An Ageing Eye Condition

An Ageing Eye Condition

April 29, 2022   Return


If you are over 40, have problems focusing up-close and need to read your newspaper or tablet from a stretched distance, it’s likely you have presbyopia — a common eye condition you develop as you age.


Did you know, the word “presbyopia” means “old eye” in Greek? Also known as long-sightedness, presbyopia is when a person gradually loses the ability to see objects clearly when the objects are up-close. Don’t worry, it is not a disease but a normal process that comes with ageing. It usually starts when a person is over the age of 40 and continues to worsen until the age of 65.


The lens in your eye flexes and relaxes with the help of muscles that surround it – it helps your eye focus when seeing an object. As you age, this lens hardens and becomes less flexible. The loss of flexibility makes it difficult for your lens to change shape when focusing on nearby objects. Thus, these images appear out of focus.


Symptoms usually first start after a person turns 40. People with presbyopia may realize that they:

  • Tend to hold their reading material further away to be able to see clearly.
  • Have blurred vision at normal reading distance.
  • Suffer headaches or fatigue when reading or doing work that requires seeing things closely.


No. People with far-sightedness (hyperopia) have difficulty seeing things that are close by, but have no difficulty seeing things from a distance. Although this may sound similar to presbyopia, far- sightedness has different causes and can occur at any age. Far- sightedness stems from having an irregularly shaped eyeball, which causes light rays to focus incorrectly once it enters the eye. This results in blurred vision.



There is no cure for presbyopia, but there are plenty of options to improve vision. Options include:

Reading glasses: Simple and affordable reading glasses (you can often find these at pharmacies or Daiso) can help presbyopia. Just pick the weakest prescription pair that allows you to read or see objects up-close clearly. The downside to this is that it only helps you see objects that are near. To see far, you would have to remove the reading glasses.

Bifocals: A popular option for many, bifocal glasses have two prescriptions in one lens. The top part allows you to see far objects, and the lower part of the lens helps you see near objects.

Progressive lenses: Progressive lenses, sometimes called multifocal lenses help you see up- close, far and at middle distance all in one lens. This saves you the hassle of changing glasses each time you see near or far.

Unlike bifocals, progressive lenses have no distinct lines between the sections of prescriptions. The transition between prescriptions is gradual and seamless, creating a clear and sleek look to the glasses. If you’re looking for a pair to try out, the Varilux® X series by Essilor offers premium progressive lenses, with an option for Near Vision Behaviour (NVB) personalization. NVB customizes each lens to a person’s posture and movement. The Varilux® X Series is available at major optical shops throughout Malaysia. For more information, visit www.


1. American Academy of Ophthalmology. What is presbyopia? Retrieved from: what-is-presbyopia. 2. Mayo Clinic. Presbyopia. Retrieved from: https:// syc-203633283. WebMD. What is presbyopia? Retrieved from: https:// WebMD. Are progressive lenses right for you? Retrieved from: https://www.webmd. com/eye-health/about-progressive-lenses#1.

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Who Says a Liquid Diet Has to Be Boring?

Who Says a Liquid Diet Has to Be Boring?

April 28, 2022   Return

For the elderly, liquid diets – which consist of pureed and blended foods as well as soups – are easy to swallow and digest, especially when they lose their teeth and their grip on eating utensils become weaker.

Meal replacements often find their way into the liquid diet. These are usually powders or beverages, formulated with a designated amount of calories and nutrients to replace a meal while still meeting the person’s daily energy and nutritional requirements.

Good for diabetes

For the elderly with diabetes, meal replacements may play an important role in the management of this condition. In fact, the American Diabetes Association issued a positive statement in 2007, stating that:[1]

Meal replacements (liquid or solid prepackaged) provide a defined amount of energy, often as a formula product. Use of meal replacements once or twice daily to replace a usual meal can result in significant weight loss.

“But … puree again? Ugh!”

However, it can be dull and even demoralising to eat the same pureed or soupy dishes every day. Eating becomes a chore when one stops looking forward to the next meal!

Fortunately, things can be improved. Here are some tips to liven up the liquid diet of your loved one.[2]

  • Serve a fruit yoghurt for breakfast. There are many different types of fruits available, so there is no shortage of different tastes and flavours to liven up the breakfast table. Just blend fruits with plain yoghurt, and add in some thin oatmeal for fibre.
  • Smoothies are great for lunch. Just blend fresh or frozen vegetables (carrots and cucumbers, for example) with ice, adding some yoghurt or pureed banana for thickening. Combine different types of fruits and vegetables for different flavours each time.
  • No chew recipes are the way to go. Who says purees and soups have to be tasteless? With a blender, you can blend different types of meat and vegetables with spices to create tasty ‘no chew’ meals. If you need recipes, search for ‘no chew recipes’ online. You’d be surprised by just how many different types of recipes available out there – for free!
  • What’s for dessert? Your loved one’s meal replacements can be used to create some fine shakes for desserts. Blend in some fruits or add some instant coffee grounds for that extra ‘kick’.

If your loved one has a sweet tooth, but you are worried about the extra calories that come with sugar (especially if he or she has diabetes), you can use sugar substitutes such as artificial sweeteners for the occasional special treat.

American Diabetes Association Diabetes Care. Available at Available at

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Hair Today, Gone Tomorrow

Hair Today, Gone Tomorrow

April 28, 2022   Return

Interview by Hannah May-Lee Wong

Dr Ruban Nathan
Consultant Dermatologist & Hair Transplant Surgeon


We met Dr Ruban Nathan at his favourite vegetarian restaurant – an earthy-looking eatery with plenty of natural shade from the surrounding greens – just a few steps away from his clinic. Dr Ruban himself is no stranger to hair loss. “I am the typical example of male pattern hair loss – high forehead, thin crown,” he says. “It happens differently in females though – they get a straight but low hairline and global thinning of hair”.

He expresses his concerns regarding the Malaysian perception of hair loss. Although many people face hair loss as they age, most continue to believe in unfounded hair myths, herbs that aren’t backed by scientific evidence and hair centres that charge premium prices promising hair regrowth but without the results. The treatment plan for hair loss should depend on the cause, and sometimes, medication or medical procedures (such as hair transplants) are needed. These should be prescribed or performed by a trained medical professional.

  1. What are the causes of hair loss?

By far, the most common cause is androgenetic alopecia, a fancy way of saying male- or female-pattern hair loss. Men experience this form of alopecia (hair loss) more, but some women do as well. In men, hair loss occurs at the crown of the head with hair line recession. In women, there is minimal or no receding hair line; instead, they usually get global hair thinning.

Another common cause would be telogen effluvium, in other words, stress-related hair loss. This is a global loss of hair which follows an emotionally or physically stressful event such as dengue, any major surgery, a loss of a family member or even a physiological event such as pregnancy. When a person experiences such events, a bunch of follicles go into resting phase and after that, the person will experience a lot of hair shedding. Since this type of hair loss is non-scarring, the follicles will revive and hair does grow back.

A slightly rarer cause of hair loss is trichotillomania, where the patient (usually an adolescent or younger child) pulls his or her own hair out as a response to emotional stress. Alopecia areata is an autoimmune disorder that causes patchy hair loss. It is less frequently seen and is often stress induced.

  1. Which of these is the most common cause of hair loss? Do our diets and lifestyle play a part?

The commonest overriding factor is genetic. But stress, poor diet, smoking and lack of sleep would accelerate the process. Neglecting to shampoo as often as one should may also lead to hair loss. Hairs are attached to oil glands, which may contain lots of bacteria. Men, especially, tend to have very oily scalps. It was theorized that excess oil may promote the growth of a certain bacteria that can cause hair loss. Make sure to shampoo regularly to minimize that.

Sometimes when appropriate, doctors will do blood tests to rule out anaemia or thyroid problems which may also contribute to hair loss.

  1. When do most people start experiencing hair loss?

It could happen at any age post puberty.

  1. What are the treatment options for hair loss?

For the most common cause of hair loss – androgenetic alopecia – treatment options can be divided into medical and surgical interventions. Medically, for men, minoxidil 5% and oral finasteride would be recommended. Women can use minoxidil. Medical treatment is long term and is taken for as long as the patient wants to prevent hair loss. Surgically, patients can opt for hair transplants, which involves extraction of hair follicles from the back of the head and planting them on the top of the head where hair loss is most noticeable.

  1. Let’s talk about hair transplants. Can you explain the difference between Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT)?

Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) refer to the different methods of extracting or harvesting hair follicles. Implanting the follicles are similar for both.

Follicular Unit Transplantation (FUT)

Also known as the strip method. This involves the removal of a very thin strip of skin from the lower back of the scalp, where the hairs are genetically more protected from future hair loss. With FUT, shaving of the whole head is not required, so the patient may return to work sooner.

Follicular Unit Extraction (FUE)

For this method, follicular units are individually pulled out of the scalp using a drilling device. An extensive area at the back of the scalp is usually involved. Because FUE uses less “genetically protected hair”, it may jeopardize the survival of hair implants, and affect how long the implants will last. Total scalp shaving is usually required.

With FUE, due to the trauma of individually pulling the donor follicles out, the surrounding pad of fat is at risk of being stripped off, further diminishing the potential survival of grafts. FUE is usually performed if donor density is lacking, and if beard or body to scalp transplants are necessary. Density of hair at the host area may also be affected – after four weeks of full hair regrowth, there might be a slight decrease in hair density. These are the downsides of FUE. But if the patient has a lot hair at the back his head, it shouldn’t be a problem.

A qualified surgeon should be able to offer both these techniques. If the patient is young, I would still recommend doing an FUT. But if the patient is older and the donor hairs aren’t as good quality, then I would do an FUE.

It depends on what the patients want too. If you do an FUE, you’ll have to shave your head and it’ll take weeks to grow back. Doing an FUT means you won’t have to shave it all off. If a patient has an important meeting coming up, I would suggest an FUT.

For both methods, the newly implanted hairs will fall off in two to three weeks and will grow back again in about three to six months, reaching maximum density in 12 to 14 months.

  1. Can women have hair transplants?

Yes, but women usually do very well with medications alone. Therefore, I normally suggest they try medications for at least six months.

  1. What is the difference between going to a dermatologist and going to a hair loss treatment centre?

Sadly, I find some of these non-medical hair treatment centres to be unscrupulous and aggressive in their marketing. Irrespective of whether the cause of hair loss is genetic (in which case there is little they can do about it) or caused by a severe auto-immune condition, some hair centres promise to treat all forms of hair loss, which is simply impossible. I have had scores of patients who complain of paying tens of thousands of Ringgit to these centres without receiving any results.

What’s even more worrying is the tendency for some hair centres to induce anxiety by claiming the presence of mites in their client’s scalp when there is none! The Demodex mite they talk about is rarely present and not at all a significant cause of hair loss. Anyone can Wikipedia this fact!

  1. How can we prevent hair loss or take care of thinning hair?

If you’ve inherited the “hair loss gene”, the best thing to do is to see a dermatologist early on. A dermatologist can advise on the right medication, which will act as a pause button and help halt the shedding.

Besides taking the appropriate medication, get rid of negative lifestyle habits such as smoking, poor diet and lack of exercise. You should also rule out the presence of seborrheic dermatitis (which might cause mild thinning) by seeing a dermatologist.

  1. Are there any supplements that help stimulate hair growth?

There are some supplements being sold in the market, but there is little clinical evidence or large-scale studies to prove their benefits.


Hair Myths Debunked

  1. A diet high in monosodium glutamate (MSG) causes hair loss.

Not true. Glutamate in MSG may cause neurochemical changes in the brain, and some people claim that taking too much of it causes headaches, tingling or sweating. But in terms of hair loss, there is no scientific backing for this.

  1. Shampooing your hair regularly leads to hair loss.

Not true. In fact, living in this hot climate, we should shampoo at least once or even twice a day. Build-up of excess oil in the hair follicles may lead to accumulation of bacteria and fungus that may cause hair loss.

  1. If you completely shave off your hair, it will grow thicker.

This is a common myth that is not true. Shaving your scalp every three weeks will not make your hair grow back thicker.

  1. When washing your hair, any shampoo will do.

Dr Ruban says, “Shampoos only vary in terms of texture. Shampoos that claim to prevent hair loss may include certain peptides in their ingredient list, but these peptides will not be left on your scalp long enough to have any effect, considering a regular hair wash is generally quite quick.”

  1. Dyeing and perming your hair causes hair loss over time.

Some textural damage to the hair may occur, but it generally does not result in irreparable hair loss. Only a small population of people might be allergic to a substance commonly found in hair dye –

  1. As you age, you start losing hair all over the body.

Not exactly. Body hair tends to increase in density as you get older, while scalp hair density decreases.

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OHHHH… Why Is the World Spinning?

OHHHH… Why Is the World Spinning?

April 28, 2022   Return

Words Lim Teck Choon

Vertigo is one of Alfred Hitchcock’s more well-known psychological thrillers, named thus because the protagonist suffered from that condition as well as fear of heights. Unfortunately, the popularity of that movie led some to assume that vertigo, dizziness and fear of heights are one and the same. Consultant ear, nose and throat surgeon Dato’ Paduka Dr Balwant Singh Gendeh sheds some insight into vertigo and how it can be treated.

Entirety with

Dato’ Paduka Dr Balwant Singh Gendeh
Consultant Ear, Nose & Throat Surgeon

Vertigo 101

  • Spinning around. “Vertigo specifically refers to a feeling of disorientation because we think that we, or the world around us, are moving, when we are actually not,” explains Dato’ Paduka Dr Balwant Singh Gendeh. It should not be confused with motion sickness and dizziness.
  • It’s about the ears. In the past, it was assumed that vertigo was a sign that something was not quite right with the brain. Now, we know that the affected area is the inner part of the ear that helps maintain our sense of balance.
  • It’s a symptom. Vertigo is not considered an illness; instead, it is viewed as a symptom of a problem that affects the sense of balance. Therefore, the duration and severity of vertigo can vary, depending on the problem that gives rise to it. We will look closer at some of these problems later.

First, let’s take a closer look at how our body maintains our sense of balance.

A Balancing Act


If we look at diagrams of our ear, we will come across what seems like a snail with a big head located in the inner ear. This “snail” is called the bony labyrinth, and like its name would suggest, its outer wall is composed of rigid bony layers to protect the soft tissue inside.

There are basically three components of the bony labyrinth: the cochlea, the three semicircular canals and the vestibule.

The cochlea is involved in maintaining our hearing rather than balance, so we won’t be focusing on it in this article. We are more interested in the other two components, the semicircular canals and the vestibule. These two components work closely together with other parts of our body such as the eyes and the nerves as well as bones to help maintain our position, whether we are staying still or in motion.

The semicircular canals. The three canals are filled with a fluid called endolymph. Each canal also has a cup-like structure called cupula. Every time we move, the endolymph also flows in the direction of the movement, and this movement is detected by thin hair-like cells in the inner lining of the cupula. These cells then generate signals, sent via nerve cells, to the brain.

The vestibule. The vestibule also has thin hair-like cells, found in the utricle and saccule. These cells help to detect movements in a straight line as well as acceleration in a horizontal direction.

Additionally, the utricle and succule has a jelly-like covering lined with tiny calcium crystals. Whenever we tilt our head or change our body’s position with respect to gravity (such as when we lie down), the calcium crystals get displaced in the direction of the movement and cause the hair-like cells to bend. These hair-like cells then send signals to the brain informing it about the change in our body’s position.

Our brain pieces the information received from the inner ear together with information sent through our eyes, skeletal system, etc in order to coordinate the maintenance of our sense of balance.

We now delve into three common issues associated with vertigo, but we should keep in mind that there are several other possible conditions that may give rise to vertigo as one of the symptoms. These include injuries and trauma, conditions that cause a sudden decrease in blood supply to the brain such as clots in a blood vessel and more.

Therefore, if we experience bothersome or frequent bouts of vertigo, it’s a good idea to consult an ENT specialist for a more thorough examination.

Benign Paroxysmal Positioning Vertigo (BPPV)

BPPV is the most common form of vertigo. “During a BPPV episode, we experience a sudden, brief sensation that we are spinning,” explains Dr Balwant.

An episode is normally triggered by specific changes in our head’s position, such as when we tilt our head or when we sit upright after lying down to sleep. BPPV can spur mild to intense dizziness that may last for a short period of time (a few seconds to a minute).

Is it serious? BPPV is rarely serious, and the affected person’s hearing will not be affected.

However, Dr Balwant cautions that the elderly may be more prone to falls should they experience a BPPV episode. Given how falls may lead to life-threatening fractures among people in that age group, he advises those affected to consult an ENT specialist if the episodes are frequent.

What causes it? BPPV could be due to the calcium crystals in the utricule getting dislodged and finding their way into a semicircular canal, where they interfere with the flow of the endolymph and make the brain think that we are moving when we are actually staying still.

Diagnosing BPPV. Interestingly, no sophisticated equipment is necessary. This is because when our head is moved into a position that triggers the BPPV, the brain will let us know that we are moving (when we aren’t) and our eyes react by moving in a specific pattern known as “nystagmus”. Thus, during the diagnosis process, the ENT specialist will ask for the patient to move his or her head into various positions while watching for signs of nystagmus.

How do we treat it? The ENT specialist will instruct us on a series of gradual positioning techniques called the Epley manoeuvre, designed to allow the dislodged crystals in the semicircular canal to find their way back to the utricle. We will also be asked to come back a week later for a follow-up examination.

If the episodes are intense, anti-vertigo medications such as betahistine dihydrochloride may also be prescribed.

Labyrinthitis Or Vestibular Neuronitis

Just like most tissues and organs in our body, various components of the bony labyrinth can also become the target of uninvited microorganisms such as bacteria and viruses. When infection occurs in one of the two nerves that connect the inner ear with the brain – called the vestibular nerves – that’s when a condition known as labyrinthitis or vestibula neuronitis arises.

Is it serious? Dr Balwant shares that people affected by labyrinthitis typically experience vertigo alongside dizziness, nausea and even loss of hearing. The hearing loss is normally temporary, but in very rare cases, it may become permanent.

These symptoms tend to occur abruptly, without warning, often after sudden movements of the head, and they may last for several days.

While these symptoms are normally not life-threatening, they can be intense and uncomfortable to undergo. They also disrupt our ability to work, drive and perform other routine activities.

What causes it? It can due to infection of the inner ear. It can also be brought upon by infection of other parts of the body, such as the lungs, stomach, etc. Just like with other infections, we become more susceptible if we smoke, drink excessive amounts of alcohol or indulge in other activities that can weaken our immune system. Allergies and stress may also be risk factors.

How do we treat it? The specialist will prescribe medications based on the cause of the infection. Bacterial infection, for example, can be treated with antibiotics, but infections caused by viruses will require a different type of treatment. Therefore, the specialist will evaluate the best treatment options on a case by case basis.

In the meantime, we should take plenty of rest and drink plenty of water to help us recover better and faster.

Ménière’s Disease

Ménière’s disease is quite rare, with studies reporting the prevalence rate as ranging from 3.5 per 100,000 people to 513 per 100,000.This rarity will be small consolation to those affected by this disease, however, as the symptoms tend to be severe.

At a glance

Usually only one ear is affected, and the affected person can experience episodic attacks, during which the following typically occur:

  • Vertigo. This often comes up without warning, and can last from 20 minutes to several hours.
  • Hearing loss. This usually comes and goes during the early stages, but over time, the affected person’s hearing loss may become permanent.
  • Tinnitus. The affected person will hear persistent noise (ringing, buzzing, whistling, hissing, etc) in the ear even when there is no external sound present.
  • A “full” sensation in the ear. There is build-up of pressure in the affected ear or on the side of the head where the affected ear is.
  • Attacks of dizziness.

Episodic attacks may occur in close succession over a few days.

Some people may also experience “brain fog”: they find it difficult to concentrate or recall things, and they are also prone to feeling fatigued and/or demotivated. Consequently, their abilities to sustain meaningful relationships as well as to perform at work or school are affected.

What causes it? Dr Balwant shares that one theory is that Ménière’s disease is the result of excessive endolymph in the inner ear. Normally, the endolymph is contained within a semicircular canal by a membrane. When there is excessive endolymph, the resulting pressure causes the membrane to rupture.

Now, the endolymph is rich in potassium ions, which is positively charged. When it leaks into the surrounding space of the inner ear, it brings with it excess positive charges, which disrupt the ability of the nerve cells in the inner ear to properly generate electrical signals to the brain.

Other researchers speculate that this disease is probably the result of blood vessels experiencing constrictions that reduce the amount of blood passing through them. Some also theorize that Ménière’s disease may be due to viral infections, genetic abnormalities and other factors that prevent the body from regulating the amount of endolymph fluid in the inner ear.

How do we treat it? Unfortunately, we have yet to find a cure. Dr Balwant explains that current treatment regime focuses on managing the symptoms.

  • Medications can be prescribed for severe dizziness, vertigo, nausea, etc.
  • Consumption of salt should be restricted to reduce the amount of fluid retained by the body (this will lead to a reduction of fluid volume and pressure in the inner ear).
  • Smoking, caffeine, alcohol and chocolates should be avoided.
  • Those experiencing emotional issues may find counselling and participation in support groups helpful.


  1. Alexander, T.H., & Harris, J.P. (2010). Current epidemiology of Meniere’s syndrome. Otolaryngol Clin North Am.;43(5):965-70. Retrieved in June 1, 2018 from

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As We Grow Older, Which Of Our Five Senses Will Be The First To Go?

As We Grow Older, Which Of Our Five Senses Will Be The First To Go?

April 28, 2022   Return


There is no clear- cut answer to that question,” consultant geriatrician Professor Dr Tan Maw Pin says when we ask her this question. “There are many factors to consider.”

For one thing, the answer depends on whether the person has any existing health conditions. Someone with type 2 diabetes, for example, may find their sense of touch being affected by the condition over time, especially if their diabetes is not properly controlled.

Other factors may include physical geography and cultural elements. People in the Himalayan region, for example, have a high prevalence of eye problems such as cataract. In Nepal, glaucoma (an eye condition that can lead to blindness) is prevalent as the people in that country age – a survey from the World Health Organization and the Nepal Blindness Survey estimated that the rate could range from 3.2 percent to as high as 9 percent. It is thought that the prevalence of these problems could be due to a combination of poor nutrition, lack of proper sanitation, the climate and other issues.

“There are many variables, and therefore which sense will be affected first by ageing can differ from person to person,” Prof Dr Tan says. “There is no ‘secret formula’, sadly, as everyone is a unique individual! It may be more worthwhile to focus on how we can go for certain screenings as we age to detect potential problems early.”

Let’s find out what these recommended screenings are.


Have our blood pressure checked every year or two.

Where? At any clinic.

Why? Age is a risk factor for high blood pressure. The older we are, the more likely we develop this condition. Earlier detection will allow for better management and reduced risk of heart problems in the future.


When we are 40 or older, we should go for an eye screening every 1-2 years.

Where? At an optometrist’s clinic.

Why? This is to check for eye problems such as glaucoma and cataract. Glaucoma is a leading cause of blindness, and our risk of developing this condition increases the older we are.


Contrary to popular belief, we lose our teeth as we grow older because of gum disease (periodontitis), not age! “It’s possible to have a full set of teeth no matter how old you are!” says Prof Dr Tan.

She recommends going to the dentist once every 6 months, so that gum diseases and other tooth issues can be detected and treated early.


Age (45 years or older) is a risk factor for type 2 diabetes. The risk increases if we are also sedentary, overweight and/or have high blood pressure and other risk factors.

Where? At any clinic. The test consists of taking our urine sample and using a dipstick to detect the presence of glucose. If the results are normal, the doctor may recommend repeating the screening every few years.

An added advantage of this test is that we can also detect the presence of problems in the bladder or kidneys by analyzing the presence of blood, nitrites, protein and white blood cells in the urine sample.

Why? Early detection of type 2 diabetes will allow for better control and a delay in the development of health problems in the eyes, kidneys, heart and more. If we are found to be at risk of developing type 2 diabetes, the doctor can advise us on making the necessary changes to our daily habits to prevent this.





Routine hearing screening is not viable due to the low pick-up rate, but Prof Dr Tan says that the test is actually quite simple.

The doctor will run some simple activities, such as whispering near our ears and asking us to repeat what has been said.

If we have difficulties hearing normal conversations, we should consult an audiologist for further examination.


Women should routinely get a Pap smear every 3 years from the time they turn 21 years old to the time they hit 65. This test is useful to detect cervical cancer and other abnormal conditions of the cervix.


Women are advised to go for a mammogram every 2-3 years from the time they turn 45 or 55 (different guidelines offer different age suggestions), earlier if they have a family history. We can discuss this further with our doctor.

After the age of 70, the benefits of breast cancer screening are not clearly defined, but some people choose to continue going for it.

Where? Most hospitals and medical centres should be able to offer this.

Why? If breast cancer is detected while it is in an early stage, there is a higher chance of recovery.


While there is a screening test for prostate cancer in men, called the prostate- specific antigen (PSA) test, Prof Dr Tan says that a more effective screening method is to have a physical rectal exam performed by a healthcare provider. It may seem like an uncomfortable or embarrassing experience to some people, but it is actually a simple and quick (about a minute or two) procedure. This method also allows for detection of haemorrhoids, lumps and other unusual growths in the rectal area.


Perhaps lesser known compared to other screenings, the memory test (also called a neuropsychological test) allows for the measuring of the capacity of our brain to function in areas such as memory and language skills. This test consists of simple question-and-answer sessions, and the results will be measured against a standardized model.

Where? Most government health clinics have special health documents for older persons which include memory screening. Also, Prof Tan mentions that it is recommended that doctors do this opportunistically when an older person attends their clinic or hospital.

Why? This test can allow for early detection of issues such as memory loss, dementia, Alzheimer’s disease and other often age-related brain function issues.


These days, we can walk into any screening facility, and pick and choose for ourselves the ones we want from a list of available screening tests. However, we do not necessarily need to take all of them – some screening tests may actually offer negligible benefits to people in the older age group.

A ggod rule of thumb to follow is to first discuss with a are professional on the types of screening that will the most value for our Ringgit. HT

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An Age-Old Conundrum

An Age-Old Conundrum

 April 27, 2022   Return


Professor Dr Tan Maw Pindo

Consultant Geriatrician

University of Malaya Medical Centre


“I was Cleopatra, I was taller than the rafters But that’s all in the past now, gone with the wind. Now a nurse in white shoes leads me back to my guestroom It’s a bed and a bathroom and a place for the end.”~ From Cleopatra by The Lumineers

Filial piety and respect for older persons are cultural touchstones of Asian culture. Despite this, the rate of abuse inflicted on older persons is high enough to spur Deputy Women, Family and Community Development Minister Hannah Yeoh late February into calling for a roundtable discussion to address this issue. She also pointed out that, in Malaysia, many abuse cases tend to go unreported.

While stricter laws may be one way to curb abuse on older persons, consultant geriatrician Professor Dr Tan Maw Pin believes that the root causes of the problem need to be addressed as well. One of these root causes is our own often contradictory views on older persons.


Age is a multi-dimensional concept. We often think of chronological age – which measures the number of years we have lived – when we use the word, but the concept of age also encompasses physiological, cognitive, social and psychological ages – all of which may not necessarily coincide with our chronological age. One may be chronologically old, but his or her physiological, cognitive and psychological ages may be younger, allowing the person to still stay sharp and active.

For example, Professor Ephraim Engleman was an active professor affiliated with the University of California, San Francisco, up to his passing at the age of 104 in 2015. Who can forget Mother Mary Teresa Bojaxhiu, who was still overseeing the Missionaries of Charity in Calcutta, India, until her death in 1997 at the age of 87. Of course, Malaysia’s Prime Minister Tun Dr Mahathir Mohamad is also demonstrating that, these days, we cannot assume that one is of limited capacity to function just because he or she is of a certain age.


In the past, people tend to attach descriptions such as ‘weak’, ‘frail’ and ‘senile’ to older persons. Research has shown that this perception is inaccurate: growing old is not an inevitable descent into decrepitude.

In fact, Prof Dr Tan points out that advances made in research and development have enabled more older persons to still lead active and fulfilling lives.

For example, there are more opportunities than before for older persons to continue learning and being self- sufficient, which in turn help to keep their mind sharp and reduces the risk of dementia and diseases that affect the nerves and brain (such as Alzheimer’s disease). There are also studies which show that sexual activity among older persons is beneficial, as it promotes an increased sense of contentment as well as a feeling of kinship with their loved ones a complete 180º turn from the prevalent belief in this part of the world that elder persons are not supposed to be experiencing sexual desire, much less having sexual relationships.

Also, history has shown that a considerable amount of the best works from creative artists as well as scientists often result during their later years. This is said to be because the brain ages like fine wine. Life experiences shape the way one looks at our world, and life-long passions may simmer and evolve to produce a period of creative bloom later in life. The famous Colonel Harland David Sanders, the face of Kentucky Fried Chicken, for instance, opened his first outlet in Utah in 1952, when he was in his 60s, and the rest was history.

Prof Dr Tan therefore reiterates that this belief that older persons must be coddled because they are physically and mentally infirm should no longer be prevalent. Older persons have the capacity to be self-sufficient, productive and passionate just like everyone else.


You may be wondering by now: does the attitude shift really matter in the long run? Won’t it be better if we focus our time and energy on improving healthcare for the elderly?

Well, it matters because abuse of older persons is present in this part of the world despite many Asian cultures emphasizing filial piety and reverence for older persons. According to a study, the prevalence of such abuse in each country in Asia ranges from 2.2% to as high as 66%.

Such abuse doesn’t just include physical violence. Other forms of abuse include psychological abuse (the most common form of abuse, in fact), financial abuse (which includes withholding the older persons’ money, defrauding and theft), sexual abuse and neglect.

Abuse usually occurs due to one of three reasons:

  • Opportunity. The abuser does it because he or she is in a position to do so.
  • Occasion. The perpetrator isn’t targeting the older person specifically – he or she will do it to anyone, and the older person just happens to be in the perpetrator’s path.
  • Desperation. Abuse occurs because the harried perpetrator has reached a point in which he or she loses all sense of restraint and commits acts that would normally be considered reprehensible.

It may seem natural to call for harsher laws to punish those responsible for such abuse, but Prof Dr Tan believes that doing so will not address issues of abuse that fall into the third group, desperation. One group that is increasingly feeling this desperation is the sandwich generation.


The term ‘sandwich generation’ is used to describe the generation of people, usually in their 30s and 40s, who juggle between their parents and their own children. In an ageing country such as Malaysia, this term describes a significant slice of the population.

The challenges of being in the sandwich generation especially affect women, as they are traditionally viewed as the primary supporter in the family. Men aren’t fully exempted either, as their role is typically seen as the primary breadwinner. As a result, a typical couple in a sandwich generation faces the challenge of having to be financially, emotionally and physically available for both parents and children.


Further compounding the pressure is the typical Asian mentality which considers supporting the parents a moral obligation. The inability to do this well is often viewed as a sign of personal failure as well as a mark of shame and guilt. Those who fail to provide adequate care for older members of the family may even face censure from society, causing them to cover up their problems and preventing them from seeking help.

The result is akin to a dam with spreading cracks on the wall once they reach a breaking point, desperation may cause them to abandon their parents while stress and various negative emotions may lead to other forms of abuse.


According to a survey conducted by LV= Insurance in the UK:

54%: want to save money for their old age but can’t afford to do so.

52%: are worried that a serious illness will affect them or their partner in the following year.

30%: are worried that they or their partner dying will leave the family without an income.

46%: cite that their children are a constant source of unexpected expenses every month.

Many experience emotional turmoil

  • Overworked and burned out
  • Lack of sleep
  • Guilt
  • Anxiety
  • Loss of interest in previously enjoyed activities
  • Depression

Many have health issues

  • Neglect of own health and wellbeing
  • More sick days
  • Higher rate of overweight and obesity
  • Higher risk of mental decline


Professor Dr Tan Maw Pin believes that an attitude shift towards older persons is key to untangling the Gordian knot of issues facing the sandwich generation and the older persons they care for.

Don’t underestimate older persons! So long as they are capable of doing so, there is no reason why older persons shouldn’t drive, manage their own money or make decisions for themselves. Such independence also helps to keep their mind sharp and focused.


An unintentional fallout of treating older persons as venerable individuals who are also weak, infirm and sickly is that younger people stop seeing them as human beings capable of making their own decisions and having emotions. When things get tough, they may even start to view these older persons as unwanted anchors around their knees that will drag them down further.

“I have seen many instances in my clinic, during which the children of the older persons insist that I talk to them instead of addressing the older person,” Prof Dr Tan recalls. Given that the older person is the one with a health issue, to her it makes perfect sense to ask the person how he or she

is feeling. Yet, quite often the older person’s children believe that the person is incapable of explaining things on his or her own, and insists that Prof Dr Tan talk to them instead.

This “Older persons should be seen but not heard!” attitude tends to persist in all areas of family life. For example, many older persons lose financial independence despite being still capable of managing their own money, as overzealous younger members of the family insist on making financial decisions for them. Many older persons also buy into the belief that they are incapable of managing their own money just because they are of certain age, and willingly hand over the responsibility away. Such arrangement is also ripe for financial abuse.

The more an older person is deprived of his or her independence, the more dependent the person is on often busy and stressed-out younger family members. This creates a sense of helplessness when the older person begins to perceive himself or herself as a burden to the family.

“What is needed is an outlook change on both older persons and their younger family members,” Prof Dr Tan


Prof Dr Tan suggests the following as a starting point for a family to juggle with providing love, care and attention to younger and older loved ones.

Older persons, let’s be independent for as long as possible. These days, with family units being smaller and increasingly fractured as younger people move to major cities or abroad to study and work, we can’t take for granted that every family will be able to fully provide for older loved ones.

That doesn’t mean that the older loved ones should be neglected or abandoned, of course! Instead, older family members can take measures to stay as independent and self-sufficient as possible. This way, they are able to live a fulfilling life on their own terms, without being dependent on other family members. These measures include:

  1. Live well and healthy. This includes eating right, being physically active on a regular basis (incorporating age-appropriate exercises and other activities), and if any non-communicable diseases are present, working closely with the healthcare team to keep these diseases well controlled.
  2. It’s fine to work. This allows older persons to continue being financially independent. There is no shame in taking up age-appropriate jobs so long as the mind and body are still willing and able. These days, one has more opportunities to work from home or on a flexible schedule, so possible job options can include writing on a freelance basis, bookkeeping, being a Grab driver, sales and more.
  3. Learn something new. Life doesn’t end after retirement; there is a world outside to discover and experience. Learning new skills allows an older person to lead a fulfilling life, without having to take time and attention from younger family members who have children to tend to. New skills don’t have to be elaborate; they can be something on a smaller scale as learning a new language, mastering how to play a new instrument, getting the hang of blogging, starting a social media account and making YouTube videos.

Make plans for the inevitable. This includes planning for one’s funeral arrangements, having a will done up as well as discovering options and making plans for palliative care. Doing this allows the older person to experience the satisfaction of planning the days ahead on his or her own terms, while eliminating the need to involve younger family members in what could be a time-consuming process.


Prof Tan has a few suggestions.

  • Be open. Ask the older persons what they want, instead of assuming or making decisions for them.
  • Plan the family finances. A financial planner may be a helpful ally when it comes to assessing current financial situation, and whether some areas of spending can be reduced to free up spending for caregiving
  • There’s no need to do everything alone. No one is an island – trying to do everything will only lead to both physical and mental burnout. Delegate responsibilities instead. For example, can the family afford getting cleaners to come in a few days each week to do the housework, leaving the family members free to tend to other needs? Instead of a single family member having to drive the older persons back and forth to various hospitals because only that person has a car, can other family members take turns to order a Grab car and accompany the older persons?
  • It’s okay to let go. Some caregivers feel that they are the only ones who can understand and care for their loved ones. Hence, they want to do everything on their own, to the point that they soon burn themselves out by overextending beyond their physical and emotional limits.These caregivers need to let go and allow others to step in to assist; if they find it hard to do this, they can seek advice from a counsellor or a member of the older person’s healthcare team.
  • Don’t feel alone – no one is. Caregiving can be an isolating responsibility; caregivers may feel that they are sacrificing their own needs and relationships with other people to tend to the loved one. Nothing builds resentment more than playing the unwilling martyr. Prof Tan advises caregivers to reaching out to other caregivers, either online or in real life, for support. Furthermore, in this age of social media, they can still form and maintain strong relationships even when they lack the time and opportunity to mingle in real life.
  • Most importantly, don’t forget to tend to one’s own needs too. If caregiving is delegated across several people or is planned well to allow the caregiver(s) to have their much needed me-time, the people involved in caregiving will be able to tend to their own personal needs as well. This allows them to stay healthy and sound in both body and mind.

Open and honest communication is key. This is an often overlooked but very important aspect of family life. Often, older persons either stay quiet in fear of offending younger family members, or they assume that they are the smartest (and loudest!) person in the room. Meanwhile, younger family members treat older persons as incapable of adult thought, often making decisions for them without consulting them. All this can generate friction and resentment on both sides.

Communication should instead be open, honest and respectful. Decades of resentment and unspoken hurt – which could bleed into daily interactions to create tension and dissent – can start to heal once everyone opens up and takes the time to understand one another. Prof Tan suggests that, should a family find it hard to initiate open conversations on their own, try asking a third party such as a family friend to mediate during the initial stages of communication.

Open and honest communication allows both sides to see one another in a truthful light. Both parties will understand the wishes and limitations of one another, and this will facilitate a more harmonious household. Less unrealistic pressures, less resentment, less of a sense of forced obligation; instead, the family may just be inviting in a stronger sense of togetherness and love. Finally, a home. HT

“The driving forces behind successful and fulfilling caregiving are love and respect between the caregiver and the loved one. ”


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10 Tips To Prevent Alzheimer’s Disease

10 Tips To Prevent Alzheimer’s Disease

 April 27, 2022   Return


In conjunction with World Alzheimer’s Day on 21st September, HealthToday shares 10 ways to prevent Alzheimer’s disease (AD) which were presented by Professor Karl J. Neeser, of the College of Public Health Science, Chulalongkorn University Bangkok, Thailand, at the 3rd World Congress on Anti-Aging, Aesthetic, Regenerative, Nutritional and Exercise Medicine 2019 in Kuala Lumpur.


Using our brain to solve complex tasks and puzzles, and engage in discussions will help prevent the brain from growing ‘stale.’


Exercise gets the blood flowing to all parts of the body. As we know, blood carries oxygen. The lack of oxygen interferes with the metabolism of our brain neurotransmitters. Exercise also triggers the production of endorphins, serotonin, dopamine, and norepinephrine. These are chemicals which carry signals in the brain, hence any increase in these chemicals improves brain function. Older folk can engage in yoga, tai chi and qigong as forms of physical exercise.

Click on this QR code to see what the MIND diet is all about.



In general, what’s good for the heart is good for the brain. Therefore, the Mediterranean diet, which consists of fresh fish, nuts, fruit and vegetables, and very little red meat or processed carbohydrates, is great for the brain. More recently, US researchers came up with the MIND diet, which is a modification of the Mediterranean diet, and another diet called the Dietary Approaches to Stop Hypertension (DASH).


Did you know that sugar is one of the most addictive substances on earth? Yes, it is just as addictive as some drugs. Also, sugar damages our brain neurons and make them more likely to die. High levels of sugar in the brain is also linked to memory loss. Here’s the catch—fructose found in fruit is more dangerous than glucose in terms of causing damage to the brain. Therefore, we need to limit our consumption of sweet fruit, too.


Avoid stress whenever possible as stress makes your brain release corticosterone, a type of hormone that blocks the brain from receiving and retrieving information. This is the reason why we sometimes cannot remember the details of a particularly stressful event.


A Harvard Health Report on AD 2018 reveals that healthy social relationship with family and friends is linked to better mental longevity. Additionally, a healthy sex life contributes the same benefit.


The same Harvard Health Report also reveals the clear link between sufficient sleep and lower risk of brain disease. Sufficient sleep isn’t enough though, as the sleep should also be of good quality. Lack of sufficient quality sleep causes brain plaque to build up, thus leading to a decline in brain health.


Vitamin D helps in the transfer of information in the brain. Those persons with higher levels of vitamin D in their blood are less likely to develop brain disorders such as dementia and AD. Vitamin D deficiency is also linked to a higher risk of depression and other diseases such as type 2 diabetes.


Yes, everything is linked. If we eat a brain-healthy diet and exercise, then it is very likely that our weight is within a healthy range. If not, then we will have to contemplate extra measures to reduce weight. Maintaining a healthy body weight isn’t just good for the brain and heart, it is also good for the joints.


Pollution in the form of pesticides, mercury, cadmium, benzene, formaldehyde and many more harm our health by disrupting our biological processes. Therefore, any step we take to reduce exposure to these pollutants will be beneficial to our wellbeing in the long run. With the advent of smartphones and tablet devices, there is the worry of exposure to electromagnetic radiation as well. The claim that electromagnetic radiation is safe and within a certain limit could be a fallacy, as recent epidemiological studies suggest the only safe exposure level is zero. HT

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Replacing Missing Teeth With Dental Implants

Replacing Missing Teeth With Dental Implants

 April 27, 2022   Return


Like many couples, Shahreen Hazaline and Muhamad Shukor are a pair of complementary opposites; one bubbling over with energy and laughter, the other calmer and more soft-spoken. Yet both share similarly warm smiles when they look at each other. It’s hard to imagine that just over 3 years ago, in the middle of Shahreen’s fourth pregnancy, they found themselves facing her diagnosis of stage 3 breast cancer. For this HealthToday issue, they share their story of a road travelled together.


It was in the 12th week of her pregnancy when Shahreen noticed the lump in her breast that wouldn’t disappear.

“I could feel something inside, like biji-biji (seeds).” She waves a hand over her chest as she recalls. “When people breastfeed, they sometimes get lumps because of mastitis or [blocked] ducts. But those usually go away if you rub repeatedly at them. This didn’t.”

What she found doubly strange was that she wasn’t even breastfeeding anymore by then; her third child had been weaned some weeks ago. Curious, she brought the matter up to her gynaecologist on her next routine check-up. Examining Shahreen, she scheduled an ultrasound that same day.

The lump appeared to be a liquid-filled cyst. Uneasy with the results, the gynaecologist referred her to a breast surgeon, who did a biopsy.

“The surgeon didn’t say ‘cancer’, just ‘something’s wrong’. But I already started to cry a lot. I cried as we walked by people in the hospital, like someone had passed away.” Shahreen mimics a dramatic wail, then laughs. “It was bad enough before with the hormone imbalance from pregnancy. My gynae referred me to a counsellor; I think she was alarmed at how upset I was.”

The surgeon recommended an operation to remove the lump when the baby was 16 weeks old and fully formed, to reduce any risks from anaesthesia. Alternately, they could wait until after the pregnancy, but there was a high risk the cancer—if it really was cancer—would progress rapidly in that time, especially due to Shahreen’s increased oestrogen levels.

Shahreen left the final decision to Shukor. His heart fell.

“I had to make a decision for two lives,” he tells me. “How could I let go of either one?”

In the end, they chose to go ahead with it. They felt that knowing the truth was better than uncertainty. And there was no ignoring the lump itself.


A month later, they operated. The results indicated stage 2 breast cancer.

Shahreen was advised to start chemotherapy as soon as possible. Her doctors assured the couple that the baby would not be affected, as the drugs would not cross the placental barrier.

It was still frightening. They had never bothered to learn much about the disease. After all, she checked none of the usual boxes of risk factors: she had no family history, she was under 40 years old, she had breastfed all her children, she didn’t smoke or eat much junk food.

December was supposed to be their long-awaited umrah pilgrimage. But treatment couldn’t be postponed, the oncologist said, as the cancer could go far in 2 weeks. Neither could she start treatment before the trip; her immune system would be so weak that the crowds at Mecca would put her at risk of infections.

Instead of boarding a plane, Shahreen found herself entering the hospital’s cancer centre, where she saw a patient being wheeled out from a chemotherapy session. Right before her eyes, the woman abruptly vomited in the hallway. She wondered if that would be her eventually, too.

How did this happen? In her mind, thoughts overcrowded. Day and night, she couldn’t stop crying. Cancer is a taboo in Malaysia. How will people react to the news? What have I done wrong? Was it a sentence by God, a kind of retribution for something I’ve done?

In fact, just 2 weeks before, Shahreen had resigned from her job in the government and joined her husband to work as an independent unit trust agent. She wondered if other people would point fingers at things like that, saying she had brought the cancer on herself. Maybe it was sceptical of her, she says, but it was a real fear.

She asked Shukor to keep her diagnosis a secret. Only their respective parents and Shukor’s older brother were informed, and Shukor always obtained her consent first before telling anyone new.

At one point, she tried sending an email to the National Cancer Council Malaysia (MAKNA), the only cancer society she knew then.

“I told them about my diagnosis. They replied and asked for my phone number; they wanted to advise me.” Shahreen smiles. “But I backed off, because I was afraid.”



Shukor did his best to support his wife in her isolation. She was scheduled for six cycles of chemotherapy up to April, each lasting 3 weeks.

“It was a very stressful time for her,” he tells me. “So I took her to the hospital whenever she wanted to go, stayed with her when she was admitted to the ward. I let go of a lot of other things to spend more time with her.”

It helped that their self-employment allowed some flexibility. Nevertheless, finances were a struggle. No longer eligible for a government employee’s medical coverage, Shahreen had a private medical card, but with how recently it had been obtained, she and Shukor would still need to pay for the first few hefty bills out of pocket first.

But there was little choice. She was pregnant and needed treatment as soon as possible.

“We had to tighten our belts. It definitely affected the time I had for the business. But if I was working under a company, I wouldn’t have been able to take so much leave.” Shukor’s smile is soft as he looks at his wife. “Because I was working independently, I could take care of her more.”

Was it frustrating for him at any point to be a caregiver? Shukor shakes his head.

“It was more a sadness. Everybody who has a life partner, a spouse … they already have things planned for their lives, right?” He takes her hand. “So when something like this happens, those dreams—you just keep them aside to deal with whatever is happening to her, right now.”


Things changed for Shahreen when she met another cancer survivor for the first time.

Her counsellor had advised her to come for a patient support group meeting at the hospital. But being afraid, she made up her mind to arrive late, hoping it would have finished without her and she wouldn’t have to actually talk to anyone.

“But when I arrived, as it turned out, the meeting had been cancelled.” She laughs. “The counsellor was like—’what a pity, she’s come all this way’ and tried to find something else for me.”

Coincidentally, there was an ongoing art exhibition in the hospital by Elaine Therese Lim, a painter who had survived ovarian cancer. The counsellor introduced Shahreen to her and left them to talk.

“So we chit-chatted … and I told her all the things I was feeling. And she said to me: the fact you got this disease isn’t because God wants to punish you, or that you’ve made a mistake. None of that. If God wants to give it, anyone can have it. There’s no need to think so hard on the reasons.”

It was like a weight lifted from Shahreen’s shoulders.

“After meeting her and being comforted by her, I felt really good. It was the first time I’d met a cancer survivor. And I started to accept the fact that … okay, I’ve got this. Fine. So get through it.”

A few days after that encounter, Shahreen opened her Facebook page and posted, for the first time, a status update acknowledging she had cancer. Dated 15th March 2015, it begins with: “God always has a better plan.”

“To my surprise, there was no negative feedback,” she says. “All of my friends just gave encouragement and support.”

It emboldened her and removed her doubts. In subsequent posts, she wrote all the details down: about her disease, about the chemotherapy she was going through, about the ‘chemo baby’ she carried.

“After meeting Elaine Therese, I thought: why not share these things?” Shahreen smiles. “I thought it might help someone out there who needed—not the medical details, but the knowledge that it can be done, even during a pregnancy. Maybe one of the reasons God gave me the cancer was so I could do that.”



At the end of April, Shahreen’s fourth child, Zhafran, arrived with no complications. To her relief, she was able to give birth to him naturally as she had her other three children; as her gynaecologist had promised, the chemotherapy had no effect on that.

She shows me a phone photo of a healthy, chubby-cheeked young boy sitting in front of a plate of cake.

Alhamdullilah, he’s okay. He turned 4 on 28th April this year.” She beams as she swipes through more photos of her son’s birthday celebration. “In fact, when I gave birth to him, he was around 3.85 kg! That’s normal for our family. My eldest was around 3.95 kg.”

Unlike most pregnant women, Shahreen’s overall weight had remained unchanged for months until her delivery date. Her body had been shrinking while her son’s had been growing.

Two weeks after Zhafran’s birth, Shahreen left him in the care of a friend while she underwent a positron emission tomography (PET) scan and a second operation on her lymph nodes. Due to the involvement of radioactive particles, she wasn’t allowed to be near her son for some days.

After the operation, based on the number of affected lymph nodes and the size of her tumours, the doctors modified her diagnosis to stage 3 breast cancer, which initially shocked her. Hadn’t she been doing chemotherapy all this time? But it was explained that the initial diagnosis had been incomplete as they couldn’t assess more than the breast lumps while she was pregnant.

Furthermore, many cancer cells in the lymph nodes were dead, which meant the chemo was working. Shahreen would still have to go through another four cycles of chemotherapy on a different medication, with an additional month of radiotherapy, but there was hope.

To her disappointment, unlike with her previous three children, this meant she would not be able to breastfeed her newborn son for his first year. Patients undergoing chemotherapy were generally recommended to wait until 6 months after their final cycle to prevent health risks to the child.

“Even with a pill to suppress the milk, it would just come out, and I would have to let it be.” Shahreen pauses, for once without a smile. “You have to understand … I breastfed my first three children until all of them were 3. When it’s something so natural to you, to have to just wipe or throw it all away … it felt very sad.”


When I ask if they had childcare issues, the couple exchange looks and laugh.

“He can cook very well!” Shahreen says proudly. Shukor is more self-deprecating and explains that they had a hired helper to take care of the children. Though yes, he did cook as well.

With her eldest being 8 at the time, the couple aren’t sure the children understood what their mother’s illness meant, even with her weight loss, her falling hair and eventually (with Shukor’s help) her shaved scalp.

“We explained to them that mum was ill. But for them, ‘being ill’ normally meant having a fever for a little while and then getting better, right?” Shukor says. “Something like cancer, that goes on for months … it was a bit harder to understand, I think.”

Shahreen thinks that the sense of normalcy was also helped by the fact that she never had to stay at the hospital for more than 2-3 days at a time, even during her initial cycles. By the third cycle, she was asking the oncologist about going back to work, and got the green light based on her blood count and her physical condition.

“I was bored staying at home and not going anywhere. So I would do chemo, and after 2-3 days I would just go out and work. The children didn’t seem to notice a difference.” Shahreen raises an eyebrow. “Is that a good or a bad thing?”

One of the things Shukor also had to handle was a barrage of well-intended recommendations for alternative treatments from others. He tried to filter through them with the help of Shahreen’s doctors and friends of his own who had medical backgrounds.

One of them, who had done research in the field of alternative medicine, explained to the couple that clinical research was a multi-stage process, and some products labelled as ‘clinically researched’ might have only been tested in animals.

“After learning more about it, I thought it’s better to follow what the doctors said.” Shukor smiles. “Especially because she was pregnant, I didn’t want to take the risk on whether the hospital’s medicines and alternative ones would complement or fight each other.”



Thirteen months after her diagnosis, the doctors declared Shahreen no longer needed treatment. She was to come in for a follow up every 6 months; in 2018, the oncologist changed it to once a year.

Even though it’s been more than 3 years, they still feel the difference in their lives.

“When you’re healthy,” Shukor says, “you feel like you’re going to live till 60 or 70 years old. But when something happens, you feel like your life will be shorter … everything we planned for the long term needed to be adjusted.”

“Before this, we used to think: okay, we have a lot of time, we can do whatever whenever, next year, or the year after,” Shahreen adds. “Like—when I was in secondary school, I was a hiker. But after getting married, I just stopped, thinking that’s something from the school days, no time for that now.”

In 2017, Shahreen hiked up Mount Kinabalu with a group of fellow survivors. It was one of over 10 mountains and hills she tackled that year. She also launched herself into things she had never considered doing before, like dragon boat racing and bowling with others from the Breast Cancer Welfare Association (BCWA).

“At university, I used to work part-time at a bowling alley. We had free games, but I never played, always thinking ‘oh no, what if my ball goes in the drain and people laugh at me?’” Shahreen grins. “But now I’m more open to whatever happens. ‘Just do it!’ Us survivors, we feel like we have a second chance. There’s so many more things we want to try.”

I ask if the two of them have advice for those starting their own cancer journeys, or with loved ones doing so.

“Don’t wait,” they both say.

Shahreen tells me about stories from her support groups; people would delay their treatment, looking for alternatives, only to come back when the cancer had progressed even further. It was ironic, she says, that people were willing to entrust hospitals with a credible diagnosis of their condition, but not with credible treatment.

To friends and family of patients, the couple also advises that they not add too much stress to the patient, and instead try to find means of emotional support.

“When someone has cancer, they’re already weighed down by heavy thoughts,” says Shukor. “Things like how easily the cancer can spread, or when they’re going to die.”

“The easiest thing you can do is to find them a support group, whether on Facebook or elsewhere. Those groups have survivors, even doctors,” Shahreen adds. “A patient can sometimes be afraid of taking that step. Help take them there.”

“Also? Don’t Google everything.” They laugh together. HT

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