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 volunteers@juronghealth.com.sg
“ 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
onehealth@juronghealth.com.sg
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
Have you
us?
www.facebook.com/JurongHealthServices