KEEP

Volume 14/2007

KDN:PP15108/5/2008

Cover Story

Cornea Transplantation
by Dr Michael S.H.Law, Consultant Eye Surgeon and Cornea Specialist

n the front part of the human eye, is where you find the CORNEA the small, round, and transparent, dome-shaped surface of your eye. This tissue, which functions primarily as a focusing lens, is an essential component of sharp, clear vision. It accounts for a large part of your eyes focusing power. Any condition that distorts the cornea or damages its transparency can reduce vision sometimes severely. One treatment option may be a cornea transplant (KERATOPLASTY). Cornea transplantation is today one of the most frequently performed and most successful organ transplantation techniques worldwide. Some of the conditions that may require cornea transplantation include: Cornea thinning or perforation

Keratoconus an eye condition that sometimes progresses to severe cornea deformity and scarring, requiring cornea transplantation.

Cornea scarring (especially in the visual axis) Clouding of the cornea eg. cornea dystrophies Swelling (oedema) of the cornea Corneal ulcers (severe) Rarely, cornea transplantation may be done for cosmesis, to improve the appearance of a white or opaque unhealthy cornea.

In the most common type of cornea transplant called PENETRATING KERATOPLASTY (PKP) the surgeon cuts through the entire thickness of the original cornea to remove a small buttonsized disc. An instrument that acts like a cookie cutter, called a trephine, makes this precise circular cut. The healthy donor cornea, cut

Cornea transplantation is one of the most frequently performed and most successful organ transplantation techniques worldwide

Currently there is still a severe shortage of locally donated eyes for cornea transplantation in Malaysia
to fit, is placed in the opening. The surgeon then uses an ultra fine thread to stitch the new cornea into place. The stitches are removed at a later visit, usually after a period of 6 months or more. The entire surgery takes about an hour, depending on the individual condition. With some types of cornea problems, partial-thickness (lamellar) cornea transplants may be used, as it reduces some of the disadvantages of a full thickness transplant. Deep lamellar transplant. This transplant replaces only the diseased layers of the cornea, either the front (DALK) or the back portion (DSEK or EK). A correspondingly cut donor graft replaces the removed portion. These procedures are less commonly performed and are still being studied. Superficial lamellar transplant. Very uncommonly, eye damage may only involve the outer layers or a small part of the cornea. These can be repaired with a custom-cut donor graft. Cornea transplants are relatively safe and have been performed for many years. But, like any surgery, cornea transplants carry the risk of complications. Though rare, serious complications can occur, including: Infection Wound problems Irregular astigmatism or scarring of the front part of the cornea Severe bleeding especially during surgery Swelling in the front or back (retina) of the eye Glaucoma abnormally high pressure inside the eyeball, which can lead to visual loss if left untreated Cornea graft rejection or failure these may occur at any time after surgery. Prompt treatment is essential. Without treatment, complications can lead to the need to replace the transplanted cornea, or very rarely, permanent loss of vision. Currently there is still a severe shortage of locally donated eyes for cornea transplantation in Malaysia. It is hoped that by raising awareness of this sightgiving procedure, more local donors will come forward to give this gift of sight.

Contact for organ donation: National Transplant Resource Centre, Hospital Kuala Lumpur

The Cornea Transplant Procedure 1

1. Diseased or injured cornea. 2. Cornea area to be removed. 3. The cornea is carefully removed from the donors eye. 4. The clear donor cornea is sewn into place.

A successful PKP for keratoconus 1 month post-op.

Telephone Directory
General Line Ambulance Travel Health Dental 7491 9191 7954 1111 7491 1310 7491 1293 General Fax A&E Department Child Health Speech & Hearing 7491 8181 7491 1163 7491 1163 7491 1226 Wellness & Aesthetics Medical Records Mum & Baby Rehabilitation Medicine 7491 1198 7491 1131 5638 8350 7491 1101

Feature Story

SunMeds In-house Wheelchair Training Programme

by Mazwin Omar

basic wheelchair training programme was run by the Rehabilitation Medicine Department, as a part of SunMeds in-house staff training from June 16th to July 21st 2007. This very first wheelchair training programme was tailored for porters, but also included staff of the customer service department, in an effort to provide exemplary front-line service to customers. Twenty-three participants enrolled, eight from the customer service department and the rest from concierge. Eleven participants were foreigners who spoke a mix of basic Bahasa Malaysia and English. Participants were divided into three

groups. Each group was trained on different Saturday afternoons. The language barrier made it quite challenging for the team of trainers to communicate with some participants, but this was overcome by placing a participant to act as a translator in each group. The training team was multidisciplinary led by course advisor Dato Dr. Zaliha Omar, our Clinical Director of Rehabilitation Medicine and Consultant Rehabilitation Physician. The trainers comprised of Mr. Naveendran (guest wheelchair trainer from Rehabshop), Mr. Manikandan (our physiotherapist), Puan Norharyanny (our occupational therapist) and Mr.

There you go... Transfering Mr. Manikandan from the wheelchair to car seat.

A wheelchair training programme was held to provide exemplary front-line service to customers

Puan Nor Haryanny and Mr. Manikandan illustrating transfer techniques to attentive participants.

Muhammad Ghazali (our sports rehabilitation therapist). The four-hour core training programme comprised of two modules. The first was to introduce the form and function of wheelchairs, where the participants were briefed on different types of wheelchairs and those to be selected based on patients needs. Basic maintenance of wheelchairs was also taught. The second module focused on general principles of patient handling, basic posture and positioning patient in a wheelchair as well as appropriate techniques for handling and transferring patients from wheelchair to bed, chair, toilet or car & vice versa. Basic theoretical and practical aspects were covered, more time being spent on the latter. Simulations on two main types of patients, i.e. totally and partially dependant were illustrated by trainers and practiced by participants. Each group of participants was evaluated the week after the training session and it comprised of theory and practical components. The highlight of this first wheelchair training programme was the introduction of a

A full concentration amongst participants.

A little something from us to Mr. Liew.

Our CEO gave away certificate to participants.

comprehensive range of wheelchairs brought in by Rehabshop, along with four invited wheelchair-users who illustrated the functionality of each of their wheelchairs. Mr Liew Chee Keong who is paralysed below the neck, showed how versatile and independent he was in maneuvering his motorized wheelchair. Mr Thuraisingam, who is Mr. Liews partner from a wheelchair service company called EZ-ride, demonstrated the

ease of transferring Mr Liew out of his specially modified van. Mr. Danny who was paralysed below his waist, fascinated course participants with his ease of movement independently, using his light-weight wheelchair, transferring out of his compact Kancil car. Mr Dany is a lawyer who runs a graphic design company, Hemisphere. Mr. Soebri was born with partially amputated upper and lower limbs. This accountancy undergraduate

from University Tun Abdul Razak, mans a motorized wheelchair using his congenitally deformed hands, to get round. All four wheelchair-users are volunteers at the Malaysian Information Network on Disability (MIND), a BAKTI project, of which Dato Dr Zaliha Omar is a project leader. The training programme culminated in a participants certificate award ceremony presided by SunMeds CEO Dr. Chong Su-Lin on July 21st 2007.

CEOs Message

Achieving Healthier Lifestyle

unless prevented and managed, will have detrimental effects on the economic productivity of our population. Please do spend a moment to read our article on the Lean Club programme and spare a thought are you, your spouse or your children overweight? If the answer is yes, then it's time to do something about it now! Wishing you the best of health!

Volume 14 / 2007
Cover Story Cornea Transplantation Doctors Schedule CEOs Message Feature Stories SunMeds In-house Wheelchair Training Programme Total Knee Joint Replacement One Visit. One Dazzling Smile. LEAN Club The Lean Way of Achieving a Sustainable Healthy Lifestyle towards Family Wellness Medical Interview Apriza Warastuty from Pekan Baru, Sumatera Shares Her Experience
The Editorial team: S. Shobana, Dr Chong Su-Lin, Dr Michael S.H.Law, Mazwin Omar, Dr Lee Chong Meng, Dr Cindy Wu, Ms Teng Yu Yuet and Thumb-Print Studio Sdn Bhd. Printed by Tinggi Press Sdn Bhd. Keep Smiling is a quarterly publication by Sunway Medical Centre Bhd. If you would like to contribute to this publication, materials can be sent to: Sunway Medical Centre Berhad 5 Jalan Lagoon Selatan, Bandar Sunway, 46150 Petaling Jaya, Selangor, Malaysia. phone: 03 5631 4032 www.sunway.com.my/sunmed Attention to S. Shobana, Senior Manager of Public Relations and Marketing shobana@sunway.com.my

alaysia Boleh! We have sent an astronaut to the international space station; we continue to have a strong and stable economy and the 9th Malaysia Plan has a raft of projects to help propel further growth. So is all well? Unfortunately the answer is not really. Our growth towards industrialised nationhood has come with a downside: our love of food has led to alarming growth of our bodies. We are becoming a nation of obese people children, teens and adults. And obesity comes with a high price of cardiac disease and diabetes which

Dr Chong Su-Lin CEO, Sunway Medical

Feature Story

Total Knee Joint Replacement

by Dr Lee Chong Meng, Consultant Orthopaedic Surgeon

ou can only walk without pain when the bones in your knee joint are smooth and cushioned by healthy smooth cartilage. You also need strong muscles and ligaments for stability because your knee is more than a simple hinge joint: each time you bend your leg to walk or climb stairs, the bones rotate, roll and glide on each other. Knee pain and stiffness often result from osteoarthritis due to injury or wear and tear. Other knee problems include rheumatoid arthritis (an inflammatory joint disease), previous infection, or poor alignment of your bones. With Osteoarthritis, your cartilage cushion wears away. Bones become rough and rub together, causing pain. With rheumatoid arthritis, your joint may also be inflamed and swollen. A painful, stiff knee can keep you from doing the simple things in life, even walking without pain. Now your orthopaedic surgeon can replace your problem knee. After your knee replacement, youll have some restrictions on using your new knee, but you can look forward to returning to many of your activities of daily living. Total knee surgery is now as safe and effective as total hip surgery. However, there are definite risks and complications associated with the operation of Total Knee Replacement. Although they are rare, and your orthopaedic surgeon and the hospital staff will do their best to try and prevent these complications from occurring, unfortunately, they do occur. Some of these complications are:

Anaesthetic Complications Infection Deep Venous Thrombosis and Pulmonary Embolism Stiffness Wound Complications Fat Embolism Pressure Sores Vessel and Nerve Injury Fractures PREPARATIONS FOR SURGERY You are asked to provide your surgeon with information regarding: Your general health. Medications that you are taking especially oral contraceptives, steroids, aspirin. Allergies. Previous operations. Bleeding disorders. Other bone and joint problems. A number of investigations will be carried out before the operation. Some blood tests and Xrays are generally required. You may be referred to a Specialist Physician or Anaesthetist to optimize your fitness for the operation. SURGERY The surgery for Total Knee Replacement will normally take 1 to 11/2 hours. The technique of Total Knee Replacement has evolved over the years. Computer aided Total Knee Replacement is a new addition to the armentarium of the joint replacement specialist. GOING HOME Once you are recovered and can bend your knee enough to go home, your surgeon discharges you. Most patients are able to go home five to seven days after the operation. You

will be given instructions regarding exercises and medications before you discharge. You should feel free to ask your discharge nurse any questions you may have. You should have appointments made for outpatient physiotherapy and a post-operative visit to your surgeon before discharge. REHABILITATION The exercises you carried out during your hospital stay should be continued at home. These exercises are aimed at improving mobility and strength of your knee. You require crutches as long as your surgeon advises you. You should visit your physiotherapist as arranged after your discharge from hospital. He will check your progress and advise you on any additional exercises you may require. Your surgeon will see you within a fortnight of the operation and your stitches will usually be removed at this stage. He will also assess your ability to walk, the mobility, strength and stability of your knee. He will then advise you on how you can get to the next level of function. You are capable of driving a car 6 weeks after the surgery. You may walk any distance within your comfort. Swimming is permitted and indeed encouraged. Activities such as dancing, golf and bowling can usually start after 2 months. Your knee will serve you well and painlessly if you are able to put in the time for the exercises. The new knee should last for many years if you exercise reasonable caution. Heavy impact sports, jumping and violent twisting of the joint can cause early failure.

Feature Story

One Visit. One Dazzling Smile.

by Dr Cindy Wu, Department of Dental Services, Sunway Medical Centre

OUR PHILOSOPHY The SunMed Dental Services team prides itself in achieving excellence in the friendly, professional service we provide. We are committed to your comfort and to delivering the highest standard of professional care. Our goal is to achieve a dazzling smile for you. One of the first things you notice about people is their smile. When you meet someone with a bright, natural smile, it catches your immediate attention. However, teeth get stained over time due to lifestyle factors (e.g. smoking, drinking coffee, tea, red wine etc.) and the natural aging process.

is administered by dental professionals. A BriteSmile Professional Teeth Whitening treatment is the best investment you can make to improve your smile: one visit, just over an hour brighter, healthier smile results last for years dental professional performs entire procedure whitening satisfaction guarantee. HOW IT WORKS Lie back, relax, listen to music, even nap. In about an hour, BriteSmile will remove years of tea, coffee, wine and cola stains,

To get your smile back to looking its best, you should choose a whitening treatment that: achieves superior and long lasting results is clinically proven to be safe and effective uses a low level of peroxide for safety and comfort

HERE IS HOW IT WORKS:

1) After the consultation and oral examination, our dentist prepares you for treatment. Your gums and lips are protected with barrier materials.

2) A gentle whitening gel is applied on your teeth and a patented cool blue light activates it.

3) You relax. After three 20-minute cycles, the procedure is completed. You rinse and clean up. You smile. Wow!

4) When youre done, our whitening consultant will talk you through how to keep your white teeth white for many years to come.

When you meet someone with a bright, natural smile, it catches your immediate attention
leaving you with naturally white teeth! GOT QUESTIONS? GET ANSWERS. Does it really work? Better than any other whitening system out there. BriteSmile has been clinically proven to whiten teeth by an average of 9 shades in just one hour. No other method can even come close to our results. How white will my teeth get? BriteSmile can whiten teeth by as much as 15 shades for individuals with very dark teeth. Results vary as starting points are different and everyones teeth responds a little differently. Ask your dentist what you can expect for your teeth during consultation. What if I have sensitive teeth? About 10% of our clients may experience a dull ache following the procedure. Taking an analgesic almost always resolves the discomfort. It is best to avoid hot and cold drinks for first 24 hours. How long do the results last? On average, it lasts 2-3 years depending on your lifestyle. Certain habits, like drinking lots of coffee, tea, cola, etc., can work against the results. With proper care, your results can last for years. Ask your dentist about BriteSmile whitening products for home use.

For further information, please contact Dental Services at 03 7491 1293 or fax 03 7491 1294

Medical Interview

Apriza Warastuty from Pekan Baru, Sumatera Shares Her Experience

implikasinya dan menerangkan hal-hal tersebut dengan sabar. Ini membantu menenangkan kekhawatiran saya. Saya yakin, Allah kasih saya sembuh melalui kedua dokter tersebut. Semasa dalam perawatan di wat, saya diberi penuh perhatian sehingga dalam waktu yang singkat kesehatan saya pulih. Di sini saya dan ibu saya ingin mengucapkan ribuan terima kasih kepada semua pihak Rumah Sakit Sunway terutamanya Staf Cafetaria, Housekeeping dan Tim Petugas Hubungan Pasien Internasional yang ramah dan professional. Mereka telah memastikan bahwa perjalanan saya menjadi pengalaman yang menyenangkan dari awal hingga perawatan selanjutnya. Terima kasih Sunway!

udah 2 kota dan 6 rumah sakit di Indonesia saya berobat, namun Tuhan belum kasih sembuh. Akhirnya, saya ke Malaysia. Alhamdulillah, saya ketemu Dr Lee Foo Chiang dan Dr Adam Pany. Dokter yang ke 12 bagi saya. Pas dengan tanggal lahir saya, Alhamdulillah Allah kasih saya sembuh. Allahu Akbar, Rumah Sakit Sunway adalah tempat karunia saya. Dr Adam Pany dan Dr Lee sungguh hebat, mereka telaten dan teliti mengobat saya. Mereka menunjukkan kepada saya hasil tes, menjelaskan berbagai

Feature Story

LEAN Club The Lean Way of Achieving a Sustainable Healthy Lifetyle towards Family Wellness
by Ms Teng Yu Yuet

professional intervention, fun physical activity, advice and follow ups. We will help each family to identify simple changes that can be made from household nutrition to shopping habits. WHAT IS IN THE PROGRAMME? You will have plenty of fun activities and games! Sports and games get hooked into heart pumping, fun activities! Try sports with proper coaching. Cooking classes we will teach you how to prepare healthy meals and making the right choice of food. Nutrition education we will help you make some lifestyle changes and teach you how to use your Nutrition Workbook. We will teach you insights into healthy choices. Amazing Race a family that plays together stays together. Peer group support and forum make full use of the forum available because you may stand a chance to meet new friends! YOU ARE IN CONTROL! Mind and body we will teach you how to understand yourself and your body better. Let us help you to deal with daily obstacles in achieving our goals and managing your weight.

WHAT IS THE LEAN CLUB ALL ABOUT? Sunway Medical Centres LEAN Club Programme is a programme that is tailored to each child and family. The focus of the LEAN Club programme is to encourage: Healthy eating habits Healthy lifestyle changes Improved physical activity Positive body image WHAT IS OUR GOAL? The primary goal of the LEAN Club is to help individuals and their families with problems of being overweight to achieve a healthy weight. Our long term goal is to assist you to develop healthy habits that reduce the risk of diabetes, heart diseases and other obesity related illness. HOW DO WE HELP YOU ACHIEVE YOUR GOAL? At LEAN Club we will teach you and your family a healthier way of living for eating, exercising and viewing life. We believe in using an integrated approach combining

WHO CAN HELP YOU? Sunway Medical Centres multidisciplinary team comprises of medical professionals such as the Paediatrician Dieticians Pharmacists Recreational co-ordinator Certified fitness instructor We can assist to provide professional advice and address your concerns. FOLLOW UP AND MONITORING We will teach you to follow the same ideas when you get home. This will encourage your effort and continue to give you a chance to stay healthy. Follow up workshops include: Shopping trip understanding food labels Progress assessment Medical follow up

For enquiries and information, contact Dietetics and Nutrition Services at 03 7491 9191 ext 7758 or fax 03 7491 8181