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YOU R Q UA RT ER LY H EA LT H & WEL L N ES S J OU R N AL
2015ISSUE
6
HEAD
TO TOE
HEALTH
We’ve got you
covered; learn more
about conditions
big and small
When it comes to being
healthy and well,
knowledge
is power.
Chronic care
closer to the
community
Inside Jurong Medical Centre
Here to care
Jurong Medical Centre
staff on what brings them
job satisfaction
Oh, my
The
aching head! angry itch
The difference between
headache and migraine
Affairs
of the heart
Don’t ignore chest pain
Dealing with hives,
eczema and psoriasis
Beauty from
the inside
Eat yourself beautiful!
Be JurongHealth's Community
Volunteer Gardener
Come Grow with Us
Passionate about gardening?
Help us create a beautiful and luscious community garden at Ng Teng Fong General
Hospital. Come join us with our like-minded friends and neighbours to plant,
grow and nurture our trees, flowers, fruit and vegetable plots.
Sign up now
For more information on this programme and other volunteer opportunities with JurongHealth,
please contact us at [email protected]
“ Take care of your body;
it’s the only place
you have to live”
- Jim Rohn
As we prepare for the move to Ng Teng Fong General Hospital (NTFGH), measures have
been rolled out to make sure our patients continue to enjoy seamless transition of care.
In fact, we have assessed our processes to ensure that we deliver the best care from our
new home in Jurong.
The theme of this issue of ONEHealth: Head to Toe Health, looks at various ailments that
can affect you from head to toe, from common problems such as headaches and skin
rashes to more serious conditions such as heart attacks and hip fractures. We also
highlight some less known but significant health conditions such as nose cancer. In
addition, we address the topic of diabetic foot ulcers and how a novel mode of treatment
using maggots is offering healing and better quality of life to patients. We hope to
increase the awareness of these conditions so that families and the elderly can identify
the symptoms when they arise, and take precautionary steps.
In our regular section, HealthBUZZ, we highlight the services offered at Jurong Medical
Centre and speak to some of our staff in WeCARE, where they share moments and
experiences that make their jobs meaningful. For more, turn to FOODforLIFE! and check
out the recipe for a yummy breakfast wrap and find out about the food that can keep you
beautiful both inside and out!
The editorial team
ONEHEALTH
01
C NTENTS
PUBLISHER
JURONG HEALTH SERVICES PTE LTD
EDITOR-IN-CHIEF
CASEY CHANG
DEPUTY EDITOR
AARON LOH
EDITORIAL ASSISTANT
WU WANWEN
CONTRIBUTING EXPERTS
DR FAREED KAGDA
DR JAMIE WEE
DR NIKOLAS WANAHITA
DR RANJIT MAGHERRA
DR SHIBLI SABINA
CHAD HAN
CHARLES LEW
NICOLAS MCINDOE
PETER CHOU
RACHEL-KIM DALLIMORE
PUBLISHING CONSULTANT
THINKFARM PTE LTD
MANAGING DIRECTOR
CHRISTOPHER TAY
EDITORIAL & DESIGN
SHERALYN TAY
SHARON HO
SHERING WEE
MYCT BOON
WRITING & PHOTOGRAPHY
ADAM KOH
BELLA LIM
LOUISA FOO
JUSTIN LOH
CHERYL SIM
ALVINN LIM
CLIENT RELATIONSHIP
JESSIE KEK
LEUNG KIT YING
HealthBUZZ
04 SPECIALIST CARE
CLOSER TO
THE COMMUNITY
Jurong Medical Centre
brings specialist outpatient
care and day surgery
services closer to patients
in the west
WeCARE
06 HERE TO CARE
The information in this publication is not
meant to take the place of healthcare or
services you may need. Please see your
doctor or primary healthcare provider
about any personal health concerns. All
information is correct at time of print.
ONEHEALTH IS PUBLISHED QUARTERLY BY
JURONG HEALTH SERVICES PTE LTD.
COPYRIGHT IS HELD BY THE PUBLISHER.
REPRODUCTION IN PART OR WHOLE
WITHOUT PERSMISSION IS PROHIBITED.
ALL RIGHTS RESERVED. MCI (P) 090/06/2014
PRINTED BY KHL PRINTING CO PTE LTD.
For general enquiries, email
[email protected]
02
ONE HE ALTH
Staff from Jurong
Medical Centre
share their passion
and mission of care
HealthSense
08 THE BIG MOVE
Frequently asked
questions about the
move to Ng Teng Fong
General Hospital
HEAD
TO TOE
HEALTH
2015 • ISSUE 6
When it comes to being
healthy and well,
knowledge
is power.
12 OH, MY
ACHING HEAD!
The signs and
differences between
headache and
migraine
16 THE
'HIDDEN' CANCER
Learn the dangers
and risk factors of
nose cancer
20 AFFAIRS OF
THE HEART
Why it’s important
to always seek help
for chest pain
24 THE ANGRY ITCH
Tackling hives,
eczema and psoriasis
27 CRACKED
IN THE HIP
The serious
consequences
of hip fractures
31 SOLE SAVIOURS
Wriggly help for
chronic foot ulcers
FOODforLIFE!
36
BEYOND STARTING
THE DAY RIGHT
Don’t skip breakfast
– or any other meal!
38
BEAUTY FROM
THE INSIDE
Your balanced diet
beautifies you inside
and out
40
POCKET-SIZED
GOODNESS
Make these wraps
and get ready to go!
HealthBites
41
GET HEALTHY
FROM HEAD
TO TOE
Everyday tips
to keep well,
happy and
healthy
34 STAND UP
FOR HEALTH
Inactivity can do
you harm. Here’s
why you need to
get off your seat
JurongHealth is a public healthcare cluster formed to integrate
healthcare services and community care for the west.
JurongHealth will operate the new Ng Teng Fong General Hospital on 30 June this year.
ONEHEALTH
03
HealthBUZZ
Specialist care closer
to the community
Jurong Medical Centre brings quality
care, greater convenience and holistic
healthcare to the community in the
west with a range of health services,
including specialist outpatient care
and day surgery
Not every specialist consultation or surgical procedure requires
a visit to an acute hospital. Jurong Medical Centre (JMC),
a one-stop ambulatory centre, brings seamless care and greater
convenience to patients in the west. Managed by JurongHealth
since 2012 to complement the services of Alexandra Hospital as
well as the upcoming Ng Teng Fong General Hospital (NTFGH),
JMC offers a comprehensive range of healthcare services.
These include specialist clinics, day surgeries, endoscopies
as well as health education and promotion. By bringing quality
hospital services nearer to patients in the west, JMC not only
increases accessibility to healthcare but also brings
convenience to patients in Boon Lay.
04
ON E HEALT H
1
4
2
1. JMC's dental clinic offers a wide range
of services, from polishing and scaling to
wisdom tooth extraction and root canal
treatment
3
2. Prescriptions from other institutions can
also be filled at the JMC Pharmacy
3. The Rehabilitation Centre brings
physiotherapy, occupational therapy and
podiatry care closer to residents in the west
4. Simple procedures can be done more
conveniently at JMC's Day Surgery Centre
JURONG MEDICAL CENTRE
60 Jurong West Central 3
Near Boon Lay Bus
Interchange and MRT station
Open Monday – Friday
8.30am – 5.30pm
Saturday, 8.30am – 12.30pm
(Pharmacy, Diagnostic Centre
Clinic, Health & Wellness)
Services
• Chronic disease management
• Day Surgery Centre
• Endoscopy Centre
• Dental Clinic
• Health & Wellness Centre
• Homecare Solutions Centre
• Laboratory services
• Pharmacy services
• Radiology services
• Rehabilitation services
• Specialist outpatient services
(eye; ear, nose and throat;
orthopaedics; general surgery;
anaesthesia; pain; dermatology;
urology; and renal medicine)
Comprehensive services
“JMC strives to provide an integrated healthcare solution for our community
in the west,” said Dr Chin Wui Kin, Clinical Director, "Patients can have their
medical conditions reviewed and tests conducted at the same time in JMC,
and complicated cases are currently referred to Alexandra Hospital, which
is managed by the same team of surgeons and physicians.” Patients will be
referred to the new NTFGH when it opens on 30 June this year.
Dr Chin pointed out that the comprehensive range of medical services available
can ensure that every patient receives fast, efficient and quality care. For instance,
the specialist outpatient clinics offer more than 10 medical specialties catering to
various conditions. The proximity of JMC means greater convenience for patients
seeking specialist treatment or for those who need minor surgeries, Dr Chin added,
"Minor procedures are also offered at the Day Surgery Centre, so that procedures
that do not require general anaesthesia or hospitalisation can be conducted closer
to home. Patients can undergo such procedures and be home in a jiffy."
In addition, the JMC pharmacy can fill prescriptions from other institutions.
Patients in the area can get their medication with greater convenience and less
travel time. The Health & Wellness Clinic also offers various health screening
packages for individuals, families as well as corporate clients. Dentistry services
are available as well, with a full suite of services such as teeth cleaning and scaling,
dental fillings and root canals as well as denture and orthodontic work. For
those who need physiotherapy, occupational therapy and podiatry services,
JMC provides rehabilitation services supported by its Homecare Solutions
Centre. This Centre features an interactive learning environment to illustrate
the best home health and safety solutions for better home care management
of patients and the elderly. These services provided at JMC not only ensure that
care is delivered in a seamless, efficient and cost-effective way, but also ensure
that patients are managed in an appropriate setting and get the right level of care.
ONEHEALTH
05
Fro m l ef t to r i g ht : Suri ya ni Sul a i m a n, Ro o m A s s i s t a nt
Dr So o n Yue n, S en i o r Co n s u lt a nt , Su rg er y
Le s l i e Ta n Yew Ki n, Pat i ent Rel at i o n s A s s o c i ate
Na g a ppa n Re ddy Th a na pa ki a m , S en i o r St af f Nu rs e
06
ON E HEALT H
WeCARE
Here to CARE
At every stage of
your visit to Jurong
Medical Centre
(JMC), dedicated
staff make it their
duty to offer you
quality care. They
share what makes
their job worthwhile
Truly patientcentred care
Dr Soon Yuen,
SENIOR CONSULTANT, SURGERY
I enjoy being there for patients,
not only in providing the medical
expertise to treat what ails them,
but also listening to them,
understanding their needs, giving
them information and resources
and partnering them in their road
to wellness. I can do all this, thanks
to my colleagues at JurongHealth
who share the same vision and
mission to care and the passion
to provide efficient, quality care
for every patient. It is rewarding
to see integrated patient-centred
care in action and be part of a
dedicated team that delivers it daily.
I recall one instance when a female
patient was referred to us for
a consultation after a cancer
diagnosis. Instead of a long and
worrying wait, we managed to get
her an appointment the very next
day and completed her tests and
screenings in just two days, saving
her time and anxiety and getting
her treatment in a timely manner.
Help is at hand
Leslie Tan Yew Kin, PATIENT RELATIONS ASSOCIATE
As a Patient Relations Associate, it is my duty and my pleasure to help
in whatever way I can so that patients are cared for and leave with a
smile. I have attended to various situations, from helping lost visitors
to ensuring medical emergencies receive the appropriate care. Once,
a referral patient mistakenly came to JMC instead of Alexandra Hospital.
After giving him the correct directions, I called the hospital to inform
them to expect his late arrival. At another time, two German ladies found
themselves in JMC instead of their appointment in Jurong Point, so
I walked them to their destination. When one of our young patients got
lost in the shopping mall across the road, I was part of the ‘search team’
to locate him. We also had an asthmatic patient arrive panting and
wheezing badly. I quickly sought advice from JMC doctors and nurses
and ensured that he received the emergency care he needed.
By your side
Nagappan Reddy Thanapakiam, SENIOR STAFF NURSE
Working at the JMC Day Surgery Centre, it is my job to prepare patients
before surgery and assist the surgeon during the procedure. I also help
to reassure patients and their families before their operation. There are
always a few nerves and concerns before a procedure, even if it is a
simple one. But I make sure they understand the steps that will be
taken and address any questions they may have. Sometimes, all it takes
is a friendly face and warm smile to put them at ease. After a surgery,
I ensure that patients are recovering well and are comfortable before
they are discharged. This job – caring for people in their time of illness
– is rewarding, and always gratifies me when patients share positive
feedback and are discharged feeling satisfied and happy.
Service with heart
Suriyani Sulaiman, ROOM ASSISTANT
I love meeting people and taking care of their needs. As a Room
Assistant, it never feels like work because I meet and help new people
daily. To me, delivering good service benefits everyone: it gives me
great job satisfaction and gives patients a pleasant experience when
they are not feeling so well. I make it a personal goal to offer service
with a smile and be alert so I can respond quickly to patients’ needs.
Once, a patient stumbled to the counter and complained of giddiness
and eye pain. I immediately assisted him to do an eye screening. It was
discovered that he had a serious eye condition that needed immediate
surgery. It was a relief to me that I responded in the correct way and
played a part in saving his vision. It is a joy for me to work in such a
caring organisation and with colleagues who have the same passion
for delivering good service.
ONEHEALTH
07
HealthSense
30
JUNE
2015
JurongHealth will
begin operating from
the new Ng Teng Fong
General Hospital (NTFGH)
at Jurong East from
30 June 2015.
To ensure minimal
disruption for patients
seeking treatment at
Alexandra Hospital (AH),
measures have been put
in place. For example, we
are working closely with
the other public hospitals
and polyclinics to ensure
continuity of care. As
JurongHealth moves to
its new home in Jurong,
AH will be closed
for maintenance and
renovation works to
prepare for a new team
from Sengkang Health.
Q
A
What are some of the ‘new’ features we can
expect from NTFGH?
When the NTFGH opens this year, it will mark many
‘firsts’ in healthcare. It is the first purpose-built hospital
to be integrated with an adjacent step-down care facility,
Jurong Community Hospital. The distinct fan-shaped wards are
also unique and will provide patients of every ward class with a bedside
window and privacy. Another first, is the combined Intensive Care Unit
and High Dependency facility, which will be vertically co-located with
Operating Theatres and the Emergency Department. The ‘one patient,
one queue, one bill’ approach to hospital appointments will also serve
to cut down on waiting time for patients.
The
BIG
MOVE
08
ON E HE ALT H
Q
I live close
to AH. What
will happen if my
elderly parent needs
emergency attention?
A
When JurongHealth
moves to NTFGH
and AH undergoes
maintenance and renovation
works, the Emergency
Department will be closed.
In the event of an emergency,
Singapore Civil Defence Force
ambulances that currently
send patients to the Alexandra
site will be diverted to nearby
public hospitals, such as the
Singapore General Hospital
(SGH) and National University
Hospital (NUH). If you live
around AH and require
emergency care, you
should also proceed to
these nearby hospitals for
treatment. For non-urgent
medical conditions, you
may wish to see the
general practitioners
in your neighbourhood.
Q
A
What can we expect in
the lead up to AH's closure?
To prepare for the opening of NTFGH on 30 June 2015,
and a smooth transition, services at AH will be
progressively scaled down and JurongHealth will
cease operations at AH on 29 June at 5.30pm. During this
period before the move, JurongHealth will work closely with
the Ministry of Health and other public hospitals to ensure that
patient safety and quality care is not compromised. Patients
warded at AH on 29 June 2015 may choose to be transferred to
NTFGH or another public hospital. For added convenience and
minimal disruption, patients at AH's Emergency Department who
require hospitalisation will be transferred to SGH or NUH from 23
June 2015. As for existing outpatients at the Specialist Outpatient
Clinics, JurongHealth has been working with them to work out
the details of care arrangements. Patients can either continue
follow-up appointments at the new NTFGH, at Jurong Medical
Centre or at another hospital in the area.
For any questions regarding appointments, contact our
Appointment Line at 6476 8828.
Have some questions about what will happen
when JurongHealth moves from its current location
at Alexandra Hospital to the new Ng Teng Fong
General Hospital at Jurong East? Call the
JurongHealth general enquiry line: 6472 2000
ONEHEALTH
09
10
ON E HE ALT H
HEAD
TO TOE
HEALTH
When it comes to being
healthy and well,
knowledge
is power.
Awareness arms and empowers you in taking the steps
needed to reduce risk, seek help and manage problems, for
a common ailment, chronic complaint or serious medical
condition. Read on to find out some of the health issues
that can affect you or your loved ones, from the crown of
the head to the base of the feet, so you can seek help
should any of these problems arise.
ONEHEALTH
11
HEAD
TO TOE
HEALTH
Oh, my
aching head!
Headache and migraine are among the most
common causes of pain and discomfort. Learn to
tell the difference and avoid the triggers By Bella Lim
IN CONSULTATION W ITH DR SABINA SHIBLI, SE N IO R CO N S UL T A N T , A N A E S T HE S IA & PA IN M E DICIN E
12
ON E HE ALT H
There is no denying
that while common,
a throbbing headache
can dampen any day.
A headache, a pain
that occurs in the
temples, scalp or
neck, is often
harmless and can
come under two
broad categories:
common headaches
and migraines.
Common headaches
Tension headaches are associated with stress
or fatigue, arthritis, anxiety or depression. Women
aged 20 to 40 are more prone to this type of
headache than men. Tension headaches can also
be caused by poor posture, eyestrain, neck muscle
or bone abnormalities, misaligned teeth or jaw
bones and unusual noise or light. Symptoms
include muscle tightness in the temple and
forehead; a feeling of pressure around the head;
and continuous but not throbbing pain.
Cluster headaches are named as such because
they happen in ‘clusters’, up to four separate attacks
a day. It is more common in men aged 25 to 45.
This type of headache causes severe and intense
pain that occurs suddenly on one side of the head
and/or one eye. It may also cause tearing from the
affected eye and a runny nose. These headaches
can last from under an hour to several hours and
they often stop as quickly as they started. The risk
of cluster headaches is linked to smoking, alcohol
use and an increased level of histamine – an
antibody that is released during an allergic response
– in the blood.
Benign exertional headaches are caused
by physical exertion, such as running, bending
and lifting, coughing or sneezing. Although
the exact cause is unknown, one theory is that
strenuous exercise dilates blood vessels inside
the skull. This headache rarely lasts more than
several minutes.
Migraine
A migraine is also a type of headache, but it is
chronic and more localised. It also occurs only in
a particular area of the head. “It usually comes on
gradually, becomes progressively more painful and
then gradually resolves,” Dr Sabina explained. The
intensity, duration, symptoms and frequency often vary.
What sets a migraine apart from a headache is that
it often tends to progress through several stages:
The prodromal phase: In the early stages,
one or two days before a migraine, pre-migraine
warning signs will appear. These may include:
constipation, depression, food cravings, hyperactivity,
irritability, neck stiffness, and in some cases
uncontrollable yawning.
The aura phase: About one in five people
experiences nervous system symptoms such as
visual disturbances. A typical visual aura presents as a
flickering, jagged or zigzag line that seems to appear
at the corner of one's vision. Another sign is numbness
and tingling of the lips, lower face and fingers of one
hand. Some people may experience temporary
paralysis on one side of the body. Auras rarely last
longer than an hour and in most cases, are followed
by a headache. Some people do not experience the
aura phase, but may have symptoms such as mood
changes, fatigue, mental fuzziness, fluid retention,
diarrhoea, increased urination, nausea and vomiting.
Other signs may include: nasal congestion, runny
nose, tearing, and/or sinus pain or pressure.
The attack phase: The migraine attack itself can
last for a few hours to several days. The throbbing pain
usually begins above the eyes and affects one side of
the head. The pain may affect the entire head or move
from one side to the other or spread to the lower face
and the neck. It worsen during physical activity.
The postdromal phase: In the aftermath of a
migraine episode, the sufferer may feel extremely
drained, washed out, confused or even mildly
euphoric.
ONEHEALTH
13
HEAD
TO TOE
HEALTH
Risk factors and triggers
Migraine is a
complicated event
and the symptoms may
not always be the same
for everyone. They usually
occur in a recognisable
pattern and can generally
be diagnosed easily,
noted Dr Sabina.
“Migraine
is treatable
and not lifethreatening,
but severe
and frequent
attacks can
result in poor
quality of life.
If it becomes
chronic, it can
be difficult to
eradicate.”
Migraines can happen to anyone, but they tend to be more common
in adult women then men. Some women may find that migraine attacks
tend to coincide with hormonal changes and occur just before or
shortly after onset of menstruation.
The risk of migraine is higher if there is a family history. Migraine is also
linked to certain medical conditions such as depression and anxiety,
cardiovascular disease, nasal or sinus inflammation, trauma to the brain
from head or neck injury, and infections or haemorrhages in the brain
and certain medications. Environmental, emotional or food triggers can
also bring on a migraine. “Because severe and frequent migraine
headaches can result in a poor quality of life, it is important to identify
the factors that can lead to an attack,” said Dr Sabina.
Common triggers include:
• Missing meals
• Alcohol, especially red wine
• Foods with monosodium glutamate (MSG), caffeine (coffee, tea,
colas), nitrates and nitrites (found in preserved meats), or tyramine
(found in aged cheese)
• Menstruation, oral contraception use and menopause
• Too little or too much sleep
• Stress
• Glaring lights, strong smells, weather changes or high altitude
Related medical conditions
Many people who suffer from migraines also suffer from a variety of
other health issues. And some of these are found to commonly co-exist
with migraine. The causes are not always clear.
These include:
• Depression and anxiety which co-exist in many migraine sufferers
• Cardiovascular disease which presents a slightly increased incidence
of migraine
• Nasal or sinus inflammation conditions which afflict many
migraine sufferers
• Certain medications, which can create a headache pattern that
becomes migraine-like
• Trauma or haemorrhages to the brain from head or neck injury,
and infections
14
ON E HE ALT H
Pain, pain go away
“Because the cause of migraine is multi-factorial, choosing the
right strategy to manage a migraine depends on the frequency
and severity of the headaches, the degree of disability they cause,
and any other medical conditions,” said Dr Sabina. In some instances
medication needs to be taken regularly to prevent/decrease the
severity, length or frequency of attacks. These medicines can cause
mild to severe side effects, and thus should only be taken according
to directions and when prescribed by a doctor. Non-drug treatments
for migraine may be helpful, such as staying away from avoidable
triggers, she added.
Do relaxation
exercises to ease the pain
One way to manage chronic
Ensure you get enough
headaches is to keep a diary
sleep (but don’t oversleep!)
to help you and your doctor
identify the triggers. Note
down: the day and time the
pain started; what you ate and
drank over the last 24 hours;
the amount of sleep you had the
previous night; what you were
doing and where you were before
the pain started; how long the
headache lasted; and what helped to ease it.
See a
doctor if…
Often, migraine headaches go undiagnosed and untreated,
noted Dr Sabina. “It is thus advisable to visit a doctor for migraine
just to rule out any sinister causes. And even if there has been a
history of headaches, a doctor should be consulted if the pattern
changes or the headaches suddenly feel different.”
Consult a doctor immediately or go to the emergency department
if your headache:
• is abrupt and severe
• occurs with a fever, stiff neck, mental confusion, seizures,
double vision, weakness, numbness or trouble speaking
• happens after a head injury, especially if it gets worse
• lasts for a few days or weeks and gets worse after coughing,
exertion, straining or a sudden movement
Do regular
aerobic exercise
“The cause of
migraine is multifactorial, so choosing
the right strategy to
manage a migraine
depends on the
frequency and severity
of the headaches, the
degree of disability
they cause, and any
other medical
conditions.
“
ONEHEALTH
15
HEAD
TO TOE
HEALTH
Nose
cancer,
known as
nasopharyngeal
cancer, occurs
when the cells in
the tissues at the
back of the nose
and just above the
throat (called the
nasopharyx) become
cancerous.
Nasopharynx
A painless lump in the neck, persistent
ringing, hearing loss in one ear or
unexplained nose bleeds may be matters
of concern. They can be signs of nose
cancer By Adam Koh & Sheralyn Tay
The
“hidden”cancer
IN C O N S UL T A T IO N WIT H D R R A N J I T M A G H ER R A , S E N IO R CO N S UL T A N T , E N T
16
ON E HE ALT H
It is one of the more common cancers in Singapore with about 300
new cases diagnosed a year, but nose, or nasopharyngeal cancer (NPC),
is often not detected till it's in the late stages. The cancer, which occurs
in the cells lining the area behind the nose and just above the back of
the throat, is one of the most common cancers in males in Singapore,
explained Dr Ranjit Magherra, Senior Consultant, ENT, JurongHealth.
“It hits hard because it occurs in people who are in the prime of their
working and family lives. It is the second and third most common cancer
in men aged between 15 to 34 and 35 to 64, respectively,” he said.
NOSE
CANCER
FACTS
2nd
MOST
COMMON
CANCER
IN MEN
aged 15–34
3rd
MOST
COMMON
CANCER
IN MEN
aged 35–64
300
cases
DIAGNOSED
every year
However, one of the biggest challenges facing the diagnosis of this type
of cancer, he noted, is the diffcultly in detecting it. "Because it grows in
a ‘hidden’ area at the back of the nose called the nasopharynx, it is not easy
to detect. The symptoms of the disease are also quite non-specific and there
may not even be any signs in the early stages," he pointed out.
Dr Ranjit noted that a Singapore study indicates that there is a tendency for
people to seek medical attention late and for doctors to delay referral to the
ENT specialist. The study revealed that a fifth of nose cancer diagnoses were
delayed for an average of seven months due to low awareness of the disease.
This resulted in many nose cancers only being detected when they are at
stage 3. This is unfortunate, said Dr Ranjit. "The cure rate after treatment for the
stage 3 disease is only 60 per cent and it drops to below 50 per cent
in stage 4." However, there is a 90 per cent cure rate if the disease is treated
at an early stage. This highlights the importance of awareness of the signs,
symptoms and risk factors.
Lumps and bumps
“There is a common misconception that cancer must cause pain, but in
many cases these signs are painless especially if they occur in the early
stages,” said Dr Ranjit. One
of the most common signs,
present in 75 per cent of newly diagnosed nose cancer
cases, is the appearance of one or more lumps in the
nose or on the neck. Neck lumps typically present in the region
on the side of the neck and just behind the ear towards the shoulder.
Other signs and symptoms include frequent headaches or nose bleeds,
blood-stained sputum or unexplained weight loss. In some cases, people
experience a change in hearing. These hearing changes may present as a
sudden loss of hearing, ringing in the ear or a feeling of blockage. If these
symptoms appear and do not heal or go away with time or treatment, you
should consider seeking advice from an ENT specialist.
ONEHEALTH
17
HEAD
TO TOE
HEALTH
Detecting cancer
Your doctor will assess if your signs and symptoms actually point to
cancer. If nasopharyngeal cancer is suspected, a battery of tests may
be needed. One way to detect nose cancer is via a nasendoscopy.
This involves the use of a long, narrow, flexible tube that is inserted
through the nose to look for abnormal growths in the tissues at the
back of the nose. A tissue sample (biopsy) of any suspicious lesions is
taken and examined under the microscope to look for cancer cells.
If there is a lump in the neck, a tissue sample of the lump may also be
removed to be examined for cancer cells. This is done painlessly using
local anaesthesia. A blood test to detect certain antibodies to the
Epstein-Barr virus (EBV) is also sometimes used to detect NPC.
If cancer is confirmed, more tests will be done to check if the cancer
has spread. Diagnostic tests may take the form of a thorough physical
examination, blood tests, chest x-rays and scans of the head and neck
region as well as a bone scan and liver scans.
Risk factors
Sometimes called ‘Cantonese tumour’, the highest incidence of the
disease is found in Guangdong province in China and in Hong Kong.
Nose cancer or NPC is associated with an EBV infection of the white
blood cells and nasal lining at the back of the nose. EBV is a very
common virus that affects 9 in 10 people by the time they reach
adulthood. It causes a minor flu-like illness in children and glandular
fever in adults. Once you are exposed, the virus will persist in the
blood cells in a dormant state. In some people, the EBV infection
subsequently triggers the development of nose cancer, although
it is not fully understood how and why.
“One of the predisposing factors is suspected to
be diet,” said Dr Ranjit. The cancer is associated with the high
consumption of preserved food such as cured meats, salted fish and
fermented soy beans. These foods are high in salt and cancer-causing
nitrites. According to Dr Ranjit, the link was discovered because there
was a high incidence of NPC among the boat people of Hong Kong
whose staple diet was salted fish. “It is theorised that the carcinogens
released during cooking or eating certain preserved foods ‘primes’ the
cells for development of cancer,” Dr Ranjit explained, “Genetics also has
a role to play in the risk of getting nose cancer, so if an immediate
family member has a history of nose cancer, you may be genetically
predisposed to it."
18
ON E HEALT H
Nose cancer
is not easy to
detect because
the symptoms,
a painless lump
in the neck,
nosebleeds
and hearing
changes, can
be quite
non-specific
Treating nose cancer
Treatment, said Dr Ranjit, depends on the location of the cancer, extent of
the disease, and if the cancer has spread as well as the health status of the
patient. “Recent advancements in radiotherapy equipment and computer
planning technology, together with improved shielding techniques to
protect healthy tissues, have significantly improved the precision of
radiation delivery,” he said, “This means sensitive nerves, organs and tissues
in the face, eyes and brain are spared, improving
the outcomes of treatment.”
Preventive steps
At the moment, it is not known what the exact
causes of nose cancer are, but avoiding risk
factors may be helpful in lowering the risk of the
disease. For example, it may help to avoid eating
excessive amounts of salted fish and other
preserved foods.
Other helpful steps are to include lots of fresh
fruit, green vegetables and other sources of
antioxidants to lower your overall cancer risk.
Avoid inhaling tobacco smoke as well. Both
smoking and passive smoking are linked to an
increased risk of cancer. Dr Ranjit pointed out
that since the disease has a high rate of cure in its
early stages, early detection is therefore the best
way to tackle it. “It
is important to know
if you are in a high risk group,”
he said, “Those with a family
history (especially first degree
relatives) of the disease should
be screened for the disease.
It is also important not to ignore symptoms like
hearing loss in one ear, blood stained phlegm
and neck lumps especially if these are persistent.
Early detection will improve the outcomes for the
patient and greatly increase the chance of a cure.”
Treatment options
Radiotherapy: High-energy
X-rays or radiation is sent towards
the cancer via a machine
Chemotherapy: Drugs are
injected into the veins to stop
the growth of cancer cells and
kill them
Surgery: Physical removal of
the cancerous tumour. This is a
relatively challenging operation
and is often reserved for disease
that recurs despite radiation and
chemotherapy treatment
ONEHEALTH
19
HEAD
TO TOE
HEALTH
Affairs
of the
heart
Not all chest pain signals a heart attack, but because
the consequence may potentially be severe, always
seek medical help if you suffer from pain
in the chest By Bella Lim
IN C ONSULTATION W ITH DR NI KOLAS WA N A H I T A , CO N S UL T A N T , CA R DIO L O GY
20
ON E HE ALT H
If you have a sudden pain in the chest, it is only normal to be concerned.
While your first instinct could be to wonder if it is a heart attack, it is also
helpful to understand that there are many causes for chest pain. Chest pain
may feel sharp, stabbing, burning, dull or squeezing and may be caused
by problems in the lungs, esophagus, muscles, ribs or nerves. The severity
of these conditions ranges from harmless to serious and life threatening.
Although many causes of chest pain are harmless, you should seek medical
advice if you suffer any type of unexplained chest pain. Said Dr Nikolas
Wanahita, Consultant, Cardiology, JurongHealth, “You don't want to
miss the cause that can be fatal: chest pain related to the heart.”
Causes of chest pain
Some of the causes of chest pain are not related to the heart at all.
These include muscular, lung or gastrointestinal conditions.
Pulled muscle or trauma due to muscle strain caused by
exercise or excessive coughing. A fall, an accident or a blow
to the body can result in bruised muscles or fractured ribs
that cause pain in the chest.
Anxiety or stress can constrict the chest and result in pain
or tightness, dizziness, shortness of breath and rapid heartbeat
(called palpitations).
Lung infections such as pneumonia can cause chest pain
when the membrane covering the lungs becomes inflamed,
causing pain when you breathe, cough, or sneeze. Typically,
these infections are accompanied by high fever, chills and cough.
Gastrointestinal problems such as acid reflux or heartburn
can result in a sour taste in the mouth and a burning sensation in
the chest or throat. Although the condition is not connected to the
heart, the pain can seem similar because the heart and oesophagus
are near each other and share a nerve network.
Various heart conditions can also result in chest pain:
Angina is caused by a blockage of the blood vessels in
the heart. Angina pain feels like a squeezing pressure in
the chest. It can be triggered by exercise, excitement, or
emotional distress. The pain can be improved with rest.
Heart attacks occur when blood flow to the heart is
stopped or severely limited, starving the cells. When
the cells die, an intense pain occurs.
Heart infections such as myocarditis or pericarditis.
Myocarditis is an infection of the heart muscle, while
pericarditis is an infection of the sac around the heart.
While the cause
may be benign, don't take
chances. According to the
Singapore Heart Foundation,
15 people die from
cardiovascular disease
(heart disease and stroke)
each day in Singapore.
In 2013, cardiovascular disease was
responsible for 1 in 3 deaths,
making it one of the top
disease killers in
Singapore.
ONEHEALTH
21
HEAD
TO TOE
HEALTH
Chest pain
or heart attack?
Risky
business
Pain in the chest caused by heart trouble is a matter of concern. One
significant cause is angina, heart pain caused by an obstruction of the
heart arteries, explained Dr Wanahita. The blockage reduces blood flow
and oxygen to the heart muscle, causing tightness and pain. This pain can
be alleviated with rest. “While it does not cause permanent damage to
the heart, it is a warning sign of a heart attack and may be fatal if not
addressed early.” he emphasised.
Some of the risk factors in
obstruction of the heart arteries
or coronary artery disease are:
A blockage in the vessels
of the heart can result in a
condition known as angina.
The obstruction limits the
the supply of blood,
causing pain that can be
alleviated with rest.
The most alarming heart pain is, of course, a heart attack, known medically
as a myocardial infarction. This occurs when blood flow to the heart is
severely limited or completely stopped by a blockage. This starves the heart
muscle of life-giving oxygen and kills its cells. Classic symptoms of heart
attack are a squeezing or pressure-like chest pain, sweating, pain
radiating from the chest and/or the left arm, jaw pain or a feeling like
something is stuck in the throat. Shortness of breath when exerting
oneself is another symptom.
It is important to note that the signs of a heart attack may vary from person
to person, and a heart attack does not always have to be accompanied by
chest pain. Dr Wanahita said, “Women and people who suffer from diabetes
are known to present with atypical symptoms when they have heart
disease. So, it is important for anyone who has a history of heart problems
or who fall into the high risk group to seek medical attention if they
experience any type of chest discomfort or shortness of breath during
exertion.” If you experience any of the symptoms, seek medical attention
immediately so that a doctor can determine the cause.
Other causes of chest pain include heart infections such as myocarditis
or pericarditis. Myocarditis is an infection of the heart muscle, while in
pericarditis, the sac around the heart is inflamed. In both cases, it is
important to seek timely medical attention.
22
ON E HE ALT H
• Hypertension
(high blood pressure)
• Diabetes
• High cholesterol
• Smoking
• A family history of
heart disease or stroke
• A previous history of stroke
or peripheral artery disease
• Being overweight
• Having a sedentary lifestyle
If any or more of these
risk factors apply, you are at
risk of a heart attack. If you
suddenly experience chest
pain, call an ambulance
immediately. “Time
is of
essence during heart
attack,” said Dr Wanahita.
“If the heart attack is
treated early in the
first few hours, a lot
of heart muscle that
would otherwise be
dead, may be
salvaged,” he stressed.
While waiting for professional
medical help, it is also helpful
to take Aspirin (the
recommended dose is 300mg
during heart attack) and
nitroglycerin tablets if you
have them. Place a nitroglyerin
tablet under the tongue until
it dissolves. Do this up to three
times, five minutes apart. Rest
until the ambulance arrives.
Heart
attack!
Chest discomfort
or pain that feels like
squeezing, fullness or
pressure
.... . . . . . . . . . . . . . . . . . . . . .......
Pain or discomfort
in arm, left shoulder,
back, neck, jaw, or
below the breastbone
.... . . . . . . . . . . . . . . . . . . . . .......
Difficulty breathing
or shortness of breath
(with or without
chest pain)
.... . . . . . . . . . . . . . . . . . . . . .......
Sweating or cold
sweat
.... . . . . . . . . . . . . . . . . . . . . .......
Anxiety or rapid or
irregular heartbeats
.... . . . . . . . . . . . . . . . . . . . . .......
Indigestion,
heartburn, nausea,
or vomiting
.... . . . . . . . . . . . . . . . . . . . . .......
Light-headedness,
dizziness, or
extreme weakness
.... . . . . . . . . . . . . . . . . . . . . .......
SUDDEN CARDIAC DEATH: rare
but deadly
Apart from heart attack due to heart disease, there is a small but alarming
incidence of sudden cardiac death (SCD). This type of death appears to
occur in many fit, young and active people. Part of this perception is due
to the understandable media attention when such deaths occur. However,
in reality, the risk of SCD is small, though the number is not inconsequential.
About 1,000 Singaporeans die from SCD a year and a majority of the deaths
are in men with a median age of 47 and women with a median age of 50.
In many instances SCD happens due to the presence of conditions that are
rare and hard to detect. The most common cause of SCD is hypertrophic
cardiomyopathy, an inherited condition that causes an unusual thickening
of the heart muscle. The second most common cause of SCD in those
under 35 is a congenital defect in the heart’s arteries that causes blood
supply to cut off when the heart beats rapidly. Other reasons for SCD
include arrhythmia and Wolff-Parkinson-White syndrome which cause
the heart to ‘short circuit’ during physical exertion.
These conditions tend to cause heart
trouble when the heart beats rapidly,
underscoring the importance of
seeking medical advice
before you embark on
any exercise regime.
What
happens
during a
heart attack?
When a heart attack
occurs due to a blockage
of the blood vessels,
oxygen-rich blood cannot
'feed' the heart, causing it
to 'suffocate'. The oxygen
deprivation kills the cells
in the heart muscle and
results in a classic
sign of a heart attack:
crushing chest pain
ONEHEALTH
23
HEAD
TO TOE
HEALTH
The
ANGRY itch
Itchy, red and unsightly inflammatory skin conditions
such as hives, eczema or psoriasis can be frustrating
to live with. Learn about the signs and how to
manage these common conditions By Cheryl Sim
I N CONS U LT AT ION WITH DR JAMIE WEE, ASSOC IATE C ONSUL T A N T , DE R M A T O L O G Y
24
ON E HEALT H
Beyond the itch, inflammatory skin conditions can
cause discomfort, embarrassment and frustration
among sufferers. Skin conditions such as eczema
and psoriasis cause redness, flaky skin, itchiness and
even pain. Another common skin complaint is hives,
medically known as urticaria. Hives tends to come
and go, but can also be a chronic problem.
A sudden case of hives
Signs of psoriasis
Hives a very common causes, causes raised, red and
itchy areas of skin. These rashes can be of varying
shapes and sizes, and may appear as large patches,
rings, or small bumps in the skin. One distinct feature
of hives is that they tend to be transient, flaring up
suddenly, changing size and even location rapidly
all over the body. Sometimes, the rash can appear
around the eyes or lips, causing swelling. These
rashes may last for several minutes to hours, but
tend to come and go, without leaving any lasting
scars or marks.
Psoriasis, which can also cause redness and itching,
is a different type of skin inflammation. “Psoriasis
is characterised by well-defined patches of raised
reddish skin that are often covered with white
scales,” Dr Wee said. The chronic condition is an
immune-related disease that commonly starts in
adulthood but can affect any age group. “The
cause of psoriasis is complex and multifactorial.
An important factor is again genetics; the condition
often runs in families and be inherited from an
affected parent,” he explained.
Although a hives outbreak appears alarming, the
condition is typically harmless. Hives occur when
something triggers the body to produce an antibody
called histamine. Histamine is normally released
when there is an allergic reaction to a subtance,
food or insect bite. When histamine is released,
blood vessels in the skin dilate (become wider) and
become leaky. This causes an accumulation of fluid
in the tissues and the skin to swell. Hives can
be triggered by food or drug allergies, alcohol,
viral infections, insect bites as well as physical
stimuli, exercise, cold weather, exposure to light
or friction on the skin. In many cases, the cause
for hives is unknown. Hives can be controlled with
antihistamines and in some chronic cases, oral
steroids may be prescribed.
Psoriasis rashes tend to be raised and covered
in silvery ‘scales’ of skin. This happens when
the normal cycle of the skin growth is hastened.
Typically, your skin cells grow gradually and flake
off about every four weeks to expose new skin
cells underneath. In psoriasis, new skin cells
move to the surface of the skin in a matter of
days rather than weeks, building up to form
thick itchy patches of skin called plaques.
Help for hives
Living with psoriasis
Avoid scratching the rash.
Moisturise regularly to soothe the inflammation
Avoid triggers such as sudden temperature
changes, excessive scrubbing or identified
'trigger foods'
Avoid skin injury as a wound to the skin can
cause psoriasis patches to form
Take antihistamines in the event of a hives
episode. If the problem does not get better,
seek medical advice
It is believed that psoriasis happens due to an
abnormal reaction from the body’s immune
system, leading to inflammation and flaking
of the skin. Psoriaris symptoms may disappear
(remission) even without treatment but then
get worse (flare-up) when exposed.
Manage stress and anxiety to avoid a flare-up
Avoid medicine such as nonsteroidal
anti-inflammatory drugs (NSAIDs), beta-blockers
and lithium
ONEHEALTH
25
Eczema occurs
when the skin
barrier is
defective and
unable to keep
the cells moist.
This causes
dryness, redness
and itching.
The marks of eczema
With eczema, Dr Wee said, the skin is dry, itchy and
can be red. It is most commonly seen in children,
but can affect people of all ages including the elderly.
Dr Wee pointed out, “There is an increased risk of
eczema in those who have family members who
suffer from eczema, a history of rhinitis (hay fever),
or asthma.” The condition is also common in people
in certain occupations that involve 'wet work' such
as frequent hand washing or exposure to certain
chemicals. Elderly people with age-related dry skin
or conditions that affect the veins in their legs are
also more prone to eczema.
“There are a number of factors that play a role in the
development of eczema,” Dr Wee said. “An important
factor is the functioning of the skin barrier, which
keeps the skin moist and keeps out allergens.
A defective skin barrier, which leads to dry skin, is a
problem that can be inherited.” Prompt recognition
of eczema and treatment can prevent eczema from
becoming more severe, he added.
Treating eczema
Combat dry skin, the biggest risk factor for
eczema, with regular moisturising
Steroid creams are needed to tackle redness
There are several sub-types of eczema:
and itching
Atopic eczema is the most common and is
Avoid long hot showers; use lukewarm
Maintain good health with adequate rest,
exercise and a healthy, balanced diet
Asteatotic eczema typically affects older people
skin health
and causes cracking of the skin.
Discoid eczema is another form which presents
as circular scaly patches.
Environmental eczema can also be caused by
exposure to irritants or allergenic substances.
26
water when showering
often seen in people with hay fever or asthma.
It typically starts in childhood and affects about two
in 10 school children in Singapore. The signs include
rashes that are itchy, red, dry and scaly. These rashes
can also cause the skin to become wet, weepy
or painful.
ON E HE ALT H
Use gentle, soap-free shower cleansers;
avoid scrubbing the skin
Do not smoke; smoking is detrimental to
Manage stress well; eczema can get worse
during stressful periods
HEAD
TO TOE
HEALTH
Cracked
in the hip
Hip fractures are painful and debilitating
– and are on the rise. Find out how this
worrying condition can be managed for
better quality of life By Adam Khoo
IN CONS U LT AT ION W ITH DR FAREED KAGDA, DEPUTY HE A D A N D S E N IO R
CON S U LT ANT , ORTHO PAEDIC SURGERY ; PETER C HO U, M A N A GE R , CL IN ICA L
OP E R AT IONS ; AND RAC HEL-KIM DALLI MO RE, PRINC IPAL PHY S IO T HE R A PIS T
A broken bone is always a painful affair – but in the elderly,
it is more serious because the consequences are significantly
detrimental. One condition of increasing concern is hip fracture.
According to Dr Fareed Kagda, Deputy Head and Senior Consultant,
Orthopaedic Surgery, JurongHealth, Singapore’s ageing population
is seeing an increased incidence and prevalence of osteoporosis
or brittle bone syndrome and a correlated rise in fractures. It is
esimated that over 1,000 cases of hip fractures occur annually
in Singapore, and numbers are expected to rise. Hip fractures
are common in older people because they are more likely to
be on multiple medications or have poor vision and/or balance
problems that increase the risk of falls.
ONEHEALTH
27
HEAD
TO TOE
HEALTH
“Hip fracture patients have to be hospitalised and require
surgery and prolonged rehabilitation,” explained Dr Fareed, so
apart from being quite a painful physical ailment, the condition can also cause
emotional trauma to the patient. It can also be a costly burden on the family as
long-term care is needed post-surgery. Dr Fareed pointed out that some of the
consequences after a hip fracture include:
•
•
•
•
•
•
Reduced walking ability that results in the use of walking aids
Loss of independence in moving around or doing daily activities
Need for a temporary or permanent caregiver
Increased risk of even more falls and other fractures
Shorter lifespan
Complications such as deep vein thrombosis (blood clots) and
surgical complications such as heart attacks, infection and bleeding
Other worrying statistics on hip fracture, according to data collected in a
Singapore Chinese Health Study, include an increased risk of death from cancer
and coronary heart disease. The study, which monitored over 60,000 people,
also found that stroke, pneumonia and urinary tract infection fatalities were
twice as likely in people with hip fractures when compared to those without.
The increased risk of poor health and mortality was attributed to long
periods of immobility.
Treatment and risk
A hip fracture almost always requires surgical repair or replacement if the patient
is fit for surgery, followed by months of physiotherapy. For the well-being of the
patient, it is common to do a series of medical tests to identify any medical risks
before surgery. The type of surgery to repair the fractured hip bone depends on
the exact location of the fracture. In most cases, special screws and/or plates are
used to secure the bones together. Over time, the bone will heal, a process called
osteosynthesis.
In some cases, the cartilage and underlying supporting bone may not receive
adequate blood even if the fracture is realigned and fixed. This may warrant hip
replacement surgery to replace the ball and/or the socket joint. While these
surgeries have a high rate of success, the recovery can take a long time and has
more severe consequences in the elderly. Taking steps to prevent osteoporosis
to maintain bone strength and prevent falls are more important to prevent hip
fractures, noted Dr Fareed. “Elderly women are most at risk because menopause
causes accelerated bone loss leading to osteoporosis. Men are affected at a much
older age group compared to women. Those who have frequent falls are also
at risk.”
28
ON E HEALT
HE ALT H
The hip is
made out of a
ball-andsocket joint
The head of the
femur (the ball)
fits into the socket
of the pelvis
A normal
hip joint
Common hip
fracture sites
In the elderly,
hip fractures
often happen
after the head
of the femur.
Other fracture
sites can occur
at the neck of the
femur or along
the leg bone
The head of the femur
– the rounded end of
the upper leg bone
– fits into a concave
socket of the pelvic
bone. This mechanism
allows the upper leg
to rotate. In elderly
patients with hip
fractures, the fracture
occurs just after the
ball and socket joint.
A holistic hip care plan
To better manage hip fracture patients, JurongHealth launched a
Hip Fracture Integrated Care Pathway (Hip Fracture ICP) programme in
October 2014. It has served 202 patients since the pilot began in June 2013.
Prevention &
management
Peter Chou, Manager, Clinical Operations, JurongHealth, explained,
"A fracture can affect mobility and lifespan and may need an increased
level of care post-surgery. The ICP is a standardised process across the
spectrum to care for patients using best practices and a multi-disciplinary
approach to ensure all essential elements of care are performed in a
timely manner. This maximises the recovery of elderly hip fracture patients
who usually have multiple medical co-morbidities."
Good bone
health is the best
way to prevent
osteoporosis
and the risk of
hip fracture
Under the ICP, case managers and geriatricians play crucial roles in
optimising patient care by coordinating care and managing any other
existing medical problems. Another key feature is the setting of an
established plan to achieve care goals for each patient, explained Mr Chou.
"The surgical team might have a goal of performing surgery within 48 hours
after emergency admission and the rehabilitation team might aim to start
rehabilitation soon after surgery for earlier rehabilitation and discharge.”
JurongHealth is also looking into integrating the Health Promotion Board’s
Strength Training Exercise Programme (STEP), a free community-based
physiotherapist-led group exercise programme into the ICP.
Hip (to) exercise
According to Rachel-Kim Dallimore, Principal Physiotherapist, physiotherapy
is important to help hip fracture patients regain strength, balance and
functional movement to recover faster and develop confidence. She
explained, “Prescribed exercises, walking and sitting out of bed are
encouraged early on to reduce respiratory complications and to avoid
weakening of muscles." The rehabilitation is done over time to improve
function, stamina and help patients return to a level of independence in
their daily lives. The role of physiotherapists also includes educating patients
and caregivers on exercises, post-operative precautions, the correct and
safe techniques for activities and fall prevention skills. Ms Dallimore
added, "Occupational Therapists also work closely with hip fracture
patients and caregivers to enable greater independence for activities
such as washing and dressing and provide recommendations for
home modifications. Together, we all work as a team to speed
up recovery for our patients."
– and this starts from
a young age by doing
weight-bearing exercise
and ‘banking’ your
calcium – eating enough
calcium to fortify bones
and laying down the
foundation before the
age of 30 when your
bones reach their
peak adult bone mass.
Calcium intake in
later years also helps
ensure that your body
has enough calcium
to use for its normal
functions without
making ‘withdrawals’
from the calcium in
your bones.
ONEHEALTH
29
Do it
at home
Hip rehabilitation exercise
(post-surgery*)
Thigh and buttock squeezes
While sitting up or lying in bed, straighten
your legs and squeeze your thigh muscle
by pushing the back of your knee
downwards towards the bed.
Hip strengthener
Move your leg outwards
to the side and then
back to midline to
strengthen the muscles
at the side of the hip.
You can also strengthen your
buttock muscles by squeezing
them together. Hold each
squeeze for five seconds.
Knee strengthener
These
exercises are good for
the muscles around the hip,
buttocks, thighs and knees.
Ankle pumps
Bend your ankles by
pointing your toes up and
down to improve
circulation in your legs. You
may also gently rotate your
foot in circles.
Place a rolled up towel
under the knee and lift
up the heel while pushing
the back of the knee down
into the towel. Hold for
five seconds.
X1O
3X
each set
a day
Leg raises and bends
While lying down, slowly
lift your leg up straight,
hold for five seconds then
slowly lower it.
Move the leg by sliding the heel
along the bed towards the
buttocks to gently bend at the hip
and knee and then gently
straighten it again.
* All exercises should be done with guidance from your physiotherapist.
30
ON E HE ALT H
HEAD
TO TOE
HEALTH
Sole
saviours
It may sound like something quite medieaval,
but maggot therapy is proving successful in
helping to heal stubborn non-healing diabetic
foot ulcers By Sheralyn Tay
IN C O NSULTATIO N WITH NIC OL A S M CI N D OE, S E N IO R PO DIA T R IS T
For people with diabetes, foot ulcers are a common risk – and one that often
leads to infection, hospitalisation, or in worst case scenarios, amputation.
However, regular foot care and timely wound treatment can reduce the risk
of serious ulcer-related complications. For many diabetics, conventional
wound treatment of special bandages and regular wound cleaning can
help these wounds heal over time. More recently, a new method
of using maggots to clean and heal wounds
is also proving successful.
ONEHEALTH
31
HEAD
TO TOE
HEALTH
In maggot debridement therapy, sterile maggots are used to clean up
a wound as the maggots are able to break down dead tissue and speed
up the healing process. Nicolas McIndoe, Senior Podiatrist, JurongHealth
explained, “Maggot debridement therapy uses maggots grown in a sterile
environment to clean up a wound. These maggots secrete enzymes that
break down dead tissue and clean up open wounds to facilitate the
healing process.”
Compared to conventional surgery, maggots do a more ‘accurate’ job
because they do not affect healthy tissues at all. Studies on maggot therapy
have also shown that compared to the conventional method of using a
scapel or scissors, maggot therapy can clean wounds up to 18 times faster.
Other studies also found that the secretions from the maggots help reduce
chronic inflammation and speed up the healing process.
Maggot therapy, Mr McIndoe said, is most useful in wounds that are
sloughy and necrotic. Sloughy wounds have yellowish tissues and necrotic
wounds have dead hardened black or grey tissues. The accumulation of
these dead cells prevents wounds from healing. Only when these cells
are removed, can healthy new cells take their place.
Creepy crawly cleaners
In maggot debridement, about 200 live baby maggots are used per
application and a special bandage keeps the maggots in place while also
absorbing excess moisture. Each application lasts two to three days. While
there is no pain, patients may experience a crawling sensation, Mr McIndoe
explained. Thus far, 12 patients have undergone just over 50 applications
at JurongHealth.
While many react initially with a squeamish face, nervous laughter
or blank stare, most people are curious about the procedure and are
open to learn more about it and how it can help, he shared. “Some
patients require multiple applications and once they’ve seen the effects
of the therapy, are more open to continue until the wound is clean.
We have found that most wounds show good improvement after
maggot therapy and together with a multidisciplinary, holistic approach,
it is a successful complementary therapy for some wounds.” In fact,
he has observed that patients are more open-minded towards maggot
therapy. “I’ve heard a few patients joke that they’re ‘raising’ them and calling
them their pets.”
32
ON E HEALT H
Diabetic
ulcers
A diabetic ulcer is an
open sore or wound
caused by poor circulation
or lack of feeling due to
nerve damage caused by
elevated blood glucose
levels. The legs and feet
are most at risk of these
ulcers. In diabetes, the
body’s ability to heal and
fight infection increases
the risk of these wounds
becoming chronic and
raises the risk of infection.
Significantly, nonhealing
diabetic ulcers result
in a large number of
amputations in Singapore.
About two major limb
amputations are carried
out daily to remove
lower limbs affected
by diabetes-related
ulcers or gangrene.
Make an
appointment
with your
podiatrist!
If you are diabetic,
regular foot examinations
are important to prevent
foot and leg ulcers as
well as ensure your feet
are in good health! Your
podiatrist will check for:
• Any loss of sensation
Prevent diabetic foot ulcers
• The level of blood
flow to the feet
To reduce the risk of wounds, regular foot care is important for those
with diabetes. Take these steps to reduce foot injuries and wounds:
• Any changes in the
shape of your foot to
assess the development
of pressure points.
•
Check your feet every day for red spots, cuts, swelling or blisters.
Use a mirror or get help to inspect the bottom of your feet
•
Wash your feet every day and dry them carefully, especially
between the toes
•
Moisturise daily, ideally after washing, to keep the skin soft and
smooth. Massage a thin coat of lotion over the tops and bottoms
of your feet, but not between the toes as the skin is thinner and
more prone to splitting
•
File away hard skin patches that occur on the sole of the feet or
toes or at least once a week to prevents foot ulcers from forming
underneath
•
Keep toenails trimmed to prevent them from snagging or cutting
into your toes. Cut toenails straight across and file the edges;
never into the sides as this causes in-grown nails
•
Always wear shoes and socks and never walk barefoot to
prevent injuries
•
Ensure shoes are comfortable and fit well
•
Maintain good blood circulation to the feet by putting your
feet up when sitting, and wiggling your toes and moving your
ankles for at least five minutes, two to three times a day. Don't
cross your legs for long periods of time
•
Don’t smoke; smoking does great harm to blood circulation
and increases the risk of many diseases
All these will help detect
changes in any foot
conditions and make
sure early preventive
treatment or management
can be given to prevent
wounds from occuring
or getting worse.
ONEHEALTH
33
HEAD
TO TOE
HEALTH
Stand
up for
health!
Studies show that prolonged
sitting can harm your overall
health. It’s time to get out
of that chair! By Sheralyn Tay
Slouching over your computer or books
for long hours or lazing on the couch
for hours watching TV does harm not
only to your posture. Research is
showing that sitting for long periods of
time increases the risk of ill health and
disease. In particular, chronic sitting is
linked to obesity and metabolic
syndrome, as well as a cluster
of lifestyle related conditions
such as high blood pressure,
high blood sugar, high
cholesterol and excess
fat (especially around
the belly).
34
ON E HEALT H
Get up;
get moving!
The risks of too much sitting
When you sit, your muscles are sedentary and so are the processes
used for burning fat and sugar. Idle muscles lower the body’s metabolism
and dull the insulin response (a process that burns sugar), contributing to
weight gain. Chronic poor sitting also can lead to poor posture that
causes all manner of muscle pain in the neck, spine, hip, buttocks and
legs. The lack of weight-bearing activity also increases the risk of
weak bones.
Apart from muscular weakness, inactivity also ‘turns off’ the biological
signals that maintain bodily functions such as your heart health.
A research study published in the journal, ‘Lipids in Health and Disease’,
found that a few hours of sitting suppresses a gene that controls
inflammation and blood clotting, increasing the risk of cardiovascular
disease. The researchers also discovered that long periods of sitting also
switch off an enzyme that removes bad fats from the bloodstream.
Being sedentary for a long period of time also affects blood circulation
throughout the body and increases the risk of deep vein thrombosis.
When you don't move, muscles that would otherwise pump fresh blood
and oxygen through the brain and trigger mood-enhancing chemicals,
remain static, resulting in a lower level of brain function and mental
alertness. Alarmingly, more evidence is also surfacing that even regular
exercise does not offset the effect of too much sitting. So that hour-long
walk at the end of the day may not be enough to couneract the eight
long hours of sitting earlier in the day.
4%
1 –2
61%
31%
14%
3 –4
5 –6
Ease tension and prevent
pain with simple stretches.
for example move your
neck from side to side as
well as up and down.
7+
Stand up or
walk whenever
you can. Even
short breaks
from sitting
can reignite
bodily
processes.
RISK O F D EATH
HOURS
OF TV
PER DAY
1
2
The mortality of sitting
A eight-year-long study in the United States
that studied the number of hours people spent
sitting in front of the TV or screen-based
entertainment found that those who did so for
longer periods had a much greater risk of dying.
The solution: Limit
sitting as much as possible
and move whenever you
can. Even intermittent
movement – a five to 10
minute walk or stretch for
every hour you spend in
your chair – can reduce
as much as half the
health risks associated
with chronic sitting.
3
Reach
for the sky
to promote
flexibility in
the shoulders,
stretch the
belly and
side body.
ONEHEALTH
35
FOODforLIFE!
Beyond
starting the day
right
A healthy breakfast goes a long way to
set the tone right for the day. But lunch and
dinner are no less important. Here’s why!
By Louisa Foo
IN CO N S UL T A T IO N WIT H CH A D H A N , DIE T IT IA N
36
ON E HE ALT H
Benefits of breakfast
So while it may not be the most important meal, taking the time for breakfast
lays the foundation for eating better for the rest of the day. Research shows that
having breakfast means you are less likely to become ravenous by lunchtime
and thus overeat or crave high-fat and high-calorie foods. Eating regular meals,
including breakfast, also prevents the body from going into ‘starvation mode’.
“People in a starved state or on crash diets have a lower
metabolism of up to 15 per cent because the body
instinctively tries to conserve energy,” Mr Han explained.
The first meal of the day ‘breaks’ your overnight fast and signals to your body to
keep your metabolism working at its normal pace. Apart from giving you
energy, breakfast also has good mental benefits, said Mr Han. “Studies have
shown that eating breakfast has positive benefits on memory and attention,
helping us remain more mentally alert on tasks, especially in the late morning.”
Plan to eat better
Mum may not have it exactly
right when she says breakfast
is the most important meal
of the day – but she still has
a point. Done right, the first
meal of the day plays a crucial
part in a healthy overall diet.
According to Chad Han,
Dietitian, JurongHealth,
all your meals are
equally important
from a nutritional
standpoint. However,
the emphasis on getting
a balanced breakfast has
become increasingly
significant as more and more
Singaporeans are skipping
their first meal of the day.
“The last National Nutrition
Survey has shown a two-fold
increase in Singaporeans
skipping breakfast, from
6.9 per cent in 2004 to
14.1 per cent in 2010,” Mr Han
pointed out, “The data shows
that skipping breakfast
Eating better, whether it is for breakfast, lunch or dinner is all about
planning. It is easy to have what is convenient (such as take-away fried
noodles, packaged cream-filled buns, cakes or fast food) rather than what
is healthy when meals are not planned. A little preparation can go a long way
to ensure your first meal of the day is appetising, nutritious and ready-to-eat,
added Mr Han. A nutritionally-sound breakfast should
contain a balance of complex carbohydrates, lean
protein as well as fresh fruit and vegetables. While not
many of us have the luxury of sitting down to a hearty full breakfast each
day, a quick breakfast can be healthy too. For example, some whole grain
breakfast cereal in milk with fruit takes just minutes to prepare but still
makes a substantial meal, Mr Han said. “If you have no time to even
sit down for a meal, you can always prepare your breakfast the night
before. A wholemeal sandwich with tuna and low-fat yoghurt or oats
soaked in low-fat milk and some fresh fruit are good
examples of on-the-go breakfast options.”
and having meals
away from home is
associated with a
higher overall calorie
intake, and thus is a
risk factor for a higher
Body Mass Index.”
ONEHEALTH
37
FOODforLIFE!
Beauty from
the inside
Good nutrition does more than stave off disease,
it keeps you beautiful inside and out By Louisa Foo
I N CON S U LT AT ION W ITH C HARLES LEW, SENIO R DIETITIAN
We all know the relationship
between food and wellness.
A balanced diet does more
than keep you trim and prevent
chronic conditions – it can
also work wonders on the
appearance of your skin, hair
and nails. The even better
news is that you don’t even
have to make special trips
to the market for these
‘beautifying’ foods – they are
(or should already be) part of
your healthy shopping list.
Feed your skin
According to Charles Lew,
Senior Dietitian, JurongHealth,
what you eat is reflected in the
health of your skin, hair, nails
and even teeth. In fact, these
tissues, just like any living thing,
need feeding. Your skin for
instance, is the biggest organ
in the body. Its role is to protect
you from the elements, regulate
body temperature and transfer
information to enable your
sense of touch. Your nails and
hair – made of keratin – also
need adequate nutrition to
prevent them from getting
brittle or dry.
38
ON E HE ALT H
Nutrition for hair and nails
The health of your hair and nails too can be affected if there are nutritional
deficiencies. Mr Lew noted that in cases of alcoholism, anorexia nervosa,
renal disease and gastric bypass, zinc deficiency is common, causing hair
to become thin, white and brittle. Research also indicates that fatty acids
can enrich the hair shaft and help maintain a good balance of natural oils
in the scalp, keeping hair hydrated. And because hair is 97 per cent protein,
an adequate amount of lean quality protein (from soy, meat and seafood)
ensures your body has the building blocks to grow healthy hair.
Protect your teeth
One of the biggest
concerns for many,
for example, is skin
damage and ageing
due to sun exposure.
“Other than using
sunscreen, you can
improve your diet
to boost the natural
ultra-violet defences
of your skin.
Studies have demonstrated
that an increased consumption
of vitamin C and E, as well as
phytochemicals such as
carotenoids and polyphenol,
can help to reduce the adverse
effects of sun exposure,”
he pointed out. Vitamin C
is essential in helping the
body produce collagen –
an essential building block
of skin that keeps it supple,
while vitamin E keeps skin
moist and guards against
sun damage. Phytochemicals,
a group of compounds that
give fruit and vegetables their
vivid colour, also enhance the
ability of skin to fight free
radicals that cause wrinkles,
discolouration and loss
of elasticity.
What you eat and drink even benefits your teeth. Mr Lew pointed to
a growing body of evidence on the beneficial role of green tea in oral
health. “Green tea protects against bacteria-induced dental caries and
bad breath because the phytochemicals in green tea have antibacterial
properties.” Antioxidants in green tea can also reduce the oxidative
stress and inflammation caused by cigarette smoking, he added.
Go natural
Natural is often best. There is no need to take a supplement if your diet
is nutritionally balanced. In fact, Mr Lew warned, “Excessive consumption
of nutritional supplements can negatively affect health.” Instead, eat two
servings each of fruits and vegetables daily to ensure a good dose of
health-giving and beauty-imparting vitamin C and phytochemicals. Opt
for fruits such as citrus, papaya, pomegranate, and kiwi and for vegetables
such as spinach, broccoli, chye sim and kai lan. To boost vitamin E intake,
Mr Lew recommends a handful of oven-baked nuts a day. As for the
minerals to boost healthy hair and nails, just ensure you eat the
recommended three servings a day of meats, seafood, fish or legumes.
ONEHEALTH
39
FOODforLIFE!
Chicken and
Peach Pockets
Preparation time: 10 minutes
Serves: 2
Ingredients
½ cup
Shredded chicken breast or
2 slices of lean chicken ham
2 slices
Tinned peaches, drained
and chopped
2 tbsp
Non-fat yoghurt
2 tbsp
Low-fat cottage cheese
½ cup
Lettuce, chopped
¼
Cucumber, chopped
1
Small tomato, chopped
1
Whole wheat pita/
tortilla wrap, halved
Method
1. In a non-stick frying pan, heat the pita bread
or tortilla wraps
2. In a bowl, mix the peaches, cucumber,
tomatoes, and lettuce with the yoghurt
and cottage cheese
3. Place the shredded chicken or fold 1 slice of
chicken ham into each pita pocket or onto a
tortilla wrap and add the peach mixture on top
4. If using a tortilla, fold the rounded end and roll
from the side into a tight roll
5. Wrap each prepared pita or tortilla roll in
plastic wrap and refrigerate until ready to eat
Nutrition value (per serving)
Calories
Protein
Fat
Carbohydrates
Fibre
140 kcal
20g
3g
8g
1.3g
Pocket-sized
goodness
Prepare these healthy protein-packed wraps in
advance for breakfast on-to-go or a handy snack!
C ONT R IBU T E D B Y THE DEPARTMENT OF DI ETETI C S AND NU T R I T I ON , J UR O N G HE A L T H
40
ON E HE ALT H
HealthBites
Cut down on sugar
and sugary foods
Avoid processed
and fast food
Opt for whole food
Hydrate well; water is best
Eat more fresh fruit
Heed medication advice
Set personal health goals
Track your results,
seek help if needed
Get
healthy
from head
to toe
Stay in tip-top shape
by taking these small,
achievable steps
Do heart-healthy aerobic activity
Include weight training for
bone health
Build healthy sleep habits
Reward yourself
for goals reached
ONEHEALTH
41
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