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).

Read This Before You Reach for Your Snacks This FIFA World Cup Season

WORDS LIM CHAIN YIN

LIM CHAIN YIN
SEA Nutrition Lead
Mondelēz International
TIP 1
Portion Out Your Snack
  1. Be sure to pace yourself throughout the equal halves.
  2. Once you’ve decided what you want to eat, portion it out. This can help you slow down, so that you enjoy your snack.
  3. Check in with yourself to see if you’re full and satisfied before having another portion.
  4. To keep tabs on how much you eat, always check the serving size per package on the label and put your snack in a bowl or on a plate.
TIP 2
Alter Your Choices

If you’re watching the game late at night, you might have a craving for something to eat. Remember that your body works harder when it’s sleeping, so try to snack on something light that will give you energy to keep going, but won’t make it hard for your body to digest.

TIP 3
Enjoy Every Bite

Snacking while engaging in other activities—in this case, watching the game—can easily lead to unconsciously eating more than you should.

  1. Take a moment during the interval to savour your snack with all of your senses. To fully enjoy your snacking experience, pay attention to the smell, taste, texture, shape, and colour of your food.
  2. Take small bites and chew slowly and be sure to finish one bite before starting the next.
TIP 4
Put Your Snacks Out of Reach

When watching a game in your living room, make sure your snacks are beyond arm’s reach. That way, you will be less likely to keep going back for more and inadvertently grab more than you need.

TIP 5
Drink Water, Lots of It!

Your brain tends to trick you into wanting to snack more, but you might just be thirsty. So, drink a glass of water and wait for a couple of minutes before deciding whether or not you’re hungry.


Snacking mindfully is a simple way to tune into your body’s needs. It can be practised by anyone, anywhere, and at any age. It is a great habit in cultivating a positive relationship with food by making deliberate and conscious choices to promote your well-being as well as keeping a balanced lifestyle. But habits take time to build and change, so taking small steps is a good way to start out!

Diets & Exercise Tips to Regain Your Pre-Pregnancy Body Shape

WORDS DR VICKY KOH

DR VICKY KOH
Medical Director
Clinic RX
WELL, READ THIS FIRST

Every woman’s body is unique. Therefore, the question of the ‘right option’ or ‘best option’ is something that each and every woman has to figure out on her own.

For example, mothers that breastfeed often experience rapid weight loss and may benefit from an increased intake of certain nutrients or supplements. Women that gave birth via caesarean section may need a longer time to recover. Existing health issues and lifestyle variables also need to be considered.

If you are interested to find out more about the topics discussed below, you should discuss the matter further with your doctor.

BREASTFEEDING CONSIDERATIONS

Postpartum weight loss averages about 4.5 to 5.5 kg in the first 6 weeks. Women often return to their pre-pregnancy weight within a year, though this time frame varies depending on how much weight was gained during their pregnancy.

Breastfeeding aids in weight loss since it consumes extra calories, resulting in a natural weight loss for many women.

Breastfeeding women should pay special attention to their diets at this time.

While experiencing weight loss after giving birth may seem like a good idea, doing so too quickly will actually hinder healing!

POST-PREGNANCY DIETARY RECOMMENDATIONS

Dietary recommendations should include a variety of fresh produce, whole grains, lean proteins, and healthy fats.

Breastfeeding mothers, in particular, should drink a lot of water (6-10 glasses daily). Try to stay away from sodas and other sugary drinks.

Meanwhile, for moms that had a C-section, they should focus on eating foods that are high in protein. Avoid junk foods and take vitamin supplements, especially if they are nursing.

Vitamin and mineral supplements are crucial for moms during and after pregnancy.

This is because nutrients such as calcium, iron, vitamin D, folic acid, zinc, and more are normally redirected from the mother’s bloodstream to the developing infant.

Furthermore, the delivery process as well as breastfeeding depletes the body of essential vitamins.

Hence, postnatal supplements such as calcium, vitamin D, B vitamins, docosahexaenoic acid (DHA), magnesium, selenium, iodine, and choline may be helpful in replenishing nutrients that were used up during pregnancy and after childbirth.

EXERCISE RECOMMENDATIONS

Regular exercise after childbirth will help strengthen and tone your muscles while increasing your energy levels and making you feel less weary.

It also aids in the loss of excess weight.

During the first 6 weeks, the uterus returns to its pre-pregnancy size, and some women may feel uterine cramping and discharge.

However, mothers are recommended to gradually resume their exercise habits, starting with less strenuous activities during the first few weeks after giving birth.

A few days after delivery, you can start doing gentle abdominal and pelvic floor exercises if they don’t cause you any pain.

Try to proceed at your own pace—you can gradually increase the duration and tempo of your workout of over time.

Swimming, cycling, yoga, pilates, mild weight training, and low-impact aerobics are all good alternatives after the first few weeks.

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.

Important Advice to Stay Prepared During the Monsoon Season

WORDS LIM EN NI

LIM EN NI
Chief Pharmacist
Alpro Pharmacy

The Malaysian Meteorological Department (MetMalaysia) recently announced that Malaysia will experience continuous heavy rainfall from mid-November, leading to probable major flash floods in several states, and the monsoon season will last until early next year.

We would like to outline several precautionary measures for residents in flood-prone areas, from a community pharmacist’s point of view, to proactively mitigate flood damages ahead of the period and in the aftermath.

BEFORE A FLOOD
  • Closely monitor your surroundings and stay up to date on weather forecasts and warnings
  • Assemble disaster supplies, including long-term medications and first aid kits in water-proof bags in case of evacuation.
  • People, especially the elderly, with chronic diseases, are advised to visit their nearest pharmacy and bring along with their chronic medications, in order to keep a record in the pharmacy and have an up-to-date medication list; this will be useful should one lose the hard-copy of their prescription and face difficulties in retrieving their medication
AFTER A FLOOD
  • Due to poor sanitation and hygiene in flood areas, there is a high risk of flood-borne diseases such as leptospirosis, cholera, and dengue fever. Keep an eye out for general symptoms such as fever, headache, diarrhoea, muscle aches, and vomiting. In the case of any such symptoms, please visit the nearest healthcare centres immediately.
  • Alpro Pharmacy and DOC2US have launched the Life-saving Medication Care Programme, which provides a one-time supply of medications for up to 7 days for free. Those with contaminated or lost chronic disease medications can visit an Alpro Pharmacy outlet and speak to the pharmacist for more details. Note that a police report copy of the flooding is required for verification purposes.

Stay dry, stay safe!

How Breast Ultrasound & Mammogram May Save Your Life

WORDS LIM TECK CHOON

DR WINNIE NG NYEK PING
Consultant Clinical Oncologist
Subang Jaya Medical Centre
NO FAMILY HISTORY OF BREAST CANCER = NO PROBLEM? WELL, THINK AGAIN!

“Even if one has no known family history of cancer, external factors such as environmental exposures, prolonged exposure to female hormones and lifestyle features may contribute to an increased relative risk of breast cancer,” says Dr Winnie Ng, a consultant clinical oncologist.

“Aside from genetics, there are numerous underlying possible causes of breast cancer,” says Dr Ng
  • Alcohol intake
  • Smoking
  • Prolonged exposure to female reproductive hormones such as oestrogen, such as in women that reach menstruation at early age, women that have never been pregnant, women on oral contraceptive pills, women that experience menopause late, and woman that have their first full-term pregnancy at a later age
  • Postmenopausal women on hormone replacement therapy
  • Obesity

Theerfore, even if you have no family history of breast cancer, Dr Ng recommends that still going for breast cancer screening.

“The easiest method of screening is by self-examination of the breast,” she adds.

How to perform a breast self-examination. Click on this image to view a larger version.
AS WE STILL DON’T HAVE A CURE FOR BREAST CANCER, SCREENING REMAINS THE MOST PRACTICAL SOLUTION TO DETECT BREAST CANCER EARLY

Dr Ng recommends that

  • Women below 40 should undergo a breast ultrasound
  • Women above 40 are advised to go for a mammogram

You should consult your doctor about your risk factors and how often you should go for breast cancer screening.

 “A breast cancer diagnosis is not a death sentence. Self-tests and regular screenings can save lives,” says Dr Winnie Ng.

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, 3-D 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, 3-D 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 technologies such as thehealthy  Proton beam, as fee paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.

Keep the Hope of Pregnancy Alive in Spite of Breast Cancer

WORDS LIM TECK CHOON

DR CHRISTINA LAI NYE BING
Consultant Clinical Oncologist
Sunway Medical Centre
DR HOO MEI LIN
Consultant Gynaecologist and Fertility Specialist
Sunway Medical Centre
WHY IS BREAST CANCER SO PREVALENT AMONG YOUNGER WOMEN THESE DAYS?

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

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

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

IS PREGNANCY IMPOSSIBLE AFTER CHEMOTHERAPY?

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

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

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

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

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

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

KEEP THE DREAM ALIVE

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

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

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

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

Invasive Mold Infections: A Rare but Deadly Fungal Disease

WORDS DR LOW LEE LEE

DR LOW LEE LEE
Infectious Disease Physician
Sultanah Bahiyah Hospital
FUNGI: OUR FRIENDS & FOES (IT’S COMPLICATED)

Fungi are found naturally in our environment. There are many different types of fungi, over 2 million species however about 600 fungi have caused diseases.

Invasive fungal infections typically manifest as a severe and aggressive form of the disease, leading to corresponding to high prevalence and death rates if left untreated.

These infections include invasive mold infections.

INVASIVE MOLD INFECTIONS AT A GLANCE
  • Usually caused by Aspergillus (giving rise to invasive aspergillosis) but can also be caused by other rarer molds such as Mucormycetes (giving rise to mucormycosis).
  • These molds produce spores; most of us encounter these spores every day without getting ill, but people with compromised immune systems may develop complications as a result of these spores.
  • Despite invasive aspergillosis and mucormycosis being relatively uncommon, invasive mold infections are often life threatening. If left untreated, the mortality rates can reach 100%!
  • Various parts of the world reported superinfections of invasive aspergillosis and mucormycosis in patients with COVID-19, which are associated with increased risk of death. COVID-19 likely increases the risk for fungal infections because it weakens the immune system or due to certain therapies used for treatment such as steroids.
  • There are no specific symptoms, as symptoms can vary depending on the type of infection. This makes diagnosis an infection a challenging and sometimes complicated task!
Invasive Aspergillosis
Aspergillosis and how it affects our lungs. Click on the image for a larger, more detailed version.
  • Invasive aspergillosis is uncommon and occurs primarily in immunocompromised people.
  • Commonly seen in people that have undergone stem cell and other organ transplants (especially lung transplant), as well as in patients with blood-related cancers such as acute leukemia.
  • Typically affects the lungs, but it can also spread to other parts of the body.
Mucormycosis
  • Mucormycosis is rare and estimated to affect approximately 10,000 cases worldwide, barring India. If India is included the numbers rise to 910,000 cases annually!
  • Typically occurs in the sinuses of the nose or lungs; however it can spread to the brain and other organs as well.
COMMON SYMPTOMS OF A POSSIBLE INVASIVE MOLD INFECTION
  • Typical pneumonia symptoms including fever, chest pain, cough, coughing up blood, and shortness of breath
  • Sinus infection, which may be painful
  • Pain, tenderness, swelling and pressure around the eyes, cheeks, nose or forehead
  • One-sided facial swelling
  • Headaches
  • Nasal or sinus congestion
  • Black lesions on nasal bridge
HOW TO REDUCE YOUR RISK OF AN INVASIVE MOLD INFECTION
  • When performing activities that involve close contact with soil and dust, such as yard work or gardening, take care to wear shoes, long pants, and long-sleeved shirts
  • Whenever possible, avoid dusty areas like construction or excavation sites; wear a N95 mask when you have to visit these areas
  • Keep your house dry and mold-free
  • Avoid staying in a moldy home (even while it is being cleaned)