Category: For Her

Keep the Hope of Pregnancy Alive in Spite of Breast Cancer

FEATURED EXPERT
DR CHRISTINA LAI NYE BING
Consultant Clinical Oncologist
Sunway Medical Centre

WHY IS BREAST CANCER SO PREVALENT AMONG YOUNGER WOMEN THESE DAYS?

Aside from unhealthy diet and exposure to cancer-causing chemicals or carcinogens in the environment, Dr Christina Lai Nye Bing shares that one possible factor is that women are choosing to marry and have children at a later age.

This somewhat paradoxical concept can be explained by the link between breast cancer and the female sex hormone oestrogen.

“Breast cancer is a hormone-related cancer, and high levels of oestrogen in the body increases the risk of breast cancer as it encourages cancer cells to grow by promoting cell division and reproduction,” Dr Christina explains. “Women in the previous generation who get married and have children earlier have a lower risk of breast cancer, as the oestrogen in their body decreases when they are pregnant and choose to breastfeed.”

FEATURED EXPERT
DR HOO MEI LIN
Consultant Gynaecologist and Fertility Specialist
Sunway Medical Centre

IS PREGNANCY IMPOSSIBLE AFTER CHEMOTHERAPY?

Given that chemotherapy plays a big part in the treatment regime of many women with breast cancer, this raises the concern of whether the dream of having a family in the future an impossible one for them.

The unfortunate truth is that chemotherapy affects a woman’s fertility, with a 40% to 80% chance of early menopause.

The ovaries stop producing eggs upon menopause, so with that, the dream dies… or does it?

While Dr Hoo Mei Lin admits that the damage to the ovaries due to chemotherapy is irreversible, there is still a glimmer of hope.

“Patients can plan ahead, as conservation methods such as embryo freezing, egg freezing, and ovarian tissue freezing are available to enable patients to fulfil their wish of having children,” she shares.

Egg and ovarian freezing are suitable options for women that do not have a partner prior to having to undergo chemotherapy.

KEEP THE DREAM ALIVE

Dr Hoo advises breast cancer patients to have an open mind about their future and even consider having children.

After all, breast cancer patients under the age of 45 have an 80% survival rate after treatment!

“With the rapid advances in medical technology today, there is hope for breast cancer patients and survivors to plan their future. Technologies like egg and embryo freezing gives them the opportunity to have children in the future,” she says.

When it comes to cancer diagnosis, the focus is often about treating it, making fertility an afterthought. However, with the advancement in medical technology, surviving a cancer diagnosis is becoming increasingly successful hence, it is important to speak to your doctor as there are ways to help preserve fertility.

A Free App for Women, Especially Marginalized Women

WORDS LIM TECK CHOON

The University of Nottingham Malaysia (UNM) and Hanai Jiwa Ibu Sdn Bhd have developed an app, called Jiwa Ibu, to provide localised and tailored information on mental, women’s, maternal, and children’s health.

This app, developed in collaboration of the two entities with St George’s University of London, Universiti Malaya and Universiti Malaysia Sabah, serves to reduce the great disparity in access to healthcare between those residing in urban and rural communities. This is because rural communities have limited access to quality medical centres and professionals, and residents of those communities have to travel further in search of quality healthcare.

AN APP FOR MARGINALISED WOMEN

“For years, we’ve wanted to shift our focus to the rural and marginalised communities of Malaysia. Since the idea began, our team of eight dedicated women have run focus groups involving doctors, nurses, midwives, community nurses and everyday women, to better learn what the ideal women and maternal healthcare pathway should look like,” explains Hanai Jiwa Ibu Founder and CEO, Shamala Hinrichsen. “We don’t expect to solve the world’s problems, of course, but one tiny step forward is better than no steps at all.”

UNM and Hanai Jiwa Ibu recently inked a Memorandum of Understanding (MoU) to allow for the copyrighting and trademarking of the app, ahead of plans to work alongside Selangkah, Selangor’s healthcare app, to embed part of Jiwa Ibu into the system.

“The Jiwa Ibu app is expected to benefit 15 million women across Malaysia. During its initial alpha-test, the app was downloaded by 3,000 women, with 75% returning to the app within the span of one month from downloading,” shares Associate Professor Dr Joanne Lim Bee Yin of the UNM School of Media Languages and Cultures. “Based on the surveys and interviews that we carried out, 95% of respondents also shared that they wanted the app.

MANY FUNCTIONS FOR EMPOWERMENT & HEALTH SELF-MANAGEMENT

Jiwa Ibu will include a directory for doctors and healthcare centres within the vicinity of the user and other important resources, such as those for violence against women cases.

Users can also store and track their own health records and seek medical assistance through the app.

In an effort to be more accessible, the app will be made available in Bahasa Melayu, English, and other native languages.

Click here to download the app (link opens in a new tab) in the Google Playstore. The app is free.

Associate Professor Dr Joanne Lim Bee Yin children's health health apps mental health obstetrics and gynaecology pregnancy St George's University of London Universiti Malaya Universiti Malaysia Sabah University of Nottingham Malaysia women's health

The Iron In Every Woman

May 8, 2022 Return

WORDS LIM TECK CHOON

It can be great to be a woman living in 2019. We have our first female Deputy Prime Minister and more women in our government than before. Women have more access to education, career and social rights than before. Things can be better, of course, hence this year, for International Women’s Day, we are calling for #BalanceforBetter.

However, making great strides require iron in both fortitude and health. No matter how strong one’s fortitude can be, one also requires iron – the mineral– as it is an essential component of health. Unfortunately, iron deficiency in women is far more common than it should be.

Hence, HealthToday is pleased to invite you to join us this month as two experienced experts have kindly shared with us their insight on this subject.

Dr Jameela Sathar

Consultant Haematologist

Hospital Ampang

Iron Deficiency: It’s More Than Just Anaemia

Oxygen is essential to convert the calories in the food we eat into energy, which then powers many essential functions of the body. It is transported in red blood cells, and iron is needed to make these cells. Hence, if our body is a factory, then that of someone with iron deficiency (ID) is comparable to a factory that is running on low efficiency due to shortage of power.

Most people usually equate ID to anaemia, a condition in which the red blood cells do not carry enough oxygen from the lungs to the rest of the body. However, Dr Jameela Sathar explains that ID doesn’t spring up abruptly overnight – anaemia is actually the manifestation of advanced ID.

“You can go on for many years before developing anaemia,” she says about people who have ID.

We Need A Change In How We Usually Detect Id

In the blood, iron is stored in a protein called ferritin. Healthcare professionals measure the levels of ferritin in the blood as an indication of the levels of iron in the body, and someone with ID typically has less than 30 nanograms (ng) of ferritin for each millilitre (mL) of blood.

However, most hospital laboratories tend to diagnose someone with ID only when there is less than 13 ng of ferritin in 1 mL of blood. Dr Jameela feels that this value is too low as by that stage, the person already has developed anaemia.

Additionally, taking absolute numbers at their face value may not give an accurate picture. For uncomplicated cases, the serum ferritin value of less than 30 ng/mL indicates ID, but Dr Jameela points out that for patients with inflammatory diseases (chronic heart failure, chronic kidney disease, rheumatoid arthritis, etc), serum ferritin below 100 ng/mL may also indicate ID.

Therefore, Dr Jameela advocates for a nationwide policy to adjust the cut-off point in diagnosing someone with ID.

For members of the public, however, the take-home message is that we don’t necessarily have to develop anaemia if we have ID. Measures can be taken to improve ID before it reaches the anaemia stage.

The Hidden Consequences Of Anaemia

Aside from having to deal with the symptoms of ID listed previously, there are other downsides to having anaemia:

Patients with anaemia undergoing surgery have a higher incidence of needing blood transfusions. This increases the overall treatment cost and the risk of possible side effects of blood transfusions (infections, lung injuries, etc).
Higher risk of developing infections of the urinary and respiratory tracts.

Therefore, We Should See A Doctor If We Suspect That We Have Id

How do we know if we may have ID?

Hair loss
Brittle nails
Headaches
Pica (an appetite for substances with little nutritive value like ice)
Fatigue
Frequent infections
Depression
Concentration impairment
Taste disturbance
Anaemia/pallor.

The doctor will typically order a blood test that specifically measures our ferritin levels. If the test shows low ferritin levels, we will receive appropriate treatment.

Associate Professor Dr Ina Ismiarti Shariffuddin

Consultant Paediatric Anaesthesiologist

University Malaya Medical Centre

Iron & The Pregnant Woman

During pregnancy, a woman needs even more iron than normal, as her body needs to increase red blood cell production in order to nourish the child she is carrying. Hence, iron intake is an important consideration, as it now potentially affects the well-being of both the mother and child.

How much iron does a pregnant woman need?

According to Assoc Prof Dr Ina Ismiarti Shariffuddin:

A 55 kg woman requires about 1,000 mg of iron throughout her pregnancy.
During the second and third trimester, she needs about 500 mg of iron for red cell expansion. 300-350 mg of iron needs to be transferred to the foetus through the placenta for foetal development, while the remaining 100-200 mg is stored as standby in case of blood loss during delivery.

Mothers-to-be should consult their gynaecologist on how much iron they should take in their diet.

ID symptoms that pregnant women should watch out for

These include:

Breathing difficulties.
Fainting.
Tiredness.
Heart palpitations (rapid heartbeat).
Sleep difficulties.

Assoc Prof Dr Ina cautions that severe ID can lead to heart failure and further complications to the delivery at a later date. It can also increase the risk of developing perinatal infections, pre-eclampsia and bleeding. The baby can also be affected by severe ID, as he or she faces an increased risk of being prematurely born, halted growth while still in the womb, and low birth weight.

How ID in pregnant women is treated

Assoc Prof Dr Ina shares that iron pills and supplements containing iron, vitamin B12 and folic acid specially formulated for pregnant women can be offered to overcome ID.

Intravenous iron – which is given through a drip – is considered for those whose pregnancy has entered the second trimester onwards, as well as for those who do not respond well to iron pills.

Therefore, expecting mothers should see a gynaecologist if they suspect that they may be suffering from ID. Prompt measures to manage ID would go a long way to ensure the safe delivery of a healthy baby. HT

Five Reasons Why Malaysian Women Can’t Conceive, and What Can be Done about Them

May 8, 2022 Return

WORDS LIM TECK CHOON

Dr Agilan Arjunan

Consultant Gynaecologist & Fertility Specialist KL Fertility Centre

Infertility cuts deep into the heart. It hurts for a couple who long for a child, but can’t conceive despite trying so hard, and the hurt is made more intense by the fact that the joy of pregnancy and childbirth is all around them. Other couples share stories, photos, and Facebook posts of their parenthood experiences, making a couple’s inability to conceive seem even more unfair.

Yet, the door to parenthood may not be closed permanently. As fertility treatments become more advanced, we are starting to have more control over our chances of conceiving a child. There are still many things that are up to chance, but we also have more options than before to address difficulties in conceiving. This month, fertility specialist Dr Agilan Arjunan takes a look at some of the main causes of infertility among Malaysian women.

AGE: IT’S MORE THAN JUST A NUMBER

Dr Agilan had touched on this in recent articles but it’s worth bringing up again because a woman’s advancing age remains the most common cause of her difficulties in conceiving a child.

A woman’s most fertile period is usually during her mid-20s.
Her fertility begins to decline after the age of 30.

However, starting a family in the early twenties is not an option for every woman. A woman these days is more likely to be able to commit to starting a family in her thirties or even forties, a time when her fertility is on a decline.

What can we do about this? A fertility specialist can run a test called the anti- Müllerian test to estimate how many primordial follicles remain in a woman’s ovaries. For this test, the woman only needs to provide a sample of her blood. Once the test result is in, the fertility specialist can advise on the next best step.

In-vitro fertilization (IVF) may be helpful when it comes to selecting the highest quality egg cell for fertilization, therefore overcoming the issue of lower quality eggs produced at a later age.

Another option is for the woman to have her eggs frozen when she is at a more fertile age. These eggs can be thawed and used when she is ready to start a family at a later age.

To understand why fertility drops with age, we first need to understand how the ovaries work.

Dr Agilan shares that a woman only has approximately 10% of her egg reserve remaining by the time she turns 30, and the reserve continues to deplete until she reaches menopause and, hence, the end of her childbearing days.

The ovaries release a mature egg cell during a woman’s menstrual cycle (typically around day 14), and new life is formed when a sperm cell fertilizes this egg during sexual intercourse.
The egg cell develops from a pre- existing cell in the ovary called the primordial follicle. This process occurs under the infuence of hormones such as the follicle stimulating hormone (FSH).
Now, the woman is born with a set number of primordial follicles. No new primordial follicles will be made after she is born. Therefore, once all her primordial follicles are used up, she will no longer be able to produce any more egg cells.
Another issue that arises is that the quality of the egg cell produced tends to decrease with the woman’s age. This may occur even when a woman still has a good number of primordial follicles. This is because the good quality eggs tend to be released during the woman’s most fertile period. Egg cells produced at a later age tend to have a higher risk of being abnormal.

ISSUES WITH THE FALLOPIAN TUBES

Figure A. Blockage in the fallopian tube can prevent a mature egg cell from being fertilized by a sperm cell.

As indicated in Figure A, the fallopian tube is a tube-like structure that provides passage for the mature egg cell to travel from the ovary to the uterus. During sexual intercourse, it will encounter a sperm cell during its journey, and the subsequent fertilization will give rise to new life.

These days, fallopian tube issues are increasingly common. These issues include blockage and damage which prevent the egg cell from ever meeting the sperm cell.

Dr Agilan explains that these issues arise because more women are becoming sexually active at a younger age. This increases their risk of developing pelvic inflammatory disease (PID), especially if they do not practice safe sex. Some women may not realize that they have PID because its symptoms can be either absent or very mild.

Other possible causes of fallopian tube issues include ruptured appendix and a previous ectopic pregnancy (which happens when an embryo attaches itself into the fallopian tube instead of the endometrium in the uterus).

What can we do about this?

If fallopian tube issues are suspected to be the cause of a woman’s difficulty in conceiving, a type of X-ray test called hysterosalpingography can be performed to confirm that this is indeed the case. Once this is confirmed, there are a few options depending on the nature and location of the damage or blockage.

laparoscopic surgery can be done to repair fallopian tube damage.
If the fallopian tube damage isn’t too close to the uterus, surgery may be able to repair the damage. However, there is risk of scar tissues forming at the site of surgery during the healing process, causing the fallopian tube to be blocked.
In-vitro fertilization is most likely the best option for couples wishing to have a child despite the presence of damaged or blocked fallopian tubes. The fertility specialist can extract eggs directly from the ovaries, bypassing the fallopian tube altogether.

ENDOMETRIOSIS

The innermost layer of a woman’s uterus is called the endometrium. It is here that the embryo, which develops from a mature egg cell that has been fertilized by a sperm cell, implants itself to develop into a baby. If no fertilization occurs, the lining tissue thickens and breaks down before exiting the body as menstrual flow.

“Endometriosis arises when tissues from the endometrium grow outside of their usual place in the endometrium,” says Dr Agilan. “They may grow in the fallopian tubes, ovaries and even in the pelvis.”

These cells thicken, break down and bleed during the menstrual cycle, and this becomes a problem as the blood and broken-down tissue cannot exit the body. This leads to irritation in the surrounding tissue as well as formation of scars and cysts.

“ENDOMETRIOSIS, UNFAIRLY CALLED THE CAREER WOMAN’S DISEASE, WAS ONCE THOUGHT TO BE CAUSED BY DELAYED CHILDBEARING. WE NOW KNOW THAT’S NOT TRUE AT ALL.”

Consequently, someone with endometriosis can experience great pain. Her fertility is very likely to be affected as well, as endometriosis can reduce both the number of eggs as well as quality of these eggs.

What can we do about this? Treatment of endometriosis, which typically involves hormone therapy, makes it harder for a woman with endometriosis to conceive, as it prevents ovulation. Therefore, if the woman wants to have a child, the fertility specialist will recommend temporarily stopping treatment.

If necessary, laparoscopy can be performed to reduce the severity of endometriosis and improve the chances of pregnancy. Intrauterine insemination (IUI) may also be useful as this procedure allows the injection of sperm cells directly into the uterus, therefore improving the chances of a successful fertilization.

POLYCYSTIC OVARY SYNDROME (PCOS)

Polycystic ovary syndrome (PCOS) is a lifelong condition that give rise to several bothersome, uncomfortable and even painful symptoms, as seen in Figure B. According to Dr Agilan, it affects about 20% of women worldwide, and in Malaysia, it is especially common among Indian women.

Depending on the severity of her PCOS, the affected woman’s ovaries may fail to regularly release eggs. Dr Agilan shares that it is not unheard of for women with PCOS to not have their period for up to six months, perhaps even a year. This naturally affects their ability to have children.

What can we do about PCOS? Dr Agilan notes that more than 50% of women with PCOS have higher than normal levels of the hormone insulin, even though they are not diabetic.

“The higher the insulin levels, the harder it is for the woman to form a mature egg cell and ovulate,” he says.

Therefore, a way to increase the woman’s chances of conceiving a child is by reducing the insulin level. This is done by prescribing metformin, the staple medication for people with diabetes.

PROBLEMS AFFECTING THE UTERUS

“These problems include the presence of fibroids, which can affect the ability of a fertilized egg to implant into the endometrium or displace the fallopian tube and make it difficult for the sperm cell to meet the egg cell,” Dr Agilan says.

Another, rarer condition is adenomyosis, which is a type of endometriosis. In this case, endometrial tissues are found in the wall of the uterus, giving rise to an enlarged uterus, heavy and/or prolonged bleeding during menses and pain.

What can we do about it? Because problems with the uterus usually affect the ability of the woman to stay

pregnant – which is to say, it may prevent an embryo from being implanted or staying implanted in the endometrium – there is no simple “one size fits all” solution. The fertility specialist evaluates the patient and considers the best options on a case by case basis. HT

Guys aren’t left out! Dr Agilan will turn the spotlight on the main reasons why men have a hard time making babies in the next Woman’s Health and Fertility column. Watch out for it!

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Laparoscopic Tubal Ligation, A Solution For Women Who Don’t Want To Have Children

May 8, 2022 Return

WORDS LIM TECK CHOON

WOMEN’S HEALTH AND FERTILITY WITH

Dr Agilan Arjunan Consultant Gynaecologist & Fertility Specialist

KL Fertility Centre

This month, Dr Agilan Arjunan gives us a closer glimpse of a method that allows a woman to stop worrying about becoming pregnant. It’s a relatively simple and safe method but be warned: the result is practically irreversible!

WHAT’S LAPAROSCOPIC TUBAL LIGATION?

Pregnancy is the result of a sperm cell meeting and fertilizing an egg cell after sexual intercourse. The egg cell is released by the ovary and travels outwards towards the uterus (see Figure A), and along the way, it may encounter sperm cells.

Cutting and tying, cauterizing, or banding the fallopian tube prevents the egg cell and the sperm cell from ever meeting. Hence, there is no worry about pregnancy.

Such a procedure is called tubal ligation. ‘Ligate’ means ‘tie up’, hence this procedure is sometimes also called ‘getting the tubes tied.’

WHAT HAPPENS DURING A LAPAROSCOPIC TUBAL LIGATION?

Dr Agilan Arjunan explains that this is currently the most widely used method of tubal ligation. The surgery involves making small cuts or incisions through the skin.

The patient is given anaesthesia and a drip in the vein of an arm or hand.
A device will be gently inserted into the vagina to move the uterus.
The surgeon makes a small incision near the navel.
A thin, flexible pencil-wide tube with a camera and light source at the end (laparoscope) is inserted through the incision.
The abdomen is inflated with gas (don’t worry, it’s safe) to make it easier for the surgeon to view tissues and organs via the laparoscope.
A second small incision is made at the pubic hairline.
Through this second incision, the surgeon uses a special device to hold the fallopian tubes in place.
The fallopian tubes are then sealed either by cutting them, passing an electric current that causes blood to clot in the tube opening (electrocoagulation) or by using a band or clip over the tubes.
The laparoscope and other devices are removed, and the incisions are stitched up.

The entire procedure takes about 30 minutes, provided there are no complications.

WHAT HAPPENS AFTER THE SURGERY?

The patient will rest awhile in the hospital for observation. If all is well, she usually will be allowed to leave on the same day.

The patient can resume working a few days after the surgery, but it’s best to resume daily activities gradually as one heals.

Normally, sexual activity can resume a week after coming back from the hospital, but it’s best to get clearance from the doctor first.

WHAT ELSE CAN A WOMAN EXPECT AFTER THE SURGERY?

There may be some vaginal bleeding for a few days after the procedure, and this is usually normal.

Menses may resume 4 to 6 weeks later, and during the first two or three cycles, one may experience heavier bleeding and slightly more discomfort than usual.

The surgery does not affect one’s ability to enjoy sexual activities.

IS THIS PROCEDURE EFFECTIVE? WHAT ARE POSSIBLE RISKS INVOLVED IN GOING FOR THE SURGERY?

Laparoscopic tubal ligation has a chance to fail, although statistically it’s a small chance—fewer than 1-in-100 women.

Dr Agilan adds that there is also a risk of ectopic pregnancy, which sees an egg cell still being fertilized by a sperm cell and developing into a foetus in an abnormal location—usually in the fallopian tube itself. According to some studies, this risk is very low, lower in fact than the risk of ectopic pregnancy in women whose fallopian tubes are not ligated.

Other risks are those usually associated with any form of surgery: bleeding, infection and anaesthesia-related side effects.

Don’t worry too much about the risks for now, as a good surgeon will explain the risks before one agrees to go for the surgery. Dr Agilan recommends taking this opportunity to have any doubts and concerns cleared by the surgeon.

WHAT ARE THE ADVANTAGES OF THIS PROCEDURE OVER OTHER FORMS OF TUBAL LIGATION?

Dr Agilan shares that the chief advantage is that one recovers more quickly from surgery due to only a few small incisions being made on the body.

Some studies suggest that this procedure can also reduce one’s risk of ovarian cancer and pelvic inflammatory disease, although we still don’t know the exact reasons for this.

The biggest advantage of this procedure, perhaps, is that it is the best contraception available for a woman. “If the woman is absolutely sure that she doesn’t want to have children,” says Dr Agilan, “then this is the best method available. It’s effective and, unlike other female contraception methods such as the Pill, doesn’t affect the woman’s hormone levels.”

If the woman is 100% sure, that is, which is important as once it is performed, laparoscopic tubal ligation is practically irreversible.

While this surgery prevents pregnancy, it offers no protection against sexually transmitted diseases—other precautions such as the use of condoms will still be needed to avoid catching these diseases.

IT’S REALLY IRREVERSIBLE?

Reversing a tubal ligation is a very complicated procedure with a small chance of success.

“Once the fallopian tube is clipped, banded, or cauterized,” explains Dr Agilan, “scar tissues can form around the affected area. These scar tissues can grow over time until they eventually obstruct the tubes permanently.”

Even if the reversal is a success, there is still no guarantee that the woman can successfully conceive.

Therefore, Dr Agilan reiterates that a woman should be absolutely, positively sure that she doesn’t want children for the rest of her life before she undergoes this surgery.

CONSIDER OTHER OPTIONS IF ONE IS UNSURE

“This surgery is not the only option available,” Dr Agilan says. “For women who believe that they may want children some time in the future, there are other forms of contraception that can be considered.”

This includes the Pill, contraceptive patch and more. Alternatively, her partner can opt for vasectomy, which can be more easily reversed should the couple change their mind about having children in the future. Dr Agilan recommends discussing this matter further with one’s doctor to explore options that best suit one’s needs. HT

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LADIES, WATCH OUT FOR THE SYMPTOMS OF THESE COMMON CANCERS Edit

LADIES, WATCH OUT FOR THE SYMPTOMS OF THESE COMMON CANCERS

May 8, 2022 Return

WORDS HANNAH MAY-LEE WONG

Early detection of cancer may lead to better treatment outcome and higher chances of recovery. Hence, it is important that women go for their regular health screenings and know the early signs and symptoms of cancer.

Consultant oncologist Dr Hafizah Zaharah says, “Women should be aware of their body changes at all times, even when they are still at a younger age—in their 20’s and 30’s. Recently, we have an increasing number of patients in the younger age group.”

GET SCREENED REGULARLY

Women over the age of 40 go for health screenings once a year.

Women younger than 40 should go every two years.

The recommended screenings include:

Mammograms and breast ultrasounds for breast cancer
Colonoscopy for colorectal cancer
Blood test and tumour marker test for ovarian cancer
Pap smear for cervical cancer.

POTENTIAL SYMPTOMS OF COMMON CANCERS

BREAST CANCER

A lump in the breast or armpit.
Changes in breast size, skin, and shape. For example, swelling, dimpling, irritation, thickening, or redness of the skin in the breast.
Nipple changes, such as spontaneous discharge, scaly appearance, or retraction of the nipple.

COLORECTAL CANCER

Diarrhoea, constipation, or narrowing of the stool for more than a few days.
Rectal bleeding with bright or dark red blood.
Blood in the stool; stool appears dark brown or black.
Constant cramping or abdominal pain.
Anaemia.

OVARIAN CANCER

Abdominal bloating or swelling.
Poor appetite and feeling full quickly.
Pelvic or abdominal pain.

CERVICAL CANCER

Abnormal vaginal bleeding. For example, bleeding after intercourse, or bleeding and spotting between periods.
Unusual vaginal discharge.
Pain during intercourse.
Vaginal bleeding after menopause.
Pain in the pelvic region.

SARIMAH SPEAKS HER MIND: THE TRUTH ABOUT MOTHERHOOD

May 8, 2022 Return

WORDS HANNAH MAY-LEE WONG

As Malaysians, most of us recognize the gorgeously charismatic Che Puan Sarimah Ibrahim. We watched her on NTV7, Astro, TV3, we heard her on Red FM and Mix FM, some of us even had the chance of attending events where she was the emcee; it’s clear that this half-Irish Malaysian beauty has been around and is here to stay. But something about her has changed lately: she’s become a mother. In this intimate and exclusive interview, Sarimah chats with us about life, motherhood and how taking care of her mental health plays a big role in helping her stay grounded.

An Introduction: Che Puan Sarimah binti Ibrahim is a Malaysian-Irish television host, actress, singer and radio announcer. With more than 20 years’ experience, her career highlights include: being a host on the Disney channel, hosting The Biggest Loser Asia on Hallmark ,Akademi Fantasia and The Sarimah Show.

Staying true to herself, Che Puan Sarimah doesn’t sugar coat when sharing her experience of being a new mother. Unexpectedly, when asked if she’s always wanted to be a mother, the answer was: no. Sarimah reveals, “I’ve got three younger brothers. Mum didn’t have a helper or anything, so I was the second in charge. I fed them, changed nappies, did everything you had to do as a mother since young. I guess from that experience I felt like I’d already done the mothering role.”

“In my 20s and 30s, I didn’t think I wanted to be a mum. I care so much about my brothers, I see them like my own kids until today … But when I hit 35, I met my husband and that’s when things started to shift. I think when you meet the right person, it changes your perception about the future. It was delayed, but my maternal instincts only started kicking in then.” At the heart of it, Sarimah tells it like it is: Every mother’s journey is unique, and the process is never easy. She elaborates on the joys of motherhood, her struggles and finding herself again through it all.

At the beginning

At 42 this year, Sarimah acknowledges that getting pregnant with baby Tunku Sofia Najihah was a miracle in itself. What may surprise some is that she did not even need the help of IVF (in vitro fertilization). “Just to clarify, I’m not against IVF at all. Everybody has their own way of doing things and IVF helps so many people,” Sarimah assures. “For me and my husband, the experience was just a little bit pushy. I was told: ‘You’re 40, your eggs are going to run out, you need to do this now!’ … I was also told that even though I was perfectly healthy, there’s no reason why I can’t get pregnant, but if I wanted to speed things up, then I should try IVF.”

After some deliberation, Sarimah paid a visit to her gynaecologist. A quick checkup was done, and her gynaecologist concluded that she was perfectly healthy and able to get pregnant naturally. He recommended a D&C (dilation and curettage) procedure for Sarimah. “They cleaned out my womb to make sure the conditions in my womb were suitable for implantation. A lot of women don’t realize they’ve got fibroids or other factors that hinders them from getting pregnant.”

A day after the procedure, Sarimah’s gynaecologist was very confident that she should have no trouble getting pregnant naturally. “Two months after that, it happened, I got pregnant,” Sarimah beamed with joy.

Tunku Sofia at 6 months, on a daily walk with mummy and daddy.

Working out through pregnancy

“In the beginning, I had morning, afternoon and night sickness (I don’t know why they call it morning sickness, it was all the time!). I felt quite sick for 7 weeks,” Sarimah said.

“I was little bit worried because I am quite a fitness fanatic. My gynaecologist kept telling me to slow down since this was my first precious baby. But I’ve been working out for 15 years with cardio and weights every day: pilates twice a week, having a personal trainer for weights once a week … I thought I would still do the same but perhaps just cut the intensity.”

Upon consulting her doctor, she was advised to stick to what she felt comfortable doing. “I tried to lie down and do nothing, but I felt sicker. When I went to the gym for workouts, I felt better. Everyone’s an individual and you can’t say what works for you works for everyone. For me, stopping exercise would have been worse.”

Sarimah worked with her doctor and trainer to come up with a suitable programme for pregnancy. “I didn’t do weight training until after 3 and a half months of pregnancy. For cardio, I also waited after my second month of pregnancy before I did anything past 15 minutes. By my eighth month, I slowed again to prevent back pains. But the day before I gave birth, I was still doing my cardio workouts, fast walking uphill!”

“During my pregnancy, I did light walks, squats, lunges, weights … My trainer adjusted my workouts. I also went for pregnancy group workouts where they have professional trainers for pregnant women,” Sarimah adds.

Speaking up about postpartum depression

When it comes to motherhood, out of “mom-guilt,” many choose to only talk about the positives of parenting. But having studied psychology in depth, Sarimah knows that this isn’t the healthiest way of going about it.

“For someone in my position, it could be seen as me being in the limelight, having help, having financial ease, what’s there to complain about? But it’s not about having 10 nannies or how much money you have in the bank.” Sarimah emphasizes that a mother’s journey has physical, spiritual and mental aspects to it—wellbeing in all those areas matter.

“I had slight postpartum depression. It’s common but no one really talks about it. A lot of people think that this is like a phantom condition that can be dismissed. People think it’s just because of the hormones, but it’s not.”

The highs and lows of motherhood

In life, Sarimah strongly believes that for every high, there naturally will be a low. “A holistic way to look at what happens to you after you give birth, is that when you give birth, you get so excited. Your adrenaline is pumped up. Your expectations for yourself, your husband, your baby, and your life are so heightened that days after (mentally and physically), there will naturally be a drop. The shock and change to your system (not just your body, but your whole life system) can just hit you.”

“It was quite challenging in terms of my emotions. I couldn’t understand why all the tears were flowing. I didn’t know why I was going through the dips, I thought you should stay perpetually high like the day you gave birth … In that process, luckily I had my supportive husband and my close friends, and I got help—I went for therapy.”

Getting therapy

Like so many women hit with postpartum depression, Sarimah inexplicably experienced waves of sadness, guilt, and confusion between the new-found happiness of being a new mom. “I knew I needed to ask for help. I didn’t know what was going on, why I was feeling like that. I was exercising, eating well, but I knew this up and down was a bit too much.”

“So, I got some therapy, and it helped. I talked it out, had my catharsis; then you find out you’re normal, then you feel safe. You find out other women are going through the same things and it takes away the shame and the taboo. I started feeling more myself.”

“If I hadn’t gone for that therapy, I think I would have still been in that foggy headspace between ‘what’s wrong with me’ or ‘I’m not good enough’ or ‘Oh my God, where is my future going to go?’”

Sarimah still continues to go to therapy to this day. “Therapy is like working out. You don’t just go, and then stop. For me, I go for my therapy every month just like I make sure I go to the gym. You can’t just take care of your body without taking care of your mind. It needs to be a holistic approach.”

Igniting the conversation

Sarimah voices her concern that people don’t talk enough about postpartum depression. “Nobody knows that suffering feeling when you don’t even know yourself after you give birth—your body and your mind has changed; your hormones have gone wonky, you’ve got all these questions like ‘Who am I? What am I doing?’”

She elaborates that the way postpartum depression presents itself to every mother is very different, and it stems from a cumulation of each individual’s history. “What you’ve been through, what you saw your mother go through, plus your own chemicals in your mind—there’s no way to prepare for it, it (postpartum depression) hits you in a way that’s customized to you.”

“The only thing you can do is: If you feel it’s too much, that’s when you should go talk to somebody. It’s just one hour of your life. Talking to a therapist can lead you to feel better or find out if you need further help.”

Mentally preparing for the future Sarimah is very much a career driven woman. Up until she had gotten married, she had 22 years’ experience being a host and public figure. She made a conscious decision to slow down after she tied the knot, but she reveals that there are many things up her sleeve at the moment. “Now that Sofia’s 6 months old, I’m looking more into how I can work in the mental health field. I want to help women, and it’s a journey. As I have helped myself, I’d like to help others.”

In closing, we also asked Sarimah what she’s looking forward to most in her life. She replied, “None of us know what the future holds. Every day I look forward to what Sofia would do and what her next words will be—those are my thrills nowadays. I look forward to finding more about myself, seeing who I am in this process and I still love entertaining people, so I don’t see myself saying good bye to that anytime soon, I’d love to combine mental health and entertainment somehow.”

To top it all off, Sarimah has her own cosmetic line named Thrill by Sarimah Ibrahim. “It’s health focused and uses natural ingredients. We sell our products (compact powders and cushion foundations) on Shopee and it’s doing quite well. That’s something I really enjoy doing. We have ingredients that help with acne and sensitive skin.”

While the multi-talented entertainer continues to work on many things that are currently in the pipeline, we wish her all the best in her future endeavours and hope to keep in touch. Speaking of exciting events, Sarimah and her husband, Tunku Nadzimuddin Tunku Mudzaffar will be at our Health in the City (HITC) Move Run 2020 event as guests of honour. Make sure to join our run to get a glimpse of the lovely couple.

Lastly, we would like to extend a special thank you, to Che Puan Sarimah Ibrahim and her husband for this interview, and graciously agreeing to be part of our event. HT

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Useful Tips for Pregnant Moms during the Covid-19 Pandemic

May 8, 2022 Return

WORDS HANNAH MAY-LEE WONG

As we unravel more information about the COVID-19 virus that’s taking the world by storm, we now know that people of all ages can be infected.

However, there are groups of people that may be more vulnerable to the virus due to having a lower immunity. These include the elderly, those with pre-existing medical conditions (such as diabetes or heart disease) and pregnant women.

No evidence that baby is at risk when the mother has COVID-19

Consultant obstetrician and gynaecologist Dr Ramesh Marimuthu assures us that currently, there is also no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19.

He adds, “There is also limited evidence to show if a pregnant woman with COVID-19 can transmit the virus to her foetus during pregnancy or delivery.”

Thus far, in Malaysia and globally, no infants born to mothers with COVID-19 have been tested for the virus. In these cases, there were no traces of the virus found in samples of amniotic fluid or breast milk.

“That said, for the best outcome, the recommendation is emergency admission through Caesarean for infected mothers. Their babies are isolated from the infected mothers and shall not be breast fed until the mothers are tested and proven negative from the virus,” Dr Ramesh explains.

Staying safe during the pandemic

Rest at home and spend this time meaningfully by preparing for your baby’s arrival.
Stay positive.
Keep yourself well-hydrated.
Eat home cooked food as much as possible.
Wash your hands or use a sanitizer before you open your gate/doors or touch any doorknobs when you arrive home.
Regularly use a disinfectant to clean doorknobs and surfaces which are frequently touched.
Reschedule all hospital appointments unless for emergencies.
Avoid going out unnecessarily. But if you do, wear a mask.
Keep a hand sanitizer handy to disinfect your hands as often as possible, when you must go out.
Most importantly, if you detect symptoms of Covid-19, such as difficulty in breathing, severe cough or high-grade fever, go to the nearest hospital for screening immediately.

“Let’s take every care to stay safe. Wash our hands as often as possible, wear a mask if we must leave home for any essential tasks, disinfect our homes regularly. Let’s protect our babies and our loved ones!” Dr Ramesh says in closing. HT

HPV DNA TESTING FOR MORE ACCURATE DETECTION OF CERVICAL CANCER

May 8, 2022 Return

WORDS LIM TECK CHOON

According to the Human Papillomavirus and Related Diseases Report on Malaysia 2019, cervical cancer ranks as the third leading cause of female cancer in Malaysia and the second most common female cancer in women aged 15 to 44 years. Approximately 1,682 new cervical cancer cases are diagnosed annually in Malaysia.

Human papillomavirus (HPV) infection is a well-established cause of cervical cancer and there is growing evidence of HPV being a relevant factor in other anogenital cancers (vulva, vagina, anus and penis) as well as head and neck cancers. “Any woman who is sexually active or used to be sexually active may be at risk of contracting cervical cancer,” says Dr Kavitha Nagandla, a consultant obstetrician and gynaecologist at IMU Healthcare.

Cervical cancer is usually found in women who are in their 30s to 40s. To mitigate the risk of cervical cancer in the female population, the Ministry of Health Malaysia has since 2010 introduced through schools, the Human Papilloma Virus (HPV) vaccination program for girls aged 13.

Regular screening are still necessary even after being vaccinated against HPV

“Women need to understand that the vaccine does not offer 100% protection,” says Dr Kavitha. “Although the vaccine is very effective, we still need more data and until then, women regardless of whether or not they are vaccinated are strongly advised to undergo regular screening.”

“The purpose of screening is to catch abnormalities in the cells early so there can be early intervention,” she further explains, adding that HPV not only causes cancer but also non-cancerous conditions like warts on the hands, feet, eye lids, lips and genital area but these conditions are highly treatable.

A Pap smear would usually be recommended by the specialist. This is a procedure in which a small brush or spatula is used to gently remove cells from the cervix to be checked for cell abnormalities that may lead to cervical cancer. It is essentially a test that detects pre-cancerous cells and is done as part of a pelvic exam.

In general, women aged 21 to 50 should get a Pap smear done annually. If the results are normal 2 years in a row, then they should do it every 3 years.

Women aged 50 to 65 should have it done every 5 years, while women aged 65 and above should get checked if they have signs and symptoms such as post-menopausal bleeding.

A Pap smear is not required for women who have never had any sexual intercourse as there is practically no risk of contracting HPVs nor cervical cancer. Women that used to be sexually active but currently aren’t, on the other hand, should still continue getting a Pap smear, as they are still at risk of developing cervical cancer from their past relationships.

HPV screening for added security and peace of mind

It is highly recommended to combine HPV DNA testing alongside the Pap smear test.

Although Pap Smear is the most common form of screening for cervical cancer, its sensitivity is only 50%. That’s why doctors are now advocating that along with the Pap smear, patients should also do HPV testing. HPV testing is 99% sensitive.

“If there is an option for HPV screening, we would advise the patient to do it as Pap Smear alone is not sufficient to identify potential issues with the cervix,” Dr Kavitha says.

“There needs to be more awareness on the HPV test and how it is a more accurate form of screening. The sensitivity is so high, you can repeat the HPV test every 5 years if confirmed negative,” she adds.

PROTECT YOURSELF AGAINST CERVICAL CANCER!

May 8, 2022 Return

WORDS HANNAH MAY-LEE WONG

Cervical cancer is a type of cancer that grows on the cervix—the lower part of the uterus which connects the uterus to the vagina. Most cases of cervical cancer are caused by the human papilloma virus (HPV).

Associate Professor Dr Ganesh Ramachandran notes that there are almost 100 subtypes of HPV. That said, not all HPV cause cancer.

He explains that cervical cancer does not occur immediately after exposure to HPV. In fact, about 90% of women recover after a HPV infection.

However, some types of HPV infections can progress to pre-cancerous lesions and subsequently may cause cancer. “Generally, this takes about 15 to 20 years in otherwise healthy women. In women with a weakened immune system, this may take up to 5 to 10 years,” Dr Ramachandran says.

Get vaccinated

Vaccination against HPV is an effective way of preventing cervical cancer. “It has been reported that the number of HPV infections and pre-cancerous lesions has dropped in countries with a vaccination programme, and in time this should lead to a drop in new cervical cancer cases,” Dr Ramachandran adds.

Adopting a healthy lifestyle, going for regular pap smears, and using self-testing kits for HPV also play an important role in preventing cervical cancer.