Tag Archives: Medicines & Sciences

Features medical breakthroughs and the latest in healthcare through informative articles

What Is The Difference Between Food Allergy & Intolerence

Dr Mecherl Lim

An Intuitive Medical Practitioner in Alternative Medicine (MD) (MA), Naturopath (ND), Holistic Kinesiology (HK), and Functional Medicine (FM)


Food Allergy occurs when the body has chemical reaction to eating a particular food & drink. The symptoms for mild to moderate food allergy or intolerance may sometimes be similar, but food intolerance does not involve the immune system and does not cause severe allergic reactions (Anaphylaxis)

A Food Allergy occurs when the immune system reacts to harmless food. Learn to read food labels so you can avoid foods that cause allergic reactions.

Food Allergy & Food Intolerance

Symptoms of food intolerance occasionally resemble those of food allergy so food intolerance is commonly confused with food allergy. Food intolerance does not involve the immune system and does not cause severe allergic reactions (know as anaphylaxis). Food intolerance also does not show on allergy testing. Food intolerance can be a difficult concept to understand and is poorly understood by doctors as well. Sometimes, substances within foods can increase the frequency and severity of migraine, headaches, rashes (such as hives) or stomach upset such as irritable bowel.

Professional diagnosis and confirmation of allergies is important. In Australia, about one in 10 infants, one in 20 children up to 5 years of age, and two in 100 adults have food allergies.

Food Allergies has been Increasing

Allergies in general are on the increase worldwide and food allergies have also become more common, particularly PEANUT ALLERGY in preschool children. About 60 per cent of allergies appear during the first year of life. Cow’s milk allergy is one of the most common in early childhood. Most children grow out of it before they start school.

Inherited Allergy

Children who have one family member with allergy disease (including asthma or eczema) have a 20-40 percent higher risk of developing allergy. If there are two or more family members with allergy disease, the risk increase to 50 to 80 percent.

Most of the time, children with food allergy do not have parents with food allergy. However, if a family has one child with food allergy, their brothers or sisters are at a slightly higher risk of having food allergy themselves, although that risk is still relatively low.

Allergy is an Immune Response

Allergies are an overreaction of the body’s immune system to a protein. These proteins may be from foods, pollens, house dust, animal hair or mould. They are call ALLERGENS. The word allergy means that the immune system has responded to a harmless substance as if it was toxic.

Food Intolerance is a Chemical Reaction

  • Food Intolerance is a chemical reaction that some people have after eating or drinking some foods: It is not an immune response. 
  • Food Intolerance also does not show on allergy testing.
  • Food Intolerance can be a difficult concept for doctors as well. Sometimes substances within foods can increase the frequent severity of migraine headaches, rashes (such as Hives) or stomach upset.
  • Food Intolerance has been associated with Asthma, Chronic Fatigue and Irritable Bowel Syndrome (IBS).
  • Professional diagnosis and confirmation of allergies is important in Australia, about one in 10 infants, or in 20 children up to 5 years of age and two in 100 adults have food allergies.

Therapy

The preferable approach to the nutritional management of immunological food reactions or food hypersensitivities consists of dietary avoidance and the treatment of symptoms resulting  from inadvertent exposure. Nutritional supplements are needed when major food groups are being avoided.  This will ensure the optimum nutritional intakes are maintained. Digestive enzymes example: Dr MH zyame should be taken by individuals who seems to be sensitive to many foods. Bicarbonate of soda , Dr MH Proflora A, taken one hour after meals can improve symptoms. By improving digestion the allergenic load may be destroyed or digested more thoroughly.


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Intraoperative Radiotherapy (IORT) A New Breast Cancer Treatment Innovation

Dr. Teoh Mei Shi

Consultant Breast, Endocrine & General Surgeon

MBBS (India), MS (USM), Fellowship Breast Oncoplastic Surgery


Screen Shot 2017-11-10 at 1.37.42 PM.pngBreast Cancer is the most common cancer amongst women in the world. Incidence of breast cancer is increasing and the lifetime risk of developing breast cancer in Malaysia is one in 15 women. In developed countries, the lifetime risk of developing breast cancer in women is as high as 1 in 8 women. With more awareness and screening for breast cancer, women are detecting breast cancers earlier, which are smaller and have better survival outcome.

Treatment for breast cancer has evolved significantly over the last few decades due to better understanding of the tumor biology and its behavior. This has led to better adjuvant therapy like systemic chemotherapy, radiation therapy, hormonal therapy and targeted therapy. For most of the earlier twentieth century, Halsted radical mastectomy was the standaradised operation for all stages of breast cancer resulting in poor cosmetic outcome. However, over the recent decades, breast conserving surgery (BCS) eg. Lumpectomy has become the popular alternative to mastectomy in the treatment of early breast cancer.

When detected early, the breast conserving surgery involves a lumpectomy followed by 4-6 weeks of external beam radiotherapy to the whole breast and boost to the tumor bed. This combined method has been proven to reduce local recurrence of breast cancer by 60-70%. However, the side effects of whole breast radiotherapy treatment can be detrimental eg. pain and oedema to the breast, skin fibrosis, fatigue and tiredness and in some cases, there can be associated radiation- induced lung injury and cardiac morbidity.

Over the last few years, a new innovative breast cancer therapy known as Intraoperative Radiation therapy (IORT) has become available using the Intrabeam technology. IORT delivers a single dose of radiation directly to the area where the tumor has been removed during surgery.The principle of this approach is to destroy the remaining cancer cells within the lumpectomy cavity where more than 90% of local recurrences usually occur close to the tumor bed.

The Intrabeam IORT is delivered using a miniaturized radiation applicator that is inserted and positioned into the lumpectomy cavity after removal of the tumor. A calculated low energy radiation dose is administered for 20-30mins after which the wound is closed surgically. The operation carries standard risks of bleeding and infection and slightly higher seroma collection comparable to normal breast surgery.

This technology is an excellent option for women having a lumpectomy or breast conserving surgery and is for individuals diagnosed with early-stage breast cancer. The IORT therapy may function as two options ie. as a boost therapy or as a single treatment. Patients are carefully selected and multidisciplinary discussion with breast surgeon and radiation oncologist is carried out to decide the best outcome for the patient.

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IORT offers the following advantages:

  • Reduced radiation treatment time (single session vs 20-25 sessions) in candidates selected for surgery
  • Minimized radiation exposure to surrounding healthy breast tissue, underlying bones, lungs and heart.
  • Reduced daily trips to the radiotherapy centre and convenient for those staying very far away.
  • Same day radiotherapy treatment and no treatment delay for those going for chemotherapy after surgery
  • Provides additional radiotherapy “boost” for high-risk patients who need additional external beam radiation therapy.

The international TARGIT research group has been investigating this new method of delivery radiotherapy for breast cancer after lumpectomy since 1998. The trial compared Intrabeam IORT to standard external beam radiation therapy and found that both treatments were comparable and equally effective with an overall low breast cancer recurrence as well as better breast cancer survival rates. Women who had intraoperative radiotherapy had the advantage of fewer skin side-effects and better cosmetic outcome compared to women who had whole breast external beam radiotherapy.

Conclusion

Intrabeam IORT will be a technology of the future for breast cancer treatment. In properly selected cases, the patients can be offered an alternative option whereby they can receive a shorter dose treatment with lesser side-effects to the breast. It can also be time saving, cost-effective and offers the patient an overall better quality of life.

This treatment will be available at Loh Guan Lye Specialists Centre where a dedicated and trained team of Breast Surgeons and Radiation Oncologists can be consulted to see if you are eligible for the treatment.

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BLOOD IN URINE: A WARNING Sign That You SHOULD NOT IGNORE!

By Mr Lau Ban Eng
Urologist
MBBS (Aust.), FRCS (Edin.), FRCS Urology (Edin.),
D. Urol (Lond.), FCS (Hong Kong), FHKAM

“Peter, a 57 years old executive chef went to the toilet one night and noticed that his urine was red in colour. The urine cleared up the next morning but Peter was very worried. He visited his family doctor who sent his urine for tests and found the presence of red blood cells. His family doctor referred him a Urologist. After some investigations, Peter was found to have early stage kidney cancer. Peter underwent appropriate treatment and is now cured.”

Seeing blood in your urine is a frightening experience for most people. When this occurs, it must be fully investigated by a doctor. Although in many patients no specific cause can be found, blood in urine – medically referred to as haematuira – can be an indication of a serious problem of the urinary system (Diagram 1) and is a warning sign that you should never ignore.

It is estimated that up to 20% of the population is at risk of haematuria. There are two types of haematuria. The first is called “gross” or “macroscopic” haematuria where the blood in the urine is visible to the naked eye. Macroscopic haematuria can vary widely in colour, from light pink to bright red with clots. It can result from as little as 1ml of blood in 1litre of urine, and therefore the colour does not reflect the degree of blood loss.

If the blood can only be detected with laboratory testing of urine, it is called “microscopic haematuria”. People with microscopic haematuria are often unaware of the problem and it will most commonly be detected from urine tests during a routine medical check-up.

Although the amount of blood in the urine may vary, the causes of gross and microscopic haematuria are the same. So, any degree of blood in the urine should be fully evaluated by a doctor, even if it resolves spontaneously.

Is there definitely blood in the urine?
Before you read on, it is worth considering whether you have recently eaten beetroot, red dragon fruits or food with colourings as these can make the urine to turn pink and cause unnecessary alarm. Certain medications and antibiotics such as nitrofurantoin and rifampicin can also turn urine brown or red. Check that the blood in the urine is not from the rectum/anus and in females, blood from the vagina should be ruled out.

What are the causes of blood in urine?
The cause of haematuria, whether microscopic or macroscopic are similar and may result from bleeding anywhere along the urinary tract (Diagram 1). 50% of patients with visible blood in the urine will have an underlying cause identified but with non-visible blood in the urine, only 10% will have a cause identified.

Risk factors for significant underlying diseases include: age over 40, smoking, exposure to certain chemicals, history of radiation, overuse of painkillers, history of diabetes and hypertension.

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Common causes of blood in the urine include:

  1. Infection of the bladder (cystitis) or kidneys (pyelonephritis). This usually causes pain when you pass urine and pain over lower part of abdomen and loin area. Fever can occur in severe infection.
  2. Kidney, ureteric or bladder stones which may be painless and may present as only haematuria.
  3. An enlarged prostate. This commonly occurs in older male and associated with symptoms of difficulty passing urine, slow urinary stream and frequency of urine.
  4. Kidney cancer. This is an uncommon cancer and may present as microscopic or gross haematuria. The gross haematuria may be intermittent. If it is detected early, the chance of cure is very high.
  5. Bladder cancer. Again this usually occurs in people aged over 50. Usually the patient is a heavy smoker. As in kidney cancer, if found early and treated, the cure rate is very high.
  6. Kidney disease can also cause haematuria. It is a common cause of microscopic haematuria in younger people. Most of the time, protein will also be detected in the urine.
  7. Medications that thin the blood like warfarn and clopidogrel (Plavix) can also cause bleeding in the urinary tract.

How is blood in urine diagnosed?
After taking a detailed history and carrying out physical examination, the Urologist will order a urine test which consists of testing the urine with a chemical test strip and examining it under a microscope. This is to confirm the presence of red blood cells. If three or more red blood cells are seen per high power field in the urine specimens on microscope, referral to a specialist, either an Urologist or Nephrologist for further evaluation is recommended.

Usually the specialist will repeat the urine test and also obtain a culture of the urine to identify the presence of bacteria. Blood tests will be carried out to assess kidney function and identify any blood clotting abnormalities. Further investigations will be ordered depend on the findings of the urine and blood tests. If necessary, two additional tests, imaging and cystoscopy will be performed.

Nowadays, CT scan is preferred to intravenous urogram (IVU) as it gives a better, more detailed image of the kidneys and ureters. It is also the best method to detect urinary stones. However, CT scan cannot visualise the lining of the bladder clearly and therefore, a second examination called a cystoscopy is necessary.

Diagram 2 showing a flexible cystoscope2

This procedure uses a small (3mm in diameter), flexible scope (Diagram 2) which is inserted through the urinary passage (urethra) into the bladder to directly visualise any abnormality or source of bleeding in the bladder. It also allows the doctor to take a sample for examination under the microscope. This procedure takes about 10 minutes and is usually carried out with intravenous sedation and local anaesthetic gel.

Treatment
Treatment depends on the exact cause for the haematuria following a specialist’s evaluation and investigations. In patients where investigations fail to find the source of the bleeding, observation with repeat urine tests is necessary. Investigations like CT scan and cystoscopy may be repeated if haematuria recurs.

Conclusion
Any degree of blood whether macroscopic or microscopic in the urine, especially for those aged 40 or above should be fully investigated by a Specialist as it might be a sign of serious disease of the urinary system.