Seafarer’s Health: Navigating Wellness in Offshore Waters

WORDS LIM TECK CHOON
PHOTO MEDSEA

Malaysia has thriving petrochemical and fishing industries, which result in a significant offshore workforce. From oil rig workers to fishermen, thousands spend extended periods at sea, facing unique health challenges. This highlights the importance of maritime health, a specialized field focused on preventing, treating, and managing health issues specific to seafaring populations.

WHAT ARE THE MAIN HEALTH ISSUES FACED BY MARITIME WORKFORCE?
FEATURED EXPERT
ANUJ VELANKAR
General Manager of MedSea

According to Anuj Velankar, General Manager at MedSea and a former maritime captain, data from MedSea reveals that the following are the most common chronic health issues among seafarers:

  • High blood pressure or hypertension (67% of all chronic conditions reported on board)
  • Diabetes
  • High cholesterol or hypercholesterolemia
  • Gout

“Non-communicable diseases pose significant health risks to seafarers, potentially leading to complications and even medical emergencies,” he adds, pointing out that these medical emergencies also necessitate vessel diversions and delays.

CHALLENGES IN ADDRESSING HEALTH ISSUES IN A MARITIME ENVIRONMENT
FEATURED EXPERT
DR KATHERINE SINCLAIR
Senior Medical Advisor of MedSea

Dr Katherine Sinclair reveals that the maritime environment can give rise to the following challenges when it comes to managing chronic conditions.

  • Limited access to medical care
  • Long periods away from home
  • Physical demands of the job

These challenges often cause seafarers to neglect their chronic conditions.

“While crewmembers are often aware of their own chronic conditions, managing these conditions can sometimes be overlooked, posing significant risks to safety onboard,” Dr Sinclair reveals.

She adds: “Captains typically lack the bandwidth to closely monitor the health of crewmembers. Therefore, management should consider implementing proactive measures such as regular health check-ups, providing health education and ensuring access to necessary medical resources.”

SUGGESTIONS FOR ORGANIZATIONS TO PREVENT COMMON INJURIES AND ILLNESSES AMONG SEAFARERS
  • Pre-employment medical examination (PEME) to aid in detecting underlying conditions and monitoring the general health of seafarers. This will ensure that those going to sea are in their optimal condition, which will aid in reducing illnesses and accidents at sea.
  • Provide support for those with chronic conditions, by developing programmes that encourage seafarers to be open about the support they need for their chronic conditions. This can help prevent them from hiding their conditions and ensure they receive the necessary care.
  • Promote healthy lifestyles. Actively encourage all seafarers to maintain healthy diets, engage in regular exercise and avoid tobacco use. Provide resources and create a supportive environment can help seafarers adopt these healthy habits.
  • Ensure that seafarers follow recommended medical treatment prescribed by their doctors. Regular check-ups and adherence to medical advice are crucial for managing health conditions effectively.
  • Practice early intervention. If there are any changes in a crew member’s medical condition, it is essential to ensure that medical attention is sought as soon as possible. Early intervention can prevent minor issues from becoming serious health emergencies.

How Continuous Monitoring Is Changing the Way We Monitor Glucose Levels at Home

WORDS DR NGU SIE TEIN

FEATURED EXPERT
DR NGU SIE TEIN
Medical Officer
Columbia Asia Hospital – Miri

Continuous monitoring of blood glucose and blood pressure has transformed how we manage our health at home. Let’s explore how this technology is changing diabetes care.

WHAT IS CONTINUOUS GLUCOSE MONIORING (CGM)?
  • CGM uses a small wearable device with a tiny sensor under the skin to track glucose levels throughout the day.
  • It sends real-time data to a smartphone or insulin pump.
  • It offers a less intrusive alternative to finger pricks.
HOW DO WE BENEFIT FROM CGM?
  • Real-time insights. Instantly access glucose data to make informed decisions about diet, exercise, and medication. This insight encourages greater adherence to both medication and lifestyle recommendations, leading to more effective diabetes management.
  • Pattern recognition. Identify how meals, activity, and stress affect glucose levels.
  • Early detection. Take steps to prevent dangerous high or low blood sugar episodes even before they occur.
  • Reduced risk of diabetes-related complications such as kidney, nerve, and eye damage as well as hospitalizations. This will significantly enhance our overall well-being.
  • Greater independence. We can take control of our diabetes management with continuous data.
  • Reduces the need for frequent clinic visits by enabling remote check-ins and efficient in-person appointments focused on specific concerns.
It is important to note that while CGM can reduce the need for frequent in-person visits, it cannot completely replace them. Regular in-person check-ups remain crucial for comprehensive care, including physical examinations, foot checks, and other essential assessments.
HOW DO HEALTHCARE PROFESSIONALS USE CGM?

Doctors and nurses use CGM data to:

  • Create personalized treatment plans for their patients.
  • Make informed decisions about their patient’s medication and insulin dosing.
  • Develop tailored lifestyle recommendations for their patients.
HOWEVER, THERE ARE SOME CHALLENGES WHEN IT COMES TO THE USAGE OF CGM
  • Cost of devices and sensors. The upfront cost and ongoing expense for troubleshooting, calibration, and replacement of sensors can be considerable for some individuals.
  • Potential skin irritation and infections at the sensor insertion sites.
  • Some people may struggle with wearing the device consistently, especially during sleep or physical activities.
  • Stress and anxiety. Some individuals may feel overwhelmed by the constant monitoring.

Addressing these challenges requires collaboration between healthcare providers, manufacturers, and users to optimize device use and enhance its benefits.

IN CONCLUSION

Despite its drawbacks, continuous glucose monitoring remains a valuable tool in modern diabetes management.

It empowers patients and healthcare professionals alike, offering the potential to significantly improve quality of life and reduce complications.

Warning! Cheap Blood Pressure Meters Rampant in the Market Could Raise Critical Health Emergency!

FEATURED EXPERT
LIM EN NI
Chief Pharmacist
Alpro Pharmacy

In Malaysia, blood pressure monitoring devices are regulated by the Medical Devices Authority (MDA).

Only devices with a Certificate of Approval from MDA can be sold in the market and they are usually priced around RM100 to RM300 per unit.

A VIRAL CONCERN

In a recent viral video, a doctor raised concerns over faulty, low-quality blood pressure meters that are easily purchased online for as low as RM15, which gave inaccurate readings.

This could lead to potential risk of a public health emergency resulting from the dangers of the uncertified health monitoring devices.

Uncertified blood pressure meters often provide inconsistent or incorrect readings, leading to false perceptions of blood pressure levels,

As a result, users may end up making inappropriate adjustments to their medication without proper medical guidance.

PHARMACY CHAIN ISSUES CAUTION TO THE PUBLIC

Alpro Pharmacy cautions the public to be more vigilant when purchasing health monitoring devices, online and offline.

Here are a few ways the public can check if their blood pressure meters are registered:

  1. Verify the registration status of a device on the MDA’s website: https://mdar.mda.gov.my/frontend/web/index.php?r=carian (link opens in a new tab)
  2. Bring your blood pressure meter to a nearby community pharmacy for the pharmacist to have a look.

If a blood pressure monitor had been registered with the MDA, the MDA registration number (“nombor pendaftaran peranti perubatan”) will be displayed on the box. Click on the image for a larger, clearer version. 

TURN TO CERTIFIED EXPERTS AND TRUSTED SOURCES

Alpro urge the public to seek professional advice from certified pharmacists or a medical practitioner prior to adjusting their medication dosage.

Self-diagnosis and straying from medication could put patients at an even higher risk of morbidity from their existing condition.

Similarly, other medical devices, such as blood pressure monitors, glucometers, and pulse oximeters, are also important. Regular check-ups with these devices help us monitor and manage our health conditions effectively.

These devices provide valuable insights into your well-being, allowing timely interventions and more informed discussions with healthcare professionals. Ensure that you purchase them from trusted sources to guarantee accuracy and reliability.

This is a press release from Lim En Ni, the Chief Pharmacist of Alpro Pharmacy. It has been edited for clarity.

A Dermatologist Shares Essential Skincare Tips for People with Diabetes

WORDS DR GAN TECK SHENG

FEATURED EXPERT
DR GAN TECK SHENG
Consultant Dermatologist
Tung Shin Hospital

The stakes are high when it comes to diabetes management.

High blood sugar is not just a number; it affects various bodily components, including your skin.

For many, a skin problem serves as an early warning sign of diabetes. Those elevated glucose levels are often the culprits behind the dry, itchy skin.

But here is the lifestyle twist–many individuals living with diabetes are not aware of the vital role that proper skin care plays. It is not just about administering insulin and watching your diet; it is about a comprehensive approach to well-being that includes your skin.

GENERAL SKIN CARE
Use gentle cleanser when bathing or showering.
  • Avoid bar soaps as they strip away natural oils and disrupt skin barrier function.
  • Also avoid cleansers that contain perfumes and harsh detergents as they may cause irritation and redness to the skin. Instead, use gentle cleansers to help maintain hydration and prevent skin dryness.
Bathe or shower the right way.
  • Use lukewarm water as hot water strips away natural oils and damages the skin.
  • Keep your baths or showers short, ideally no longer than 10 minutes.
Dry your skin carefully.
  • After a bath or shower, dry your skin with gentle pats.
  • Remember to dry the skin between your toes, armpits and other skin folds. Intertrigo—rashes and inflammation caused by skin-to-skin friction—occurs more easily in warm moist environments.
Apply moisturizer every day.
  • Keep your skin moisturized and prevent cracks that lead to infection.
  • Pick a hypoallergenic, fragrance-free moisturizing cream or ointment.
  • Apply after bathing or when your skin is dry or itchy.
FOOT CARE
Check your feet daily.
  • First, dry your feet carefully.
  • Make sure to check between your toes and your feet for rashes, cuts, sores, or any other changes to the skin.
  • Use a mirror if you cannot see your soles.
Wear shoes that fit well.
  • Always wear shoes and socks to avoid injury.
  • Wear closed, well-fitting shoes with cushioned sole.
  • Check if there is any object or pebble inside your shoes before putting them on.
Treat dry, cracked heels.
  • Apply urea cream on dry, cracked hills every day before getting into bed. This will help in preventing the development of non-healing sores and serious skin infections.
Take care of your toenails.
  • Keep your toenails short and trim them straight across.
  • Gently smooth any sharp edges with a nail file.
  • Do not let the sides of your toenails grow into the skin.
See a doctor for treatment of corns and calluses on your feet.
  • Do not remove corns or calluses with sharp objects. Any skin injury on the feet may increase the risk of ulcers and infection, especially patients with diabetic neuropathy.
  • Be cautious when using over-the-counter products, as these products may irritate your skin.
Treat all wounds immediately.
  • Wash wounds with antiseptic and water.
  • Only apply antibiotic cream if recommended by your doctor.
  • Cover the wound with an adhesive bandage.
  • Perform daily dressing to help your skin heal.
SEE A DOCTOR IF YOU EXPERIENCE ANY OF THE FOLLOWING
  • Reddish and swollen skin.
  • Pain or tenderness.
  • Honey-coloured crusts.
  • Change in the colour and temperature of your feet.
  • Wound that is weeping or leaking pus.
  • Thickened or discoloured nails.

First Large-Scale Diabetes Cohort Study Launched in Malaysia

WORDS LIM TECK CHOON

On 10 July 2023, the Seremban Diabetes (SeDia) Cohort Study, was officially launched by Duli Yang Maha Mulia Yang Di Pertuan Besar Negeri Sembilan, Tuanku Muhriz ibni Almarhum Tuanku Munawir in Seremban.

PURPOSE OF THE SeDia COHORT STUDY

This study was launched to holistically explore all the factors involved in the development of diabetes as well as the complications experienced by people with diabetes in this country.

THE HISTORY OF THE STUDY

The genesis of the SeDia Cohort Story began on 17 May 2022 when the Ministry of Health Malaysia and the International Medical University signed a memorandum of understanding for the establishment of this study.

The research protocol of the study received the approval of the Medical Research and Ethics Committee (MREC) on 17 March 2023.

OVER 12,000 PARTICIPANTS SIGNED UP TO AID INVESTIGATION

This SeDia Cohort Study will cover a period of 12 years.

The first important step now is to obtain data that is socio-culturally relevant to the local community. So far, over 5,000 patients and over 7,000 of their family members have voluntarily registered as part of the Diabetes Registry of Klinik Kesihatan Seremban.

The investigators will use digital systems and data infrastructure to collect these participants’ personal and medical information.

Blood samples will also be obtained from these participants for genetic profiling, to study individual predisposition to diabetes and, for people with diabetes, their predisposition to complications and response to medications as well as physical and dietary interventions.

These participants will be followed regularly, with the process of data collection conducted every 3 years over the next 12 years.

Additionally, details of the participants’ life events, such as hospital admission and deaths, will be collected and updated every year.

STUDY HOPES TO IMPROVE DIABETES PREVENTION & MANAGEMENT IN MALAYSIA

Using the data obtained from these participants, the investigators will study and analyze the complex web of factors that contribute to the development of diabetes and its complications.

These factors include genetics and family history of diabetes to lifestyle and environmental factors, dietary regimes, physical activity, socio-economic levels, and healthcare delivery.

The investigators believe that the understanding of these complex factors and the connection between them would enable us to uncover optimal strategies for diabetes prevention and treatment.

Such strategies would enable implementation of evidence-based policies and programmes to address the escalating burden of diabetes in Malaysia.

ACCESS WILL BE GRANTED TO LOCAL & INTERNATIONAL RESEARCHERS

To establish the SeDia Cohort as a study of national significance, local and international researchers will be granted access to SeDia Cohort to conduct further analysis and studies, subject to approval of the MREC.

FUNDING INFORMATION

The SeDia Cohort study will be funded through public funds, which includes contributions from corporations and individuals.

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.

Advice for People With Health Conditions That Will Be Fasting This Ramadan

WORDS LIM TECK CHOON

For the upcoming fasting month, we are pleased to share some important advice from the good people at Alpro Pharmacy.

WILL THE USE OF INHALERS INVALIDATE YOUR FASTING?
  • There are 2 types of inhalers: ‘preventer’ inhalers and ‘reliever’ inhalers. If you are unsure which of your inhalers is which, check with your doctor.
  • While fasting, you should continue to use your preventer inhalers, typically twice a day—before sahur and before you go to bed. It’s best to check with your doctor how often and when you should use your preventer inhaler.
  • Use your reliever inhalers when you have an asthma attack.
WILL FASTING PUT YOU AT RISK OF DEHYDRATION OR LOW BLOOD GLUCOSE (HYPOGLYCAEMIA)?
  • If you have diabetes, check your blood glucose 2 hours after sahur and when you experience symptoms such as dizziness, cold sweat, blurred vision, and shivering. Checking your blood glucose won’t invalidate your fasting.
  • If your blood glucose level is below 3.9 mmol/L, you will need to break your fast for the sake of your health.
  • People with diabetes shouldn’t delay breaking their fast. Keep some dates with you if you have diabetes and you’re fasting. That way, when you’re still stuck in traffic or at work during iftar, you can break your fast with 1 or 2 dates.
  • Eat foods rich in dietary fibre for optimal blood glucose control during the fasting month. Dietary fibre helps keep you feel full longer and stabilize your blood glucose levels.
HOW TO FAST WHEN YOU HAVE GASTRIC PROBLEMS
  • If you have gastric problems, break your fast by eating moderate amounts of foods.
  • Avoid eating fried foods and gassy drinks in too much amounts or too quickly.
  • Also, it’s best to avoid drinks that are high in caffeine, such as coffee.

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.

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