A Spine Surgeon Discusses the Complications of Scoliosis in Adults and What Can be Done about Them

WORDS LIM TECK CHOON

FEATURED EXPERT
DR SAW LIM BENG
Consultant Spine Surgeon
Sunway Medical Centre
DR SAW EXPLAINS WHAT SCOLIOSIS IS
  • “Scoliosis is a condition where a patient’s spine exhibits an abnormal lateral curvature,” says Dr Saw. The most common types of spine curvature are C-shape and S-shape.
  • In Malaysia, data reveals around 2.55% of young adults between 13 and 15 have been diagnosed with scoliosis.
HOW SCOLIOSIS AFFECTS ADULTS
Adult Idiopathic Scoliosis

This type of scoliosis develops during one’s childhood or teenage years but becomes more severe and causes issues when one becomes an adult.

Based on Dr Saw’s personal experience, about 50% to 70% with idiopathic scoliosis have minor spinal curve of less than 20-30 degrees. Their scoliosis can become more severe due to degeneration at later adult age.

This group of scoliosis patients typically will be observed by the doctor with regular follow ups to monitor their spinal curve and treat any issues they may face due to their condition.

De Novo Scoliosis
Also called adult scoliosis, it develops in adulthood due to spine degeneration as a result of ageing.

Risk factors of developing adult scoliosis include:

  • Lack of paraspinal muscle strength due to inadequate exercise
  • Poor bone quality
  • Long-term labour-intensive work
  • Poor back care or posture
  • Spine fractures at a young age
IMPACT OF SCOLIOSIS ON ADULTS
  • Back stiffness or pain, particularly in areas where the facet joints are compensating for the imbalance.
  • Spinal nerve compression, which may cause leg numbness, weakness, and difficulties in walking.
  • Dr Saw adds that when the thoracic spine is involved, it can lead to reduced exercise tolerance and respiratory distress.
HENCE, IT IS IMPORTANT TO SEE A DOCTOR FOR PROPER DIAGNOSIS & TREATMENT
  • “To accurately diagnose scoliosis, an X-ray is the best tool as it allows for precise determination of the severity of the condition,” Dr Saw explains.
  • He adds: “Additionally, a spine magnetic resonance imaging (MRI) analysis is conducted to assess any nerve compression.”
  • Dr Saw further explains that these diagnostic tools are crucial for evaluating the severity of scoliosis and for tailoring a treatment strategy with spine surgeons.
HOW IS SCOLIOSIS IN ADULTS MANAGED?
  • Dr Saw shares that treatment is often tailored based on the specific needs and conditions of each patient, to optimize outcomes and enhance patients’ quality of life and expectations.
  • This personalized strategy considers various characteristics of each patient, including the severity of the spinal curvature, age, overall health status, bone quality, lifestyle habits, and specific symptoms.
Conservative Approach
  • Often involve physiotherapy or exercises like swimming, pilates, and yoga to improve spinal flexibility and strength as well as the use of medication to relieve pain or muscle tension.
  • Useful to improve pain and quality of life without undergoing surgery.
  • Dr Saw tells us that most adults with scoliosis are able to live a quality life with this approach.
Surgery
  • Necessary for some cases of adult scoliosis, such as people with severe spinal curvature or significant neurological or nerve-related symptoms.
  • Surgery has its drawbacks. “It can limit spine mobility due to the fixation of the spine, so it is not recommended for patients with mild curves or symptoms,” Dr Saw reveals.
  • Because of this, the decision to perform a surgery requires careful consideration of the benefits of surgery against the associated risks.

Fortunately, Dr Saw shares that recent advances in machinery and surgical techniques have paved the way in making the outcome of a surgery far more favourable.

  • Precise monitoring of nerves and neurological functioning during surgery.
  • Navigation- or robotic-assisted technology to enhance the accuracy of inserting pedicle screws during surgery. For those that also have severe osteoporosis, cement augmented pedicle screws enable better screw engagement to the bone and allow the surgeon to correct the scoliosis and body balance.
Pain Relief

For people experiencing pain but not keen to undergo major surgeries, Dr Saw points to possible options such as radiofrequency ablation technique as well as epidural steroid and various pain block procedures.

“These procedures allow short to moderate period of pain control before the patient’s condition becomes too severe and surgery is necessary,” he says.

Regular Check-Ups and Lifestyle Adjustments

  • “Early detection, comprehensive management, and ongoing monitoring are crucial in slowing down the progression of scoliosis and improving overall health outcomes,” says Dr Saw.
  • He recommends going for a regular checkup every 2 years.
  • Regular exercise is important to maintain spinal flexibility and muscle strength, which can prevent severe complications and enhance the patient’s quality of life. A physiotherapist or physical therapist can advise on the suitable types of exercise that can be safely carried out.
  • A combination of vitamin D and calcium supplements can help strengthen bones and reduce the risk of fractures and scoliosis progression.

An Expert Explains What Many People Tend to Misunderstand about Palliative Care

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HAYATI YAAKUB
Consultant General Physician
Sunway Medical Centre

Palliative care is often misunderstood. Many think it’s only for those nearing the end of life, but that couldn’t be further from the truth.

“Palliative care isn’t just about managing physical pain,” Dr Hayati Yaakub explains. “It provides emotional and psychological support to both patients and their families throughout their entire journey.”

THE DIFFERENCE BETWEEN HOSPICE CARE AND PALLIATIVE CARE
  • Dr Hayati clarifies that hospice care is a part of palliative care but is only for patients when treatment is no longer aimed to cure. It focuses on managing symptoms during the remaining phase of life.
  • Palliative care focuses on improving the quality of life for patients and their loved ones throughout the entire journey.
  • Unlike traditional medical care, palliative care mainly focuses on treating the disease holistically and being patient-centred, ensuring comfort in every aspect of the patient’s and family’s experiences.
  • “In a world where only 14% of people globally receive the palliative care they need, this underscores the importance of expanding the support, especially as Malaysia’s ageing population continues to grow,” says Dr Hayati.

Dr Hayati recalls how, one month after her patient passed away, a family member returned to her for emotional support. “He had fallen into depression,” she shares, “and his inability to manage the emotional strain was affecting his work and overall well-being.”

The story highlights a crucial, often overlooked aspect of palliative care—it extends beyond the patient’s passing.

PALLIATIVE CARE EXPLAINED IN MORE DETAIL
  • The word “pallative” is derived from the Latin word ‘pallium’, which means ‘cloak’.
  • Palliative care focuses on ‘cloaking’ or relieving the suffering of those with life-threatening illnesses and improving their quality of life.
  • Palliative care can be introduced at any stage of a serious illness, working alongside ongoing treatment to improve the patient’s quality of life by managing symptoms and providing comprehensive support.
  • Beginning from the patient’s diagnosis and continuing through the patient’s treatment, the palliative care physician will work alongside other specialists such as oncologists and cardiologists to offer both physical and emotional support to the patient and their families.
THE PALLIATIVE CARE SYSTEM IN MALAYSIA

According to Dr Hayati, the palliative care in Malaysia can be categorized into:

  • Hospital-based hospices
  • Community-based hospices, primarily run by non-governmental organizations (NGOs)

While both categories are tended by healthcare professionals, community-based hospices are especially beneficial for patients who prefer not to remain in a hospital.

WHO SHOULD CONSIDER GETTING PALLIATIVE CARE?

Among those that would benefit from palliative are people that are suffering from chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS, and diabetes.

Dr Hayati explains: “With these diseases, patients may struggle with symptoms like shortness of breath or pain. Palliative care can help alleviate the symptoms and manage the comorbidities associated with the disease.”

“In cases of cancer, it assists patients in managing the side effects of chemotherapy or radiation such as nausea or vomiting, allowing them to live as fully as possible,” she adds.

By integrating palliative care into the overall healthcare plan, patients can continue to receive treatment for their illness while also benefiting from the additional support provided through palliative care.

MORE THAN JUST TREATMENT

Dr Hayati further reveals that palliative care can offer emotional and spiritual support for patients’ families and caregivers in navigating the challenges of their loved one’s illness.

“Beyond emotional care, they can also rely on palliative care providers for practical assistance such as patient care education, caregiver support and education, access to necessary equipment, and spiritual guidance,” she explains.

“This ensures that they are not alone throughout the entire process, even after the patient passes away. By offering consistent, compassionate and clear communication, palliative providers build trust and provide stable support systems for families and caregivers.”

PALLIATIVE CARE IS NOT AN ACT OF GIVING UP; IT IS A COMPASSIONATE APPROACH

Dr Hayati assures us that palliative care should not be seen as a sign of giving up.

“Rather, it should be viewed as a compassionate approach that empowers patients and their families to live as actively as possible throughout the healthcare journey,” she states.

 

Understanding and Navigating Migraine with a Consultant Neurologist

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HIEW FU LIONG
Consultant Neurologist
Sunway Medical Centre

Migraine is often mistaken for a simple headache or even misunderstood as a mental illness. However, it is a chronic neurological disease that has no known cure.

It significantly affects a large portion of the Malaysian population. Research shows that migraines disproportionately impact women more than men, with 1 in 4 women and 1 in 12 men experiencing migraines at some point in their lives.

WHAT IS MIGRAINE?

“Migraine is not just a headache; it is frequently accompanied by other symptoms like dizziness, nausea, vomiting, fatigue, sensitivity to light (photophobia), and fear of loud sounds (phonophobia),” explains Dr Hiew Fu Liong.

He adds that migraines can also involve emotional aspects and are known as recurrent episodes of severe headaches.

MIGRAINE EPISODES TYPICALLY PROGRESS THROUGH 4 PHASES
  1. Prodrome. Subtle warning signs such as malaise, fatigue, and food cravings.
  2. Aura. Sensory disturbances like visual flashes or heightened sound sensitivity.
  3. Attack. Intense, unilateral head pain coupled with aversion to light and sound, lasting from 4 to 72 hours.
  4. Post-drome. Lingering lethargy that may persist for a few days
THERE ARE A FEW TYPES OF MIGRAINES

Dr Hiew identifies several types of migraines:

  • Migraine without aura. The most common type, characterized by sudden and severe pain localized to one side of the head.
  • Migraine with aura. Accompanied by blurred vision or auditory hallucinations, often serving as precursors to pain.
  • Basilar migraine. Primarily involves dizziness, vomiting, and auditory hallucinations without the typical head pain.
  • Ocular migraine. Involves eye pain or temporary vision loss in one eye.
  • Catamenial migraine. Affects women during their menstrual period, indicating a link to hormonal fluctuations.
  • Hemiplegic migraine. A severe form that not only includes intense head pain but also paralysis on one side of the body.
UNDERSTANDING THE TRIGGERS & RISK FACTORS IS ESSENTIAL TO MANAGE MIGRAINES

Triggers can include sudden weather changes, dehydration, sensitivity to strong odors, caffeine consumption, and exposure to loud noises, among others.

HOW MIGRAINE IS TREATED & MANAGED

The primary goal of migraine treatment is to manage the condition effectively. By consulting a neurologist, patients can develop personalized strategies to either prevent migraines or better manage their symptoms.

“There are two main treatment options: one to stop the pain and another to prevent the migraine attacks,” notes Dr Hiew.

Pain relief treatments include painkillers, while preventive treatments involve anti-epileptic, anti-hypertensive, and antidepressant medications.

Advanced treatments, such as calcitonin gene-related peptide (CGRP) receptor blockers, are also available, targeting the trigeminal nerve to prevent migraine attacks.

A Neurosurgeon Discusses Trigeminal Neuralgia, the ‘Suicide Disease’

WORDS LIM TECK CHOON

FEATURED EXPERT
DR SYED ABDULLAH AL-HADDAD
Consultant Neurosurgeon
Sunway Medical Centre

Trigeminal neuralgia, also known as the ‘suicide disease’ or tic douloureux, is a rare and agonizing condition. While it is considered a rare disease due to its low occurrence among us, it has gained notoriety due to celebrities such as George Clooney and Salma Hayek revealing that they suffer from it.

It is more prevalent among women as well as people over the age of 50.

FACTS ABOUT TRIGERMINAL NEURALGIA
Causes a sudden, intense, stabbing, or electric shock-lain pain in the jaw or face

People with this disease can experience brief bouts of intense pain while carrying out daily activities that involve facial movements, such as chewing, talking, smiling, and more.

Dr Syed Abdullah Al-Haddad reveals that such painful episode can last from a few seconds to several minutes each time.

The pain is recurrent—one could experience a few to even a few hundred such attacks in a day!

He adds: “The intense, electric shock-like one-sided facial pain characteristic of this condition often leads to misinterpretation and misdiagnosis. Patients endure years of debilitating pain with one patient describing it as worse than labour pain.”

Commonly affects one side of the face

These bouts of pain commonly affect only one side of the face (the right side is more common). It is possible for both sides of the face to be affected, but such incidences are rare in an already rare disease.

It’s due to the disruption of the function of the trigeminal nerve

The trigeminal nerve transmits touch and pain sensations from our face and head to our brain.



There are 3 branches in the trigeminal nerve:

  • The ophthalmic branch transmits nerve impulses to the top portion of our face, including our forehead.
  • The maxillary branch transmits nerve impulses to the middle region of the face, including our cheeks, nostrils and upper lip.
  • The mandibular branch transmits nerve impulses to the lower portion of our face, including the lower lip and jaw area.
Causes of trigeminal neuralgia

One of the more common causes is a blood vessel causing pressure on the trigeminal nerve.

Another common possible cause is multiple sclerosis, which causes the myelin sheath, the coating of nerve cells, to break down and put the person with multiple sclerosis at risk of developing trigeminal neuralgia.

Other possible causes include the presence of a tumour or lesion that compresses the nerves and damage to the trigeminal nerve due to surgery, stroke, or injury.

However, it is also possible for some cases of trigeminal neuralgia to have no specific identifiable cause.

It is often misdiagnosed

Due to how it is often misdiagnosed, trigeminal neuralgia can cause those affected to live with the pain for a long time. Dr Syed Abdullah Al-Haddad shares that one of his patients had one whole side of his teeth taken out due to his condition being misdiagnosed as dental pain.

Leaves a profound impact on the lives of those affected by this disease

The disease can make it difficult for those affected to perform daily activities like eating and talking as well as affect their mental health and relationships with their loved ones.

Dr Syed Abdullah Al-Haddad adds: “As they endure the intense pain, some patients decide to stop talking or even living a normal life. The symptoms can also interfere with their ability to work, impact relationships as some believe that sufferers are ‘mad’ or exaggerating their pain and lead to depression and sleep problems.”

DIAGNOSING THE DISEASE

According to Syed Abdullah Al-Haddad, the biggest challenge here is getting an accurate diagnosis.

Frequently, the condition is misdiagnosed as dental problems or issues related to the ear, nose, and throat first.

This is why it is crucial for doctors to listen to their patient’s symptoms and understand the characteristic features of the pain. The pain often described by patients is crucial and can be a sign of the disease.

Trigeminal neuralgia is diagnosed through a combination of patient-reported symptoms as well as a thorough physical examination and a magnetic resonance imaging (MRI) scan to rule out other potential causes such as multiple sclerosis or tumours.

TREATMENT

Treatment options include medications to block pain signals and surgical methods such as stereotactic radiosurgery.

The latter is a non-invasive procedure that delivers focused radiation to the trigeminal nerve root, reducing pain signals with a shorter recovery time and surgery to relieve pressure on the trigeminal nerve.

BE AWARE OF THIS DISEASE

Dr Syed Abdullah Al-Haddad tells us: “With trigeminal neuralgia often being misdiagnosed, it is important for rare diseases such as this one to not only be in the minds of neurologists but all healthcare professionals from general physicians, dental, ENT surgeons to the public alike so these patients can get the help they need and do not need to suffer any longer in silence.”

Malaysia’s First Women Ophthalmology Forum Commemorates International Women’s Day

WORDS LIM TECK CHOON

On 7 March 2024 Roche Malaysia Sdn Bhd launched the inaugural Empowering Visions: Malaysia Women Ophthalmology Forum in conjunction with International Women’s Day.

Moderated by talk show host Freda Liu, the forum featured the following prominent panelists:

  • Datuk Dr Nor Fariza Ngah, Deputy Director of Health, Research & Technical Support
  • Dr Tara Mary George, a consultant ophthalmologist
  • Dr Shamala Retnasabapathy, a consultant ophthalmologist

The panelists covered a multitude of relevant topics such as breaking barriers and overcoming stereotypes, patient care, the importance of interpersonal skills, the significance of continuous education as well as the professional development of women in the medical profession.



WOMEN BRING VALUE THAT CAN ELEVATE THE MEDICAL PROFESSION

According to Datuk Dr Nor Fariza, women bring a distinct perspective that enriches the profession and elevates patient care.

“In a domain where empathy, communication, and meticulousness reign supreme, women’s inherent strengths make them indispensable contributors,” she said during the forum.

She added: “Moreover, diverse representation ensures healthcare systems are attuned to the varied needs of patients, including those specific to women. By championing and empowering women in ophthalmology and healthcare at large, we not only advance gender equality but also enhance the caliber and efficacy of healthcare provision for all.”

A COMPASSIONATE APPROACH TO OPHTHALMOLOGY

Dr Tara Mary George said: “It is the compassionate approach commonly associated with us women which can significantly enhance patient care. Through empathetic communication and understanding, we can alleviate fears, clarify treatment plans, address patient concerns with as much sensitivity and understanding as possible, and cultivate a supportive environment where patients feel valued and heard.”

FAMILY SUPPORT VITAL FOR WORK-LIFE BALANCE

This key point was brought up by Dr Shamala Retnasabapathy, who said, “The supportive role of family is pivotal in achieving work-life balance, contributing to the empowerment of women in their professional endeavors.”

For her fellow women in the field of ophthalmology, she advised no to neglect continuous education and professional development, as these are essential when it comes to staying abreast of the latest advancements.

“This is another way of showcasing our commitment to providing the highest standard of care to their patients while contributing to the advancement of the field as a whole—and how we pave the way for greater inclusivity, diversity, and progress within the profession,” she added.

AN INITIATIVE TO CHAMPION DIVERSITY & INCLUSION

Choong Mei Chen, who is the Ophthalmology Country Disease Area Lead for Roche Malaysia, Vietnam, Philippines and Indonesia, told us that initiatives such as the Empowering Visions: Malaysia Women Ophthalmology Forum send a resounding message of support and empowerment.

“Together, let us boldly challenge the status quo, dismantle barriers, and pave the way for a future where every individual, regardless of gender, enjoys equal opportunities to excel!” she said.

A Breath of Fresh Hope For Women Against Lung Cancer

A panel discussion titled ‘A Breath of Fresh Hope’ was held on 7 December 2023. This was a collaboration between the pharmaceutical division of Roche (Malaysia) Sdn Bhd and the Lung Cancer Network Malaysia (LCNM).

This panel discussion highlighted the alarming prevalence of lung cancer in non-smoking Malaysian women, the related medical implications of this prevalence, and the social stigma surrounding this cancer.

“Over 2.2 million lung cancer cases were reported in 2020 globally, and more than 770,000 of them were in women. Lung cancer is the third top malignancies seen in the global female population, after breast and colorectal cancers,” said Ms Deepti Saraf.

SHIFTING PUBLIC PERCEPTION OF LUNG CANCER
FEATURED EXPERT
DR ANAND SACHITHANANDAN
Consultant Cardiothoracic Surgeon and Co-Founder of Lung Cancer Network
Malaysia

“The majority of lung cancer cases affect smokers. Having said that, we are now starting to see increasing numbers of cases of lung cancer in non-smokers, of whom women are overrepresented,” said Dr Anand.

Lung cancer does not affect smokers only; there are other risk factors that could put one could be at risk.

Dr Anand Sachithanadan revealed that fewer than 2% of Malaysian women smoke, but lung cancer is one of the main cancers that affect women in Malaysia.

Thus, contrary to popular perception, lung cancer does affect people that do not smoke, as outlined below.


Common lung cancer risk factors. Click on the image for a larger, clearer version.


BE AWARE OF THE SYMPTOMS OF LUNG CANCER—EVEN IF YOU DO NOT SMOKE
FEATURED EXPERT
DR JENNIFER LEONG
Consultant Clinical Oncologist
Sunway Medical Centre

Dr Jennifer Leong told us, “Many women harbour the preconceived notion that because they don’t smoke, they are not at risk of lung cancer. At times, even when displaying typical symptoms, they can easily miss out on these symptoms and do not get the required medical attention in the earlier stages of disease, affecting their chances at longer survival.”

“While I wouldn’t say that lung cancer is preventable, it’s very much a curable disease provided that you can detect it early on,” she added.

On the other hand, ignoring or overlooking the early symptoms of lung cancer would lead one to seek medical treatment only when the cancer has advanced to a late stage, during which the chances of a positive outcome are far more diminished.

Dr Anand concurred with Dr Jennifer’s statement. He stated: “Lung cancer care has been revolutionized in the last four or five years, leading to significantly better outcomes for our patients as well as overall survival. Despite all these tremendous promises, the fact remains most patients are still being diagnosed late in stage.”


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


WOMEN SHOULD PRIORITISE THEIR OWN HEALTH AS WELL AS THAT OF THEIR LOVED ONES
FEATURED EXPERT
ASSOCIATE PROFESSOR DR CARYN CHAN MEI HSIEN
Consultant Health Psychologist
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

“Many women are expected to and are taught to prioritise the health of family, sometimes at the expense of their own health. Consequently, some women would ignore or dismiss their symptoms, or feel guilty when their medical treatments become a significant expense to the family,” said Associate Professor Dr Caryn Chan.

One unfortunate consequence of women putting the needs and well-being of others over their own is that they often neglect their own health.

Often, Associate Professor Dr Caryn Chan pointed out, they overlooked symptoms such as those of lung cancer, and seek medical attention only when their illness had deteriorated to an advanced stage.

This attitude on both the parts of women and society need to change. “Taking care of your health does not mean you are burdening the rest of the family,” Dr Caryn stated.

She also called for the family to come together to distribute caregiving and support responsibilities, typically delegated to a woman, across all capable family members. This way, a woman would have ample opportunity to also tend to her own needs and well-being.

BE MORE PROACTIVE IN DETECTING LUNG CANCER EARLY!
FEATURED EXPERT
MS. DEEPTI SARAF
General Manager
Roche Malaysia Sdn Bhd

“All of us have a part to play in raising awareness of lung cancer,” Ms Deepti Saraf reiterated while closing the panel discussion.

Be alert for symptoms.

If you, your loved ones, or your friends have symptoms, seek medical help.

If you are at high risk of lung cancer, consult your doctor.

The doctor can arrange for you to undergo regular screening to detect early the presence of cancer or other issues with your lungs.


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A Dermatologist Addresses 3 Common Misconceptions About Dry Skin

WORDS LIM TECK CHOON

FEATURED EXPERT
DR FELIX YAP BOON BIN
Consultant Dermatologist
Sunway Medical Centre
MISCONCEPTION 1
DRY SKIN IS NOTHING SERIOUS.

Dr Felix Yap Boon Bin points out that this is not always true.

“Lack of water or skin dehydration will cause dry skin to peel, crack, irritate, itch and become sensitive,” he explains. “If we scratch the itch, it may lead to damage of the skin’s epidermis, causing it to become thinner or eventually recede away.”


Our skin consists of three layers: the epidermis, the dermis, and the subcutaneous layer. Click on the image for a larger, clearer version.


“When the epidermis is compromised, germs and dust can penetrate into the second layer of the skin or dermis, causing inflammation, in addition to causing other skin problems, such as eczema and psoriasis,” Dr Felix shares.


A comparison of healthy and dry skin. Click on the image for a larger, clearer version.


What causes dry skin?

Dr Felix says that being under the hot sun for a long period of time can cause dry skin.

Being in an air-conditioned room for long periods of time can also be a factor, as air conditioning can cause the skin to dry.

However, many cases of dry skin are due to genetic factors. “Some individuals are born without a protective skin layer, causing their skin to be easily dehydrated,” Dr Felix says. Therefore, it is possible for someone to develop this condition without spending much time under the sun or air-conditioning.

Additionally, the use of improper skincare products can lead to dry skin. Dr Felix cites the frequent usage of body scrubs or soaps with a higher pH level (pH above 7) as an example.

If you spend much time under the sun or in air-conditioned rooms, Dr Felix recommends, applying moisturizers regularly to ensure that the skin is healthy and has a good level of hydration. “However, if dryness is at a serious level, it is recommended to use medicated moisturizers,” he says.
MISCONCEPTION 2
ANY SKIN MOISTURIZER WILL DO.

Not true. 

“For dry skin types, oil-based moisturizers are more suitable because the oil content will moisturize the skin and reduce itching or peeling,” Dr Felix explains.

He adds: “Individuals with oily skin can choose oil control moisturizers to prevent acne growth.”

For sensitive skin, Dr Felix recommended the use of specialized moisturizers, products without fragrance or chemicals produced by certified medical brands.

Hence, he reminds everyone to identify their own skin type before choosing their skincare products, in order to ensure that these products are suitable for long-term use.

MISCONCEPTION 3
DRINKING A LOT OF WATER AND EATING VEGETABLES REGULARLY CAN HELP THE SKIN STAY HYDRATED

Research has proven that this assumption is inaccurate.

“Lack of water in the body will certainly affect the quality of the skin, but drinking a lot of water at one time does not help the skin to stay hydrated,” Dr Felix elaborates.

“Also, consuming a lot of vegetables does not necessarily help to hydrate the skin. Healthy and hydrated skin requires a balanced diet, which includes a variety of nutrients and not just vegetables,” he adds.

BONUS: DR FELIX’S TIPS TO PROTECT YOUR SKIN

“The water content in our skin will also decrease as we age,” Dr Felix reminds us. “The protective layer will become thinner and its efficiency to trap water will also become lower when we reach between 40 to 50 years old.”

Therefore, he offers some tips to help us take care of our skin in order to avoid skin problems in the future.

  • Sleeping for 7 hours a day and have a consistent bedtime, preferably before 12 midnight.
  • Lead an active lifestyle to improve the immune system. Low immunity can cause skin diseases such as eczema.
  • Use moisturizers before going to bed, especially in rooms with air conditioning.
  • Apply sunscreen before leaving the house.

An Expert Spills the Bean on Lactose Intolerance & Your Kids

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ONG SIK YONG
Consultant Paediatric Gastroenterologist and Hepatologist
Sunway Medical Centre

According to Dr Ong Sik Yong, lactose intolerance is a common gastrointestinal condition caused by the inability to digest and absorb dietary lactose.


Lactose intolerance is the result of your small intestine not producing enough of an enzyme called lactase. Lactase helps to break down lactose or milk sugars into simple sugars for absorption by your body.


BLAME IT ON DECLINING LEVELS OF LACTASE

Dr Ong shares that newborns can digest about 1 litre of breast milk every day.

However, the enzyme lactase, which digests lactose, usually declines in levels once the child stops breastfeeding, a circumstance known as lactase non-persistence.

“Approximately 70% of the world population are affected by lactase non-persistence, which causes the condition called primary lactose intolerance,” Dr Ong reveals.

He adds that generally a child shows symptoms of primary lactose intolerance after they turn 5. However, some children may exhibit symptoms as early as 2 years old.

CAN ALSO BE DUE TO OTHER GUT ISSUES

In young children, lactose intolerance may also be caused by underlying gut issues such as:

  • Gut infection.
  • Cow’s milk allergy.
  • Celiac disease.
  • Inflammatory bowel disease.

Dr Ong further shares that sometimes a child may temporarily lose the ability to digest lactose during an episode of acute gastroenteritis. Once the child recovers, however, they can continue to consume milk without further issues.

SYMPTOMS OF LACTOSE INTOLERANCE

“Usually, symptoms begin about 30 minutes to two hours after consumption,” says Dr Ong.

He adds that the common symptoms are:

  • Abdominal discomfort.
  • Bloating.
  • Farting.
  • Diarrhoea.
  • Perianal skin irritations with raw lesions surrounding the anus, due to low faecal pH in the child’s stools.
MANAGING THE DIET OF A LACTOSE INTOLERANT CHILD

Dr Ong advises parents to feed dairy products with naturally lower lactose content to children that show signs of lactose intolerance.

“After a period of limiting food with lactose, the child can consume back small amounts of foods and drinks containing lactose,” he adds.

The child’s symptoms should be observed throughout this trial period and over time, the parents or even the child would be able to tell how much of lactose the child can take.

“Besides that, parents can also consider using lactase enzyme, which can be taken by the child prior to consumption of dairy products to reduce unwanted consequences from consuming lactose,” advises Dr Ong.

NUTRITIONAL CONSIDERATION FOR THE LACTOSE-INTOLERANT CHILD

Milk and other various dairy products are a major source of calcium and vitamin D.

“Hence, it is important to make sure children who has limited dairy product intake to have other non-dairy food which are rich in these nutrients, like fish with soft edible bones, such as salmon and sardines, as well as green leafy vegetables. They may also require calcium or vitamin D supplement for their growing bones,” Dr Ong says.

A Tips-Filled Bumper Article to Help You Sleep Better Featuring Four Experts

WORDS LIM TECK CHOON

FEATURED EXPERT
CELESTE LAU
Chief Dietitian
Sunway Medical Centre
ADD MAGNESIUM-RICH FOODS IN YOUR DIET

“Magnesium plays a crucial role in various bodily functions, such as muscle and nerve operation, protein synthesis, glycolysis, and blood pressure regulation,” says Celeste Lau.

She explains further that this mineral aids in the conversion of protein into chemicals that induce sleepiness, promote muscle relaxation, and maintain gamma-aminobutyric acid (GABA), a neurotransmitter responsible for promoting restfulness.

You should consume between 100 and 350 mg of magnesium daily for optimal sleep support.

Celeste recommends adding sources of magnesium such as walnuts, almonds, flaxseeds, salmon, and mackerel into your meals. It is recommended to consume between 100-350mg of magnesium daily for optimal sleep support.

“Additionally, refrain from consuming a heavy meal in the evening. It is recommended to have dinner 2 to 3 hours prior to your bedtime,” she adds.

FEATURED EXPERT
MICHELLE CHONG HUI YEE
Clinical Psychologist
Sunway Medical Centre
PRACTICE RESTFULNESS

Michelle Chong explains that restfulness is a deliberate act of nurturing yourself—physically, mentally, and emotionally.

It is characterized by a feeling of peacefulness and contentment, often accompanied by a sense of relief from stress, worries, tension, or fatigue.

Mentally, restfulness means quieting the mind, letting go of worries, and embracing a sense of mental stillness.

  • Learn to embrace mindfulness and relaxation techniques.
  • Grounding yourself in the present moment. This heightened awareness allows you to detach from worries about the past and anxieties regarding the future as well as to foster a sense of presence that can alleviate stress and enhance your awareness of immediate experiences.
  • Practice deep breathing exercises and progressive muscle relaxation (PMR) methods to heighten your body awareness and release muscle tension, focusing on achieving a state of ‘physical rest’.
  • Prioritize relaxation techniques that calm the mind before bedtime. “Activities such as mindfulness meditation and journaling can effectively declutter the mind and reduce stress hormones, creating a more seamless transition into sleep,” Michelle says.
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DR NURUL YAQEEN
Consultant Respiratory, Sleep & Internal Medicine Physician
Sunway Medical Centre Velocity
START SLEEPTIME RITUALS 
  • Do not use your bed as an office to answer calls, respond to emails and avoid watching television in bed,” advises Dr Nurul Yaqeen.
  • Instead, reserve your bed for sleep. Remove electronic devices (televisions, computers, smartphones, etc), from the bedroom.
  • Try to start a sleep ritual as rituals help signal the body and mind that it is time to sleep. Some suggestions from Dr Nurul Yaqeen are drinking a glass of warm milk, taking a bath, or listening to calming music to unwind before bed.
  • “There is also the 10-3-2-1 method to help you rest better at night,” she says, “which is no caffeine 10 hours before bed, no food or alcohol 3 hours before bed, no work 2 hours before bed, and no screen time 1 hour before bed.” 
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Effendy Nadzri
Interior Designer
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  • Keep your room cool at night,” says Effendy Nadzri. “The ideal temperature in the bedroom should be between 20º and 23º Celsius.”
  • If you have an air conditioner at home, he recommends switching it on at night to signal to your body that it is time for sleep.
  • Set the perfect ambience with dimmable or mood lighting to enhance your bedroom space and create the desired mood for a restful evening before you retire to sleep.
  • “You may want to have aromatherapy or essential oils that can help you relax at night,” Effendy adds.

 

Tuberculosis Cases Are Rising in Malaysia. An Expert Shares What You Should Know & Do About This

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ROSMADI ISMAIL
Consultant Interventional Pulmonologist and Internal Medicine Specialist
Sunway Medical Centre

Quite recently, our Minister of Health Dr Zaliha Mustafa revealed at the United Nations General Assembly High-Level Meeting that there was a concerning increase of 17% in tuberculosis cases in 2022 compared to 2021, along with a 12% increase in tuberculosis-related deaths during that time period.

In light of this development, Dr Rosmadi Ismail shares his thoughts with us about tuberculosis, its detection, treatment, and prevention.


Tuberculosis is an infectious disease that is caused by the bacteria Mycobacterium tuberculosis (MTB) infecting the lungs as well as certain other parts of the body.


An overview of the symptoms and preventive measures of tuberculosis. Click on the image for a larger, clearer view.


IS DETECTION OF TUBERCULOSIS GETTING BETTER?

Dr Rosmadi reveals that there are several innovative techniques currently undergoing clinical trials in a few countries.

These techniques, which include biosensing technologies and nano-diagnostics, promise quicker and more accurate results.

He shares: “Ongoing research focuses on innovative methods like computer-aided detection (CAD) through artificial intelligence, aerosol capture technologies, and antigen-based skin tests. They are poised to revolutionise TB diagnosis, enhancing efficiency and effectiveness in the future.”

In Malaysia, there are diverse methods employed to ensure accurate and timely detection of tuberculosis, such as:

  • Sputum smear microscopy, typically the first test for tuberculosis.
  • Culture and sensitivity testing to diagnose tuberculosis.
  • Nucleic acid amplification tests (NAATs) to facilitate the identification of tuberculosis cases.
  • Chest radiography and clinical tests like the Tuberculin Skin Test (TST) to confirming the infection.

TREATMENT OF TUBERCULOSIS

Treatment of tuberculosis in Malaysia follows the World Health Organization guidelines, which is the global standard.

Dr Rosmadi tells us, “The standard treatment for drug-susceptible tuberculosis in Malaysia involves a combination of four drugs administered for a duration of 6 to 8 months.”

Treatment utilizes the Directly Observed Treatment (DOT) strategy, which sees the patients receiving close supervision from healthcare workers to ensure that they complete their medication intake.

Currently, there are no new medications or treatments that show superior results over current ones when it comes to treating tuberculosis. Dr Rosmadi notes that treatment for drug-resistant TB involves a distinct medication regimen and extended treatment duration.

“This tailored approach has proven effective even in cases of drug-resistant TB, reinforcing our commitment to comprehensive patient care,” he says.

DR ROSMADI’S TUBERCULOSIS TIPS 
  • Stay clear of crowded places. It’s best to avoid crowds, especially if they’re poorly ventilated.
  • If you’re experiencing a persistent cough, fever, or unexpected weight loss, seek medical help promptly. This will help you get better and stop the disease from spreading.
  • Get checked if you’re at risk. If you have a weak immune system or have been around people with tuberculosis, consider getting tested. It’s a simple step that can catch the disease early if exposed.
  • If you’re diagnosed with tuberculosis, completing your treatment is essential. P
  • Preventive measures such as wearing a mask, covering your mouth and nose when you cough or sneeze, and disposing of tissues properly can help protect yourself and those around you.
  • If your job puts you in contact with many people, wear the proper protective gear as an added layer of safety.
  • Think about getting vaccinated. The current vaccine, Bacillus Calmette Guérin (BCG), offers partial protection to infants and young children against severe forms of tuberculosis. It doesn’t protect adolescents and adults that are the primary carriers of the tuberculosis bacteria, but it could help in the long run.