Inovatif

Tag: Health

  • Restoring Symmetry – What is Breast Reconstruction?

    Restoring Symmetry – What is Breast Reconstruction?

    Dr Rica Farah Muhammad Abdullah Ichihashi, a consultant plastic and reconstructive surgeon at ParkCity Medical Centre, debunks the misconception that breast reconstruction is cosmetic or aesthetic, and explains that it is actually a procedure to restore the original breast form and symmetry.

    For women in Malaysia, breast cancer is one of the most common forms of cancer that affect them. Treatment for breast cancer sometimes includes mastectomies where part or the entire breast is removed. After the procedure, women have the option of undergoing breast reconstruction.

    Speaking to Calibre, Dr Rica acknowledges that while breast cancer patients are a main group of people that undergo breast reconstruction, any woman whose breasts have been disfigured or mutilated in some way can benefit from reconstruction.

    Consultation & Methods

    Dr Rica explains that more often than not, surgeons treating breast cancer patients would advise and educate their patients on what kind of breast reconstruction procedure to do. “It’s not really something that the patient themselves can choose, because they wouldn’t know what would be best for the situation they are in.”

    Dr Rica Farah Muhammad Abdullah Ichihashi ParkCity Medical breast reconstruction
    Dr Rica Farah Muhammad Abdullah Ichihashi

    Mainly there are three methods—an implant reconstruction whereby a saline or silicone implant is inserted, an autologous or flap reconstruction that uses a patient’s transplanted tissue, or sometimes a combination of both. Because there is also an exhaustive variant of techniques that can be used, some of which aren’t Googleable. It is best for the surgeon to determine which method is best for the patient based on their assessment. An open and comfortable consultation between the surgeon & patient is important. The decision for breast reconstruction and the type would be a joint discussion between the plastic surgeon, the patient and in some situations her family and loved ones.

    For breast cancer patients, Dr Rica stresses the importance of a quick recovery so that the patient’s cancer can be treated, which is the priority. “The aim is for an uncomplicated, quick recovery so patients are ready for any other cancer treatment such as chemo or radiotherapy.”

    Timing & Recovery

    Much like the method, Dr Rica mentions that the timing of the procedure can also vary and is dependent on many factors. Apart from the surgeon’s skill set, other factors to take into consideration are the methods used and the number of surgeons working on the patient at any one time.

    “Sometimes the reconstructive surgeon is the same surgeon taking out the patient’s tumour, so that procedure would evidently take up more time. But sometimes, if two surgeons are working simultaneously, the procedure would be completed quicker. Timing is quite subjective.” On average however, Dr Rica says a typical breast reconstruction surgery can take between an hour and a half to three to four hours.

    “Post surgery, most patients don’t stay in the wards for more than a week. They would return after being discharged a week later for a follow up and to remove their stitches, and more often than not, they are fully recovered between a month to six weeks.”

    As breast reconstruction is a surgery that’s meant to restore symmetry of the breast, there isn’t much change or adapting for the patient post-surgery. They are able to wear the same bras and clothes as before and if needed, proceed to undergoing their breast cancer treatments.

    “Patients are usually also very concerned about pain, but seeing as everyone’s pain threshold is different, I would say it is subjective,” Dr Rica remarks. “Generally however, most patients are home within the week.”

    Considering the Risks

    Like other surgeries, breast reconstructions have similar risks but also some that are specific to this particular procedure. The risk of asymmetry is more common with implant reconstructions, and also carries an increased risk of the rare cancer, anaplastic large cell lymphoma (ALCL). “If a patient undergoes radiotherapy post-reconstruction, they could sometimes be subjected to slight impact on the skin from the radiotherapy,” Dr Rica says.

    With autologous reconstructions, some risks are blood clots, necrosis of the transplanted tissue and weakness, pain or sensitivity around the donor sites. The interruption of the blood flow also can impact the way the tissue recovers post-reconstruction. However, since the tissue is the patient’s own, Dr Rica mentions that recovery might sometimes be faster with autologous reconstructions, and it might also yield better results. Some risk also include interruption of the blood flow to the reconstructed tissues, pain or sensitivity around the donor site.

    Making an Informed Choice

    Breast reconstruction offers women an opportunity for better quality of life, which is pertinent after going through an ordeal such as a mastectomy. By offering women this sense of normalcy after the loss of a breast, the procedure is one that is both healing and empowering. With so many considerations and risks to assess, it is important that women make informed choices about the procedure they choose to undergo, and to also be comfortable with the surgeon they consult with in order to get the best possible care.

  • Learning More about Kidney Cancer

    Learning More about Kidney Cancer

    Dr J.R Sathiyananthan, a Consultant Urologist at ParkCity Medical Centre, explains about kidney cancer and the measures that can be taken to minimise the risks of getting it.

    Kidney cancer is a disease in which malignant tumour is found in one  or both kidneys.

    Kidney cancers account for a small proportion of all cancers, and the insidious nature of it makes early detection difficult.

    In 2010, kidney cancer was reported to affect 1.9 in every 100,000 Malaysians, while 2020 data from World Health Organisation showing 2.1 per cent of all cancers in Malaysia to be kidney cancer.

    Types of kidney cancer

    “Kidney cancer is generally divided into two—primary and secondary kidney cancer.

    “Primary kidney cancer comprises renal cell carcinoma, which accounts for 90 per cent of all kidney cancers, and other rare cancers such as lymphoma or medullary and collecting duct cancers.

    Dr J.R. Sathiyananthan ParkCity Medical Centre kidney cancer
    Dr J.R. Sathiyananthan

    “Secondary kidney cancer originates from cancers in other organs such as breast and colon. This in turn spreads to distant organs such as liver, lungs, and the kidney. This is not considered kidney cancer per se.,” says Dr Sathiya.

    Although there are instances when kidney cancers are caught early, most are diagnosed at a more advanced stage. This is due to a variety of reasons, including the cancer being localised and growing without causing any pain or symptoms. Besides that, the nature of the kidneys lying deep within the body, small kidney tumours cannot be felt during a physical exam.

    “At times when we examine patients for kidney cancer, it may have progressed to be locally advanced. Patients may have come in with flank pain, blood in urine, and sometimes the cancer is large enough to be palpable. The definite test which can confirm this is a contrasted multiphase CT scan, an imaging tool that provides accurate diagnosis. Besides that, percutaneous biopsies are also used in some circumstances to confirm the diagnosis and exclude metastasis from other cancers, bilateral cancers affecting both kidneys, or possibly benign tumours,” explains Dr Sathiya.

    How the disease progresses

    Currently there are no recommended screening protocols for kidney cancer in people who are not at increased risk. As of now, no screening test has shown to lower the overall risk of dying from kidney cancer.

    Kidney cancer is known in some instances to grow aggressively and invade the surrounding bowel and solid organs, which is called local extension.

    Other methods of progression could be blood borne, and spread to the lungs, liver, pancreas, lymph nodes, and bone. This is referred to as metastasis. When metastasis occurs, the outcome is expected to be poor as patient may not benefit from surgery.

    The spread could occur anywhere between six months to years depending on the type of kidney cancer. Clinical data suggests that cancers larger than 3cm have higher tendency to spread compared to smaller ones. Nonetheless, the more common renal cell carcinoma has a slow progression rate compared to the rarer varieties, leading to the possibility of better outcome.

    Treatment options

    “Localised kidney cancer can be treated by surgery. This can be done by removing the entire kidney, also known as radical nephrectomy, or removing only the tumour, with multiple factors taken into consideration prior to this decision. For metastatic kidney cancer, there is evidence that removing the kidney may benefit the long-term systemic treatment, and it is still an evolving area. For those with advanced cancer where surgical options are not available, arterial embolisation to block blood supply to the tumour can treat some symptoms,” describes Dr Sathiya.

    Although radical nephrectomy has been the mainstay of treatment for kidney cancer, the last 20 years has seen partial nephrectomy being the treatment of choice for most patients. This can be performed by open surgery, keyhole (laparoscopic) surgery, or robotically with the Da Vinci robot. The newer treatments include cryoablation and radio-frequency ablation, which can be used for tumours smaller than 4cm. Larger tumours may require multiple treatments.

    “However, the evidence for the newer treatments is not strong and only supported by inferior clinical trials. Nevertheless, they are a viable option for weak patients who are unfit for surgeries or could be used in combination with surgery in familial kidney cancers where multiple tumours are found within the kidney,” Dr Sathiya elucidates.

    Since it’s difficult to catch kidney cancer early, what can people do?

    “The known risk factors associated with kidney cancer are smoking, obesity, and hypertension. If you can avoid those or keep them in check, you could reduce the chances of getting kidney cancer.

    “Those who are at risk, for instance known family history of kidney cancer, should be aware of the symptoms and perform regular screening by ultrasound, blood, and urine test as prescribed by your Urologist,” highlights Dr Sathiya.

  • Preventing Cardiac Catastrophe

    Preventing Cardiac Catastrophe

    Dr Chong Yoon Sin, a Consultant Cardiologist at ParkCity Medical Centre highlights the effects of heart disease and the importance of its prevention.

    Heart disease has long been acknowledged as a silent killer in Malaysia, affecting a large number of the population each year. According to the Department of Statistics Malaysia, heart disease is the main cause of death among Malaysians and has remained so for the past fifteen years. In 2019, 16,325 victims of heart attack made up 15 per cent of medically certified deaths. Furthermore, the onset age for heart disease has also alarmingly lowered in recent years, with the disease being the leading cause of death for people aged between 15 and 64 years old.

    Although there are many ways in recent years to catch heart disease quickly and ample treatment options available for patients, the adage “prevention is better than cure” holds true for the disease.

    Understanding Heart Disease

    Ischemic heart disease, also called coronary heart disease (CHD) or coronary artery disease (CAD), is the term given to heart problems caused by narrowed coronary arteries that supply blood to the heart muscle. A heart attack, or myocardial infarction, occurs when the blood supply to part of the heart muscle is severely reduced or stopped. This occurs when one of the coronary arteries is blocked by an obstruction, such as a blood clot that has formed on plaque due to atherosclerosis.

    Dr Chong Yoon Sin
    Dr Chong Yoon Sin

    When the blood supply is cut off drastically or for a long time, the heart’s muscle cells suffer irreversible injury and die, causing disability or death to the patient depending on how much of the heart muscle is damaged.

    “Sometimes, a coronary artery also temporarily contracts and goes into spasm, causing it to narrow and decrease or stop the blood flow to part of the heart muscle. The spasm can occur in blood vessels blocked by atherosclerosis or regular blood vessel, and when severe causes heart attack,” says Dr Chong.

    Effects of Heart Disease

    It is important to know the warning signs of a heart attack: chest pain, breathing difficulty, profuse sweating, giddiness, epigastric pain, and loss of consciousness. If you notice yourself or someone around you experience these symptoms, it is important to immediately rush to the hospital for treatment.

    “Upon treatment, recovering after a cardiac arrest is a process that requires patients to be committed to avoid a repeat of the incident. Most of the time, after a heart attack, there will be some degree of muscle damage. If the damage sustained by the heart is small, patients will be able to return to an almost normal life except for a stricter diet and medication. However, if the damage is significant, the heart will be weak, causing patients unable to exert themselves as much as they were able to before. Other effects even include breathlessness and inability to drink a lot of water immediately,” explains Dr Chong.

    Preventing Heart Disease

    In Malaysia, heart disease is proven to be caused by the sedentary lifestyle led by a large portion of the population. In addition, Malaysians are also prone to various heart disease risk factors, such as smoking, obesity, hypertension, diabetes, and high cholesterol.

    Many scientific studies show that certain characteristics increase the risk of coronary heart disease, with the four major modifiable risk factors being smoking, high blood cholesterol, high blood pressure and physical inactivity. It is crucial that people control their modifiable risk factors to keep heart disease at bay. Furthermore, if you experience chest pain continuously even if you practise a healthy lifestyle, it is vital that you pay a visit to the doctor.

    “Nowadays we’re seeing patients in their 30s with heart disease due to their lifestyle practices. That’s why I always emphasise on the importance of early detection by going for screenings especially if you have lifestyle or genetic risk factors. It is also important to lead a healthy lifestyle by always exercising at least 30 minutes every day, not smoking, practising a healthier diet by eating more vegetables, fruits, lean meat, fish, beans and so on. Also, cut down on high-fat food, always stay hydrated, and manage your stress better. Once you practise a healthy lifestyle and go for screenings consistently, you will be fine,” assures Dr Chong.

  • Eyes Wide Open for Squint Eye

    Eyes Wide Open for Squint Eye

    Squint eye or strabismus can be found in both children and adults, with each of the categories developing it due to a variety of reasons. With squint eye, the key is early detection and treatment, for the benefit of vision as well as the self-esteem of the patient. Dr Norazah Abdul Rahman, a Consultant Ophthalmologist and Paediatric Ophthalmologist & Strabismus at ParkCity Medical Centre, shines the light on the importance of early treatment of strabismus, especially for children.

    By Esvaren Sekar

    Strabismus is the medical term for the condition where the eyes point in different directions, resulting in misalignment of the eyes. There are few different types of squint: convergent squint (esotropia) when one eye turns inward, divergent squint (exotropia) when it turns outward, and vertical squint if the eye turns up or down. These types of squint could always be present or only appear intermittently at certain times.

    Squint Eye in Children

    “Squint eye usually appears in children before five years old, but it can also appear later. And it is not limited to children either, as adults can develop strabismus too. Though the main reason for strabismus is unknown, children with disorders that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus, and brain tumour have higher chances of developing strabismus,” says Dr Norazah.

    In Malaysia, one of the most common cases of strabismus is intermittent exotropia, a condition which allows patients to have straight, aligned eyes when they’re focused, but an eye will begin drifting away intermittently when they are ill, tired or daydream. Once they focus again, the eye will immediately go back to the normal position. Accounting for up to 30 per cent of all ocular misalignment in early childhood, intermittent exotropia starts to develop in a child between one and four years old.

    In addition, another common case is undiagnosed refractive error among children causing acquired squint. For example, when a young child suffers from long-sightedness and has problem focusing on items that are near, they will start forcing their eyes, causing the eye to squint inwards.

    “With children, it is very important for parents to keep an eye out for these signs. Children can be born with squint (known as congenital or infantile squint) and we can detect it as early as four months after being born. Most squints in children need to be evaluated as soon as possible to ensure the vision is protected and to improve the chances of successful treatment. Treatment is to improve eye alignment, and may involve glasses, eye exercises, prism, and eye muscle surgery. If your child has a lazy eye, they may even need to wear an eye patch to improve vision in the affected eye.

    Squint Eye in Adults

    Dr Norazah Abdul Rahman

    For adults, squint eye could either be caused by issues that occur later in life or due to hidden squint eye during childhood that was left untreated.

    “In younger population, we often find decompensated squint, which happens when an adult has squint at an early stage of life, but they managed to control it. So, the squint becomes masked. However, throughout their life, these adults might encounter any events and the squint becomes decompensated causing it to develop again. Most of the time it is trauma related, such as a motor vehicle accident,” explains Dr Norazah.

    Apart from that, stroke also plays a part in squint eye in adults, as the nerve that controls the movement of the eyes in the brain becomes affected. A sign of squint eye in adults is also the appearance of double vision.

    “Most adults who grow up with squint eye due to a lack of awareness. Adults with strabismus may have lack depth vision (3D) or stereopsis, which limits career opportunities. Furthermore, growing up with squint eye may cause the child to be bullied, resulting in low self-esteem as an adult,” says Dr Norazah.

    Treating Squint Eye

    Squint eye in children must be corrected early. “When a child has squint, we first look at non-surgical options for squint correction. For example, if they have refractive error, we give them glasses. A lot of children have good outcomes with glasses and the squint disappears. Some still have squint with glasses but decreases significantly, and we try to correct residual squint with surgery. In some cases, corrective surgery may be undertaken to correct double vision or, in young children, for the two eyes to work together to achieve depth vision,” explains Dr Norazah.

    Meanwhile, adults with squint eye may receive glasses with prism if the angle of their squint is small. Nonetheless if they suffer from headaches or double vision, surgery is the go-to step.

    “It is important for parents to not be afraid of sending their child for surgery if it is needed to treat squint eye. Not only is it very safe, but it will also help the child grow up to their full potential,” assures Dr Norazah.