Advice for People With Health Conditions That Will Be Fasting This Ramadan

WORDS LIM TECK CHOON

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.

Can Stress Cause Heart Diseases in Young Adults? A Cardiologist Explains

WORDS LIM TECK CHOON

HOW COMMON IS HEART DISEASE AMONG YOUNG ADULTS? 
Dr Timothy:

Heart disease is common. In general, the risk factors are:

  • Male gender
  • Advancing age
  • Smoking
  • Diabetes
  • High blood pressure or hypertension
  • High levels of fats in the blood or hyperlipidaemia
  • Family history
  • Physical inactivity.

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?
Dr Timothy:

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?
Dr Timothy:

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?
Dr Timothy:

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.

Not Sure What Immunotherapy Is? Get Your Answers From an Oncologist!

WORDS LIM TECK CHOON

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.”

The cells that make up our immune system. Click on the image for a larger, clearer version.

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
  • Cervical cancer
  • Gastric cancer
  • Oesophageal cancer
  • Bladder cancer
  • Melanoma
  • Liver cancer
  • Renal cell carcinoma
  • Endometrial cancer
  • Colon cancer
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

3 Tips to Work From Home Without Hurting Your Posture

WORDS DR LIM SZE WEI


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.

TIP 1
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.
TIP 2
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.
TIP 3
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.

NKF Offers Kidney Transplant Subsidy to Needy Organ Donors & Patients

WORDS LIM TECK CHOON

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
  • Blood tests
  • 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
  • Traveling expenses
  • 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
  • Lodging
  • Subsistence
  • Income loss
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. 

Have Diabetes? Here’s an Improved Way to Track Your Blood Sugars

WORDS LIM TECK CHOON

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

Happy Chinese New Year Everyone & Here’s an Article About Rabbits

WORDS LIM TECK CHOON
PHOTO RAHIM SOFRI

UNDERSTANDING THE RABBIT
  • 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.

References:

  1. Jenkins J. R. (2001). Rabbit behavior. The veterinary clinics of North America. Exotic animal practice, 4(3), 669–679. https://doi.org/10.1016/s1094-9194(17)30030-0
  2. Crowell-Davis S. (2021). Rabbit Behavior. The veterinary clinics of North America. Exotic animal practice, 24(1), 53–62. https://doi.org/10.1016/j.cvex.2020.09.002

Important Advice & Tips to Plan & Prepare for a Flood

WORDS LIM TECK CHOON

DR CHAN YANJUN
Medical Director, Singapore & Malaysia
International SOS

“With forecasts indicating that our rainy season is far from over, Malaysians need to be prepared in case of floods,” advises Dr Chan Yanjun. “While there are many different actions people should undertake in a flood situation, the most important rule is do not try to walk, swim or drive through flood water. Cars and people can be swept away, so always remember safety first and to stay alert so you don’t get hurt.”

WHAT YOU SHOULD DO TO SAFEGUARD YOURSELF & YOUR LOVED ONES IN CASE OF A FLOOD
  • Identify flood or landslide-prone areas near you. Watch weather alerts and warnings.
  • Stock up enough water (ration roughly 4 litres per person per day) and dry food for 3 days.
  • Know your community’s evacuation routes and emergency shelter locations.
  • If you are stranded, injured or ill, contact your local emergency services department and wait for help.
IF A FLOOD HITS YOUR HOME, REMEMBER THESE POINTERS
  • Check the drainage system behind or outside your house to see the water levels. The higher the water level climbs, the more likely you will have to evacuate.
  • Switch off all gas, electricity, and water when electricity supply is down, water has entered your home, or before you evacuate. Make sure to unplug appliances to avoid electrical shock when power returns.
  • Move to higher ground. Only move to the roof if necessary.
  • If your family is advised to evacuate, do so immediately (lock gates and doors before leaving if possible).
WHEN YOU ARE ON THE ROAD DURING A FLOOD
  • Stay off bridges as they can be washed away in severe floods.
  • Stay inside your vehicle if you are trapped by rapidly moving water.
  • Move to the roof of your car if water starts to fill the interior.
WHAT TO DO AFTER THE FLOOD
  • Do not return home unless advised to do so. Wait for a signal by authorities or emergency services on the status of your housing area.
  • Look out for animals that may be inside your house. This includes snakes, lizards and even crocodiles.
  • Keep children and pets out of the affected area until clean-up has been completed.
  • Wear rubber boots, rubber gloves, and goggles during clean-up of affected area.
  • Remove and discard items that cannot be washed and disinfected (such as, mattresses, carpeting, carpet padding, rugs, upholstered furniture, cosmetics, stuffed animals, baby toys, pillows, foam-rubber items, books, wall coverings, and most paper products).
  • Remove and discard drywall and insulation that has been contaminated with sewage or flood waters.
  • Thoroughly clean all hard surfaces (such as flooring, concrete, moulding, wood and metal furniture, countertops, appliances, sinks, and other plumbing fixtures) with hot water and laundry or dish detergent.
  • Help the drying process by using fans, air conditioning units, and dehumidifiers.
  • Have your onsite waste-water system professionally inspected and serviced if you suspect damage.
  • After completing the clean-up, wash your hands with soap and clean water.
  • Wash all clothes worn during the clean-up in hot water and detergent. These clothes should be washed separately from uncontaminated clothes and linens.
  • Seek immediate medical attention if you become injured or ill.

Thinking of Traveling? Get These Tips to Keep Yourself Flu-free!

DATUK DR CHRISTOPHER LEE
Consultant Infectious Diseases Physician
Member of the Malaysian Influenza Working Group
FLU FACTS THAT ARE NOTHING TO SNEEZE AT
  1. On board the plane, you have an 80% chance of getting the flu if there is an infected person–who may or may not have symptoms–sitting one row in front or behind you, within 2 seats to either side.
  2. Flu viruses can survive for up to 48 hours on certain surfaces, including your overhead compartment handle, seat-belt buckle, video screen, food tray, arm-rest, and control panel.
  3. You can try disinfecting the items mentioned in the above point, but it would be impractical to disinfect everything you will touch when you land, such as your luggage bag, trolley, the toilet flush, car door handle and so on.
TRAVELING SOON? HERE ARE 2 SIMPLE TIPS

Tip 1: Follow the COVID-19 SOPs when possible
Masking, although no longer promoted in most countries, may help reduce the chances of catching the flu.

However, it is less effective when those around you are not masked. This is where the next tip comes in.

Tip 2: Get the flu shot
The additional protection conferred by the annual flu vaccination is therefore recommended to prevent the disease.

When injected, the vaccine introduces inactivated flu viruses into the body. These have been killed and are unable to cause disease.

Instead, they stimulate your body to produce antibodies that will spring to your defense if you happen to be exposed to the flu.

Allow 2 weeks to reach the desired level of immunity before flying off.

MORE ABOUT THE FLU VACCINE
It gives you a better shot at beating the flu and reducing your risks of heart problems 

Flu vaccination helps prevent severe flu-related infection, hospitalization, and death . It is also associated with a 34% lower risk of major adverse cardiovascular events . There was also an 18% reduced risk of death reported in patients with heart failure .

In people with type 2 diabetes, flu vaccination has been associated with a reduced risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15% .

With the COVID-19, flu, & RSV triple threat in the northern hemisphere, the flu shot is a good bet 

Noting that flu viruses mutate constantly, Datuk Dr Christopher Lee explains that currently available flu vaccines have been updated to effectively fight virus sub-types that are circulating in the northern hemisphere at this time.

“This will help reduce your risk of contracting the disease. The flu vaccination is recommended for those travelling abroad, especially high-risk groups as the importation of flu cases through air travel can result in the spread of flu within the community,” he adds. “So, if you have not been vaccinated against the flu, now is a good time to get it done. The annual flu vaccination is your passport to healthy holidays. Don’t leave home without it.”

This article was contributed by the Flu Prevention is An Act of Love campaign under Immunise4Life, a major initiative to promote life course vaccination by the Ministry of Health, Malaysian Paediatric Association, and the Malaysian Society of Infectious Diseases & Chemotherapy. Learn more at actoflove.ifl.my (link opens in a new tab).

MMA Collaboration Offers Free Health Screening to People Over 40

WORDS LIM TECK CHOON

FROM DECEMBER 2022 TO FEBRUARY 2023, MALAYSIANS AGED 40 & ABOVE CAN GET FREE HEALTH SCREENING

This is thanks to SCREEN.DETECT.ACT, a campaign jointly organized by Malaysian Medical Association (MMA) and Viatris Malaysia.

This campaign aims to have more Malaysians aged 40 and above screened for risk factors for non-communicable diseases such as diabetes, hypertension, and high cholesterol.

LACK OF HEALTH SCREENING LEAVES MANY UNAWARE THAT THEY HAVE NON-COMMUNICABLE DISEASES

The campaign is an effort of the MMA to support of the National Health Screening Initiative (NHSI) 2022, launched in July this year by the Ministry of Health, to address the low rate of health screening among the public.

Dr Muruga Raj Rajathurai, the President of the MMA, tells us: “It is concerning that a high number of Malaysians with high blood pressure, blood sugar, and cholesterol were unaware of their health status, as they did not see a doctor for a medical check-up to get a diagnosis.”

He adds that the SCREEN.DETECT.ACT campaign is timely because the rate of health screenings has dropped over the last 2 years due to the lockdowns.

PILOT PROGRAMME ROLL-OUT

The SCREEN. DETECT. ACT campaign will roll out in Klang Valley and Negeri Sembilan, targeting 1,000 people above 40 years of age and those at higher health risks.

“We urge those above 40 years of age, those at higher risk, and especially, those who have yet to undergo any medical check-ups or health screening, to seize this opportunity to get yourself screened. Early detection and timely treatment can potentially lower your risks of complications and result in better outcomes. Health screening can save lives,” says Dr Muruga.

Free health screening under the SCREEN.DETECT.ACT is available at participating general practitioner clinics. For more information, contact Malaysian Medical Association (MMA) at 03-4041 1375 (office) or 018-277 8794 (WhatsApp only) from Monday to Friday (9 am to 6 pm).