SUGAR & AGEING

BY DR. CHARLES LEE
CONSULTANT PLASTIC, COSMETIC & RECONSTRUCTIVE SURGEON
KPJ SABAH SPECIALIST HOSPITAL

IT’S ALL ABOUT FOOD

Before and After Treatment

Anyone who is familiar with the wrinkle-free, blemish-free, perfect even complexions of Japanese women will be unsurprised that the key to redefining beauty in Japanese skin care is what you put inside the body. Traditionally, in Japan, beauty is natural, simple, and edible! The theory is that appearance reflects the food you eat and women should not apply anything on their skin that is toxic to the body because skin is porous.

Hence natural, plant-based skin care is of utmost priority in redefining beautiful skin. The secret to natural Japanese beauty is all in the ingredients of a well-balanced Japanese diet which is full of vitamin-rich vegetables like broccoli and lots of fish rich in omega 3 fatty acids and extremely low in meat and sugary foods. This helps to reduce the body’s production of the inflammatory chemicals involved in the ageing process.

ADVANCED GLYCATION END PRODUCTS (AGEs)
Advanced Glycation End Products (AGEs) are a complex group of compounds formed when sugar reacts with amino acids, proteins or lipids. This occurs in everyone’s body and skin cells. Along with oxidation, glycation is one of the major causes of cell death and ageing because it affects the molecular and cellular mechanisms that promote and restore cell growth and development. Restriction of dietary intake of AGE’s and exercise safely reduces circulating AGEs with further reduction in oxidative stress and inflammatory markers thereby delaying the ageing process.


TOXIC SUGAR AND THE SKIN AGEING PHENOMENON
Of all the molecules capable of inflicting damage in our body and speeding up the ageing process, sugar molecules are probably the most damaging of all. The older we get, and the more sugars we consume, the more glycation damages our skin.

One of the most damaging AGE’s as a result of this metabolic process is the creation of 3-deoxyglucosone (3DG) which is responsible for much of the skin damage seen in ageing. Most of the 3DG gets sweated out of the skin during exercise but the residual product causes:

• Inflammation
• Decreased collagen production
• Collagen and elastin cross-linking
• Formation of further Advanced Glycation End products (AGEs)
• Oxidative stress and free radicals

IT’S ALL ABOUT SKINCARE
The most important beauty secret of Japanese women is a multistep skin care ritual that is as important to beautiful skin as the product themselves. The ritual of applying each product, from cleansing to face and neck massage allows the skin to detox the toxic effects of AGEs and de-stress the damage caused by free radicles. This helps you to beautify your skin from the inside out and at the same time allowing the body to restore and heal from the damage caused by the external environment.

A customized Anti-Glycation Therapy (AGT) will include: deep cleansing, exfoliation, extraction, toner, lymphatic detox, antioxidant mesotherapy, sheet mask, serums, moisturizer, and finally sunscreen.

The relationship between sugar and fine lines can be life changing. Esthe Twin’s Anti-Glycation Therapy harnesses the antioxidant and collagen-restoring powers of plant stem cells which activates the enzyme processes in the skin that restore flexibility and suppleness to glycated collagen fibers.

For more information, please contact KPJ Sabah Specialist Hospital at 088-322 000. 

Find them at Lorong Bersatu, Off Jalan Damai, Luyang, Kota Kinabalu, Sabah. 

Website: www.kpjsabah.com

For the complete article about this subject can be read on this October to December 2016 issue of Parents Avenue Magazine. 

*Disclaimer: All information is for your general reference only. We (Parents Avenue) do not accept any responsibility whatsoever in respect of such information. 

VARICOSE VEINS & LEG PAIN

Bulging Veins in The Leg: A new solution to Leg Pain and Varicose Veins

BY DR. CHARLES LEE | CONSULTANT PLASTIC, COSMETIC & RECONSTRUCTIVE SURGEON | KPJ SABAH SPECIALIST HOSPITAL

Introduction
For years, people who experienced painful swelling and bulging varicose veins in their legs had one of two options: learn to live with the pain or undergo vein stripping, a surgical intervention that requires the diseased vein to be literally stripped out. Pain and prolonged hospitalization was a disadvantage.

Now, a new laser procedure, first introduced in Sabah in 2010, has revolutionized the treatment of varicose veins in patients with Chronic Venous Disease. This exciting new high-tech, minimally-invasive option to better looking, less painful and healthy legs for life has improved the lifestyle of many patients.

What are varicose veins and spider veins?
Varicose veins occur secondary to abnormal vein walls or abnormal valves in the veins, which act as one-way valves preventing blood from pooling backwards, causing the veins to dilate (swell/enlarge) and become varicose. This is called venous reflux and often begins in the great or small saphenous veins situated in the leg. These veins are usually not visible and run along the front and back of the leg. When the valves in these veins get damaged, the branches enlarge and prominent varicose veins develop.

The relationship between varicose veins and spider leg veins (telangiectasias) is intimate. Increased pressure in the veins (venous hypertension) as a result of venous reflux is transmitted to the superficial epidermal vessels causing them to elongate and dilate and become visible to the human eye.

How do you diagnose venous reflux or malfunction of the valves in veins?
Venous reflux or insufficiency can be easily diagnosed with a simple non-invasive test called venous ultrasound or duplex examination. This will determine the severity of the abnormal veins and valves and plan of treatment.

What are the symptoms and causes of varicose veins and how can we prevent it?
Venous reflux disease results in symptoms such as painful, aching legs, heaviness, tiredness, night cramps, skin changes and ultimately skin ulceration. Left untreated, these symptoms can worsen over time.

Causes include increasing age, strong family history, obesity, multiple pregnancies or working in a profession that requires a lot of time on your feet, for example nurses, hotel workers and even housewives. Other causes can include sitting for prolonged hours for example clerks, managers and executives. Women are 4 times more likely to be affected. Conservative prevention will include leg elevation, compression stockings, weight loss and exercise.

What makes the new laser procedure different?
The new EndoVenous Laser Ablation (EVLA) uses heat from the laser light to seal off the diseased varicose vein under ultrasound guidance and local anaesthesia. The sealed vein is gradually reabsorbed by the body and the remaining healthy veins then take over the task of moving blood through the patient’s legs. Painless, no scar, quick recovery with no hospitalization required, this new laser therapy is a step into the future for patients with chronic venous disease.

What are the 5 most popular/common treatments for varicose veins and spider veins?
Each patient is unique and treatment should be tailored based on the underlying problem. For some, varicose veins and spider veins are a cosmetic issue. For many, the symptoms are significant and affect their lifestyle.

The most popular treatment for spider leg veins is microsclerotherapy. The superficial dilated veins are treated with an injection of a chemical solution and compression stockings are applied.

Other treatment options include laser and pulsed light sources for spider veins. The current most popular non-surgical treatment for varicose veins is the Endo-Venous Laser Ablation (EVLA) using heat from the laser light to seal off the varicose vein under ultrasound guidance and local anaesthesia. The procedure is painless and recovery is quick.

Foam sclerotherapy, the second most common form of treatment, to the tributaries (branches) is usually done at the same time and patient can return to work within a few days. Here, the chemical solution injected causes the vein walls to swell, stick together, and seal shut.

The collateral branches and tributaries can also be surgically removed by what is called ambulatory phlebectomy. All treatment modalities require post-treatment compression stockings to enhance early recovery and good results and strong patient compliance is required.

For more information, please contact KPJ Sabah Specialist Hospital at 088-322 000. Find them at Lorong Bersatu, Off Jalan Damai, Luyang, Kota Kinabalu, Sabah. Website: www.kpjsabah.com



For the complete article about this subject can be read on this July to September issue of Parents Avenue Magazine. *Disclaimer: All information is for your general reference only. We do not accept any responsibility whatsoever in respect of such information. 

Liver Cancer: Symptoms and Prevention

By Dr. Nerenthran Loganathan
Consultant Physician and Gastroenterologist
KPJ Sabah Specialist Hospital


INTRODUCTION

Liver cancer or also known as Hepatoma / hepatocellular carcinoma has been on the rise and is now a leading cause of cancers in the world according to the recent detailed health screening program conducted by the Ministry of Health Malaysia. According to the research, liver cancer is the third highest leading cause of cancer death and has been identified to be the cause of death in about 250,000 to 1,000,000 people worldwide.

Two of the root causes have been identified as the Hepatitis B and Hepatitis C infections which were estimated to cause around 80% of the total cases of reported liver cancer.

To date, the highest recorded incidences of liver cancer in East Asia are from China, Taiwan, Hong Kong, Malaysia, Indonesia and Thailand.

Based on our own local Malaysian National Cancer registry, the incidence of liver cancer is 2.8/100,000 population in peninsular Malaysia and it had been identified as 1 out of the 10 leading cancers among the male population. Factors and genetic characteristics of the Asian populations might also have a predetermining factor.

It is estimated that as much as 5.2% of our population is suffering from chronic Hepatitis B and 2% from Hepatitis C. Most of them are healthy carriers of the disease and are unaware that they have the highest risk of developing iver cancer. These are the population who will develop chronic liver disease which in time will progress to hardening or scarring of the liver known as liver cirrhosis if not treated early. There is an annual incidence of about 5% of liver cirrhosis patients developing liver cancer.

Besides Hepatitis B and C, other causes of liver cirrhosis includes;

1. Chronic alcohol consumption
2. Fatty Liver or also known as NASH (Nonalcoholic steato-hepatitis)
3. Diabetes Mellitus
4. Certain rare autoimmune diseases like Primary Sclerosing Cholangitis, Autoimmune Hepatitis, Primary Biliary Cirrhosis
5. Obesity
6. Hemochromatosis
7. Wilson’s disease
8. Prolonged use of steroids
9. Fungal infection – prolonged exposure to aflatoxin produced by this fungus
10. Consuming arsenic contaminated water in certain countries.


WHAT ARE THE SIGNS AND SYMPTOMS OF LIVER CANCER?

People suffering from Liver cancer may not have any symptoms at the early stages, however here are some of the symptoms;

• Abdominal Pain especially at the right upper abdominal area.
• Decease in effort tolerance, easy fatigability, loss of weight, loss of appetite and unexplained fever.
• Abdominal Swelling especially at the right upper quadrant of the stomach.
• Jaundice – yellowish discoloration of the skin, eyes and passing dark urine.
• Back ache or bone pain due to spread of the cancer to the bones.
• Ascites – abdominal distension due to accumulation of fluid in the stomach.
• Vomiting blood – due to rupture of blood vessels in the esophagus (food pipe) or stomach.
• Poor appetite.
• Early satiety – fullness after eating a small meal.
• Pain at the left shoulder – referred pain.
• Abdominal discomfort.
• Nausea.


When the persons have these above mentioned symptoms, it is usually in the late stages of the disease. There is not much treatment which may be offered at this stage except symptomatic treatment and palliative care. That is why it is imperative that we detect early cancer so that it may be promptly treated and a possible cure obtained. How we do that is to screen all the high risk population.

Those who are Hepatitis B/C carriers should visit their local doctors and get an ultrasonography of the liver, liver function test and alpha feto-protein (cancer marker) blood test every 6 monthly for life. A computerized tomography (CT scan) of the liver or a Magnetic resonance imaging (MRI) scan of the liver is required once there in an abnormality detected from the above tests to confirm the presence of liver cancer and initiate appropriate early treatment.

COMPLICATIONS

Patients suffering from liver cancer may exhibit the following complications:

1. Haematemesis (Vomiting blood)
– as a sequalle of liver cirrhosis and liver cancer , these patients develop a condition called portal hypertension and as a result there is enlargement of blood vessels in the esophagus, stomach, duodenum( small intestine) . When this blood vessel ruptures it will cause hematemesis (vomiting blood) and this could be life threatening.

2. Abdominal pain as a result of bleeding within the liver cancer and bacterial infection of the abdominal fluid known as spontaneous bacterial Peritonitis.

3. Abdominal pain due to enlarged liver compressing the adjacent organs.

4. Jaundice - yellow discoloration of skin and eyes due to high bile pigment levels in the blood.

5. Confusion and coma due to a condition called hepatic encephalopathy where there is high level of ammonia in the blood.


TREATMENT

The treatment for liver cancer is divided in a few stages. Early detection is crucial and the key to a successful treatment. If the patient presents in the late or advanced stage of liver cancer, there is no option for curative treatment except palliative care which is supportive treatment, relief of pain, nutritional support and end of life care.

For those patients who are detected early, the options of surgery for a potential cure is highly possible depending on the stage of the disease and overall condition of the liver. This surgery called hepatic segmentectomy or hepatectomy which is usually done by removing the segment of the liver affected or even removal half of the liver.

For those patients with poor liver reserve or function and who have multiple medical conditions where surgery is too high of a risk or where surgery is not possible, they have other options like TACE (Trans Arterial Chemo Embolization) – directly injecting chemotherapy into the liver cancer or Radio-Frequency Ablation therapy- Using high intensity Radio frequency to burn the cancer. Another option for treatment is a liver transplant.


PREVENTION

Patients suffering from liver cancer on the whole has underlying liver cirrhosis or are a hepatitis B/C carrier. Therefore the best method of prevention is Hepatitis B vaccination, early screening for hepatitis C and regular blood monitoring for other conditions leading to liver cirrhosis like fatty liver.

Those who are carriers of Hepatitis B/C should restraint form alcohol, smoking, unrecognized traditional herbal treatments, direct sales supplements and requires regular visits to a doctor for surveillance. Finally if there is any history of liver cancer in the family, all family members related should go for a blood screening for Hepatitis B and Hepatitis C.

                                                      





KPJ SABAH SPECIALIST HOSPITAL
Lot No.2, Off Jalan Damai,Luyang, 88300 Kota Kinabalu,Sabah, Malaysia. 
Website: http://www.kpjsabah.com/
Tel: 088-322 000 | Emergency: 088-322 199
Follow them on Facebook HERE.

Skin Care For Tiny Tots

What is the BEST practice?

By Dr. Joanne Lee Guey Feng
Consultant Paediatrician & Lactation Specialist
KPJ Sabah Specialist Hospital | Tel: 088-211 333

For most parents whom I came across, have different ideologies in caring for the delicate skin of their
newborn babies. For some new parents, bathing a baby can be a huge task with lots of ‘EXCITEMENT’ and ‘ANXIETY’ (more so if you have to bath a crying baby in a tub of water, who is just a few days old). How stressful! What a struggle!

Parents Frequently Asked Questions (FAQ) would be:
• Does a newborn baby who has just delivered truly need a shower? Do they need a bath time after coming out from labour room?
• Must you bath your young baby every day?
• How many times do you need to shower your baby in a day?
• Can I use plain water to clean them? Or must I use a baby shampoo/ body cleanser?

Surprisingly, the approach to skin care for newborn babies has created some confusion among neonatal staff from 9 nurseries in United Kingdom, and even in our local setting among the confinement ladies of Sabah. So, what is the best practice that we can refer to?

World Health Organization (WHO) and National Institute for Health and Clinical Effectiveness (NIH) published a statement in 2006 with recomendations for the issue of caring for the newborn skin.

Below are the guidelines adapted by North Trent Neonatal Network, United Kingdom:

1. Leave Vernix Caseosa to absorb into the skin. Do not rub it off.
2. Only bath a baby when he/ she is physiological stable.
3. If necessary, bath a ‘well’ baby when his/her temperature has been within an acceptable range for 2-4 hours after delivery, but preferably delay the first bath until the second or third day of life to assist with skin maturation.
4. Ensure the temperature of bath water is maintained at 37°C. Use a bath thermometer.
5. Avoid baby toiletries and other cleansing products until the baby is at least a month old—use plain water to cleanse baby’s skin.
6. Only bath baby 2-3 times a week—‘top and tail’ in between bathing.
7. Use the best quality nappy available to the baby—changed soiled nappies frequently and cleanse the nappy area with plain water or unperfumed, alcohol-free baby wipes.
8. Expose the nappy area as often as possible and consider using a thin layer of barrier ointment in nappy area to protect the stratum corneum –ensure ointment is preservative-free and does not contain
anti-septic, fragrance or colourings.
9. Avoid the use of ointments/ lotions/ talc powder on the baby’s skin unnecessarily.
10. Ensure the umbilical cord is kept clean and dry, allowing it to be exposed to air as frequently as possible.

Dr. Joanne’s Q & A

Q: What is Vernix Caseosa?
A: Vernix is the sticky, whitish covering on the outer skin of a newborn baby. It is formed from the skin epithelial cells during the last trimester (6 months of pregnancy). It is said to be the ‘Natural Skin Cleanser & Moisturizer’ for the baby with important protective functions, preventing the invasion of harmful bacteria attaching to the skin as well as preventing excess water/ temperature loss to the environment.

Q: Do we need to remove this Vernix immediately after birth?
A: No need to. You could just wipe it off from baby’s eyes and mouth, but leave the Vernix on the skin over 24 hours.

Q: When would be the best time to give a newborn baby his/ her ‘FIRST’ bath?
A: Recommend to bath baby after day 2 or 3 post-delivery, when the baby’s temperature is more stable with less risk of hypothermia (low body temperature). For premature babies or a baby who is ill, it is best to delay the bathing until baby is more stable.

Q: What is ‘Top-Tail’ bathing?
A: Most hospital baby nurseries or neonatal units adopted this method to clean the baby’s skin, mainly cleaning baby’s face and buttocks.
i. Before starting, wash your hands clean with soap and running tap water.
ii. Place baby is a safe and flat changing mat or changing table.
iii. Soak some cotton balls into a bowl of warm water. Then squeeze the cotton balls dry.
iv. First, wipe the inner part of the eyes softly and spread to the outer eyes. Using seperate cotton buds for each eye.
v. Take another cotton ball to wipe the face, nose and mouth.
vi. Wipe the earlobes, back of the ears and neck area.
vii. You can then wipe the baby’s hands and feet with cotton balls or a piece of towel.
viii. Lastly, use a cotton ball to wipe the baby’s buttocks clean. You can apply a layer of the nappy barrier cream to the buttocks before changing a new diaper.

Q: If we bath our babies 2 to 3 times a day, will it give any effect to baby’s skin?
A: For the first 1 month of life, it’ll be enough to just bath a baby 2 to 3 times per week (once every 1 or 2 days). Babies don’t tend to sweat as much as a normal grown-up toddler. If we bath them too frequently, their delicate skin will lose the acidic protective barrier and its moisture.

Q: How do I make choices between different brands baby body cleanser in the market?
A: A good baby skin product should be non-fragrant without chemical ingredients that can irritate the skin. However, during baby’s first month of age, bathing with plain water will be sufficient.

Q: Is there any difference between cloth diapers versus disposable diapers in the prevention of nappy rash?
A: 17 collective reports in the Cochrane Review reported no difference between the usage among these two. Frequent changing of diapers and strong absorptive diapers are proven to reduce the risk of
nappy rash.

Q: Which nappy rash cream should I consider buying?
A: From my personal experience, I actually kept 3 different nappy rash creams for my little one. It’s more of preference with affordability of the purchase, there’s no one magic cream to suit all ‘bum bums’. The main factor is to consider having is a good habit of frequent washing of the buttocks each time your baby wees or poops (my boy poops up to 8 time per day!) remember to change their diaper before you go to sleep.. ZZzz

Please feel free to call KPJ Sabah Specialist Hospital 088-211 333 should you need more information or advice regarding to this topic.