The Haze Is Back, and Here’s How You Can Protect Your Lungs

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KOW KEN SIONG
Respiratory, Internal Medicine, and Interventional Pulmonology Consultant
Sunway Medical Centre
WHAT, THE HAZE IS BACK?
  • The API readings for September 2023 showed alarming levels of fine particulate matter.
  • Experts predicted that the haze would persist until October.
  • Dry and monsoon seasons will further increase the risk of forest fires and haze during this period.
WHY SHOULD YOU BE CONCERNED?

Dr Kow Ken Siong tells us: “Fine particulate matters in the haze less than 2.5 microns in diameter, though often short-term, can leave a lasting impact, especially when inhaled.”

  • Short-term exposure can result in acute bronchitis symptoms like cough, phlegm, chest tightness, breathlessness, and lethargy.
  • Long term or chronic exposure can lead to respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and lung cancer.
  • Air pollution, including haze, is linked to premature deaths, infections and various diseases, with chronic respiratory illnesses ranked the third-leading cause of death globally in 2019.
  • In Malaysia, nearly 20% of hospitalizations in government hospitals and over 12% in private hospitals are due to the abovementioned respiratory diseases!

He adds that:

  • Vulnerable groups such as children, the elderly, and those with pre-existing conditions (such as asthma and cardiovascular diseases) face higher risks of worsening pre-existing chronic lung conditions, increased the risk of lung cancer, and frequent bronchitis episodes.
  • Individuals without prior health issues may develop upper respiratory symptoms and become more susceptible to viral infections.
DR KOW’S TIPS TO PROTECT YOURSELF AGAINST THE HAZE
  • Staying indoors as much as possible, especially in areas where the air pollution index is unhealthy.
  • Keep doors and windows closed to prevent indoor air pollution.
  • Use high-quality air purifiers with high efficiency particulate air (HEPA) filters, especially when natural ventilation is limited.
  • Use N95 masks for prolonged outdoor exposure, to filter out potentially harmful fine particulate matter that may be harmful.
  • Stay hydrated throughout the day.
  • Stay informed and seek medical advice. Monitor air quality through official sources, limit outdoor activities during the haze, and seek professional medical advice if experiencing lung or heart symptoms.
  • Self-medication, particularly with inhalers, is discouraged as it may lead to unwanted side effects.

A Haematologist Explains Why You Should Consider Donating Your Blood

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FEATURED EXPERT
DR HO KIM WAH
Consultant Haematologist and Transplant Physician
Sunway Medical Centre
BLOOD DONATION SAVES LIVES

Blood transports oxygen and nutrients to the cells in every nook and corner of your body and carries waste products away from these cells for elimination.

While this seems like a simple statement, its importance cannot be understated. Your body cannot function properly when there is not enough blood in your body to perform its life-sustaining function.

“That is why blood donation is extremely crucial, especially for those born with hereditary blood disorders or have contracted blood cancers that prevent their bone marrow from producing healthy blood cells naturally,” says Dr Ho Kim Wah.

ARE THERE RISKS OF DONATING BLOOD?

According to Dr Ho, the risk of donating blood is fairly minimal as long as the donor fulfills the qualification to become a blood donor.

You can be a blood donor if you:

  • Meet the age criteria (between 17 and 60 years old).
  • Aren’t fasting.
  • Are within your ideal body weight range.
  • Have had more than 5 hours of sleep before donating blood.
  • Are physically and mentally sound.
  • Have no chronic diseases.

There may be other criteria, but don’t worry. You will be first examined by a medical officer to determine whether you are eligible to donate blood. You can also take the opportunity to ask the medical officer about any concerns you may have.

IS BLOOD DONATION A TAXING PROCEDURE?

Not particularly. The entire process of blood donation takes only about 30 minutes or so.

Dr Ho points out that after donating your blood, you will be advised to rest for at least 10 minutes.

You should have some light refreshments and to drink plenty of water in the meantime.

You should also avoid strenuous activities in the first 24 hours after blood donation, to avoid unpredictable fainting spells that can occur as a result of these activities.

“In any case, if you develop symptoms such as fever, chills, rigours, chest pain, sweatiness, itchiness, breathlessness, or any sense of uneasiness, you should notify the nurses or doctors immediately,” advises Dr Ho.

NO, THESE WOULD NOT HAPPEN IF YOU DONATE YOUR BLOOD!

Reduce your lifespan. No, this won’t happen.

Damage your internal organs. That’s not true.

Contract infections. Stringent measures are taken to avoid this.

Have your blood discarded and hence wasted when the blood bank has too much blood stored. Any surplus in a blood bank is transported to areas that are in need of such blood.

1 BAG OF DONATED BLOOD WILL SAVE 3 LIVES

“Take a stand and save a life,” Dr Ho urges.

To donate blood, you can visit the National Blood Centre at Jalan Tun Razak, Kuala Lumpur or the state hospital nearest to you. You can also keep an eye out for mobile blood donation programmes visiting your neighbourhood from time to time.

“Don’t Let Diabetes Ruin Your Eyesight!” Warns Expert

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FEATURED EXPERT
DR PEH KHAIK KEE
Consultant Ophthalmologist and Vitreoretinal Surgeon
Sunway Medical Centre
DIABETES IS THE MOST COMMON CAUSE OF BLINDNESS AMONG WORKING-AGE ADULTS

“1 in 5 Malaysians is diabetic, which equals to an estimated 4.6 million Malaysians, and diabetic eye disease affects 1 in 3 diabetics. That means about 500,000 of these people will experience vision-threatening eye disease,” says Dr Peh Khaik Kee.

DIABETIC RETINOPATHY IS A DIABETES-LINKED EYE DISEASE THAT CAN LEAD TO VISION LOSS

According to Dr Peh, diabetes affects the eye in several ways:

  • It causes changes to the lens, leading to blurry vision.
  • Increased pressure in the eye can lead to glaucoma.
  • Damages the nerves that control the eye muscles, giving rise double vision.
  • Damages the blood vessels in the retina, leading to diabetic retinopathy.
Overview of diabetic retinopathy. Click on the image for a larger, clearer version.

Dr Peh shares: “Diabetic retinopathy has become of epidemic proportions. A large part of this issue is due to poor awareness. Many people with diabetes do not undergo regular eye exams to check for signs of the condition.”

REGULAR EYE EXAMS ARE IMPORTANT BECAUSE EARLY STAGE DIABETIC RETINOPATHY DOES NOT SHOW ANY SYMPTOMS

Vision loss occurs at late-stage diabetic retinopathy—this is when most people affected by this disease seeks medical help.

Dark spots floating around in the person’s vision (floaters) are a possible symptom of diabetic retinopathy.

Unfortunately, the vision loss is permanent, and at that stage, there is little to be done to improve the person’s eyesight.

On the other hand, should diabetic retinopathy be detected at its early stages, treatment can be prescribed to help slow down or stop the vision loss over time.

“That is where the importance of screening comes in,” Dr Peh said.

EYE SCREENING FOR DIABETIC RETINOPATHY IS MORE COMFORTABLE THESE DAYS

In the past, such screening can involve staring at a bright light for up to 5 minutes for each eye, which can be very uncomfortable for some people.

Dr Peh shares that the eye screening process has improved since. “These days we have ultra-widefield fundus cameras that can capture a single, 150-degree field view of the retina; 3 times more field view than a standard camera.”

He adds that the camera captures images in under 1 minute, with up to 98% accuracy in detecting and grading retina disease when combined with targeted slit-lamp examination.

Thus, the screening process is faster and hence the person undergoing screening will have a more comfortable experience, while at the same time offering a high accuracy rate in detecting diabetic retinopathy.

EYE SCREENING MAKES A DIFFERENCE

“Diabetic eye screening was formally initiated in the UK in 2009, and by 2014, diabetes is no longer the commonest cause of blindness in working adults in the UK. That is the difference that screening makes,” says Dr Peh.

WHO SHOULD GO FOR EYE SCREENING?

Dr Peh encourages those with a family history of diabetes to have their blood sugar screened, and those diagnosed with diabetes should see an ophthalmologist to have their retina examined.

A Cancer Expert Explains What You Should Know About Wilms Tumour

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FEATURED EXPERT
DR ENI JURAIDA ABDUL RAHMAN
Consultant Paediatrician, Paediatric Haematologist, and Paediatric Oncologist
Sunway Medical Centre

“Wilms tumour is the most common type of kidney cancer affecting children, usually those that are under 5 years old,” says Dr Eni Juraida Abdul Rahman.

FACTS ABOUT WILMS TUMOUR
  • It is also called Wilms’ tumor or nephroblastoma. The name Wilms came from Max Wilms, a German surgeon that first described this cancer.
  • The tumour is the result of mutations of genetic materials in kidney cells, which typically occur after birth.
  • Usually only one kidney is affected, but in 5% to 7% of cases, it can be found in both kidneys.
WHAT CAUSES WILM TUMOUR?

Just like with most cancers, we still haven’t found the exact causes for this cancer.

However, Dr Eni Juraida points out that there are certain genetic disorders that can increase a child’s risk of developing Wilms tumour, such as:

  • Aniridia, or the abnormal development of the iris of the eye due to genetic mutation, usually along chromosome 11 that led to deleted genes and hence missing genetic information.
  • Hemihypertrophy or hemihyperplasia, a condition in which one side of the body or a part of one side of the body is larger than the other in an extent that is greater than what is considered normal.

“Patients with WAGR syndrome have a 45% to 60% chance of developing Wilms tumour,” says Dr Eni Juraida.  WAGR stands for: Wilms tumour, aniridia, genitourinary malformation, and range of developmental delays.

SYMPTOMS TO WATCH OUT FOR IN A CHILD
  • Painless swelling in the abdomen, occasionally noted by parents while bathing the child; the tumour may cause discomfort
  • Haematuria, or blood in urine
  • Hypertension or high blood pressure
  • Fever
  • Unusual loss of appetite, resulting in weight loss
  • Pain in the abdomen
  • Generally feeling unwell
  • Cough and shortness of breath
HOW IS WILMS TUMOUR TREATED?

Treatment options will depend on the stage of the tumour.

Surgery

The mainstay treatment, usually done upfront for stage I and II tumours and sometimes delayed for stage III, is a surgical procedure called nephrectomy. This surgery removes the affected kidney and hence the tumour from the child’s body.

In the rare cases when tumours are present in both kidneys, partial nephrectomy removing only the parts affected by the tumour will be performed to preserve as much of the kidneys as possible.

Chemotherapy

“Chemotherapy are medications that are given to kill cancer cells,” Dr Eni Juraida explains.

For stage I and II tumours, these medications can be given after a nephrectomy, to kill off any remaining cancer cells.

However, stage III tumours are much larger in size compared to stage I and II ones, and chemotherapy will be prescribed before a surgery to first shrink the tumour. This will allow the surgery to be carried out more safely.

Radiotherapy

This may be prescribed in some cases, usually for tumours that has spread to other organs such as the lungs or are not completely resolved via chemotherapy.

CAN WE HELP PREVENT THE DEVELOPMENT OF WILMS TUMOUR IN OUR CHILD?

“Since we don’t know the cause, it is difficult to have any preventive measure,” Dr Eni Juraida points out.

However, for children with WAGR syndrome, having them undergo a surveillance ultrasound of the abdomen on a periodic basis—such as every 6 months—can help detect Wilms tumour.

Some Facts to Help You Understand Better What Dementia Is

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FEATURED EXPERT
DR TEH HOON LANG
Consultant Geriatrician
Sunway Medical Centre

The World Health Organization reveals that about 10,000,000—that’s ten million—new cases of dementia are diagnosed every year.

In Malaysia, the Alzheimer’s Disease Foundation shares that 204,000 to 264,000 adults were diagnosed with dementia in 2020, and they expect the numbers to rise to between 637,500 and 825,000 by 2050.

DEMENTIA IS ACTUALLY A GENERAL TERM THAT COVERS CONDITIONS IN WHICH ONE EXPERIENCES SIGNIFICANT DECLINE IN COGNITIVE FUNCTION

Consultant geriatrician Dr Teh Hoon Lang explains that the decline should be significant enough to affect one’s thinking, memory, and social skills until it impedes their ability to carry out their usual day-to-day routines.

DEMENTIA IS A TERM THAT INCLUDE A NUMBER OF CONDITIONS INCLUDING
  • Alzheimer’s disease, the most common one
  • Frontotemporal dementia, a rare form that usually develops in people younger than 60
  • Lewy body dementia
  • Vascular dementia, caused by blood vessel damage that interrupts blood and oxygen flow to the brain
  • Mixed dementia, a combination of two or more types of dementia
THERE ARE MANY FACTORS THAT CAN INCREASE ONE’S RISK OF DEMENTIA

“These factors can be divided into modifiable and non-modifiable risk factors,” Dr Teh says.

Non-modifiable risk factors—things that we can’t change—include:

  • Advancing age
  • Being female
  • Certain types of dementia can be passed down from parent to child; however Dr Teh assures us that having a gene for one of these types of dementia is not a surefire guarantee that the person will develop that type of dementia

Meanwhile, modifiable risk factors include:

  • Diabetes mellitus
  • High blood pressure or hypertension
  • Obesity
  • Excessive alcohol consumption
  • Smoking
  • Depression
  • Traumatic brain injury
  • Sedentary lifestyle
  • Social isolation
  • Mid-life hearing impairment
  • Air pollution

“The more risk factors a person has, the higher their chances of getting dementia,” Dr Teh says.

TEN EARLY WARNINGS OF DEMENTIA TO WATCH OUT FOR
  • Memory loss
  • Difficulty performing familiar tasks
  • Problems with language
  • Disorientation to time and place
  • Poor or decreased judgement
  • Problems keeping track of things
  • Misplacing things
  • Changes in mood and behaviour
  • Challenges understanding visual and spatial information
  • Withdrawal from work or social activities
WHERE TO SEEK HELP IF YOU BELIEVE THAT YOUR LOVED ONE MAY HAVE DEMENTIA

It is fine to consult a general practitioner or GP, who can refer your loved one to a specialist if necessary.

A geriatrician is a specialist that can help with dementia in older persons, and other types of specialists such as neuropsychologists and psychiatrists may also step in to help.

DEMENTIA CAN’T BE CURED, BUT IT CAN BE SLOWED DOWN

Dr Teh shares that there is no cure for dementia at the moment.

However, she assures us that there are many measures or strategies to slow down the progress of the disease and provide both the affected person and their caregivers a better quality of life.

“The most important part of dementia care is to get diagnosed early and get professional advice on the management plan,” says Dr Teh. “Every person with dementia is unique and the approach should be individualized. The basic principles of care include understanding the disease pattern and the struggles or difficulty they are facing, providing a supportive environment, maximizing their strength and minimizing their loss due to cognitive decline.”

How Much Do You Know about Male Breast Cancer? Let’s Find Out!

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FEATURED EXPERT
DR NIK MUHD ASLAN ABDULLAH
Clinical Oncologist
Sunway Medical Centre
BREAST CANCER AFFECTS MEN AS WELL AS WOMEN

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.

WARNING SIGNS

According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

  • Lumps in the breast tissue
  • Skin dimpling or puckering
  • Nipple retraction
  • Unusual discharge from the nipple
HORMONAL CHANGES CAN GIVE RISE TO BREAST CANCER

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?
  • Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
  • Injury to the testicles
  • Use of androgen inhibitors
  • Liver cirrhosis (scarring of the liver)
  • Obesity 
Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.
MEN WITH HR-POSITIVE BREAST CANCER ARE MORE LIKELY TO RESPOND TO HORMONE TREATMENTS

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.

Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.

Important Things That You Should Know About Silent Heart Attacks

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FEATURED EXPERT
DR PATRICK TIAU WEI JYUNG
Consultant Cardiologist
Sunway Medical Centre

Dr Patrick Tiau reveals that silent heart attacks, also known as silent myocardial infarction, account for 45% of heart attacks.

These heart attacks are “silent” because they occur without the usual, recognizable symptoms of a heart attack.

COMMON SYMPTOMS OF HEART ATTACK
  • Chest pain (often described as heavy or pressure sensation)
  • Radiating pain in the arm, neck, or jaw
  • Sudden shortness of breath
  • Sweating
  • Dizziness
HOWEVER, THESE SYMPTOMS ARE USUALLY NOT PRESENT WHEN ONE HAS A SILENT HEART ATTACK!
Because of this, many people may not know that they have experienced one until days or even weeks after.

However, Dr Patrick shares that there are some early warning signs to look out for.

SIGNS THAT YOU MAY HAVE HAD A SILENT HEART ATTACK

It’s good to consult a doctor when you have concerns, especially if you experience these signs and fall under the high-risk below (see below).
  • Feeling tired
  • Indigestion
  • Nausea
  • Sweating.

Dr Patrick says, “We have come across many patients who have dismissed the early warning symptoms as simply feeling tired, indigestion, nausea or sweating. By the time they seek out medical treatment for these symptoms, they are shocked to learn that what they are experiencing is actually due to a reduced blood flow to their heart, and that has caused them to have a silent heart attack.”

Silent heart attacks can lead to more serious health complications if left untreated over an extended period of time, such as an increased risk of another, potentially more deadly heart attack.

COMMON RISKS OF SILENT HEART ATTACKS
RISKS THAT CANNOT BE AVOIDED 
  • Age. The risk increases as we grow older.
  • Gender. Men are more at risk than women. However, women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.
  • Family history. The risk is higher for people with a family history of heart diseases.
RISKS THAT CAN BE MODIFIED 
  • Smoking. Chemicals in cigarettes stimulate one’s heartbeat and can dramatically increase one’s risk of heart attack.
  • High cholesterol. Individuals with elevated cholesterol levels can lead to formation of atherosclerotic plaque in the blood vessel and reduce blood flow to the heart.
  • High blood pressure: Having high blood pressure puts extra strain on the heart muscle. Over time, this causes the heart muscle to stiffen, thicken, and perform less optimally.
  • Individuals that are overweight or obese, especially when their weight tends to sit at the waist, are more at risk even if they do not have any other risk factors.
  • Physical inactivity. Doing regular exercise helps protect the heart by keeping under control other risk factors such as cholesterol, blood pressure, diabetes, and obesity.

“Undeniably our heart health is essential to allowing us to have a well-balanced and fulfilling life,” he says. “The heart itself is the first and last sign of life that is responsible for, quite literally, keeping us going. In combatting heart attacks, the most important thing to remember is that prevention is definitely better than cure.”

DR PATRICK’S TIPS TO REDUCE YOUR RISK OF SILENT HEART ATTACKS

Make the necessary small changes to daily lifestyle to reduce one’s risk factors. These changes include:

  • Regularly monitor blood pressure and cholesterol
  • Get sufficient exercise
  • Quit smoking
  • Eat a balanced diet of fruit, vegetables, lean meats and whole grains
  • Ensure that one’s blood pressure, cholesterol and blood sugar are well-controlled
  • Inform a doctor as soon as possible about any unusual symptoms that may indicate a silent heart attack

Once you go home from the hospital, it is essential that you keep taking your medications as prescribed. “This will ensure your heart health is kept in check, possibly for the rest of your life,” says Dr Patrick.

Consider joining a support group. Dr Patrick acknowledges that heart attack survivors may start to develop feelings of shock, sadness, and anxiety. This is normal, and these feelings can be managed with the right support.

“Some people find it helpful to join a support group where they can talk with others that have gone through a similar experience or seek out companionship and encouragement through avenues such as the gym, or yoga classes,” he advises.