What Do You Know about Alzheimer’s Disease? Find Out from a Geriatrician!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR TEH HOON LANG
Consultant Geriatrician
Sunway Medical Centre

21 September is World Alzheimer’s Day. We’re pleased and really appreciative of the fact that, in conjunction with this day, Dr Teh Hoon Lang has graciously shared her insight on Alzheimer’s disease with us.

IS DEMENTIA THE SAME THING AS ALZHEIMER’S DISEASE?

Dr Teh explains that:

  • Dementia is a complex brain function impairment set that interferes with daily life.
  • Alzheimer’s disease is a common type of dementia.
  • It is a progressive brain disorder characterized by the buildup of abnormal proteins in the brain.
  • This buildup will lead to a gradual decline of memory, thinking, and reasoning skills.
  • This condition will get worse over time.
An overview of Alzheimer’s disease. Click on the image to view a larger, clearer version.
  • According to some studies, over 8.5% of Malaysians aged 60 and above have dementia, with a higher prevalence among women.
  • However, note that Alzheimer’s disease and other forms of dementia can also occur to people at a younger age. They should not be considered as merely ‘old people’s disease’.
WE SHOULD BE VIGILANT & KEEP AN EYE OUT FOR EARLY SIGNS

According to Dr Teh, symptoms of dementia can be mild and hence overlooked.

“Many people may assume these symptoms as part of the normal ageing process,” she adds.

COMMON EARLY SIGNS OF DEMENTIA (OF WHICH ALZHEIMER’S DISEASE IS ONE TYPE)
  • Recent memory loss, such as being unable to recall recent events or appointments.
  • Difficulties in planning and carrying out tasks or solving problems such as following a recipe, managing their finances, or managing their own medicines.
  • Difficulty in completing familiar tasks such as cooking, driving or using appliances.
  • Confusion about time and/or place—they may lose track of the date, time, or where they are. They may also get lost in familiar places.
  • Trouble understanding visual images and spatial relationships. This can manifest as difficulties in understanding maps, following directions, judging distances, determining the size of objects, etc.
  • Problems with languages, such as difficulty finding the right words or using the wrong words during a conversation.
  • Frequently misplacing things and losing the ability to retrace steps.
  • Decreased or poor judgement. They may make poor decisions, such as giving away large sums of money or insisting on driving when they are no longer fit to drive.
  • Withdrawal from work or social activities that they used to enjoy. They may also become isolated and avoid interacting with others.
  • Changes in mood or personality such as becoming depressed, anxious, or irritable. They may also experience personality changes, such as becoming more passive or withdrawn.
CERTAIN FACTORS CAN INCREASE ONE’S RISK OF DEVELOPING ALZHEIMER’S DISEASE & OTHER FORMS OF DEMENTIA

Dr Teh shares that common risk factors include:

  • Sedentary living—not getting regular physical activity.
  • Smoking and/or excessive alcohol consumption.
  • History of head injuries.
  • Infrequent social contact and isolation. This can lead to depression, a risk factor. Thus, we, especially the elderly, are encouraged to stay socially active no matter our age.
  • Less or low levels of education in early life, as this can affect cognitive reserve—the ability of the brain to maintain our cognitive function and withstand deterioration and damage.
  • Obesity, especially during one’s mid-life.
  • High blood pressure or hypertension.
  • Diabetes, primarily type 2 diabetes.
  • Hearing impairment or individuals with hearing loss. Hearing aids may help reduce this risk.
WHY EARLY DETECTION IS CRUCIAL

Any damage to the brain is irreversible; there is no way to treat or undo the damage.

“It is important to see a doctor for an assessment as soon as possible, as early diagnosis and treatment can help to prevent or delay irreversible brain damage,” Dr Teh states.

HOW ABOUT SCREENING FOR ALZHEIMER’S DISEASE?

“According to guidelines, routine cognitive screening isn’t recommended for everyone, it’s only recommended to screen people at risk,” Dr Teh shares.

She adds, “However cognitive screening is not 100% accurate, hence, it’s crucial to educate the public about the early warning signs of dementia.”

Furthermore, some conditions may resemble dementia, such as vitamin B12 deficiency and hypothyroidism, and these can be reversed by early treatment.

INNOVATIONS OF THE PHARMACEUTICAL INDUSTRY IN DEVELOPING A TREATMENT FOR ALZHEIMER’S DISEASE

In other news, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has released a video highlighting the challenges and advances made by the pharmaceutical industry in finding means to slow the progression of Alzheimer’s disease. Have a look!

For more information, visit the IFMPA (link opens in a new tab).

A Consultant Urologist Talks about Kidney Stones & How They Affect Children & Younger Adults

WORDS DR GOH ENG HONG

FEATURED EXPERT
DR GOH ENG HONG
Consultant Urologist
Prince Court Medical Centre

Kidney stones are formations that develop in the kidney.

The process of stone formation often begins with a blood flow issue. Such issue causes a small crystal to start to grow and eventually transforms into a stone—a kidney stone.

Kidney stones. Click on the image for a larger, clearer version.

There are typically a few types of kidney stones, with calcium stones being the most prevalent.

NOW, HOW DO THESE STONES FORM IN THE URINARY TRACT?

There are several factors contributing to their formation.

  • Structural abnormalities along the kidney tract.
  • A malfunction in the body, leading to a higher risk of stone formation in the urine.
  • Lifestyle choices.
  • It’s essential to consider the presence of other concurrent medical conditions. For instance, diabetes and cholesterol can contribute to stone formation as well.
KIDNEY STONES ARE INCREASINGLY MORE COMMONLY DIAGNOSED AMONG YOUNGER PEOPLE?

I can’t provide an exact prevalence, but it’s evident that kidney stones are becoming more frequently diagnosed in young people, especially young women.

There are several reasons contributing to this trend.

  • Improved medical care leads to more regular check-ups that detect the presence of kidney stones.
  • Modern lifestyle, characterized by the consumption of fast and convenient foods. Such processed foods tend to be high in salt content, a known risk factor for stone formation. Moreover, sugary beverages, processed drinks, and excessive sugar consumption also contribute to the risk of stone formation.

In the case of young women, several additional factors may play a role.

  • Many of them desire to maintain a lower body weight, which leads them to adopt special diets that may lack proper balance. This imbalanced diet can contribute to stone formation.
  • Their busy lifestyles and work commitments may result in reduced water intake and holding in of urine for extended period of time (finding a restroom can become inconvenient). This inadequate hydration can also lead to stone formation.
OTHER INTERESTING POSSIBLE RISK FACTORS OF KIDNEY STONES AMONG YOUNGER PEOPLE
  • Climate change. Rising temperatures lead to increased dehydration. While outdoor activities and games are encouraged, inadequate water intake during these activities can contribute to stone formation.
  • Antibiotic misuse. The direct role of antibiotics in the formation of kidney stones remain uncertain. They may affect the formation of kidney stones indirectly, probably by causing issues related to nutritional absorption in the gut.
SYMPTOMS OF KIDNEY STONES

Kidney stones can present in various scenarios. For instance, some patients may exhibit symptoms like pain, bleeding, or fever when the stone obstructs the urinary tract, causing an infection.

Alternatively, kidney stones may be detected early in some fortunate cases, while these stones are still small, and hence there are no significant issues.

So, the manifestations of symptoms of kidney stones can vary.

POTENTIAL CONSEQUENCES AND COMPLICATIONS OF UNTREATED KIDNEY STONES

The stone might not cause any significant issues to the person’s quality of life if it is quite small.

However, the kidney stone may block the ureter—the passage in which urine is expelled from the body—creating a ‘traffic jam’ that leads to kidney swelling.

If left untreated, this blockage can lead to pain, infections and even kidney failure.

KIDNEY STONES MAY COME BACK OR RECUR IF ONE’S DIET IS NOT PROPERLY MANAGED

While water intake is often emphasized in relation to kidney stones, it is essential to consider other factors as well, such as salt and sugar intake.

Without proper diet management, there is a high chance of recurrence of 50% in 5 years, with some patients experiencing kidney stone formation again only 5 years after their initial operation.

This is also true for children. There is always a risk of kidney stone recurrence, especially if their diet is not properly managed.

Additionally, if a child has any structural or functional body issues that have not been adequately addressed by the doctor, it can also contribute to recurrent kidney stones.

HENCE, SPECIAL ATTENTION IS NEEDED FOR CHILDREN THAT HAVE EXPERIENCED KIDNEY STONES

They should undergo thorough medical assessments to rule out any body structural defects or functional problems that could lead to stone formation.

Proper management and monitoring are also essential.

TIPS TO REDUCE THE RISK OF KIDNEY STONE FORMATION
  • Adopt a healthy lifestyle. This is crucial. It involves maintaining a balanced diet, controlling one’s body weight, engaging in regular exercise, and managing blood sugar and cholesterol levels.
  • Drink an adequate amount of water daily as it helps in both hydrating the body and flushing out stones.
  • Avoid or limit foods that are high in sugars and salt.

Don’t Let Glaucoma Rob You of Your Eyesight!

The eye is one of life’s treasures. It is our organ for vision.

The retina, located at the back of our eye, plays a key role in giving us our gift of sight. This is where information on shape, colour and pattern is picked up and carried to the brain via the optic nerve.

We must, therefore, be vigilant of eye conditions that may damage our optic nerve, impact our vision and eventually lead to sight loss. One such chronic condition is glaucoma.

WHAT IS GLAUCOMA?

Glaucoma occurs when the optic nerve connecting the eye to the brain is damaged. It often develops because of fluid building up in the in the front part of the eye, resulting in raised intraocular pressure (IOP).

While anyone can develop glaucoma, it is more common in people over 60 years old and can result in vision loss and eventual blindness, if not treated.

With no known cure for glaucoma, regular eye examinations are therefore, very important for early detection and proper treatment to slow or stop its progression.

WHAT ARE SOME SIGNS AND SYMPTOMS?

Symptoms can start so slowly that you may not even notice it.

Thus, it is good to promptly consult your ophthalmologist if you have any tell-tale signs.

These include loss of peripheral vision, having tunnel vision, a blurred or hazy vision, experience of halos or glare especially at night and having some eye pain and discomfort.

HOW TO TREAT GLAUCOMA?

The goal in glaucoma treatment is to control IOP, the main risk factor for the development and progression of glaucoma.

The first and most common treatment option is always noninvasive through medications or eye drops.

In Malaysia, a group of medicines called prostaglandin analogues (PGAs) are a common treatment choice because they are effective in lowering pressure in the eye and are easy to use with daily application.

However, it is reported that about 50% of users of PGA eye drops may experience visible changes that occur around the eye including the eyelids, known as prostaglandin-associated periorbitopathy syndrome (PAPS), after over one month.

Common signs of PAPS are sunken eyes or deepening of the upper eyelid sulcus (also known as DUES), excessive eyelash growth, droopy upper eyelid, darkening of skin around the eyes or eyelids, flattening of the lower eyelid bags and/or fat loss around the eye, and eyelids pressing firmly against the eye.

These can adversely affect the quality of life of glaucoma patients causing them to feel gloomy, avoid looking in the mirror, lack confidence to socialise, and interfere with their work.

Beyond these cosmetic changes, PAPS can also have negative impact on treatment outcomes, including unreliable eye pressure measurements and added difficulty and poor outcomes related to glaucoma surgery in the future.

Some patients are known to discontinue their treatment because of these side effects and this can hamper the overall management of their condition.

Nonetheless, the good news is that with advancements in ophthalmology, there are other class of medicines now available to fulfil the unmet needs among glaucoma patients. These newer options can help them be free from PAPS so they can continue treatment without compromising their quality of life.

BE PROACTIVE FOR BETTER VISION

Detect your condition early for better outcomes and consult your ophthalmologist to learn of a suitable eye drop for you.

Remember, regular and frequent eye examinations are essential to monitor the progression of glaucoma and to adjust treatment as needed.

Prevent the risk of vision loss and continue to enjoy the beautiful wonders of creation.

How CEO Patricia Tan Took Her First Step to a 1,000-Mile Journey

WORDS PATRICIA TAN

FEATURED EXPERT
PATRICIA TAN
Chief Executive Officer
SCORE Sports Management
www.score.my

‘My fitness journey’, ‘my transformation’, ‘exercise challenge’—the road to the finish line always already sounds daunting, even before we can start.

While fitness is by no means a short-term journey, I have learnt over the years that it never has to be limited to the physicality, and it certainly doesn’t have to be difficult to start.

As a matter of fact, as the saying goes, it actually all begins with that first, single step.

MY FIRST STEP WAS TAKEN 10 YEARS AGO AFTER A LONG DAY AT WORK

I wanted to shake off the monotony of the day and made a spontaneous decision that set my life on a new path for good.

I went for a short run around my neighbourhood and returned feeling refreshed, rejuvenated, and more energized than I had been in a long time.

As it became part of my daily routine, I grew to love the physical benefits of consistent running.

Enhanced overall health and mobility. A strengthened cardiovascular system. The undeniable benefits of weight management. Eradicating the troublesome ailments that are often entangled with excess weight.

These tangible perks may have been the factors that first motivated me, but what has kept me here is something else entirely: it was the realization that running goes far, far beyond the physical.

What running is really, truly about is the benefits less commonly discussed, the mental and personal fortitude that carries over into almost every other area in life.

WIN AT RESILIENCE, DISCIPLINE & DEDICATION

Even small, incremental changes like more balanced meals or more leg days is an experience that ultimately homes in on discipline, focus, and perseverance.

As we consistently build these habits and regimes, the brain subconsciously taps into them to overcome other mental hang-ups in both our personal and professional lives.

The end result? It becomes much easier to stick to what it takes to achieve a goal—even if it’s something that was difficult to imagine previously!

CELEBRATE THE SMALL VICTORIES FOR YOU & YOUR CONFIDENCE

Crossing the finish line for a run is one thing and may be the easiest to focus on.

However, it is the process that truly does wonders for a personal sense of accomplishment.

It often lies hidden in the ‘sub’-achievements like managing to run a longer distance than at the beginning, or even no longer aching as much as before!

Everything comes together in a big boost for the self-esteem, a sense of pride and satisfaction, and most importantly, the motivation to tackle other challenges in life with the understanding that even a small win along the way deserves to be celebrated.

STERLING CONVERSATION STARTER & COMMUNITY CONNECTION

Just as much as running helps get us into shape, it is also a community favourite in its own way.

Being an accessible (and relatively free) form of exercise, it attracts people from all walks of life. A daily run can quickly turn into a space to meet and connect with like-minded individuals — and not just within running circles either! Sharing an interest in or goals for running can be a great ice-breaker in both personal and professional spaces.

IT’S BEEN A LONG JOURNEY, AND I WILL KEEP GOING

It’s been more than 10 years since my journey as a runner began, and it has been one which has impacted me for the better.

As we celebrate a decade of working towards a healthier, more holistic Malaysia, it is also an opportunity to look back on the process, which is something running has taught me.

My experience from a beginner to now an annual runner has bled into my enthusiasm at work as well. It shapes my many initiatives to go beyond running, to also involve other sports that contribute towards scalable fitness journeys like yoga and badminton.

Yet, no matter how far we go, running is still where our heart lies. Recognizing and nurturing the potential of running can go a long way to helping Malaysia harness its power to enhance society’s well-being and progress in body, in mind, and in the confidence that shines through every aspect of their life.

All we need to do is take that first step.

Everything You Need to Know About Managing Disruptive Menopause Symptoms

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR NAZIMAH IDRIS
Medical Director
IMU Healthcare

I’m still young. Should I be concerned about menopause at this point in time?
“We should speak to women long before they reach menopause, so that, when it happens, they are more prepared and less anxious about it,” says Professor Dr Nazimah Idris.

She adds: “Many women I see wish they had known earlier what they could have done to prepare themselves. As every woman will go through this experience, you should enter this life phase empowered with knowledge.”

What’s menopause, exactly?
According to Prof Dr Nazimah, menopause is when a woman’s ovaries stop producing eggs and she stops menstruating.

Medically, menopause is confirmed when a woman has not experienced menstruation after one year.

Generally, this takes place when a woman is between 45 and 55 years old.

About 5% of women worldwide, however, experience early menopause between the ages of 40 and 45.

It’s also possible to experience menopause after undergoing a hysterectomy, chemotherapy, and other medical procedures that can damage the ovaries and affect menstruation.

Common symptoms of menopause. Click on the image for a larger, clearer version.

Why do some women experience symptoms of menopause even when they are still menstruating?

Prof Dr Nazimah explains that this is likely because the woman is experiencing perimenopausal stage (often called perimenopause for short), which can occur even before a woman enters menopause.

This stage usually lasts 4 to 5 years.

“During this time, it is normal to have irregular menstruation that may include heavier bleeding as well as infrequent or skipped cycles,” she elaborates.

Perimenopause can occur due to changes in a woman’s endocrine system. These changes can cause a reduction in the levels of oestrogen, the female sex hormone.

Because of this reduction in levels, a woman may experience symptoms of menopause such as hot flashes, fluctuating emotional states, difficulty sleeping and vaginal dryness.

She may also experience forgetfulness, low energy levels and reduced libido which, combined with vaginal dryness, can lead to less interest in sex and intimacy.

Once the woman enters menopause, the symptoms can become more severe and last up to another 5 years.

That sounds uncomfortable. Can anything be done about it?

Prof Dr Nazimah admits that a woman going through perimenopause and later menopause may experience around 10 years of symptoms. “This is a long time to be coping with symptoms if they are disrupting your daily life.”

Hormone therapy can help to manage severe and disruptive symptoms.

Tell me more about hormone therapy. Does it work, and how does it work?

“Hormone therapy can be very helpful in relieving hot flashes and improving sleep quality, vaginal dryness and urinary incontinence, among others,” she says.

There are different types of hormone therapy: tablets, topical creams, vaginal ring, and more. Medications may also be prescribed when necessary, such as to reduce the risk of osteoporosis due to low levels of oestrogen in the body.

The doctor will recommend the most suitable option based on a woman’s needs, family history, and other factors.

This sounds intriguing. Is hormone therapy an option for every woman experiencing symptoms of menopause?

Well, for one thing, Prof Dr Nazimah points out that hormone therapy is generally well-tolerated.

Hence, it is an option available to most women even when they have chronic diseases such as type 2 diabetes and high blood pressure.

However, hormone therapy may not be suitable for women that have certain diseases and conditions such as breast cancer, liver disease, thromboembolism, and heart disease.

If you have a health condition and are interested in hormone therapy, Prof Dr Nazimah recommends consulting a doctor for more information.

FEATURED EXPERT
SIN YEN SUAN
Certified Chinese Medicine Practitioner
IMU Healthcare

How about natural remedies for menopause symptoms? Do they work?

According to Sin Yen Suan, a certified Chinese medical practitioner, natural remedies such as evening primrose and black cohosh are traditionally turned to for perimenopause and menopause.

However, research on the efficacy on these remedies has yet to uncover any conclusive evidence on their efficacy in relieving the symptoms of perimenopause and menopause.

“However, Chinese medicine may be able to help,” Yen Suan offers.

She explains that the effectiveness of Chinese medicine can be seen by about 3 cycles of treatment, although the whole treatment process for menopause symptoms may last 1 to 2 years.

How exactly can Chinese medicine help?

Yen Suan further elaborates that Chinese medicine treat health problems by addressing imbalances in the body through individualized therapies, based on each person’s health status, needs, and other factoers.

“Many women come to me for help with symptoms such as persistent or heavy vaginal bleeding especially, heavy sweating, hot flashes, and disturbed sleep,” she says. “To help, we use several different treatments such as herbal medications to balance their qi or acupuncture to stimulate blood flow at the meridian points. These methods help to ease their emotional state, so they are able to feel better and sleep better at night.”

Chinese medicine can complement a person’s current Western medicine regime. If you are considering Chinese medicine to complement your current medical treatments, she recommends keeping both your doctor and Chinese medicine practitioner updated on your current forms of treatment.

PROF DR NAZIMAH’S TO-DO CHECKLIST FOR WOMEN EXPERIENCING MENOPAUSE
  • Menopause is not the end of life as you know it. Embrace new experiences, learn new things, take up a new hobby, make new friendships and rekindle old ones—the list goes on and on.
  • Speak to your doctor about health screenings such as Pap smear, mammograms, and colonoscopy, which are useful in detecting early stages of cancer and other health issues.
  • Also consider tests such as blood tests for anaemia and diabetes as well as bone density scans for osteoporosis.
  • Women over 51 should increase their calcium intake to 1,200 mg a day and consume vitamin D3 to keep their bones healthy and reduce their risk of osteoporosis.
  • Do regular Kegel or pelvic floor exercises, weight bearing exercises, and strength training to keep your body in good working condition.
  • Quit unhealthy habits such as smoking.

Expert Dishes on Staying Safe & Comfy During This HOT HOT Heat Wave

WORDS LIM TECK CHOON

FEATURED EXPERT
DR CHAN YANJUN
Medical Director
International SOS
HEAT WAVE AT A GLACE
  • The official definition of a heat wave in Malaysia is a period when the daily maximum temperature is higher than 37ºC for 3 consecutive days.
  • As of 12 May 2023, the Ministry of Health has recorded a total of 14 cases of heat-related illnesses such as heat stroke (4 cases), heat exhaustion (4 cases) and heat cramps (6 cases).
  • The Ministry expects the number of such cases to increase until August 2023!
Heat awareness at a glance, courtesy of International SOS. Click for a larger, clearer version.

Dr Chan Yanjun tells us: “Heat waves can lead to heat exhaustion and heatstroke, which can have severe consequences on health. It is crucial to prioritize personal well-being and take necessary precautions to prevent heat-related illnesses.”

COMMON HEAT-RELATED ILLNESSES
  • Heat stroke occurs when your body overheats—your body temperature goes over 40ºC—and it can quickly damage your brain, heart, kidneys, and muscles if you didn’t receive prompt treatment. This is considered a medical emergency.
  • Heat exhaustion is the result of excessive sweating in high temperatures, which leads to enormous amount of loss of water and salt. Symptoms include heavy sweating, dizziness, thirst, decreased urine output nausea, and vomiting. Without prompt medical attention, this can lead to heatstroke.
  • Heat cramps occur in your muscles due to depletion of water and salt as a result of excessive sweating.  These cramps, which can be painful, usually occur in muscles of the calves, thighs, and shoulders.
DR CHAN’S 5 TIPS TO STAY HEALTHY & COMFY DURING A HEAT WAVE
TIP 1: STAY HYDRATED
  • Drink plenty of fluids, especially water, regularly (about every 20 minutes) even before you feel thirsty.
  • Avoid excessive consumption of caffeine, alcohol, and very sugary drinks, as they can contribute to dehydration.
TIP 2: DRESS APPROPRIATELY
  • Wear loose-fitting, lightweight, and light-coloured clothing to allow your body to breathe and stay cool.
  • Protect your head and face with a hat and use sunscreen to prevent sunburn.
TIP 3: SEEK SHADE
  • Avoid direct exposure to the sun, particularly during peak heat hours.
  • If possible, stay indoors or find shaded areas when the sun is at its strongest, typically between 10 am and 4 pm.
TIP 4: TAKE REGULAR BREAKS
  • If engaging in outdoor activities, schedule frequent breaks to rest and cool down in shaded areas.
  • Listen to your body and do not overexert yourself.
TIP 5: MONITOR HIGH-RISK INDIVIDUALS
  • Keep a close eye on children, elderly individuals, and those with pre-existing medical conditions, as they are more susceptible to heat-related illnesses.
  • Ensure they have access to cool environments and sufficient hydration.

How Technology Can Grow & Improve Our Healthcare Ecosystem

WORDS IRIS CHIN

FEATURED EXPERT
IRIS CHIN
Sales Director
Wistron Medical Technology Malaysia

Malaysia’s healthcare system is underinvested, overburdened, and has faced increasingly urgent calls for improvements to our national healthcare policies and strategies.

While public concern surrounding COVID-19 has largely fizzled out, the pandemic has brought to light the fractures in our public healthcare system.

This includes specialist shortages, chronic under-funding, and the need to future-proof our health infrastructure to alleviate the burden borne by hospitals.

BUDGET 2023 YET TO ADDRESS POLICY FOCUS IMBALANCE

Budget 2023 has allocated RM36 billion to strengthen the capacity of public health services. However, this has yet to address the imbalance in policy focus between hospital care and primary care. Primary care involves extending beyond healthcare facilities to continue serving a patient’s medical needs, such as through treatment and rehabilitation.

With the proper investment and development, primary care has the potential to reduce the overall cost of care and to make positive health outcomes more accessible to all Malaysians — which is why more needs to be urgently done to grow the local rehabilitation industry.

WHY GROW THE LOCAL REHABILITATION INDUSTRY?

Based on my experience in expanding primary care, rehabilitation departments tend to have the smallest budget allocation or be the most neglected in the eyes of hospital management. Some hospitals may not even be equipped with a proper setup for patient rehabilitation treatment.

But in truth, rehabilitation is—and this cannot be stressed enough —an incredibly crucial step in the recovery process.

I would go so far as to say rehabilitation can do something that traditional medicine or operational procedures would not be able to: empowering patients to live with a changed body and independently manage their health condition while recovering.

This is especially important in cases such as brain injuries (where rehabilitation can come in the form of speech and language therapy), impaired movement and flexibility, patients of advanced age, or cancer and stroke survivors.

CHALLENGES TO THE GROWTH OF THE REHABILITATION INDUSTRY

The main issue currently plaguing the industry is accessibility.

Rehabilitation services are often provided only at high-cost specialist centres in urban areas, often with long waiting lists and long waiting times too. This also indirectly means that there are fewer trained rehabilitation professionals compared to other types of medical caregiving.

Even when rehabilitation services are available, patients face high out-of-pocket expenses as they are billed on specialist hours. Rehabilitation programmes are also less commonly covered by medical financial support such as insurance plans. Referral pathways to rehabilitation services are affected by this, preventing the industry as is from growing and patients from accessing the support they need.

Taking into account the country’s ageing population, there is a greater need now than ever for rehabilitation to share a greater burden of care with healthcare facilities at large.

To fill these gaps and drive primary care growth more quickly, I believe we need to look at a game-changer that can help lower barriers to rehabilitation and make it more easily accessible — a role that technology and robotics has already started to play.

INTEGRATING ROBOTICS INTO REHABILITATION

Contrary to the name, robotic rehabilitation doesn’t mean that it removes the quintessential human element of care. Instead, it comes in the form of robotic devices that patients can wear or use during rehabilitation programmes, complementing the instructions and advice of trained physiotherapy professionals.

This technical support, so to speak, is a game-changer for rehabilitation for a number of reasons.

Not only does this open up opportunities for more treatment options, it is also easier to make global technology more readily available to a larger number of people—as compared to a mad rush to train rehabilitation specialists or accommodate geographical restrictions.

At the same time, it is a cost-effective way to offload partial tasks from physical therapists. They would have more time to meet or assist particularly complex cases, applying their knowledge to specific rehabilitation programmes that may need more specialised input.

In sum, advanced technology-assisted rehabilitation has the potential to more quickly shift the focus to growing primary care within Malaysia.

With robotics, we are now able to bring global rehabilitative technology directly to the people who need it most—with portable devices that are not only available in specialist centres but also community clinics in non-urban areas.

With increased access also comes increased awareness among the general population, which can play a significant role in improving overall health literacy and the everyday Malaysian’s perception of physical therapy.

We already have the demand for rehabilitation. A little nourishment with the right talent, policies, and funding could be all it takes to lead a new and improved rehabilitation industry within Malaysia’s medical ecosystem. It is high time we harness that potential.

An Endocrinologist Talks About the Thyroid Gland & The Butterfly Effect

WORDS DR KANG WAYE HANN

FEATURED EXPERT
DR KANG WAYE HANN
Consultant Internal Medicine Physician and Endocrinologist
Columbia Asia Hospital Puchong

You are sitting at your work desk, but you can hardly get any work done properly. You struggle to curb the trembling in your fingers.

Sweat trickles down your back. You wonder why it feels this warm despite the air-conditioning blowing at maximum speed.

You swear that you felt a missing beat from the normal pace of your heartbeat. It just feels like there was just something weird with your heartbeat.

Your friends have been complimenting you about how much weight you have lost, but you have a voracious appetite and you keep eating.

Your mercurial mood swings have kept them and other people around you at a distance.

With all these going on, you just could not help thinking, are all these closely related to your scanty and irregular menses? Or is it part and parcel of that smooth neck swelling at your neck and your protruding eyes?

YOU’RE NOT GOING CRAZY—IT COULD BE YOUR THYROID GLAND

If you had experienced any of the symptoms mentioned above, you may have a condition known as hyperthyroidism or thyrotoxicosis.

This is a result of high levels of thyroid hormone, also known as thyroxine, circulating in your blood levels.

An overview of hyperthyroidism. Click the image for a larger, clearer version.

Sitting at the neck and resembling a butterfly, the thyroid gland secretes and stores thyroxine, the hormone that plays a vital role in maintaining your daily metabolism and other bodily functions.

Normally, the levels of the thyroxine hormone are kept in check by your body’s mechanism called homeostasis, with any alterations resulting in compensatory responses in your body.

When this mechanism fails, then the rising thyroxine hormone levels will eventually lead to the symptoms mentioned above.

THE MOST COMMON CAUSE OF HYPERTHYROIDISM IS A ‘GRAVE’ ONE 

Graves’ disease is one of the most common causes of hyperthyroidism.

An overview of Graves’ disease. Click on the image for a larger, clearer version.

In this disease, the tyroxine stimulating hormone-receptor antibodies stimulate the thyroid gland to produce and release high levels of thyroxine into the blood levels.

People with Graves’ disease have smooth neck swelling often accompanied by protruding and swollen eyes as well as skin problems such as hives.

This affliction often plagues women within the reproductive age, especially if they have other autoimmune diseases or family members with autoimmune thyroid diseases.

TOXIC NODULES

Another cause of hyperthyroidism is the presence of thyroid tissue that independently and uncontrollably releases thyroid hormones into the blood stream.

Known as toxic nodules, this disease is more common in the older population, especially those with past history of iodine deficiency.

There can be just a single toxic nodule or multiple toxic nodules in the neck area, giving the appearance of an uneven neck swelling.

At times the neck swelling can be large enough to cause difficulties in swallowing or breathing.

OTHER POSSIBLE CAUSES OF HYPERTHYROIDISM

Other rarer causes include acute infection of the thyroid gland or side effects of certain medications.

IT IS IMPORTANT TO SEE A DOCTOR WHEN YOU THINK YOU HAVE HYPERTHYROIDISM

If left untreated, chronically high levels of thyroid hormones may result in irregular fast beating of the heart and subsequently heart failure.

This may also result in excessive bone mineral loss that can give rise to osteoporosis.

Sometimes, patients with hyperthyroidism may develop a severe life-threatening condition known as a thyroid storm if they are down with other acute medical condition such as a chest infection or heart attack.

A visit to the endocrinologist can be helpful if you think you may have hyperthyroidism, as sometimes the symptoms may be very vague in the early stages.

On top of a clinical assessment, a blood test is necessary to evaluate the thyroid function and confirm high levels of thyroid hormone in the blood.

Aside from that, further tests such as antibody level testing, ultrasound of the neck, or even a radioactive iodine scan are required to determine the exact cause of hyperthyroidism.

THE RIGHT MANAGEMENT PLAN CAN VARY ACCORDING TO THE DIFFERENT CAUSES OF HYPERTHYROIDISM

For instance, patients with Graves’ disease may recover after 18 months of medical treatment. However, patients with toxic nodules usually require life-long medications to control their thyroid hormone levels. In such cases, other options such as surgery and radioactive iodine therapy can be considered.

Is Tuberculosis Still a Disease That We Should Be Worried About?

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR JAMES KOH KWEE CHOY
Head of Division of Medicine
School of Medicine
International Medical University (IMU)

Tuberculosis, often abbreviated as TB, has been around for a long time. In fact, it was known as “consumption” back in the 1800s.

Perhaps this is what many of us rarely spare this disease a thought unlike, say, dengue and COVID-19.

WHAT CAUSES TUBERCULOSIS

It is caused by the bacteria Mycobacterium tuberculosis.

TUBERCULOSIS CAN ATTACK DIFFERENT PARTS OF THE BODY

“It can attack different parts of the body, with the lungs–referred to as pulmonary tuberculosis– being the most common,” says Professor Dr James Koh Kwee Choy,

These different parts of the body include the lymph nodes and bones (usually the spine), in rare cases in the gut. The bacteria can also attack the brains of people with suppressed immune system, such as those living with HIV. Such cases of tuberculosis are called extrapulmonary tuberculosis (EPTB for short).

Symptoms and prevention of tuberculosis. Click on the image to view a larger, clearer version.
WHO IS AT RISK OF CATCHING THIS DISEASE?

According to Prof James, the most susceptible groups of people are:

  • The elderly
  • People with lowered immunity, including young children whose immune system is still developing
  • People with suppressed immune system, such as those on chronic steroid therapy and people living with HIV
  • People living in overcrowded living spaces, such as the poor and migrant workers, as this close proximity makes it easy for the bacteria to be passed on from person to person
HOW EASILY DOES TUBERCULOSIS SPREAD?

Similarly to all respiratory diseases, it is spread by water droplets that come from coughing or spitting.

However, the bacteria responsible for this disease need to be in significant amount in water droplets for the disease to spread.

“You have to be in quite close contact and in a situation where there’s prolonged exposure. Generally, more than eight hours a day,” says Prof James.

It is also worth noting that the bacteria can become dormant in the body of the host, and someone with dormant bacteria will not pass the bacteria on to others.

Similarly, people with only extrapulmonary tuberculosis—the infection doesn’t affect their lungs—will not spread the bacteria to other people.

THE SYMPTOMS OF TUBERCULOSIS

Detecting tuberculosis at its early stage can be challenging because the symptoms may not show immediately.

“You could have been exposed long ago, and the bacteria will stay latent or dormant in the body and hibernate. Symptoms can come up months or even years later,” says Prof James.

SYMPTOMS OF PULMONARY TUBERCULOSIS (TUBERCULOSIS IN THE LUNGS)
  • Chronic cough
  • Profuse sweating at night
  • Unexplained weight loss
  • Recurrent rise in body temperature in the evenings
SYMPTOMS OF EXTRAPULMONARY TUBERCULOSIS (TUBERCULOSIS IN OTHER PARTS OF THE BODY)
  • Swollen lymph nodes
  • Chronic back pain and fragile bones
  • A sensitive gut and
  • Seizures, headaches, confusion and even alterations in personality if the brain is infected
WHAT TO DO IF YOU BELIEVE THAT YOU HAVE TUBERCULOSIS

“Don’t wait to cough up blood,” says Prof James. “See a doctor if you have had a persistent cough for two weeks!”

Also see a doctor if you have unexplained night sweats and weight loss together with swollen lymph nodes or chronic back pain.

“If you are aware that you’ve been exposed to someone with TB, someone you share a working or living space with, then you might also want to see a doctor to be screened,” Prof James adds.

HOW IS THIS DISEASE TREATED?

Treatment is straightforward, but can take place over a long period of time.

Once the treatment is started, a person will be non-infective in ten to 14 days. In hospitals, a patient will be put in isolation but there is no prescribed quarantine period. “The most important thing is to wear a mask and wash your hands frequently,” Prof James says.

Antibiotics to overcome tuberculosis

“A combination of 4 antibiotics will be prescribed for a period of 6 months to a year, depending on which part of the body is affected,” explains Prof James.

There are newer medications can potentially treat tuberculosis within 3 months, but Prof James shares that, unfortunately, they are not yet available in Malaysia. “At the moment, we’re still using the old regime,” he says.

It is crucial to take these antibiotics on time and as prescribed by the doctor

Otherwise, the bacteria can become resistant to the antibiotics. “This can escalate into extensively drug-resistant TB (XDR TB) and multidrug-resistant TB (MDR TB) – or what is commonly known as superbugs!” Prof James warns.

“Those with MDR/XDR TB can spread it to others and unfortunately for that someone, because the bacteria is already resistant, it becomes very hard to treat. These cases will need a lot of alternative medications involving injections and much longer therapy for up to 2 years. It gets very, very complicated,” he further explains.

WHY ARE WE STILL CONCERNED ABOUT TUBERCULOSIS? WE ALREADY HAVE THE BCG VACCINE TO PROTECT US FROM IT

The Bacille Calmette-Guerin (BCG for short) vaccine is given to Malaysians when they are babies and at primary school.

While the vaccine confers protection against tuberculosis, its effectiveness decreases over the years,

“By the time we are adults, many of us no longer have immunity against the disease,” says Prof James.

Tuberculosis cases in Malaysia are on the rise

Malaysia is still considered a country with a high incidence rate, estimated at 92 per 100,000 population. Prof James reveals that we have about 20,000 to 25,000 new cases every year, with an average of 1,500 to 2,000 resulting deaths.

Interestingly, the number of cases went down during the lock down, when we were wearing masks and practicing social distancing as well as movement control orders. It is when the SOPs are relaxed that the number of cases is up again.

CAN’T WE JUST GET A BOOSTER SHOT?

Sadly, there is no such booster shot currently in existence!

Prof James advises that the best way to keep tuberculosis at bay is to ensure a healthy lifestyle. “Generally, a person who is healthy with a good immune system should be able to fight off TB on their own.”

It is also important to be aware of the symptoms and seek early treatment. “If left for too long, even after recovery, tuberculosis can leave scarring on the lungs that will forever curb a person’s lung capacity,” Prof James states.

Also, it is equally important to stay healthy after recovering from tuberculosis. “Maintain a good diet, exercise, don’t smoke. You can get re-infected with TB and that can be quite bad,” says Prof James.

Here Is Everything You Need to Know About Inguinal Hernia

WORDS ASSOCIATE PROFESSOR DR KUMAR HARI RAJAH & ASSOCIATE PROFESSOR DR SOMANATHAN M N MENON

FEATURED EXPERTS
ASSOCIATE PROFESSOR DR KUMAR HARI RAJAH
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR SOMANATHAN M N MENON
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University

You may have heard of the term ‘hernia’ or ‘angin pasang’ once or twice before. Affecting both women and more commonly, men, many seek medical attention for reducible swellings which were discovered incidentally or swelling which suddenly appears during a period of physical straining.

WHAT IS HERNIA?

A hernia is defined as a protrusion, bulge, or projection of an organ or a part of an organ through the body wall that normally goes away on lying down.

They are extremely common and often seen in the groin.

Types of hernia. Click on the image to view a larger, clearer version.
Common risk factors 
  • Being a male
  • Family history
  • Smoking
  • Chronic obstructive pulmonary disease or COPD
  • Low body mass index or BMI
  • High intra-abdominal pressure
  • Collagen vascular disease
  • Thoracic or abdominal aortic aneurysm
  • History of open appendectomy
  • Undergoing peritoneal dialysis
INGUINAL HERNIA
  • The protrusion occurs through the inguinal canal in the body’s anterior abdominal wall.
  • By far the most common medical conditions in which primary care physicians refer patients for surgery, comprising approximately 96 percent of all groin hernias.
  • Generally, inguinal hernia affects all ages, but the incidence increases with regards to age.
  • Women manifest inguinal hernia later with a median age of 60 to 79 years, unlike that of men which is 10 years earlier.

Inguinal hernias are traditionally classified as one of the following three types:

  • Direct hernia. The hernia sac bulges directly through the posterior wall of the inguinal canal. It usually occurs in men over 40 years of age.
  • Indirect hernia, which passes through the internal inguinal ring alongside the spermatic cord, following the coursing of the inguinal canal.
  • Combined hernia. The hernia sacs are on both sides of the inferior epigastric vessels.
SIGNS THAT YOU MAY HAVE INGUINAL HERNIA
  • A bulge in the area on either side of the pubic bone; there may be a burning, gurgling or aching sensation at the bulge.
  • For male patients, pain and swelling can occasionally occur around the testicles, when the protruding intestine descends into the scrotum.
  • Pain or discomfort in the groin, especially when bending over, coughing, or lifting.
DIAGNOSING INGUINAL HERNIA
Physical examination

Most early inguinal hernias can be diagnosed by careful physical examination.

The physical examination begins by carefully inspecting the inguinal areas for bulges while the patient is standing.

Then, the patient would be asked to cough or strain down (Valsalva manoeuvre) while the physician observes for bulges.

Imaging

Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations such as suspected sports hernia, recurrent hernia, uncertain diagnosis, and surgical complications, (especially chronic pain).

Magnetic resonance imaging (MRI) provides the most sensitive detection of a hidden hernia in a patient with clinical suspicion for hernia.

TREATING INGUINAL HERNIA

There is currently no medical recommendation about how to manage an inguinal hernia condition.

Wait and see

Watchful waiting is a recommended reasonable option, especially for hernia with minimal symptoms.

Repair

Most inguinal hernia repairs can be performed safely, accurately, and cost-effectively using local anaesthesia, through an open anterior approach.

Hernia repair using prosthetic mesh would be a good choice in patients with a direct hernia or older patients with a longstanding hernia and attenuated fascia.

What about surgery?

Traditional hernia surgery carries a high risk of chronic pain, and as many as 17% of patients can have significant pain for years.

This high incidence is likely due to the location of the mesh used for this kind of surgery. It may also be related to nerve scarification, mesh contraction, chronic inflammation, or osteitis pubis.

Fortunately, there are procedures that lower this chronic pain, for example, the open pre-peritoneal repair, where the nerves responsible for the chronic pain are avoided, leading to a lower incidence of this problematic complication.

There are also minimally invasive surgical procedures involving transabdominal preperitoneal (TAPP) repair and total extraperitoneal repair (TEP). These procedures facilitate the placement of the mesh without any need for suturing, allowing passive pressure of the peritoneal contents to keep the mesh in place.

CAN WE PREVENT INGUINAL HERNIA FROM HAPPENING TO US?

Yes, you can reduce the risk of developing an inguinal hernia by reducing the pressure on the abdominal wall.

  • Maintain a healthy weight. Extra weight will put more stress and pressure over the abdominal walls especially when one stands or moves.
  • Be active and do the right exercises. Many exercises are available but doing the right exercises without overexertion is the key. Exercises like increasing core strength, sit ups, cycling and yoga are helpful.
  • Avoid heavy lifting. Try not to lift objects if they are too heavy. If you must, adopt the right technique such as bending knees and lifting with your legs.
  • Consume foods high in dietary fibre to reduce incidence of constipation; constipation can trigger a hernia when one strains during the passing of stools.
  • Get treatment if you have urinary problems due to an enlarged prostate gland or if you have a chronic cough.

References:

  1. Onuigbo, W.I.B., & Nieze, G.E. (2016). Inguinal hernia. A review. Journal of surgery and operative care, 1(2). https://doi.org/10.15744/2455-7617.1.202
  2. Jenkins, J. T., & O’Dwyer, P. J. (2008). Inguinal hernias. BMJ (Clinical research ed.), 336(7638), 269–272. https://doi.org/10.1136/bmj.39450.428275.AD
  3. Öberg, S., Andresen, K., & Rosenberg, J. (2017). Etiology of inguinal hernias: A comprehensive review. Frontiers in surgery, 4, 52. https://doi.org/10.3389/fsurg.2017.00052
  4. Köckerling, F., & Simons, M. P. (2018). Current concepts of inguinal hernia repair. Visceral medicine, 34(2), 145–150. https://doi.org/10.1159/000487278