH AWAY FROM OUR BABY

Change our baby’s diapers often. Soiled diapers should be removed promptly. If your baby is cared for by a nanny or a daycare centre, remind them to do this in your absence.

Clean our baby’s bottom gently but thoroughly during diaper change. We can do this using a moist washcloth. As Dr Leong mentioned earlier, avoid the use of wet wipes as much as possible.

It’s okay for baby to go without diapers. Exposing our baby’s skin to air is a gentle but effective way to let the diaper region dry. Therefore, after a diaper change, we can lay our baby down on a large towel (just in case our baby decides to do another round) and play with him or her for a while.

Wash our hands before and after a diaper change. Our hands may carry germs that can be passed on to the baby’s diaper region and cause an infection.

MY BABY HAS DIAPER RASHES… WHAT SHOULD I DO?

Diaper rashes are rarely life threatening and can often be addressed without having to bring the baby to a paediatrician.

Dr Leong advises the following:

Keep the baby’s skin dry as much as possible.
Wash soiled areas with tap water. Then, use a clean cloth or towel and gently pat to dry.
Change the baby’s diapers as often as possible.

However, we should bring our baby to a paediatrician if we observe any of the following:

The rashes look severe.
The rashes remain or get worse despite our efforts to keep our baby’s skin dry and clean.
There is also bleeding and/or pus formation.
Our baby also has a fever.

KEEP THE BABY’S SKIN CLEAN AND DRY, AND CHANGE DIAPERS AS OFTEN AS POSSIBLE. HT

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