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MyHEALTH JOURNEY TO BETTER HEALTH COMPLIMENTARY MAGAZINE OCTOBER 2016 Chest pain and heart attack CARDIOLOGIST EXPLAINS WHY URGENT CARE IS NECESSARY Is Lasik safe for you? FREEDOM FROM GLASSES AND CONTACT LENSES Managing Back Pain A SURGICAL PERSPECTIVE The best care for your little angel NEONATAL INTENSIVE CARE UNIT MYHEALTH 1 MyHEALTH JOURNEY TO BETTER HEALTH CONTENTS World Heart Day - 29th September 2016 Journée Mondiale du coeur , le 29 septembre 2016 Cardiovascular diseases have gradually grown to be at the heart of our health concern in Mauritius. In today’s fast paced world, heart diseases are becoming a worrying trend due to changes in people’s diet, environment and lifestyle. For a healthy heart you should keep your cholesterol level and salt intake low, exercise regularly to keep a healthy weight and avoid smoking. Preventive cardiac health screening is an effective and affordable way of identifying hidden cardiac disease risks. Les maladies cardiovasculaires se sont progressivement placées au centre de nos préoccupations de santé à Maurice. Dans ce monde où tout semble aller plus vite, les maladies cardiaques sont une vraie menace en raison des multiples changements dans notre régime alimentaire, notre environnement et notre mode de vie. Pour un coeur en bonne santé, vous devez maintenir un faible taux de cholestérol, limiter votre consommation de sel, faire des exercices régulièrement pour garder un poids de forme, et éviter le tabac. Le dépistage préventif est un moyen efficace d’identifier les risques cachés de troubles cardiaques. In this issue 2 MYHEALTH 4 Never underestimate chest pain! 6 Breast Reconstruction Surgery 8 What is LASIK eye surgery? 10 Comment vous protéger de la conjonctivite 11 Beware of hypertension 12 HPV Vaccine : protecting women from cancer 13 Exercise : myths & facts 14 Pour travailler à la NICU, il faut avoir des compétences spécifiques 16 Why breastfeed your newborn? 18 Managing back pain 20 Mieux identifier les douleurs à l’épaule 21 10 ways of keeping your heart healthy 22 This month’s receipe MYHEALTH 3 MyHEALTH JOURNEY TO BETTER HEALTH CARDIOLOGY Chest discomfort Arm or back discomfort Neck or jaw discomfort Never underestimate What should one expect at the Chest Pain Clinic ? Chest pains can sometimes be benign such as heart burn, but sometimes it can be much more serious like a heart attack! So how do you distinguish chest pains? C What are the signs of a Heart Attack? Dr Mahesh Krishna Kumar Senior Consultant Interventional Cardiology, Apollo Bramwell Hospital, speaks on chest pain. Characteristics of a heart attack are often described as a pressure or heaviness or tightness or squeezing in the chest that can radiate up to the shoulders or the arms and sometimes the jaw or even the teeth. It can also go into the back. But it doesn’t have to have all these characteristics! Also associated symptoms such as shortness of breath, a feeling of nausea, sweatiness, light-headedness, or feeling like the heart is racing or skipping. Now it is very important to understand that it doesn’t need to have all these characteristics. But if you have these characteristics of chest pain... you should be very concerned, it may be a heart attack! So what should you do in such situations? ACT FAST! • Do not try to drive or walk! • Call for help immediately. Or simply dial 132 for our ambulance hotline. • Or ask someone to take you to our Chest Pain Clinic where facilities are available to do complete diagnosis of your chest pain and a stateof-the-art 24/7 catherisation Lab to unblock arteries. Bear in mind that a heart attack happens because of blockage of artery or a blood vessel which supplies blood to the heart muscle. So the most important treatment is to unblock that blood vessel so that the blood supply is restored as quickly as 4 MYHEALTH heaviness and if you have it longer than 1 – 2 minutes lasting for 5 – 10 minutes, then you should call for help or dial ‘132’ for our advanced cardiac life support ambulance. REMEMBER...THE SOONER YOU ACT, THE BETTER ! Chest Pain! hest pain is a common symptom. It is very difficult to tell when you are having such symptoms exactly what’s going on! Sometimes it can be benign such as heart burn, but sometimes it can be much more serious like a heart attack! Many people are concerned whether chest pain is heart related or not! CARDIOLOGY possible. Therefore It is very important that you go to a medical centre which has the ability and facility to do this on a 24/7 basis as quickly as possible. If not, you are going to lose time and in that process you are also going to be losing precious heart muscles. The longer the delay to ensure optimal blood supply, the more the damage to the heart is likely to happen. Recognise the signs of a Heart Attack Trouble breathing with or without chest discomfort Feeling light headed or breaking into cold sweat Feeling sick or discomfort in your stomach The Chest Pain Clinic is located at the emergency department of the Apollo Bramwell Hospital. Here, further tests are perfomed to evaluate the chest pain and to check whether they are heart related or not. The centre has formalised processes and protocols in place to evaluate patients quickly and a Senior Cardiologist on standby to treat patients more effectively for a better outcome. Emergency heart attacks require an angiography followed by balloon angioplasty or stenting in a catherisation lab. Sometimes the patient’s heart disease is so severe, they require a bypass surgery. Chest pain is a medical emergency and time is of the essence, therefore don’t ignore it! Call the emergency cardiac ambulance hotline number ‘132’ or visit the Chest Pain Clinic at the Apollo Bramwell Hospital. It could be your nearest path to survival! What happens when you call the ‘132’ ambulance hotline? Non-Modifiable and Modifiable risk factors of cardiac arrest: We send our advanced cardiac life support ambulance. The emergency doctor & paramedics who come to your house in the ambulance can do an ECG right in your house and find out if you are having a heart attack. Then they alert the Apollo Bramwell Hospital so that the cardiac team is ready to receive you for heart attack care. What could happen if your care is delayed? If you go to a health care centre that doesn’t have the critical care needed for treating a heart attack or it doesn’t have the facility to unblock arteries on a 24/7 basis, your care will be delayed! During a heart attack, the heart muscles are dying every minute because there is lack of blood supply to the heart muscles. So it is important to restore the blood supply to the heart as quickly as possible. Every minute your care is delayed, more and more of the heart muscles are getting damaged. Sometimes the damage is permanent. Therefore it is absolutely critical that the blood supply to the heart is restored as soon as possible. Remember, the minimum amount of heart muscle lost , the better the efficiency of the heart and better the protection. Time is of essence when it comes to a heart attack. We therefore say, ‘ TIME IS MUSCLE’. When the muscles of the heart are lost, the heart is going to get damaged. Therefore if you have such episodes of chest discomfort or • AGE, GENDER, GENETIC FACTORS, ETHNICITY • HIGH BLOOD PRESSURE, SMOKING, DIABETES, PHYSICAL INACTIVITY OBESITY, HIGH BLOOD CHOLESTEROL Catherisation lab “Cardiologists emphasize that during a heart attack, the heart muscle is dying every minute and the longer you delay, the greater the difficulty for you to recover and return to a normal life afterwards” MYHEALTH 5 NIC Health Plan MyHEALTH JOURNEY TO BETTER HEALTH PLASTIC SURGERY BREAST Médical • Chirurgical • Dentaire • Auditif • Ophtalmologique • Maternité • Troubles de la fertilité • Services ambulance • Assurance catastrophe et plus encore. October is the Breast Cancer awareness month Reconstruction SURGERY care for my family W ith more than 500 cases of breast cancer detected per year in Mauritius, that is to say nearly one new case per day, plastic surgery needs more than ever to be a major element in the treatment of breast cancer and breast reconstruction. Currently, three methods of breast reconstruction are of standard reference in the medical world. The choice of methodology depends on the patient’s desires, the stage of the illness and the joint opinion of an oncologist and a plastic surgeon. Conservative therapy: Conservative therapy occurs through lumpectomy, which includes removal of the tumour and a small quantity of the tissues surrounding it. Such surgery can be carried out by way of an incision around the areola or vertically below the breast. For the sake of symmetry, the other breast will then be reduced and modelled. The only drawback to this therapy is that it can’t be carried out when the cancer is multifocal or when the patient has already undergone radiotherapy. Immediate reconstruction: This procedure starts right after mastectomy (surgical removal, partial or total of one breast or both). The immediate reconstruction can be carried out with prosthesis or body tissue (from the back or the abdomen), or even both, as per the surgeon’s advice. The prosthesis used is made of two parts, one is in silicone gel and the other is gradually filled with a physiological serum until it reaches the desired curvature to recreate a harmonious vision of the bosom. The reconstruction then follows two steps: firstly the positioning of the prosthesis and secondly, once the latter stabilises, the surgeon recreates the nipple and then the areola. Differed reconstruction: It entails the same steps as immediate reconstruction, but is carried out from one to one and a half years after the radiotherapy sessions, if the latter had been necessary. A vec plus de 500 cas de cancers du sein détectés par an à Maurice, soit près d’un nouveau cas supplémentaire par jour, la chirurgie plastique doit plus que jamais se placer comme acteur majeur du traitement du cancer du sein et de sa reconstruction. Aujourd’hui, trois façons de reconstruire le sein font référence dans le milieu médical. Le choix de la méthode dépend des désirs de la patiente, du stade d’avancée de la maladie et de l’avis émis conjointement par l’oncologue et le chirurgien plasticien. 6 MYHEALTH La thérapie conservatrice: La thérapie conservatrice passe par la tumorectomie, qui consiste à enlever la tumeur et une petite quantité des tissus qui l’entourent. Cette chirurgie peut notamment être réalisée grâce à une incision autour de l’aréole et une autre, verticale en dessous du sein. Par souci d’harmonie, l’autre sein sera ensuite réduit et modelé. La seule limite à cette thérapie est qu’elle ne peut être proposée lorsque le cancer est multifocal ou que la patiente a déjà bénéficié de radiothérapie. La reconstruction immédiate: Cette méthode débute immédiatement après la mastectomie (l’ablation partielle ou totale d’un ou des deux seins). La reconstruction immédiate peut se faire avec prothèse ou lambeaux, voire les deux, selon l’avis du chirurgien. La prothèse utilisée a la particularité d’être fabriquée en deux parties, l’une en gel de silicone et l’autre, raccordée à une pipette, est remplie progressivement de sérum physiologique jusqu’à atteindre le galbe voulu pour recréer une vision harmonieuse de la poitrine. La reconstruction se fait alors en deux étapes : d’abord le positionnement de la prothèse et ensuite, une fois celle-ci stabilisée, le chirurgien recrée le mamelon et ensuite l’aréole. La reconstruction différée: Celle-ci implique les mêmes étapes que la reconstruction immédiate, mais elle s’effectue entre 1 an à 1 an et demi après la fin des séances de radiothérapie, si celles-ci se sont avérées nécessaires. Dr Van Den Broeck Plastic & Cosmetic Surgeon, Apollo Bramwell Hospital Parce qu’il vaut mieux prévenir les hasards de la vie, la NIC vous propose des assurances santé innovantes et élaborées en fonction de vos besoins et de ceux de votre famille. Pour votre confort, une souscription rapide et pas d’avance de frais en cas d’hospitalisation vous permettront de profiter pleinement de nos tarifs très compétitifs. Alors, soyez prévoyant et appelez nous dès aujourd’hui au 602 3000 pour plus d’information. Follow us | NIC Mauritius | www.nicl.mu ServingYou ServingTheNation The NIC General Insurance Co. Ltd is licensed by the Financial Services Commission. MYHEALTH 7 MyHEALTH JOURNEY TO BETTER HEALTH OPHTHALMOLOGY OPHTHALMOLOGY Do you want freedom from glasses and contact lenses? LASIK is the solution for you! Dr Bharti Sharma Senior Ophthalmologist Apollo Bramwell Hospital gives a complete update on LASIK and its advantages. L ASIK (Laser in-situ Keratomileusis) is a laser eye surgery technique that reshapes the surface of the eye (cornea) to correct nearsightedness, farsightedness and astigmatism. LASIK surgery is performed on individuals suffering from myopia (short-sighted), hypermetropia (longsighted), astigmatism (unevenly curved cornea), and offers them freedom from glasses and contact lenses. LASIK is a great option for many individuals considering laser vision correction for a variety of very personal and professional reasons. We have invested in the only 100% bladeless refractive laser technology in Mauritius thus benefitting patients who wear glasses. The Alcon Wavelight Refractive Suite performs blade-free LASIK (Laser Eye Surgery), which is safer and more advantageous than the conventional Lasik surgery. The basis for successful Lasik treatment is an accurate diagnosis. We offer high precision diagnosis with the one and only Allegro Oculyzer on the island. The benefits of this industry leading equipment are advanced safety and increased comfort due to the high speed eye tracking precision of the laser ensur- 8 MYHEALTH ing reduced chances of corneal ectasia and lower risk of infections. The Refractive Technology offers our patients best outcomes with quicker recovery times. What are the advantages of Blade Free Lasik and how safe is it? Femtosecond LASIK / BLADE FREE LASIK is generally safe, effective, and has very few side effects. It is a highly successful procedure that can at the very least reduce a person’s dependence on glasses or contact lenses. The lifestyle benefits can be tremendous for active and social people. These benefits can enable people to more freely pursue their hobbies, sports activities or career options. How is the procedure carried out? LASIK combines the accuracy of the Femtosecond laser to cut a flap in the cornea along with excimer laser to reshape the cornea. Femtosecond assisted LASIK : In usual LASIK surgery, a surgical instrument called a microkeratome is used to create a flap of the corneal tissue. A microkeratome is a tool with a blade that cuts a circular flap of tissue from the surface of the cornea. This thin flap of corneal tissue, attached by a hinge, is fold- ed back exposing the inner layer of the cornea (stroma). Next, the excimer laser is used to reshape the cornea (stroma). After the inner tissue of the corneal is reshaped, the flap is repositioned, without the need for stitches. In Blade Free LASIK / Femtosecond LASIK, femtosecond laser is used to cut a flap of the corneal tissue (usually with a thickness of 100120 microns). Femtosecond (FS) laser is an infrared laser with a wavelength of 1053nm. It works by producing photo disruption or photoionization of the optically transparent tissue such as the cornea. Application of Femtosecond Laser results in the generation of a rapidly expanding cloud of free electrons and ionized molecules. The acoustic shock wave so generated results in disruption of the treated tissue. What about LASIK flap creation with femtosecond laser ? A suction ring is centered over the cornea and suction is applied. The docking procedure is then initiated while keeping the suction ring parallel to the eye. An applanating contact lens is used to stabilize the globe and to flatten the cornea .The surgeon administers the FS laser treatment. Each pulse of the laser generates free electrons and ionized molecules leading to formation of microscopic gas bubbles dissipating into surrounding tissue. Multiple pulses are applied next to each other to create a cleavage plane and ultimately the LASIK flap. Suction is then released. A spatula is carefully passed across the flap starting at the hinge and sweeping inferiorly to lift the flap for excimer laser ablation What are the major advantages of FS laser? 1. Reduced incidence of flap complications like buttonholes, free caps, irregular cuts etc. 2. Greater surgeon choice and control over flap diameter and thickness, side cut angle, hinge position and length. 3. Increased precision with improved flap safety and better thickness predictability. 4. Capability of cutting thinner flaps to accommodate thin corneas and high refractive errors. 5. Other advantages over microkeratome assisted LASIK include stronger flap adherence, better contrast sensitivity, decreased incidence of epithelial ingrowth, less increase in intraocular pressure , lesser incidence of dry eyes, hemorrhage from limbal vessels less likely and the ability to retreat immediately if there is incomplete FS laser ablation. Loss of suction during FS laser LASIK flap creation is easier to handle and the suction ring may be reapplied and treatment resumed immediately in many cases. What are the disadvantages associated with Femtosecond assisted LASIK? 1. Opaque bubble layer (OBL): Gas bubbles may accumulate in the flap interface during FS laser treatment. There is a significant reduction in the incidence and extent of OBL when novel LASIK flap ventilation canal parameters of width and spot line separation are used as in Alcon FS 200. 2. Transient light sensitivity syndrome (TLSS): Also called as good acuity plus photosensitivity (GAPP). TLSS usually occurs days to weeks after FS laser LASIK. Patients present with photophobia and good visual acuity with paucity of clinical findings on exam. It resolves without sequel but requires aggressive topical steroids for weeks. Are there any other alternatives to LASIK? I would say Photorefractive keratectomy (PRK). In this procedure only epithelium is removed (so no flap is created) and Excimer laser is given to the cornea. Recovery time is longer with PRK than with LASIK, though the final outcome is about the same (very good). However the disadvantage is that this procedure cannot be performed for higher refractive errors. Implantable collamer lens or ICL : In patients with thin corneas, where LASIK / PRK cannot be done, another option would be ICL. Implantable collamer lens or ICL is a soft, flexible gel-lens for the permanent correction of myopia (nearsightedness). The ICL procedure is an intraocular procedure where an ICL is implanted inside the eye . ICLs consists of a small biocompatible intraocular lens (IOL), also known as a posterior chamber phakic intraocular lens (PIOLs), with distinct footplates, called haptics, to hold the lens in place within the cilliary sulcus inside the eye and the anterior vault designed to minimize contact with the eye’s crystalline lens. Who are the patients suitable for an ICL ? Moderate to high myopia(nearsightedness) of -3 to -20 diopters who are not good candidates for LASIK because of thin corneas. What are some of the disadvantages of ICL ? • Infection - Like any intraocular surgery there is a potential of an infection. • Increased intraocular pressure - Pressure may build in the eye after an ICL procedure. The sooner a surgeon is alerted to this complication, the greater the chance of avoiding serious damage. • Repositioning or removal of lens -ICLs have the potential, however slight, of needing to be repositioned. The frequency of this complication may vary by implantable contact lens models. MYHEALTH 9 MyHEALTH JOURNEY TO BETTER HEALTH INTERNAL MEDICINE OPHTHALMOLOGY Disadvantages of ICL ( continued) • Damage to crystalline lens - Because implantable contact lenses are implanted into the eye, there is a potential that the eye’s natural lens may be damaged during the procedure. If the damage is severe, the crystalline lens may need to be replaced with an intraocular lens. • Cataract development - Over 50 percent of the population will develop cataracts by the age of 65, however, it is believed that the use of some implantable contact lenses may cause cataracts at an earlier age. Conjunctivitis: How to protect yourself? C onjunctivitis is an inflammation or infection of the conjunctiva, the thin transparent layer of tissue that lines the inner surface of the eyelid and covers the white part of the eye. Conjunctivitis, often called “pink eye”, may affect one or both eyes. Some forms of conjunctivitis can be highly contagious and easily spread in schools and at home. While conjunctivitis is usually a minor eye infection, sometimes it can develop into a more serious problem. Comment vous protéger de la conjonctivite ? L a conjonctivite est une inflammation ou une infection de la conjonctive, la fine couche transparente de la membrane qui tapisse la face postérieure des paupières et recouvre le blanc de l’oeil. Elle peut affecter un oeil ou les deux yeux à la fois. Certaines formes de la maladie peuvent être hautement contagieuses et peuvent se répandre rapidement dans les écoles et à la maison. Le plus souvent un trouble oculaire mineur, la conjonctivite peut parfois aboutir à un problème de santé plus grave. What are the different types of conjunctivitis? As per Dr Bharti Sharma, Consultant Ophthalmologist there are different types of conjunctivitis: • Viral • Bacterial (such as gonorrhea or chlamydia) • Allergic such as dust and pollen, contact lens wearers. Quels sont les différents types de conjonctivite? Selon le Dr Bharti Sharma, ophtalmologue, il y a différents types de conjonctivite : • Viral • Bactérien (comme la blennorragie ou la chlamydia) • Allergique (à la poussière et au pollen, pour ceux portant des lentilles). Viruses are a common cause of conjunctivitis in patients of all ages. A variety of viruses can be responsible for conjunctival infection; however, the adenovirus is by far the most common cause. Viral conjunctivitis, although usually benign and self-limited, tends to follow a longer course than acute bacterial conjunctivitis, lasting for approximately 2-4 weeks. Les virus sont une cause fréquente de la conjonctivite chez les patients de tout âge. Une pléthore de virus peut être responsable d’infections conjonctivales ; toutefois, l’adénovirus est de loin la cause la plus fréquente. La conjonctivite virale, bien que généralement bénigne et spontanément résolutive, a tendance à suivre un plus long cours que la conjonctivite aiguë bactérienne,avec une durée de deux à quatre semaines approximativement. Who is at risk? Anyone who is in close contact with a person who already has conjunctivitis or with contaminated swimming pools. How to avoid contracting the virus? Dr Bharti Sharma says that practicing a good hygiene is the best way to control the spread of conjunctivitis. Avoiding close contact with infected patients and washing hands frequently will greatly reduce the risks of infection. Measures and Precautions Once an infection has been diagnosed, follow these steps: • Don’t touch your eyes with your hands. • Wash your hands thoroughly and frequently. • Change your towel and washcloth daily, and don’t share them with others. • Discard eye cosmetics, particularly mascara. • Don’t use anyone else’s eye cosmetics or personal eye care items. • Follow your eye doctor’s instructions on proper contact lens care. 10 MYHEALTH Qui sont les personnes à risque? Quiconque est en contact rapproché avec une personne ayant déjà la conjonctivite ou nageant dans des piscines contaminées. Comment éviter d’attraper le virus? Le Dr Bharti Sharma affirme que pratiquer une bonne hygiène est le meilleur moyen de contrôler la propagation de la conjonctivite. Éviter un contact rapproché avec des patients infectés et se laver régulièrement les mains réduira le risque d’infection. Mésures de précautions une fois une infection diagnostiquée, suivez les consignes suivantes : • Ne touchez pas vos yeux avec vos mains. • Lavez vos mains fréquemment et abondamment. • Changez de serviette et de gant de toilette quotidienne ment et ne les partagez pas avec autrui. • N’utilisez pas de produits de beauté pour les yeux, en particulier le mascara. • Ne faites pas usage des produits de beauté d’une tiers personnes ou ses produits personnels pour les yeux. • Suivez les consignes de votre ophtalmologue concer- nant l’entretien convenable de vos lentilles de contact. Beware of hypertension Dr Arshad Peerbux Consultant Internal Medicine U nfortunately hypertension is very common in Mauritius and worldwide. In Mauritius, hypertension (HT) is prevalent amongst 35-40% of the adult population. Therefore it is very common for us to see patients with HT. Sadly we see many patients coming to us with untreated and uncontrolled HT. This leads to many complications. Based on the statistics, it would be right to say that one person per family is suffering from HT. These results are alarming given that HT leads to many complications, notably cardiovascular diseases. I feel that the public are not taking enough precautions to monitor, discover and treat HT. Further statistics show that most patients are not achieving normal BP despite taking medications. The causes could be : Not following up with the doctor, not taking enough medications, non-compliance with tablets and poor diet. 1. What is hypertension? Hypertension is defined as a blood pressure more than 140/90. Stage 1: systolic 140-159, diastolic 90-99 Stage 2: 160 systolic or diastolic > 100mmHg 2. Who is most affected? As per NCD survey conducted in Mauritius : • HT increases with age • HT is higher in men than in women 3. What are the causes? Primary HT- develops because of genetical and environmental factors. By far the MOST common ones are : Genetic- high Bp: has a substantial heritable component from 33-57% in Framingham study. Environmental factors - obesity, smoking, lack of exercise, poor diet, alcohol. Secondary factors : Due to other diseases such as : 1. Renal disease 2. Vascular disease 3. Endocrine problems (imbalances hormone) 4. Neurogenic causes 5. Obstructive sleep apnoea 6. Medications: alcohol, OCP, COCAINE, NSAIDS, erythropoietin, nasal decongestants, some herbal remedies containing liquorice, nicotine. 4. What are the adverse effects on long-term and short term health? Long term problems include cardiovascular problems and risk factor associated with acute problems such as myocardial infarction (cardiac arrest) and stroke. HT also causes end organ damage like hypertensive nephropathy and cardiomyopathy. In the short term, we only worry about hypertensive emergencies. That is, an acute uncontrolled high blood pressure can lead to neurologic end damage such as stroke or intracranial haemorrhage, cardiac damage, renal problems and eye problems. Engage in aerobic exercises at least 30min on most days (Decrease of 4-9 mmHg). Promote consumption of fruits, vegetables and low fat dairy products. If lifestyle is inadequate then medications are needed. The choice of medication will depend on your other medical problems. Patients also need an assessment of their cardiovascular risk factors such as smoking, obesity, cholesterol, diabetes and appropriate treatment will be given. 5. What are the remedies and solutions? To lower the blood pressure we can do lifestyle changes and use appropriate medications. Lifestyle: Weight loss 5-20 mmHg drop in HT per 10kg loss. Limit alcohol intake. Reduce sodium intake. Maintain adequate intake of potassium. Stop smoking. MYHEALTH 11 MyHEALTH JOURNEY TO BETTER HEALTH HPV Vaccine, protecting women from cancer EXERCISING: MYTHS AND FACTS Cervical cancer is the 4th most common cancer in women. It can be even prevented entirely by early vaccination and regular pap tests. Dr Shilipa Sinha, Obstetrician & Gynaecologist, explains why vaccination is recommended. H PV vaccine is safe, effective vaccine which protects people from most of the cancer caused by human papilloma virus infection. What is HPV infection and what do they cause? HPV is the most common sexually transmitted infection. More than 100 varieties of Human Papilloma Virus exist but around 40 HPV types can infect the genital areas of males and females. They can also infect the mouth and throat. Most people with HPV never develop symptoms or health problems. Most HPV infection (9 out of 10) go away by themselves within 2 years . But sometimes HPV infection will exist and can cause: - Cancer of cervix, vagina and vulva in women. - Cancer of penis in men. - Cancer of anus or back of throat including base of tongue and throat (oropharynx) in women and men. - Cause genital warts in men and women. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancer. What is the importance of HPV vaccine? Vaccins can protect against the strains of HPV likely to cause genital warts and cervical cancer. Why does my child need HPV vaccine? How HPV vaccine prevents young girls from getting Cancer? 12 MYHEALTH HEALTH & WELLNESS GYNAECOLOGY Various strains of HPV spreads through sexual contact and are associated with most cases of cervical cancer and genital warts. Vaccines can prevent most cases of cervical cancer if given before a girl is exposed to HPV. Hence girls should receive all doses of HPV vaccine long before they begin any type of sexual activity and are exposed to HPV. Also HPV vaccine produces a higher immune response in pre-teens than it does in older teens and young women. Is the vaccine still effective if you have sexual relations? Yes, even if someone has already had sex they should still get HPV vaccine. You may have one strain of HP virus, the vaccine can protect you from other strains that you haven’t been exposed. What are the side effects of vaccine? Vaccines like any other medications may have side effects. Many people who get HPV vaccine have no side effects at all. Some people report mild side effects like - Pain, redness or swelling in the arm where shot was given - Fever - Nausea - Headache or feeling tired - Muscle or joint pain. Sometimes dizziness or fainting spells (remaining sitting or lying for 15 minutes after vaccination helps preventing this) - Rarely severe (anaphylactic) reaction can occur if allergic to any component of vaccine Why do you think parents are reluctant when it comes to vaccination? Safety concerns about HPV vaccine and worries about the side effects prevents some parents from giving the vaccine. Some parents believe that this vaccine is not needed. Some parents put off the HPV shots because their daughters are not sexually active - a mistaken justification because doctors recommend giving the vaccine at age of 11 or 12 years before a teen becomes sexually active. Some parents are afraid that giving vaccine acts as a sort of permission for teens to be sexually active. What can you say to parents who have refused to vaccinate their daughters? It is rightly said “ prevention is better than cure”. So all parents should vaccinate their daughters at 11 or 12 years of age. Those who did not get when they were young should get it now. Young women can get HPV vaccine through age 26 years. Myths: “Physical activity is time consuming!” “I am too busy!” Fact: Physical activity takes less time than we think. You can exercise without making any drastic changes in your routine. Making easy targets and accommodating them in your life will make you active. Gradually, it will become easier to follow the recommended 30 minutes of daily physical activity. And if you exercise regularly, your efficiency will go up and you will gain more time for other activities because of your fitness condition. Myth: “Exercising is for weight loss” Fact: Weight loss is not the only benefit. Exercise improves our quality of life, helps us to work `more efficiently and to enjoy our days better. We are able to carry out meetings and office tasks with greater efficiency. Myth : “Exercising is too hard!” Fact: You should keep physical activity easy. You could, for example, get off the bus one stop earlier and add a little walk to work. Or you could park your car a little further from the shopping mall and get in a small stroll while shopping. Climbing stairs, instead of using elevators would help burn a few extra calories. Myth: “I don’t know how to exercise!” Fact: Getting help is easy. At Apollo Bramwell Hospital, exercise sessions are tailor-made and customized for every patient. At the Health and Wellness Centre of the Apollo Bramwell hospital prevention is the key word. We help patients be aware of their health but also arm them with important tools that help fight stress and lifestyle-related diseases. HEALTH & WELLNESS Kinesiologist Ismael Malleck wants to make physical activity an essential part of people’s lives. He reveals some myths and facts about exercising. Exercices physiques : fini les idées reçues! Ismael Malleck, kinésiologue, souhaite que l’activité physique devienne un élément central de nos quotidiens. Il réfute les idées reçues qui nous découragent souvent à faire des exercices. Idée reçue: « L’activité physique prend trop de temps! » « Je suis trop occupé ! » L’activité physique prend moins de temps que nous le pensons. Nous pouvons nous exercer sans changement drastique dans nos habitudes. Identifier des cibles faciles à atteindre et qui intègrent facilement notre routine nous rendra de plus en plus actifs. Peu à peu, il sera plus facile alors d’atteindre les 30 minutes d’activité physique quotidienne recommandées. Si vous vous entraînez régulièrement, votre efficacité augmentera et vous gagnerez donc plus de temps pour vos autres activités en raison de votre condition physique. et ainsi mieux profiter de son temps. Les réunions et autres activités de bureau, par exemple, deviennent beaucoup moins épuisantes ! Idée reçue: «C’est trop dur! » L’activité physique doit rester à votre portée. Au début, vous pouvez, par exemple, descendre du bus un arrêt plus tôt que d’habitude et faire un peu de marche avant d’aller au travail. Pour brûler quelques calories supplémentaires, vous pouvez aussi garer votre voiture un peu plus loin du centre commercial, ou encore, prendre les escaliers plutôt que l’ascenseur. Idée reçue: “Je ne sais pas comment faire!” Il est facile de se faire aider. À l’hôpital Apollo Bramwell des séances d’exercices sont conçues « sur mesure », personnalisées pour chaque patient. Au ‘Health & Wellness Centre de l’hôpital Apollo Bramwell, la prévention est le mot clé. Nous aidons nos patients à être conscients de leur état de santé, mais nous les aidons aussi à acquérir les connaissances et les techniques qui leur permettront de combattre le stress et les maladies liées au mode de vie. Idée reçue: « C’est pour perdre du poids… » La perte de poids n’est pas le seul avantage de l’activité physique. Faire des exercices, c’est aussi améliorer sa qualité de vie, être plus efficace MYHEALTH 13 MyHEALTH JOURNEY TO BETTER HEALTH PAEDIATRICS PAEDIATRICS les gestes techniques pour la réanimation néonatale, notamment la ventilation au masque, le massage cardiaque externe, l’intubation trachéale et savoir cathétériser le nouveau-né. Il est impératif de savoir faire face à toute urgence néonatale tant en salle de naissance qu’au cours du séjour du nouveau-né à l’hôpital. “Pour travailler à la NICU, il faut avoir des compétences spécifiques” Dans la maternité où vous allez accoucher, vous entendrez peut-être parler du service de néonatologie. Quels bébés y sont accueillis et quel personnel soignant y rencontre-t-on ? Dr. Faeza Soobadar, ‘Senior Consultant in Paediatrics and Neonatology’, nous propose une incursion dans l’unité de pédiatrie et de néonatologie qu’elle a mise en place en 2009. Qu’est-ce que la pédiatrie ? La pédiatrie est la spécialité médicale concernant les enfants, notamment tout ce qui englobe la maladie de l’enfance et les traitements, et tout ce qui touche au bien-être de l’enfant. A titre d’exemple, nous proposons des conseils sur l’alimentation, des vaccins et la médecine préventive, entre autres. Les maladies que nous traitons au quotidien sont les rhino-pharyngites, les otites, la gastro-entérite, la bronchiolite, les bronchites, les laryngites, les crises d’asthme et d’autres urgences pédiatriques telles les convulsions. Et jusqu’à quel âge un enfant va-t-il chez le pediatre ? A l’île Maurice c’est généralement jusqu’à l’âge de 13 ans, mais dans certains pays c’est jusqu’à l’âge de 16 ans. Les enfants prétendent-ils souvent être malades ? J’appellerai cela la somatisation. Cela se produit lorsque l’enfant a une angoisse ou est sous un stress quelconque. Et c’est ce qui lui cause des symptômes comme le mal de ventre ou des maux de têtes. Ainsi, au lieu de lui faire faire une série de tests qui le traumatiseront davantage, nous essayons de discuter avec l’enfant pour comprendre la source du problème. Qu’est-ce la néonatologie ? La néonatologie est une branche de la pédiatrie, voire une sous-spécialité, qui touche aux maladies 14 MYHEALTH affectant les nouveau-nés. Médicalement parlant, ce sont les soins intensifs pour les bébés qui sont gravement malades, notamment les nouveau-nés prématurés, les bébés qui ont contracté une infection au cours de la grossesse ou encore ceux qui présentent une malformation congénitale. Toutefois , la prématurité est la cause la plus fréquente d’hospitalisation en néonatologie. La néonatologie requiert l’utilisation de technologies et comprend beaucoup de traitements et d’interventions invasifs. Quels sont les services de l’unité de pédiatrie et de néonatologie ? Apollo Bramwell est le seul hôpital privé qui offre un service complet en pédiatrie et néonatologie, cela avec une salle de pédiatrie d’une capacité de 20 chambres uniquement pour les enfants, mais on permet aussi à la maman de rester avec son enfant malade. Nous avons un OPD (Out-Patient Department) qui est ouvert tous les jours, du lundi au samedi de 8h30 à 20 heures. Mais toutefois les consultations se font sur rendez-vous uniquement, sauf en cas d’urgence. Le département de néonatologie fonctionne en étroite collaboration avec le département de la maternité. Il y a une nursery pour les bébés en bonne santé et aussi une unité de soins intensifs de néonatologie (NICU) qui accueille les bébés qui ont besoin de soins médicaux particuliers. En quoi consistent les interventions ? En tant que néonatologue, il faut savoir pratiquer Quelles sont les causes d’hospitalisation les plus fréquentes ? Chez les prématurés, une des maladies les plus fréquentes est celle de la membrane hyaline (RDS) qui est occasionnée par une déficience du surfactant causant des troubles respiratoires chez le bébé. Dans les premières heures de vie, l’enfant subit une intubation trachéale (une sonde est placée dans sa trachée) pour sa ventilation pour les jours qui suivent sa naissance. Pour ce faire, le personnel soignant doit absolument avoir les compétences nécessaires et bien comprendre les particularités physiologiques et pathologiques du nouveauné. Et les complications ? Le couple place tant d’espoir dans la naissance de leur enfant. Si l’accouchement se passe bien pour certaines mamans, pour d’autres, c’est très difficile d’accepter que son enfant naisse avec des complications. Nous, en tant que médecins, nous savons ce qui est possible ou pas. Ainsi à ABH , nous assurons aussi un service de conseil pour les parents afin de les préparer à surmonter certaines épreuves. Il faut savoir également gérer le stress des parents à cet effet. De nos jours, lorsqu’on effectue le suivi de la grossesse d’une future maman, il y a des fois, le foetus montre certaines complications. Le gynéco-obstétricien peut recommander ainsi la naissance par césarienne pour une meilleure chance de survie du bébé. Nous, en tant que néonatologues, nous faisons notre maximum pour sauver l’enfant. Si nous rassurons les parents, nous les préparons aussi au pire en cas d’échec. Car dans certaines cas, l’enfant peut surmonter les complications et nécessite d’autres soins pour être en bonne santé. Toutefois, l’unité des soins intensifs, c’est là où les bébés frôlent aussi la mort. Un petit bout de chou qui vous a le plus marqué ? Je me souviens d’un bébé qui était à terme mais qui souffrait de troubles respiratoires. C’était lorsque je travaillais à l’hôpital du Nord. En dépit des soins qu’on avait administrés à l’enfant, son état continuait à se détériorer et son coeur avait commencé à flancher. Les parents ont été alertés de la situation et on les avait preparés au pire. Et ces derniers ont décidé de faire une prière spéciale pour leur enfant car ils gardaient toujours espoir que leur enfant survive. Le même soir l’enfant a commencé à montrer des signes d’amélioration et il s’en est sorti. Aujourd’hui, cet enfant est âgé de 10 ans et il est en pleine forme. Qu’est ce qui cause la mort des nouveau-nés ? C’est triste à dire mais ce sont les cardiopathies congénitales la plus part du temps. A Maurice, on n’a pas les facilités pour des interventions chirurgicales appropriées pour les nouveau-nés. Pour cela, il faut donc se rendre à l’étranger. Cette pratique est toutefois à risque car l’état de santé du nouveau-né est souvent instable. On n’a pas les personnes avec les compétences requises pour ce genre d’opération au pays. On a des ‘foreign teams’ qui effectuent le déplacement pour le faire mais on n’a pas au pays des personnes spécifiques pour ce genre d’intervention. Mais il est à noter que la néonatologie à Maurice a bien progressé depuis les 15 dernières années. Quelles sont les qualités requises pour faire ce métier ? Pour etre pédiatre, je dirais qu’il faut avoir beaucoup de patience, être à l’écoute et faire preuve de beaucoup de disponibilité. Il faut savoir amadouer l’enfant quand il pleure et aussi bien répondre aux multiples questions des parents sur leur enfant et les rassurer. Quant à la néonatologie, c’est un métier exigeant et éreintant. Pour le faire, il faut de la passion et un bon esprit d’équipe. Et j’insiste sur le fait que le personnel soignant doive être formé et avoir les compétences nécessaires. Parlez-nous de votre équipe... L’équipe médicale et soignante d’Apollo Bramwell Hospital est composée de deux pédiatres employés à plein temps, avec les compétences requises, épaulés d’une équipe d’infirmières . Cependant, nous collaborons aussi avec des ‘visiting doctors’ pour offrir un service de qualité. Nous avons, à l’hôpital Apollo Bramwell, une équipe d’infirmières douées qui nous assistent pour chaque cas. Elles sont toutes formées et ont les compétences nécessaires pour administrer les soins, que ce soit à l’enfant en pédiatrie ou au bébé en soins intensifs. Notre équipe comprend des infirmières étrangères et Mauriciennes. Faeza Soobadar a été boursière du ‘Junior Scholarship’ en 1975. De 1976 à 1982, elle entame des études secondaires au Queen Elizabeth College où elle sera lauréate de la filière scientifique. Elle met le cap sur l’Angleterre où elle effectue des études de médecine de 1983 à 1988 à l’université de Manchester. De 1989 à 1998 , elle se spécialise en pédiatrie et néonatologie (MRCP en 1993 et CCST en 1998). De retour au pays en 1998, elle crée l’unité néonatale de l’hôpital Sir Seewoosagur Ramgoolam et y travaille jusqu’en 2009. Par la suite, elle se retrouve à l’hôpital Apollo Bramwell où elle a mis en place l’unité de pédiatrie et de néonatologie. Elle y travaille désormais à plein temps en tant que ‘Senior Consultant in Paediatrics and Neonatology.’ MYHEALTH 15 MyHEALTH JOURNEY TO BETTER HEALTH PAEDIATRICS Dans l’ombre, elles sont les anges gardiens... Le Dr. Faeza Soobadar insite sur le fait que les infirmières et auxiliaires, bien qu’elles soient souvent dans l’ombre, jouent un grand rôle dans les soins intensifs des nouveau-nés. “J’ai une grande admiration pour elles, pas seulement pour celles d’Apollo Bramwell Hospial, mais aussi pour celles affectées aux NICU de Candos et de SSRN”, ditelle. Et d’ajouter que ce sont elles les anges gardiens des bébés en quelque sorte. WHY BREASTFEED YOUR NEWBORN? 1st to 8th August was the international breastfeeding week. To mark this event, world’s leading infant nutrition brand, ‘NUTRICIA‘ organised an awareness talk during which Dr. Faeza Soobadar explained why breastfeeding is necessary. What are the advantages for you? • It is a natural food designed for your baby. • Numerous health benefits for baby. • Health benefits for mother. • It is free. • Available whenever needed. • Right temperature. • Free from contamination. • Encourages bonding. What are the health benefits for your baby? • Contains protective factors : IgA, Mac rophages, Antibodies, oligosaccha rides, Lactoferrin. • Reduces Gastroenteritis in babies, Ear infections, and Chest infections. • Protects children from Obesity & Type2 diabetes, Eczema, Higher scores in cognitive function testing. Health benefits for the mother : • Short-term: • Suckling increases oxytocin which leads to uterine contraction and reduction in PPH. • Breast feeding is also a Natural contra ceptive. • Uses 500 calories/day therefore can lead to some weight loss. • Long-term: • Reduces the risk of breast 16 MYHEALTH and ovarian cancer. • Lowers the incidence of osteoporosis and hip fractures over the age of 65. What should mothers eat during breast feeding? • 5 portions of fruit/veg • Starch – wholemeal bread, pasta, rice potatoes. • Fibre – cereals, pulses, wholemeal bread. • Protein- lean meat, chicken, fish, eggs, pulses. • Dairy food – milk cheese yogurt. • Plenty of fluids : water, milk, fresh fruit juices. Foods to Avoid FISH: • Only 2 portions oily fish (fresh tuna, sardines, mackerel, trout) allowed per week. • Only 1 portion of shark or swordfish or marlin (Hg) allowed per week. CAFFEINE: • Tea, coffee, chocolate, energy drinks. • Drink occasionally – not daily. • Try decaffeinated tea/coffee, herbal teas. from someone else other than the mother. • It is best to try giving a bottle when the mother is not present. • Something that smells of the mother nearby may help. Expressed breast milk and storage • At room temperature (no more than 25 degrees C), for up to six hours. • In a cool box, with ice packs, for up to 24 hours. • In a fridge (at four degrees C or colder), for up to five days. Store it at the back of the fridge, where it’s coldest, away from meat, eggs, or uncooked foods. • In a fridge’s freezer compartment, for two weeks. • In a home freezer (at minus 18 degrees C or lower), for up to six months. Expressed breast milk • Frozen expressed breast milk should be defrosted in the fridge and should not be re-frozen once thawed. • Breast milk should be warmed by standing the feed in a jug of hot water for a few minutes. ALCOHOL: • 1 or 2 units once or twice per week • AVOID GETTING DRUNK Returning to work • Continuing baby-led feeding before and after work is possible. • Mother can express milk so that the infant can be fed by cup or bottle when she is away. • The baby is more likely to take a bottle MYHEALTH 17 MyHEALTH JOURNEY TO BETTER HEALTH ORTHOPAEDICS ORTHOPAEDICS combination of steroid plus anaesthetic medication can help to decrease the pain. • Micro-discectomy This surgery is selective for young individuals with significant disc prolapse compressing the nerve. The remaining disc should be normal and without any arthritis of joints of the spine. Micro-discectomy is done by removing the portion of the disc that has prolapsed and pressing against the nerve. Sometimes these patients can have a recurrent disc prolapse from the remaining disc. Managing Back Pain Dr. S Karunagaran, Orthopaedic & Spine Surgeon speaks on back pain management 1.Back pain is common and often results from bad posture. How can we avoid this? 90% of back pain is non-structural (or) postural, associated with poor posture at work or home. The most common mistake is to sit with a bent posture for a long time. Repetitive bending forward and/or lifting heavy objects can also cause back pain. The best way to prevent back pain is to sit up straight in a chair with good back support to match the curvature of the spine. If you are sitting in a chair for more than an hour, you are strongly advised to stand up every 45 minutes to one hour and go for a walk or stretch yourself for 3- 5 minutes before sitting again. Avoid bending forward and lifting weight. If you are carrying heavy shopping bags, always ensure you distribute the weight evenly in both hands. 2. Can abdominal and back exercises help to prevent back pain? 18 MYHEALTH Prevention is always better than cure. Proper posture and regular back and abdominal muscle strengthening exercises will often help prevent back pain to a great extent. Other forms of exercise including aerobics, aqua gym or yoga are also beneficial. It is important to note that sufferers of back pain are advised to take great care when performing strenuous physical activity. One should consult a spine surgeon who will guide you regarding the most appropriate exercises for your particular back problem. It is good practice for everyone to perform back exercises, more so for people who sit at a work-station for a prolonged time, and/or people who use heavy machinery in the workplace. 3. What are the consequences of bad posture in the long run? Bad posture in the long term will almost certainly cause back pain. The current working environment usually means that we often sit and work in one posi- tion for a long time. Using modern day technology notably laptops, tablets and smartphones, whilst sitting in the wrong position or lying down can have long-term health consequences on the spine. Sitting on the sofa with a hunched back, the so-called ‘couch-potato’ position can also cause back pain. At first bad posture causes non-structural back pain or sprain, but in the long run it may lead to disc dehydration, disc prolapse, and arthritis of the joints in the spine. This will eventually lead to severe and persistent back pain with nerve problems. have a severe back problem requiring some kind of intervention in one or more of the following situations: • If the back pain is consistently very severe and persistent, even after use of medications and physiotherapy for a considerable period. • If the pain is severe enough to affect your daily routine. • If there is radiating pain to one or both legs with numbness and/or weakness. • If there is an inability to sit, stand or walk for a reasonable period. • If there is a disturbance in your usual bowel and/or bladder habits. 4. Under what circumstances does back pain require surgery? 5. What are the types of interventions that are practised for disc problems? 90% of back pain will get better with-in 2 – 4 weeks, following prescribed medications, physiotherapy and exercises, and most cases are non-structural. 10% of patients may Types of spine interventions • Epidural injection This procedure can be useful in individuals with early disc problem not affecting the nerves. The • Laminectomy The procedure involves removing the bone coverage and the thickened ligament which presses against the spinal cord and nerves. The disc is not removed; more room is made for the cord and nerves. It is done for elderly patients with a stable spine and a reduced life expectancy. Laminectomy can also be useful in a severely compressed spine needing surgery, where the patient is not anesthetically fit to undergo a long surgery. • PLIF – Posterior lumbar interbody fusion and TLIF – Transforminal Lumbar interbody fusion: These surgical procedures involve both decompression of the spine and also address the stability of the spine by placing pedicle screws connected by rods. The disc is removed completely and the space is filled with a spacer device and bone graft. The procedure will ensure that the spine is not only decompressed but also stabilised. • Other interventions like endoscopic spine surgery, minimally invasive spine surgery and Robot-assisted spine surgery essentially give the same result as more traditional procedures, but the surgeries are done with the latest equipments. 6. Is surgery helpful for disc problem, and what are the post-operative results? Yes, surgery really does work wonders for the quality of life of the patient. If patients are selected carefully, and the appropriate procedure is performed at the right time, as per the condition demands and by a specialized spine surgeon, 99% of cases can stand and walk the next day following surgery, and even go home after 3 days. Successful surgery, carried out at the right time, makes a huge difference to the quality of life of both patients and close family members, and it can even avert paralysis. 7. What are the risks or complications associated with such surgical procedures? There are predictable and unpredictable risks in all types of surgeries. The associated risk of any possible infection can be avoided by following standard sterile precautionary measures and clean operating room practices. Antibiotics also help to prevent infection. The patient’s age and other medical illness related factors can be well controlled following advice of experts. The most feared complication amongst the public is neurological paralysis following surgery, and it is the main deterrent that prevents many patients from having a timely intervention. Sometimes patients end up with paralysis prior to even seeing a specialist since their fear of paralysis is such that they want to avoid surgery altogether. It is extremely important to consult a spine surgeon as early as possible, in order to avoid any such complications. Please be assured that if surgery is done by a well-trained, professional and competent spine surgeon, paralysis can be avoided and almost all of our patients go home walking. 8. How much time is needed before the patient can resume daily activities? Normally the patient can walk as from the first day after surgery. They can go to the toilet unaided and eat independently. It is strongly advised for the patient not to bend forward nor lift weights for 6 weeks to 3 months, depending on the type of surgery they have undergone. Generally, one can resume light work after 6 weeks. They can drive for short distances as from 6 weeks post-surgery. After 3 months they can resume their normal activities, such as working and driving. It is always advisable to continue good back care practices and exercises to prevent disc problems in other parts of the spine in the future. Article by Dr S. Karunagaran Apollo Bramwell Hospital. MYHEALTH 19 MyHEALTH JOURNEY TO BETTER HEALTH ORTHOPAEDICS Mieux identifier les douleurs à l’épaule La pathologie de l’épaule est mieux appréhendée depuis le développement de l’arthroscopie qui permet une approche plus précise des affections couramment liées à cette articulation. En introduisant dans l’articulation un petit tube rigide, l’arthroscope, relié à Une caméra qui va permettre au chirurgien de visualiser la région intra-articulaire sur un écran de contrôle, les affections de l’épaule sont identifiées plus finement. Il s’agit principalement de tendinite, de rupture du tendon, de déboîtement de l’épaule, d’arthrose, de rhumatisme et de fracture. La tendinite du susépineux, - l’un des quatre tendons de la coiffe des rotateurs – est souvent due à au frottement de l’os acromial sur le tendon. Saviez-vous que cette pathologie touchant l’adulte d’âge moyen peut être aussi calcifiante. Il faut entendre par là, qu’un dépôt de calcium, situé le plus souvent au niveau du susépineux, entraîne de très fortes douleurs lorsque cette calcification se rompt. Dans le cas des tendinitis inflammatoires et calcifiantes, la première étape du traitement est médicale. Il repose sur la prescription d’antalgiques, d’anti-inflammatoires, associés à des protecteurs gastriques, ainsi que plusieurs séances de physiothérapie. Si ce traitement aboutit à un échec, les infiltrations constituent alors la solution pour soulager la douleur, mais limitée à trois uniquement car les corticoids presentent de vrais risques pour les tendons. Dans le cas où les traitements médi- 20 MYHEALTH caux s’avèrent infructueux, qui plus est lorsqu’une rupture de la coiffe des rotateurs – un ensemble de tendons qui « coiffe » l’articulation - estavérée, le traitement chirurgical est tout à fait indiqué et peut se faire sous arthroscopie. Les etudes menées dans ce sens indiquent que celle-ci permet une récuperation plus rapide de la fonction et les suites opératoiressont le plus souvent, moinsdouloureuses. L’instabilité de l’épaule, l’autre pathologie fréquemment rencontrée, est un mal qui touche surtout l’adulte jeune lorsqu’il pratique un sport. En cas de luxation répétée - plus de deux, voire trois -, le traitement chirurgical est une alternative à l’échec de la physiothérapie. Ce traitement de stabilization peut se faire sous arthroscopie, lorsqu’il est pratiqué suffisamment tôt, et en l’absence de lesion osseuse. Lorsque les lesions osseuses sont associées aux lesions ligamentaires, alors l’opération de la butée d’épaule de vient indiquée. Pour les autres pathologies fréquentes chez les patients plus âgés, l’arthrose, - appelée omarthrose pour l’épaule après l’échec d’un traitement médicalsur du très long terme, peut conduire à l’impotence fonctionnelle douloureuse avec mobilité réduite et justifiant, chez le patient demandeur, d’une arthroplastie avec pose de prothèse. Bien entendu, les maladies inflammatoires touchant toutes les articulations – la polyarthrite rhumatoïde par exemple – peuvent ells aussi toucher l’épaule et justifier d’un geste chirurgical, qu’il passe par l’arthroscopie ou la pose d’une prothèse lorsque la maladie est très avancée. La souffrance du sportif par surcharge micro-traumatique s’exprimera surtout par une instabilité de l’épaule ou par une lésion du bourrelet - le stabilisateur de l’épaule - pouvant aussi être traité par arthroscopie. Bien entendu toute fracture survenant encas de traumatisme direct ou indirect du member supérieur, - et l’épaule n’échappe pas à cette situation – peut être traitée chirurgicalement lorsque cette fracture est très déplacée. Vous souhaitez être éclairé sur votre type de douleur à l’épaule, contacter le Dr Philippe Soubrane au 6051000. 10 T NUTRITION Ways of keeping your heart healthy! he circulatory system comprises of the heart and blood vessels and failure of these to function correctly affects major parts of the body which can become deprived of nutrients and oxygen. Cardiovascular Diseases are the leading cause of death in the US according to the American Heart Association. In Mauritius, several factors including stress, unhealthy diets, cigarette consumption directly impact on the occurrence of heart disease. Many pre-disposing conditions exist like uncontrolled hypertension, diabetes mellitus and obesity which altogether add to increased risk of cardiovascular diseases. Unfortunately many young adults and adolescents are nowadays diagnosed with hypertension which, if uncontrolled, develop into complications at an early age. Fast food consumption has been on the increase in many developed and developing countries including Mauritius either due to time scarcity or as part of our shopping culture and leisure. The high salt content and accompanied myriad of processed sauces, and processed foods aggravate the condition for hypertensive patients. It is thus advisable to cut down on sodium from hidden sauces besides just table salt. Soya sauce, food enhancers, monosodium glutamate, packet cubes and gravies, canned foods in brine, smoked meats need strict surveillance in the effort to fight high blood pressure and heart diseases. Coronary heart Disease or Coronary Artery disease where the main artery supplying blood to cardiac muscles become blocked is often encountered. Besides high blood pressure and cigarette smoke, elevated blood cholesterol concentrations, mainly LDL-cholesterol (bad cholesterol) is a major risk factor to heart diseases. A Healthy Heart For Life! Dietary intervention against bad cholesterol therefore aims at reducing intakes of saturated fats and trans fats, adds on good quality fats-monounsaturates and polyunsaturates (Omegas 3 and 6) in order to protect the cardiovascular system. It is important to note that the arousal and progression of cardiovascular diseases rest on inflammatory processes at arterial level. Many superfoods on their side possess highly anti-inflammatory properties which can protect our blood vessels. Adding a variety of multi-coloured fruits and vegetables in the daily diet can therefore do the miracle. Vegetables like broccoli, capsicum, cabbages, asparagus as well as berries, cherries, pomegranate and most locally available fruits are packed with these molecules apart from antioxidant vitamins A and C from most veggies and fruits. Adequate intakes of antioxidants and good fats – from olive oil, avocado, seeds and nuts altogether scavenge and synergistically promote healthy blood vessels and the heart. Many studies have demonstrated positive effects of B-complex vitamins also in management and prevention of cardiovascular diseases and their relapse. It is undoubtedly beneficial to add on wholewheat cereals likes- multigrain breakfast cereals, brown breads,/pasta/ flour/oats which apart from the high fibre content, also contain B vitamins at all ages is a priority that has to be inculcated from an early childhood. The key tips for a healthy heart are : 1. Avoid too much salt/sodium from processed, fast foods, commercial sauces 2. Limit the intakes of palm oil or trans fats from biscuits and cakes 3. Choose lean meats- with fish and chicken as priority 4. Choose low fat milk and dairy products. 5. Boost your HDL-good cholesterol with oily fish (salmon, mackerel, herring), olive oil, nuts and seeds and avocado to protect your heart! 6. Minimise the amounts of butter/ margarine use 7. Avoid deep frying of foods- grill, bake, steam most of them! 8. Snack on fruits, nuts and seedssunflower, pumpkin, chia, safflower, flax seeds. 9. Make vegetables of different colours the major part of your plate at each meal! 10. Do not forget to exercise! Dietary control is a strong modifiable factor that can fight against the occurrence of overweight, diabetes and cardiovascular disease and to reduce associated morbidity rate. Our sedentary lifestyle coupled with a lack of time for healthy food preparation directly influence our health and immune system. Therefore the need for a balanced meal. Article by dietician Amiirah Hosenbux Apollo Bramwell Hospital. MYHEALTH 21 MyHEALTH JOURNEY TO BETTER HEALTH NUTRITION THIS MONTH’S RECEIPE From our dietician LES RECETTES DU MOIS De notre diététicienne Banana shake Ingredients (4 servings) • 2 bananas • ½ litre of fresh orange juice • 2 tablespoon of honey • 250 ml of water Preparation: 1. Peel and chop the bananas. 2. Place all the ingredients in a blender and blend until a creamy mixture is obtained. 3. Serve the shake in goblets with crushed ice and drink immediately. Suggestions from the dietician: Water may be substituted with soy, almond or non-fat milk to obtain a creamy and nutritious drink with a touch of distinction. Nutritional Value (per serving): Energy = 143kcal Protein = 1.45g Carbohydrates = 34.1g Total fat = 0.5g Saturated fat = 0.1g Cholesterol = (nil) Sodium = 2.28g LE BANANA SHAKE Ingrédients (4 portions) DID YOU KNOW? Bananas are rich in potassium and poor in sodium. They are known for their vitamin B content, as well as magnesium and fibre. They also contain small amount of serotonin, a vasodilating substance, i.e., which improves blood circulation in the arteries. This banana and orange shake is thus very helpful to keep a healthy heart! • 2 bananes • Un demi-litre de jus d’orange frais • 2 cuillères à soupe de miel • 250 ml d’eau Préparation: 1. Peler et hacher les bananes 2. Placer tous les ingrédients dans un mélangeur et l’activer jusqu’à obtenir un mélange crémeux. 3. Servir le shake dans des gobelets avec de la glace pilée et consommer immédiatement. Suggestion de la diététicienne: LE SAVIEZ VOUS? Les bananes sont riches en potassium et pauvres en sodium. Elles sont réputées pour leur teneur en vitamine B, ainsi qu’en magnésium et en fibres. Elles contiennent aussi des petites quantités de sérotonine, une substance vasodilatatrice, c’est à dire, qui améliore la circulation du sang dans les artères. Ce shake à la banane et à l’orange est donc très utile pour un coeur en bonne santé! 22 MYHEALTH L’eau peut être remplacée par du lait de soja, du lait d’amande ou du lait écrémé, afin d’obtenir une boisson nutritive crémeuse et avec une touche distinctive. Valeur nutritive (par portion) Energie = 143kcal Protéines = 1,45 g Glucides = 34,1g Graisses (total) = 0,5 g Graisses saturées = 0,1 g Cholestérol = (zéro) Sodium = 2,28 g MYHEALTH 23 MyHEALTH JOURNEY TO BETTER HEALTH 24 MYHEALTH