For the upcoming fasting month, we are pleased to share some important advice from the good people at Alpro Pharmacy.
WILL THE USE OF INHALERS INVALIDATE YOUR FASTING?
There are 2 types of inhalers: ‘preventer’ inhalers and ‘reliever’ inhalers. If you are unsure which of your inhalers is which, check with your doctor.
While fasting, you should continue to use your preventer inhalers, typically twice a day—before sahur and before you go to bed. It’s best to check with your doctor how often and when you should use your preventer inhaler.
Use your reliever inhalers when you have an asthma attack.
WILL FASTING PUT YOU AT RISK OF DEHYDRATION OR LOW BLOOD GLUCOSE (HYPOGLYCAEMIA)?
If you have diabetes, check your blood glucose 2 hours after sahur and when you experience symptoms such as dizziness, cold sweat, blurred vision, and shivering. Checking your blood glucose won’t invalidate your fasting.
If your blood glucose level is below 3.9 mmol/L, you will need to break your fast for the sake of your health.
People with diabetes shouldn’t delay breaking their fast. Keep some dates with you if you have diabetes and you’re fasting. That way, when you’re still stuck in traffic or at work during iftar, you can break your fast with 1 or 2 dates.
Eat foods rich in dietary fibre for optimal blood glucose control during the fasting month. Dietary fibre helps keep you feel full longer and stabilize your blood glucose levels.
HOW TO FAST WHEN YOU HAVE GASTRIC PROBLEMS
If you have gastric problems, break your fast by eating moderate amounts of foods.
Avoid eating fried foods and gassy drinks in too much amounts or too quickly.
Also, it’s best to avoid drinks that are high in caffeine, such as coffee.
In conjunction with International Women’s Day, the Mental Illness Awareness and Support Association (MIASA) hosted a half-day event at Royale Chulan, The Curve (Kuala Lumpur) on March 11, 2023.
TRANSCENDING ALL BOUNDARIES: BE REVOLUTIONARY
The theme of International Women’s Day this year, ‘Transcending All Boundaries: Be Revolutionary’, calls for the championing of efforts that will empower women in spite of continuing challenges faced across many sectors of society.
The Founder and President of MIASA, Puan Anita Abu Bakar, outlines the different barriers faced by women due to various cultural and societal norms, which are further compounded and exacerbated for those who have a particular disability or struggles with their mental health.
“When women find it hard to talk about difficult feelings, they tend to internalize them,” she says. “This can lead to depression, eating disorders, and self-harm.”
She shares that past statistics indicated that around 1 in 5 women faces a mental health challenge such as depression and anxiety.
“So, today, we want to let every woman know that there is help, there is support, there is recovery when facing mental health issues. No one has to struggle alone. You don’t have to struggle alone,” she asserts.
BREAKING DOWN BARRIERS ACROSS ALL GENDERS, BECAUSE MENTAL HEALTH ISSUES DON’T DISCRIMINATE
While MIASA champions and supports the efforts to empower women across various social and political sectors of life in Malaysia, the association also is well aware that mental health issues do not discriminate based on one’s gender.
Hence, to achieve the goals and objectives of the association, Puan Anita highlights that broad discussions of gender stereotypes and gender equity should not be restricted to only barriers faced by women.
“In our work within the mental health field in particular, we have a front-row seat to witness the harmful effects gender stereotypes can have not only on women but men too, namely when it comes to expressing one’s feelings. For example, we know that many young boys are implicitly taught to believe that they need to ‘man up’ and that crying is a sign of weakness for example,” she explains.
“So let’s take this opportunity to acknowledge those barriers and boundaries as well, and ensure that all of us, man and woman alike, work harmoniously together to ensure gender equity from all sides,” she concludes.
LAUNCH OF YOUNG ADVOCATES FOR MENTAL HEALTH PROGRAMME TO ACHIEVE GENDER EQUITY THROUGH A ZERO-STIGMA GENERATION
This inaugural programme from MIASA will build on the importance of building a generation free of stigma and discrimination—the zero stigma generation.
The MIASA Young Advocates for Mental Health programme is a 6-month programme that provides a platform for young people to:
Learn about mental health and mental health conditions
Understand the stigma and discrimination around mental health
Acquire qualities and skills of an effective advocate
Receive access to the different resources that support people struggling with mental health issues.
“It is a programme that also goes beyond acquiring knowledge; it provides participants hands-on experience with mental health peers through the shadowing sessions,” Puan Anita further elaborates.
For more information on MIASA and its mental health services as well as programmes, you can visit their website by clicking here (link opens in a new tab).
Heart disease is common. In general, the risk factors are:
High blood pressure or hypertension
High levels of fats in the blood or hyperlipidaemia
Young people that develop heart disease often are significantly overweight, or they have smoking or uncontrolled diabetes from young as major risk factors.
HOW ABOUT FATAL HEART DISEASE?
Fatal heart disease is rare in otherwise apparently fit young people.
Nonetheless, we all know of people that have heart attacks or those who even collapse at a young age.
In many cases there is an underlying driving factor, such as smoking, or an underlying heart muscle defect such as hypertrophic cardiomyopathy
CAN STRESS INCREASE A YOUNG ADULT’S RISK OF HEART DISEASE?
Stress may also play a role, but this is hard to define. Stress is a very personal matter.
For example, some people thrive in stressful environments, while others struggle. How this translates into cardiac risk is not clear-cut, especially as there is no universal definition or measurement scale for stress.
WHAT IS YOUR ADVICE TO YOUNGER ADULTS WHEN IT COMES TO STRESS MANAGEMENT?
We all feel stressed. Sometimes it can be a motivating factor, but sometimes it can be overwhelming and daunting.
It is important to be comfortable and happy in life. Find things you enjoy.
Work hard but don’t do things to excess. This includes overworking, overeating, etc.
Find a job you enjoy. After all, you will spend a significant amount of your time at work.
Find time to relax yourself and keep your body fit and healthy. A simple evening walk may be enough. Jogging or cycling with your family may be even better.
Most people with diabetes or those that have someone close to them that have this disease will know that the disease can harm many organs in the body—such as the eyes, nerves, kidneys, heart, and more.
DO YOU KNOW THAT DIABETES CAN AFFECT THE TEETH AND GUMS AS WELL?
People with diabetes are more likely to have:
Periodontal or gum disease
Persistent bad breath
Tooth decay or cavities
Oral fungal infections
Loss of teeth
Diabetes can cause increased levels of glucose in the blood as well as saliva
The increase of glucose in the saliva encourages the growth of bacteria in the mouth and together with food particles can build soft sticky whitish layer called plaque.
Plaque is the yucky smelly stuff that you can scrape off from your teeth if you haven’t been cleaning them properly. It is the main cause of bad breath.
If left unchecked, the persistent plaque buildup can cause tooth decay and harden to form tartar.
Persistent plaque or tartar buildup causes irritation to the gums
The gums can become red and swollen, and bleeding may occur.
This is the first warning sign that it’s time to visit the dentist.
Otherwise, the infection will go deeper under the gums, causing infection of the bone structure supporting the teeth. This is periodontitis, the second stage of gum disease.
The gums will start to recede, trying to pull away from the tartar formed. Over time the teeth will become unstable, and one may experience pain as a result.
At the final stage of gum disease, the teeth will become so infected and painful that it may need to be removed
In poorly controlled diabetic cases, the gum disease may progress much faster. The severity of the condition may be worse, which is why it is important to visit the dentist early to resolve the issues.
Diabetes and certain drugs can reduce the production of saliva in our mouth
Our saliva contains minerals to protect our teeth from tooth decay, mucin to keep the teeth moist and slippery, antibacterial substances to eliminate potentially harmful bacteria, and it also has the ability to neutralize the acids produced by bacteria in our mouth.
Without the presence of saliva, there is a higher risk of tooth decay and gum disease.
Dry mouth can increase the risk of developing fungal infections called thrush, which are painful white patches in the mouth.
In denture wearers, the dryness can decrease the suction effect of the denture and increase abrasion against the gums, leading to ulcers and mouth sores.
Smoking will worsen the condition further.
In severe uncontrolled diabetic cases, some people can develop burning mouth syndrome—a continuous burning sensation in the mouth that will alter taste and sensation.
HOW THE DENTIST CAN HELP YOU
Gingivitis or periodontitis
The dentist will need to carry out deep cleaning of the teeth and gums, in order to decrease the bacterial load and to allow the gums to heal.
However, the dentist can only do so much—you have to also keep good oral hygiene and use of mouthwash daily.
Your dentist may prescribe some medications to kill the fungus responsible for the infection.
If you use dentures, they will be checked to ensure that they are still fitting properly. You must keep them clean in a disinfection solution at night.
For most non-severe cases, the simplest solution is to keep your body well hydrated at all times. Drinking water regularly also moistens the mouth.
Only in severe cases are saliva substitutes prescribed.
Burning mouth syndrome is usually more complicated and will require specialist attention.
A well controlled blood glucose level as well as a healthy diet and lifestyle are key to reducing and preventing oral health problems. Keeping your mouth healthy will also prevent diabetes-related health problems such as heart disease and kidney disease.
Good oral hygiene will keep your gums and teeth healthy. Brushing twice a day every day, and use a floss or water floss daily.
Visit your dentist regularly for a routine checkup. Please make sure you tell your dentist if you have diabetes. Keep your dentist updated about any changes to your health and blood sugar levels.
For denture wearers, make sure your dentures fit properly, and clean them by soaking them in denture disinfectant at night.
Quit smoking. Smoking will worsen gum condition and overall health.
As we get older, our bodies start to go through normal and expected changes.
It can be upsetting to find yourself unable to keep up with activities and lifestyles that were once simple and effortless, but we must learn to accept that aging is a natural part of life.
Changes in our physical capabilities become more noticeable as we age, and vaginal function, like many other areas of the body, can be affected by age.
AS WOMEN AGE, ESPECIALLY DURING MENOPAUSE, THE VAGINA AND SURROUNDING AREA MAY EXPERIENCE CHANGES THAT IMPACT THEIR ABILITY TO EXPERIENCE PLEASURE
Vaginal dryness is a common menopausal symptom that many Malaysian women experience. Furthermore, 56.1% and 39.9% of postmenopausal women had sexual problems and vaginal dryness, respectively.
However, according to one study, only 38% of the respondents with vaginal dryness sought treatment.
These statistics show that, despite its prevalence, many Malaysian women do not seek treatment for it. This could be due to a lack of awareness about the condition and available treatment options, as well as the societal stigma associated with it.
WHAT CAUSES VAGINAL DRYNESS?
Decrease in oestrogen levels
One of the most common causes.
Oestrogen plays an important role in maintaining the health of the vaginal lining, ensuring that it remains thick, elastic, and well-lubricated.
Its levels tend to drop in older women.
Examples: antihistamines, antidepressants, and birth control pills.
Certain medical conditions
Examples: diabetes, Sjögren’s syndrome, and lupus.
Examples: smoking and inadequate water intake.
SYMPTOMS OF VAGINAL DRYNESS
Burning, pain, or discomfort in the vaginal area
Vaginal bleeding after intercourse
Vaginal bleeding or spotting between periods
Frequent urinary tract infections
THE SOLUTIONS TO VAGINAL DRYNESS
While experiencing vaginal dryness can be frightening, it does not mean the end of the world.
Over-the-counter lubricants or moisturisers
These can help to relieve symptoms and make intercourse more comfortable.
They can help provide temporary relief from the symptoms of vaginal dryness, but they may not be effective for all women and may need to be used frequently.
Examples include coconut oil and aloe vera gel, which can also be used to moisturise the vagina and relieve discomfort.
These natural remedies can also help improve of overall skin texture, reduce of inflammation, and relieve itching or burning sensations.
This can help to replace oestrogen and improve vaginal lubrication.
Can be prescribed in a variety of ways, including vaginal rings, tablets, and creams.
However, hormonal therapy is not the best choice for everyone, so it is important to talk to a doctor or speak to a specialist before you begin.
Ultra Femme 360
This is a non-surgical radiofrequency treatment for both internal and external vaginal rejuvenation.
It can help improve muscle strength and laxity in the vagina, giving you a tighter, firmer vagina.
There is no downtime or scarring.
WHEN SHOULD YOU SEE A DOCTOR?
Although vaginal dryness can be treated at home or with non-invasive treatments, you should seek medical attention if you have symptoms such as:
Bleeding or unusual vaginal discharge
Discomfort from the vaginal dryness interfering with your daily activities
Bleeding between periods or after sexual intercourse.
It is important to note that vaginal dryness can be a sign of an underlying medical condition, such as vaginal infections or sexually transmitted infections.
If the vaginal dryness is severe or long-term, it is best to consult with a specialist, such as a gynaecologist. They can help determine the cause of vaginal dryness and recommend the best treatment option for you.
Abdullah, B., Moize, B., Ismail, B. A., Zamri, M., & Mohd Nasir, N. F. (2017). Prevalence of menopausal symptoms, its effect to quality of life among Malaysian women and their treatment seeking behaviour. The medical journal of Malaysia, 72(2), 94–99. https://www.e-mjm.org/2017/v72n2/menopausal-symptoms.pdf
Nik Hazlina, N. H., Norhayati, M. N., Shaiful Bahari, I., & Nik Muhammad Arif, N. A. (2022). Prevalence of psychosomatic and genitourinary syndrome among menopausal women: A systematic review and meta-analysis. Frontiers in medicine, 9, 848202. https://doi.org/10.3389/fmed.2022.848202
IMMUNOTHERAPY IS A NEWER APPROACH TO TREAT CANCER, BUT WHAT EXACTLY IS IT?
According to Dr Hafizah Zaharah, immunotherapy is a pretty unique way to treat cancer, in that it uses the body’s own immune system to attack cancer cells.
“The immune system is like the police force of our bodies,” she says. “It is designed to protect the body against infections, illnesses, and diseases.”
When it comes to faulty or mutated cells in our body, the immune system identifies and eliminates these cells before these cells become a significant threat to our healty.
However, the cells of our immune system may not be strong enough to kill cancer cells, according to Dr Hafizah. Sometimes, the cancer cells are able to fool our immune system by resembling normal cells or hiding themselves.
THIS IS WHERE IMMUNOTHERAPY COMES INTO THE PICTURE
“Immunotherapy can boost or change how the immune system works, so it can recognize and kill cancer cells,” explains Dr Hafizah.
For example, cancer cells originate from normal cells, so the immune system may still mistake them for normal cells.
“These cancer cells can push a ‘brake’ button on the immune cells, so the immune system would not attack them,” Dr Hafizah adds.
Now, a type of immunotherapy called checkpoint inhibitors can take the ‘brakes’ off the immune system, allowing it to now recognize and attack the cancer cells!
There are other types of immunotherapy, of course, and these treatments can be used for various cancers.
CANCERS THAT CAN RESPOND TO IMMUNOTHERAPY
Non-small cell lung cancer
Triple negative breast cancer
Head and neck cancer
Renal cell carcinoma
WHAT IS IMMUNOTHERAPY LIKE?
According to Dr Hafizah, various immunotherapy agents are given as an infusion into a vein (a drip) typically once every few weeks.
These immunotherapy agents can be given to the patient all by itself, or in combination with targeted therapy or chemotherapy.
“For advanced stage cancer, immunotherapy treatment generally is given for 2 years, alongside close monitoring,” Dr Hafizah further says.
IS IT EFFECTIVE, THOUGH?
Although immunotherapy seems like the answer every person with cancer is looking for, Dr Hafizah warns that not all types of cancers will respond well to the treatment.
This is why, before embarking on immunotherapy, one will first undergo a specific biomarker test, such as the PD-L1 test, which will be carried out on a cancer specimen to ensure that the person will respond to the treatment.
ARE THERE ANY SIDE EFFECTS TO BE CONCERNED ABOUT?
“Generally, the treatment is well tolerated,” Dr Hafizah assures us.
However, just like with most types of treatments, side effects are possible. These include:
Feeling tired, skin rash, or muscle or joint pain
Rare side effects include allergic reactions such as dizziness, fast heart rate, face swelling, or breathing problems
Autoimmune reactions, which can lead to serious problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, etc
While working from home does come with benefits but it also limits physical movements and takes a toll on our postures.
We started seeing a rapidly rising number of young Malaysian adults that are suffering with neck and back pain, especially those working from home and who work for long hours on their devices.
Consciously, we must remind ourselves to pay attention to the signs our back and neck is giving us, so that we can lower the risk of developing serious spinal conditions down the road.
CREATE AN OPTIMAL WORK AREA
Invest in a proper desk and office chair.
Ensure that the chair and desk you’re going to be working on is comfortable, supportive, adjustable, and ergonomically sound.
Pick a work desk with an optimal height so that the neck, shoulders, and arms remain at a neutral position.
Sett up your workstation perpendicular to the window and away from direct light, to minimize the strain on your eyes.
WORK ON YOUR POSTURE
Good standing or sitting posture involves having the body be symmetrical, weight evenly distributed and well aligned so it does not strain the neck and back muscles.
Use a monitor as a primary working computer instead of a laptop to help improve your posture. If that is not possible, use a book or laptop stand to raise the laptop, so it is at eye level.
While being seated, place a small pillow behind your lower back to maintain an arch to lean back in and relieve your back muscles.
Keep your forearms and hands leveled and straight by having the keyboard and mouse close to the laptop.
RELAX YOUR MUSCLES
The issue isn’t sitting or remaining still while working; It’s being stuck in one place for too long. The body accumulates stress between managing tight deadlines, budget demands, performance reviews, and even the everyday challenges of the day.
To keep the mind and, by extension, body healthy, you can combine basic stretches with breathing exercises and other relaxation techniques while you work.
Stretches, short walks, or even small bursts of exercise are a great way to get the muscles active and engaged throughout the day.
Set alarms or reminders throughout the day to get up and stretch. A 30-second “microbreak” is just enough to change your posture briefly and helps take the pressure off and relax.
GOOD NEWS FOR MALAYSIANS THAT REQUIRE FINANCIAL ASSISTANCE TO UNDERGO KIDNEY TRANSPLANT
The National Kidney Foundation (NKF) of Malaysia has launched its Kidney Transplant Subsidy.
This subsidy aims to help underprivileged patients and organ donors with their financial burden of kidney transplantation.
The subsidy will cover various costs from pre- to post-kidney transplantation, including income loss replacement for the workup and recuperating period.
“The subsidy accounts for the many costs that are prevalent in the process of transplantation, which can discourage organ donors and patients from following through especially for those that are underprivileged. With over 8,000 Malaysians being diagnosed with kidney disease annually, it’s imperative that we help facilitate transplantation to the best of our ability,” says Khor Xin Yun, the Chief Executive Officer of NKF Malaysia.
WHAT THE KIDNEY TRANSPLANT SUBSIDY COVERS
BEFORE THE KIDNEY TRANSPLANT
Traveling expenses for out-of-town patients
Lodging expenses for out-of-town patients
Income loss replacement during organ donor’s workup
Other pre-kidney transplant workups, should services/facilities are not available at government hospitals and are needed in private settings
Other areas, where the need for kidney transplant screening is not available in government hospitals or being referred by government hospitals to private medical centres
DURING THE KIDNEY TRANSPLANT
Lodging expenses for the patient, organ donor, and carer
Subsistence for the poor, from pre to post-kidney transplant, as needed
Income loss for the organ donor during the recuperating stage
AFTER THE KIDNEY TRANSPLANT
Traveling expenses for follow-up
HOW TO APPLY FOR THE KIDNEY TRANSPLANT SUBSIDY
Government or university hospitals
To apply for the kidney transplant subsidy, the consultant nephrologist from a government hospital refers and recommends a patient along with a detailed medical summary and a list of items required for the subsidy.
If a government or university hospital does not have the capacity to tend to the patient
The nephrologist can refer the patient to a private hospital for pre-transplant screening and workups under the subsidy. However, the subsidy does not include the cost of surgical fees, as government hospitals have the capacity to perform kidney transplant surgery and provide immunosuppression therapy.
For more information about the NKF Kidney Transplant Subsidy, visit their website (link opens in a new tab) call 03-7954 9048 ext 208.
Continuous glucose monitoring (often abbreviated as CGM) is basically a system that allows one’s blood glucose levels to be monitored automatically.
HELPS TO IMPROVE YOUR DIABETES MANAGEMENT
This system opens up a world of opportunities for better blood glucose management for people with type 1 diabetes as well as those on type 2 diabetes that require insulin.
After all, with information of their blood glucose levels that can be obtained immediately, they can make quick informed decisions about their food choices and the dosage of their insulin as well as when to administer it.
LETS YOU ANTICIPATE A POTENTIAL INCOMING MEDICAL EMERGENCY
The ability to observe the pattern of the rise and fall of their blood glucose also allows them to be alert of the possibility of a hypo- or hyperglycaemic episode, and take prompt measures accordingly.
NOT JUST FOR PEOPLE WITH DIABETES
Additionally, continuous glucose monitoring can also benefit people with kidney problems as well as pregnant women worried about gestational diabetes.
RECOMMENDED BY EXPERTS
It’s really not surprising, therefore, that the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium reported a growing consensus on the definitions and targets of continuous glucose monitoring metrics to allow healthcare professionals and people with diabetes to make full use of this system in diabetes management.
Indeed, the United Kingdom has already taken steps to do this.
All in all, this is a remarkable example of how technology is making diabetes management, which can be complex and confusing to some people, considerably easier to figure out and implement correctly!
Continuous glucose monitoring is a feature in certain types of blood glucose monitor or glucometer. You can talk to your doctor or your pharmacist for more information on continuous glucose monitoring and whether you can benefit from using a glucometer that comes with this feature.
Reference: Oliver, N., Chow, E., Luk, A. O. Y., & Murphy, H. (2023). Applications of continuous glucose monitoring across settings and populations: report from the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors – East Meets West Symposium. Diabetic medicine : a journal of the British Diabetic Association, e15038. Advance online publication. https://doi.org/10.1111/dme.15038
Rabbits are pack animals that have many predators, so they are conditioned to always be alert and wary. Therefore, when you adopt a pet rabbit, it may take a while for the rabbit to become familiar with its new home and to feel safe.
Wild rabbits live in warrens—underground homes interconnected by tunnels. Therefore, even tame rabbits have this urge to dig with their paws. Therefore, line your rabbit’s new home with something that it can dig on.
Rabbits answer the call of nature in the same spot as much as possible, so minimize the risk of predators tracking them down. Therefore, tame rabbits can be trained to do their business in the same place every day.
A rabbit’s tooth never stops growing throughout its life, and a wild rabbit keeps its teeth to manageable length by chewing down on rough parts of plants. Therefore, give your pet rabbit things that it can always chew on, so that its teeth won’t become overgrown.
A rabbit tells you that it is not happy with you by thumping its rear feet. It may also bite, although fortunately rabbits are usually not aggressive to humans.
YOUR RABBIT’S IDEAL HOME
Keep your rabbit in a well-ventilated cage—such cages are sold in pet shops. Avoid putting rabbits in closed “houses” or glass cases, as these often lack ventilation.
Rabbits may develop sore hocks, with its feet becoming raw and inflamed, when they spend too much time on wire flooring, so make sure that the wire flooring has a mesh size that is as small as possible (1 x 2.5 cm should be good).
Have a solid and smooth area for the rabbit to rest on, such a wood or Plexiglas surface, so that it can take a break from moving around on the wire flooring.
Grass hay makes good bedding for the rabbit, as it is comfy and also provides a nice snack for a hungry rabbit!
HEALTHY RABBIT MUNCHIES
A rabbit needs plenty of dietary fibre to keep its digestive system healthy. Unfortunately, most commercial-available pelleted diets sold in stores do not provide enough fibre for the needs of an older, non-breeding, and physically inactive house rabbit.
Usually, such rabbits will need to their pellets supplemented with grass hay, leafy green vegetables, and a small amount of treat foods (rolled oats, stale bread, fruits, etc). Therefore, discuss with a veterinarian (that’s an animal doctor) on how to best meet your rabbit family member’s nutritional needs.
Make sure that your rabbit always has clean and fresh water to drink. If you have an inverted sipper bottle for your rabbit, check often to make sure that the drinking or ‘straw’ part of the bottle is not blocked.
TRIPS TO THE VET
Ideally, have the vet examine your rabbit once a year to check for lice, parasites, and tooth problems as well as signs of diseases.
Pet rabbits can be neutered when they are 3 or 4 months old to keep them from being aggressive.
IF YOU NEED TO LIFT & CARRY THE RABBIT AROUND IN YOUR ARMS
Grasp your rabbit family member gently by the scruff of its neck to keep it docile.
Cup its hindquarters with your other hand to keep it from kicking you with its rear legs.
Then gently pick the rabbit up, keeping it in a vertical position.
Alternatively, once you have grasp the rabbit’s scruff gently, you can place its head under your other arm (be gentle, don’t squeeze!) and use that arm to support its hindquarters.