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. 

FAQ About VACCINATIONS

By Dr Mohd Iqbal Iyen | Consultant Paediatrician | Jesselton Medical Centre

INTRODUCTIONS

Immunization is one of the most effective preventative health measures and has saved countless children from death or serious disability. However, misinformation may lead parents to hesitate or refuse to immunize their children. 

In the early stages of life, your child may be susceptible to various bacterial & viral infections which could affect their vital organs and bodily functions. Some of these pathogens cause mild complications while others may be terminal if left untreated.

WHAT IS VACCINES?

Vaccines provide pre-emptive immunity; while vaccination is the process of administering the vaccines into the body which can be done via injection, consumed orally, or through aerosol inhalation.

HOW IT IS WORKS?

Immunity is the body’s way of preventing disease. The immune system recognizes germs that enter the body (called antigens) and produces proteins called antibodies to fight them. Most of the time, the immune system isn’t able to work fast enough to prevent the antigen from causing disease, so the child still gets sick.

Nevertheless, the immune system “remembers” that particular antigen and if it reappears, the body will be ready and respond much faster next time round to prevent any infections. This protection is called IMMUNITY. Vaccination, on the other hand, helps your child develop immunity WITHOUT him/her getting sick in the process. Here’s how:

1. A weakened form of the disease germ is injected into the body

2. The body makes antibodies to fight these invaders

3. If the actual disease germs ever attack the body, the antibodies will return to destroy them.

TYPES OF VACCINES AVAILABLE IN MALAYSIA (LATEST IMMUNIZATION SCHEDULE 2016)

ARE VACCINES SAFE?

YES. In fact, experts agree that vaccines are even safer than Vitamins.

The most common minor side effects from vaccines are: swelling or tenderness at the injection site and fever; in which will resolve spontaneously within 48 hours post vaccinations.

IS IT SAFE TO HAVE MULTIPLE SHOTS?

YES. Getting vaccines is no extra burden to the immune system; even for babies. Scientific data shows that vaccination with multiple vaccines at the same time has no harmful effects on the normal childhood immune system.

WHAT ABOUT AUTISM?

Scientific studies have concluded that there is no link between vaccines and autism.

While the rates of autism continue to rise around the world, autism rates are no different in vaccinated and unvaccinated children.

Recent studies on autism suggest that children with autism have too many cells in a key area of the brain needed for communication, social and emotional development. This type of brain development occurs during the second trimester of pregnancy; LONG before a child gets any vaccinations.

WHAT ABOUT HOLISTIC MEDICINE AND BREAST-FEEDING? IS IT ENOUGH TO PROTECT YOUR BABIES?

Holistic medicines may be helpful for some conditions, but only vaccines provide specific immunity to diseases. Only vaccines have been scientifically proven to protect against whooping cough, measles, mumps, and other diseases. 

Breastfeeding is very healthy for your baby, but breastfeeding alone cannot fully protect babies from diseases like whooping cough or measles. Also, antibodies passed on from moms to babies during pregnancy do not last beyond infancy.

WHAT ABOUT “NATURAL IMMUNITY?

Some people think getting a disease is the “natural” way to trigger the body’s immune response, but this comes at a risk; many vaccine-preventable diseases can have dangerous complications, like pneumonia, blindness, brain damage, and even death. 

Vaccines safely trigger a natural immune response; but not the disease. Most vaccines are over 99% effective in preventing illness.

CONCLUSION

Having your child immunised; helps to protect them from many serious childhood infections, some of which may be life threatening. There’s no doubt that vaccines are the best option for both your child and the population at large. Com-pared to the risks of vaccinations, the complications of actually suffering vaccine-preventable diseases are much worse. 

Don’t wait, make the right decision and see your doctor to have your child immunised today. Don’t neglect booster shots, as they must be completed in order to effectively protect your child.

For more information, please contact Jesselton Medical Centre at 088-366 333 or 
for Emergency at 088-366 399. Find them at Metro Town, Off Jalan Lintas. 

Website: www.jmc.my

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. 

HAND FOOT MOUTH DISEASE

What Parents Must Know About Hand Foot Mouth Disease (HFMD)

DR. ANG SIANG CHIE | CONSULTANT PAEDIATRICIAN | JESSELTON MEDICAL CENTRE

“My Kid’s school was recently instructed to close temporarily for 2 weeks as there is currently an outbreak of HFMD. He has had fever for the last 2 days and now is drooling saliva and refuses orally. I have just noticed a few red dots on his palms… May I know whether my kid has HFMD?”

Often parents get worried about kids contracting hand, foot, and mouth disease (HFMD), unfortunately basic hygienic care in our community is still largely neglected hence leading to the spread of bugs.

What is hand, foot and mouth disease? 

Hand, foot and mouth disease (HFMD) is a common infectious disease of infants and children. It is a very contagious illness caused by viruses from the enterovirus family, most commonly caused by Coxsackie virus A16 which usually results in a mild self-limiting disease with few complications. However, HFMD can also be caused by Enteroviruses, including Enterovirus 71 (EV71) which has been associated with serious complications, and may be fatal.

How does it spread? 

These viruses live in the patient’s digestive tract and spread from person to person usually through unwashed hands and surfaces contaminated by stool of the infected person. Transmission also occurs by direct contact with nose and throat discharges, saliva or fluid from blisters.

How soon after exposure do symptoms appear? 

The usual period from exposure to onset of symptoms (Incubation period) is about 3–7 days. During this period, a child can remain well and asymptomatic.

Who is at risk for HFMD? 

EVERYONE who has not already been infected is at risk of infection, but not everyone who is infected becomes ill. HFMD occurs most commonly in children younger than 5 -6 years of age. Younger children tend to have worse symptoms. Children who attend daycare centers, schools, shopping centers or even playgrounds are at risk of contracting HFMD. Intra-family spread is also another means of transmission.

Can you be infected with HFMD more than once? 

Yes, infection only results in immunity to one specific virus, another infection may occur with another different virus type.

WHAT are the classical signs and symptoms and HOW serious is HFMD?

Fever : Lasting 24- 48 hours, is often the first symptom of HFMD. Children also experience malaise, poor appetite, and frequently have a sore throat.

Oral Ulcers : One or two days after fever onset, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the gums, tongue, and inside of the cheeks. That leads to drooling of saliva and often, children will have very poor oral intake, especially solids and semisolids.

Vesicle/Rashes : A non-itchy skin rash develops over 1–2 days with flat or raised red spots, some with vesicles typically with a red halo. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks.

A child with HFMD may not have symptoms, or some may have only the rash or only mouth ulcers which is also known as HERPANGINA.

How is HFMD treated? 

Presently, there is no proven treatment available for HFMD. It usually goes away on its own within a few days to a week. Acetaminophen (Paracetamol) can be given to help a child who is achy or irritable, or to ease painful mouth ulcers or discomfort from fever. 

A child who refuses solid food can be offered milk or even cold foods like ice cream and popsicles which help by numbing the area, and will be a welcome treat for kids who have trouble swallowing.

Besides, make sure children drink plenty of fluids to stay hydrated ( e.g: coconut water, barley water e.t.c). Discourage sour drinks as they contain mild acid which can cause more pain to the ulcers. Seek help if your child continues to be irritable, can’t be comforted, or seems to be getting worse or even looks dehydrated, with signs like a dry tongue, sunken eyes, or decreased urine output.

Children with blisters on their hands or feet should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and pat dry.

Can HFMD be prevented? 

There are no specific antiviral drugs or vaccines available against HFMD. Fortunately, the risk of infection can be lowered by good, hygiene practices and prompt medical attention for children showing severe symptoms.

Hand washing is the best protection. Remind everyone in your family to wash their hands often. Frequent handwashing with soap and water especially after touching any blister or sore, before preparing food and eating, before feeding young infants, after using the toilet and after changing diapers is very important.

Regular cleaning of contaminated surfaces and soiled items, including toys, first with soap and water, and then disinfecting them using a dilute solution of chlorine-containing bleach would help.

Avoiding close contact (kissing, hugging, sharing utensils) with children with HFMD may also help to reduce of the risk of transmission.

Keep infants and sick children away from kindergarten, nursery, school or gatherings until they are well (at least 1-2 weeks). Maintain good cough etiquette (covering mouth and nose when sneezing and coughing) disposing properly of used tissues and nappies into waste bins that close properly; maintaining cleanliness of the home, child care center, kindergartens or schools are steps to reduce the spread of HFMD

Even after kids recover, they can pass the virus in their stool for several weeks, so the infection still can spread to others.

***********************

For more information, please contact Jesselton Medical Centre at 088-366 333 or for Emergency at 088-366 399. Find them at Metrow Town, Off Jalan Lintas. Website: www.jmc.my

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
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Understanding Autism Spectrum Disorder

By Dr. Fauziah Zainal Abidin 
Consultant Paediatrician with special interest in Developmental Paediatrics
Gleneagles Kota Kinabalu Hospital 088-518 888


“Ahmad’s mother has been concerned about him for sometime now. At three years of age, he has not started talking like the rest of his siblings. He has not even called her “mama” and sometimes she was not even sure whether he can hear well. He hardly looked at her or responded to her calls. He would be quite happy being on his own rather than playing with his siblings.

He somehow finds watching the wheels of a moving car or the turning of a fan more fascinating than anything else. She is also concerned with his feeds. He does not like anything else with his rice and efforts to feed him the fried chicken or meatballs have resulted in almost battlefield like scenes and a
meltdown for Ahmad. She had talked to her husband and her own mother about her concerns but she would be reassured that he would “grow out of it” as one of her cousin’s did before.”

What is Autistic Spectrum Disorder?

Autism Spectrum Disorder (ASD) is a developmental condition which affects an individual in the areas of communication, social interactions and having restricted, repetitive patterns of behaviour, interests or activity. This affects the individuals ability to interact with others and they often find the world to be a confusing place as they have difficulty adjusting and adapting to new and unfamiliar people and surroundings.

They may also have sensitivity issues, either being too sensitive or less sensitive in any of the five senses, hence the preference for or avoidance of certain foods, noises, clothing or even certain lights. Every individual with ASD is also different. The term itself reflects that no two people with ASD are alike, even though they all have difficulties in communication and socialisation, each will have a unique combination of character and so may seem quite different.

ASD affects around one in every 100 people and is diagnosed 4 to 5 times more common in boys than in girls. Although it is a life long condition and there is no cure, early intervention can have a tremendous results in helping those affected to live to their full potential.


What are the causes?

There is no known direct cause of Autism. Much research is being done to try to find out more of the cause but at this point it is believed to result from changes in the brain development which may be caused by a combination of genetic factors and environment. ASD is known to run in families but no specific genes have been determined so far. ASD is not caused by parenting or social circumstances. Various reputed research has been done to prove than ASD is NOT cause by vaccines or other medical treatments.

Assessments and diagnosis

Whilst receiving a diagnosis can be distressing or a heartbreak for most families, sometimes it can come as a relief to all their questions and worries before. For the young children, diagnosis leads to acceptance and empowerment for their parents to seek assistance and can dramatically improve their outcome. There are no laboratory or imaging tests that diagnose Autism. Diagnosis are made based on the ability of the individual in the main area of concern ie. social and communication and behavioural patterns.

For older children and adults, a diagnosis can help to explain why they feel different and allow them to access support and assistance to improve their quality of life. Developmental Paediatricians, Psychiatrist, Clinical Psychologist are trained to diagnosed individuals through a series of clinical evaluation and assessments.

Experts disagree about the true increase in ASD prevalence. More awareness about ASD leads to parents become more likely to take their children to be diagnosed and more doctors now are able to properly diagnosed ASD.

Living with ASD

ASD causes individuals to struggle to understand and relate to other people and environments. This can often result in extreme behaviour, such as tantrums in a young child or rudeness in older individuals. It is the only way they can cope with their stresses and feelings of anxiety. Parents on the other hand are often perceived as bad parents who are unable to control their children from behaving badly.

Adults with ASD also struggle with social situation and ‘small talk” They may appear rude, overly critical and awkward. They will have difficulty in forming relationships and maintaining friendships. Parents may feel unprepared or doubtful of their ability to provide the necessary care and education.

On a positive note, there are many treatment options, social services and programmes that can help. The problem is usually how to get access to them. Meeting with a healthcare provider or an educator can be a good source of information. Talking to an Autism Support group can help find local resources.

Meeting with a Paediatrician can help evaluate a child’s development and rule out other problems that may be helped and subsequently referred to the other experts who will develop an intervention plan for the child. Going through the transition to adulthood should be dealt with together with family members, healthcare service providers and other professionals.

Communications and reports should be kept well. Some adults with ASD are able to achieve independence to a certain extent thus self-advocay is an important aspect for individuals and family members with ASD. Through Self advocay, they may take on more responsibility for their education, employment, health care in their own community and else where.


For more information about this topic, please feel free to contact Gleneagles Kota Kinabalu Hospital at 088-518 888 

Sex and Pregnancy

By Dr. Alagammai Ramanathan | Consultant Obstetric & Gynaecologist
Gleneagles Kota Kinabalu Hospital (Tel: 088-518 888)

Sex is considered a taboo subject especially for Asian community. Both women and men are just too shy to bring the subject up for discussion and hence do not get accurate information on this subject be it.

Most women wait at least six to eight weeks after giving birth to have sex again, according to a new study published in BJOG: An International Journal of Obstetrics and Gynaecology. It may also be the absolute last thing in your mind especially while you are dealing with nausea and vomiting and later on with the baby, breast feeding and diaper changings through the night.

Most women avoid sex during pregnancy for the fear of losing the baby. It is good to take time and
discuss it with your partner as intimacy is an important part in life. Other women, however, may crave sex in pregnancy. And men, too, are split into different groups regarding sex during pregnancy. Some men may find nothing sexier than a pregnant woman, but other men may be too afraid of hurting the baby. But desire aside, is sex during pregnancy even safe?

Can I have sex during pregnancy?

A lot of times the male partners are more frightened to have sex than the women. In most cases, sex is 100% safe for mom and baby. During the first trimester most women needs to deal with nausea, vomiting and hormonal changes to the body so sex may be the last thing in your mind. During the second trimester women most feel better, there is more lubrication, and have engorgement in the genital area and the tummy is not so rounded yet. This is usually the best time.

As for third trimester the stomach grows and it becomes more tiring, sex may seem less attractive- not to mention physically difficult during the final weeks of pregnancy. There are some exceptions, which your gyny doctor will warn you about. Among other issues is, if you have an incompetent (or weakened) cervix, unexplained bleeding, diagnosed with placenta previa, frequent premature contractions with no known cause or rupture of the amniotic membranes. The best will be to discuss with your gyny doctor along with your partner. It is important for both partners to be there during this session.

Sex can hurt the baby?

Babies are well cushioned. Below the skin is our fat layer, followed by muscles, thick uterine muscles, amniotic fluid only then the baby. As there is water surrounding the baby, it is well cushioned and most movements do not harm the baby. So go ahead! babies are very safe inside the womb and the jolt will not affect the baby.

Can infection occur due to sex?

Well from below the cervix is closed and it has a mucous plug to seal and hence infection does not enter into the cavity. So it is safe. Same goes for swimming, it is ok to swim during pregnancy, the water does not enter the vagina and into the uterus and harm the baby, so there is no need to change your lifestyle. In fact swimming is a good form for exercise during pregnancy.

Can I develop contractions during sex and will that lead to delivery prematurely?

If you start cramping after sex, don’t jump. An hour or two of mild cramps isn’t unusual because both orgasm and the prostaglandins in semen can cause uterine contractions. Increased blood flow and congestion makes blood vessels more fragile on the cervix surface, and they may bleed a bit if
your partner’s penis rubs against the cervix.

However, heavy bleeding warrants call to your gyny because the placenta could be breaking away from the uterus and other causes needs to be looked into for example a cervical growth. But don’t worry - it’s all unlikely to happen. Having an orgasm causes the release of prostaglandins, which can theoretically cause contractions, unfortunately never been completely validated in scientific studies. Does it work? Well...if you’re ready to deliver, a little sex might jump-start the process.

Sexual positions during pregnancy.

This is by far the most difficult question to answer. Well usually what is good and comfortable for the baby is good and comfortable for you. The traditional man-on-top position is more uncomfortable for pregnant women and in the 3rd trimester it is not advisable for women to be flat on the back as the pregnancy can compress the blood vessels and cause a little fall in the blood pressure.

If possible avoid oral sex as bowing air into the vagina may predispose to air embolism though it is very rare.

You can have satisfying sex when pregnancy. You will need to find the most comfortable position, it is the time to explore and experiment together. Communication and openness are the keys to maintaining or improving sexual satisfaction during your pregnancy.

Riverson@Sembulan Block A-1, 
Lorong Riverson@Sembulan, 
88100 Kota Kinabalu, Malaysia
Tel: 088-518 888 
Website: www.gleneagleskk.com.my
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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.

Gastro-oesophageal Reflux in Infancy

Blergggh!! Regurgitation in young infants - should I be worried?

By Dr. Alvin Khoh, Consultant Paediatric Gastroenterologist

Gleneagles Kota Kinabalu Hospital | Tel: 088-518 888

A newborn baby!

Congratulations all around! The birth of a child is definitely a joyous occasion for the family. One can spend hours just staring at a newborn baby - watching every expression and every movement that the baby makes. And then suddenly, the baby regurgitates out its milk! And not for the first time. The baby seems to regurgitate various amount of milk every now and then.

The above scenario happens quite frequently to many newborn babies and causes a lot of distress among parents. Various unhappy thoughts would often come into mind: Will my baby have enough milk, since he seems to “vomit” everything out? Will my baby grow well? Am I feeding my baby correctly? Is there anything wrong with my baby’s digestive system? Will the milk go into my baby’s lung and cause damage? Should I change formula? Thankfully, for the majority of these babies, these episodes of regurgitation are not harmful to them.

Gastro-oesophageal reflux (GOR) is a common condition and is a normal phenomenon in healthy babies. Reflux happens when there is movement of stomach content back up into the oesophagus. The oesophagus is the food tube that carries food from our mouth into our stomach. When reflux happens in babies, the milk may regurgitate all the way up into the mouth. This manifests as regurgitation or “posseting”.

Many parents often perceive these episodes of regurgitation as vomiting. From a doctor’s perspective, vomiting occurs when there is a forceful contraction of the stomach, leading to emptying of the stomach content out through the mouth. Usually, vomiting is a symptom of an underlying illness.

Compared to vomiting, the process of regurgitation is effortless and occurs spontaneously. Some babies regurgitate more than others - this does not necessarily mean that anything is wrong. It does not harm your child and is unlikely to cause problems in later life.

Why does reflux happen in babies?

The lower oesophageal sphincter (LES) is a muscle the closes the oesophagus from the stomach after we swallow. In babies, this muscle relaxes more frequently, thus allowing the stomach content to reflux upwards into the oesophagus. Studies have shown that a healthy baby can reflux up to 30 times a day, although not all reflux leads to visible regurgitation. Most babies tend to regurgitate at least once per day, although in some, it can be as frequent as after every feed. It mostly happens after feeding, but it can occasionally occurs at other times, e.g. after coughing or crying.

For most babies, you don’t have to do anything about reflux and regurgitation. It is a natural process and will resolve by itself with time. This is because as the baby grows, the oesophagus gets longer, the stomach grows larger and more importantly, the lower oesophageal junction also becomes more mature and stronger. After 6 months of age, an infant also starts to take more solids and spend more time sitting upright, and this will also lead to an improvement in symptoms. Generally, the problem disappears around 1 year of age.

When should I worry about my baby’s reflux?

Generally, if parents have any concerns or uncertainty about their baby, they should seek medical advice. You should also seek treatment if your baby has the following:

• blood or bile (greenish) in the vomit
• fever, unwell, irritable
• choking episodes
• breathing difficulty or fast breathing
• not gaining weight or losing weight
• feeding refusal

What is the treatment for reflux?

In most babies with reflux, there is NO need for medical treatment. As mentioned before, reflux is a normal phenomenon and will get better over time. However, the following practice may help in some

babies with frequent regurgitation.

You should regularly burp your child after each feed. In babies with more frequent regurgitation, some parents find it helpful if they stop and burp their baby midway, or hold the baby upright for 20 to 30 minutes after each feed. You can also try giving smaller and more frequent feeds, but definitely avoid overfeeding, especially with bottle-feeding.

Changing from breastfeeding to bottle feeding/formula is NOT RECOMMENDED as it does not have effect on reflux. If your baby is already on infant formula, it is also not recommended to routinely change formula for the same reason. There are some special infant formulas in the market that may reduce the frequency of visible regurgitation, but it is generally better to consult your doctor first before switching formulas.

Gastro-oesophageal Reflux Disease

In a small percentage of babies with reflux, it can lead to problems. This is when doctors call it Gastro-oesophageal Reflux Disease. These babies may have breathing problems due to milk aspiration, or sometimes poor weight gain. In these group of babies, the doctor may start some

medication or suggest the use of a special thickened infant formula.

Conclusion

Regurgitation or reflux is a common problem in young infants. In most cases, it does not cause harm to them and will improve with time. It does however cause parents to be distressed and often leads to

tired parents from constant washing and mopping up. It is best to seek professional advice is you are worried about your baby’s condition.


Please feel free to call Gleneagles Kota Kinabalu Hospital 088-518 888 should you need more information or advice regarding to this topic.