Here’s How Post-Menopausal Women Can Manage Their Vaginal Dryness

WORDS DR HOE YUT HUNG


As we get older, our bodies start to go through normal and expected changes.

It can be upsetting to find yourself unable to keep up with activities and lifestyles that were once simple and effortless, but we must learn to accept that aging is a natural part of life.

Changes in our physical capabilities become more noticeable as we age, and vaginal function, like many other areas of the body, can be affected by age.

AS WOMEN AGE, ESPECIALLY DURING MENOPAUSE, THE VAGINA AND SURROUNDING AREA MAY EXPERIENCE CHANGES THAT IMPACT THEIR ABILITY TO EXPERIENCE PLEASURE

Vaginal dryness is a common menopausal symptom that many Malaysian women experience. Furthermore, 56.1% and 39.9% of postmenopausal women had sexual problems and vaginal dryness, respectively.

However, according to one study, only 38% of the respondents with vaginal dryness sought treatment.

These statistics show that, despite its prevalence, many Malaysian women do not seek treatment for it. This could be due to a lack of awareness about the condition and available treatment options, as well as the societal stigma associated with it.

WHAT CAUSES VAGINAL DRYNESS?
Decrease in oestrogen levels
  • One of the most common causes.
  • Oestrogen plays an important role in maintaining the health of the vaginal lining, ensuring that it remains thick, elastic, and well-lubricated.
  • Its levels tend to drop in older women.
Certain medications Examples: antihistamines, antidepressants, and birth control pills.
Certain medical conditions Examples: diabetes, Sjögren’s syndrome, and lupus.
Lifestyle habits Examples: smoking and inadequate water intake.
SYMPTOMS OF VAGINAL DRYNESS
  • Vaginal itching
  • Burning, pain, or discomfort in the vaginal area
  • Vaginal bleeding after intercourse
  • Vaginal bleeding or spotting between periods
  • Frequent urinary tract infections
THE SOLUTIONS TO VAGINAL DRYNESS

While experiencing vaginal dryness can be frightening, it does not mean the end of the world.

Over-the-counter lubricants or moisturisers
  • These can help to relieve symptoms and make intercourse more comfortable.
  • They can help provide temporary relief from the symptoms of vaginal dryness, but they may not be effective for all women and may need to be used frequently.

Natural remedies

  • Examples include coconut oil and aloe vera gel, which can also be used to moisturise the vagina and relieve discomfort.
  • These natural remedies can also help improve of overall skin texture, reduce of inflammation, and relieve itching or burning sensations.
Hormone therapy
  • This can help to replace oestrogen and improve vaginal lubrication.
  • Can be prescribed in a variety of ways, including vaginal rings, tablets, and creams.
  • However, hormonal therapy is not the best choice for everyone, so it is important to talk to a doctor or speak to a specialist before you begin.
Ultra Femme 360 
  • This is a non-surgical radiofrequency treatment for both internal and external vaginal rejuvenation.
  • It can help improve muscle strength and laxity in the vagina, giving you a tighter, firmer vagina.
  • There is no downtime or scarring.
WHEN SHOULD YOU SEE A DOCTOR?

Although vaginal dryness can be treated at home or with non-invasive treatments, you should seek medical attention if you have symptoms such as:

  • Bleeding or unusual vaginal discharge
  • Discomfort from the vaginal dryness interfering with your daily activities
  • Bleeding between periods or after sexual intercourse.

It is important to note that vaginal dryness can be a sign of an underlying medical condition, such as vaginal infections or sexually transmitted infections.

If the vaginal dryness is severe or long-term, it is best to consult with a specialist, such as a gynaecologist. They can help determine the cause of vaginal dryness and recommend the best treatment option for you.

References:

  1. Abdullah, B., Moize, B., Ismail, B. A., Zamri, M., & Mohd Nasir, N. F. (2017). Prevalence of menopausal symptoms, its effect to quality of life among Malaysian women and their treatment seeking behaviour. The medical journal of Malaysia, 72(2), 94–99. https://www.e-mjm.org/2017/v72n2/menopausal-symptoms.pdf
  2. Nik Hazlina, N. H., Norhayati, M. N., Shaiful Bahari, I., & Nik Muhammad Arif, N. A. (2022). Prevalence of psychosomatic and genitourinary syndrome among menopausal women: A systematic review and meta-analysis. Frontiers in medicine, 9, 848202. https://doi.org/10.3389/fmed.2022.848202

Some Facts to Help You Understand Better What Dementia Is

WORDS LIM TECK CHOON


The World Health Organization reveals that about 10,000,000—that’s ten million—new cases of dementia are diagnosed every year.

In Malaysia, the Alzheimer’s Disease Foundation shares that 204,000 to 264,000 adults were diagnosed with dementia in 2020, and they expect the numbers to rise to between 637,500 and 825,000 by 2050.

DEMENTIA IS ACTUALLY A GENERAL TERM THAT COVERS CONDITIONS IN WHICH ONE EXPERIENCES SIGNIFICANT DECLINE IN COGNITIVE FUNCTION

Consultant geriatrician Dr Teh Hoon Lang explains that the decline should be significant enough to affect one’s thinking, memory, and social skills until it impedes their ability to carry out their usual day-to-day routines.

DEMENTIA IS A TERM THAT INCLUDE A NUMBER OF CONDITIONS INCLUDING
  • Alzheimer’s disease, the most common one
  • Frontotemporal dementia, a rare form that usually develops in people younger than 60
  • Lewy body dementia
  • Vascular dementia, caused by blood vessel damage that interrupts blood and oxygen flow to the brain
  • Mixed dementia, a combination of two or more types of dementia
THERE ARE MANY FACTORS THAT CAN INCREASE ONE’S RISK OF DEMENTIA

“These factors can be divided into modifiable and non-modifiable risk factors,” Dr Teh says.

Non-modifiable risk factors—things that we can’t change—include:

  • Advancing age
  • Being female
  • Certain types of dementia can be passed down from parent to child; however Dr Teh assures us that having a gene for one of these types of dementia is not a surefire guarantee that the person will develop that type of dementia

Meanwhile, modifiable risk factors include:

  • Diabetes mellitus
  • High blood pressure or hypertension
  • Obesity
  • Excessive alcohol consumption
  • Smoking
  • Depression
  • Traumatic brain injury
  • Sedentary lifestyle
  • Social isolation
  • Mid-life hearing impairment
  • Air pollution

“The more risk factors a person has, the higher their chances of getting dementia,” Dr Teh says.

TEN EARLY WARNINGS OF DEMENTIA TO WATCH OUT FOR
  • Memory loss
  • Difficulty performing familiar tasks
  • Problems with language
  • Disorientation to time and place
  • Poor or decreased judgement
  • Problems keeping track of things
  • Misplacing things
  • Changes in mood and behaviour
  • Challenges understanding visual and spatial information
  • Withdrawal from work or social activities
WHERE TO SEEK HELP IF YOU BELIEVE THAT YOUR LOVED ONE MAY HAVE DEMENTIA

It is fine to consult a general practitioner or GP, who can refer your loved one to a specialist if necessary.

A geriatrician is a specialist that can help with dementia in older persons, and other types of specialists such as neuropsychologists and psychiatrists may also step in to help.

DEMENTIA CAN’T BE CURED, BUT IT CAN BE SLOWED DOWN

Dr Teh shares that there is no cure for dementia at the moment.

However, she assures us that there are many measures or strategies to slow down the progress of the disease and provide both the affected person and their caregivers a better quality of life.

“The most important part of dementia care is to get diagnosed early and get professional advice on the management plan,” says Dr Teh. “Every person with dementia is unique and the approach should be individualized. The basic principles of care include understanding the disease pattern and the struggles or difficulty they are facing, providing a supportive environment, maximizing their strength and minimizing their loss due to cognitive decline.”

Experts Pave the Way to Improve Outcome of Osteoporosis in Malaysia

WORDS LIM TECK CHOON

On January 17, 2023, Malaysian Osteoporosis Society (MOS), the Academy of Medicine Malaysia, and our Ministry of Health launched their jointly-published 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis.

In the media briefing held in conjunction with this launch, our Director General of Health Tan Sri Dato’ Seri Dr Noor Hisham Abdullah shares that:

  • Malaysians are now growing older and living longer. As a result of this, many of us will be affected by age-related non-communicable diseases, which includes osteoporosis.
  • Osteoporosis results in bone fractures, which are associated with disability and premature death.
An illustration of osteoporosis. Click on the image for a larger, clearer version.
WHY IS OSTEOPOROSIS SUCH A CONCERN?

A 2020 study revealed that all people with hip fractures, upon treatment and discharge from the hospital, need walking aids.

6 months later, only 24% (that’s about 1 out of 4 people) regain their mobility and their ability to live independently.

Another 26% die within one year after the fracture.

Tan Sri Dato’ Seri Dr Noor Hisham Abdullah voices his concern that osteoporosis is a serious disease that requires early detection, intervention, and management even at later stages.

This is especially relevant, as the incidence of hip fractures is projected to rise from 5,880 in 2018 to 20,893 in 2050, a 3.6-fold increase!

THE KEYSTONES TO IMPROVING THE AWARENESS OF & TREATMENT OUTCOME OF OSTEOPOROSIS


Dr Yeap Swan Sim, the current President of the Malaysian Osteoporosis Society, states that the cornerstone principles in ensuring that Malaysians can age healthily and gracefully while minimizing the threat of osteoporosis are:

  • Understanding the disease
  • Taking preventive measures
  • Good management of osteoporosis
  • Knowing the appropriate surgical options, should these options become necessary
FRACTURES & OSTEOPOROSIS ARE NOT “NATURAL” AGEING PROCESS, SO TAKE THEM SERIOUSLY!


Dr Terence Ong Ing Wei points out that osteoporosis usually happens in older people and is almost as common as diabetes. “Diabetes evokes fear and concern, yet most people wouldn’t give osteoporosis a second though,” he muses.

Many people often assume that bones weaken and falls and fractures become more common because all these are a ‘natural’ part of ageing.

Dr Terence disagrees, stating that there is nothing natural about osteoporisis.

In fact, it is actually a very complex condition influenced by many factors. “Some things that we do not think too much about in our everyday lives have a huge impact on our bone health. These include physical inactivity, fad diets, cigarette smoking, and age-related hormonal changes such as oestrogen in ageing women and testosterone in men. All these increase the rate of bone loss at a time when strong bones are most needed.”

DIAGNOSIS AT LATE STAGE OSTEOPOROSIS FORCES DOCTORS TO RULE OUT IDEAL TREATMENT OPTIONS 

Dr Yeap says, “We usually only see osteoporosis at its late stages—after a fracture has occurred. By then, the patient would have incurred significant amounts of bone loss. At that stage, it is no longer possible to offer treatments to replace the lost bone, which is the ideal scenario. Instead, treatment options will instead attempt to minimize the detrimental effects of a fracture experienced by the patient.”

“Clearly, we should be giving more emphasis to screening and early detection, followed by suitable interventions so that we can protect the most vulnerable persons from this terrible illness,” she adds.

EARLY DETECTION CAN ALLOW FOR EARLY PREVENTIVE MEASURES 

Professor Emerita Chan Siew Pheng concurs with the other experts. “This is because mainly because you don’t even realise osteoporosis is there until you suffer from a fracture. So, the only way to know if you have osteoporosis before a fracture occurs, is by going for a bone density scan, also called dual-energy x-ray absorptiometry, DEXA or DXA.”

More about bone density scan
Prof Chan explains that the bone density scan is a quick and painless X-ray procedure that allows doctors to find out whether osteoporosis is present.

It also allows doctors to predict the risk of future fractures in order to provide timely and suitable treatment. “This would save you so much trouble in the future!” she says.

According to Prof Chan, women aged 65 years or older and men 70 years or older should have a DXA scan done every two years.

Younger individuals may also need to be screened if they have certain conditions such as diabetes, thyroid disorders, nutritional malabsorption, eating disorders, rheumatoid arthritis, or are taking certain medications (like steroids) long term.

If you fall into any of these categories, you should consult your doctor for more information as to how you can benefit from a DXA scan.

With the right steps at the right time, osteoporosis can be effectively managed 
Prof Chan explains: “There are effective medicines that can be tailored to suit all sorts of patients based on their disease stage and lifestyle. Moreover, whenever pharmacological treatment is necessary, the medications that are available in Malaysia can reduce the risk of fractures from 15% up to 70%!”

She adds that these anti-osteoporosis medicines are generally well-tolerated and effective.

THIRD-EDITION CLINICAL PRACTICE GUIDELINES LAUNCHED TO IMPROVE SCREENING, DIAGNOSIS, & TREATMENT OF OSTEOPOROSIS

Dr Yeap Swan Sim shares that this clinical practice guidelines, meant for healthcare professionals in Malaysia, consists of evidence-based statements intended to assist healthcare providers in optimizing patient care.

“We must first recognize the fact that osteoporosis is a multi-factorial condition,” she says. “Nutrition, age, hormone, lifestyle and the presence of pre-existing disease are some of the aspects that can affect bone health. All these requires not only input from one profession but multiple of them in order to provide patients with proper and effective care.”

She adds: “As such, the clinical practice guidelines had to be written by a panel of experts from all the related disciplines, such as nutrition, geriatrics, endocrinology, orthopaedic surgery, obstetrics and gynaecology, rheumatology, primary care and pharmacy. The wide variety of expertise involved in the writing of the clinical practice guidelines ensures extensive coverage so that the guidelines will be able to inform all types of healthcare professionals who would be involved in the screening, diagnosing and treatment of osteoporosis.”

The 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis was the fruit of the labour of the CPG Working Group comprising:

  • Dr Yeap Swan Sim (Chairperson)
  • Dr Terence Ong Ing Wei (Co-chairperson)
  • Associate Professor Dr Lim Lee Ling (Co-chairperson)
  • Professor Emerita Dr Chan Siew Pheng
  • Professor Datuk Dr Sabarul A Mokhtar

Interested healthcare professionals can download the 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis by clicking here. This link will open in a new tab.

Get the Flu Shot to Prevent a Heartbreaking Holiday Season!

In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!

DO YOU KNOW THAT YOU COULD END UP WITH A HEART ATTACK OR STROKE WHEN YOU GET THE FLU?

Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!

Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.

Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”

HOW THE FLU AFFECTS YOUR HEART

When the flu virus enters your system, your immune system strings into action.

Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can also damage your own healthy tissues and organs.

One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.

 

An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.

Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.

Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.

OLDER PERSONS ARE ESPECIALLY AT RISK WHEN THEY CATCH THE FLU

In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.

Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”

“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.

FLU VACCINATION CAN PROTECT YOUR HEART

Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.

There is also an 18% reduced risk of death reported in patients with heart failure.

For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.

This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

The article has been edited by HealthToday for publication on this website.

For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).

References:

  1. Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794. https://doi.org/10.1183/13993003.01794-2017
  2. Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488. https://doi.org/10.1161/CIRCULATIONAHA.121.057534
  3. Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
  4. Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351. https://doi.org/10.1503/cmaj.151059
  5. King, S. C., Fiebelkorn, A. P., & Sperling, L. S. (2020, November 2). Influenza vaccination: Proven and effective cardiovascular disease prevention. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention
  6. Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351. https://doi.org/10.1016/j.arr.2021.101351

Could Stem Cell Therapy Be the Future of Medicine in Malaysia?

WORDS LIM TECK CHOON

Stem cells are a unique type of cell in our body. This is because they are the only type of cells that can develop, under the right triggers and condition, into a variety of more specialized cells, such as blood cells, muscle cells, bone cells, and more.

HOW STEM CELLS ARE USEFUL 
  • Researchers can generate a variety of human cells from stem cells in the laboratory. These cells are then used to test new medications for possible side effects.
  • Research is also conducted on generating healthy cells that can replace those in our body that are dying or damaged due to age or disease. Such use of stem cells is called regenerative medicine.
THE 2 TYPES OF HUMAN STEM CELLS
  • Hematopoietic stem cells (usually abbreviated as HSCs), which are found in cord blood, bone marrow, and peripheral blood
  • Mesenchymal stem cells (MSCs), which as found in the gel-like substance (Wharton’s jelly) of the umbilical cord, bone marrow, fat tissue, and tooth pulp
REGENERATIVE MEDICINE IS THE FUTURE?

Judging from the versatility of stem cells when used to produce of a variety of healthy human cells, regenerative medicine has obvious benefits for people whose tissues are damaged or dying due to diseases as well as people in need of tissue transplant.

Just some of the cells that can be generated from stem cells in the laboratory. Click the image above for a larger version.
Promising for treating heart diseases

Dr Lee Tjen Jhung, a cardiologist affiliated with the National Heart Institute (IJN), says, “While heart diseases are usually treated with medication, angioplasty and by-pass surgery, cell-based regenerative therapy is gaining popularity in the cardiovascular field due to the ability of mesenchymal stem cells to provide new blood in areas affected by restricted blood flow as well as promote the formation of new blood vessels.”

An answer to ageing-related health issues?

Dato’ Dr Rajbans Singh, the President of the Malaysian Wellness Society, points out that stem cells can play a crucial role in treating aging-related health problems.

He elaborates: “At birth, the human body has approximately 80 million active stem cells However, by age 40, less than 25 million active stem cells are functional. Ageing leads to a massive loss of stem cells in the body, affecting the ability of organs and tissues to repair and regenerate as the body gradually ages and deteriorates.”

Here’s a general, simplified overview of how the whole procedure works
  1. Stem cells are grown in a laboratory, and then manipulated to grow and specialize into a more specific type of cells (heart muscle cells, blood cells, etc)
  2. These cells are then implanted into the person that can benefit from this procedure, for example a person with heart disease could be implanted with heart muscle cells, injected into their heart
  3. These transplanted cells will then play a role in repairing and/or replacing the affected damaged tissue or organ of that person.

In reality, the procedure is not so straight forward, as there are many potential complications to take into account.

Nonetheless, the promise of regenerative medicine is too good to resist, hence researchers are continuously looking into creating and fine-tuning various procedures that can hopefully one day reduce or even replace our reliance on medications!

THE STEM CELL CONTROVERSY

There is considerable ethical debate on the use of stem cells that are sourced from fertilized egg cells or embryos that are donated for research.

These days, many centres that offer stem cell therapy claim to source their stem cells ethically—from the umbilical cords of young and healthy women after they have delivered their babies.

In Malaysia, the sourcing and processing of stem cells are governed by the Current Good Manufacturing Practices or cGMP, issued by the National Pharmaceutical Regulatory Agency (NPRA). You can view it here (link opens in a new tab).

How Much Do You Know about Male Breast Cancer? Let’s Find Out!

WORDS LIM TECK CHOON

DR NIK MUHD ASLAN ABDULLAH
Clinical Oncologist
Sunway Medical Centre
BREAST CANCER AFFECTS MEN AS WELL AS WOMEN

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.

WARNING SIGNS

According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

  • Lumps in the breast tissue
  • Skin dimpling or puckering
  • Nipple retraction
  • Unusual discharge from the nipple
HORMONAL CHANGES CAN GIVE RISE TO BREAST CANCER

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?
  • Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
  • Injury to the testicles
  • Use of androgen inhibitors
  • Liver cirrhosis (scarring of the liver)
  • Obesity 
Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.
MEN WITH HR-POSITIVE BREAST CANCER ARE MORE LIKELY TO RESPOND TO HORMONE TREATMENTS

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.

Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.

A Health-Centric Wishlist for the Malaysian GE15

WORDS ANWAR ANIS

ANWAR ANIS
Executive Director
ALTY Orthopaedic Hospital
FORMATION OF A LONG-TERM PARTNERSHIP BETWEEN PUBLIC & PRIVATE HEALTHCARE

Building upon the successful collaboration between public and private healthcare during the pandemic, a long-term policy on greater partnership will benefit both the government and the private sector, with all Malaysians being the key beneficiary.

There still are waiting lists for procedures in the public hospitals, and these can certainly be reduced if there is a structure long term arrangement for the private hospitals and centres to assist in reducing and maintaining a short wait time, especially for elective procedures which can greatly enhance an individual’s productivity, although it may not be life threatening.

GREATER FOCUS ON AN AGEING SOCIETY

These include the necessary social safety nets, proper care facilities and also post hospitalization care and support.

Here, the government should consider partnering the many physio and home care organisations to ensure patients have good compliance to post hospital care, including physio, wound care and others.

An aging population also typically means reduced mobility due to various issue—for example orthopaedic-related issues, where it can be address with proper intervention, and where needed surgery.

Government subsidy for implants, such as knee and hip implants can reduce the burden for the uninsured (which is a large majority of those who need such care) – and thus ensuring they have good mobility and thus independence even as they age.

INNOVATION IN HEALTHCARE WITH ROBOTICS, 3D PRINTING & OTHER NEW TECHNOLOGIES

The government should consider encouraging the adoption of such technologies especially in healthcare.

Grants or even personal subsidies to access such health technologies where appropriate can propel the adoption and perhaps even development of such tech.

For example, 3D printed casts or prosthesis will improve recovery and long-term quality of life. The regulatory framework also needs to support the faster adoption of such health technologies, to ensure Malaysia is able to maintain its advantage as a healthcare travel destination.

COMPETITIVE & FACILITATIVE IMMIGRATION POLICIES

Competitive and facilitative immigration policies, for healthcare travellers especially, will allow Malaysia to be serve a greater no of patients, which in turn lowers the cost of investment in health-related technologies and equipment, thus enabling more Malaysians to access it as well.

Some of our neighbouring countries continue to attract patients from a number of different countries, despite being less competitive overall than Malaysia, primarily due to the ease of arriving into the country.

Thus, they are able to invest in technology such as proton beam, as fee-paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.

Important Things That You Should Know About Silent Heart Attacks

WORDS LIM TECK CHOON

DR PATRICK TIAU WEI JYUNG
Consultant Cardiologist
Sunway Medical Centre

Dr Patrick Tiau reveals that silent heart attacks, also known as silent myocardial infarction, account for 45% of heart attacks.

These heart attacks are “silent” because they occur without the usual, recognizable symptoms of a heart attack.

COMMON SYMPTOMS OF HEART ATTACK
  • Chest pain (often described as heavy or pressure sensation)
  • Radiating pain in the arm, neck, or jaw
  • Sudden shortness of breath
  • Sweating
  • Dizziness
HOWEVER, THESE SYMPTOMS ARE USUALLY NOT PRESENT WHEN ONE HAS A SILENT HEART ATTACK!
Because of this, many people may not know that they have experienced one until days or even weeks after.

However, Dr Patrick shares that there are some early warning signs to look out for.

SIGNS THAT YOU MAY HAVE HAD A SILENT HEART ATTACK

It’s good to consult a doctor when you have concerns, especially if you experience these signs and fall under the high-risk below (see below).
  • Feeling tired
  • Indigestion
  • Nausea
  • Sweating.

Dr Patrick says, “We have come across many patients who have dismissed the early warning symptoms as simply feeling tired, indigestion, nausea or sweating. By the time they seek out medical treatment for these symptoms, they are shocked to learn that what they are experiencing is actually due to a reduced blood flow to their heart, and that has caused them to have a silent heart attack.”

Silent heart attacks can lead to more serious health complications if left untreated over an extended period of time, such as an increased risk of another, potentially more deadly heart attack.

COMMON RISKS OF SILENT HEART ATTACKS
RISKS THAT CANNOT BE AVOIDED 
  • Age. The risk increases as we grow older.
  • Gender. Men are more at risk than women. However, women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.
  • Family history. The risk is higher for people with a family history of heart diseases.
RISKS THAT CAN BE MODIFIED 
  • Smoking. Chemicals in cigarettes stimulate one’s heartbeat and can dramatically increase one’s risk of heart attack.
  • High cholesterol. Individuals with elevated cholesterol levels can lead to formation of atherosclerotic plaque in the blood vessel and reduce blood flow to the heart.
  • High blood pressure: Having high blood pressure puts extra strain on the heart muscle. Over time, this causes the heart muscle to stiffen, thicken, and perform less optimally.
  • Individuals that are overweight or obese, especially when their weight tends to sit at the waist, are more at risk even if they do not have any other risk factors.
  • Physical inactivity. Doing regular exercise helps protect the heart by keeping under control other risk factors such as cholesterol, blood pressure, diabetes, and obesity.

“Undeniably our heart health is essential to allowing us to have a well-balanced and fulfilling life,” he says. “The heart itself is the first and last sign of life that is responsible for, quite literally, keeping us going. In combatting heart attacks, the most important thing to remember is that prevention is definitely better than cure.”

DR PATRICK’S TIPS TO REDUCE YOUR RISK OF SILENT HEART ATTACKS

Make the necessary small changes to daily lifestyle to reduce one’s risk factors. These changes include:

  • Regularly monitor blood pressure and cholesterol
  • Get sufficient exercise
  • Quit smoking
  • Eat a balanced diet of fruit, vegetables, lean meats and whole grains
  • Ensure that one’s blood pressure, cholesterol and blood sugar are well-controlled
  • Inform a doctor as soon as possible about any unusual symptoms that may indicate a silent heart attack

Once you go home from the hospital, it is essential that you keep taking your medications as prescribed. “This will ensure your heart health is kept in check, possibly for the rest of your life,” says Dr Patrick.

Consider joining a support group. Dr Patrick acknowledges that heart attack survivors may start to develop feelings of shock, sadness, and anxiety. This is normal, and these feelings can be managed with the right support.

“Some people find it helpful to join a support group where they can talk with others that have gone through a similar experience, or seek out companionship and encouragement through avenues such as the gym, or yoga classes,” he advises.

Here’s What You Should Know About Osteoporosis & Ageing

 

ASSOCIATE PROFESSOR (C) DR G RUSLAN NAZARUDDIN SIMANJUNTAK
Consultant Orthopaedic,
Arthritis & Sports Surgeon
ALTY Orthopaedic Hospital

Osteoporosis is a disease that weakens your bones, making them more prone to fractures.

Often, there are no symptoms. Many people only learn that they have osteoporosis after they experience a fracture and see a doctor.

Because fractures are potentially life-threatening when they occur to older persons, it is good to take steps to prevent this disease from quietly ‘sneaking up’ on you.

YOU CAN GET SCREENED TO FIND OUT HOW HEALTHY YOUR BONES ARE
If you are 65 or older, you should consult your doctor on getting screened for osteoporosis.

Tests such as bone mineral density (BMD) test will provide useful information about your bone health.

Blood profile tests help to detect presence of health conditions that can weaken the bones and increase your risk of osteoporosis.

WHEN SHOULD YOU SEE A DOCTOR AFTER A FALL?
  • When you experience severe pain that don’t improve after taking over-the-counter painkillers
  • When you are unable to move after your fall

After you are admitted, you will be given an imaging test—typically X-ray and, if necessary, magnetic resonance imaging (MRI)—to determine the location and extent of the fracture.

HIP FRACTURES CAN BE COMMON AMONG OLDER PERSONS
Hip fractures usually occur on the long bone of the thigh, called the femur (see image).

A surgery, called hip replacement, helps to address this problem.

A total hip replacement replaces the socket (acetabulum, see image) and the head of the femur.

A partial hip replacement replaces only the femoral head (see image). This is usually an option for older persons with more limited mobility.

The surgery takes place within 2 hours, and you’ll stay in the hospital for around 3 more days. During this period, a physiotherapist will guide you on the exercises that you can do to restore the range of motion of as well as to strengthen your hip.

WORK WITH YOUR HEALTHCARE TEAM TO REMAIN INDEPENDENT & MOBILE
For example, you may use a walker or wheelchair to remain mobile, and you may need to master new techniques (such as for using the toilet, bathing, dressing, etc) that take into account your condition.

 

If you have problems traveling to see your physiotherapist, consult your healthcare team on the possibility of having the physiotherapist visit your home instead.

This article is brought to you by ALTY Orthopaedic Hospital.

 

Free Age Plus App Helps Older Persons Self-Manage Their Own Health

WORDS LIM TECK CHOON

The University Malaya Medical, Business, Computing and Software Engineering teams have launched a free app, called Age Plus.

“The main objective of the project is to develop a health management application for users to self-manage their health,” shares Associate Professor Dr Mumtaz Begum Mustafa, the creator of the Age Plus app.

WHAT DOES THE APP CURRENTLY PROVIDE?
LIFESTYLE
Provides visualization patterns of your daily activities as well as personalized recommendations for a healthier lifestyle

  • Information on healthy foods
  • Calorie calculator to help you plan healthy meals
  • Seat goals for and track your water intake, caffeine consumption, sleep, and exercise

PERSONAL MEDICAL DETAILS
Useful for managing medical information such as medication and consultation detail

  • Record and keep tab on your medications
  • Record and keep track of your medical appointments
  • Find nearby hospitals

HEALTH MANAGEMENT
Improve awareness on disease-related conditions among older persons.

  • Get useful advice and tips on health-related matters
AGE PLUS IS USER-FRIENDLY

Dr Mumtaz explains that the app boasts design solutions to improve its usability especially among older persons. Features of the app that reflect this include:

  • Increased action time and reduction of multiple tasks
  • Simplified in-app navigation/navigation assistance
  • User-friendly interfaces
  • Voice-response technology, with information dissemination through speech
  • Big buttons and simple, static menus

Age Plus is now available for free for Android phone users. Visit this link (link opens in a new tab) to download the app.