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

If You Have Diabetes, You Need to Do This for Your Kidneys!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KENNETH LAI KOAH KIEN
Consultant General Physician and Nephrologist
Bukit Tinggi Medical Centre

Diabetic kidney disease, also known as diabetic nephropathy, develops when one’s kidney has trouble filtering waste from the blood.

An overview of diabetic nephropathy. Click the image to view a larger, clearer version.

When left untreated, the affected kidney may eventually fail and one would need either a kidney transplant or dialysis.

SYMPTOMS USUALLY SHOW UP UNTIL THE DISEASE IS AT AN ADVANCED STAGE, AND BY THEN, IT CAN BE MUCH HARDER TO MANAGE

According to Dr Kenneth Lai Koah Kien, it can take many years for diabetes to substantially damage the kidneys.

“Even then, the symptoms usually don’t show up until late in the course of the disease,” he says.

WHAT ARE THE SYMPTOMS, ANYWAY?
  • Unusual weight gain
  • Swollen ankles
  • Nausea or vomiting
  • Frothy urine
  • Lethargy
  • Urine breath
  • Itching
  • Reduced appetite
  • Swelling of the leg.
  • Blurring of visions and floaters (the eye can also be affected by kidney disease)
SO, WHAT SHOULD SOMEONE WITH TYPE 2 DIABETES DO TO DETECT DIABETIC KIDNEY DISEASE EARLY?

Dr Kenneth recommends the following:

If you have other health conditions alongside type 2 diabetes, keep them well-controlled too along with your diabetes

“These patients would need to monitor their co-morbidities closely with their doctors. These include hypertension, obesity, hypercholesterolemia, and smoking. All these are mercenaries of death together with diabetes,” he says.

Go for kidney disease screening

Recommended screening tests include:

  • A urine test called urine ACR to look for protein leakage
  • A simple blood test called serum creatinine test to look at kidney function

As for when one should start screening:

  • For type 2 diabetes, screening should start on the date of diagnosis.
  • For type 1 diabetes, screening should start 5 years after the onset of type 1 diabetes.

5 Popular Dengue Myths Debunked by a Family Medicine Specialist

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN
Family Medicine Specialist
International Medical University (IMU)
Myth 1
YOU ONLY CATCH DENGUE ONCE IN YOUR LIFETIME 

Unfortunately, no.

“There are 4 dengue serotypes,” says Associate Professor Dr Verna Lee Kar Mun.

Serotype is a word used to describe a strain of microorganism, which means that there are 4 different types of the dengue virus that can infect us.

This means that each of us can get infected up to 4 times, once with each serotype, and achieve total immunity to dengue only after being infected with all 4 serotypes!

“However, before you start thinking it’s a good idea to get infected four times, bear in mind that subsequent infections are likely to be more serious than the first,” warns Assoc Prof Dr Verna, “and each infection only increases your chances of getting severe dengue.”

Myth 2
YOU’RE GETTING BETTER WHEN YOUR FEVER GOES AWAY

Well, things are not so simple.

You see, according to Assoc Prof Dr Verna, there are 3 different stages of dengue fever.

  • Febrile phase: 1 to 2 days of high fever that begins suddenly. During this time, we’re likely to have experience aches, headache with pain behind the eyes, flushed faces, and sometimes blotchy skin or rashes.
  • Critical phase: the fever subsides, and we may feel that we are getting better. However, these 1 to 2 days are also a period when our blood capillaries may leak plasma, leading to a sudden drop in blood pressure and sending us into shock.
  • The next phase will depend on the outcome of the critical phase. We may get better after receiving proper medical treatment and proceed to the recovery phase, or we may get worse and experience severe dengue instead.

“Many viral illnesses such as dengue are self-limiting, which means they will naturally subside,” Assoc Prof Dr Verna shares. “In most cases, patients only need self-care at home, and the most important thing to remember is to take plenty of fluids to prevent the dehydration that comes with plasma leakage.”

“Anyone who gets dengue fever should aim to drink at least 3 litres of water daily for the first 3 days,” she adds.

Myth 3
DENGUE IS ONLY A SMALL CONCERN; AFTER ALL, YOU CAN GET BETTER FROM PRACTICING SELF CARE AT HOME

Not necessarily true.

“An estimated 1% of patients will experience severe dengue, also known as haemorrhagic dengue, which will require hospitalization,” says Assoc Prof Dr Verna.

She goes on to explain that one may begin to experience bleeding during the febrile phase, usually in the skin or gums. If the bleeding weren’t managed well, the dengue will worsen during the critical phase, forcing us to be admitted into the hospital.

“Those with a healthy immune system usually recover in 2 days, but if there is inflammation affecting the organs such as the heart, liver or brain, it can take up to a week, longer if there are other complications,” she goes on to say.

Myth 4
YOU SHOULD ONLY TEST FOR DENGUE AFTER 3 DAYS 

“It is true that the initial symptoms are vague, as a fever can be a sign of many different illnesses,” says Assoc Prof Dr Verna.

However, with dengue, the high fever usually comes suddenly.

“The S1 dengue rapid antigen test can detect dengue from the first day, so don’t delay seeking medical advice if you suddenly develop a high fever,” she advises.

Delay in getting tested may lead to severe consequences, as we will enter the critical phase 1 to 2 days after catching dengue—a time when our condition can suddenly take a turn for the worse!

Myth 5
ONCE YOUR NEIGHBOURHOOD HAS BEEN FOGGED, THERE IS NO NEED TO DO ANYTHING ELSE TO PREVENT DENGUE

Not true.

Assoc Prof Dr Verna reveals that while fogging helps to kill adult mosquitoes and getting rid of stagnant water in public drains and other places helps to prevent breeding sites, this method are only partially effective.

To illustrate, millions are spent on fogging efforts every year—an estimated RM777 million was spent on fogging efforts in the 2009 to 2010 period—but dengue remains prevalent to this day. There is even evidence that mosquitoes have grown resistant to the common insecticides used in fogging!

“On a personal level, all of us can do something at home to help prevent mosquito bites and breeding sites. We need to make a bigger effort to protect ourselves and our loved ones by making sure our home environment is clear of any breeding sites, covering up exposed skin and using mosquito repellents, especially during sunrise and sundown,” she advises.

Oral Health Tips From a Dentist for People With Diabetes

WORDS DR LAU LAKE KOON

FEATURED EXPERT
DR LAU LAKE KOON
Dentist
Koks Dental Surgery

Most people with diabetes or those that have someone close to them that have this disease will know that the disease can harm many organs in the body—such as the eyes, nerves, kidneys, heart, and more.

DO YOU KNOW THAT DIABETES CAN AFFECT THE TEETH AND GUMS AS WELL?

People with diabetes are more likely to have:

  • Periodontal or gum disease
  • Persistent bad breath
  • Tooth decay or cavities
  • Oral fungal infections
  • Oral ulcers
  • Loss of teeth
Diabetes can cause increased levels of glucose in the blood as well as saliva
Progression of gum disease, from gingivitis to the more serious periodontitis. Click on the image to view a larger, clearer version.

The increase of glucose in the saliva encourages the growth of bacteria in the mouth and together with food particles can build soft sticky whitish layer called plaque.

Plaque is the yucky smelly stuff that you can scrape off from your teeth if you haven’t been cleaning them properly. It is the main cause of bad breath.

If left unchecked, the persistent plaque buildup can cause tooth decay and harden to form tartar.

Persistent plaque or tartar buildup causes irritation to the gums

The gums can become red and swollen, and bleeding may occur.

This is the first warning sign that it’s time to visit the dentist.

Comparison of normal tooth and a tooth with periodontitis. Click on the image for a larger, clearer version.

Otherwise, the infection will go deeper under the gums, causing infection of the bone structure supporting the teeth. This is periodontitis, the second stage of gum disease.

The gums will start to recede, trying to pull away from the tartar formed. Over time the teeth will become unstable, and one may experience pain as a result.

At the final stage of gum disease, the teeth will become so infected and painful that it may need to be removed

In poorly controlled diabetic cases, the gum disease may progress much faster. The severity of the condition may be worse, which is why it is important to visit the dentist early to resolve the issues.

Diabetes and certain drugs can reduce the production of saliva in our mouth

Our saliva contains minerals to protect our teeth from tooth decay, mucin to keep the teeth moist and slippery, antibacterial substances to eliminate potentially harmful bacteria, and it also has the ability to neutralize the acids produced by bacteria in our mouth.

Without the presence of saliva, there is a higher risk of tooth decay and gum disease.

Dry mouth can increase the risk of developing fungal infections called thrush, which are painful white patches in the mouth.

In denture wearers, the dryness can decrease the suction effect of the denture and increase abrasion against the gums, leading to ulcers and mouth sores.

Smoking will worsen the condition further.

In severe uncontrolled diabetic cases, some people can develop burning mouth syndrome—a continuous burning sensation in the mouth that will alter taste and sensation.

HOW THE DENTIST CAN HELP YOU
Gingivitis or periodontitis

The dentist will need to carry out deep cleaning of the teeth and gums, in order to decrease the bacterial load and to allow the gums to heal.

However, the dentist can only do so much—you have to also keep good oral hygiene and use of mouthwash daily.

Fungal infections

Your dentist may prescribe some medications to kill the fungus responsible for the infection.

If you use dentures, they will be checked to ensure that they are still fitting properly. You must keep them clean in a disinfection solution at night.

Dry mouth

For most non-severe cases, the simplest solution is to keep your body well hydrated at all times. Drinking water regularly also moistens the mouth.

Only in severe cases are saliva substitutes prescribed.

Burning mouth syndrome is usually more complicated and will require specialist attention.

HELPFUL TIPS
  • A well controlled blood glucose level as well as a healthy diet and lifestyle are key to reducing and preventing oral health problems. Keeping your mouth healthy will also prevent diabetes-related health problems such as heart disease and kidney disease.
  • Good oral hygiene will keep your gums and teeth healthy. Brushing twice a day every day, and use a floss or water floss daily.
  • Visit your dentist regularly for a routine checkup. Please make sure you tell your dentist if you have diabetes. Keep your dentist updated about any changes to your health and blood sugar levels.
  • For denture wearers, make sure your dentures fit properly, and clean them by soaking them in denture disinfectant at night.
  • Quit smoking. Smoking will worsen gum condition and overall health.

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

WORDS DR HOE YUT HUNG

FEATURED EXPERT
DR HOE YUT HUNG
Founder and Medical Director
MyClinic

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

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

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

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

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

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

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

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

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

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

Natural remedies

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

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

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

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

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

References:

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

Not Sure What Immunotherapy Is? Get Your Answers From an Oncologist!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HAFIZAH ZAHARAH AHMAD
Consultant Clinical Oncologist
Sunway Medical Centre Velocity
IMMUNOTHERAPY IS A NEWER APPROACH TO TREAT CANCER, BUT WHAT EXACTLY IS IT?

According to Dr Hafizah Zaharah, immunotherapy is a pretty unique way to treat cancer, in that it uses the body’s own immune system to attack cancer cells.

“The immune system is like the police force of our bodies,” she says. “It is designed to protect the body against infections, illnesses, and diseases.”

The cells that make up our immune system. Click on the image for a larger, clearer version.

When it comes to faulty or mutated cells in our body, the immune system identifies and eliminates these cells before these cells become a significant threat to our healty.

However, the cells of our immune system may not be strong enough to kill cancer cells, according to Dr Hafizah. Sometimes, the cancer cells are able to fool our immune system by resembling normal cells or hiding themselves.

THIS IS WHERE IMMUNOTHERAPY COMES INTO THE PICTURE

“Immunotherapy can boost or change how the immune system works, so it can recognize and kill cancer cells,” explains Dr Hafizah.

For example, cancer cells originate from normal cells, so the immune system may still mistake them for normal cells.

“These cancer cells can push a ‘brake’ button on the immune cells, so the immune system would not attack them,” Dr Hafizah adds.

Now, a type of immunotherapy called checkpoint inhibitors can take the ‘brakes’ off the immune system, allowing it to now recognize and attack the cancer cells!

There are other types of immunotherapy, of course, and these treatments can be used for various cancers.

CANCERS THAT CAN RESPOND TO IMMUNOTHERAPY
  • Non-small cell lung cancer
  • Triple negative breast cancer
  • Head and neck cancer
  • Cervical cancer
  • Gastric cancer
  • Oesophageal cancer
  • Bladder cancer
  • Melanoma
  • Liver cancer
  • Renal cell carcinoma
  • Endometrial cancer
  • Colon cancer
WHAT IS IMMUNOTHERAPY LIKE?

According to Dr Hafizah, various immunotherapy agents are given as an infusion into a vein (a drip) typically once every few weeks.

These immunotherapy agents can be given to the patient all by itself, or in combination with targeted therapy or chemotherapy.

“For advanced stage cancer, immunotherapy treatment generally is given for 2 years, alongside close monitoring,” Dr Hafizah further says.

IS IT EFFECTIVE, THOUGH?

Although immunotherapy seems like the answer every person with cancer is looking for, Dr Hafizah warns that not all types of cancers will respond well to the treatment.

This is why, before embarking on immunotherapy, one will first undergo a specific biomarker test, such as the PD-L1 test, which will be carried out on a cancer specimen to ensure that the person will respond to the treatment.

ARE THERE ANY SIDE EFFECTS TO BE CONCERNED ABOUT?

“Generally, the treatment is well tolerated,” Dr Hafizah assures us.

However, just like with most types of treatments, side effects are possible. These include:

  • Feeling tired, skin rash, or muscle or joint pain
  • Rare side effects include allergic reactions such as dizziness, fast heart rate, face swelling, or breathing problems
  • Autoimmune reactions, which can lead to serious problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, etc

Have Diabetes? Here’s an Improved Way to Track Your Blood Sugars

WORDS LIM TECK CHOON

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

Important Advice to Stay Prepared During the Monsoon Season

WORDS LIM EN NI

FEATURED EXPERT
LIM EN NI
Chief Pharmacist
Alpro Pharmacy

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

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

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

How Breast Ultrasound & Mammogram May Save Your Life

WORDS LIM TECK CHOON

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

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

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

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

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

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

Dr Ng recommends that:

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

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

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

A Health-Centric Wishlist for the Malaysian GE15

WORDS ANWAR ANIS

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

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

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

GREATER FOCUS ON AN AGEING SOCIETY

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

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

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

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

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

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

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

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

COMPETITIVE & FACILITATIVE IMMIGRATION POLICIES

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

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

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