What is Obstructive Sleep Apnea (OSA)

Good sleep is essential to ensure an efficient and effective performance of your daily activities. A normal adult requires an average of 8 hours of sleep per day. That is one third of our lifetime!

WHAT IS SLEEP APNEA?

Sleep apnea is a condition characterized by multiple brief interruptions or cessation of breathing during sleep. It is increased with obesity and age and estimated to affect 5% of the adult population. The commonest form of obstructive sleep apnea (OSA).

WHAT HAPPENS DURING OSA?

osha

Apnea can occur when excess tissue in the upper airway, such as abnormally large tonsils, blocks the airway during sleep. Apnea can also occur when the tongue or throat muscle relax too much leading to the collapse/closure of the upper airway.

RECOGNIZING OSA

  • Loud snoring
  • Cessation of breathing during sleep (apnea)
  • Choking, gasping, snorting during sleep
  • Restless sleep
  • Excessive daytime sleepiness (Epiworth Sleepiness Scale)
  • Morning headache
  • Dry mouth
  • Poor concentration and short term memory
  • Decreased libido

WHAT HAPPENS IF NOT TREATED

  • Hypertension
  • Stroke
  • Ischemic heart disease
  • Gastro esophageal reflux disease
  • Depression
  • Diabetes mellitus
  • Increased risk of motor vehicle accidents in drivers

WHAT CAN I DO

  1. You need to undergo a physical examination and assessment by a physician
  2. You would then undergo an overnight sleep study (polysomnography [PSG]). This can be performed either at your home or at a hospital.
  3. The PSG would provide your doctor with details of your sleep pattern, breathing disturbances and blood oxygen level. Treatment will depend on the severity of the condition. Most patients will require the use of a Continuous Positive Airway Pressure (CPAP) machine during sleep to relieve the obstruction and symptoms.

The Epworth Sleepiness Scale is a simple way of accessing the degree of sleepiness. The higher the score (>10), the greater the likelihood of you suffering from sleep apnea.
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Rate yourself in these situation. Chances of dozing from scale of 0-3

  1. Sitting & Reading
  2. Watching TV
  3. Sitting, inactive in public places
  4. As a passenger in a car for an hour without a break
  5. Lying down to rest in the afternoon when circumstances permit
  6. Sitting & talking to someone
  7. Sitting quietly after lunch without alcohol
  8. In a car, while stopping for a few minutes in the traffic

Note: Not all people with OSA experience daytime sleepiness. If you did not score in the higher ranges but you have concerns about your sleep, talk to our Specialist. Our Consultant Physician, Dr. Lau Wee Ming specialises in Sleep Study. She is available by appointment on Wednesday and Saturday. For more information, please call 603 – 6141 8533. 

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Understanding the different types of diabetes

The number of people afflicted by diabetes has risen significantly in recent years. What is your understanding of diabetes?

THE main sugar in the body is blood glucose, which comes from consumed food and is also made in the liver and muscles.

After a meal, blood glucose level rises. The cells in the pancreas, which is an organ in the abdomen, are stimulated to release a hormone called insulin into the bloodstream.

The insulin then attaches to the body’s cells and signals them to absorb glucose from the blood and use it for energy.

Sometimes, the body does not produce enough insulin, or the insulin does not function as it should. When this happens, glucose remains in the blood and does not reach the body’s cells. Its level rises, causing diabetes mellitus, which is a lifelong condition.

Many people have blood glucose levels above the normal range, but not high enough to be diagnosed as diabetes. This is a condition called pre-diabetes.

If the blood glucose level gets above the normal range, the risk of developing full-blown diabetes is increased.

It is important that diabetes is diagnosed and treated as early as possible because it will only worsen with time. If untreated or treated inadequately, it will cause multiple health problems.

According to the National Health and Morbidity Survey (NHMS) IV in 2011, the overall prevalence of diabetes was 15.2%. The prevalence was highest among Indians (24.9%), followed by the Malays (16.9%) and Chinese (13.8%). There were no gender differences.

The overall prevalence of known diabetes was 7.2%, and undiagnosed diabetes 8.0%. The prevalence of impaired fasting blood glucose was 4.9%.

The overall prevalence of diabetes among adults above 30 years rose from 8.3% in NHMS II in 1996 to 14.9% in NHMS III in 2006. This has significant implications for the healthcare delivery system.

Types of diabetes

There are two types of diabetes: type 1 and type 2.

Type 1 diabetes is caused by attacks of the body’s immune system on the pancreatic cells that produce insulin. Since no insulin is produced, the blood glucose is raised.

Type 1 diabetes is often called insulin-dependent diabetes. It usually develops before the age of 40 years, often when the sufferer is in the teens. Its incidence is a fraction of type 2 diabetes.

All type 1 diabetics require insulin for the rest of their lives. In addition, there has to be a healthy lifestyle to ensure that blood glucose remains within normal limits.

Type 2 diabetes is caused by insufficient production of insulin, or the failure of the body’s cells to respond to insulin. The latter is called insulin resistance. It usually develops after the age of 40 years and its incidence is about four to five times that of type 1 diabetes.

It is often associated with obesity. It is controlled by a healthy diet, regular exercise, and eventually, medicines – usually tablets. Medicines are often required at some stage because type 2 diabetes is a progressive condition.

Features of diabetes

The signs and symptoms of diabetes include feeling thirsty, hungry and/or tired; passing urine more often than usual, especially at night; weight loss without attempting to lose weight; loss of muscle bulk; feeling pins and needles in the feet; losing feeling in the feet; blurred vision; wounds that heal slowly; and itching around the genitalia or frequent fungal infections.

There may be no signs or symptoms in some people, or if there are symptoms, they are usually vague.

The only way to confirm a diagnosis of diabetes is to have a blood test.

There are two tests used to diagnose diabetes: fasting blood glucose and glucose tolerance test.

Fasting blood glucose is a reliable diagnostic test. A single blood sample is taken after an overnight fast. The normal levels are below 6.0 mmol/L. Levels above 7.0 mmol/L on two or more occasions is indicative of diabetes, and no other tests are needed.

A glucose tolerance test (GTT) is done after an overnight fast. Blood is taken for the fasting blood glucose, followed by consumption of 75g of glucose, with blood samples taken on two or four subsequent occasions within a period of up to two hours, to measure the blood glucose.

The levels rise and then fall rapidly in a non-diabetic. In a diabetic, it increases to a higher level than normal and does not fall as rapidly. The body’s response to a GTT may vary and requires interpretation by a doctor.

Blood tests are just part of the information required. The doctor will also consider the patient’s history and physical examination findings in planning the diabetic’s management.

Gestational diabetes

The placenta in a pregnant woman produces a hormone called human placental lactogen (HPL), which modifies maternal handling of carbohydrates and lipids as it makes the body less sensitive to insulin, thereby raising the mother’s blood glucose level.

HPL raises the blood glucose level so that the foetus gets enough nutrients from the extra glucose in the blood.

Another hormone, called human placental growth hormone, is also produced in pregnancy. It also ensures that the foetus gets enough nutrients by raising maternal blood glucose levels.

It is normal for maternal blood glucose levels to increase a bit during pregnancy because of the effect of the placental hormones.

However, sometimes, the increase is too high. This condition is called gestational diabetes. It usually develops between 14 and 28 weeks of pregnancy, and disappears after the baby is born.

Gestational diabetics are at increased risk of developing type 2 diabetes later in life.

It is more common in women who are above 25 years, overweight or obese, have a family history of diabetes, or who had gestational diabetes in a previous pregnancy.

Gestational diabetes could increase the risk of problems for the foetus, and also worsen type 1 diabetes. As such, it is important for a gestational diabetic to keep her blood glucose levels under control.


Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

甲状腺癌

电脑断层扫描显示着一粒甲状腺肿瘤,以及左边锁骨断裂。

桌上的病理报告分析了锁骨上的细胞,说是甲状腺癌症。

办公室内已空无一人死寂空洞,就好像我的心空空荡荡的一片。夜已深,外面走廊的灯已经熄灭,只剩下远处电梯间有些光亮隐隐约约照亮了廊道的一角。我在座位上发呆了不知多久。现实就是如此的无常,大意的摔了一跤,竟然摔出了个癌症,还要是末期癌症。我每天庸庸碌碌忙工作为赚钱,就连假期都在公司开会谈交易签合同,从来不做伤天害理之事。为什么那些恶人全都活得好好的,我们这些好人却要受病魔所折磨。

较早前诊所的情景历历在目。

郑生,我建议你尽快动手术,张医生言犹在耳:先切除甲状腺,再用放射碘清除其他扩散的癌细胞。

医生,手术的风险高吗?治愈的机会又有多少我慌张的问。之前张医生那电视剧般的开场白似乎已经暗示了这个坏消息,但是一当听到癌症、手术等字眼时,我的心还是狠狠的抽了一下。

有没有其他人陪伴你过来,张医生直视我双眼,握住了我的双手,让我感到一股真诚的安慰:情况比较复杂,通常在多点家人的支持鼓励下所做出的决定会比较理性。

我老婆孩子都还不知道,我听见自己软弱的声音:们以为我是来骨折复诊。

我不想让我老婆儿子担心,这是我的潜台词。当骨科把我转过来外科时,我已经有了不良的预感,只是没料到情况如此糟糕。

郑先生,我知道你不想让家人知道这恶耗,但是我需要强调家人的了解与鼓励,会是你治疗的动力。我听得见张医生心中叹了口气,他仿佛知道我在想什么。同时我也可以预料他下一句会说什么,一定是情况不乐观,快点交代身后事之类的话。

有没有一个好消息一个坏消息?通常电影里头医生都这么说的。今天已经是很坏的一天,我希望有点好消息可以至少给我一些安慰。

割除甲状腺的手术风险不高,最主要就是可能会伤到控制声带的神经线,而导致发声的问题,医生笑了笑:我想这是你要的好消息。

嗯,嗯,我木然应道:接下来就应该是坏消息了吧。

好消息还是坏消息是见仁见智的。张医生苦口婆心时还不忘幽默:现在还有一个好消息和一个坏消息,你想先听哪一个?

还有好消息,不错嘛。我心想,嘴巴却冒出了:那就先告诉我坏消息。

这癌症的死亡率高达四成,就算是做了手术外加放射碘治疗。

不治疗可以活多久?

郑先生,如果换个思考角度,那坏消息就是好消息了。张医生放缓了语气:如果接受治疗,存活率高达六成,也就是说十个人里面有六个人生存。以机会率计算,你不可能放弃治疗的吧。

我。。我。。头脑乱成一团,说到底还是要开刀。

相信我,这段治疗的路程,我会一直在你身边。医生他信誓坦坦。

“………”我已经不知道该有些什么反应,为什么是我?天下这么多人为何就是要选我,把这个末期癌症给了我,然后看我怎么死。人说上天有好生之德,什么屁话!老天爷一定是个很喜欢恶作剧的家伙。

这样吧,你回去考虑考虑,下星期同样时间,我们再讨论吧。他知道我已经失去了主张:希望你下次来的时候,会在家人的陪同下到来。

当晚,我在妻子的怀中大哭了一场。反而是我妻子,她比我冷静很多,给了我超多的正能量,让我有勇气面对接下来的挑战。

既然连死你都不怕,又何必担心那些区区的治疗。妻子一针见血,当头棒喝:如果不治疗等于死亡,那就来场show hand,我们至少还有六成的机会。

是的,六成!这是很高的希望了。彩票万分之一的机会人们都乐此不疲,这简直是个天大的喜讯。

结果,一星期后我上了手术台,哭着跟妻子儿女,然后在病房醒来时再次抱着妻子痛哭,不同的是这是喜极而泣。

一个月后,我接受了第一次的放射碘治疗,这次不痛不痒,只是比平常累罢了。至少没有上次手术前后的悲欢离合,在心理上情绪上也是比较可以接受。

两年后,我还活着。癌症还没治愈,但是没有持续恶化,它被控制在一个很好很小的水平,这对我来说已经是很好的消息了。借用张医生的话:好消息还是坏消息是见仁见智的事。他永远都持有着积极乐观的态度。他说这至少是属于比较良性的癌细胞。香港电影黑社会里面都会有卧底警察,癌症里面有良性的癌细胞也不会奇怪吧。其实所谓良性的癌细胞是指那些会被放射碘消灭的甲状腺癌细胞。

上个星期进行了第四次的放射碘治疗。那肿瘤医生说一切都往好的方面发展。我很相信我会是那六成活下来的病患。现在我终于了解为何上天要让我患上癌症,这是因为要我看清人生短短于世,我们应该追求的事物。每个人要的都不一样。就像我,之前从来没有感觉亲情的伟大,大病了一场过后,终于梦如初醒,陪我们到最后的不会是我们的老板,朋友或者下属。生命一步一脚印,在死亡来临之前,在身边的永远都是最亲的人。现在我每天准时上班下班,把所有的时间都放在该放的位置上,让每一分每一秒都过得充满意义。如今我的座右铭是:要活得就好像没有明天。言下之意就是要珍惜今天,珍惜眼前。

如果您对以上的状况有任何疑问请咨询我们的手术专科医生, Dr Chong Shun Siang. 请拨电 03-61418533 以做预约。

Stones in the Bladder

Yes, stones can form in the bladder, too.

BLADDER stones (calculi) are common, particularly in tropical climates. Bladder calculi are less common than kidney calculi. The former are usually a consequence of urinary tract conditions, in which there is stasis of urine, e.g. urinary tract infections, especially recurrent ones, bladder diverticulum, enlarged prostate and conditions of the nervous system, although they can also occur in healthy people.

The presence of calculi in the kidneys and ureters does not necessarily mean that the risk of bladder calculi is increased.

Most bladder calculi occur in adult males. However they can also occur in children. The materials that comprise bladder calculi in adults include uric acid, calcium and ammonium compounds. It is not uncommon to find that the core of a calculus is of one particular chemical surrounded by layers of different chemicals around it.

The factors associated with bladder calculi in children include bladder diverticulum, infant feeding with breast milk and polished rice, high intake of animal proteins, and spinal cord conditions.

Most bladder calculi arise from the bladder itself. However, some calculi are initially formed in the kidney and are then passed into the bladder when additional deposits lead to an increase in the size of the calculi. The renal calculi which are tiny enough to traverse the ureters to reach the bladder are also tiny enough to be passed out when bladder function is normal and there is no obstruction in the channel that leads from the bladder to the exterior (urethra).

Bladder calculi can be single or multiple and are of various sizes. Although most bladder calculi are mobile, there are some which are adherent to the bladder.

Clinical features

Some people with bladder calculi have no symptoms.

For those with symptoms, these arise from the calculus irritating the bladder or obstructing the flow of urine from the bladder.

The common symptoms include lower abdominal pain or pressure, pain on passing urine (dysuria), frequent passing of urine (frequency), passing urine at night (nocturia), interruption of urine flow (hesitancy) and retention of urine.

Other common symptoms include blood in the urine (haematuria), urge to pass urine (urgency), sudden stopping when passing urine associated with pain at the tip of the penis, scrotum or back, and inability to pass urine except when in certain positions. There may also be incontinence and fever.

There may be a history of previous pelvic surgery.

The common findings on physical examination include lower abdominal tenderness above the pubic bone and a palpable bladder if there is urinary retention. Rectal examination may reveal an enlarged prostate. There will be signs of neurological dysfunction if there is a disorder of the nervous system.

Children with bladder calculi may have persistent erection of the penis, which is unrelated to any stimulation and/or occasional involuntary passage of urine at night (nocturnal enuresis), the latter resulting in bedwetting.

The complications of untreated or inadequately treated bladder calculi include obstruction of the upper urinary tract, urinary tract infection, incontinence of urine, urinary retention, recurrence of the calculi and permanent damage to the bladder and/or kidneys.

Management

Laboratory and imaging tests may be done. They will provide information about the presence of calculi, their nature, and associated or causative conditions.

An abdominal or pelvic x-ray will reveal radio-opaque calculi. However, uric acid calculi are radiolucent and may not be seen on the x-rays if they are not coated with calcium. Bladder calculi are also commonly diagnosed by computerised x-ray tomography (CT scan) and ultrasound.

Microscopic examination of the urine may reveal the presence of an infection, blood or crystals. Culture of a mid-stream specimen of the urine may reveal a urinary tract infection.

Many people get rid of the bladder calculi by themselves, i.e. they pass out the calculi when urinating. This often happens with small calculi.

Cystoscopy is a procedure in which a telescope-like instrument is inserted through the urethra under anaesthesia to visualise the inside of the bladder and its contents, if any. It is a common method used to diagnose bladder calculi.

After the calculus or calculi has been visualised, it is broken up into fragments with an energy source, which include mechanical, ultrasonic and laser. The fragments are then removed through the cystoscope.

The miniaturisation of these instruments has made it possible for the use of the treatment modalities in selected children, whose urethral diameter is usually smaller than that of adults. Complications are few and usually minor in nature. They include urinary tract infection, fever, perforation of the bladder, and bleeding.

In general, the majority of bladder calculi are surgically removed through the cystoscope. However, there are situations in which the calculi are too large or hard or when access to the bladder is limited by a narrow urethra, e.g. in children. In such situations, the percutaneous or open suprapubic surgical approach is used.

The percutaneous approach involves approaching the bladder through the skin above the pubic bone. This is the main approach in children. It permits the use of larger diameter and shorter endoscopic equipment to rapidly break up the calculi, which are then removed. It is not uncommon that the urethral and percutaneous approaches are used together to stabilise the calculi; break it up followed by removal of the fragmented debris.

Open suprapubic cystotomy is an operation in which the bladder is surgically opened and the calculi removed. This method is used when the calculi are large and/or hard and when open prostatectomy and/or removal of bladder diverticula is done.

The advantages of this method are the easy and rapid removal of several calculi at a time, the removal of large calculi, and the removal of calculi that are stuck to the bladder surface. Its disadvantages include longer hospital stay, post-operative pain and longer bladder catheterisation times.

Other procedures may be done at the same time as removal of the bladder calculi, e.g. removal of an enlarged prostate.

The conditions which are contraindications to the surgical removal of bladder calculi are few. These include pregnancy and poor general health of the patient.

Medicines are sometimes used in the management of bladder calculi. The only potentially effective medicine is the alkalinisation of urine to dissolve uric acid stones. However, excessive alkalinisation may result in phosphate deposits on the uric acid calculi surface, thereby rendering ineffective any further medical treatment.

Prevention

Bladder calculi can be prevented by prompt and effective treatment of urinary tract infections and treatment of conditions affecting the lower urinary tract. Drinking sufficient fluids daily would also help in preventing bladder calculi formation and facilitating the expulsion of the calculi from the body.


Dr Milton Lum – is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Disclaimer: Nothing on this blog should be considered or used as a substitute for medical advice, diagnosis or treatment. Blog visitors with personal health or medical questions should consult their health care provider.

Platelet Rich Plasma (PRP) Injection available at Alpha Specialist Centre

Platelet rich plasma injections (PRP injections) can be used in the treatment of many musculoskeletal injuries including that of tendons, muscles and joints.

PRP can be injected into:

  • Tennis elbow (common extensor tendinosis)
  • Golfer’s elbow (medial epicondylitis)
  • Jumper’s knee (patellar tendinosis)
  • Achilles tendinosis
  • Plantar fasciitis
  • Hamstring tendons
  • Adductor tendons
  • Gluteal tendons
  • PRP can also be used in:
  • Trochanteric bursitis
  • Knee MCL tears
  • Knee osteoarthritis
  • Hip Osteoarthritis

Benefits of PRP

Pain Relieve and Healing

Packed with growth and healing factors, platelets initiate the repair process and attract the critical assistance of stem cells to intensify the body’s effort to heal. PRP injection stimulates the wound healing process and reduces the pain duration much faster.

Safe, effective and lasting

Because your own body is used, there is no risk of transmittable infection and allergic reaction. PRP resolves pain through healing; the results gradually increase as the healing progresses more than 1 – 2 years.

The earlier the treatment, the better the outcome

PRP can be very effective in treating osteoarthritis, especially in earlier stages. PRP may stimulate cartilage regeneration, which could potentially slow down the deteriorating effect of age and the progression of arthritis.

PRP injection is available now in Alpha Hand Surgery Centre. Prior consultation with a specialist is required. Our Consultant Hand & Microsurgeon, Dr. Terence Tay is available to discuss further about the treatment options with PRP. For more information, please call 03 – 6141 8533. 

骨骼疏松

木都躺在病床上,左脚打上了厚厚的石膏。我站在病床右边,他妈妈站在左边。

这是副甲状腺素过多导致骨骼疏松,然后轻微意外就导致骨折了。我解释道。

医生,骨骼疏松不是老年人才会有的吗?我儿子他才十七岁呢。木都妈妈问道。她一脸的憔悴,疲惫的眼神和凌乱的头发,望过去好像比实际年龄苍老的不少。

哦,那是普遍上来说,骨骼疏松症通常都是在老年人身上,那是因为骨本流失所致。诓诓而谈,这类的解释已经是我生活的一部分了:你儿子则是因为副甲状腺肿瘤释放了过多的腺素,导致骨本大量的流失,而造成骨骼脆弱以及容易骨折。

什么?肿瘤!妈妈反应超大的:那。那。那。不是要开刀咯?

我望着她,点了点头:这是唯一的办法。

割哪里?木都插了一句话。

颈项这里。我用手指在木都的颈项划了划,有点尴尬的笑了笑。忘了不是所有的人都知道副甲状腺是在哪里。

什么?割颈项?木都他妈妈神经质的声音又响起:会不会有危险的,手术风险高吗?

们每个星期都有几台类似的手术,所以风险不会高,近乎99%都会成功。

那。那。那。那。是不是癌症?术后要不要去化疗?

不,你别担心,这类的肿瘤大都是良性的,手术后只是定期来复诊罢了。

还好,还好。。过后要回去买椰花酒还神了。

汗!还神也就算了,还要椰花酒。

虽然这不是一个很大的手术,技术方面也不会太复杂,但是人们普遍上的心态都是对手术有一定的恐惧感,还是费了一番唇舌几两口水,他们才同意。

术就如预料中般顺利,用少过一个小时的时间,副甲状腺肿瘤就以微创方式取了出来。这也要多得如今的科技发展一日千里,以往连想都不敢的手术,现在都得以轻松完成。疤痕也是小小的几个公分而已。

术后,木都被送回病房,但是就得静脉注射钙质,外加口服钙片和维他命D这是因为当副甲状腺素恢复正常水平后,原本从骨骼流失的钙质会由血液回到骨骼。也是因为如此,血液内的钙质会减少而需要补充。当一切恢复正常后,就只需要日常的钙质量罢了。

木都出院了。看着他的背影,一手拿着拐杖,另一手搭在妈妈的肩膀上,慢慢的进入了电梯。他比妈妈高出了整个头,体型也明显大了不止一号,但是他的妈妈还是用自己瘦弱的身体,为孩子撑起了半边的风雨。我不禁的想起,无论孩子多大,母亲多老,她都会尽心尽力不求回报的为儿子付出自己所可以付出的,牺牲自己所可以牺牲的,只要孩子可以幸福快乐健康平安就行了。

电梯关门前,我依稀听见木都母亲的声音:老爸已经买了椰花酒,我们等会就拿去还神,感谢祂保佑你从此平平安安健健康康。

如果您对以上的状况有任何疑问请咨询我们的手术专科医生, Dr Chong Shun Siang. 请拨电 03-61418533 以做预约。

Acid reflux or Heartburn

Acid reflux is also known as heartburn or acid indigestion. It creates a burning pain in the lower chest area and often after eating. Acid reflux is often associated with our lifestyle and eating habits.  Eating frequent but smaller meals can help reduce your risk of heartburn and acid reflux diseases. Reduced consumption of carbonated drinks and alcohol along with exercise may help to reduce the symptoms.

Symptoms to note:

  • Hard to swallow food down your throat
  • Indigestion for 3 weeks or more
  • Sudden weight loss
  • Frequent burping or trapped wind
  • Nausea or vomiting
  • Pain in the upper stomach area

People who suffer from persistent heartburn for more than 3 weeks should seek help from doctor or a Gastroenterologist as it may lead to stomach and oesophageal cancers or other medical conditions.

Gallstones

1. What are gallstones?

Gallstones are stones found within the gallbladder, a small bag-like organ which is attached to the lower surface of the liver. The stones are composed of different materials (chemicals) such as cholesterol or bile pigments. They vary in size from about 1 millimeter to a few centimeters. Symptoms are not related to size of stones. Rather, it is their location within the bile drainage system which is crucial. In fact, small stones have the risk of dropping into the bile duct, thereby causing blockage of flow of bile from the liver to the duodenum. The result is jaundice, a yellow discolouration of the skin and whites of the eyes – a potentially serious complication.

Before the modern era of surgery, many famous figures have suffered or died from gallstones. Anthony Eden, a British prime minister during the Suez Crisis of 1956, was one such tragic victim. Surgery was delayed as it was deemed to be too dangerous. When it was eventually done, he remained very ill and required heavy medication which caused exhaustion and possibly impaired judgment. It is often speculated whether the outcome of history might have been drastically different if only he could have had timely removal of the offending gallstone.

2. What are the symptoms?
Gallstones are usually asymptomatic (clinically silent) – the patient feels perfectly well. They are detected during routine ultrasound scans of the abdomen, such as in pregnancy or during health check-ups. Common symptoms are gallstone colic (upper abdominal pain), abdominal discomfort and bloating, especially after heavy or oily meals. The pain will usually subside after about 3 to 4 hours. Occasionally, it may be so severe as to require injection medication. Complications of gallstones are acute cholecystitis (inflammation of the gallbladder) which causes continuous, unremitting severe pain; bile duct obstruction resulting in jaundice; and pancreatitis (inflammation of the pancreas). The latter two conditions may be fatal if treatment is delayed.

It should be noted that gallstone colic is often mistakenly attributed to gastric ulcer.

3. How are gallstones diagnosed?
Diagnosis is made from a good clinical history obtained by a trained specialist (surgeon or gastroenterologist). Confirmation is via radiological scanning, either with ultrasound or computed tomography (CT, “CAT”) of the abdomen

Gallstones2

4. What treatment is available?
Asymptomatic gallstones can be left alone. Treatment is recommended only if there are symptoms or complications. The risk of these events happening is about 1 to 2 % per year. However, once symptoms develop, the patient will invariably suffer further attacks and treatment is strongly advised. The gold standard of treatment is laparoscopic cholecystectomy, which is removal of the gallbladder via key-hole surgery. The main advantage of this method is that it is minimally invasive: the scar is small; post-operative pain is minimal; and hospital stay is consequently reduced. In about 5 to 10 % of cases, the operation has to be converted to the open technique involving a surgical incision of 8 to 10 cm. The usual reasons are either inflammation which renders it difficult to identify key anatomical structures, or complications such as bleeding.

The symptoms of gallstones will be relieved permanently after surgery.

5. More about laparoscopic cholecystectomy.
The patient is admitted to hospital for one or two days. The operation is performed under general anaesthesia. It takes about one hour. Four small holes (5 to 12 mm in diameter) are made in the abdomen. The surgeon places laparoscopy instruments into the abdominal cavity through these holes (ports) to perform the operation. Titanium clips are placed on two vital structures (cystic duct and cystic artery) which have to be cut during the operation. These clips are specifically designed for this operation and will remain in the body; they do not produce any side effects. The entire gallbladder, including the stones it contains, is removed (“delivered”) through one of the ports. The procedure is recorded and the patient can have a hard copy such as on DVD.

6. What are the complications of laparoscopic surgery?
The main complication is bile duct injury, which happens in about 1 to 2 % of operations. Treatment depends on the extent of injury and whether the injury is recognized immediately during the surgery or delayed post-operatively. Options range from stenting the bile duct (by placing a temporary plastic tube) for minor injuries, to major surgical reconstruction of the bile duct for complicated injuries, a difficult and hazardous process.

Obviously, such complications are best avoided. The risk is related to previous scarring in the abdomen and the operative experience of the surgeon.

7. What are the long-term effects of laparoscopic cholecystectomy?
Patients will lead normal lives after the operation. No more dietary restrictions! Long-term follow-up is not required.


Dr Milton Lum – is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Disclaimer: Nothing on this blog should be considered or used as a substitute for medical advice, diagnosis or treatment. Blog visitors with personal health or medical questions should consult their health care provider.

Hand Surgery Centre, Kuala Lumpur Malaysia

Who We Are?

Hand CentreOur hand centre is a state-of-the-art facility conveniently located in Alpha Specialist Centre, Kota Damansara, Petaling Jaya, providing all forms of treatment and evaluation of the hand, wrist and upper extremity. Our values of compassion and concern for your particular needs are complemented by the professional expertise of our highly-skilled, board certified orthopedic surgeon. At Alpha Hand Surgery Centre, we know your hands are your livelihood and that’s the reason why we take particular care in providing the best, thorough treatment that will allow you to recover as quickly and confidently as possible.

Our Services

  • Comprehensive hand care

We are dedicated to provide comprehensive care for all conditions related to hand and upper extremity. Our hand team is made up of fellowship-trained doctor, operating theatre and clinic nurses, certified physiotherapist with extensive knowledge and experience in hand reconstructive surgery, microsurgery, congenital hand problem, and upper limb prosthesis.

  • Ambulatory day care surgery

Our operating theatre is fully equipped to handle any complex hand cases under local anaesthesia, regional or general anaesthesia. Most of the hand surgery does not require an overnight hospital stay, therefore patients may go home after the procedure.

  • In clinic fluoroscopy

This is a low radiation X-ray machine which allows imaging of the hand and upper extremity in the fastest and convenient way.

  • Doctor-assisted hand therapy

The essential aspect of hand care involves guided rehabilitation of hand patients and the usage of specific splints for quicker recovery. Our hand surgeon will personally takes care of the rehabilitation of their patients and you will be referred to therapists when needed.

  • Dedicated occupational therapist

An experienced occupational therapist who has more than 30 years of clinical experience, including having a comprehensive knowledge of advanced clinical skills and theory in upper limb rehabilitation.

Why Hand Surgery?

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Hand surgery is the field of medicine that deals with problems of the hand, wrist, and forearm. Hand surgeons are specially trained to take care of these problems with or without surgery.
Why visit a hand surgeon?
If you have problem in your fingers, hand or wrist, or have any other upper extremity related concerns, you may want to consult a hand surgeon. Because hand surgeons are specialists in hand care, they are very meticulous in examining, diagnosing and treating any condition of the hand.
Not every visit to a hand surgeon results in hand surgery.
Hand surgeons often recommend conservative treatment options, including hand therapy, a combination of physical and occupational therapy to reduce or eliminate pain and restore movement of the hand. If non surgical treatment fails, only surgery is advocated.

Conditions We Treat

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a disorder of the hand caused by pressure of the nerve that run through the wrist. Symptoms include numbness, pins and needles, and pain around the fingers. These sensations are often more pronounced at night and can awaken people from sleep.

Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles and frequent dropping of objects from the hand due to reduced in grip strength.

Trigger Finger

Trigger finger, trigger thumb, or trigger digit  is a common disorder characterized by catching, snapping or locking of the involved finger, associated with pain. Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning.

De Quervain Tenosynovitis 

De Quervain’s disease is a painful inflammation of tendons in the thumb that extend the wrist.The typical symptom is pain over your wrist at the base of your thumb that is made worse by activity and relieved by rest. It is commonly seen in women carrying their babies after delivery and repetitive activities requiring movement of the wrist while gripping the thumb (eg. Hammering, assembly line jobs).

Ganglion cyst

A ganglion cyst is a fluid-filled swelling that develops near a joint or a tendon. The cyst can range from the size of a pea to the size of a golf ball. It is most frequently located around the wrist and on the fingers.

Hand arthritis

The wear-and-tear process can affect most joints in the body, including the hand and wrist. Osteoarthritis normally causes no symptoms in many patients. However, some patients may experience symptoms like local pain, stiffness, tenderness, and occasionally swelling in the affected joints.

Hand fractures

Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a direct injury, a fall, a crush injury, work injury or during sports. Careful diagnosis and early treatment is important to avoid pain, deformity or finger growth disturbance especially in growing child.

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Nerve or Vascular Injuries

Nerves and blood vessels of the hand and fingers usually are quite delicate and some are really small. Optimal repair of injuries often requires the microsurgical expertise of a hand surgeon.

Sports Hand Injuries

There are a variety of common sports injuries of the hand and wrist. These include mallet finger, skier thumb, golfer elbow, tennis elbow, wrist sprain and tendinitis.

 For more information, please visit www.alphahandcentre.com or call us at 03 6141 8533 for appointment. 

Cushing Syndrome

医生,我到底是怎么了?黄嫂捧着打上石膏的右手,着急的问:说的话我怎么听都不明白,你可不可以用华语再说一遍?

我看着她圆圆肉团一般的脸,尽量放缓:这是<库欣综合症>,Cushing Syndrome。。。

等等,等等。。还没说完,黄嫂急急打断我的话:什么<哭心哭心>的,我就快要哭死了,还哭心。我的手轻轻敲到门板,就无端端的断了。打上石膏后你就忽然间不知从哪里跑了出来,告诉我这什么劳子的哭死什么什么症。

就当它是哭死症好了,我无奈的摊摊手,顺着她的语气:我来,就是要帮你医好你这所谓的哭死症的。

这时的情况自然不能继续解说库欣综合症与肾上腺的关系,以及电脑断层扫描之类的医学用语。不然的话,不是黄嫂哭死,而是我自己会被黄嫂激得哭死了。

要怎样医?黄嫂问。

开刀动手术。我正想着库欣的一些资料,微微走神,所以反射性的回答。

什么?开刀?高八度的声音把我拉回了现实。

我深吸一口气:别这么慌张,我慢慢告诉你。我用力的捉着黄嫂的肩头,帮她冷静一些。

医生,老实说,我到底是怎么了?问题转了一个圈,又回到了原点。

实,黄嫂这些反应是可以理解的,内分泌失常并非是三言两语可以解释得清楚的。更何况如果病变的器官是比较鲜为人知的腺体。黄嫂患的是肾上腺肿瘤,这种瘤算是比较罕见的病历,往往一千人中只有一个人会有如此的疾病,而这些所谓的病患就算活到壽终正寝都不知道自己有这么的一颗肿瘤在体内。在这些病患当中,像黄嫂一般的病历,只占了总数的七巴仙。这是肾上腺释放太多的皮质醇,导致身体机能病变。患者大都会骨骼疏松,身体肥胖但是手脚瘦弱,皮肤容易受伤容易瘀血,还有等等等等的一大堆症状,统称为库欣综合症

问题现在来了,起先这并不容易跟病患解释何为库欣综合症,再来就是关于肾上腺,还有它所释放的荷尔蒙。很多人都不晓得什么是肾上腺,以及不能理解小小的一粒腺体,如何释放三四种不同的荷尔蒙。每一种荷尔蒙失调都会对身体造成巨大的影响,就好像库欣综合症就是皮质醇过多而引起的。到了这里,每个人都会问什么是皮质醇,皮质醇就是肾上腺所制造的类固醇,我们需要一定的份量来维持生命与活力,但是多了的话就是这种库欣综合症。有很多原因可以导致库欣综合症,黄嫂的是因为肾上腺肿瘤的关系。好消息是它是有可能根治,坏消息却是需要动手术,而这类的手术有一定的风险。

医生,真的要开刀吗?还记得当时黄嫂颤抖的声音在我耳边徘徊。

不开不行。我直视她的眼睛,诚恳的道:术是有一定的风险,但是无论发生什么事,我们医生都会在你身边。

实说,成功率有多少?望着电脑荧幕上的肿瘤x光片,黄嫂的眼泪不自觉的沿着她肥肥的面颊滑到了下巴。荧幕上是个接近十公分的左边肾上腺肿瘤。

别担心,成功率超高的,超过九十巴仙。我笑着,尽量隐藏笑容里面一点点的心虚,因为在医学上,九十巴仙是个不是很高的巴仙率,很多手术我们都能做到99.9%

“………”黄嫂静静的抽泣着。

给了她一张纸巾:说,你这手术不只是我一个人做的。我的大教授,麻醉科教授以及内分泌内科专科教授都会一同联手,所以你不必担心这么多。手术的事就让我们来担心吧!

一大串的内科外科麻醉科教授大教授专科教授等等名词全都搬了出来后,黄嫂的情绪也比较平复,比较放心了。

术如期进行。开刀房闹烘烘的,医生护士开刀房助理甚至医学生都来了。难得一见的病历,难得一见的手术自然吸引了不少的人潮。还好一切顺利,三个小时后,我步下了手术台,扯开无菌袍后就坐在一旁等黄嫂醒来。这是我多年来的习惯,总会等到病患苏醒后才离开。

三天后,黄嫂出院了。三个星期后,她容光焕发的来复诊,还带来了一袋的萍果。
我打趣道:你一定是不想再见到我们了。

为什么呢?问。

为。。因为。。我笑了笑:“an apple a day, keep the doctor away

如果您对以上的状况有任何疑问请咨询我们的手术专科医生, Dr. Chong Shun Siang. 请拨电 03-6141 8533 以做预约。