New Developments in Managing Atopic dermatitis (AD)/eczema

After a year of hiatus, I finally attended the first media event! Rightly so, to update myself about the latest developments in managing atopic dermatitis. Even though this event was meant for the public, I must say that I have also learnt a lot!

AD affects 20% children and 8% adults. 4 main elements in AD includes irretractable itching, dryness, redness/inflammation which can be complicated by secondary bacterial infection due to ineffective skin barrier function.

AD is more than a skin condition. It also affects productivity due to constant scratching. This can result in poor sleep up to 2.5hours! Furthermore, AD can also cause loss of employment, social and psychological burden, embarrassment from socializing and schooling. AD is also costly to treat.

The first talk of the afternoon was delivered by Dato’ Dr Noor Zalmy Azizan. She is a Consultant dermatologist at HKL/Thompson Medical Center. The talk was entitled Introduction to AD (causes, symptoms and impact on patients).

Eczema can be subdivided into Endogenous (eg atopic dermatitis, seborrheic dermatitis) vs exogenous (contact dermatitis due to specific triggers). AD is a clinical diagnosis and does not need blood/patch test to confirm.

AD is a complex, chronic and recurrent itchy inflammatory skin disorder. Disease can flare up with stress and dry environment. However, certain cases can also be continuous. Prolonged uncontrolled ezcema can cause lichenification/thickening of the skin or nodular prurigo. AD is also associated with asthma, allergic conjunctivitis and allergic rhinitis.

The prevalence of AD in Malaysian children has risen from 9.5% (1994)to 12.5% (2002) based on the ISACC studies. The risk is higher if there’s family history with filaggrin gene mutation, causing a lack of protein in the skin which moisturizes the skin naturally. Oxidative stress can further damage the skin. The real reasons behind AD are not fully understood yet. The vicious cycle of scratching, sweating, hot water and sun damage further causes skin breakdown, mimicking a failing brick and mortar model.

According to the Malaysian Clinical Practice Guideline of management of AD,
Emollients is the mainstay of treatment of all AD stages based on Cochrane systematic review and is able to reduce the need for steroid use.

The second presentation by Dr Leong Kin Fon, a prominent pediatric dermatologist spoke about the Management of AD & Tips for Parents.

AD is a dynamic disease with many faces. The distribution of the rash differs with age. Therefore, it is important to seek treatment from dermatologists as early treatment can prevent complications. AD usually starts after 6 months of life as the fetus was initially protected in amniotic fluid. The newborn skin was also protected with vernix.

In general, the amount of emollient needed is 500g for adults and 300g children in a week. Oil or cream based moisturizers should be used over the limbs and body as this can last over the day. Lightweight, lotion/gel based emollients can be used on the face instead. Look for hypoallergenic and low irritation emollient and cleanser which are effective against all these symptoms: Itchiness, dryness and erythema.

Other tips including:
-Avoid extreme weather
-Avoid prolonged bubble bath
-Bathe less than 15minutes with lukewarm water (test with closed eyes)
-Rebalance antioxidant levels on the skin
- Empower the patient in the management plan

6 principles of AD management are:

1. Fine tune expectation-eczema takes months to years to control, not cured. It’s like running for a marathon.
2. Always listen, demystify and educate patients - it is not possible to pinpoint the exact cause of AD as it is complex and multi factorial.
3. Need to mix and match treatment to 'flatten the curve' ( tackling itchiness, infection, dryness and inflammation)- persist with effective treatment until remission is achieved.
4. Learn how to befriend steroid cream (they are natural!) with 7 potency levels depending on severity and thickness of skin- usually 2 weeks long, need to review use regularly and watch out for skin thinning.
5. AD starts with itch first then red rash lastly weeping rash- start treating when it’s itching.
6. Natural products can be harmful and loaded with high potency steroids
--Scrutinize the research behind the products, if possible backed by Randomised Controlled Trials

Lastly, Dr V Shubashini, Medical Affairs Manager of Menarini launched their latest AD products– Introduction to Relizema™️-Dermarel™️

Relizema cream is a topical emollient used to protect the skin’s barrier function containing antioxidants (furfuryl palmitate and tocopherol). It has a fast onset and offered sustainable relief for itchiness.

Dermarel lotion containing 3 types of ceramides and plant based oils. It is a lightweight emollient.

Dermarel cleanser is made of ceramide and amino acids suitable for dry face and body.

Dermarel spray & go soothes red and burning sensation especially in inflamed and dry private areas without the need to rub in.

These tips really help our family of 4 to deal with AD. Be in control!

Dieting versus Meal Replacement for healthy lifestyle | Good Morning Multigrain Beverages Review

Having a strong family history of type 2 diabetes mellitus, I am beginning to adopt healthy lifestyle. Besides ditching the lift, (yes I take stairs to 8th floor, multiple times in a day), I pay attention to what I eat, most of the time but restricting carbohydrate, adding on vegetables, fruits and lean meat or seafood. Soon I'll need to start my single life in KL with long hours in the traffic, so I figure out I better eat on the go! This is called Meal Replacement or Diet Shake. Find out more here on WebMD.

Good Morning Multigrain Beverages has a great range of meal replacement options. I have tried the following options.

1. GSure
2. Pea Protein
3. V 18 Grains

These Good Morning Multigrain Beverages are based on  18 Multigrains with 5 colours

1. Red- Red Quinoa, Red Bean and Red Rice
2. Black- Black Sesame, Black Bean, Chia Seed and almond
3. Green - Mung Bean, Green Peas, Lentils
4. Brown- Flaxseed, Lotus Seed, Buckwheat
5. Orange- Corn, Millet, Soy Bean, Brown Rice, Garbanzo Bean

It's very important to take rainbow coloured phytonutrients as each provides specific nutrients and protects us against certain ailments. Details on this article at Harvard Health Publishing Site.

Red: Rich in carotenoid lycopene, a potent scavenger of gene-damaging free radicals that seems to protect against prostate cancer as well as heart and lung disease.

Green: These foods are rich in cancer cell-blocking chemicals like sulforaphane, isocyanate and indoles.

Orange and yellow: Provide beta cryptothanxin, which may help prevent heart disease

White and brown:  This contains allicin, which has anti-tumor properties. Other foods in this group contain antioxidant flavonoids like quercetin and kaempferol.

Besides that, these 3 beverages are lactose free, vegan friendly, gluten free with no added sugar. The Multigrains used are also non GMOs. The high soluble fiber content helps to ameliorate digestive and constipation issues.

Good Morning Global Sdn Bhd is documented in the Malaysian Book of Records as the biggest multigrain based product company. Their products go through strict quality control as set out by ISO22000, HACCP, GMP and MESTI. Therefore the ingredients used are also of premium quality and safe for consumption of the whole family.

Below are the other special features:

V18 Grains

This is now fortified with ginger and prebiotic inulin which is food for healthy bacteria in the gut.  Besides the fragrant taste of multigrain, the ginger gave a spicy kick which is surprisingly pleasant and not too overpowering with powerful anti-inflammatory properties.

GSure

This provides complete nutrition and is suitable for people who need to build muscle bulk and prevent muscle loss because it contains CaHMG. Muscle loss is common with ageing and impacts negatively in the ability to perform self care. This is called sarcopenia. Lutein helps to improve vision. Omega 3&6 are great for cardiovascular health. Read more about sarcopenia on WebMD.

Pea Protein

Good Morning Pea Protein is so a complete nutrition fortified by essential and non-essential (meaning we may not need to take it from our daily diet because our bodies are able to make them) vitamins, minerals and amino acids. Remember I just talked about sarcopenia? This can actually start as early in our 30s. Especially for those who are obesed, the body is made of fat and not muscles-- aptly called sarcopenic obesity. You can imagine how difficult it is to get these people moving and regain the muscle bulk. This is when Pea Protein can help as meal replacement to lose weight yet building muscles.

What does Dr Yingzangel think?

I would love to follow the suku suku separuh healthy eating dietary needs 3 times a day. But it's simply mission impossible. Working full-time means most we dine out for lunch most weekdays. It can be a real chore to grab a nutritious and well balanced diet in Malaysia while eating out when char kuay teow and nasi lemak are some of the calorie loaded staples for many.

Good Morning beverages offer great and affordable options for supplementing and replacing our meals with quick and nutritious shakes. Most importantly, they taste really good (naturally sweetened with no added refined sugar!) Perfect for me who doesn't have the time to grab healthy lunches.

To know more, remember to visit their sites. Good Morning Global Sdn Bhd is having their 12th anniversary sales at the moment. Hurry up and get yours!

Good Morning estore
Instagram: @goodmorningglobal @goodmorning18grains 

Clean Future with Clean Water | Cleanwash Home Solutions

Malaysia is blessed with plenty of water supply compared to other countries like the neighboring Singapore and Australia. However, the water supply is disrupted frequently due to scheduled maintanence or unplanned piping problems. We often notice unpleasant smell and taste of water, especially in certain areas even though the water is disinfected as the transporting water pipes are often corroded and rusty, risking leakage of metal into our water. Therefore, almost half of the Malaysian households have installed water filters and most will boil the water before consumption. 

Poor water quality is also bad for our health including skin issues. It can lead to eczema, lead toxicity, acne, premature ageing and dark circles! Marie Claire has an interesting article based on some anecdotal experience on how consuming enough water boosts energy level, mood and makes skin more supple.

Pay attention to the color of the new filter before installing to the water heater.

A day after installation.

Home water treatment systems consist if water conditioners and water filters. They can also be divided into point of entry (treat all the water supplied to the house) and point of use systems (usually limited to one faucet). Generally speaking, it is not advisable to have water filtration systems that use reverse osmosis or distillation as it completely removes minerals including fluoride which is a very important source to protect against dental caries. 

Another practical point about water filters is to service or replace cartridges regularly every 1-3months so that the system filters effectively, provides quality filtration and to prolong the lifespan of the system.

To ensure clean water supply, we have installed a few point of use water filtration systems in the house. We have been using the good old fashioned Panasonic water filter in the kitchen until we come across Clean Wash.

Cleanwash Home Solutions - Multipurpose Water Filter

Cleanwash Multipurpose Water Filter consists of a PP filter with calcium sulfite balls. It effectively filters out particles bigger than 5microns size and also chlorine in the water. Each set comes with tubings and accessories and the installation is super easy. Only took an inexperienced person like me 5mins!

Washing machine installation video

Shower line installation video

Their replacement cartridge is also affordable and can be purchased online through ClearLiving website.

Look at how dirty the filter is after a week! 

What does Dr Yingzangel think?

I have installed Cleanwash Multipurpose Water Filter on my washing machine and shower line for a few weeks now. Remember in my previous post I discussed about my skin issues due to prolonged face mask use? I have noticed significant improvement in acne and irritative rash. My laundry also smells so fresh now. I had some problems with installing the filter to my water heater with pump- but it's quickly resolved by the efficient and friendly customer service team. Good aftersale service is definitely a plus when considering a water filter.

Good news to my Malaysian readers! I am collaborating with Cleanwash for a giveaway. Just pay RM0.99 and, 5, yes 5 lucky readers get a set of Cleanwash Multipurpose Water Filter (NRP RM88, delivery excluded ) each if you follow these steps:

1. Like and Follow Clear Living FB.
2. Tag 3 friends in the comment section of this post.
3. Share, like and follow my FB OR Repost, like and follow my IG!

Deadline on 30 June 20!

Dr Yingzangel

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Clear Living

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(postage not included)

* Peninsular Malaysia – Rm 8.00 delivery charge per trip in a single purchase.

* East Malaysia – Rm 15.00 delivery charge per trip in a single purchase

* Storewide purchase at Rm 100.00 or above entitles for FREE DELIVERY in peninsular Malaysia

How and When to use Sanitizer | Cellnique Sanitising Nano Mist Review

Sanitizing is no longer a foreign concept to us. Personal hygiene is of upmost importance nowadays. Whenever possible, hand washing using soap and water is the most effective way to get rid of germs, especially when the hands are greasy or contaminated by harmful chemicals. 

Hand washing reduces respiratory illnesses, like colds, in the general population by 16-21%.
At work, healthcare workers like me practise 5 moments of hand hygiene. But it's not always feasible to reach for a tap at each moment. That's when, sanitizers become very useful.

Read CDC guideline about sanitizer use.

This is how we should wash our hands.

https://youtu.be/UTNi1oEQjZc

At work, we use alcohol based hand sanitizers as they are proven to work. However, frequent use can really wreak havoc on our skin. Alcohol dehydrates the skin. They strip away the skin’s natural acid layer. This makes the appearance of fine lines and wrinkles more obvious. Besides that, alcohol also irritates the skin which can cause contact irritant dermatitis especially for those with sensitive skin. The natural lipid barrier of the skin is also removed which may make acne worse. Not surprisingly, skin cells also die when exposed to alcohol.

Cellnique Sanitising Nano Mist could be a promising solution other than alcohol based sanitizer.

Cellnique Sanitising Nano Mist features
-No alcohol
-No skin irritants
-No preservatives
-Nitrates-Free
-Tricosan-Free
-Chemical-Free

The main active ingredient is Nano-Colloidal Silver. This is basically silver in ionized form or nanoparticles. Nano-Colloidal Silver exhibits excellent antimicrobial, antifungal properties and is used for coating medical devices for preventing biofilm formation. It is also good in wound dressing in ionised form. Nano-Colloidal Silver use is definitely not foreign to my work as a doctor.

Infused with essential oils, this nano-colloidal silver sanitising mist is specially formulated to protect our skin including the face against germs and fungal infections. It is long lasting and suitable for all skin types including sensitive skin.

Nigella Sativa Seed Oil is rich in antioxidants. This retards premature skin ageing and is also great to calm irritated skin due to eczema, psoriasis and other forms of dermatitis. Besides that, Nigella Sativa Seed Oil also has potent antibacterial properties even for bugs resistant to antibiotics such as the MRSA superbug.

Bitter Orange Seed Oil, on the other hand, helps to maintain the oil water balance of the skin to optimise the skin's function as a natural barrier against germs. This oil also contains citric acid (Vitamin C), which maintains fairer complexion and strengthens the barrier even more.

A little bit about the background of Cellnique Paramedical. Cellnique Paramedical strives to combine the latest pharmaceutical grade skin care with advanced medical formulation including ingredients such as collagen and CoQ10. Backed by science, Cellnique has even established Cellnique Institute of Advanced Derma Aesthetics. This is how serious the company views the importance of research in product development. Recently, Cellnique Paramedical has turned its focus to solve skin problems in Asians. This is a great news for us because Asian skin is definitely not the same as others!

What does Dr Yingzangel think?

I really love these comparison charts to show how effective yet protective Cellnique Sanitising Nano Mist is. They even compare with chlorox which immediately remind me of Mr Trump :p

Traditionally highly concentrated alcohol is known to kill germs including Covid19, but many people especially healthcare workers like me, having to hand rub up to 100 times/day, will end up with irritant contact dermatitis. And we definitely cannot use those on our face. Cellnique Sanitising Nano Mist is suitable and safe for whole body use including the face. Kill virus but please spare our skin!

Get your own Cellnique Sanitising nano mist using this code SDY05 now!

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Is Vitamin C Supplementation necessary? | EC Pomegranate Mixture Review

When I was younger, my mom asked me to pop a vitamin C tablet every morning. I simply enjoyed the taste of the sweet chewable tablet. But is it necessary? Vitamin C is one the safest supplements one can ever take. It may not be the panacea to everything. But it really does have benefits in boosting the immune system, protecting our heart, brain and eyes. Not to mention the anti-ageing effects. Therefore, it is not surprising to know that Vitamin C Supplementation is beneficial against Covid19 infection. You can find the published study here.

However, most of the benefits are only seen at a higher dose of at least 500mg daily. It is simply not practical to consume that from our normal dietary intake. On top of supplementation, we will still have to take 5-9 servings of fresh fruits and vegetables everyday. The safe dosage of vitamin C Supplementation varies to age and gender and can be found in this article.

There are so many Vitamin C preparations out there- chewable tablets, effervescent tablets and liquid formulation. We do know that some preparations stronger than 500mg can cause some stomach lining irritation and discomfort, so look for  a non-acidic, buffered form of the vitamin. This is why I consume EC Pomegranate Mixture regularly.

Read more about Vitamin C Supplementation on WebMD.

EC Pomegranate Mixture

Pureway C is the more superior form of vitamin C in the form of its fatty metabolites. This allows faster absorption from the gut into the bloodstream and to the cells where it's needed. Pureway C also has potent antioxidant effect that remove free radicals that can damage normal cells and cause premature ageing. It is approved by the European Food Safety Authority (EFSA), categorized as Generally Recognized as Safe (GRAS) by the FDA. This preparation is also stomach friendly.

Besides that, EC Pomegranate Mixture does not contain added sugar. It's naturally sweetened by apple and pomegranate juice. Apple and Pomegranate contain strong antioxidants, vitamins and minerals. This help to supplement our daily fruit intake, all compressed into 15ml and 400mg of vitamin C goodness. 

What does Dr Yingzangel think?

You may think I'm a non conventional doctor. I am not against all sorts of supplementation but I do urge people to be alert and vigilant. Study about the product before consuming from valid sources. Only buy from reputed sources and not some herbal shop with homemade supplements made in the back alley. People love supplements undoubtedly. However, those with chronic illnesses- kidney failure, liver failure,heart failure and diabetes need to steer away from supplements and herbal remedies. If you really want to try, bring it to your doctor so you are monitored regularly if needed for side effects.

Disclaimer: the opinion given is merely a personal experience and does not constitute formal medical advice. Please seek your medical professional's advice before any complementary therapy. Always ask for certified professionals before proceeding with treatment and stop if discomfort or side effect ensues.

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Jasper Live Series: How to protect our seniors from covid 19

For those who didn't manage to catch us live, you can watch the whole interview here on FB. If you prefer to read my response instead, I have listed all my answers here. Hope it's useful information for everyone to learn how to protect their seniors from the deadly covid 19!

1. Please introduce yourself

1. Hi everyone. I am Dr Angel Ho. I am a specialist in internal medicine and will pursue further studies in geriatrics which is the care of the elderly. I am also one of the visiting specialist at Jasper Lodge-- which is a franchise of doctor-managed nursing homes, aiming to provide quality care to the residents. 

2. Besides being a fulltime doctor, I am also a partime blogger at www.dryingzangel.com . I enjoy sharing about healthy lifestyle tips with my readers. If you google @yingzangel, you will be able to have a look at my IG, FB page, blog as well as YouTube.

3. A little bit more information about myself. I am a mother to 2 active boys and wife to Dr Ryan, a wound care specialist. Both our parents are already more than 60 years old. So we are very much aware of how important it is to keep them safe and healthy nowadays. 

4. Besides that, I love talking and listening to people’s experience. And I absolutely love whipping up healthy nutritious meals for my family (which sometimes is disapproved because in my kitchen, every dish is low sugar, low salt and less oil)

5. I have shared today’s live series on my FB and IG as well. I hope you feel as excited as I feel right now! Do share the live video with your family and friends because we are going to discuss about a very important topic today-- which is how to protect our parents from covid 19.

1. Why did you choose to pursue the pathway of becoming a Geriatrician? And what exactly does a Geriatrician do?

1. When I was much younger, I thought I wanted to do something sexy, something more exciting like being a cardiothoracic surgeon. Perhaps I was fairly impressionable and was really inspired by Team Medical Dragon which was a popular Japanese drama series back then. 

2. As I gained more experience, I noticed that healthcare for older people in Malaysia really needs attention. I grew passion in caring for them. Even though it can be really difficult to get a concise and precise assessment when you are time pressed because most older people just have too much to tell! But sometimes all they need is just some therapeutic talking.

3. A geriatrician is trained to treat people older than 60 years old. Because as we age, the bodily functions change due to wear and tear. And we cannot treat older people the same way we do with other grown ups. A geriatrician is also sensitive to the multiple interactions between chronic illnesses, medications (you will be surprised at how many drugs a person takes both from various doctors and over the counter!) and other social as well as psychological factors that contribute towards the health of an elderly person. It can be extremely complicated and most of the time, requires a multidisciplinary team of healthcare professionals to tease out the issues. The study of geriatrics is about empowering our elderly population -- to improve quality of life and optimize social participation.

1. Give us an update on the COVID-19 situation in Malaysia, where do you think we are heading towards?

1. Malaysia is indeed quite lucky in the sense that local transmission of the disease has been managed to be controlled due to an effective MCO. We have diagnosed almost 8500 cases of covid 19 throughout the country with a recovery rate of 82% and death rate at only about 1%. Not surprisingly those who did not make it were mostly elderly with multiple medical illnesses. And this is precisely why we are having the discussion today-- about how to protect our loved ones who are the most vulnerable.The trend is definitely down going. We need to continue with our efforts to stop it from climbing back up again. 

2. The most important point here is only obtain your information from official portals. To get the latest accurate covid 19 statistics, please join the following telegram accounts : Majlis Keselamatan Negara and CPRC KEMENTERIAN Kesihatan Malaysia. ALternatively, download MySejahtera App to know hotspots around certain areas.

1. I understand that you are mainly working with elderly seniors. How do you think COVID-19 has impacted the lives of the senior population in Malaysia?

1. The aged, unfortunately, have suffered the most in this pandemic. Taking Italy as an example, most of the Covid 19 deaths occurred among the elderly with multiple medical problems such as diabetes, heart problems and not surprisingly with dementia. They are often the ones with weaker immunity and are much easier to get infected. Besides that complications from the infection such as kidney failure and the need to be on life support machine can often spell disaster in this age group of patients. 

2. For those who are relatively healthy, social distancing measures make people feel isolated. Many elderly people are restricted from their morning walks and grocery shopping. It can be extremely depressing when they are confined to their home for long periods of time. Sometimes, caregivers become stressed out as well, especially for those who care for older people with dementia. For example, Mr A has problems with wandering to nearby coffee shop which is not allowed during MCO. He gets argumentative when being stopped from going out. Usually his main caregiver who is his daughter gets some respite from visiting siblings from interstate once a week. But due to MCO, they are unable to travel interstate to care for their father. So you can imagine the stressful situation in the household. 

2. Many elderly have an assortment of medical conditions. What should we be more worried about? Managing their existing medical conditions or avoiding COVID-19? If so, what course of action should we be taking?

1. Both are equally important. That is why we have implemented a few contingency plans for this.

2. For elderly with other medical problems-- we usually delay their clinic appointments until later dates if their condition is stable. That is via reviewing their blood test results which may eliminate the need for the patient to have a face to face clinical consultation. This is because we have to implement social distancing measures in all outpatient clinics. And to make sure the patients we really need to review are seen fast with a short waiting time.

3. We are in the process of setting up virtual clinics. We will set up computer systems to have virtual consultations with patients whom we have determined to be able to self monitor to a certain degree. We do have to be very careful to select our patients because we are not able to perform clinical examination during virtual consultation. When in doubt, we may still need to call the patient back to see them in person. 

4. As for regular medication top ups, our pharmacy department is very helpful in terms of setting up drive through, locker as well as mailing systems to the nearest clinic or even to home. This has greatly reduced the queue and waiting period at the pharmacy.

3. The government is doing free PCR swab tests for all nursing homes, care centers and old folks home staff and residents in Malaysia. What about those staying in such facilities? How do you think we could protect them?

1. I really applaud the move to do PCR swab for people who stay in nursing care facilities. If you look at the situation in the US, they only detected covid 19 in their nursing facilities after a sudden surge of initially unexplained deaths. This is a painful lesson that we should learn because many older people simply present in an atypical manner-- many just become confused and refuse to eat. Rarely they will come to doctors with the typical fever, cough and shortness of breath. In other words, we tend to underdiagnose possible infections in the older population. By diagnosing more cases via free PCR , people become more vigilant towards suspecting possible infections. This will stop the infection from spreading like wild fire. 

2. In Malaysia, many nursing homes are overpopulated due to high demand. Not to mention that dementia is highly prevalent, under diagnosed and under managed. As I mentioned before this, people with dementia are at the highest risk of dying from covid 19 infection. Social distancing is also definitely a huge issue in these settings. We, in fact, will not be surprised if good respiratory etiquette and social distancing is not being practiced in many centers. People are just not aware of it. And it can be a real struggle to ask people with dementia to wear masks and wash their hands.

3. I strongly advise nursing homes to adhere strictly to the Malaysian Society of Geriatric Medicine guidelines. Please take hand hygiene and good respiratory etiquette very seriously. Visitation should be limited to only next of kin with screening of temperature upon entry. But this does not mean that residents are locked up. Because the centers should have daily social activities modified to less physical contact such as colouring and mental arithmetics so as to adhere to social distancing measures. Other means such as video calls between residents and their loved ones should also be arranged . Physically isolating the residents is the key to protect them.

1. Moving forward, how can we as a community protect our seniors? How should seniors protect themselves?

1. Our community needs to be aware that covid 19 is here to stay. Therefore, we have to adapt to the new normal. As there is a possibility of asymptomatic carriers, everyone has the responsibility to break the chain of transmission by- wearing masks, washing hands or using hand rubs, staying at home as much as possible especially when you have cold like symptoms. Remember young healthy people may have little or no symptoms but if the infection is passed onto the older age groups, it may mean life or death for them.

2. Similarly, our seniors need to be equally vigilant. Be aware and avoid sick contact. Even though they may miss their loved ones very much, they will need to practice social distancing as much as possible. We really have to learn from our Muslim friends, for example, for doing so well this Raya Season-- No open house and just BerRaya Di Rumah. 

2. What other advice would you be giving us to move forward after the COVID-19 pandemic? How should we and our senior population prepare ourselves in case of another outbreak or pandemic?

1. The virus is here to stay and we human, as a community, just have to live with it and make adaptations to our old practice. Reduce physical contact, but we can still communicate to each other frequently and effectively by using technology. There are so many free applications like WhatsApp, WeChat, Skype and Zoom that allow interactive virtual communications. As for shopping, there are so many platforms like Shopee and Lazada which make online purchase fast, secure and convenient.

2. Humans are blessed with brains so we can think and plan around unfortunate circumstances like this. This is for survival sake. And it is no joke. In the healthcare setting, we are also actively trying to adapt to the new normal while still providing the best quality of care to our patients. Now that daycare centers are opened and schools are to follow suit gradually, we really have to protect our children as well. It is really just the same sets of advice here- wash your hands, cover your mouth and your nose while sneezing and coughing, wear masks and stay at home as much as possible. 

3. These advice applies to many other infectious diseases and we as a community have to embrace the change for the better.

Probiotics and Prebiotics for Children | H2Kid Review

Since the day we are born, our gut is full of bacteria (called microbiota). Don't be disgusted because they are good bacteria. They are hardworking creatures helping to break down and digest food, feedback to the immune system about gut's health status and dampen inflammation. Our two main BFFs are Lactobacillus and Bifidobacterium.

So how do probiotics and prebiotics fit into the picture? Probiotics are living bacteria isolated from human, grown (cultured) in the laboratory and then made into supplement. When probiotics are consumed, the good bacteria goes and populate in the gut. Prebiotics is simply food for probiotics. It doesn't get digested by our body so it goes straight to the bowel, to our BFFs in the gut who can feast on it.

Does everyone need to take probiotics and/or prebiotics then? Not really. If you are able to eat clean and healthily all the time. And have no issues with indigestion, then there's no need. But if you are like me- work hectically, no fixed meal time, eat outside food a lot, have a bloated and gassy stomach most of the time, as well as constipation. Then you should give it a try. Or if you have chronic illnesses especially those involving your gut such as irritable bowel syndrome, you will definitely benefit from it.

Read more about probiotics and prebiotics from this article at ClevelandClinic.

What is H2Kid?

H2Kid is a gluten free natural supplement for children. It contains probiotics and prebiotics in the form of Bifidobacterium and galacto-oligosaccharides (GOS). It is flavoured by 100% natural real berries-- Cranberries, blackberries, raspberries, as well as acerola berries. Therefore it's naturally sweetened without added sugar. These berries are rich in vitamins, minerals and antioxidants. Besides being tasty, they are absolutely safe for children.

Read here to know more about the safety of probiotic use in children.

How to prepare H2Kid?

H2Kid can be mixed in cold/room temperature/warm water or juice. It doesn't need to be refrigerated either unlike some other probiotics. Children older than 1 year old can consume H2Kid.

Other additives in H2Kid are:

Water soluble fiber to soften stools, regulate bowel habits and ease constipation.

Papain enzyme to improve digestion, leading to better appetite.

DHA & ALA are important for brain development and general well-being.

What does Dr Yingzangel think?

It can be a real struggle to get my boys to take in enough fibre. They don't really have problems with taking in water thankfully. On the odd occasion, they do suffer from constipation. It's heart breaking to see them cry because of the colicky tummy ache. Giving commercially prepared laxatives is not easy due to the taste. Luckily H2Kids is very well accepted by my boys as the berry taste is delicious.

Want to try H2Kid and witness the change for your children? We are giving away 10 units of H2Kid for free! Just follow the steps:

1. Follow H2Kid FB page https://www.facebook.com/h2kidmalaysia/
2. Tag 3 friends in the comment section of this post.
3. Share, like and follow my FB OR Repost, like and follow my IG!

Deadline on 15 July 20!

Masked face and Double Cleansing | Chrisear White Milk Cleanser Review

Welcome to the new normal! 

Masked faces and even face shields are the way to go, probably for the next 6 months. What does this mean to me as a full-time doctor? On average, I have to wear a 3 ply surgical mask for up to 9 hours a day， perhaps even longer when I'm on call.

Do you know that prolonged face mask use can cause skin damage? The tight fitting N95 masks tend to feel fairly suffocating to breathe in, and the edges of the mask can exert significant pressure on skin surface, causing pressure injury especially where the skin is thin and near to bony surface. Even normal surgical masks can increased humidity level and skin irritation due to trapped sweats under stressed conditions, causing acne, itchiness and rash.

Wound care experts from the European Wound Management Association and NPIAP (US) have spoken extensively with this regards. You can find the video here. And the article here.

What can we do to mitigate the risk?

A good skincare regime is the key. Cleansing and moisturizing are important steps to prevent skin problems. In certain cases, preventive dressings can be applied on the face to stop pressure injury from developing.

Will double cleansing help?

Double cleansing is the backbone of many popular Korean skincare regimes. At the end of the day, it is extremely vital to clear our skin off dirt, impurities, pollutants and makeup residues. Even if one doesn't wear makeup, it is still important to double cleanse as impurities can cause premature skin ageing including sun spots and wrinkles.

The first step of double cleansing involves an oil based cleanser (examples include Chrisear White Milk Cleanser) or micellar water. This removes makeup and sebum buildup without stripping the skin off natural oil.

Step 2: Use a lathering cleanser to wash upwards and outwards in the direction of the hair follicles for deep cleansing.

Step 3: Rinse with water and pat the skin dry.

Chrisear White Milk Cleanser

Chrisear White Milk Cleanser is a non-foaming cleanser with cleansing and makeup removing function suitable for all skin types. It's gentle yet effective so it can also be used around the eyes.

The main ingredients are-

Liquorice provides deep cleansing to unclog the pores so as to prevent acne from forming. It also faints skin pigmentation to achieve fairer complexion.

Isaflavonoids are potent antioxidants which rejuvenate the skin and soothe irritated skin.

It doesn't contain harsh chemicals or preservatives. Therefore, Chrisear White Milk Cleanser is suitable for expecting mothers as well.

What does Dr Yingzangel think?

Whenever possible, I double cleanse before hitting the sacks- at least 2-3 times/week. Honestly, sometimes I'm just too tired. But I'll at least use a lathering cleanser and apply moisturizer. I don't put on much makeup but eye makeups can be notoriously difficult to remove because most are waterproof. Chrisear White Milk Cleanser makes the job much easier. It's lightweight and doesn't burden the skin. At the same time, it preserves natural sebum to protect the skin. I find the light scent relaxing at the same time.

Get your own Chrisear White Milk cleanser at JomBeautii 

360° Medi Skin is a certified aesthetic clinic that offers a range of beauty solutions - from medical grade facial treatments to minimally invasive office aesthetic procedures like filler injection and laser treatments.

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Safe Remedy for Aches and Pains | Perozin cream review

Aches and Pains are parts of our lives. As we age, we are only going to get more of it as body parts undergo wear and tear. This is especially true for joints, particularly the knees and backbone. No one should suffer in pain because it's just not humane. However, consuming long term painkillers can have deleterious effects to the kidneys. Therefore, applying creams with pain relief properties remain the main stay and the safest way.

Simplied illustration of a normal joint
(Photo courtesy of lumenlearning.com)

Osteoarthritis is the medical term to describe ageing joints. A joint links bones together. The end of the bones have a layer of cushion called articular cartilage. Synovial fluid is the lubricating oil to make joint movements smooth and painfree.

As we age, especially if we overuse the joints, the joint space becomes narrowed. The cushion becomes exhausted. There's also less production of the lubricating fluid in the joint. Small spiky parts formed on the ends of bones called osteophytes. This makes movement difficult and painful. Read more about osteoarthritis at Mayo Clinic.

I am a specialist in internal medicine. My interest is in caring for the elderly. With the silver hair tsunami, it's all the more important to ensure our ageing population have a good quality of life and remain as productive as possible. Managing joint pain is a very common issue yet often neglected due to the many other medical problems that we have to deal with. But it cripples many older people. Once people stop moving, their muscles become wasted. And this becomes a vicious cycle of what we call deconditioning, resulting in poor mobility and inability to care for one self independently.

Therefore, I always recommend my patients to get an effective topical preparation such as Perozin which is an effective cream to relieve muscle and joint aches. Sometimes we need to combine that with pain killer tablets and/or even surgery to replace the joint using artificial metal implants.

The main ingredients in Perozin are:

Menthol, cetearyl alcohol, glycerin, Mentha arvensis (wild mint), cetyl palmitate, glyceryl stearate, citrate caprylic/capric triglyceride, Rosemarinus officinalis (rosemary), Arnica montana, Zingiber officinalis (ginger), tocopheryl acetate, octyldodecanol, carbomer, Na gluconate, Na hydroxide, phenoxyethanol, Na dehydroacetate, limonene, linalool, citral

Arnica is an herb that grows mainly in areas with temperate climates. It has anti-inflammatory, analgesic (pain killing) and antiseptic properties. With the addition of menthol, mint and ginger, Perozin cream contains natural ingredients that gives a long-lasting cooling effect to the skin.

The beauty of using analgesic cream is the ability to reapply whenever the pain recurs without having to worry about overdose and side effects. Pain can be very subjective to assess so I really rely on my patients' pain threshold to guide my recommendation with treatments.

Quote PERO5ANGEL to get 100ml Perozin with a minimum purchase. Until 31 July 2020 only.

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Perozin is also available at many major pharmacies like Watson's and Guardian. It's available over the counter which means that it doesn't need a prescription. Get yours now!

Disclaimer: the opinion given is merely a personal experience and does not constitute formal medical advice. Please seek your medical professional's advice before any complementary therapy. Always ask for certified professionals before proceeding with treatment and stop if discomfort or side effect ensues.

Tiger Milk Mushroom Supplementation by GKB- Is it worth the hype?

Tiger's Milk Mushroom is medicinal plant used by the aborigines in South East Asia for more than four centuries.

It's only found in the rain forest at Malaysia,  Indonesia, Thailand, Philippines and Papua New Guineas. Legend has it that the mushroom grows from where the tigress's milk dripped while feeding her cubs. It's extremely scarce and difficult to find in the wild though.

The different tribes of indigenous people in Peninsular Malaysia (Orang Asli) have named Tiger Milk Mushroom differently;  as betes kismas to the Semai, as tish am ong to the Kensiu, as Pěti’ A a’ to the Besisi. It is called susu rimau in Malay and
‘Ndurabi in Indonesia.

Tiger's Milk Mushroom is rich in nutrients such as polysaccharide, polysaccharide peptides, proteoglycans and tritepenoids. B-D-glucan is a type of polysaccharide found abundant in Tiger's Milk Mushroom that is touted to strengthen immunity against pathogens. It also has anticancer properties. 

Orang Asli has used Tiger Milk Mushroom traditionally in treating cancer, coughs, asthma, lung diseases, and food poisoning, as well as to accelerate wound healing and promote general well being.  Hong Kong doctors have experience using Tiger Milk Mushroom in managing liver cancer, gastric ulcers, and chronic hepatitis. The University of Malaya has an excellent research paper talking about the scientific research behind the use of Tiger Milk Mushroom.

Tiger Milk Mushroom became a national treasure in 2002 when Malaysian Ex-Prime Minister Tun Dr.Mahathir Bin Mohamad announced at the International Biotechnology Convention that he consumed Tiger Milk Mushroom to relieve chronic cough.

The scientific name for Tiger Milk Mushroom is Lignosus Rhinocerus Mycelium. GKB sources its raw ingredient from Taiwan at premium quality. Being MESTI certified, this ensuress GKB supplements are produced under the strictest and hygieneic condition.Do you know that you can search the NPRA website for registered supplements and to know whether the product contains any ingredients that may jeopardize our health? GKB Tiger Milk Mushroom is registered with the number MAL17117005T. Simply take 2 tablets twice daily after meal to reap the benefits.

What does Dr Yingzangel think?

Besides the touted efficacy, we also have to scrutinize the safety of consuming Tiger Milk Mushroom in both short and long term. So far, animal and lab studies have not shown any detrimental effects on the liver, kidneys, heart, lungs and bone marrow. It's also been used safely in pregnant rats without ill effects to their offsprings. However there's no study in human pregnancy as it's simply unethical to try. Therefore, I would advise against consumption when pregnant or breastfeeding.

To purchase the product--

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Disclaimer: the opinion given is merely a personal experience and does not constitute formal medical advice. Please seek your medical professional's advice before any complementary therapy. Always ask for certified professionals before proceeding with treatment and stop if discomfort or side effect ensues.