Malihah Medical Clinic

Malihah Medical Clinic General Practitioner Clinic, also carry out stem cell injection.

My encounter today 40 plus auntie came in with sore throat.Look to her past medical notes. I referred her to GH Ent 2 ye...
06/08/2025

My encounter today

40 plus auntie came in with sore throat.

Look to her past medical notes. I referred her to GH Ent 2 years ago for single blocked nose for 3 months, further history has loss of weight 3 months.

Examination that time : Nostril no obvious abnormality. Multiple small lump which we called lymph nodes were felt over the neck.

I asked her what happened after that. She said she was diagnosed with Lymphoma ( cancer of lymph nodes) of the nose. Done curative surgery, completed radiotherapy and chemotherapy. All is well now, under yearly follow up with GH.

It made my day.

Lymph nodes are small gland which responsible to produce white blood cell to attack bugs in the body. Mainly located in neck, armpit and groin.

Common cause of multiples enlarged lymph nodes include
- cancer ( lymphoma, leukaemia, secondary spread from other organs cancer)
- chronic infection( TB, HIV, heart valves infection etc)
- autoimmune condition ( SLE, Rheumatoid arthritis)

If you experienced constitutional symptoms like significant loss of weight >5kg in 3 months, Loss of appetite, night sweats, lumps and bumps over your body. Take it seriously.

06/08/2025

Dear Mr I,

One of my many common encounter.

26 yo female, no underlying medical illness came with palpitations for 2 weeks.

History: accompanied by shortness of breath, dizziness, lasting 15 to 30 minutes. Work has been very stressful for her lately.

Examination: heart, lungs, heart beat regular, blood pressure normal. Done ECG, normal as well.

In this case, her palpitations is clearly associated with panic attack/ anxiety. In her case, self relaxation technique doesn't help. The frequency is so often that she needs to resign from work. Started her on oral medicine, symptoms much improved, but it takes time.

Palpitation is a subjective feeling of heart racing. If you feel that your heart racing is fast,and accompanied by evidence of fast heart rate like pulse oximeter or manual counting. This is what we called Tachycardia.

Sinus Tachycardia generally means a fast heart rate but it is regular in rhythm as the pacemaker in our heart is still functioning well. Generally, it is is less much of a concern as compared with non-simus tachycardia.

Frequently encountered causes in gp setting
-anxiety related
- acute illness especially with fever
- hyperthyroidism
-medication induced/ excessive coffee/ tea
-alcoholism

Less common cause
- heart related
-low red blood cell
- low blood sugar level
- endocrine causes

tips

- Take it seriously, if you have family history of hear disease/ premature death, or you symptoms is associated with syncope, chest pain

- You can't know whether it is sinus tachycardia or non sinus tachycardia until you do a ECG. So if you have palpitation, at least do a baseline ECG.

- in Gp setting, our main role is to differentiate cardiac Vs non cardiac cause of palpitation, and whether it is life threatening or not.

- when you come with palpitation, we will check your heart sound, pulse, signs of anaemia/ hyperthyroidism/ and your temperature/ review your medication.

- if we think it is heart related,

1) a structural heart condition like valves problem, we will refer you for a holter test, which is a small device to monitor your heart rhythm for 24 hours, as ECG done in our clinic can only show your heart rhythm at the point of testing only, and also Echocardiogram which is a ultrasound scan, a hand probe device, to visualise your heart more clearly.

2) ischaemic heart disease ( aka heart attack)
We will refer you for a exercise stress test to make your heart work harder, and monitor you for ischaemic changes.

Hope it answer your question. Thanks

05/08/2025

Post in the comments below which health condition/ symptoms/ health topic you all wish to know more. I will post a real life scenario and practical tips for it. Those topic with more people comment I will post first in a descending order to least people comment. 😊

THIS IS NOT ACNE.20 years old plus male, tough body build, came in with a singlet after gym, complain of cough. No other...
30/07/2025

THIS IS NOT ACNE.

20 years old plus male, tough body build, came in with a singlet after gym, complain of cough. No other complaints.

Incidentally saw his back with multiple acne like lesion.

Me: How long have you been having this. He said 1 year. Tried antibiotic acne cream. Not effective.

Me: Do you take steroids for muscle building?

He: Yes

I told him this might not be simple acne. It is a condition known as Hiadradenitis Supputiva which is a condition where multiple sweat glands inflamed. The cause is slightly different from acne which looks really similar.

This condition is often confused with acne. Typically less responsive to topical treatment alone as it is widespread. Can be familial, linked with obesity, high blood pressure, diabetes and cholesterol (metabolic syndrome), exogenous steroids usage, smoking etc.

Normally occurs in area which is rich in sweat glands like back, armpit, and groin.

Complication includes recurrence, infection and rarely cancerous skin lesion, poor self esteem.

Treatment often need oral systemic medication. In an acute flare, a course of antibiotics and steroids might be required. Long term treatment, steroids sparing anti-inflammatory drug will be required.

This is a chronic recurring scarring condition and is often extensive and permanent. Early diagnosis and treatment can prevent extensive scarring.

30/07/2025

Ga-uutt

SAKIT PERUTMy encounter78 years old elderly gentleman, underlying heart disease on blood thinner, diabetes, high blood, ...
24/07/2025

SAKIT PERUT

My encounter

78 years old elderly gentleman, underlying heart disease on blood thinner, diabetes, high blood, with history of hip fracture can only ambulate with help.

Daughter: My father have abominal pain for 3 days, I bought painkillers from pharmacy, but his pain is getting worse. His stool also looks different from normal.

Me: Can you let me see what type of painkiller is he taking for the past few days. It's diclofenac, a type of widely used painkillers under the group of medication named NSAID( non-steroidal anti-inflammatory drug)

Patient looks pale and weak.

Examination- low blood pressure 80/50, heart rate 126, abdomen is tense and tender over whole abdomen

Me: Your father is likely having bleeding from stomach. As he is taking long term aspirin,and on top of that the recent painkiller is bad for stomach.

Based on my examination, his stomach has likely perforated causing spillage to the whole abdomen which explains the situation he is having now.

I will start some drip, and some medication through his vein hopefully can stop the bleeding.

That night, I referred urgently to hospital, needing ambulance from hospital, as his condition is unstable for self transport.

# 🚨🚨🚨Kindly know the medication you are taking. Sakit perut has so many causes, and there is no single medication that can solve all sakit perut. It might worsen your condition.

Patient passed away few days after admission as his too old and unstable for abdominal surgery. 🌹🌹

****The stool above is a black tarry stool indicating bleeding from the upper bowel usually stomach

Patient : I have this rash for 2 weeks already. Patient is a women, in mid 20s. Visitted multiple doctor, they say is ec...
23/07/2025

Patient : I have this rash for 2 weeks already. Patient is a women, in mid 20s. Visitted multiple doctor, they say is eczema. I have so many types of cream at home now. Had a jab as well. Very unsightly la doctor.

Me: This is not eczema. It's psoriasis. It's quite extensive in your case. It might not respond to topical cream alone. I will refer you to skin specialist, they have better meds for you.

1 year later, came back for cough. I asked how's the rash. She said no more rash at all, totally clear ( showing me her previous site of rash)

Psoriasis is very common. When I was working in Dermatology clinic in SGH, we have a special clinic allocated just for psoriasis patient. We need to do scoring every time they come. Including how has the rash disturbed their life. Trust me, it is torturing for some to the extend they develop depression.

Psoriasis affects mainly skin, sometimes it affects the joint, eyes and bowels. It also increases the risk of cardiovascular event. It is a disease with high burden.

is a term that is used very often when doctors don't know what the diagnosis. Technically it's correct as eczema literally just means inflammation of skin.

My encounterPatient 50 plus male, came in right leg swollen 5 days, visited doctor 2nd day of onset. No fever, mild pain...
23/07/2025

My encounter

Patient 50 plus male, came in right leg swollen 5 days, visited doctor 2nd day of onset. No fever, mild pain only. Doctor gave him antibiotics treat for infection previously.

Further question, feeling shortness of breath. Just came back from china long journey flight before leg got swollen.

Examination, right leg slightly swollen, not painful when pressed, not reddish.
Lungs normal, heart rate increased.

Was thinking something is not right. Referred GH.

End up, blood clot in lungs, hospitalised 3 days discharged with blood thinner.

This is what we called deep vein thrombosis(DVT).

Risk factors
-immobility(any reason including not mobilising during long flight)
-cancer patients
- old age especially above 60
- any injury or surgery done to leg
-pregnancy
- overweight

Practical tips

Both leg swollen Vs single leg swollen has different causes. Single leg swollen normally is because of infection or DVT. Both leg swollen normally seen in heart failure, chronic kidney disease/ liver disease and etc.

So , if single leg swollen is because of infection, normally will be accompanied with fever, and excruciating pain, reddish and warm leg. If it is due to clot, sometimes the only symptom is only swollen limb, if accompanied by heart racing, breathlessness, chest pain, always need to rule of clot in your lungs.

Have you seen someone with this before?First picture is cholesterol deposits around the eyelids frequently associated wi...
18/07/2025

Have you seen someone with this before?

First picture is cholesterol deposits around the eyelids frequently associated with high cholesterol especially the bad one LDL cholesterol.

Second and third one depicts a diagonal crease across earlobe with is a sign and independent risk factor to develop cardiovascular disease.

4th and 5th picture shows blackish discolouration around skin folds like armpit, neck groin. This is commonly associated with metabolic disease especially diabetes. It can be seen is other endocrine disorder as well like hypothyroidism.

So, these all skin signs if present will increase the risk of one having cardiovascular disease like stroke and heart attack if it affects the large vessels. If it affects the smaller vessels, eye problem and chronic kidney disease might develop in long run.

If your close ones/ relative are having these, kindly ask them to check their blood pressure, blood glucose and cholesterol and get treated if they are abnormal. Dont brush them of by saying, ' just use some whitening cream' on those dark sin area/ see a doctor to remove the patches around the eyes.

Yes I understand it is aesthetically unpleasant, but what is most important is that you must address the underlying cause. And yes, I have seen many patients requesting to remove the unsightly patches around the eye and gives some whitening cream for the dark skin.

Do you know someone that thinks that the best solution for shortness of breath is nebulisation(neb)? My encounter70 plus...
17/07/2025

Do you know someone that thinks that the best solution for shortness of breath is nebulisation(neb)?

My encounter

70 plus auntie, self claimed history of asthma complained of semput/ shortness of breath( SOB) for 2 days request my staff at counter for neb only because it works for her every time. So, I just tell my staff to proceed with her request.

So, she came here for 2 consecutive days for neb.

On the 3rd day, she request to see doctor as she was still feeling breathless. Further history, she has diabetes, high blood, and cholesterol as well.

Examination- BP rocket high 200/110, both leg swollen, lungs flooded. Heart rate 130 very fast, irregular

Conclusion, not all shortness of breath is equal to 'neb'!

In this case, neb actually worsened her condition. She is likely suffering from heart failure causing leg swelling and water in the lungs as the heart is too weak to pump back the water.

Frequent nebulisation side effects are increase in heart rate, tremors, low potassium. Increase in heart rate is actually worsening her heart failure as her heart is too weak to cope with demand. Imagine a failing water pump, but you increase the rate of pumping.

Furthermore, the low potassium will cause disturbance in heart rhythm. In her case, she was having atrial fibrillation( irregular heart rhythm) which could anytime cause a blood clot to travel up to the brain and cause a stroke.

Breathless has a long list of causes which is impossible to list it all down. Mainly lung causes like infection, air or water trapped in lungs, clots in lungs. Other common causes are like severe diabetes/ high BP, panic attack, hyperventilation, any infection, any heart problem, the list goes on.

Conclusion, neb is not the so-called mighty all-in-one solution for breathlessness and might worsen it. In fact, neb only works for breathlessness caused by tight airway which accounts for less than 5% of the breathlessness causes.

Two weeks ago encounter.15 years old girl, came with headache for 4 days. Saw another doctor 2 days ago, was given paink...
17/07/2025

Two weeks ago encounter.

15 years old girl, came with headache for 4 days. Saw another doctor 2 days ago, was given painkillers, doctor said migraine.

Take further history, sounds like normal headache. Thought of discharging patient with stronger painkillers. While taking blood pressure, saw her left eyes reddish and some pimple like rash on forehead.

Referred her to GH emergency for eye check up.

Came back 1 week later, mother said she was referred to eye doctor immediately that night. It was herpes zoster, what we called 'kayap' or 蛇 in Chinese.

Herpes zoster in face especially near eye area is an emergency until proven otherwise. Imagine if I missed the acne like rash, because her hair actually covered her forehead and the red eyes. The patient might lose her vision if not given immediate treatment

Tips
Herpes zoster normally comes in blister like rash, it usually follow dermatomes (nerve distribution of the body, mostly one sided), often feel pain/itchy. The virus is the same as chicken pox virus.

Acute complication includes spread to lungs and brain covering layer, long term complication most commonly post herpetic neuralgia aka phantom pain in the area previously affected. People prone for complication are those with low immune system like elderly, child, cancer patient.

Good news is that treatment is available and best effect is achieved when antiviral is started within 3 days of onset of the blister.

17/07/2025

Patient: I bought antibiotics from pharmacy. Why is my cough still so terrible. It must not be infection

Me: let me see the antibiotic. Bro, it's s just supplement. How much is it?

Patient: 60 ringgit( which is much expensive than the most expensive antibiotic available in our clinic)

Pharmacy is not allowed to sell antibiotics over the counter without doctor's prescription by law. Google the so called antibiotic to double confirm. Don't waste your money.

Address

34 Taman Sungai Tengah Valley, Jalan Matang/Batu Kawah
Kuching
93050

Opening Hours

Monday 08:30 - 14:00
18:00 - 21:00
Tuesday 08:30 - 14:00
18:00 - 21:00
Wednesday 08:30 - 14:00
18:00 - 21:00
Thursday 08:30 - 14:00
18:00 - 21:00
Friday 08:30 - 14:00
18:00 - 21:00
Saturday 09:00 - 12:00
18:00 - 21:00
Sunday 09:00 - 12:00
18:00 - 21:00

Telephone

+6082642496

Website

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