Tip 1 START EARLY—CLEAN YOUR BABY’S GUMS AT LEAST TWICE A DAY
“It is easy to overlook oral care in babies – after all, they won’t have teeth till months later!” says Dr Yogeswari Sivapragasam,
Get a clean, damp washcloth.
Use the washcloth to gently wipe clean your baby’s gums.
Also gently clean the front of your baby’s tongue.
You should do this after every breastfeeding.
“Besides that, parents should also get advice from healthcare practitioners, such as a nurse advisor at community clinics or paediatricians, on how to care for their child’s oral health from birth, which includes what to do when their teeth first appear,” Dr Yogeswari further advises.
Tip 2 DELAY ADDING SALT & SUGAR INTO YOUR KID’S DIET
Dr Yogeswari advises us to hold back the introduction of added salt and sugar into their child’s diet.
This is because getting your child hooked early on sweet or salty foods can increase their risk of dental problems as well as chronic health conditions (obesity, type 2 diabetes, etc) later in life.
Instead, let your child develop a liking for naturally unsweetened and unsalted foods.
Tip 3 TAKE YOUR KID TO THE DENTIST REGULARLY & MAKE THESE VISITS AS FUN AS POSSIBLE
Children should receive their first dental check-up when they are 1 year old.
“Remember this: first birthday, first dental check-up!” says Dr Yogeswari.
After the first dental visit, you are advised to bring your kid to the dentist every 6 months.
“While it is unlikely that they will have any dental problems at this young age, this will help young children have a positive experience rather than associate dental visits with pain and fear,” Dr Yogeswari further adds. “Regular visits will help to normalize the experience of visiting a dentist and will go a long way towards preventive care.”
Of course, regular visits to the dentist will also help to detect early any potential problems with your kid’s oral health and tooth development, and allow the dentist to address these problems without further delay.
Tip 4 KEEP AN EYE OUT FOR UNUSUAL CHANGES IN BEHAVIOUR
Your child sometimes refuses certain foods or refuses to brush their teeth. “While this may be easily explained as the child being fussy or picky, there could be another reason behind it,” says Dr Yogeswari.
For example, your child may have developed cavities or gum disease, and the constant pain and discomfort may cause them to refuse foods that need to be chewed.
“This may inadvertently lead them to avoid whole foods such as apples and chicken,” Dr Yogeswari elaborates, “and choose softer foods instead, many of which are processed and contain higher levels of salt, sugar and fat. Over time, this may lead to nutritional deficiencies or chronic conditions that can affect a child’s health into adulthood.”
The constant pain can also cause irritability and affect their ability to concentrate during lessons in school.
“In addition, poor oral health can also affect a child’s self-esteem if they are teased due to the appearance of their stained or rotten teeth. This may cause them to avoid social activities or become withdrawn,” Dr Yogeswari adds.
As such, be alert and check for possible dental problems if your child suddenly appears to be unwilling to chew or becomes irritable without any apparent cause.
As we welcomed 2023, China reported a huge spike in daily COVID-19 cases during the end of year holiday seasons 2022.
After a period of pandemic fatigue and indifference, the event sparked sudden and short-lived fear and caution among the global as well as Malaysian community.
The news triggered some Malaysians to be up in arms, calling for a ban on travellers from China and reinforcement of pandemic SOPs such as the mandatory wearing of mask in public areas.
Nonetheless, the interest soon died down as other headlines made their way in the news.
It appears that it is only when crises are about to hit our shores that we react.
In fact, as highlighted by the World Health Organisation (WHO), we need to always be prepared and cannot afford to be reactive.
On January 27, 2023, it announced and reminded member countries that COVID-19 remains a public health emergency of international concern.
WHO compared 28-days data between Dec 5, 2022 to Jan 1, 2023 and Jan 2 to Jan 29, 2023.
It found that although the number of cases reported decreased by 78%, the number of deaths increased steeply by 65%.
This result is mainly due to the large wave of cases and deaths in the Western Pacific Region, especially in China.
WHO further states that the numbers may be an underestimation due to the reduction in testing and delay in reporting in many countries.
STAY VIGILANT & PROTECT THE VULNERABLE
3 years into the pandemic, Malaysia has reported more than 5 million cases and over 36,000 deaths.
In 2021, it became the main cause of death in Malaysia, overtaking heart disease.
The risk of death is higher among:
Those above 60 years
Individuals with underlying health conditions
Unvaccinated individuals
According to MOH data between Jan 1, 2022 to July 31, 2022, 75% of COVID-19 deaths were among individuals 60 years and above, and 86% of deaths were among those with at least one underlying health condition .
Compared to the first year of pandemic, we are now more prepared to curb COVID-19 due to advancement in preventive measures, rapid diagnoses, and management tools such as vaccination, rapid test kits (RTK) as well as early treatment with antivirals.
These tools are important particularly to prevent severe COVID-19, keeping individuals especially those with risk factors away from hospitalization, intensive care unit (ICU) admissions and ultimately death.
Nonetheless, these tools will only be useful if they are being utilized optimally.
While Malaysians were quick on the uptake of primary COVID-19 vaccination doses, the uptake of booster doses are very poor with only 49.7% uptake of the 1st booster and a mere 1.6% of the 2nd booster (as of Feb 7, 2023) .
While no concrete data is available, there are good reasons to believe that due to pandemic fatigue, people are now less likely to test and seek treatment for COVID-19.
It is also important to note that antiviral treatment needs to be taken within the first 5 days of symptom onset. Thus, speed is of the essence.
We cannot risk another surge of COVID-19 globally or locally as it would put a toll on our healthcare system and risk overwhelming it.
As it stands, we are currently experiencing overcrowding in Emergency Departments.
Hence, it is crucial that we answer the calls of WHO and the Ministry of Health Malaysia to continue urging the public especially those who are in the high-risk groups (older persons, individuals with underlying medical conditions) to take precautions against COVID-19.
OUR CAMPAIGN
The Malaysian Society of Infection Control and Infectious Diseases (MyICID) in collaboration with the Family Medicine Association Malaysia (FMSA) and Malaysian Medical Association (MMA) are organising an educational campaign themed COVID-19: QUICKLY TEST & TREAT.
Our objectives
This campaign aims to urge the public especially individuals who are at high-risk as well as their family members to continue protecting themselves and others from severe COVID-19 by:
Getting primary and booster doses
Testing immediately upon onset of symptoms
Seeking early treatment, within the first five days of symptoms
Our campaign’s panel of experts
Dr Alif Adlan Mohd Thabit Infectious disease physician
Dr Ang Peng Peng Infectious disease physician
Dr Suriani Sulaiman Family medicine specialist
Dr Balachandran S Krishnan General practitioner
THIS IS A PUBLIC COMMUNITY MESSAGE BROUGHT TO YOU BY
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:
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
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
It takes charge of almost every daily activity—your movement, body temperature, hunger, memory, and thoughts.
It can also affect your moods, emotions, and eventually your mental health.
HOW YOUR FOOD INTAKE CAN AFFECT YOUR MOODS & BRAIN
Choosing the right food is important not only for physical health, as what the common nutrition research shows, but also for your mind.
Well-balanced, nutritious foods help your bodies (and brains) to function well
As a matter of fact, the brain accounts for about 20% of your total daily energy requirements. From macronutrients (carbohydrates, proteins, and fats) to micronutrients (the vitamins and minerals), all of these play a role in brain health and function.
A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis
In our gut, billions of microbiota profoundly affect this gut-brain relationship.
Don’t underestimate these tiny little organisms, as they take charge of producing mood-regulating chemical substances, namely serotonin and dopamine.
Serotonin and dopamine, our body’s natural ‘feel-good’ neurotransmitters, help us to regulate emotions, sleep, and appetite. They are connected to our brain’s reward system and help to produce a happy sensation.
Since more than 90% of serotonin resides in the gut, taking good care of our stomach with food can transmit a happy signal to our brain.
Too happy isn’t always good, though! Don’t get too carried away with comfort foods
In stress-inducing situations, people tend to reach for comfort foods. However, these foods are usually high in fats and sugars, which makes them addictive. Yes indeed, the sugar is creating a surge of dopamine and a short boost of happiness.
However, other than contributing an exceeding amount of calories, these comfort foods also lacks essential nutrients such as omega-3 and vitamin B fatty acids and vitamin D, which are beneficial for your nervous system that regulates emotions.
Besides, high consumption of these calorie-dense foods might result in obesity, which is known to stimulate proinflammatory status—a plausible way to increase depression risk.
WHAT ARE THE BEST TYPES OF DIET TO IMPROVE YOUR MENTAL WELL-BEING?
Studies found that following a healthy eating pattern is associated with better stress management, improved sleep quality, increased concentration, and better mental well-being in general.
However, an emerging field of research known as nutrition psychiatry looks into a more specific relationship between diet and mental health. A few types of diet have been identified to be likely helpful for mental well-being.
Mediterranean diet
The Mediterranean diet emphasizes fruits, vegetables, whole grains, nuts, legumes, and healthy fats (such as olive oil) while limiting dairy products, red meat, alcohol, and processed foods.
The reason why the Mediterranean diet is beneficial to mental health could be due to its anti-inflammatory effects of the food components and the high content of antioxidants.
This diet might be relatively helpful in reducing the risk of depression as well as improving cognitive function.
If you are already dealing with depression, the depressive symptoms might reduce over time while preventing its remission.
The Mediterranean diet is also rich in selenium, tryptophan, omega-3, and vitamin D, which can help to improve sleep quality.
DASH diet
The DASH diet is a dietary approach that initially was designed to reduce blood pressure.
Same as the Mediterranean diet, the DASH diet is also rich in whole grains, vegetables, fruits, and other low-fat products such as fish, poultry, and beans. Try to limit high saturated fat food such as fatty meat and tropical oil.
The DASH diet emphasizes choosing food that is high in protein, fiber, potassium, calcium, and magnesium while cutting down those high in saturated fats and sodium.
Following a DASH diet could help to reduce symptoms of depression, anxiety, and stress. Additionally, nutrients that can be found in the DASH diet, such as vitamin B, omega-3 fatty acids, and antioxidants, are linked to brain function and mental well-being.
MIND diet
The MIND diet is the combination of Mediterranean diet and DASH diet, which also emphasizes the intake of natural plant-based foods and limits on animal and high-fat food.
However, leafy green vegetables and berries are exclusively focused.
Similar to the Mediterranean diet and DASH diet, the MIND diet could be helpful in reducing depression risk and psychological distress due to its high concentration of antioxidants.
Psychological stress and eating habits are closely related. It doesn’t matter which diet plan you want to choose, the key is to eat a healthy and balanced diet in appropriate portion sizes.
However, bear in mind that nutrition is just one factor among many that could impact mental health. Don’t just rely on changing your diet—you should seek advice from a mental health professional for personalized treatment for your mental issues.
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.”
While working from home does come with benefits but it also limits physical movements and takes a toll on our postures.
We started seeing a rapidly rising number of young Malaysian adults that are suffering with neck and back pain, especially those working from home and who work for long hours on their devices.
Consciously, we must remind ourselves to pay attention to the signs our back and neck is giving us, so that we can lower the risk of developing serious spinal conditions down the road.
TIP 1
CREATE AN OPTIMAL WORK AREA
Invest in a proper desk and office chair.
Ensure that the chair and desk you’re going to be working on is comfortable, supportive, adjustable, and ergonomically sound.
Pick a work desk with an optimal height so that the neck, shoulders, and arms remain at a neutral position.
Sett up your workstation perpendicular to the window and away from direct light, to minimize the strain on your eyes.
TIP 2
WORK ON YOUR POSTURE
Good standing or sitting posture involves having the body be symmetrical, weight evenly distributed and well aligned so it does not strain the neck and back muscles.
Use a monitor as a primary working computer instead of a laptop to help improve your posture. If that is not possible, use a book or laptop stand to raise the laptop, so it is at eye level.
While being seated, place a small pillow behind your lower back to maintain an arch to lean back in and relieve your back muscles.
Keep your forearms and hands leveled and straight by having the keyboard and mouse close to the laptop.
TIP 3
RELAX YOUR MUSCLES
The issue isn’t sitting or remaining still while working; It’s being stuck in one place for too long. The body accumulates stress between managing tight deadlines, budget demands, performance reviews, and even the everyday challenges of the day.
To keep the mind and, by extension, body healthy, you can combine basic stretches with breathing exercises and other relaxation techniques while you work.
Stretches, short walks, or even small bursts of exercise are a great way to get the muscles active and engaged throughout the day.
Set alarms or reminders throughout the day to get up and stretch. A 30-second “microbreak” is just enough to change your posture briefly and helps take the pressure off and relax.
WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI
DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS
Dysphagia comes from Greek word ‘dys’, which means difficulties, and ‘phagia’, which means swallowing.
Medically, dysphagia is a term for swallowing difficulties. Someone with dysphagia takes more time and effort to move food or liquid from their mouth down to their stomach.
Episodes of dysphagia can be intermittent or progressive.
IT IS A SYMPTOM FOR MANY MEDICAL CONDITIONS
In adults, dysphagia is very common in adult that has a history of stroke, dementia, Alzheimer’s disease, neck cancers, and gastroesophageal reflux disease (GERD).
It could also be present in children with attention deficit hyperactivity disorder (ADHD), autism, Down syndrome, and cerebral palsy.
Dysphagia can also be a sign that there are some issues with the many nerves and muscles that are involved in swallowing activities.
YOU MAY HAVE DYSPHAGIA IF YOU EXPERIENCE THE FOLLOWING
Persistent drooling of saliva
Coughing or choking when eating or drinking
Bringing food back up, sometimes through the nose
Feeling as though food is stuck in your throat or chest
Being unable to chew food properly
PEOPLE WITH DYSPHAGIA FACE ISSUES THAT CAN JEOPARDIZE THEIR HEALTH & WELL-BEING
Choking and lung infection
Individuals with dysphagia are susceptible to choking. Due to difficulties in swallowing normally, consumed foods or liquids can accidentally enter the airway into the lungs. This could result in aspiration pneumonia, often known as a lung infection and can be fatal.
Poor nutrition intake
The prevalence of malnutrition among people with dysphagia is reported to be anywhere between 3% and 29%, which is quite a high number.
Malnutrition leaves people with dysphagia more vulnerable to diseases, should they not receive enough essential nutrients for optimal body function.
Muscle wasting, underweight, and stunting could be other issues that arise. Hence, people with dysphagia needs to be aware of any weight loss, hair loss, feeling of coldness, and fatigue as these are the early symptoms of malnutrition.
Loss of appetite and fear of mealtimes
People with dysphagia often lose their appetite in conjunction with their reduced swallowing ability.
They might develop some degree of “laziness” when it comes to drinking more often, which may lead to dehydration.
Because their eating experiences can be difficult, uncomfortable, and unpleasant, they may develop anxiety during mealtimes.
Inability to talk fluently
Dysphagia can hinder one’s ability to talk fluently and, combined with difficulties in eating, may cause the affected person to experience low self-esteem and lead to self-isolation.
The decrease in social engagement will give a negative impact in the person’s quality of life.
Thus, social support from their carer, family members, and close friends are crucial. A little extra kindness and help will give a huge impact in their life and sometimes even touch their heart.
Proper nutrition management for people with dysphagia involves providing adequate nutrients through modification of food texture and fluid consistency.
We need to also keep an eye out for symptoms of dehydration such as dry mouth or tongue, thirst, headache, and lethargy.
Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.
IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA
Consult a speech language pathologist, a healthcare professional trained to diagnose dysphagia, for a proper diagnosis.
People with dysphagia can consult with dietitians for their nutritional concerns or if they want to assess their nutritional adequacy.
TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION
Understand the extent of one’s dysphagia
Discuss with the speech language pathologist and other relevant healthcare professionals on the degree of swallowing ability in the person with dysphagia.
Refer to the International Dysphagia Diet Standardization Initiative (IDDSI) Framework
This guideline has seven levels. Flow test, spoon tilt, and fork drips are used as measurement methods to determine each level.
Click to view a larger and clearer image.
Further information can be obtained from the IDDSI website(link opens in a new tab).
Modify foods into certain textures
For more detailed information on how to modify the textures of various foods, you can refer to this page on the IDDSI website (link opens in a new tab).
While modifying the textures of foods into appropriate textures, take into consideration the nutritional content (carbohydrates, protein, fat, as well as vitamin and minerals). Daily meals should provide all the nutrients to improve the person’s nutritional status.
Always choose softer food options if texture modification is not possible. For example, choose papaya instead of apple, and ‘soften’ a dish with gravy.
Add special thickening powder to watery liquids. This thickening allows for easier swallowing.
Useful tips for eating
Have the person with dysphagia sit upright to prevent choking.
Have them tilt their heads to prevent liquids from going into their air passage.
Encourage the person to take smaller bites, and give enough time to chew the food thoroughly.
If small pieces of food or liquid are stuck, have them cough a little.
Dysphagia is a journey of eating experience that may switch an individual’s life 360 degree. Hence support and motivation play an important role in the management of one’s dysphagia.
References:
O’Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical medicine (London, England), 14(2), 196–199. https://doi.org/10.7861/clinmedicine.14-2-196
Shaheen, N. A., Alqahtani, A. A., Assiri, H., Alkhodair, R., & Hussein, M. A. (2018). Public knowledge of dehydration and fluid intake practices: Variation by participants’ characteristics. BMC public health, 18(1), 1346. https://doi.org/10.1186/s12889-018-6252-5
Ueshima, J., Momosaki, R., Shimizu, A., Motokawa, K., Sonoi, M., Shirai, Y., Uno, C., Kokura, Y., Shimizu, M., Nishiyama, A., Moriyama, D., Yamamoto, K., & Sakai, K. (2021). Nutritional assessment in adult patients with dysphagia: A scoping review. Nutrients, 13(3), 778. https://doi.org/10.3390/nu13030778
Continuous glucose monitoring (often abbreviated as CGM) is basically a system that allows one’s blood glucose levels to be monitored automatically.
HELPS TO IMPROVE YOUR DIABETES MANAGEMENT
This system opens up a world of opportunities for better blood glucose management for people with type 1 diabetes as well as those on type 2 diabetes that require insulin.
After all, with information of their blood glucose levels that can be obtained immediately, they can make quick informed decisions about their food choices and the dosage of their insulin as well as when to administer it.
LETS YOU ANTICIPATE A POTENTIAL INCOMING MEDICAL EMERGENCY
The ability to observe the pattern of the rise and fall of their blood glucose also allows them to be alert of the possibility of a hypo- or hyperglycaemic episode, and take prompt measures accordingly.
NOT JUST FOR PEOPLE WITH DIABETES
Additionally, continuous glucose monitoring can also benefit people with kidney problems as well as pregnant women worried about gestational diabetes.
RECOMMENDED BY EXPERTS
It’s really not surprising, therefore, that the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium reported a growing consensus on the definitions and targets of continuous glucose monitoring metrics to allow healthcare professionals and people with diabetes to make full use of this system in diabetes management.
Indeed, the United Kingdom has already taken steps to do this.
All in all, this is a remarkable example of how technology is making diabetes management, which can be complex and confusing to some people, considerably easier to figure out and implement correctly!
Continuous glucose monitoring is a feature in certain types of blood glucose monitor or glucometer. You can talk to your doctor or your pharmacist for more information on continuous glucose monitoring and whether you can benefit from using a glucometer that comes with this feature.
Reference: Oliver, N., Chow, E., Luk, A. O. Y., & Murphy, H. (2023). Applications of continuous glucose monitoring across settings and populations: report from the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors – East Meets West Symposium. Diabetic medicine : a journal of the British Diabetic Association, e15038. Advance online publication. https://doi.org/10.1111/dme.15038
Rabbits are pack animals that have many predators, so they are conditioned to always be alert and wary. Therefore, when you adopt a pet rabbit, it may take a while for the rabbit to become familiar with its new home and to feel safe.
Wild rabbits live in warrens—underground homes interconnected by tunnels. Therefore, even tame rabbits have this urge to dig with their paws. Therefore, line your rabbit’s new home with something that it can dig on.
Rabbits answer the call of nature in the same spot as much as possible, so minimize the risk of predators tracking them down. Therefore, tame rabbits can be trained to do their business in the same place every day.
A rabbit’s tooth never stops growing throughout its life, and a wild rabbit keeps its teeth to manageable length by chewing down on rough parts of plants. Therefore, give your pet rabbit things that it can always chew on, so that its teeth won’t become overgrown.
A rabbit tells you that it is not happy with you by thumping its rear feet. It may also bite, although fortunately rabbits are usually not aggressive to humans.
YOUR RABBIT’S IDEAL HOME
Keep your rabbit in a well-ventilated cage—such cages are sold in pet shops. Avoid putting rabbits in closed “houses” or glass cases, as these often lack ventilation.
Rabbits may develop sore hocks, with its feet becoming raw and inflamed, when they spend too much time on wire flooring, so make sure that the wire flooring has a mesh size that is as small as possible (1 x 2.5 cm should be good).
Have a solid and smooth area for the rabbit to rest on, such a wood or Plexiglas surface, so that it can take a break from moving around on the wire flooring.
Grass hay makes good bedding for the rabbit, as it is comfy and also provides a nice snack for a hungry rabbit!
HEALTHY RABBIT MUNCHIES
A rabbit needs plenty of dietary fibre to keep its digestive system healthy. Unfortunately, most commercial-available pelleted diets sold in stores do not provide enough fibre for the needs of an older, non-breeding, and physically inactive house rabbit.
Usually, such rabbits will need to their pellets supplemented with grass hay, leafy green vegetables, and a small amount of treat foods (rolled oats, stale bread, fruits, etc). Therefore, discuss with a veterinarian (that’s an animal doctor) on how to best meet your rabbit family member’s nutritional needs.
Make sure that your rabbit always has clean and fresh water to drink. If you have an inverted sipper bottle for your rabbit, check often to make sure that the drinking or ‘straw’ part of the bottle is not blocked.
TRIPS TO THE VET
Ideally, have the vet examine your rabbit once a year to check for lice, parasites, and tooth problems as well as signs of diseases.
Pet rabbits can be neutered when they are 3 or 4 months old to keep them from being aggressive.
IF YOU NEED TO LIFT & CARRY THE RABBIT AROUND IN YOUR ARMS
Grasp your rabbit family member gently by the scruff of its neck to keep it docile.
Cup its hindquarters with your other hand to keep it from kicking you with its rear legs.
Then gently pick the rabbit up, keeping it in a vertical position.
Alternatively, once you have grasp the rabbit’s scruff gently, you can place its head under your other arm (be gentle, don’t squeeze!) and use that arm to support its hindquarters.
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.
