VOLUME 13 : Jan - June 2015

KDN : PP 1720/04/2013 (029678)

FOREWORD
In the fast-paced 21st century, everything moves and changes
at tremendous speed. Anyone who cannot or does not move
in tandem will get left behind. The pressure begins even at
childhood, where we see young children being pressured to do
well academically so as to achieve a string of As and enter a
good university. The same applies at work, in our personal lives,
even passions. Competition appears to be everywhere.
This has given rise to rising mental health problems especially
among urbanites. Unfortunately, a lot of mental health problems
go undiagnosed and untreated, mainly because of the stigma.
It is time the public realise that having mental disorders do not
necessarily mean one is crazy or dangerous. With awareness, more people will come
forth to seek advice or find ways to manage their mental instability.
We hope and trust that you will enjoy this issue of Assunta Xchange, where many
aspects of mental disorders are covered. One important message is that not all
patients with mental health problems will need medications. For some, talk therapy
or having people to share their problems with, are all that is needed for recovery.
However, the patient or caregiver must first recognise that there is a problem, so that
steps can be taken to initiate treatment of any sort, medication or otherwise.
So stay happy, be positive and surround yourself with the people and things that
empower you. Our specialists and healthcare team are always ready to render
assistance if you need help.

Peter Leong
Chief Executive Officer

Mental health & surgery

How surgery affects the state
of mind
Pg. 2 and 3
Bipolar disorder
Swinging from one mood pole
to another
Pg. 4 and 5
Schizophrenia
Are you hearing voices in your
head?
Pg. 6 and 7
Depression & Cancer
Depression in cancer patients
Pg. 8 and 9
YOUR FOOD,YOUR MOOD
10 Tips To Feed Your Feelings
Pg. 10 and 11

EDITORIAL & PRODUCTION TEAM

Editorial Team
Lim Ee Hsia
Assistant Manager,
Business Development

Official Printer
Peraliph Sdn Bhd (341279-A)

Chan Li Jin
Editorial Consultant

Noorlidah Abdul Aziz

Business Development Coordinator

Contributors

Lakshmieswari Samynathan
Account Manager

Dr.M.M.S Krisnan

Consultant General Surgeon

Dr Deva Dass
Consultant Psychiatrist

Dr Lee Aik Hoe

Consultant Psychiatrist

POSTPARTUM DISORDERS
I hate my baby
Pg. 12 and 13

Circulation/Publicity

Nurul Syafikah Abd Razak

Marketing Executive
Designer
Mohd Firdauz Ismail
Digital Marketing Executive
Graphic Designer

Dr Ragu Shanmuganathan
Consultant O&G, and Gynae-oncologist

Stephanie Ng Suat Yean

EVENTS
Launch of Assunta Renaissance
Pg. 14 and 15

EVENTS
Assunta @ Karnival Keluarga
Sihat Desa Mentari
Pg. 16 and 17

60TH ANNIVERSARY
Assunta Hospitals Birthday
Bash
Pg. 18 and 19

Dietetic Manager

Assoc Prof. Dr. Philip George

Consultant Psychiatrist

EVENTS
Mineral water for flood relief
Medical support at Jerantut
Pg. 20

DISCLAIMER:
Assunta X-Change is proudly brought to you by Assunta Hospital. This magazine serves to
provide general information on health, treatments and remedies. It is strongly advised that
you consult your physician or other qualified healthcare professional for advice regarding any
medical condition. The owners, employees, authors and contractors of Assunta X-changes
content assume no responsibility for the use or misuse of this material.

Have a question or comments? We would love to hear from you!

Write to:

The Assunta X-Change

c/o The Marketing Communications Department,
Assunta Hospital, Jalan Templer,
46990 Petaling Jaya, Selangor.
You can also email us at enquiries@assunta.com.my or fax to 03-7872 3183.

ASSUNTA HOSPITAL

by Mr M.M.S Krisnan , Consultant General Surgeon

ost patients would be emotionally and psychologically

when they receive a diagnosis stating that surgery is
Whether it is a major open surgery or a minor endoscopic
surgery, the thought of going under the knife sends shivers
spine of patients and sometimes their family members.

disturbed
required.
(keyhole)
down the

Being aware of these psychological upheavals and offering some form

of relief in the form of counselling or medications is what differentiates
a surgeon as a doctor instead of the surgeon as a technician. Surgeons
must know and understand the psychological distress of surgery and
provide ample assistance whenever required pre and post surgery.
It is sometimes easier said than done because patients and their
caregivers may not be aware of their unstable mental and emotional
conditions. On top of that, psychological distress is not measurable in
certain terms such as getting an x-ray or blood test. It requires a large amount of trust for
patients and caregivers to share their concerns and anxieties with their healthcare providers
especially the surgical team.
As such, a healthcare team that is caring and empathetic can make a lot of difference in
relieving the anxieties of patients and caregivers. It all starts with recognising signs of
emotional distress, pre or post surgery, and taking the initiative to talk to the patient about
his/her feelings.
The most common psychological issues affecting patients and caregivers before and after
surgery are:

Depression
Depression may or may not be related to the medical condition at hand. If the depressive state
is related to or is the result of the medical condition, surgery can commence immediately, as
getting the surgery will resolve the illness that is making the patient depressed.
For instance, a patient with a persistent pain in the abdominal area is frequently depressed,
irritated and emotional, out of fear that it may turn out to be a fatal condition. The diagnosis
may be a growth of some sort, which will resolve the problem.After surgery, the patients
depression is usually relieved, because its source has been eradicated.
On the other hand, if a patient has an existing problem with depression and requires surgery
to correct a growth in the abdominal cavity, it is advisable to first treat the depression with
medical or non-medical therapies before doing the surgery. This is to ensure that the patient
will be able to handle post-operative depression resulting from pain, loss of mobility or
independence and possibly financial loss.
Depression after surgery is common but is usually temporary. Nursing staff, family members
and friends can support the patient by providing a listening ear, helping with physical matters
such as housework, childcare and fetching the children to school or tuition. Antidepressants
or other drug therapies are usually unnecessary.
However, patients who express suicidal intentions need to be assessed immediately by a
psychiatrist as it constitutes an emergency. Do not take threats or mention of suicide lightly
as it is often a call for help.

Anxiety

High levels of anxiety can lead to other physical symptoms such as insomnia
or
night
awakenings,
irritability,
fatigue
or
loss
of
appetite.
Anxiety
from
surgery is usually the result of two things a previous bad experience from a
similar or related surgery, or poor understanding of the intended procedure.
Examples of bad experiences include having a claustrophobic attack during a
MRI scan or waking up too soon in the middle of a procedure. Some patients
may also have existing phobias for needles, blood, anesthesia or surgical knives.
These phobias should be addressed early and managed well by the nursing team before the
procedure. As such, patients must inform the nurses and doctors of any anxieties or fears
early so that interventions in the form of medications or calming sedatives can be given.
Sufficient and detailed information will help defuse the anxieties of patients who fear the
unknown in their procedure. Showing them a video or talking to someone who has been
through the procedure will help them feel less afraid once they know what to expect.

Palliative Care and Bereavement

Some surgeries are conducted with the purpose of providing palliative care, which is to make
the patient more comfortable in the terminal stages of their disease. Patients (and sometimes
their caregivers or family members) facing the prospect of death typically go through five
emotional stages denial, anger, bargaining, depression and finally acceptance. They may
go back and forth between the stages, and the time taken from one stage to another differs
greatly between individuals.
This explains why some patients or their relatives sometimes react aggressively with the
healthcare personnel when they receive news of an incurable disease such as cancer. This
behaviour may be one of their ways for them to deal with the situation. The anger will later
subside as they move to another stage
of their grief process.
Healthcare
personnel,
caregivers,
relatives and friends need to allow the
patient the space and time to come to
terms with their condition until they
reach the acceptance stage.
It can be challenging to be kind,
supportive and understanding when a
patient or loved one is behaving badly
such as throwing tantrums, refusing
food and medicine or generally being a
pain. However, the kindness rendered at
this point is critical to help the patient.

ASSUNTA HOSPITAL

By Dr Deva Dass, Consultant Psychiatrist

ipolar Disorder is a biological illness that causes unusual shifts

in your mood, energy levels and ability to function in different
aspects of your life (for example, work, going to school, taking care of
yourself and maintaining relationships).
This illness used to be called Manic Depression because it was thought
that people with this illness would fluctuate only between episodes
of highly elated, euphoric moods and episodes of major depression.
However, the illness is not quite that black and white there are many
moods that actually occur on a spectrum as shown below:
Depression

Dysthymia
(low grade
depression)

Euthymia
(normal
mood)

Hypomania
(mild mania)

Mania

The mood shifts that occur are very different from the normal ups and downs that everyone
experiences at times. For some people, the mood changes brought about by bipolar disorder
can be dramatic. They can go very quickly from feeling euphoric or high, to feeling extremely
irritated to feeling sad and hopeless.
For others, however, the changes are not so severe or are easily identified and can involve
mild to moderate levels of mania, known as Hypomania. For still others, both depression
and mania can occur at the same time, leading to a tumultuous, chaotic experience of feeling
extremely energetic but sad and hopeless at the same time, with much anxiety. This is known
as a mixed episode.
Usually, people experience periods of normal mood between these episodes (known as
euthymia), when they are neither manic or depressed. While many people return to a fully
functional level during these periods, many also continue to experience some symptoms,
such as low mood (which is known as dysthmia if it lasts for more than two years), anxiety
or problems sleeping. This can continue to have an impact on relationships, and functioning
on areas such as jobs, marriage or social life or studies.
About 5% of the general population suffer from this disorder, irrespective of age, gender,
race or social status. The genetic heredity is close to 80% and like diabetes, heart conditions
and many physical illnesses, bipolar disorder is a lifelong illness that requires careful and
constant management with medications and psycho-social modalities, treatment with much
support and commitment.

Identifying the signs

Unlike other specialties, there is no blood test, cereboscope or x-ray at our disposal. There
are checklists or questionnaires for guidance. However, detailed history from several sources
including the patient, an intuitive assessment of mental status and behaviour over several
sessions, is essential in coming to a conclusive diagnosis while medical treatment is ongoing.
In some cases, admission is necessary.
Bipolar disorder and Major Depressive Disorder are both mood disorders. In some ways,
bipolar disorders may look a lot like depression. These two disorders are frequently confused,
even though they are not the same. What makes bipolar disorder different is that in addition
to depression, a person may experience the highs of a manic phrase.

The manic phrase

You might notice some of the following:

Having a lot of energy and feeling restless

A decreased need for sleep

Extreme, even frantic activities

Talking excessively, quickly, and/or loudly

Experience racing thoughts

Bring easily distracted and unable to focus or concentrate

Doing reckless things without caring about possible bad consequences such as

speeding, sexual prosmicuity

Exercising poor judgement
Some people going through bipolar mania also occasionally feel like their minds are playing
tricks on them and they see or hear things, they think people are out to get them, or they
believe they have special powers. Alcohol or substance abuse like marijuana can worsen
these symptoms.

The depressed phrase

During the bipolar depressed phrase, patients typically feel extremely sad or empty for days,
weeks or longer. Normal activities are just not fun or interesting any more. You might also
notice:

Changes in appetite or weight

Trouble sleeping or waking up

Difficulty concentrating and making decisions

Being agitated or tired and listless/lazy

Feel worthless, hopeless or guilty

Thoughts of dying or suicide
If not treated, the symptoms of the depressive phrase can get worse over time the low
feelings get lower and last longer. Risk of contemplating suicide is high among bipolar
sufferers.

Treatment

The treatment for bipolar disorder is generally made up of several components.

Medications Some medications are used to provide instant relief from a acute episode
of mania or depression, while some help keep symptoms under control. There are also
medications that are used on a long-term basis to prevent recurrences of future episodes
(relapse). Commonly prescribed medications are:
Mood stabilisers

For instant relief of acute episodes

For prevention of future episodes

Examples include Lithium, Sodium Valproate, Lamotrigin Carbamazepine
Antipsychotics

For treating symptoms of mania

Usually used together with a mood stabiliser

Examples include Quetiafine, Olanzapine, Risperedone, Sopheus
Antidepressants

For treating symptoms of depression

Must be used together with a mood stabiliser

Examples include Fluphenazine, Sentraline, Esaitabopuam
Psychosocial treatment works hand in hand with medications to help increase your mood
stability and improve your day-to-day functioning.

Psychoeducation helps you recognise your condition and its treatment.

Interpersonal and social therapy helps you improve your relationships in the family
and others and develop daily routines.
Cognitive behavioural therapy teaches you ways to change negative thoughts
patterns or behaviours.
Family therapy teaches strategies to reduce stress levels within your family
Occupational therapy provides training in a skill area to allow you to rejoin society
and improve self-confidence.
Support group helps you expand social network. The Malaysian Mental Health
Association conducts support group meetings that you can join.

ASSUNTA HOSPITAL

By Dr Lee Aik Hoe, Consultant Psychiatrist

he word schizophrenia may elicit fear . There is a lot of misunderstanding among the
public with this disorder. The term actually means split (schizo) mind (phrenia). But it is
a misnomer as the illness does not split the mind.
The features of this illness include positive symptoms. These are not good symptoms but
they refer to distressing symptoms.They appear as hearing of imaginary voices (auditory
hallucinations), and abnormal beliefs (delusions) such as becoming paranoid to people
around them. There can be a variety of positive symptoms.
Then there are negative symptoms such as social withdrawal and inability to concentrate or
express emotions. There are also cognitive and mood symptoms.

How common is it?

Schizophrenia occurs throughout the world, in all cultures and their presentations have been
recorded throughout history although they were misunderstood. The incidence is markedly
about the same through all geographical regions and the lifetime incidence is about 1%.
The onset is often late adolescence and early adulthood although it can occur at all ages. The
sex ratio is equal among males and females although the onset in males tend to be earlier.
In the olden times when the illness was not understood, they have been blamed on the devil,
on being charmed and on being witches. As such the people affected by schizophrenia had to
suffer all forms of supernatural treatments and torture without any relief.
Till the present times, many schizophrenic patients have been wrongly managed! I recall
a middle class teenaged girl who was suffering from auditory hallucinations and other
behavioural changes which the family did not recognise as illness for a few years. The delay in
the treatment resulted in the illness becoming chronic despite improvement in her condition
with treatment.
In the recent decades, the illness was blamed on parents and the childs environment and
upbringing. We now know that there is a neuro-biochemical basis to this illness. There is a
disorder of the neurochemistry in the brain in certain areas.

Understanding schizophrenia

What is difficult is to understand how and why it develops. There is a lot of progress in the
understanding of this disorder. There are complex causes which include the interplay of
multiple genes, brain structure and the environment, such as problems at childbirth and the
use of illicit drugs, such as cannabis and amphetamines.

A common case that I encountered is a young male who had abused amphetamines who
developed symptoms of schizophrenia. Even after stopping the use of these drugs, the
symptoms persist. It is like the drugs have precipitated the illness which might not have
developed if the person had not abused these psycho-active drugs.
Early diagnosis and initiation of treatment will result in a much better outcome. This has
to be emphasized, as often the delay in treatment will result in the person not being able to
recover.
Parents and families have difficulty persuading the person to seek treatment and may wait,
hoping that the person will recover spontaneously. This will not happen. So do not delay.
In recent years and being in private practice, I have noticed that some patients present very
early, within a couple of weeks of positive symptoms even though there may have been a
period of prodromal changes in the person. It is very satisfying to treat such patients as the
person responds quickly to treatment.

Treatment and management

Nowadays, there is a range of medications that are very effective. The drugs have progressed
from first generation drugs in the 1950s to newer second generation drugs. There are even
third generations medicines today.
An important point is to maintain on treatment when there is improvement or recovery as it
is well known that the recurrences of this illness becomes less responsive to medicines and
higher doses will be required.
Apart from medical treatment, there is a need for psychosocial intervention. This includes
psychoeducation and counselling of the patients and their families, providing rehabilitation
and occupational therapy to improve recovery and reduction of impairment.
There are community self-help organizations that assist families and provide training for
the individuals. Such an organization in our community is the Malaysian Mental Health
Association. There are similar organizations in other states.
Nowadays, patients with schizophrenia can be quite well, leading fairly normal lives. Many
continue to work and are self-supporting. They may continue their studies and even start
their own families. Their prognosis have improved a great deal.

ASSUNTA HOSPITAL

By Dr Ragu Shanmuganathan
Consultant Obstetrician & Gynaecologist; Gynae Oncologist

ne of the most difficult part of being a clinician is having to tell

a patient that they have cancer. Although many types of cancers
are now curable especially with early diagnosis and treatment, most
people still consider cancer to be a one-way ticket to nowhere.
Strangely enough, treating cancer as a disease is actually the least
difficult part. The most difficult part is handling the patients
emotional and mental wellbeing after their diagnosis, because it can
affect the prognosis and treatment outcome. One example is patients
who delay treatment for too long after getting their diagnosis. This can
cause the condition to get worse, and it may be too late or take more
effort for treatment to work eventually.
According to psychiatrists, studies show that about 70-75% of cancer patients will
experience clinical depression. The main reason for depression is deep-seated anxiety, of not
understanding what is happening to their bodies and what to expect. Classic signs of clinical
depression include losing interest in favourite activities, withdrawal from social activities
and simply not wanting to get out of bed in the morning.
This is sometimes frustrating for friends and family who cannot understand why the patient
is delaying or refusing treatment. What most people do not understand is that treatment
is not something that immediately comes to mind when someone is diagnosed with cancer.
Usually their minds will first go blank, until the reality sets in.
Their most immediate concerns would be mundane things like who will cook for the family
and take care of elderly parents, whether they have enough finances for treatment, what
happens now. Although they may appear calm and collected, they are usually going through
great internal turmoil.
Having the support of family and friends to ensure that the other aspects of life such as
family, finances, work and other responsibilities are well taken care of is crucial. This will
allow the patient to focus on his treatment plan without having to worry about daily affairs.
It is important to recognise the symptoms of depression in patients and offer support in the
form of counselling or medical advice. Depression puts the body under constant stress and
may affect healing. Patients with strong support from family and friends tend to cope better.
One thing to remember about cancer is that the treatment is a long-drawn process. Even after
treatment, the cancer may return after a few years. Hence patients emotional needs will
sometimes be on a roller-coaster, as they always harbour the fear of their cancer recurring.

Continous support for the patient is necessary in order to keep him/her confident, positive
and motivated to continue with treatment. In societies where inter-personal relations are
poor, suicide among cancer patients stands at 10%, considering the better prognoses for
cancer in recent years. Parasuicidal may be subtle and insidious signs, such as not taking
treatment and medications, basically an indication that they have given up fighting their
cancer.

Getting the Diagnosis

When told that they have cancer, most people will go through 5 main stages before accepting
their diagnosis. Without emotional support, they will delay treatment until Stage 5. With the
support of family, friends and the healthcare team, they may proceed with treatment, at the
same time battle their internal demons as below:
Stage 1 - Shock and denial: They will pretend as if nothing has happened and that the
diagnosis was just a nightmare. This is sometimes frustrating for family members or doctors
who want to initiate treatment as soon as possible for the best results.
Stage 2 - Anger: They start to feel sorry for themselves, asking Why me? and go on a guilt
trip, blaming themselves, others, even God for their condition. At this point, it is advisable
to give the patient space to lash out, whether internally or externally. This stage is necessary
for them to internalise the situation and fully embrace the reality of their illness.
Stage 3 - Bargaining: Once their emotions have stabilised, they will try to negotiate with their
Maker. Some will pray hard for a miracle, others try to negotiate for more time, promising to
do more charity, help someone in need, etc in exchange for a cure. Most will set timelines,
such as asking to be alive until they have seen their children graduate or get married, until
they have performed the Hajj, carried their first grandchild, etc.
Stage 4 - Depression: Most patients will at some point feel despair or depressed. Symptoms
include social withdrawal, loss of interest in favourite pastimes, lack of grooming and self
care, loss of appetite, refusing medications and treatment. Emotional support is most critical
at this point to ensure the patient does not give up hope.
Stage 5 - Acceptance: This is the stage when they come to terms with their disease and move
forward to do something about it, such as proceed for treatment, write a will, get their
finances and property in order, say all the thank yous and goodbyes.

How you can help

Respect the patients wish for treatment options

Provide a shoulder to cry on

Listen more, talk less

Provide physical support such as cooking, childcare,

shopping for groceries, paying utility bills, bringing
them to the hospital

Encourage them to exercise, take lots of antioxidants,

sleep well to avoid daytime fatigue and take their
medications as advised

Dont forget the caregivers and family members they need

support and help too
Consider joining a cancer support
group such as MAKNA, Breast Cancer Welfare Association,
Pride Foundation, etc.

Effective 28 April 2015 , Dr Ragu Shammuganathan will be having evening clinics every Tuesday
from 7 pm - 10 pm. For more details or to make an appointment, please call 03-7872 3775

ASSUNTA HOSPITAL

By Stephanie Ng Suat Yean, Dietetic Manager

ver wondered why some people are perpetually

moody, unmotivated and restless? The most common
perception is that these people have attitude problems.
However, many studies have shown that diet can play a
vital role in mood regulation. In other words, what you
eat is what you feel.
This is especially true in this day and age, particularly
in the cities where many people are so caught up with
pressures of daily living that their nutritional needs are
compromised. When that happens, they find themselves
increasingly unable to face pressure and stress. What they
think is emotional stress is actually a lack of physical
energy.
Hence, having a good, well-balanced diet is not only vital for your physical wellness but will impact
the way you feel and react to life challenges. Good mental health begins at the mouth!

So if youre often tired, sluggish and demoralised without any reason, here are ten nutritional tips
to kickstart your journey to a happier you:
EAT IN A COMFORTABLE
SETTING
DONT SKIP BREAKFAST
Many people mistakenly think
that the digestive system begins
Breakfast is the most important
HAVE A BALANCED AND
in the stomach or intestines.
meal of the day because you
VARIED DIET
In actual fact, it begins in the
have just fasted for the last 10mouth, beginning with the
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salt, sugar and oil.
elderly folks show that they
One important thing to note
tend to eat more and are
If you still find this difficult
is taking breakfast is often a
happier when eating with
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of your familys routine and
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positive mood for the rest of
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a group or clan.

10

CHOOSE YOUR CARBO

Carbohydrates are a necessary

part of our diet because they
provide the energy for us to
continue with daily activities.
Insufficient
carbohydrate
can make you feel cranky.
However, not all carbohydrates
are the same.
There are basically two kinds
of
carbohydrates.
Complex
carbohydrates consist of food
with higher fibre content such
as whole grains, beans, nuts
and roots. These carbohydrates
make you feel satiated as they
are turned into sugars and
absorbed in a slower, steadier
manner.
This
gives
you
sustained energy for the next
few hours, hence preventing
negative moods.
Refined
carbohydrates,
on
the other hand, are found in
cookies, white rice, cakes,
wafers and others. Because
they are already in refined
form, they do not require
digestion, and get absorbed
into the bloodstream very
quickly. This causes the sugar
rush, where you feel high and
happy 30 minutes after eating
refined carbohydrates, only to
crash after that where you
feel even lousier than before.

TAKE MORE OMEGA-3

Many studies show that the

modern diet consist more
Omega-6 and is insufficient in
Omega-3 fatty acids. Omega-3
is known as the good fat and it
helps to maintain the health of
the heart, brain, skin and other
cells in the body. Taking two or
more servings of salmon, tuna
or other oily fish, or flaxseed
per week, will help to improve
both
memory
and
mood.

EAT REAL FOOD

Modern
processed
foods
promise all kinds of nutritional
benefits such as enhanced
flavour, sugar-free, fortified
with vitamins and minerals.
But all forms of processed
foods require varying amounts
of preservatives and additives
to lengthen their shelf life.
Most also contain artificial
flavouring,
colouring
and
others to make them taste
good, while containing empty
calories that makes you feel full
but (remove )does not contain
any essential nutrients.
Processed food may be hard
to avoid in this fast-paced
modern life, but if you are
feeling down most of the time,
it is time to consider whether
youre eating more processed
foods than real food.
Wholesome and nourishing,
real food is simple, unprocessed
and complete. Eating real
foods that are naturally rich in
macro and micronutrients will
give you life and vitality.

CONSIDER GETTING
SUPPLEMENTS

If you have been feeling down

and lethargic for no known
reason, it might be a good idea
to assess your diet first before
starting
on
medications.
See a doctor or dietician for
advice on whether you should
include vitamin or mineral
supplementation and at what
dosage. Many urbanites today
need some form of nutritional
supplementation due to poor
food choices and irregular
meals.
Remember, childrens moods
and temperaments can also
be affected by the food we
feed them. Some children
who appear to be naughty,
hyperactive,
depressed
or
sullen may be suffering from
some form of vitamin or
mineral deficiency.

11

BOOST YOUR VITAMIN B

Vitamin
B
complex,
in
particular
Vitamin
B6,
is
necessary for production of
serotonin, a mood regulator
in our brain and aids sleep. A
deficiency in Vitamin B often
results in constant fatigue,
poor sleep, mood swings,
irritability and poor muscle
strength.
Vitamin
B6
is
found
in
bananas, salmon, poultry and
potatoes. Vitamin B6 and other
B complex are also found in
dark green leafy vegetables
such as spinach and kale.
The
2012
Raine
Western
Australian
Pregnancy
Cohort Study suggests that
teenagers or children who
appear to be misbehaving,
having unexplained tantrums,
have
Attention
Deficit
Hyperactivity Disorder and
autism should be assessed for
Vitamin B deficiency.

ADEQUATE PROTEIN

The building block of protein

is the amino acids. Tryptophan
is an amino acid needed for
the production of serotonin,
which can result in depression,
sleep disturbance and anxiety
when in insufficient amounts
in the body.
Protein is found in foods
such as red meat, fish, eggs
and dairy products including
cheese, yoghurt and milk.
Make sure you include these
protein sources into your
familys meal every day.

10

REDUCE CAFFEINE
INTAKE

Coffee and tea can be taken,

but sparingly because they
have a diuretic effect on your
body. This means they tend to
make you urinate more, which
might lead to dehydration if
you do not consume enough
liquids.
Also
beware
the
hidden caffeine in soft drinks,
energy drinks and chocolates.

ASSUNTA HOSPITAL

By Assoc Prof. Dr. Philip George, Consultant Psychiatrist

he baby is here and you are happy and relieved. Now that there
is another little one in your life, your life as a family is complete.
You too, feel fulfilled as a woman now that you have experienced
pregnancy and childbirth. There will be joy, excitement and new
adventures as you watch your baby grow.
However, all you feel is sadness, anxiety and self-doubt. You worry
about whether you are being a good mother and feel intimidated when
other mothers give advice on babycare.
Deep down, you wonder if theres something wrong with you because
you somehow dont feel the happiness, fulfilment or excitement other
new mothers do.
The good news is that you are not alone. Depressive symptoms after childbirth, commonly
known as post-partum depression, are extremely common and have already been described
in detail by Hippocrates in 700 B.C.
Basically, Postpartum Disorders fall into three categories: Maternity Blues, Post-partum
Depression and Psychotic Depression. The first is the mildest category, and most women
overcome it successfully soon after childbirth. The latter two warrants more attention.

Maternity Blues

This is a common condition affecting 50-80% of all new mothers. It usually begins right after
birth and can last for up to 14 days. Common symptoms include mood changes, tearfulness,
anxiety, irritability and feeling tense.
Maternity blues are believed to be caused by hormonal changes, anxiety about childcare and
problems with breastfeeding. Usually no medication is required as all the mother needs is
a lot of reassurance and family support. Practical advice, such as how to bathe baby, breastfeed, change diapers, swaddle or baby massage helps make the new mother feel empowered
and confident

Postpartum Depression

Postpartum depression affects up to 20% of new mothers. Mothers suffering from this feel
sad, hopeless, helpless and worthless. They lose interest in normal passions and feel unable
to cope with their new responsibilities due to low energy, low drive, poor attention and
concentration.
Some mothers may feel guilty, inferior and suicidal. The feelings are usually worse in the
mornings, and they may experience loss of appetite and sleep disturbances. Some present
instead with physical symptoms such as bringing their healthy babies repeatedly to the
clinic.

12

Postpartum depression can stem from many causes such as:

-
Hormonal changes - Sharp drop in oestrogen and progesterone that are normally
increased 10x during pregnancy. There are changes also in plasma cortisol, the stress
hormone occuring at this time.
-
Psychosocial factors such as feeling of inadequacy regarding childbearing
-
Ambivalence towards pregnancy
-
Low self-esteem
-
Interpersonal issues such as marital and mother-daughter problems.
-
Financial problems with additional expenses
-
Obstetric complications
Interestingly, many women with post-partum depression do not recognize they have an
illness, thinking that they are just having the blues. Many associate depression with false
notions, such as that it is untreatable and there is a stigma associated with treatment.
Left untreated, postpartum depression can lead to :
-
Disturbed mother-infant relationship
-
Marital tension
-
Psychiatric morbidity in children later stage
-
Vulnerability to future depression
-
Suicide and/or infanticide (killing of baby)
In managing postpartum depression, the psychiatrist will first investigate social factors and
mobilise support. In mild cases, this is often sufficient. The new mother will also be
connected to self-help networks and groups for material, emotional and physical help.
Mothers who have had the same experience can share their experiences.
In more severe cases, antidepressant medication, psychotherapy and/or Electroconvulsive
treatment may be recommended, whether independently or in combination. A combination of
drug treatments with psycho-social interventions is known to have the best results.
Antidepressants need to be taken for at least 3-4 weeks before any improvement can be seen.
Once they feel better, the medication needs to be continued for at least 6- months to prevent a
relapse. Mothers who are breastfeeding will need to discuss with the doctor about the safety
of the medication.

Psychotic Depression

Psychotic depression is almost the same as postpartum depression, but in addition they have
delusions (false beliefs) and hallucinations (false perceptions) such as feeling that someone
or something is watching or disturbing them. Patients may also show gross abnormalities
of speech and behaviour.
Psychotic depression is considered a Psychiatric Emergency and needs inpatient treatment.
It is a severe and life-threatening condition, and the patient must be closely monitored for
suicide and/or infanticide. Fortunately it is not very common, affecting only 0.2% of new
mothers.
Factors that lead to psychotic depression include:
-
Hormonal changes
-
Out of wedlock baby
-
First child
-
Caesarean birth
-
Perinatal death (stillbirth or neonatal death)
-
Psychiatric history
-
Family history of Psychiatric illness
Treatment is with Electroconvulsive Therapy or a combination of antipsychotics & antidepressants. Most patients often recover but will need further monitoring as they may cause
problems to the family. Some women may blame the child for their condition, while anger
from the family can be projected to the child. On the opposite end, some women go on the
opposite end and overprotect the child. Counselling is necessary to handle the topic of future
pregnancies.

13

EVENTS

ssunta Hospital officially launched its Heritage Halls and

newly refurbished wards in a special ceremony on 28-30 April
as part of its 60th anniversary which took place last year. Invited
guests comprising insurance companies, corporations, media
representatives, general practitioners and specialists were invited
for a tour of the old wing of the hospital which was given a total
makeover.
The renovations and upgrading works which started two years
ago were part of the Assunta Renaissance, the hospitals efforts to
improve comfort levels of patients and visitors, says Peter Leong,
Chief Executive Officer of Assunta Hospital. His take is that a
hospital should not feel like a hospital; it should feel like home so
that patients can recover faster.
The renovated sites include the wards, the Kidney Unit, baby
nursery, Physiotherapy Centre and Heritage Gallery which stretches
across four floors of the Old Wing. Some elements were maintained,
however, such as the old banisters and floor tiles, to reflect Assunta
Hospitals historical significance.

14

For a warmer, friendly feel, the walls are painted in lemon yellow,
following studies showing that white walls have a tendency to make
patients feel cold and anxious. Oil paintings depicting Mediterranean
scenery line the walls, providing pleasant surroundings for patients
and visitors alike.
Invited guests were awestruck by the black and white photos in the
Heritage Gallery showcasing larger-than-life photos of the Franciscan
Missionaries of Mary (FMM) nuns in the early days of the hospitals
establishment in the 1950s. The nuns were not just missionaries of
their faith but were also qualified doctors and nurses.
The Heritage Halls, which serves as an epitome of Assunta Hospitals
dedication to patient care, will continue to inspire and intrigue
visitors, patients, staff and healthcare providers. The hospital is not
just one the oldest private hospitals in the country but also ranks
high as a healthcare provider with the best nursing care, with its
own nursing college, the Tun Tan Cheng Lock College of Nursing,
providing a steady supply of nurses.
In the last 60 years, Assunta Hospital grew from a small maternity
clinic to what it is today as a commitment to the Petaling Jaya
community. As a not-for-profit organization, the core of the hospital
had always been to serve the people. The hospital does not have
directors but is governed by a non-salaried board of directors. 30%
of the hospitals profits are channeled to medical treatment for the
underprivileged with a family income of below RM1500. Currently,
there are 300 families on the hospitals beneficiary list.

15

EVENTS

hree teams from Assunta Hospitals Mobile Clinic, Tun Tan Cheng Lock College of Nursing and the
marketing department were present at the Karnival Keluarga Sihat health event officiated by YB
Wong Chen, the Member of Parliament of Kelana Jaya. Held at the low-cost flats at Desa Mentari, the
event was a joint collaboration between organizers MyHealth Outreach and Assunta Hospital.
Interactive and engaging, the carnival featured various activities such as games and morning aerobics,
health screenings, dispensing of medications, deworming and free pneumococcal vaccine shots for
children.

Over 100 children received the pneumococcal vaccination as prevention against the pneumococcal
disease, one of the main causes of morbidity and mortality worldwide in children under 5. In 2005,
World Health Organization (WHO) estimated 1 million deaths of children aged less than 5 years.
PnD is a complex disease that can cause blood poisoning (septicaemia), middle ear infection (otitis
media), brain infection (meningitis) and lung infection (pneumonia), which can lead to death and long
term disability like deafness. Pneumonia is the 6th main cause of death in Malaysia, with 5% of deaths
in 2010 attributed to this disease.
In his welcome address, YB Wong Chen said, We have been conducting various health camps around
Kelana Jaya to impress upon the community on the importance of taking care of their health. Often
our camps are targeting at adults and senior citizens, therefore we are delighted to be able to focus
on children and the importance of immunisation this time. The partnership with MyHealth Outlook
and Assunta Hospital today has given more opportunities to us to provide better healthcare for the
constituents.

16

17

60TH ANNIVERSARY

Community Day celebrations to commemorate 60 years of service to healthcare

he Specialist Clinic area had a carnival-like atmosphere on 21 December 2014 when

Assunta Hospital held its Community Day celebrations in conjunction with its Diamond
Jubilee celebrations. Hundreds of visitors and well-wishers of all ages took the opportunity
to visit the hospital premises, play games, participate in Christmas caroling, purchase gifts
from non-profit organizations and take photos from the Franciscan sisters, including one of
the founding nuns of the hospital.
Almost 200 people took the rare opportunity to tour the hospital, led by hospital personnel
who acted as tour guides for the day. The tour brought visitors across the newly refurbished
wards and healthcare facilities such as the dialysis centre, baby nursery, cafeteria and
rehabilitation centre. The refurbishments were part of the hospitals efforts to increase
comfort levels of patients and their families.
The highlight of the tour was the Heritage Halls, which showcased historical photos of the
hospital in its early days. The hospital was founded in 1954 by four Franciscan Missionaries
of Mary (FMM) nuns to serve the Petaling Jaya area, which used to have a population of
800 people. Petaling Jaya now has a population of 700,000, which made it necessary for the
hospital to grow in tandem.
Visitors who joined the tour were later presented with 60th anniversary notepads and
other goodies. To add to the celebrations, 62 adults and children who were born in Assunta
Hospital were given a specially designed anniversary umbrella when they presented their
birth certificates to hospital staff.
At midday, a bell was rung announcing the start of the Happy Hour, where the first 60
customers will be entitled to a 60% discount of selected health screening packages. The
special package, specially created for the occasion, was quickly taken up by eager customers
who recognized health as the biggest wealth.
Gift-hunters were kept busy looking at painted pots and pans, beautifully handcrafted felt
bags, pre-loved books, eco maps, health supplements and Christmas items. Meanwhile, over a
hundred children were busy producing masterpieces at a colouring competition held outside
the Paediatrics Unit.
While waiting for their friends or relatives, many made their way to the Health Screening
Centre for complimentary health checks courtesy of Assunta Hospital. They took the
opportunity to speak to the nurses on duty on their health concerns, while taking visiting the
Heart Centre located within the same premises.
The hospital started off as a small clinic called Ave Maria. With the growing population,
the clinic was expanded to a maternity home. It was once said that half of all Petaling Jaya
babies were delivered in Assunta Hospital, more so after the current building was completed
in 1959 with a donation drive by philanthropist late Tun Leong Yew Koh. In 1967, the Tun
Tan Cheng Lock College of Nursing was established next door, making it among the first few
private nursing colleges in the country, to provide quality nursing services for the hospital.
A 60th anniversary cake-cutting ceremony was also held, followed by lucky draws and prizegiving ceremony for colouring contest winners and a Guess The Pen anniversary contest.

18

60TH ANNIVERSARY

19

EVENTS

ealising the urgent need for drinking water supplies of the residents in flood-stricken
areas in Kelantan, Assunta Hospital donated 400 cartons of mineral water on 14 January
2015 to relieve their sufferings.
The mineral water donation was most timely, said Mejar Mohd Sayuti B Awang, who led
the Askar Wataniah team in coordinating flood relief items at the Pengkalan TUDM Subang
drop-off point. Speaking from experience, he shared that drinking water is the fastest item
to run out among flood-hit residents as well as volunteers who are helping them to rebuild
their lives.
Common water-borne diseases include typhoid fever, cholera, leptospirosis, hepatitis A,
dysentery, cholera and typhoid. Symptoms include fever, vomiting, diarrhea, muscle pain,
chills and fatigue.

n 27 January 2015, Assunta Hospital sent a medical team comprising doctors and nurses
to villagers in Temerloh and Jerantut, Pahang, as people in flood affected areas begin
the labourious task of rebuilding their lives. The flood relief exercise, organised by Syarikat
Perumahan Negara Berhad (SPNB) and PM Care Sdn Bhd, also involved several hospitals and
corporations.
The medical team set up base at the Balai Raya of Kampung Simpang Tebing Tinggi, Jerantut,
and provided medical aid to 160 families from 6 neighbouring villages. The medical team
screened for water-borne disease and other pre-existing conditions, distributed mineral
water to the affected families, and provided advice to villagers on hygiene practices and
the importance of using clean water for drinking or cooking. Common problems such as skin
infections, minor injuries, colds and coughs were also treated.

20