Category: Top to Toe

WORDS HANNAH MAY-LEE WONG

According to the Malaysian National Cancer Registry Report (2012-2016), lung cancer is the third most common cancer in our nation. However, late diagnosis of the disease is common in our country. Only 3 to 4% of those diagnosed with lung cancer are in Stage I, while up to 90% are in Stage III or Stage IV. 

What are the symptoms?

Respiratory and internal medicine specialist Dr Ronald Lim Chor Kuan explains: “This disease causes very limited symptoms and may even be asymptomatic at the early stage, resulting in difficulty in early diagnosis.” 

Symptoms of lung cancer include: 

• Persistent cough
• Chest pain
• Haemoptysis (blood in cough)
• Shortness of breath
• Loss of weight or appetite. 

These symptoms are commonly brushed off as a prolonged cold, which could be one of the reasons why lung cancer is often diagnosed so late.

What are the risk factors?

According to Dr Lim, approximately 85 to 90% of lung cancer cases are caused by cigarette smoking. There is also a 20 to 30% increased risk of lung cancer from second-hand smoke exposure associated with living with a smoker. Thus, both active and passive smokers carry the risks of developing lung cancer.

Other risk factors of lung cancer include: 

• Family history
• Chronic obstructive pulmonary disease or pulmonary tuberculosis
• Exposure to radiation, asbestos, diesel exhaust and other dangerous elements

Dr Lim adds, “Never forget indoor pollutants, as it is a major risk factor for lung cancer in Asian women who’ve never smoked before.”

Is there any way to reduce the risk of lung cancer?

Smoking is the main risk factor for lung cancer. 

“If you’re smoking, make a concentrated effort to quit. It can be hard for the first few months, but your lungs will thank you for it. 

“Also, if you are surrounded by second-hand smoke, walk away—you have the right not to inhale. 

“And with everything else, eat in moderation, exercise regularly, and go for your regular health screenings,” Dr Lim says.

High-risk groups should get screened for lung cancer with LDCT (low-dose computer tomography). These include people who:

• Have a history of heavy smoking, and 
• Smoke now or have quit within the past 15 years 
• Are above 55 years old.

WORDS HANNAH MAY-LEE WONG

According to Ear, Nose, & Throat (ENT) Consultant Dr Kaw Bee Lian,  sinuses are air-filled cavities in our skull. There are 4 groups of sinuses:

• Frontal sinus, located in the forehead
• Maxillary sinus, located in both cheek regions
• Sphenoidal sinus, located behind the nose
• Ethmoidal sinus, located in between the eye and nasal bridges

What is sinusitis?

Sinusitis is an inflammation or swelling of the mucosal lining of the sinuses. It can be caused by a viral, bacterial or fungal infection. 

People who are more prone to sinus problems include:

• Those with nasal septal deviation or nasal polyps. These structural abnormalities in the nose interrupt and block the drainage system of the sinuses. It leads to a build-up of mucous in the sinuses and can subsequently cause infection
• Smokers
• Those with poor general health or are immunocompromised

The symptoms

Sinusitis usually starts with symptoms of an upper respiratory tract infection. Common symptoms include:

• Nasal blockage and running nose
• Fever
• A feeling of facial heaviness, discomfort or pain
• Headache aggravated by bending the head down
• Some may also notice a foul-smelling discharge from the nose

Treatment

• Antibiotics and medications to reduce swelling inside the nose may be given, as prescribed by a doctor
• Nasal spray
• Nasal douche to help clear out discharge from the nasal cavity 

Home remedies that may also help alleviate symptoms include:

• Drinking plenty of water 
• Applying warm compresses over the cheeks, nose and eyes

What are the potential complications that can occur if sinusitis is not treated?

If sinusitis is left untreated, it may progress into chronic sinusitis whereby the patient would experience persistent facial discomfort and have foul-smelling nasal discharge. 

Because the sinuses are close to the eyes and brain, in some rare cases, untreated sinusitis can lead to meningitis (an infection of the membranes that cover the brain and spinal cord), brain abscess, or other infections. It’s best to see your doctor if you have any concerns. 

Dr Kaw Bee Lian is a consultant ear, nose, and throat (otorhinolaryngology) specialist affiliated with Pantai Hospital Sungai Petani.

This year, the Ministry of Health Malaysia once again made improvements to the NIP by introducing a 6-in-1 vaccine and announcing a new immunisation schedule.

The Director General of Health, Tan Sri Dato’ Seri Dr Noor Hisham Abdullah, issued a statement recently regarding the introduction of this vaccine and the change to the new immunisation schedule for children who get their immunisation at Ministry of Health Clinics. He said, “The switch in the immunisation schedule is done following the change in the type of vaccine used, from the 5-in-1 vaccine to 6-in-1 vaccine, under the National Immunisation Program for children. The implementation will be conducted in stages, which will start as early as November 2020 depending on the availability of this vaccine supply at MOH health facilities.”

The Benefits of the 6-In-1 Vaccine

Dr Jamiatul Aida Md Sani, Senior Principal Assistant Director at the Ministry of Health’s Disease Control Division, said the move to introduce the 6-in-1 vaccine in the NIP was made with careful consideration by the National Immunisation Policy and Practice Committee.

Dr Rozita Ab Rahman, Senior Principal Assistant Director from the Immunisation Unit, Family Health Development Division, Ministry of Health Malaysia, said “There are several advantages in the use of this 6-in-1 vaccine. The main advantage is the reduction of the number of injections required and immunisation visits at Health Clinics.

“The second advantage is from the point of view of the comfort of the baby itself. Injections are painful for babies, even for a moment. Less injections means less episodes of pain and crying. Thirdly, healthcare personnel will have more time during clinic appointments to conduct assessments of the babies’ health and development such as their growth and their sensory and intellectual development.”

The 6-in-1 Vaccine is Safe for Children

Ms Norleen bt Mohamad Ali, Senior Principal Assistant Director, Pharmacovigilance Section at the Centre of Compliance & Quality Control, National Pharmaceutical Regulatory Agency (NPRA), said, “The 6-in-1 vaccine is safe to use. Just like other vaccines, this vaccine will go through a few clinical trial phases including a large-scale trial before it can be used commercially. This is to ensure the effectiveness and safety of the vaccine to the recipients.

“In Malaysia, a vaccine goes through a strict and thorough registration process by the Drug Control Authority (DCA) under the Ministry of Health. After the approval for registration is granted, only then can the vaccine be used and marketed in Malaysia, including being introduced in the National Immunisation Programme.”

The New NIP Schedule

This article is courtesy of the Immunise4Life programme by Ministry of Health Malaysia, Malaysian Paediatric Association and Malaysian Society of Infectious Diseases & Chemotherapy, supported by the Vaccination is Protection for Kids initiative. 

WORDS ABRAHAM MATHEW SAJI

Epilepsy is a chronic and non-communicable disorder of the brain that causes unprovoked and recurrent seizures, resulting in brief episodes of involuntary jerky movement of a part or full body. These spontaneous attacks may be accompanied with loss of consciousness and control of bladder and/or bowel functions, depending on the type and severity of the attack.

Anyone can develop an epileptic condition; but its prevalence is more in young children and older adults than middle age, and more in males than in females.

Epilepsy has no cure for the moment, but it can be managed. The social impacts like the discrimination, fear, prejudice, and stigma that the epilepsy patients go through are more difficult to treat than the condition itself.

Types of Epileptic Seizures and Symptoms

A seizure occurs when there is a sudden rush of electrical activity in the brain.

A generalized seizure affects the whole brain; whereas a partial seizure affects part of the brain.

Mild seizures may be difficult to recognize, lasting for a few seconds during the patient lacks awareness. Stronger seizures can cause spasms and uncontrollable muscle twitches, lasting from a few seconds to several minutes. During a stronger seizure, some patients go into a state of confusion or lose consciousness.

A seizure may be caused due to high fever, head trauma, very low blood sugar, or alcohol withdrawal. Seizures can also vary in frequency from less than one per year to several times per day.

There are several types off seizures such as:

• Simple partial seizure (no loss of consciousness, alterations to sense of taste, smell, sight, hearing, or touch, dizziness, tingling and twitching of limbs)
• Complex partial seizures (loss of awareness or consciousness. staring blankly, unresponsiveness, performing repetitive movements)
• Absence seizures (also called “petit mal seizures,” cause a blank stare, may also cause repetitive movements like lip smacking or blinking, short loss of awareness)
• Tonic seizures (characterized by muscle stiffness)
• Atonic seizures (characterized by loss of muscle control and can make the patient fall down suddenly)
• Clonic seizures (characterized by repeated, jerky muscle movements of the face, neck, and arms)
• Myoclonic seizures (causing spontaneous quick twitching of the arms and legs)
• Tonic-clonic seizures (also called “grand mal seizures”, with symptoms of stiffening of the body, shaking, loss of bladder or bowel control, biting of the tongue, loss of consciousness)

Triggers of Epileptic Seizures

Many patients are unable to remember the incident or their condition following a seizure, just that they tend to feel slightly ill for a few hours. Whereas, there are others who are able to identify things or situations that triggered their seizures. A few of the most commonly reported triggers are:

• Lack of sleep
• Illness or fever
• Infectious conditions
• Stress
• Bright lights, flashing lights, or patterns
• Caffeine, alcohol, medicines, or drugs
• Skipping meals, overeating, or specific food ingredients

To help identify or be aware of the possible trigger factors, epilepsy patients are advised to keep a small note pad to record in addition to their name, address, emergency contact details:

• Day and time of the attack
• Activities they were involved in
• Surrounding conditions
• Presence of unusual sights, smells, or sounds
• What they were eating or how long it had been since they had taken their last meal
• Their level of fatigue
• How well they slept the night before

The more the information entered, the better it is to help identify trigger factors.

WORDS ABRAHAM MATHEW SAJI

Causes of Epilepsy and its Seizures

In a majority of cases, the underlying cause of the epileptic seizure cannot be determined. The most possible causes may include:

• Traumatic brain injury
• Scarring on the brain after a brain injury (post-traumatic epilepsy)
• Serious illness or very high fever
• Stroke (leading cause of epilepsy in people over age 35)
• Other vascular diseases such as lack of oxygen to the brain
• Brain tumor or cyst
• Dementia and Alzheimer’s disease
• Maternal drug use
• Prenatal injury and lack of oxygen at birth
• Brain malformation
• Infectious diseases such as meningitis
• Genetic or developmental disorders or neurological diseases
• Heredity also plays a role in some types of epilepsy—genetics may also make some people more susceptible to seizures from environmental triggers.

Diagnosis of Epilepsy and Its Seizures

In addition to taking of medical history, the healthcare practitioner will carry out pathological tests to check for signs of infection, blood glucose levels, and functioning of certain vital organs like heart, liver, and kidney.

There could also be a neurological examination to test motor abilities and mental functioning. Additional tests may include electroencephalogram (EEG) and positron emission tomography (PET) to record the electrical activities in the brain, andd CT and MRI scans to check on the image of the brain for any potential damage or deformation or growth.

Treatment of Epilepsy and Its Seizures

There is no established cure for epilepsy, but it can be managed.

The medication and treatment regimen will vary based on the type, severity and frequency of symptoms. It will also depend to a great extent on the general health and presence of any other underlying conditions of the patient. Some patients stop having epileptic seizures and are able to stop the anti-epileptic medication therapy.

Surgery or resection is another option for treatment. This involves removing the part of the brain where the seizures start. In some cases, the patient will be kept awake during this surgery so that the doctors can communicate with the patient and avoid removing part of the brain that controls important functions such as vision, hearing, speech, or movement.

If the area of the brain is too big or important to remove, there’s another procedure called multiple subpial transection, or disconnection. The surgeon makes cuts in the brain to interrupt the nerve pathway. That keeps seizures from spreading to other areas of the brain.

With advances in medical research and technology, the future could witness some non-invasive procedures like brain or nerve stimulation, control of electrical signals in the brain and radiosurgery.

The Road Ahead for Better Management of Epilepsy

In addition to regular doctor visits and following your treatment plan, here are some things that can be done to cope with epilepsy.

• Keep a seizure diary to help identify possible trigger factors so that they can be avoided
• Wear a medical alert bracelet so people know what to do in case of a sudden seizure
• Teach the near and dear ones about seizures and what to do in an emergency
• Seek professional help for any symptoms of depression or anxiety
• Join a support group for people with seizure disorders
• Incorporate lifestyle changes by eating a balanced diet and getting regular exercise
• Be safe and stay safe by adapting to some practices like covering sharp corners or edges, avoid locking bathroom doors, have guards or insulations on heaters
• Get adequate sleep daily
• Take stops or exchange drivers while on long drives to enable the body and mind recoup
• Always wear a helmet while riding a bicycle or motorbike

WORDS HANNAH MAY-LEE WONG

Although having a baby is a straightforward and natural process for many couples, according to fertility specialist Dr Farah Leong Rahman, infertility affects 1 in 7 couples.

Factors that can affect fertility

Dr Farah shares that some of the causes of infertility can include:

• Irregular ovulation (often seen in women with polycystic ovaries)
• Blocked or damaged fallopian tubes
• Endometriosis
• Poor semen quality (in men)

Certain medical treatments or procedures, such as cancer treatment and surgeries on the female reproductive organs, can also affect fertility rate.

In a quarter of infertility cases, the cause remains unknown. These cases are labelled as ‘unexplained infertility’.

When to visit a fertility doctor

Couples trying to conceive but have been unsuccessful for a year, should visit a fertility doctor for advice on their next steps.

“Do see the fertility doctor if the woman is 35 years and above, as the fertility rate declines with age. The ovaries will have fewer eggs to offer and may be of poorer quality,” Dr Farah adds.

Men with a history of undescended testes, problems with pubertal development, erectile dysfunction, or men who have had previous genital surgery or infection are also advised to see the fertility doctor.

During the visit

Several tests would likely be offered at the fertility clinic. They include:

• The Anti-Mullerian hormone test. This test estimates how many potential eggs a woman has in reserve.
• Tubal patency test. This checks if the woman’s fallopian tubes are blocked
• Ultrasound to check on the womb and ovaries

For men, a sperm test would be carried out to check for sperm count, motility, and form.

“The treatment options may be different for each couple depending on the underlying problem and discussions made,” Dr Farah says.

Turning to each other for emotional support

Treatment for infertility can be time consuming, and an emotional and mentally draining process. That’s why couples going through it must lean on each other for support.

“It is important to be honest about your feelings and able to express it in the right way. There are also support groups out there and counsellors if one needs help. Always remember that you are not alone in this journey,” Dr Farah advises.

Dr Farah Leong Rahman is a consultant fertility specialist and Obstetrics & Gynaecologist specialist at Sunway Medical Centre Velocity.

WORDS HANNHA MAY-LEE WONG

During the pandemic, children are increasingly spending time hunched over their electronic devices. Matt Kan warns that long hours of sitting, poor posture and slouching when using electronic devices can negatively affect a child’s spine health in the long run.

According to Mr Kan, children between 8 and 15 years old go through growth spurts and bone development. During this time, sitting on chairs for too long, coupled to a lack of exercise, can increase the risk of developing spine issues amongst children of this age group. One example of such issues is postural kyphosis—an excessive curve of the spine, also called hunch back or rounded back. It is commonly caused by bad posture or prolonged slouching.

What can parents do?

There are a couple of things parents can do to help their children build healthy posture habits and reduce the risks of musculoskeletal issues in the future.

Taking breaks to walk around the house, especially after a study or gaming session, can improve musculoskeletal health. Stretching and simple exercises can also help strengthen and increase blood supply to the muscles.

Parents should keep a close eye on their children’s back posture, especially when their children are studying on their laptops or gaming on their mobile phones. If they are slouching, parents should give gentle reminders to correct their children’s posture.

Matt Kan is the founder of and senior consultant of chiropractic at Chiropractic First.

WORDS LIM TECK CHOON

Is it true that the COVID-19 vaccine may harm pregnant mothers and their foetus?

The vaccines that are currently available in Malaysia can be used by pregnant mums. However, mRNA vaccines are preferred as these vaccines has the most safety data available to date. In a country like Malaysia, where these vaccines are available, pregnant women should be offered this vaccine.

Why should pregnant women receive the COVID-19 vaccine?

Pregnancy can increase a woman’s risk of developing severe COVID-19, needing assistance to breathe, and ICU admission. Her risk of dying is also higher. 

If severe COVID-19 occurs, the baby is more likely to be stillborn or be born prematurely.

Vaccination will reduce the risk of these problems.

Do pregnant women at different stages of pregnancy respond to the COVID-19 vaccine differently?

No.

Do pregnant women experience different typical side effects of a COVID-19 vaccine, compared to other people?

Also, no.

After receiving her COVID-19 vaccine, can a pregnant woman transmit any sort of immunity to her infants?

The baby does get some antibodies, but not in amounts high enough for the baby to be considered to consider protected from COVID-19.

It is, therefore, important for as many people as possible to receive the COVID-19 vaccination. Doing so will strengthen the herd immunity effect, to increase protection against the disease to babies, young children, and groups of people that cannot receive the vaccination for medical reasons.

Does the COVID-19 vaccine cause any adverse effects to lactating mothers or infants who are being breast-fed?

Very little of the vaccine or antibodies will appear in breast milk.

Will the COVID-19 vaccine affect the reproductive ability of a woman either in the short-term or long-term?

No, it won’t.

WORDS HANNAH MAY-LEE WONG

As more people get their COVID-19 vaccination appointments, some may start to wonder whether they should delay their elective surgeries. A common worry is that the vaccine might interact with the anaesthesia administered during surgery and this may cause an adverse reaction.

According to consultant anaesthesiologist Dr Mohamad Fadhil Hadi, many of these concerns stem from misinformation that is circulating online.

YES, IT IS SAFE TO FOR SURGERY

Dr Mohamad Fadhil Hadi assures that it is safe to go for scheduled surgery even after getting vaccinated.

He explains that anaesthesia is a treatment using drugs called anaesthetics to keep patients from feeling pain during surgery or medical procedures.

“Anaesthesia and the COVID-19 vaccine operate in two completely different systems and as such, anaesthesia does not pose any effect to our antibody, immune system or reaction towards any vaccines,” he elaborates.

That said, patients that have scheduled surgeries are encouraged to complete their COVID-19 vaccinations before going for their surgeries. This is to minimize the risk of getting infected with Covid-19 and spreading it to healthcare workers in the hospital.

GO FOR A PRE-OPERATIVE VISIT

In general, elective surgeries should be planned at least a few days after getting vaccinated.

If patients are still concerned about the safety of getting vaccinated shortly before or after their surgery, it is best for go for a pre-operative visit. During this visit, patients can consult their doctor or anaesthesiologist about their concerns and ask any other questions that they may have.

“I would advise my patients to rest for a few days after they have completed their COVID-19 vaccination. This is because some patients may experience side effect such as fever, muscle ache or nausea post-vaccination. However, if it is an urgent case such as bone fracture or spinal injury, we would proceed to perform the procedure,” Dr Mohamad Fadhil Hadi elaborates.

“A spoonful of sugar helps the medicine go down,” sang Mary Poppins as she tried to get the naughty Banks children to take their medicine. Well, you can put all that sugar away, as here are some tips to help you get your children to take their cough medicine without too much fuss.

Smile, it’s medicine time!

Look happy when you’re about to give your child cough medicine. Children are good at picking up negative tones or body language. So, project some positive vibes to your child!

Smile at your child, play with him and let him swallow the medicine willingly. Never force him to swallow because he will either spit it out or inhale it into his lungs. Both are not good and will worsen his cough.

Squirt it in!

Try using a syringe or dropper to help your child swallow the medicine without tasting it. Children have a problem swallowing medicines once they have tasted it. So, carefully push the syringe or dropper along your darling’s cheek to the back of his mouth. Squeeze the syringe or dropper slowly and the medicine will go down his throat!

Add flavours

Ask your child what his favourite flavour is and try adding it to the cough medicine. For example, if he likes orange juice, you can mix the cough medicine into some orange juice and let him drink it. When your child discovers the cough medicine comes in his favourite flavour, he will be more willing to swallow it.

Your child decides

Let your child have a say on how he wants to take his medicine – in a syringe or dropper, and the flavour he prefers. By letting him decide, he feels empowered to taking care of himself.

Serve it cold

Storing the cough medicine in the fridge may make it easier for your child to swallow. The taste of medicines tends to be better when chilled. Another method is to let your child suck on ice chips or even an ice popsicle before giving him the cough medicine. The ice will numb his tongue and taste buds so he won’t be able to taste the medicine so much and will find it easier to swallow.

It’s playtime!

Let your child pretend to be a doctor. Pretending to give his favourite toy the medicine will make it easier for him to take the medicine himself.

Tell the truth

Tell your child the truth. Explain to your child that the medicine will make him better but he may not like the taste. Reasoning with your child can make it easier for him to take the medicine. Never, ever refer to medicine as sweet. Children may accidentally swallow more than what they are supposed to and end up sick.

Ask your doctor or pharmacist

If all your attempts fail to get your child to take his medicine, check with your doctor or pharmacist for other options.

References: 1. Parents.com. Available at www.parents.com. 2. WebMD. Available at www.webmd.com.

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