JAN FEB
2014 a Bimonthly Publication of Singapore General Hospital and SingHealth ACADEMIC HEALTHCARE CLUSTER MCI (P) 069/06/2013 www.sgh.com.sg | www.singhealth.com.sg
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AWARD OF EXCELLENCE
SGH’s new clinics sport a fresh new look and elder-friendly features
APEX Awards 2013
07
The spine “pacemaker” may be the last resort for patients with chronic pain
P3
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Local researchers develop a new antibiotic from a compound in mangosteens
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随身携带 泵和输注器 可为糖尿病患者 提供更多便利 P27
Prolonged use of handheld devices can lead to repetitive stress injuries
Photo: ALVINN LIM
Portable insulin pump offers diabetics greater convenience
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最新人工晶状植体，去除白内障也“矫 正”其他眼疾，一举多得
02
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Preciosa Reynoso Ramos For editorial enquiries, please e-mail editor@sgh.com.sg For advertising enquiries, please call 6319-3022 or e-mail jrani@sph.com.sg All rights reser ved. Copyright by SGH (registration no: 198703907Z). Opinions expressed in Singapore Health are solely those of the writers and are not necessarily endorsed by SGH, SingHealth Group and/or SPH Magazines Pte Ltd (registration no: 196900476M) and their related companies. They are not responsible or liable in any way for the contents of any of the advertisements, articles, photographs or illustrations contained in this publication. Editorial enquiries should be directed to the Editor, Singapore Health, 7 Hospital Drive, #02- 09 Block B, Singapore 169611. Tel:+65 6222 3322, Email: editor@sgh.com.sg. Unsolicited material will not be returned unless accompanied by a self-addressed envelope and sufficient return postage. While every reasonable care will be taken by the Editor, no responsibility is assumed for the return of unsolicited material. ALL INFORMATION CORRECT AT TIME OF PRINTING. MCI (P) 069/06/2013. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).
singapore health
JAN – FEB 2014
NEWS
03
“Portable pancreas” for better diabetes control A palm-sized pump which administers insulin to diabetics via an infusion set can help reduce episodes of low blood glucose level By Desmond Ng
M
r Wong Leng Hoe, a diabetes patient and user, dubbed it the “portable pancreas”. Worn discreetly on the body, the palm-sized, pager-like insulin pump delivers the hormone round the clock. It mimics closely the normal discharge of insulin by the pancreas to regulate the body’s glucose or sugar level. Insulin is needed to convert carbohydrates into energy, and without it, sugar builds up in the blood, which can lead to serious health problems. Mr Wong, who switched from injections to using the insulin pump in July 2013, carries the device with him 24/7. “I used to forget to inject the insulin – or not do it altogether – when it was inconvenient to do so, like when I was having lunch with clients. “With the pump, I don’t have to excuse myself to go to a quiet place to prepare the insulin and inject myself. I merely press a button to deliver the (higher) dose of insulin needed before a meal. And I don’t have embarrassing blue-black marks on my body because of the injections,” he said.
Fast- or rapid-acting insulin is delivered via an infusion set which includes a short, soft tube, called a cannula, that sits comfortably under the skin of the abdomen. Dr Bee Yong Mong, Consultant, Department of Endocrinology, and Director, Diabetes Centre, Singapore General Hospital , on how the pump administers insulin into patients
Diabetics need to adjust the amount of insulin they use before meals or sports, as their blood sugar levels can go up (after a meal) or down (when exercising). Mr Wong, who is in his 50s, was diagnosed with Type 2 diabetes more than 15 years ago. This form of the disease, also known as adult-onset diabetes, is associated with obesity and an unhealthy lifestyle, unlike Type 1 diabetes where the
Worn discreetly on the body, the pager-like insulin pump delivers the hormone round the clock and mimics closely the normal discharge of insulin by the pancreas to regulate the body’s glucose level.
PhotoS: Alvinn Lim
According to Dr Bee Yong Mong (in blue), patient Wong Leng Hoe’s diabetes was better controlled after a month on the pump.
pancreas isn’t able to produce insulin. Type 1 diabetes is an autoimmune disease and is often diagnosed in childhood. Type 1 diabetics require insulin treatment from the onset of the disease, while treatment for Type 2 involves medication, or insulin injections when the disease progresses and medication is not enough to control the disease. Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin to control the amount of sugar in the blood. According to Dr Bee Yong Mong, Consultant, Department of Endocrinology, Singapore General Hospital (SGH), insulin pump therapy is a good option for people who have poor control over their diabetes. Mr Wong, for instance, struggled to control his diabetes even after starting insulin therapy more than 10 years ago. “Over the years, we’ve had to increase his insulin dosage significantly,” said Dr Bee, who is also Director, Diabetes Centre, SGH. With the pump, “fast- or rapid-acting insulin is delivered via an infusion set which includes a short, soft tube, called a
One-week training before patients start on insulin pump treatment Patient s who opt for the insulin pump treatment are trained for a week by a team comprising a doctor, a dietitian, a diabetes nurse and a representative from the insulin pump supplier. “We will work with the patient to get him acquainted with the equipment, his diet and to improve his knowledge of the insulin pump. The doctor will then decide on the amount of insulin that he should use,” said Dr Bee Yong Mong, Consultant, Department of Endocrinology, and Director, Diabetes Centre, Singapore General Hospital.
cannula, that sits comfortably under the skin of the abdomen,” said Dr Bee. The device pumps out insulin in a steady, measured and continuous dose 24 hours a day (this is known as the basal rate), and is also capable of discharging a surge of the hormone when needed (this is known as the bolus dose). Before a meal, a patient decides how much more insulin he needs based on his blood sugar reading, and presses a button on the pump to push extra insulin units into his body. The extra insulin is needed to account for the carbohydrates consumed, and to bring the patient’s glucose levels back to a specified target range. After a month on the pump, Mr Wong’s diabetes was better controlled. He no longer saw large swings in his blood glucose levels, and he could be more flexible about what and when to eat. Studies elsewhere have shown that patients on insulin pump treatment can achieve better diabetes control and reduce the incidence of hypoglycaemia, a condition where the blood sugar levels are abnormally low, Dr Bee said. When hypoglycaemia occurs, diabetics can lose consciousness if they don’t eat something sweet quickly to raise their glucose levels. Insulin pumps have been in use in Singapore for more than 20 years, but few patients opt for it, mostly because of the cost. The pump is expensive and is not covered by local medical insurance, unlike in the US for instance. Prices range from $2,500 to $9,000 for a pump, and consumables like the > Continued on page 4 ( 华文版本请翻阅至27页 )
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JAN– FEB 2014
> Continued from page 3
infusion sets will set the patient back by another $150 to $200 a month. The infusion set, which includes the cannula, needs to be changed every three days. “In the US, 50 per cent of Type 1 patients are on pump treatment, as they can claim the costs from their insurance. In Singapore, the adoption rate is low,� Dr Bee said, noting that only about six patients at SGH – mostly Type 1 diabetics – use the pump. Mr Wong paid about $2,700 for his – a mid-range model – but he is just glad that he now needs less insulin than when he was on injections. Diabetes affects about 10 per cent of Singapore’s population, with the Type 2 form of the disease accounting for 90 to 95 per cent of sufferers.
Turn t to fin o page 11 d more out a new about phon mobile e for d app iabet ics
Photo: Alvinn Lim
“Portable pancreas� for better diabetes control
New location, more facilities The refurbished Diabetes Centre in Singapore General Hospital (SGH), which relocated to its new location at SGH Block 1 Basement 1 in June 2013, has more consultation rooms. It also has a facility for staff to create fundus photographs that show clear pictures of the retina and other parts of the inside of the eye. Diabetes patients can lose their sight if diabetic retinopathy, a compli-
cation of the disease, is not detected. The disease has few symptoms until it is at an advanced stage. By then, the patient may have limited or no vision. At the centre, patients can now have their retinas tested and their results ready before they see their doctors. Said Dr Bee Yong Mong, Consultant, Department of Endocrinology, and
Director, Diabetes Centre, SGH: “The patient comes to us, we take a picture of his retina and the image is sent to SAILOR (Singapore Advanced Imaging Laboratory for Ocular Research). The report comes back to us quite quickly and we can see the patient on the same day. This frees up the doctors’ time and improves the care of patients too.� In the past, doctors like Dr Bee had to interpret the results, which took time. But now the images are transmitted instantly to SAILOR – part of the Singapore Eye Research Institute (SERI) – for interpretation by accredited technicians (pictured left). Since July 2013, the technicians have examined the retina images of 163 SGH patients, of which 47 were referred to the Singapore National Eye Centre (SNEC), said Ms Haslina Hamzah, Programme Manager, SAILOR (pictured standing). Of the patients referred to SNEC, 25 were found to be suffering from diabetic retinopathy. She said that about 30 per cent of diabetes patients in Singapore have diabetic retinopathy, with 10 per cent having a severe form of the disease.
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05
Better nutrition speeds up recovery A new study suggests that malnourishment in elderly patients is linked to longer hospital stays and poorer ability to regain functional independence By Teh Joo Lin
By The Numbers
Photo: WONG WEILIANG
F
or older people recovering from a debilitating illness, getting back on their feet can take longer if they are malnourished. A new research study by Singapore General Hospital’s (SGH) Department of Dietetics suggests that malnourishment in elderly patients is linked to longer hospital stays and a poorer ability to regain functional independence. Functional independence is a measure of physical and cognitive disability, and uses 18 items of ability such as walking, feeding and dressing. The research is significant because more than half of the 109 SGH rehabilitation patients under study were found to be malnourished to some extent. The men and women in the study had an average age of 69 years, and were admitted to the SGH rehabilitation ward at Bright Vision Hospital (BVH) for continuing care after being treated at SGH in Outram Road for conditions such as stroke, hip fracture, or brain or spinal injuries. Many were elderly; the oldest patient in the study was 94, although the youngest was 20. These patients who were under acute care for a serious illness at SGH might not have eaten as well as they should because of their condition. So by the time their condition had stabilised and they were ready to be transferred to a rehabilitation ward for longer term convalescence, they might have become undernourished. Dietitian Yang Jie, the lead investigator of the study, known as the Nutritional Status of Hospitalised Rehab Patients, said the findings supported the observations that she and her colleagues had made about these patients. Others behind the study include Dr Loh Yet Hua, Head, Department of Dietetics; Mr Tan Lee Boo, Senior Principal Dietitian; and Dr Ng Yee Sien, Senior Consultant and Head, Department of Rehabilitation Medicine. “In general, a patient who comes in with normal nutrition does better. They are usually not as sick as those who
are severely malnourished and tend to recover and improve faster,” Ms Yang said. Ms Yang presented the team’s findings from the study at the 7th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM) in Beijing in 2013. To determine if the patients were malnourished, and if they were, whether they were mildly or moderately malnourished, the researchers used a standard tool to gauge their nutritional status. Known as the Subjective Global Assessment, the tool looked at factors such as the patients’ weight, oral intake, gastrointestinal symptoms, physical signs of malnutrition, and whether they had lost significant amounts of weight recently. Only about 44 per cent of the patients were found to be well-nourished. This finding was supported by the results of
The study assessed the nutrition levels of
About
recovering patients when they started rehabilitation last year
of the patients were found to be malnourished, 11% of them severely so
109 56%
Dietitian Yang Jie (standing) is the lead investigator of the Nutritional Status of Hospitalised Rehab Patients study by Singapore General Hospital. As people age, their sense of taste and smell can become impaired. If they feel that food is not tasty, they may not eat well.
The patients, who were transferred from Singapore General Hospital, where they were first warded after suffering from debilitating conditions, had a mean age of
a second, similar tool known as the Mini Nutritional Assessment. This tool was only used on patients who were at least 65 years of age. Of the 71 patients in this age group, 68 per cent were malnourished or at risk of malnourishment. Each patient’s functional independence measure was rated weekly by the rehab team. The researchers found statistically significant differences between the score improvements of the well nourished and severely malnourished patients. This means that severely malnourished patients fared worse in performing daily tasks ranging from eating to walking. In fact, the severely malnourished patients remained in hospital for an average of 51 days, while the well nourished ones went home on average about 20 days earlier. Ms Yang said that there are many possible reasons for the patients’ malnourished state, which does not happen “overnight”. For example, suffering a stroke can mean that a patient has difficulty eating. As more than half the patients were already malnourished when they started rehab, one recommendation is to screen them earlier so that their nutrition levels can be improved at an earlier stage. “We would like to be able to see the patients once they show that they are not eating well and have lost their appetite. We can assess if what they are eating is nutritionally enough, and then recommend a suitable diet and/or nutritional supplements to help them recover faster,” she said. Family members can also do their part by watching the eating habits of the elderly, who may not have a balanced diet or eat enough of the food placed before them. Ms Yang said: “As people age, their sense of taste and smell can become impaired. If they feel the food is not tasty, they may not eat as well. Loss of vision and hearing can affect their ability to prepare and buy food. Dentures can make it hard for a wearer to chew food. “Family members need to be able to recognise signs that the patient is not eating well, losing muscle, or losing weight. And they should take action to help them to maintain their weight. Otherwise, if disease attacks, they will be sicker.”
Severely malnourished patients stayed about
20 68 % 68.8 Among the 71 patients aged 65 and above,
were malnourished or at risk of malnourishment
days more than the well nourished patients, who stayed an average of 31 days in hospital
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singapore health
JAN– FEB 2014
The Centre for Digestive and Liver Diseases is colour- and design-coded to make it easier for patients to find their way around.
PhotoS: ZAPHS ZHANG
Signs such as to the washrooms now use larger fonts and images for greater clarity.
Designed with the elderly in mind Colour, design and elder-friendly equipment figure prominently in refurbished clinics
T
he spanking new clinics at Singapore General Hospital (SGH) do not just look good. They were designed with the elderly in mind. The Centre for Digestive and Liver Diseases – a giant clinic that resulted from the merging of three regular-sized clinics – is colour- and design-coded to make it easier for patients to find their way around. “When giving directions to the patients, our nurses in the clinic tell them to walk to the blue corridor, for instance, look for the door number, and wait to be called,” said Mr Zhuo Weichao, Operations Executive, Specialist Outpatients Clinics, SGH. The clinics now also use softer yellow light, while corridors and consultation rooms (pictured above) use brighter white light for clarity. The same age-friendly considerations can be found at the refurbished
Height-adjustable examination couches Examination couches in the consultation rooms are height-adjustable to aid the elderly. SGH staff can adjust the height of a couch by using its pedal. Available only at the refurbished centres for now, such couches will eventually be standard issue in all SGH clinics.
L (neurosurgery, psychiatry and rehabilitation) and M (kidney and geriatric conditions) clinics. “We use both conventional and elder-friendly weighing machines. The ones for the elderly have a chair for patients who are wheelchair-bound, are weak or can’t stand,” said Ms Janet Fung, Nurse Clinician in charge of the clinics. Height-adjustable examination couches in the consultation rooms, as well as TV screens, are other elder-friendly equipment at these clinics. “Patient education is priority at our clinics,” said Ms Fung. For instance, renal patients often need to collect urine for 24 hours before their appointments. But old people can be forgetful, so a video recording of the steps they have been told to follow is played over and over again on the TV screen at the renal clinic.
Seats marked for seniors, and space for wheelchairs
The waiting rooms at the new clinics have seats in the front rows clearly marked for the elderly, as well as space for wheelchairs.
easy to locate
To help elderly patients locate the right rooms at the clinics, the door numbers are colour- and designcoded for easy reference.
TV monitor plays steps in a loop Renal patients often need to collect urine for an entire day for their regular tests. A TV monitor outside the registration room plays the steps needed in a loop, to reinforce what was told to patients – especially the elderly who can be forgetful – by the nurses.
weighing machines for the elderly In addition to regular weighing machines, special machines with chairs are used for patients who are old and frail, wheelchairbound, or are not able to stand.
JAN – FEB 2014
singapore health
NEWS
07
Spinal “pacemaker” is the last resort for chronic pain The battery-operated pulse generator tricks the brain into perceiving a more pleasant sensation
Pacemaker to the rescue Two years ago, she decided to have the spinal cord stimulator implanted. She did not see much change immediately after the operation, but a few months later, she realised that the pain which had plagued her for years was no longer bothering her. Now Mdm Chu does not even think about it, as she no longer feels the pain. “I still stay at home watching TV most of the time, but now I can go out without having to worry about the pain.” Most days, she can be found travelling to places in her neighbourhood in her motorised wheelchair, and occasionally, on weekends, enjoying the outdoors at East Coast Park. Now, she even dreams about eventually returning to work. Associate Professor Ng Wai Hoe, Senior Consultant and Head, Department of Neurosurgery, National Neuroscience Institute (NNI) said that Mdm Chu had one of the most severe levels of pain among his patients, but she has had the best results. “Her condition has improved by about 90 per cent,” said Prof Ng. “She used to spend six months a year in hospital. I’m delighted that she is able to enjoy life now. It was a pleasant surprise to discover that her healthy tan now is the result of many hours spent at the beach at East Coast Park.” How it tricks the brain Mdm Chu is among six patients who have undergone NNI’s Surgical Neuromodulation Pain Programme, which is an exten-
sion of the pain relief services provided at the Singapore General Hospital and Tan Tock Seng Hospital. The programme offers three types of surgeries: spinal cord stimulation, motor cortex stimulation and deep brain stimulation. All six had their pain reduced greatly after spinal cord stimulation. The procedure involves placing a stimulating electrode in the spine and connecting it to a battery-operated pulse generator, which acts like a pacemaker, implanted in the lower abdominal or loin region. The pacemaker creates electrical signals which are delivered by a lead (thin wire) to nerves in the spine, stimulating it for the brain to alleviate the experience of chronic pain.
Sometimes they don’t want to try this, even though we believe it may help them a lot. It’s rather sad because it can give them a one-intwo chance of pain relief which is a fairly good chance of being pain-free.
The pacemaker is a batteryoperated pulse generator implanted in the lower abdominal or loin region of the patient.
Prof Ng Wai Hoe (left) using an anatomical model of the spine to explain the procedure; and Mdm Chu Sai Leong, who had the worst pain among his patients, but has experienced the most pain relief.
PhotoS: ALVINN LIM & Zaphs zhang
M
adam Chu Sai Leong, 51, had lived with chronic pain in her legs and back for more than eight years. So, she was naturally sceptical when her doctor told her about a procedure to implant a spinal cord stimulator – which acts like a pacemaker in the spine – to reduce the pain. She had already had three operations to treat her spinal cord injury, but they had done nothing to relieve the pain. The first operation had also left her paralysed and wheelchair-bound with stabbing pains in her legs and back all day long, every day. The pain was so severe that she had difficulty sleeping. When it got so bad that she could not even get out of bed – which was every two or three weeks – she had to be hospitalised. Sleeping pills and pain relief medication did nothing for her. Mdm Chu was also unable to work as the pain kept her a virtual prisoner at home.
illustration: COURTESY OF ST. JUDe medicaL (S) PTE LTD
By Lediati Tan and Satish Cheney
Associate Professor Ng Wai Hoe, Senior Consultant and Head, Department of Neurosurgery, National Neuroscience Institute on why patients who have haD many surgeries without positive results should give the spinal cord stimulation procedure a try
“In a way, the electrical signals trick the normal nervous circuitry (that perceives nerve damage as pain) and the brain into perceiving a more pleasant sensation. It converts a pain sensation into something that is more acceptable,” explained Prof Ng. While it is not a cure for chronic pain, the procedure provides pain relief and helps patients lead a normal lifestyle and not be crippled by it. Research shows that approximately half of all patients will get about 50 per cent pain relief. Before the operation, patient s undergo trial stimulation for three to five days either as inpatients or outpatients. “For the trial, the electrode is placed on the surface of the spinal cord and the
wire is connected to an external pacemaker. Over the next few days, the medical team will set different parameters and change the amount and frequency of the current that is running to determine the optimal setting,” said Prof Ng. Who is it meant for? Those who will benefit most from spinal cord stimulation are those who have had many back surgeries and are still in a lot of pain, as well as those who have exhausted all the usual modes of pain management and treatment. The procedure, while not new, uses the latest technology. It can also be used to treat arm pain due to nerve damage, although it does not work well for pain at the central neck area. “But researchers
are now developing new electrodes that may help in this respect in the future,” said Prof Ng. “The pain we can alleviate the most using this procedure is actually leg pain rather than back pain. Back pain is caused by many factors but leg pain is usually caused by nerve damage (at the back) and this kind of pain is very responsive to the procedure,” said Prof Ng. He said some patients who have had many surgeries without positive results can become sceptical about the spinal cord stimulation procedure. “Sometimes they don’t want to try this, even though we believe it may help them a lot. It’s rather sad because it can give them a one-in-two chance of pain relief which is a fairly good chance of being pain-free.”
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singapore health
Jan – Feb 2014
Don’t ignore a minor stroke If left untreated, a Transient Ischaemic Attack can lead to a full-blown stroke which causes lasting brain damage
A
t only 37, store supervisor Mr Ang Tiong Boon did not fit the typical profile of someone who would have a mini stroke or Transient Ischaemic Attack (TIA). But he did have one. In May 2013, Mr Ang had a terrifying TIA attack, which lasted several hours. On his tea break, a colleague noticed that the right corner of his mouth was tilted up. At first, Mr Ang did not know that anything was wrong, but soon after, he felt dizzy, and numb on the right side of his face and right arm. His first thought was that he was having a stroke, as the symptoms were similar to those his mother had when she had one. Within two hours, he was in hospital and put on a battery of tests including an MRI. Doctors also diagnosed him with
high blood pressure and diabetes, which he was unaware he had. The TIA symptoms disappeared after four hours and he was relieved it was not a full-blown stroke. But it was a sobering wake-up call to take his health seriously. “I was scared and shocked. I am still young and the main breadwinner of my family,” said Mr Ang, who is married with a five-year-old son. In fact, Mr Ang was unaware his health had plummeted. He was working late, carrying heavy things, sleeping about six hours a night, eating whatever he wanted, drinking about eight cans of soft drinks a day and still smoking. “I realised that things had to change. On my doctor’s advice, I have stopped taking sugary drinks, quit smoking and
Photo: inmagine.com
By Lediati Tan
Figures showed that in about five per cent of Transient Ischaemic Attacks (TIAs) patients developed a stroke within 48 hours, and one in four patients had a stroke, heart attack, recurrent TIA, or died within 90 days of the TIA. (Stock Photo)
am watching my diet. I also try not to work so late every day and get more sleep.” In addition, he takes medicine to control his high cholesterol, diabetes and high blood pressure. No permanent damage to the brain Dr Rajinder Singh, Consultant Neurologist, National Neuroscience Institute, said that a TIA is a temporary severe reduction in blood supply to certain parts of the brain or the central nervous system. This can result in stroke symptoms but without permanent damage to the brain. The reduction in blood supply can be caused by a narrowing of a blood vessel in the brain due to the build-up of fatty deposits called plaque. It can also be due to a blood clot in a blood vessel in the brain or a blood clot in another part of the body, such as the heart, which travels to the brain and blocks the blood supply to the brain. The effects of a TIA are temporary, unlike a stroke, which can result in permanent damage to the brain. Most patients recover from a TIA within 10 minutes to a few hours. Stroke risk after a TIA Dr Singh said that although Mr Ang was relatively young, he had risk factors such as poorly controlled hypertension and diabetes mellitus which increased his risk of TIA. A minor stroke must be taken seriously as it is usually a harbinger of worse things to come. It serves as a warning sign of an impending stroke, so it should not be ignored. Dr Singh highlighted a US study published in 2000, which looked at the short-term risk of stroke and cardiovascular events among 1,707 TIA patients seen at the emergency department. Figures showed that about 5 per cent of them developed a stroke within 48 hours, and one in four had a stroke,
Symptoms of a Transient Ischaemic Attack (TIA)
They are the same as that of a stroke (except for being transient) and can include one or more of the following: Temporary numbness or weakness on one side of the body or face Difficulty talking or understanding what others are saying Temporary loss of vision in one eye Severe dizziness or loss of balance Difficulty swallowing Anyone with any of these symptoms should get to a hospital as soon as possible as it could mean a TIA or a full stroke.
Who is at risk of having a TIA?
The elderly Those with conditions such as diabetes, high blood pressure, high cholesterol, atrial fibrillation (irregular heartbeat) and heart disease which are poorly controlled Smokers Males are at higher risk than females
heart attack, recurrent TIA, or died within 90 days of the TIA. A TIA is a wake-up call and Dr Singh noted three ways patients can reduce their risk of getting another TIA or a full-blown stroke. First, they should control risk factors such as high blood pressure, diabetes, high cholesterol, as well as stop smoking. They should also make lifestyle changes, exercise and take their medication. Second, they should take blood thinning medication if there are no complications. Third, in some cases, surgery is recommended for those with moderate to severe blockage of the carotid artery, which delivers blood to the brain. The longer a patient stays without another TIA or a stroke and with proper control of their risk factors, the lower their risk of having another TIA or stroke. The risk of stroke is highest in the first few days after a TIA.
Jan – Feb 2014
singapore health
NEWS
09
Mangosteens battle bacteria Local researchers have developed a powerful new antibiotic from a compound they discovered in mangosteens By AJ Leow
F
This molecule was modified into an antibiotic to combat MRSA (methicillin-resistant staphylococcus aureus) which the team found works better than any antibiotic currently available. MRSA is a potentially lethal hospital-acquired bacterial infection with ever-growing antibiotic resistance. The 20-strong team includes scientists, biologists, chemists and ophthalmologists from SERI, the Singapore National Eye Centre, the National University of Singapore (NUS) Department of Chemistry, the Biological Sciences Department at Nanyang Technological
Photo: vernon wong
ruits are part of a healthy diet but now local researchers have found that one of them – the mangosteen – is the basis of a new antibiotic, and a very superior one at that. A multi-disciplinary team, spearheaded by the Singapore Eye Research Institute (SERI), developed this new compound while looking for new treatments for eye infections. They successfully isolated a natural compound called alpha-mangostin from mangosteens, and modified its structure to create a molecule with powerful antimicrobial activity.
University (NTU), the Bioinformatics Institute, and the South China Uni ve r s it y of Technology. The team was led by Professor Roger Beuerman, Senior Scientific Director, SERI, Professor at Duke-NUS Graduate Medical School, and an Adjunct Professor at the Departments of Ophthalmology and Biochemistry, NUS and the Bioinformatics Institute in Singapore. Prof Beuerman – originally from the US and now a long-term resident in Singapore, is a world expert on antibiotic resistance and the author of three books on ophthalmology. He said that in tests, the molecule proved more potent against MRSA than any antibiotic currently available. “It kills MRSA much faster than other antibiotics and is also easily absorbed into the body. Existing antibiotics take eight to 20 hours to completely kill microbes, but the most potent compound the team concocted could produce the same results within an hour or less.” It kills MRSA bacteria by breaking down their membranes. “Traditional antibiotics only ‘slip’ through the membrane, and often less successfully. We also use smaller doses to kill the bacteria Prof Beuerman (standing) in the laboratory with Research Officer Nandhakumar Muruganantham. The next step for the team is to develop an antibiotic against MRSA (methicillinresistant staphylococcus aureus) which will not only save lives but reduce hospital costs.
without them developing resistance.” Prof Beuerman said that it is a significant breakthrough for the medical community because there are very few new antibiotics entering the market, as pharmaceutical companies are not keen on researching this area of medicine. “It is costly to develop a new drug, and the hesitancy is greater if the targets – unlike cancer cells for example – have a predisposition to mutate, causing the drug to lose its effectiveness over time,” he said. The next step Since the announcement of the finding, the team has discovered that the new molecule can also potentially treat endocarditis (inflammation inside the heart), and work on this is in progress. The next step for the team is to develop an antibiotic against MRSA that will not only save lives but also reduce hospital costs. However, the earliest any new antibiotic can reach the market is in four or five years’ time, as three phases of clinical trials have to be conducted first to ensure that the drug is safe. The team’s research was funded by several grants, including those from the Biomedical Research Council, the SingHealth Foundation, Exploit, and the National Research Foundation – known as Translational Clinical Research (TRIOS) – with collaborative efforts from the NUS Department of Chemistry, NTU’s Biological Sciences Department, and the Bioinformatics Institute.
the rise of the superbug When you get the flu, an antibiotic will not help, because the flu is caused by a virus, while antibiotics only fight bacteria. If the doctor takes a swab, he can tell if it is a viral or bacterial infection. Yellow or green phlegm and nasal discharge generally mean that the flu is caused by bacteria. Professor Roger Beuerman, Senior Scientific Director, SERI, Professor at Duke-NUS Graduate Medical School, and an Adjunct Professor at the Departments of Ophthalmology and Biochemistry, NUS and the Bioinformatics Institute in Singapore, said the over-prescription of antibiotics in healthcare, food preservation and animal feedstock has caused the rise of today’s “superbugs” which are highly resistant to antibiotics. This is how superbugs emerge: For every 100 people, an antibiotic might work for 99 but develop resistance
in one person. This mutated bacteria can be passed around to others. “Today, we fly around the world and move in crowds, so bacteria spreads easily. Fifty years ago, no one was that worried about MRSA (methicillin-resistant staphylococcus aureus), as the incidence was small. But in the last 15 years, it’s become a huge problem worldwide because of resistance to the antibiotics commonly used. “When bacteria become resistant, they mutate into different organisms and tend to hang around. This explains why many antibiotics developed in the last 30 years are no longer as effective. We are at the stage now when antibiotics do not work very well and people are dying needlessly because of antibiotic resistance,” said Prof Beuerman. One of these increasingly antibiotic-resistant bacte-
ria, MRSA, has the potential to be lethal – especially in hospital settings – to patients with weakened immune systems. It is also responsible for the growing problem of antibiotic resistance that threatens to increase deaths in hospitals and hike up healthcare costs. As MRSA is a more resistant strain of bacteria, doctors now have to try different types of antibiotics to treat MRSA infections, often making treatment more costly and hospital stays longer. A recent report from the Center for Disease Control in the US revealed that about 23,000 patients out of every two million affected with antibiotic resistant bacteria in 2011 had reportedly succumbed to infections brought on by MRSA and other resistant bacteria. This is why hand washing is strongly encouraged, not only among hospital staff, but also visitors in hospitals.
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NEWS
singapore health
Jan – Feb 2014
Hospitals fit for the future Work is progressing steadily on SingHealth’s two new hospitals in the northeast By Ng Hui Hui
Photo: Courtesy of Sengkang Health
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he groundbreaking ceremony of the Sengkang General and Community Hospitals, which took place on Oct 27, 2013, marked an important early milestone in their construction. Work on the two hospitals – Singapore’s largest regional hospitals in the northeast – is progressing steadily, and is expected to be completed by 2018. Mr Gan Kim Yong, Minister for Health, who officiated at the ceremony, said the challenge for the Sengkang Health team is to build a hospital fit for the future. “As such, the team has incorporated innovative designs to maximise space, and adopted concepts that allow some of the facilities to be adapted quickly to meet changing demands, while ensuring that the hospitals are able to keep functioning during this period.” The hospitals will offer residents in the northeast – including the young growing population in Sengkang and
Artist’s impression of the new Sengkang General and Community Hospitals which are expected to be completed by 2018.
older communities in Hougang and Ang Mo Kio – myriad healthcare amenities and services. Located in Sengkang new town in close proximity to public transport systems, there will be 1,000 beds in the general hos-
pital and 400 in the community hospital. Their shared resources will enable patients to enjoy seamless transition in care from the general hospital to the community one. Professor Ivy Ng, Group Chief Executive Officer, SingHealth, said patients will
also have access to comprehensive care from SingHealth’s network of physicians. Professor Christopher Cheng, ProTem Chief Executive Officer, Sengkang Health, said Sengkang Health will work with schools and healthcare organisations to increase awareness of preventive care in the community and build an ecosystem for healthy living. These organisations include the Health Promotion Board, the Singapore Sports Council and the Tobacco Free Generation 2000 Movement. Sengkang Health’s Millennia Kids programme, aimed at encouraging and empowering youth in the northeast to be ambassadors for healthy living, has already garnered support from Compassvale Primary School and Seng Kang Primary School. To bring the community together, there will be an open hub called the Community Heart, with cafes, shops and open spaces for activities. There will also be an auditorium for public forums and health talks, and a rooftop garden, within the development. “We wish to serve the community to help them stay healthy, and hopefully they never need to come to the hospital. If they do, I hope it is only to use our community hub facilities to learn more about wellness, preventive care, and to participate in health screenings,” said Prof Cheng.
Jan – Feb 2014
singapore health
App prompts dosage needed
Photo: alvinn lim
SGH and Duke-NUS Graduate Medical School want to find out how effective a new mobile app is in helping diabetes patients decide how much insulin to inject
By Desmond Ng
D
iabetes patients on insulin therapy need to check their blood sugar readings each morning to gauge how much insulin to inject themselves with. Without the right amount of insulin, their blood glucose levels can fall too low or rise too high, and this can bring on medical complications. But many diabetics, especially those who are new to insulin injections, often do not have the confidence to figure out the dosage. They would rather wait for their next clinic visit, which can be weeks or even months away, to let their doctor decide instead. To take the guesswork out of insulin adjustments, doctors from Singapore General Hospital’s (SGH) Department of Endocrinology have begun offering diabetic patients a smart phone app as part of a joint SGH-Duke-NUS Graduate Medical School (Duke-NUS) trial. The app, known as the SGH Diabetes Pal, measures a diabetic’s blood sugar level, and uses the reading to determine the amount of insulin needed. “This study can potentially change current practices and improve the clinical understanding of diabetes management given the pervasiveness and simplicity of mobile apps,” said Dr Bee Yong Mong, Consultant, Department of Endocrinology, and Director, Diabetes Centre, SGH. He is also the site-Principal Investigator of the study. Professor David Matchar, Director for Health Services and Systems Research, Duke-NUS, noted that “research gaps in diabetes management remain, particularly in the Asian setting”. The need to improve diabetes management deserves greater attention in Singapore where incidence is among the highest in developed countries, and diabetes prevalence is consistently high across ethnic groups, he added.
Singapore General Hospital and DukeNUS Graduate Medical School are testing the effectiveness of an app that helps diabetic patients determine the right insulin dosage to inject. From left are Dr Bee Yong Mong, Professor David Matchar, and Mr Benedict Tan, Group Chief Information Officer, SingHealth. The SGH Diabetes Pal measures a diabetic’s blood sugar level and uses the reading to determine the required amount of insulin.
The trial, which began in March 2013 and is expected to wrap up when the target 80 participants are recruited, aims to find out how effective and useful the app is. At least 35 diabetes patients have been given the app since it became available. Half of the patients in the study will use the app for six months, while the other half will not get the app. At the end of the study, the change in glycaemic control between both groups will be compared. The glycaemic index measures how quickly blood sugar levels rise after eating a particular type of food. If the results are promising, a larger study – involving more participants – will be initiated, with the ultimate aim of offering the app to diabetes patients seen by doctors at polyclinics, not just at SGH. The app was developed by SGH endocrinologists and the Ministry of Health’s Integrated Health Information Systems. Insulin is produced naturally in the pancreas. But in people who have diabetes, the pancreas does not produce or stops producing enough of the hormone to control the amount of sugar in the
blood, or the body becomes resistant to insulin. There are two main types of diabetes: Type 1 is an autoimmune disease that is often diagnosed in childhood, while the more common Type 2 is associated with obesity and an unhealthy lifestyle. The app is for Type 2 diabetes patients who are newly put on insulin therapy. Poor diabetes control can lead to other complications, such as blindness, kidney failure, heart attack, stroke, vascular disease and even loss of limbs through amputation, said Dr Bee. The number of people with diabetes in Singapore is rising, with 11.3 per cent or one in nine people recorded with the disease in 2010. More worrying, he said, is the significant rise in young adults with the disease. According to official statistics, the percentage of diabetics aged between 18 and 29 rose to 1 per cent in 2010 from 0.5 per cent in 2004, while for those aged between 30 and 39, the number was 4.3 per cent vs 2.4 per cent in 2004. For patients who are on insulin therapy, it is important that the right dose be taken. Patients monitor their glucose levels before deciding if their next dose should be adjusted. A dose that is too low on insulin can result in persistently high sugar levels, and that can cause serious problems such as hypoglycaemia, seizures, loss of consciousness, and even death. With the app, the patient just needs to measure his blood sugar level in the morning, and then enter the reading into the app. Based on the information and the patient’s prescribed treatment plan, the app will prompt the patient with the correct amount of insulin needed to achieve his optimum blood sugar levels. Based on the patient’s real-time condition, the app will alert him to lower the dosage, or even to not inject any insulin, if the reading indicates a low sugar level. A safety feature pre-sets the maximum dose of insulin the patient can inject based on his body weight. Another is an SMS alert that reminds the patient to check his glucose level daily. If the patient still does not or forgets to submit his reading, another alert will be sent by 11.30am. The app is able to generate graphs from the patient’s daily readings, so he can see his progress or improvement in managing his diabetes. The app also has an administration function that allows his doctor to remotely oversee the patient’s progress online, and intervene where necessary.
NEWS
11
Phoning for better health
In recent years, SingHealth has developed several apps, many in conjunction with the Health Ministry’s Integrated Health Information Systems or IHis, to encourage people to look after their health and well-being better.
Health Buddy
IOS and Android This award-winning app is one of the most comprehensive health mobile apps in Singapore to date. With extensive information contributed by doctors and healthcare professionals, Health Buddy provides users with up-to-date health information and medical services, as well as tips and advice for healthy living.
Woman&Child HealthPedia
IOS Developed by KK Women’s and Children’s Hospital (KKH), this app provides useful information on diseases and conditions concerning women and children. It also features a comprehensive list of services available at KKH, including advice from in-house experts and a pregnancy planner.
MyEyeDrops
IOS and Android This glaucoma mobile app was developed by Singapore National Eye Centre (SNEC) and IHiS. Key features include reminder alerts to patients to apply their eye drops, and a medical diary – a convenient way for patients to record important events for discussion with their doctors.
SingHealth Nurses Pal
(For SingHealth staff only) This app helps SingHealth nurses manage pressure ulcers and prevent falls among patients. The mobile app also features an intravenous drip rate calculator, and an alarm function which nurses can use to enhance medication safety.
Rheumatoid Arthritis
Log in via mobilecare.sgh.com.sg Developed by SingHealth and Singapore General Hospital, this web-based app collects information about a patient’s daily activities and general health as a way of monitoring his condition and the progression of his disease, pain levels, and any side effects from medicine taken.
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upclose
singapore health
Jan – Feb 2014
Bone Osteoporosis
One in three people with hip fractures suffers considerable loss of function and becomes dependent on others.
One in five people with osteoporotic hip fractures dies within a year.
Prevention Brisk walk, climb the stairs, do tai chi and other weight-bearing exercises at least three times a week. Don’t smoke or drink alcohol excessively. Eat a balanced diet with adequate calcium and vitamin D.
(Tips)
Health While any bone in the body can be affected by osteoporosis, hip and spine fractures are of particular concern as they almost always lead to hospitalisation or even death
Fast facts Women who menopause before the age of
Men and women over the age of
45 65 20 are at a higher risk of osteoporosis.
are at a higher risk of osteoporosis.
Text By Ng Hui Hui
Common symptoms
Women are more prone to osteoporosis as they can lose up to
per cent of their bone mass after menopause.
Back pain
Fracture of the spine, wrist, hip or other bones
Loss of height over time, with a stooped posture
Over the last 30 years in Singapore,
hip fractures
in those aged 50 and above have increased
(
)
Treatment
for Diet
Calcium is better absorbed when taken in small amounts throughout the day. An adult under 50 needs 1,000mg of calcium and 400-800IU of vitamin D daily. Adults over 50 need over 1,200mg of calcium and 800-1000IU of vitamin D daily. Eat foods rich in Vitamin D such as salmon and eggs as vitamin D aids calcium absorption. Add skimmed milk powder or low fat milk to soups, smoothies, milkshakes and sauces. choose breads, cereal and juices that are fortified with calcium.
Worldwide, incidence of spine fracture increases with age in both sexes. Most studies indicate that the prevalence of spine fracture in men is similar to or even greater than that seen in women, aged 50 to 60 years.
times men
times
women
Osteoporosis cannot be cured.
A bone mineral density test to measure the density of calcium and other minerals in different bones of the body is the best way of diagnosing osteoporosis. Medication can stop the depletion of bone mineral from bones and stimulate bone formation. Precautions should be taken when engaging in moderately intense to vigorous exercises.
Sources: www.moh.gov.sg, hpb.gov.sg, singhealth.com.sg
JAN– FEB 2014
singapore health
Stork service
Madam Ho Ai Lian never dreamed that she would – or could – deliver babies. But in a career spanning more than 40 years as a midwife, she has delivered thousands of them
O
ne eventful day 43 years ago, Madam Ho Ai Lian mustered up the courage and willpower to deliver a baby without supervision. “It was very scary, and I was very nervous,” the Singapore General Hospital (SGH) Senior Midwife recalled. “I nearly fainted, but I managed to do it with guidance from my (senior nurses).” Since then, Mdm Ho has delivered thousands of babies, not just at SGH where she has been based for the last 27 years, but also at various hospitals and polyclinics in Singapore. When she was based at the polyclinics, she often had to deliver babies at home when the mothers went into labour and it was too late to go to the hospital. “Sometimes, (delivery) happens in taxis too!” she said. Midwifery wasn’t what Mdm Ho had in mind as a career when she applied for a job with the Public Service Commis-
sion. After some initial resistance, she accepted the offer to be trained as a midwife. “The training they gave me took more than two years. We were exposed to a lot of real situations, where we picked up practical skills in caring for a mother, both before and after she has had her baby. The hands-on skills helped us build our experience, and we shared those experiences over and over again with the new mothers that we met.” She seldom delivers babies now as that role is typically undertaken by an obstetrician. Instead, she leads the hospital’s nurses in training new mothers to breastfeed. SGH, accredited by the World Health Organization recently as a BabyFriendly Hospital, encourages mothers to breastfeed exclusively for at least six months. “I have great satisfaction seeing my mothers excel in breastfeeding after the training and education I give them. It’s a challenge to educate and motivate
Photo: wong weiliang
By Satish Cheney
Madam Ho Ai Lian seldom delivers babies now, but teaches new mothers how to breastfeed and care for their infants.
them (in ante and postnatal care), and to support them psychologically,” she said. “Most mothers these days are educated and knowledgeable. They go online for information. So, as nurses, we have to keep ourselves constantly updated as well.” Before SGH began preparations for accreditation, only about a third of the women who had their babies delivered at SGH chose to breastfeed exclusively. That number is now about 90 per cent, said Mdm Ho proudly. “I love this job. Very often the mothers will bring their babies
people
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to show me how they’ve grown,” said the midwife, who has won major awards including the prestigious SGH CEO Award. Still, Mdm Ho has had her share of regrets. She had wished to further her career through training, but chose to stay by her mother who was sick with cancer. She also wanted to leave her job several times, but the joy of seeing the children she had delivered all grown up changed her mind. Now 65, Mdm Ho hopes to retire in a year or two. When she retires, she intends to volunteer for more projects, in addition to her work with the gynae-oncology and lactation support groups. She currently also helps distribute food to the needy as an Apex Club volunteer, and volunteers at a free TCM (Traditional Chinese Medicine) clinic, and at the Association of the Visually Handicapped. Mdm Ho also plans to spend more time with her colleagues, relaxing and listening to music at karaoke lounges. After her retirement, she also wants to go on a long trip with her travel partners, perhaps to Europe or New Zealand. “We might try travelling for a month. We will take our time to see the sights because we tire easily, so we cannot rush.” She will not stop looking after mothers and babies after she retires. When her son and his wife-to-be have children in the future, she will be there with her expert care and knowledge to help.
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people
singapore health
JAN– FEB 2014
Sound support When doctors are able to help the deaf to hear, they also prevent a life of social isolation for these patients
T
he man thought he would never be able to hear again after a viral infection caused him to become deaf. He became frustrated and withdrawn when he couldn’t communicate properly with his family and friends. Then, a cochlear implant helped restore his hearing – and a dramatic change came over him. It was this kind of transformation in people that ear, nose and throat (ENT) surgeon Dr Barrie Tan wanted to see when he decided to specialise in hearing as a young medical officer. “I really feel that (this sub-specialty of otolaryngology) can make a big difference.” He recalled a story the patient told him. “He was at a coffee shop. The coffee shop attendant was very curious about his cochlear implant. My patient told him: ‘This is the latest radio, don’t you know?
This is my radio receiver so I can hear my radio through here.’ “My patient was very proud of his cochlear implant, and he was able to joke about it. Basically, he was just very happy to be able to interact with people again,” said Dr Tan, Head, Department of Otolaryngology, Singapore General Hospital (SGH). Adults who have lost their hearing or who are struggling to hear can feel isolated socially. “Unlike children who were born deaf, these adults know what it’s like to be able to hear. So it’s very frustrating when they lose that, and to give them their hearing back and see their joy – that’s very meaningful to me,” he added. “It’s a personal sense of gratification from having helped restore something that was broken. I think that’s very precious.”
Photo: DARREN CHANG
By Sol E Solomon
Dr Barrie Tan hopes that Singapore will have an ENT (ear, nose and throat) national centre in the future as such a facility will help bring together resources for ENT clinical care and research.
While the decision to specialise in ENT came during his training, the inspiration to enter the field of medicine came earlier. Dr Tan’s father is a retired ophthalmologist and it was at his clinic that Dr Tan, as a child, would often see patients leave the clinic happy after their eye bandages came off.
“I want everyone to be happy and not to be burnt out,” he said. Dedication to work and patients is important, but being able to function effectively is also crucial if the team is to take care of their patients properly. “I try to get the department to go out together so we have time off from our clinical work, and we get to know each other more as friends and family,” he said. “I believe that a family that eats together sticks together.” The former President ’s Scholar Unlike children who keeps a busy schedule. In addition to were born deaf, these his clinical work, he also trains young adults know what’s it doctors as Director of the SingHealth Residency Program. He like to be able to hear. Otolaryngology still finds time to volunteer for overseas So it’s very frustrating medical missions as he doesn’t want “to take for granted what I’ve been when they lose that, and to ensure that I don’t lose and to give them their given, sight of why I entered medicine in the hearing back and see first place, which was to help people most in need. These are people who their joy – that’s very otherwise have no means of accessing meaningful to me. specialist help.” Dr Barrie Tan, Head, Department of OtoDr Tan doesn’t forget his family laryngology, Singapore General Hospieither, making jogging, swimming and tal , on why adults who have lost their hearing or are struggling to hear can visiting parks his hobbies so that he can feel isolated socially enjoy these activities with his young daughter and son. He has also picked up photography, as a result. His father supported his decision High on his priorities, though, is his to join the medical fraternity, but not work in ENT. “We are in the era of super his mother. “She had seen how gru- specialists. So I would like each ENT elling my father’s earlier days in med- specialist to find the sub-speciality that icine were, and she didn’t want her he enjoys, and go for the best training children to go through that as well. he can possibly afford, in terms of per“Little did she know that all three sonal time as well as money. And then of her children were quite set on to come back with those skills and furbecoming doctors,” he said. Dr Tan’s ther develop ENT in Singapore.” brother is a urologist while his sister is Dr Tan hopes that Singapore will a general practitioner. have an ENT national centre in the As the head of his department and future, as such a facility will bring Director of SGH’s Centre for Hearing similar minds together and help harand Ear Implants, Dr Tan wants his ness resources for ENT clinical care team to have work-life balance. and research.
JAN – FEB 2014
singapore health
Money
15
How to get the max out of Medisave Medisave Account funds are not just for paying medical bills, but can be used for medical insurance and other policies to meet healthcare needs By Mok Fei Fei
Y
ou can die in Singapore, but you can’t afford to fall sick here” is a common refrain heard on the street. A recent survey by research company GfK found that 42 per cent of respondents expressed concern about the cost of healthcare in Singapore. September’s inflation data released by the Department of Statistics showed that healthcare costs went up by 4 per cent compared to the same period a year
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Know what Medisave can be used for
A part of your monthly CPF contribution will go into your Medisave Account, which can be withdrawn to pay for your healthcare needs or that of your immediate family. Currently, between 7 and 9.5 per cent of your wages go to the Medisave Account, depending on how old you are. The contribution rate increases as you age. Among other things, you can tap Medisave to pay for certain health screenings, outpatient treatments of some chronic diseases and premiums for MediShield. The Ministr y of Health (MOH) regularly updates and expands the list of procedures and treatments that can be paid using Medisave, so it reduces your out-of-pocket expenses if you know when you can use Medisave. For example, from January 2014, you can use it to help pay for the treatment of five more chronic conditions, including Parkinson’s disease and osteoarthritis. But before you go around using your Medisave for every eligible bill, financial advisers urge you to think again. Ms Lau Sok Hoon, Vice-President at NTUC Income’s Group and Health Division, said: “Every-
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ago, higher than the 1.6 per cent increase in the overall consumer price index. But healthcare in Singapore can be affordable. The system has multiple tiers of protection to ensure that no Singaporean is denied access to basic health care because of affordability issues. The first tier of protection comes from heavy government subsidies which all Singaporeans can access. The second tier of protection is provided by Medisave, a compulsory individual medical savings
one should exercise caution when using Medisave as there may not be sufficient funds in the account when he or she needs it. Also, the Medisave Account currently offers an attractive 4 per cent interest, which is another reason to keep the funds in this account.” Another factor to bear in mind is the Medisave Minimum Sum, or the minimum amount you must leave in your Medisave Account when you withdraw your CPF savings. That figure has been on the rise, and it currently stands at $40,500 for Singaporeans turning 55 from July 1, 2013 to June 30, 2014. Even if you can attain the Medisave Minimum Sum, the money may not be enough to last you a lifetime. Mr David Ng, Chief Marketing Officer, Prudential Singapore, said: “The reserve that we have set aside for Medisave would not be sufficient to cover the escalating healthcare costs. In addition there may be a preference for higher-class wards, which would add to costs.” Insurers say a better way to prepare for such an eventuality is to use your Medisave to buy insurance.
Pick the most suitable MediShield plan
A low-cost basic medical insurance scheme, MediShield is meant to cover large hospitalisation bills incurred at B2 or C class wards. In 2012, 92 per cent of the resident population were covered under MediShield, and less than 1 per cent of policyholders opted out of MediShield, according to an MOH spokesman. Annual premiums for MediShield can be paid using money from your Medisave Account. You pay between $50 and $1,190 every year for the coverage, with the premium progressively higher as you grow older. If you want coverage for a higher-class ward or a private hospital, you will need to pay more for the options by buying Integrated Shield plans offered by private insurers, which give other benefits on top of the basic MediShield. Currently, you can use your Medisave to pay for the premiums of the Integrated Shield plans offered by AIA, Aviva, Great Eastern, NTUC Income and Prudential, up to a stipulated withdrawal limit. It is tempting to make comparisons simply on the basis of the additional cost alone, but that would not be wise.
Mr Daniel Lum, Director of Product and Marketing, Aviva Singapore, said: “Integrated Shield plans offered by the various insurers vary not just in terms of premiums but also benefits. Rather than simply comparing premiums, consumers should look at the benefits to ensure the plan they’ve selected best suits their needs.” For example, some insurers already offer lifetime coverage now, ahead of MOH’s planned launch of MediShield Life, which will provide medical coverage for life. Other Integrated Shield plans offer coverage for pre-existing conditions, overseas medical treatments and also insure your children for free up to a certain age. Ms Ho Lee Yen, Chief Marketing Officer, AIA Singapore, said: “Health insurance is anything but a one-size-fits-all product and different schemes offer benefits to people of diverse financial and protection needs. If you are undecided on an Integrated Shield plan, you should meet up with your insurance adviser.”
account scheme which allows practically all Singaporeans to pay for their share of medical treatment without financial difficulty. The third level of protection is provided by MediShield, a low-cost catastrophic medical insurance scheme. Finally, there is Medifund, a medical endowment fund set up by the Government to act as the ultimate safety net for needy Singaporean patients. Mr Tan Kuan Ho, Great Eastern Life’s Acting Chief Product officer said: “One
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should not wait until old age to plan for healthcare needs as being older, the time horizon for savings may be shorter and premium rates for protection insurance would be higher as premiums usually increase with age.” One useful instrument in your medical financing toolkit is Central Provident Fund (CPF) savings, which you can use to pay for certain things such as your healthcare insurance premiums, outpatient or hospitalisation bills.
Look beyond medical insurance
Mr Tan said healthcare coverage should also be viewed more holistically, so if you can afford it, consider an income protection insurance plan. Such policies give you payouts when you are unable to work due to a disability or an illness. If all else fails and you
do not have much in your Medisave Account, there is still Medifund, an endowment fund set up by the Government. This article is adapted from How to get the max out of Medisave, The Sunday Times, dated Nov 3, 2013.
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singapore health
JAN– FEB 2014
Health Xchange
Our experts answer all your questions about health
Anxiety during menopause How exactly is anxiety during menopause different from the usual kind of anxieties people may have? Women experience emotional changes usually during the peri-menopausal period when the menses change, becoming lighter or heavier for some women, and irregular or less frequent. This has been thought to be due to hormonal changes, particularly the drop in estrogen (the “feel-good” hormone for women) during those years. Women often report experiencing prominent physical symptoms such as hot flushes, night sweats and insomnia, along with palpitations, or tension and anxiety.
PhotoS: GETTY IMAGES
Will food cravings derail good nutrition?
Typical symptoms for women in other age groups include anxiety, excessive and constant worrying thoughts, a state of tension, as well as accompanying physical symptoms, such as palpitations, breathlessness, giddiness, tremulousness, muscle cramps and headaches. These can be persistent, episodic, situation-specific or coming in intense waves as in a panic disorder. Hormonal changes are less likely to be the main cause of anxiety, but some patients have reported that their anxiety tends to worsen just before their menses. Dr Helen Chen, Senior Consultant and Head, Department of Psychological Medicine, KK Women’s and Children’s Hospital
I am worried that my wife is not getting enough nutrition during her pregnancy. She has been craving different kinds of food. How long do these food cravings last? Should she take a supplement? How much should she eat to ensure she gets enough nutrition? She also suffered from morning sickness at one point. Why do some pregnant women suffer from it while others don’t? As this is her first pregnancy, my wife is understandably worried about having a painful delivery. We want to opt for a normal delivery but if it becomes difficult, will she need surgery then? What options do we have to ensure the delivery is painless? Food cravings depend on the individual, but pregnant women should have a good and balanced diet to ensure the well-being of both the mother and the baby. A balanced diet is one that can provide all the necessary iron, calcium and vitamins required to maintain the health of the mother and baby. Her doctor will prescribe vitamins if neces-
sary to supplement her diet. However, I would advise all pregnant mothers to take folic acid daily. Most pregnant mothers experience morning sickness, nausea and vomiting of varying degrees of severity during the first trimester. This is due to the hormonal changes that accompany pregnancy. If the vomiting is severe and results in dehydration, admission to hospital may be necessary. Delivery, whether natural or by caesarean section, will involve some pain. However, the pain can be eased by inhaling nitrous oxide/oxygen, intra-muscular injection of painkillers, or epidural analgesia. Please discuss the options with your obstetrician during your antenatal visits. If the baby cannot be delivered safely through a normal vaginal delivery, then logically the only other option is a caesarean section. Similarly, consult your obstetrician regarding delivery options. Associate Professor Tan Hak Koon, Senior Consultant and Head, Department of Obstetrics and Gynaecology, Singapore General Hospital
Protein build-up causes eye discomfort I have used contact lenses for the past 20 years but switched to daily disposable lenses two years ago due to the twitching and discomfort in my eyes. The optician told me that I had quite a lot of protein build-up in my eyes even though I regularly used protein removal tablets. Recently, I have been feeling grit in my eyes halfway through the day, even with the use of daily disposables. Is there a “shelf-life” for using contact lens? Should I use eye washes, and if so, which kind? It is important to see your contact lens practitioner to check your eyes if you experience discomfort related to contact lens wear. If you have worn contact lenses for several years, you could have developed an allergic condition known as giant papillary conjunctivitis, a chronic allergic eye condition related to contact lens wear. Daily disposable lenses are good for this condition as there is no protein buildup on the lenses. However, the condition may not resolve completely even with daily disposable lenses. If you continue to have discomfort wearing lenses, you should stop wearing them for a period of time, for example, for six weeks, to allow the eye to recover. It is not necessary to use eye washes as eyes produce tears. It is important to have regular eye checks with your contact lens practitioner even if you do not experience any problems with wearing contact lenses. Dr Lim Li, Senior Consultant and Head (Clinical Service and Education) Corneal and External Eye Disease Service, Singapore National Eye Centre
These articles are from www.healthxchange.com.sg, Singapore’s first interactive health and lifestyle portal.
Topics for discussion in January 2014: Questions on medication Visit the website www.healthxchange. com.sg for information on the topic for February.
JAN – FEB 2014
singapore health
Opinion
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Let patients live... before they leave Turning to palliative and hospice care gives doctors an opportunity to improve the quality of life of patients who are terminally ill times, things did not go as planned.” He has realised the importance of just listening and offering comfort and care whenever the need arises. Every patient is different, and what works for one may not work for another, even in a similar situation, said Dr Boon. He recalled a patient who did not want to take medication asking him if she was dying. “Holding back tears, I could only tell her that I thought she might be right.” He then listened as she reminisced about past home visits and her life experiences. This was enough to help her sleep through the night with a smile on her face. A few days later, she died peacefully at home. The incident helped Dr Boon realise that while medication may be readily available, the ability to comfort sometimes lies in a simple touch or the mere presence of the physician. He said, “The old adage, ‘To cure sometimes, to relieve often, to comfort always,’ still
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atching a loved one slip away as he takes his final breath – even as we cling to hopes of a reprieve – can be very painful. For some patients, the end can come unexpectedly without them having a chance to say goodbye or have their wishes fullfilled, for example, dying at home. Family and friends often experience fear, anger, regret and guilt when that happens. Preparing a patient’s family and friends for the inevitable can help ease their eventual loss. But how do medical professionals decide when it is time to refer a patient to palliative and hospice care? Is there ever a “right time” for doctors to move the focus from treatment to relieving the patient’s pain, loss of independence and stress? Doctors agree that when a patient is terminally ill and the prognosis is dismal, it is time to begin discussions about engaging hospice care. But they may sometimes hesitate to do so, fearing that a referral to hospice care is akin to stopping treatment, giving up on the patient, or taking the easy way out. They may even be unfamiliar with hospice care and the work involved. Yet, turning to palliative and hospice care actually gives doctors an opportunity to take active measures to improve the quality of life of their patients such as by treating various types of pain. Many families of terminally ill patients are often uncertain about what to do
and need advice from a trusted medical practitioner who carefully considers the wishes of the patient and his family before making a referral to hospice care. “Ideally, patient s should be allowed to be cared for or die at home, if families can provide and cope with the basic nursing care that is required,” said Dr Chan Kin Ming, a geriatrician.
The old adage, ‘To cure sometimes, to relieve often, to comfort always,’ still rings true. Dr Boon Jiabin, medical officer, HCA Hospice Care, on how the ability to comfort sometimes lies in a simple touch or the mere presence of the physician
Initiating discussions about end-oflife care with patients and their families is not easy, even for doctors who are familiar with the role and benefits of hospice care. Dr Boon Jiabin, Medical Officer, HCA Hospice Care, said that even though he prepared carefully for each visit, “many
rings true.” There is no need to choose between providing aggressive treatment or hospice care for terminally ill patients; both options can be offered concurrently. Palliative and hospice care professionals are part of a multi-disciplinary team that promotes the best interests of patients and their families. Understanding what patients and their loved ones want when faced with a life-limiting illness is key to identifying how palliative and hospice care can contribute to the continuum of care for patients at this critical stage of their lives. In keeping a patient’s best interests at heart, doctors may find themselves in a better position to assess and evaluate if and how palliative and hospice care can enable, rather than disable, him and his loved ones.
This article is adapted from HCA Connect, a bimonthly newsletter by HCA Hospice Care.
your say
Redirected to A&E department
singapore health
I had a sudden, excruciating pain in my chest and asked for an urgent appointment with any of your doctors. I was willing to wait for an available appointment slot, but was advised to go to the nearest Accident and Emergency (A&E) department instead. Why could I not go directly to the National Heart Centre Singapore (NHCS) for emergency treatment of my heart problem? People who experience severe chest pains that persist for more than 20 minutes are advised to go to the A&E department of the nearest hospital for urgent help for the following reasons: There are a variety of other potentially serious medical conditions apart from a heart attack that may cause chest pains, so getting a full evaluation by the A&E department will be the safer option. The NHCS Specialist Outpatient Clinics are meant for non-urgent medical appointments and long-term follow-up with existing patients. It is not designed to deal with medical emergencies and hence does not have the full facilities to manage medical emergencies. Waiting for an available appointment slot while still experiencing serious symptoms may be potentially dangerous.
NHCS
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JAN– FEB 2014
More visitors than hospital policy allows
I was admitted to SGH recently and was annoyed to see the patient in the next bed getting eight to 10 visitors each time. Why was he allowed so many visitors when your policy restricts us to just four? The patient’s visitors also came at all hours. Why were they allowed to visit outside regular visiting hours? have a strict visitor policy SGH We to protect our patients. Having
says
too many visitors in the ward can disturb our patients who need adequate rest and quiet, especially those who have undergone surgery and are recovering from anaesthesia. Our nurse managers do remind visitors to leave the ward at the end of visiting hours. But there are visitors who can only come later due to work commitments or other personal reasons. Whenever possible, we try to be flexible and allow them to spend some time with the patient. At the same time, patients who are dangerously ill are also allowed an unlimited number of visitors. It’s a challenge for our staff to try and balance the needs of patients and their relatives, and they have often been subjected to verbal abuse. We seek everyone’s understanding to help us make the wards a pleasant environment for all.
tributes
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We would like to commend Associate Professor Lo Ngai Nung, Senior Consultant, Department of Orthopaedic Surgery, Singapore General Hospital (SGH), for successfully performing hip replacement surgery on my wife. She had suffered pain for two years and had undergone three other procedures elsewhere. With no improvement, the other hospital advised us to look for another surgical specialist. We were lucky to meet Prof Lo who instilled confidence into us from our first meeting with his care and concern, professionalism and knowledge. Thank you, Prof Lo, for serving your patients with your heart and soul! I strongly recommend SGH to my friends and relatives, both in Singapore and overseas. - Mr Wong Chung Yuk I would like to thank Dr Lim See Lim, Senior Consultant, Department of Cardiothoracic Surgery, National Heart Centre Singapore, for performing my dad’s valve replacement surgery with such skill. Thank you for arranging for Dr Tan Boon Yew to perform the cardiac resynchronisation therapy-defibrillator implantation procedure. Thank you also for your kind attention and care during his stay. We’re glad to report that my dad now has a good appetite and can enjoy simple home-cooked meals again. He also does not wheeze when walking. He has been to five cardiovascular rehabilitation exercise sessions so far, and will continue to do so. His feet are no longer swollen from water retention, and he does not feel cold as easily as before in air-conditioned rooms. He is even able to drive again. If we have any regrets, it is only that we did not heed your advice to operate earlier, for that could have saved us much grief over the last few months. Thanks to the noble work that you do, we no longer have to stand by helplessly, unable to help while he suffers. Your professional expertise and ethics have moved and inspired us, and we are forever grateful for all you have done for our family. - Mr Goh I would like to commend Senior Staff Nurse Pauline Soon Kim Chin for her kindness, patience and skill. She treated me with care and kindness when I was a patient at the Neuroscience Clinics. When I asked her about
my blood test and procedures, she explained them to me very patiently. The information she provided was clear and easy to understand. Even when she drew blood for my blood test, she did it gently and I did not feel any pain. What is more, she always had a big smile on her face whenever she attended to me. - Madam K I would like to commend Ms Samantha Tong Li Hua, Physiotherapist, SGH, for helping my 64-year-old sister with exercises to strengthen her right knee after an operation earlier in 2013. She constantly encouraged and motivated my sister, who was in pain after the surgery and was worried that she would not recover properly. Ms Tong addressed my sister’s questions about her knee and also provided warm words of encouragement. She constantly checked that my sister was doing her exercises correctly at home. My sis ter said that Ms Tong changed her (wrong) perceptions about physiotherapy; her friends had told her that the exercises were useless and that she could easily exercise without professional help. But her progress has assured her that she had made the right decision to work with a physiotherapist. My sister has pledged to continue with her exercises at home after being discharged. She is no longer fearful about knee replacement surgery and is looking forward to her next operation this year. Thank you very much, Ms Tong, and we wish you well in everything you do. - Mdm E Soh I would like to thank Madam Juriah Lon, Senior Patient Service Assistant, SingHealth Polyclinics (Outram), for going out of her way to help locate my misplaced pouch which contained important and valuable items. I truly appreciate her effort. - Mr Wan I would like to thank Staff Nurse Eleanor Htut Jumei and Staff Nurse Maureen Ang Meiyun for looking after my grandmother when she was warded in SGH. Ms Ang was heavily pregnant but she continued to do her job well. She was kind, patient and careful, as was Ms Htut. I wish both of them well, and wish Ms Ang a healthy and lively baby! - Mr SD Wong
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about your health experience and win a prize for best letter Letters must include your full name, address and phone number. Singapore Health reserves the right to edit letters and not all letters will be published. Write to editor@sgh.com.sg or The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608, or talk to us on Facebook. The winner will receive a bottle of Heritage® Cordyceps CS-4. The product, worth $94, is sponsored by Heritage® by HST Medical, Singapore.
JAN– FEB 2014
singapore health
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FYI
singapore health
Jan – Feb 2014
event Calendar
▲
Compound in cabbage, cauliflower and broccoli protects against radiation
Session 1 Date Jan 4, Saturday Time 3-4pm Venue Choa Chu Kang Public Library,
Activity Room
Researchers at Georgetown University Medical Center said a compound derived from vegetables, such as cabbage, cauliflower and broccoli, may be able to protect normal tissues during radiation therapy for cancer treatment and prevent or mitigate sickness caused by radiation exposure. The compound, known as DIM (3,3’-diindolylmethane), was found to have cancer preventive properties, and the most recent tests suggested that DIM may also act as a radiation protector, said Dr Eliot Rosen, Professor of Oncology, Biochemistry and Cell and Molecular Biology, and Radiation Medicine, at Georgetown Lombardi Comprehensive Cancer Center, and an author of the study. “DIM could protect normal tissues in patients receiving radiation therapy for cancer, but could also protect individuals from the lethal consequences of a nuclear disaster,” he added.
Session 2 Date Jan 26, Sunday Time 2-3pm Venue Jurong West Public Library,
Programme Zone
Registration Free for individuals.
Sign up at the library eKiosks or golibrary.nlb.gov.sg. Brisk walking is a physical activity that is suitable for most people. It has many health benefits, including improving stamina and fitness, as well as lowering blood pressure and blood cholesterol. This introductory talk on the benefits and correct technique of brisk walking is by the Health Promotion Board.
Source: Georgetown University Medical Center
after treatment ceased
An infant infected with HIV-1, the most common strain of the virus, and treated with combination antiretroviral therapy (ART) beginning at 30 hours of age remained healthy and had no detectable signs of the HIV-1 virus at age 30 months, despite having discontinued ART 12 months earlier. “This case suggests that very early
Poverty affects
ART in infants may alter the establishment and longterm persistence of HIV-1 infection,” said Dr Deborah Persaud and colleagues in an article published online in the New England Journal of Medicine. Dr Persaud is Associate Professor of Pediatrics and Infectious Disease, and Director of the Infectious Disease Fellowship Program at Johns Hopkins University School of Medicine, Baltimore, Maryland, in the US.
learning difficulties
Depression second most
Visit family-central.sg for more details. This practical, social gerontology programme covers the physical, psychological and social aspects of ageing. Interactive workshops will build awareness and promote positive attitudes towards meaningful ageing through active living. This programme is an initiative of and supported by Council for Third Age, and organised by Family Central, a service by Fei Yue Community Services.
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inability to cope with stress
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photo: GETTY IMAGES
depression
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common cause of disability globally
Source: Medscape Medical News
SMS 9104-6554 for timings. Venue Tiong Bahru Central Plaza, 298 Tiong Bahru Rd, #03-02 Registration Call Family Central at 6593-6455 or SMS 9104-6554 for fees. Participants must be Singaporeans or Permanent Residents above 50 years old.
Children who grow up poor may suffer negative brain changes that can lead to lifelong problems:
1
1. How long are patients trained on the insulin pump before they start using the treatment? 2. Which story in this issue did you find the most informative? Closing date: February 1, 2014 Send in your answers and stand to win a Kyäni Sunrise 30-pack, worth $83.75, sponsored by Kyäni Singapore Pte. Ltd. TM
Empowering People Who Care Date Jan 16, Thursday Time 12.30-2.45pm Venue KK Women’s and Children’s
Growing up in poverty can have long-lasting, negative consequences for a child. But the effects may be particularly worrisome for poor children raised by parents who also lack nurturing skills, according to a new study at Washington University School of Medicine, St Louis. Among children living in poverty, the researchers identified changes in the brain that can lead to lifelong problems such as depression, learning difficulties, and limitations in ability to cope with stress. The good news, said the researchers, is that a home where the parents are able to nurture their children may offset some of the negative changes in brain anatomy among poor children. The findings also suggest that teaching nurturing skills to parents — particularly those living in poverty — may provide lifetime benefits for their children.
Hospital (KKH) multi-purpose room at Rehabilitation Department, Basement 1, Children’s Tower Registration Free. Register by Jan 10, Friday, by e-mailing your contact details to fiona.cheng.xt@kkh.com.sg or calling 6394-1582. Visit www.kkh.com.sg for more details. This public forum is held in conjunction with Occupational Therapy Day. Occupational therapists from KKH will share insights on understanding and managing children’s behaviour, as well as helping children learn through play.
Source: Washington University School of Medicine
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contest
I’m Senior & I’m Loving it
Date Jan 9, 16, 23 & 27, Thursdays Time Call Family Central at 6593-6455 or
children’s brain development
Source: Medscape Medical News
Depression is the second most common cause of disability worldwide, after back pain, according to the journal PLOS Medicine. Clinical depression was compared with more than 200 other diseases and injuries as a cause of disability. The researchers said the study provides the most recent and comprehensive estimates of the degree to which death and disability are attributable to depressive disorders, both worldwide and in individual countries and regions. The findings reinforce the importance of treating depressive disorders as a public-health priority.
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Girl born with HIV still in remission
Learn the Correct Technique of Brisk Walking
Include your name, age, gender, address and telephone number. Winners will be notified via phone or e-mail. Incomplete or multiple entries will not be considered. E-mail editor@sgh.com.sg Post The Editor, Singapore Health, Singapore General Hospital, Communications Department, #13-01 Surbana One, Blk 168, Jalan Bukit Merah, Singapore 150168 Winners of Contest 25: Each will receive a bottle of Ultra Hemoshield and Ultra Organic Green Barley, worth $112.85. Prizes must be claimed by February 1, 2014. 1. Colleen Chan 2. Ng Shah Ai 3. Nicholas Wong 4. Yeo Chay Yan 5. Esther Yong
Love Without Walls: Art Experiential
Date Feb 15, Saturday Time 10am-1pm Venue Creative Hub, Block L, #01-4790,
Goodman Road, Singapore 439053
Registration Free. Register by e-mailing
ch@samhealth.org.sg or calling 6344-8451 and leaving your name, email address and contact number. This programme seeks to help caregivers realise the importance of self-care through movement, art, drama and music. Visit www.singhealth.com.sg/events or the websites of respective institutions for any changes, more information, and other listings.
JAN – FEB 2014
singapore health
21
YOUR GUIDE TO BETTER LIVING
) l a e r ( e h T a f o price t r a sm e c i v de
device t r a m s d l A handhe nvenient to may be co the problems eware use, but b n result from i that ca Thava Ran y B . e s u prolonged
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taying connected via a smartphone or tablet can be a health hazard. Texting or gaming – with the hand and fingers repeatedly making the same actions – on a smart device can put the user at risk of injury. The repetitive action can cause damage, while the way that the device is held – especially for long periods – can also lead to soreness and pain in the wrist, thumbs and fingers. Likewise, sitting or standing hunched over a tablet can strain the neck ligaments and muscles. Most people stretch their neck and head forward when reading, watching a film, or typing on a tablet, and if they hold that posture for a long time, micro or very tiny tears can occur in the muscle fibres or tendons. “The bad posture occurs when reading a book too, but you are more likely to adjust your posture when you start feeling some strain. With digital media that includes sound and moving pictures, people are usually engrossed to the point of not moving, at least not until the battery dies!” said Dr Darren Tay, Consultant, Department of Orthopaedic Surgery, Singapore General Hospital. Indeed, some studies have shown that spending many hours in the same position, doing the same action, puts the user at twice the likelihood of suffering from neck aches and other symptoms as someone who uses the device less frequently.
sit up straight! Maintaining the right posture while using your mobile phone or tablet can prevent more serious injuries in the long run. Ms Ruby Poh, Physiotherapist, Singapore General Hospital, shows what is correct posture when using smart devices:
Bad posture: The neck is fully flexed, the upper back bent and lower back is slumped while using the device.
To identify the right standing posture, stand against a wall. The head, buttocks and heel should be in contact with the wall. When standing or seated, position the head and neck so that the ears are aligned with the shoulders. Hold up the device without hunching. Take a 15-minute break every 45 minutes to avoid being in the same position for too long. Stretch and pull the head back during the break.
> Continued on page 22
Danger signs
Text neck See a doctor if: • the pain in the neck-shoulder-backarm area persists or worsens rapidly, making it difficult to change clothes or walk • there is numbness in the arms or weakness in the muscles
Trigger finger/thumb See a doctor if: • the thumb or fingers can’t be straightened easily after bending • there is numbness in the hand and/or fingers Posture correction, mild painkillers, steroid injections, physiotherapy and heat treatment can usually reverse muscle and tendon damage in the early stages, said Dr Tay. In more serious cases when the condition has worsened, deep tissue massage, steroid injections or even surgery may be needed, he added. Dr Darren Tay has seen an increase in the number of patients with neck and hand pain, especially in the younger, more tech-savvy age group.
photos: alvinn lim
In the early stages of a repetitive stress or strain injury (RSI), people may buy over-the-counter painkillers or muscle creams to ease their aches and pains. Corrective posture exercises will also help. But if a condition worsens, one should seek medical attention, said Dr Darren Tay, Consultant, Department of Orthopaedic Surgery, Singapore General Hospital.
While this posture is fine when using a tablet for a short time, it is better to raise the tablet to eye level when using it for a longer period.
Avoid flexing the hand toward the palm for too long. Change the way the device is held every 30 minutes.
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singapore health
JAN – FEB 2014
> Continued from page 21
Micro tears and soreness usually heal with time, but poor posture that is not corrected can put increased pressure on the discs that cushion the bones of the neck. In the long term, the discs may wear out, or even slip out, causing them to pinch on the nerves. The affected person will then feel pins and needles running down his or her arms. Popularly referred to variously as text neck, blackberry thumb, nintendonitis, trigger finger or trigger thumb, “these pains are broadly grouped as repetitive stress or strain injuries (RSI),” said Dr Tay. If not treated, RSI can lead to other more serious conditions, he added. Typing repeatedly on a smart device can cause the tendons of the thumb or fingers to become inflamed, with pain on the inner side of the thumb or fingers, or at the joints. Over time, it might become difficult to flex the thumb or fingers as the digits become locked in a certain position, a condition known as trigger thumb or trigger finger. Such injuries are reversible in their early stages. So, while keeping such activities to a minimum is still the best option, practising good posture while using handheld devices can go a long way towards preventing more serious and irreversible consequences.
Stretch those muscles!
Exercise 1
Gentle nodding
Sit with the back and neck straight and slowly lower the chin towards the chest. Hold this position for five seconds before returning to the starting position. (Exercises 1-3 help stretch the neck muscles, keeping them supple and flexible.)
It’s not always possible to maintain the correct posture throughout the day and with time, slouching and poor posture can lead to aches and pains in the neck and shoulders. Ms Ruby Poh, Physiotherapist, Singapore General Hospital, demonstrates some stretching exercises to help loosen and stretch the neck and back muscles after being in the same position for a long time. All exercises should start from a good sitting or standing posture.
Exercise 2
Supported neck extension
Clasp the hands behind the neck. Without arching the back, slowly move the head back and look up. Hold for five seconds and return to the starting position.
Exercise 3
Not surprisingly, Dr Tay said that he is seeing more younger patients with neck and hand pain. Although no study has established a definite link between device usage and RSI, Dr Tay has started seeing an increase in the number of patients with neck and hand pain, especially in the younger, more tech-savvy age group. “The problem is probably more prevalent than we think. We have not accounted for those who self-medicate or seek more traditional forms of treatment. We only get to see the cases which have become severe,” he added.
Neck side flexion
Let the head fall towards the shoulder while applying gentle pressure with the hand. Hold for 10 seconds and return to the starting position.
Exercise 4
Neck rotation with arm flexion
Turn the head to one side while lifting the hand over the head. (This exercise helps to stretch the neck and back muscles.)
Exercise 5
Shoulder pull backs
Pull the shoulders back without arching the back. It helps to prevent the injuries that may arise from sitting in a slouching position for too long. (Exercises 5-7 help to stretch the back and shoulder muscles.)
Exercise 6
Wall angels
Stand against the wall and raise the arms up such that the elbows are at shoulder level and bent at 90 degrees. Lower the elbows towards the waist.
Exercise 7
Pectoralis stretch
Stand facing a corner, with one arm on each wall. Lean in and stay in that position for 10 seconds.
photos: alvinn lim
The (real) price of a smart device
For more exercises by SGH physiotherapists, visit youtube. com/user/mysghonline.
JAN – FEB 2014
23
pattern repeats itself. By then, one might have amassed an extra 216g of carbohydrates and 158g of sugar in a day – four times higher than what the Singapore Health Promotion Board recommends as the daily sugar intake limit for healthy individuals, which is a maximum of 10 per cent of calories, or 40g to 55g of added sugar. Chinese New Year only comes once a year, and one might think that caving in to temptation for an extra piece of scrumptious kueh bangkit is forgivable. But for some people, giving in to temptation can spiral out of control and they end up bingeing or consuming a large quantity of food in a relatively short period of time. The additional carbohydrates will go into their tally of total carbohydrates eaten during the day and cause a surge in their blood sugar levels. The end result – unhealthy weight gain. More effort may be needed to shed those extra pounds later. “We should be mindful of total calorie intake. Excessive calorie intake regardless of source (carbohydrate, protein or fat) will result in unwanted weight gain, so it is advisable to limit your intake of these festive goodies,” said Ms Kala Adaikan, Principal Dietitian, Singapore General Hospital.
Sugar rush Popping too many bak kwa slices, pineapple tarts and other delectable Chinese New Year delicacies can lead to a sugar overload – and kilos that are hard to get rid of later
photoS: GETTY IMAGES
F
easting with family and friends is part of the tradition and excitement associated with the Chinese New Year celebrations. Many of us also look forward to indulging in Chinese New Year goodies such as pineapple tarts, kueh bangkit, love letters, and bak kwa with our families during the festive period. Unfortunately, most Chinese New Year delicacies are also high in refined carbohydrates and loaded with sugar. For instance, a slice of tantalising bak kwa contains 22g of carbohydrates and 22g of sugar, which is similar to a packet drink with 24g of carbohydrates and 23g of sugar. Two pineapple tarts – everyone’s favourite – contain 22g of carbohydrates and 12g of sugar, while two pieces of love letters can contain as much as 18g of carbohydrates and 10g of sugar. Tempted by the huge array of sweet treats, one might start off with a piece of bak kwa, then pineapple tarts – one, two, three and four – followed by two crunchy love letters, all washed down with a packet drink. In just one sitting, as much as 108g of carbohydrates and 79g of sugar would have been consumed. Visit another relative later in the afternoon and the
singapore health
Keep those extra kilos at bay
1
Have a healthy breakfast before visiting relatives and friends A healthy breakfast should include complex carbohydrates packed with lots of fibre (eg whole oats, multigrain cereals, wholemeal bread), nuts and seeds to make one feel full for a longer time and less inclined to binge. Complex carbohydrates release glucose into the blood stream at a slower rate, compared to sugary foods.
2
Skip the sugary canned drinks Ask for tea instead, or even water. Hosts can prepare lemon water or offer their guests beverages with reduced sugar.
3
Spread out the carbohydrates throughout the day Instead of consuming large quantities of food at one go, cultivate the habit of taking small, frequent meals.
Counting Calories Sample Festive Delicacies Packet drink (average) Bak kwa, 1 slice Pineapple tart, 2 pieces Love letters, 2 pieces Kueh bangkit, 2 pieces
Carbohydrates (g) 24 22 22 18 8
Source: Department of Endocrinology, Singapore General Hospital
Sugar content (g) 23 22 12 10 2
Energy (kcal) 92 229 163 112 46
4
Cut down on the portions The piece of bak kwa may look tempting, but instead of wolfing it down whole, try a bite-sized portion or offer to share it.
5
Snack on fruits, seeds and nuts The complex (starchy) carbohydrates contained in fruits, seeds and nuts (eg sunflower seeds, almonds, pumpkin seeds) are filling, making one less inclined to binge on festive goodies. Have a fruit with main meals – the recommended fruit intake is two servings per day.
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Exercise more Exercises, such as walking, help the muscle cells to absorb blood glucose. Brisk walk for 30 to 60 minutes every day during the festive period. Source: Ms Kala Adaikan, Principal Dietitian, Singapore General Hospital Information for the article was adapted from www. healthxchange.com.sg.
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singapore health
JAN– FEB 2014
Battling morning sickness
Common in early pregnancy, the condition can be mild and not need any treatment, or severe enough to put the mother-to-be in hospital. By Lediati Tan
P
ment to severe, intractable vomiting that needs to be treated with intravenous fluids and medication, and may even require hospitalisation. Patients with hyperemesis gravidarum tend to have more severe symptoms that may last longer. When it strikes, there is excessive vomiting and nausea before 20 weeks of gestation. Dr Hong said that while it does not pose any severe risks to the pregnancy in most cases, and usually clears up later, severe hyperemesis can lead to serious maternal malnutrition and maternal complications like Wernicke’s disease (brain disease caused by vitamin B1 deficiency) and Mallory-Weiss syndrome (bleeding from a tear in the lower oesophagus). If there is excessive maternal weight loss, there is also a risk that the baby will be smaller than average.
Photo: ZAPHS ZHANG
regnancy has been a challenging experience for Ms Jacelyn Pan who is expecting her first child and battling hyperemesis gravidarum – an extreme form of morning sickness that was widely publicised when it afflicted the Duchess of Cambridge during her pregnancy. Ms Pan, 31, an administrative assistant, first started experiencing symptoms such as fatigue, nausea, vomiting and loss of appetite six weeks into her pregnancy. The symptoms persisted during the day and became so severe that they upset her daily routine. Once, she was unable to stop throwing up for 15 minutes. She could not go to work or get out of the house, and was even hospitalised. At the time of the interview, she had already taken a month’s worth of medical leave. “With such severe symptoms, I couldn’t function normally. I couldn’t work, meet my friends or go out. My social life was affected. I was also always tired and could not concentrate,” she said. Ms Pan was diagnosed with the condition at KK Women’s and Children’s Hospi-
Ms Lynn Toh experienced only mild symptoms of morning sickness in the first trimester of her two pregnancies.
ing sickness, which is nausea and vomiting in pregnancy, is very common in the early weeks of pregnancy.
Despite suffering from an extreme form of morning sickness during her first pregnancy, Ms Jacelyn Pan has not been dissuaded from having more children.
Causes vary Dr Hong said while the exact cause of morning sickness is not fully understood, it is thought to be caused by a combination of factors, including hormonal changes during pregnancy, genetics, overall health, as well as psychological and socio-cultural factors. Increased levels of beta human chorionic gonadotropin – known as the pregnancy hormone – in the first trimester and high oestrogen levels throughout the rest of the pregnancy contribute to nausea and vomiting, she added. The severity and duration of symptoms varies with individuals – from very mild symptoms which do not need treat-
Photo: darren chang
tal (KKH) and hospitalised for three days. She was given a strong dose of anti-vomiting medication, which she has continued to use since then to help stop the vomiting. Her baby girl is due in January 2014. Not everyone is hit so hard Although most pregnant women experience some form of morning sickness, Ms Pan’s case is quite rare. Only a small fraction of women experience such severe morning sickness. Most have mild symptoms that go away after the first trimester. Ms Lynn Toh, 25, an administrative executive and mother of a five-year-old girl, is one of those lucky ones. She gave birth to her second child, a baby boy, in August 2013. During her first pregnancy, she vomited about three times during her first trimester but had no other symptoms. During her second one, she had no appetite throughout the first trimester, but did not vomit. She coped by eating small snacks or meals. Dr Hong Sze Ching, Associate Consultant, Department of Obstetrics and Gynaecology, KKH, explained that morn-
Seven in 10 experience nausea About seven in 10 women have symptoms of nausea or vomiting, which start between the sixth and ninth weeks of pregnancy, said Dr Hong. It can affect the mother at any time of the day, but usually improves as the pregnancy progresses. In nine out of 10 women, the symptoms disappear by the third month of pregnancy. However, some women, or one in 10, continue to have nausea and vomiting after 20 weeks, said Dr Hong. There is also a tendency for this condition to recur in subsequent pregnancies. Although morning sickness cannot be entirely prevented, there are ways to reduce the severity of the symptoms (see below). Ms Pan overcame hers by drinking fruit juice or honey water instead of plain water, which she cannot stomach. Her supportive husband helps by preparing fruits for her when she has hunger pangs at night. Despite the challenges, Ms Pan has not been dissuaded from having more children. She said: “My husband and I love children and we intend to have two. I will be more experienced and better prepared next time since I already know what to expect.”
Coping with morning illness Ensure adequate hydration by taking small sips of water (about 30ml hourly) or small amounts of fluids containing electrolytes between meals Avoid lying down flat after food, and use extra pillows to prop yourself up when sleeping Minimise situations that can cause nausea, such as removing sources of unpleasant odours Have small frequent meals of dry or easily digested foods such as porridge or boiled eggs, or fluids such as fruit juices and milk
JAN – FEB 2014
Cookbook for mums-to-be
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Pregnant women can now still eat healthily while tucking into dietitian-approved local favourites. By Jamie Ee
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here is no need to give up your favourite foods such as char kway teow and bubur cha cha when you are pregnant – not with the new dietitian-approved cookbook from KK Women’s and Children’s Hospital (KKH). The book, Good Eats For Mums-to-be, comes complete with nutritional advice, and features 35 local dishes with a healthy twist to increase their nutritional value but retain their taste and flavour. It is co-written by two KKH dietitians – Ms Christine Ong, Chief Dietitian and Ms Nehal Kamdar, Senior Dietitian – as well as popular food blogger and mother of three, Ms Heng Ju Ee (known to her fans as Ju on her blog The Little Teochew). The recipes were modified by the Mums-to-be should choose their foods wisely as they need more than 40 different nutrients during pregnancy.
dietitians to reduce their total fat and salt content while increasing their vitamin and mineral content, such as folic acid, calcium and iron, which are critical nutrients for pregnancy. Professor Kenneth Kwek, Chief Executive Officer, KKH, said: “While there are many antenatal cookbooks available, few are written with an Asian perspective and have certified dietitians as co-authors.” Eating healthily during pregnancy In the book, Ms Ong said that recent studies suggest that certain chronic diseases such as coronary heart disease, hypertension and obesity have their origins in the womb. “This indicates that the nutritional status of a woman at the time of conception can affect the subsequent health of her baby. It makes healthy eating before and during pregnancy extremely important,” she said.
She also dispelled the misconception that healthy eating means bland foods, saying that the recipes – even for char kway teow – were given a healthy twist without compromising taste and flavour. More than 40 nutrients needed Women need more than 40 different nutrients during pregnancy, some of the most important being vitamin A, vitamin C, folic acid, calcium, iron and DHA (Docosahexaenoic acid). The recommended daily allowances, functions and food sources are detailed in the book. For example, women need 600mcg of folic acid a day during pregnancy to protect their baby from birth defects in the brain and spinal cord. This can be found in foods such as spinach, honeydew, lentils and broccoli. The book also has a guide on how much weight a woman should gain at each stage of her pregnancy. For example, a woman of normal weight (Body Mass Index of between 18.5 and 24.9) should gain between 0.36 kg and 0.45kg per week during her second and third trimester. For those suffering from morning sickness, constipation or heartburn, the book provides both recipes and advice; for example, in the case of heartburn, to cut down on oily, spicy and acidic foods.
photo: GETTY IMAGES
Good Eats for Mums-to-be 35 dietitian-approved recipes
tips
for a healthy diet during pregnancy
Load up on high-fibre foods Increase your fibre intake with whole grains, fruits and vegetables. Skip foods like soft cheeses and raw or undercooked meat, eggs and seafood These are potentially risky for mums-to-be as they may harbour bacteria that can cause food poisoning and lead to miscarriages and stillbirths. Ensure that meat, eggs and seafood are cooked thoroughly before eating.
Focus on foods rich in calcium, iron and folic acid These nutrients will help your baby develop well. Folic acid prevents certain birth defects like spina bifida. Go for fresh foods Eat foods cooked with fresh ingredients to get maximum nutrients, flavour and taste. Preserved, canned and frozen foods may have lost some nutritional value, but they are still safe to eat, as long as they are properly packaged, sealed and stored,
Good Eats for Mumsto-be is now available at KKH’s Patient Education Centre for $20, as well as at all major bookstores for $25. All sales proceeds will go to the KKH Health Endowment Fund to support needy patients.
and consumed before their expiry dates. Avoid alcohol and caffeine Drinking alcohol may cause mental disabilities and poor foetal growth, as well as lead to miscarriage, stillbirth and premature birth. If you use it in cooking, let the food simmer for at least 30 minutes to allow the alcohol to evaporate. Caffeine is a stimulant and is best avoided. Source: Good Eats for Mums-to-be
Fish & Potato Pie Ingredients (serves 2) (A) 400g 2 large floury potatoes, boiled till soft, then peeled and mashed roughly ½ teaspoon (tsp) salt 1 small pinch pepper 1 small pinch paprika 30g butter, softened (B) 200g skinless snapper fillets (or any firm white fish), cut into mediumsized chunks and marinated in juice of 1/2 lemon 1 tablespoon extra virgin olive oil 30g or quarter wedge of yellow onion, chopped finely 150g frozen mixed vegetables, rinsed and drained ½ tsp sea salt flakes ¼ tsp pepper 1 tablespoon fresh parsley, chopped 90g shredded mozzarella Method 1 For (A): Boil potatoes in water till fork tender. Remove skins when it is cool enough to do so. Mash with salt, pepper, paprika and butter, then set aside. 2 For (B): In a skillet, heat oil and add onions. Cook over a low flame until the onions have softened but not browned. Add in the marinated fish chunks. As the fish cooks, flake some of it with your spatula. Add mixed vegetables, salt and pepper to taste. 3 Add (B) to (A), sprinkle parsley and mash gently to combine all the ingredients. Taste test and add more salt or pepper, if desired. Transfer to an ovenproof casserole dish and top with shredded mozzarella. 4 Bake for about 15 to 20 minutes in a preheated oven, at 170 ºC. The sides should bubble and the cheese should be lightly golden. 5 Leave to cool for about 10 minutes and serve with a side dish of salad leaves. The information and recipe in this article were adapted from Good Eats for Mumsto-be, co-written by KK Women’s and Children’s Hospital dietitians – Ms Christine Ong, Chief Dietitian and Ms Nehal Kamdar, Senior Dietitian – as well as Ms Heng Ju Ee, food blogger.
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brush, so it was difficult to care for them,” he said. He has since stuck to a meticulous oral care regime. He brushes his teeth twice a day, for about 15 minutes each time. He brushes them using the up-down motion as well as at a 45-degree angle. Once he is done with that, he uses an interdental brush to clean gaps between his teeth. And he rinses his mouth every time he eats, whether it is a snack or a full meal. “I used to spend only five minutes brushing my teeth in the past, but now I spend at least half an hour each day over two sessions,” said Mr Chan. Despite having a sweet tooth, he now avoids ice cream and chocolates.
Photo: GETTY IMAGES
What cancer patients should do Dr Sim said that patients undergoing radiotherapy should cut down on high-sugar foods, especially sticky foods, as they tend to adhere to the teeth. She also advised patients not to snack between meals or, if they must, to choose less acidic snacks. “The oral environments in the mouths of these patients can be quite acidic because they produce less saliva,” she said, explaining that an acidic oral environment increases the risk of tooth decay. Taking chewing gum that contains xylitol, a sugar substitute, and drinking hydrating fluids might help stimulate saliva production and help reduce acidity levels in the mouth, said Dr Sim. Besides taking impeccable care of his teeth and gums, Mr Chan also does jaw exercises twice a day. Dr Sim said that this is important to ensure patients can maintain the ability to open their mouths adequately, as there are patients whose jaw muscles become so scarred after radiotherapy that they cannot open their mouths wide enough for a dentist to reach their back teeth with a mouth mirror, let alone fix any dental problems. “For these patients, we can only prescribe painkillers,” she said.
When teeth come first
Cancer patients should fix their dental problems before radiotherapy to avoid flare-ups. By Ng Hui Hui “Cancer patients may overlook dental problems, which may flare up during radiotherapy. It may be tough to treat them then, as they might be feeling too tired or anxious from the cancer treatment. “It is important that patients practise good oral care because some of the side effects of radiotherapy are not immediately felt. We don’t want patients to have to deal with the side effects later, when they have recovered from their cancer.” Meticulous oral care regime is crucial When Mr Chan learnt of the possible side effects of radiotherapy, the food lover was afraid he would lose all his teeth, so he made up his mind to take good care of them, as advised by the doctors. He had two molars and one remaining wisdom tooth extracted before starting radiotherapy. “These were perfectly healthy teeth, but they were difficult to reach with the tooth-
Photo: ZAPHS ZHANG
W
hen Mr Stephen Chan, 62, was diagnosed with nose cancer three years ago, the first thing he wanted to do after recovering from the shock was prepare his family for his death. The retiree wanted to write his will and teach his wife how to manage the family finances. The last thing on his mind was taking care of his teeth. But that changed when he had to go for a thorough dental review at the National Dental Centre Singapore (NDCS) before starting his 33 sessions of radiotherapy. The review lets cancer patients get any untreated oral problems fixed before they begin high-energy radiotherapy, which kills cancer cells but can also impair oral health. Side effects include increased risk of dental decay, dry mouth, limited ability to open the mouth, sores in the mouth and difficulty using dentures or a prosthesis. Dr Christina Sim, Senior Consultant, Prosthodontics Unit, Department of Restorative Dentistry, NDCS, said:
Cancer patient, Mr Stephen Chan, addressed his dental problems before he underwent radiotherapy sessions and has since stuck to a meticulous oral care regime.
How to cope with the side effects of radiotherapy on oral health Side effects
Coping methods
Mucositis: Sores in the mouth Sores and ulcers cause discomfort and may interfere with chewing, speech and oral hygiene
Rinse with warm, alkaline salt water solution to soothe the sores
Apply anaesthetic gel to numb the mouth before eating or brushing
Avoid alcohol-based mouthwashes
Xerostomia: Dry mouth Radiation affects the salivary glands, resulting in a decrease in normal salivary flow. Saliva, which lubricates the mouth and protects teeth, thickens, and this makes swallowing difficult
Drink plenty of hydrating fluids
When eating, try to drink between each bite of food
Use salivary substitutes which are available from pharmacies
Caries: Tooth decay When salivary flow decreases, the protective mechanism of the saliva diminishes, leaving teeth susceptible to decay
Avoid high-sugar foods
Brush teeth after each meal
Visit the dentist every 3 to 6 months
Osteoradionecrosis: Bone death Radiotherapy destroys small vessels which carry nutrients and oxygen to the living bone. This reduces the bone’s ability to heal itself
This is a difficult condition to treat; therefore, a strict preventive programme is important
Trismus: Limited ability to open the mouth Radiotherapy may scar the muscles which open and close the mouth
Do jaw exercises
Difficulty using dentures or a prosthesis
Consult a dentist before wearing dentures again
An ideal exercise schedule – 10 to 15 times a day, for 10min each time
新加坡中央医院与新加坡保健服务集团的双月刊
“便携式胰腺”有助 于有效控制糖尿病 糖尿病患者可利用一个手掌般大小的泵和输注器，随时为 自己注入胰岛素，以帮助减少低血糖水平的情况发生。
糖
图：ALVINN LIM
感到尴尬。我只需在用餐前，按个按 钮就能为自己注射胰岛素了。” 现年50多岁的黄龙和被诊断患有第 二型糖尿病已有15年。在本地，糖尿 病患者占总人口的10%左右，而其中 90 – 95%是第二型糖尿病患者。 与无法产生胰岛素的第一型糖尿病 不同，第二型糖尿病是当人体开始产 生抵抗胰岛素或胰腺不再分泌足够的 胰岛素来稳定血糖所引起的。第二型 糖尿病的形成，往往与过度肥胖和不 健康的生活方式有关。 虽然黄龙和已在10余年前接受治 疗，可是至今仍没能把病情控制好。在 别无选择的情况下，他的剂量增加了。 根据新加坡中央医院内分泌科顾问 医生兼糖尿病中心主管马荣茂表示， 对不善于管理自己的病情的患者来 说，这个胰岛素泵会是个好帮手。 胰岛素泵是由泵、小注射器和小 软输管组成。胰岛素注射是经由连接 注射器和身体之间的小软输管。胰岛
根据马荣茂医生 (左), 糖尿病患者黄龙和先生使用胰岛素泵一个月后，血糖水 平不再大起大落, 比以前更有效地控制自己的病情。
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犹如传呼机一样的 胰岛素泵和输注器， 不只轻巧、毫不起眼， 却可以模拟正常胰腺 的分泌功能，帮助 调节血糖水平。
新地方，更多设施
原文 Desmond Ng
尿病患者黄龙和先生有个 神奇的装置。这装置犹如传 呼机一样，不只轻巧、毫不 起眼，却可以模拟正常胰腺的分泌功 能。黄龙和称它为“便携式胰腺”。 自2013年7月，黄龙和弃用胰岛素 注射，改用胰岛素泵。现在，无论他 到哪里都会带着装置，形影不离。“ 以前，我不是忘了注射胰岛素，就是 以不方便为借口，比如与客户用餐 等，放弃注射。” 由于糖尿病患者用餐时血糖值会升 高，运动时会降低，所以他们在进食 或运动前，都必须先注射胰岛素调节 血糖。 胰岛素是胰腺分泌出来调节体内的 葡萄糖或血糖代谢，是人体不可或缺 的要素。少了胰岛素，血糖就会不断 累积，进而造成严重的健康问题。 他说：“如今有了这个胰岛素泵， 我再也不必找借口到没人的地方注射 胰岛素，也不必为注射所造成的瘀伤
2014 年1 – 2月刊
使用前，患者必须接 受为期一周的训练 选择接受胰岛素泵疗法的患者必 须接受为期一周的训练。负责训 练的团队成员包括医生、营养 师、糖尿病专科护士和胰岛素泵 供应商代表。新加坡中央医院糖 尿病中心主管及内分泌科顾问医 生马荣茂说：“我们将与患者一 起合作，让他熟习装置，了解他 的饮食习惯，并提升他对胰岛素 泵的认识。然后，医生才会决定 适合他的胰岛素剂量。”
素泵可以在何时候连续输出微量的 胰岛素基础值，或在有需要时增加注 射量。 因此，为了有足够的胰岛素去分解 摄取到的碳水化合物，患者可以在用 餐前，根据自己当时的血糖水平，决 定需要补缺的分量才按下按钮，让胰 岛素泵把胰岛素注入体内。 使用胰岛素泵一个月后，黄龙和的 血糖水平不再大起大落，他比以前更 有效地控制自己的病情，餐饮选择方 面也得到更多的自由。 据马医生指出，其他国家的研究显 示，使用胰岛素泵的患者的确能更有 效地控制糖尿病病情，并减少低血糖 （血糖值异常偏低）的情况发生。当 患者出现低血糖的情况时，他们必需 赶紧吃些甜食，让葡萄糖水平急速提 升，不然他们就会晕倒。 其实，胰岛素泵早在20多年前就被 引进新加坡了。可是由于费用昂贵， 所以很少患者选用它。 在本地，一个胰岛素泵配套需要 $2,500至$9,000不等。患者每隔三天就 得更换输注器，这些额外的开销每月 大概也需要$150至$200。再说，这些 费用也不像其他欧美国家一样，可以 向医疗保险索赔。因此，在本地很少 患者使用胰岛素泵。 黄龙和所使用的是个价值约$2,700 的中档胰岛素泵。虽然其价格不便 宜， 但他仍感到庆幸，因他现在所使 用的胰岛素剂量比以前采用注射疗法 时来得低。
经过翻新后的新加坡中央 医院糖尿病中心已在今年6 月投入运作。中心不但设 有更多会诊室，更设立了 一项新设施，以供职员拍 摄患者的眼底照片，以便 清楚地检查患者的视网膜 和其他眼内部分。 如果没有及时检查出 糖尿病视网膜病这种并发 症，患者有可能会失明。 这种并发症直到后期才会 出现症状，到时候，患者 的视力很可能已严重受 损，或甚至是已完全失明。 现在，患者可以在糖 尿病中心内检查视网膜， 并在与医生会诊前得知检 查结果。新加坡中央医院 内分泌科顾问医生兼糖尿 病中心主管马荣茂说：“ 当患者来中心看诊时， 我们会拍摄他们的视网 膜影像，然后把影像传 送给新加坡眼科研究像 实验室（Singapore Advanced Imaging Laboratory for Ocular Research 简称 SAILOR）。 SAILOR可以在很短的时间内 把报告传回给我们，这样 我们就可以同时进行会诊 和检查报告，为医生节省 时间之余，也提升对患者 的服务。” 以前，马医生和其他同 事必须花时间去理解和说 明报告。现在，中心会把 拍摄到的影像立即传送给 新加坡眼科研究院附属的 SAILOR，让合格技术人员 理解并说明结果。 SAILOR的项目经理哈施 丽娜（Haslina Hamzah）女 士表示，自2013年7月起， 技术人员检查了来自新加 坡中央医院的163名患者的 影像，其中，47人被转介 到新加坡全国眼科中心。 在这些被转介的患者之 中，25人被证实患上糖尿 病视网膜病。 哈施丽娜说，在新加坡 的糖尿病患者之中，患有 糖尿病视网膜病的患者约 为30%，病情严重的患者则 占10%。
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刷出健康的牙齿 保持健康的口腔能降低罹患慢性疾病甚至癌症的风险 原文 Desmond Ng
是杞人忧天吗？ 据新加坡国立牙科中心修复牙医部牙 周病组顾问医生徐豪杰称，这项研究 并没有证实口腔菌斑的数量究竟是不 是导致癌症死亡的直接或间接因素之 一。这是个好消息。 他补充道：“有趣的是，研究发 现，那些死于癌症的病人，他们的口 腔健康状况的确是比战胜癌症的病人 还要恶劣。从这里得出的推论是：癌 症病人的死亡风险被提高与不良的口 腔健康可能有关联。要确证两者之间 是否真正存有因果关系，那就有待进 一步的研究了。” 他随即补充道，在过去的十年里， 牙周或牙龈病也受到其他医疗风险的 关联。各项研究将牙龈疾病和一些慢 性疾病联系起来，例如：糖尿病、心 脏病、中风、骨质疏松症、呼吸系 统疾病、早产低体重儿等。徐医生表 示：“一些研究显示，孕妇若有牙龈 疾病而未曾接受治疗，可能会产出体 格较小或早产的婴儿。” 恶劣的口腔健康以及不受控制的牙 龈疾病，还可能会使糖尿病恶化造成 血糖水平升高。 “有些病人前来看诊时，并未意 识到自己可能已经罹患糖尿病，”徐 医生说。“如果病人有糖尿病的家族 病史，或发现有严重的牙龈疾病时， 我会劝他们到综合诊疗所或看家庭医 生，进行空腹血糖检测，以便排除任 何糖尿病的可能性。这很重要，因为 牙龈疾病是糖尿病的并发症之一。” 他补充道，牙龈血管和体内较大的 血管相连。牙龈疾病的细菌可以穿过 牙龈缝隙，进入血流，然后转移到身 体其他部位。 据新加坡国立牙科中心顾问医生徐豪 杰，新加坡近一半人口的口腔健康状 况欠佳。
徐医生说：“细菌是通过嘴巴侵 入体内的。举例来说，在拔牙时，嘴 里的细菌可以通过刚取出牙齿的部 位，沿着血管，感染病人体内的其他 部位。幸运的是，在大多数情况下， 人体天然的防御机制有能力抵抗这些 袭击。”
刷牙齿的咀嚼 表面。可是， 切勿使用硬毛 牙刷过于猛烈 地刷牙，因为 这样可能会导 致牙釉质的过 度摩擦。
建立防御机制 要预防口腔问题，可以采取的措施有 很多。《美国医学杂志》刊登的一项 新研究发现，年纪较大的成年人若接 受彻底的口腔清洁治疗，相对于那些 不太关心口腔健康的人，出现心脏病 发作或中风的可能性会比较小。 在2012年4月，路透社曾报道一则 涉 及 将 近 2万 2千 名 50岁 以 上 的 台 湾 成年人的研究，发现假若第一年里接 受了专业的洗牙治疗，接下来的七年 里都不大可能会出现心脏病发作或 中风。 徐医生表示，最好的防线就是在家 养成良好的口腔卫生习惯，并定期看 牙医。
清洁牙齿10步骤
以下是新加坡国立牙科中心修复牙医部牙周病组顾问医生徐豪杰的一些 建议：
6
2
7 8
刷牙时切勿过于用力，否则可 能会对牙釉质或牙本质表面 造成过度的摩擦，给牙齿带来损 伤。
3
新加坡的统计数据 在2011年，本地的一项研究发现，每 10个新加坡人当中就有6人未遵从牙 医的建议每半年进行一次口腔检查， 而且43%的人仅在出现牙疼等问题时 才会去看牙医。此外， 56%的人每天 刷牙的时间都不到两分钟，18%的人 并没有每天刷牙两次。 据徐医生所言，由于20年前学校里 便开始强调口腔护理的重要性，新加 坡人对口腔卫生有良好的意识，口腔 健康水平也令人相当满意。 “可是，口腔健康水平 差的仍有四五成。他们 当中有些未曾意识到这 会酿成牙龈疾病，有 些则是因为牙科治疗 费而怯步，还有些根 本都不知道综合诊疗 所设有牙科服务。这些 阻碍会继续对口腔健 康造成不良的 影响，”他 说道。
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使用软毛牙刷，因为硬毛可能 会对牙龈线和牙齿表面造成过 度的摩擦。
以45度角刷牙，以便确保能够 接触到牙齿和牙龈线之间的区 域，也就是牙菌斑聚集的区域。
4
采用画小圈或者左-上-右的动 作抖动牙刷，以便清洁和刷除 牙龈线上聚集的牙菌斑。上下刷 牙或在牙齿之间进行剧烈的左右 移动，都不足以到达牙菌斑的所 在位置。
图：roger chua
爱
吃甜食、牙齿刷得不够彻 底或讨厌看牙医会影响口 腔健康。可是，有些人完 全都不把这儿当一回事。但假如您知 道，口腔卫生恶习可能与癌症有关， 您还会继续置知不理吗？ 在 2011年 6月 ， 瑞 典 发 表 了 一 份 《牙菌斑与癌症死亡率是否有关联》 为标题的研究，报告宣称因癌症而过 早死亡可能与口腔卫生有关。 研究发现，大量聚集在牙齿表 面上以及牙龈袋或牙缝中的菌斑 （bacterial plaque），长期下来可能 会成为致癌的因素之一。
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采用抖动动作，刷牙龈线处的 牙齿表面。对于前牙内侧，采 用上下动作。另外，还需要刷牙 齿的咀嚼表面。
刷牙两到三分钟，以便确保所 有牙齿都得到彻底的清洁。人 们平均的刷牙时间是一分钟到一 分半钟，实在是太短了。 每天至少刷牙两次，可以的话 最好是三次（即每餐后）。
刷牙后切勿吃零食，否则会造 成牙菌斑再次聚集。唾液含有 天然洁牙的功能，但入睡时唾液 流量会减少。所以临睡前，若口 中还残留着食物碎块，唾液并不 能完全清理你的牙齿。
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牙线抵住 牙齿向 上兜，而 不是往复 动作，否 则可能会 割伤牙龈。
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每年至少 看牙医一次，因为只有牙 医才能正确地诊断您的口腔 健康状况。要求牙医为您 进行牙龈检查。在检查 时，牙医会测量每颗 牙齿周围的牙龈袋深 度，并判断是否需 要进行牙龈治疗。
小型牙间刷能够进 入牙齿之间的缝 隙，进行更为彻底 的清洁。
2014 年1 – 2月刊
全效白内障手术 最新人工晶状植体，去除白内障也“矫正”其他眼疾，一举多得 原文 Tan May Ping
近
三年来，房地产经纪江先 生因白内障的关系而视力 下 降 。 尽 管 如 此 ， 他 仍 坚持自己不必动手术，继续过着忙 碌的生活。 “ 眼 前 虽 然 总 是 灰 灰 蒙 蒙 的 ， 感觉很不舒服，可是我承受得 了，”他说。 然而江先生情况一直恶化，直到 去年才肯接受治疗。没想到一次手 术不仅去除了白内障膜层，还解决 了他的散光、远视和近视问题，让 他感到无比惊喜。 开始时是植一只眼睛，两周后再 植另一只眼。完成手术后，他便永 远卸下那副陪伴他十年的多焦点眼 镜。“现在我的视力已近乎完美， 我可以对眼镜说‘再见’了，”他高 兴的说。 虽然晚上还会看得见光晕，但江 先生认为问题不大，还说：“我没 后悔做这手术，我还向几个朋友推 荐呢。”像江先生一样选择高端人 工晶体植入手术的患者，在新加坡 全国眼科中心已是越来越普遍了。
这个结合了白内障和屈光手术技术 的高端人工晶体使得手术更加便捷， 产出的效果更好，让患者永远免去戴 眼镜的麻烦。 根据新加坡全国眼科中心眼科高级 顾问徐纯碧副教授的统计，每年该中 心进行的白内障手术一共有约10,500 例，其中有11%的病例是采用高端眼 内人工晶体的。而她病人当中，有约 一半至七成选了这个疗法。
“高端人工晶体不仅可以改善病人 的远距视力，还能矫正散光从而获得 更清晰的视觉，” 徐教授说。 “另外，人工晶体可以矫正视觉偏 差，提高夜间视力，”徐教授补充道。 市面上虽然也有提供增强视力功能 的高端人工晶体，但不是每人都适合 使用，而是必须特别配置的。 然而，并存着的眼疾可能会影响视 力矫正的成功率。 所以医生应该视个人情况提供指导 与建议，再选出最适合的人工晶体来 以满足病人的视觉需求。 徐教授说，白内障手术所采用的 单焦点人工晶体能改善远距视力，有 矫正近视或远视的作用。 单焦点人工晶体可使主导眼有远距 视力能力，从眼有中距或近距视力能 力。这样一来两眼并用时，视力范围 就会提高，不用戴眼镜。不过，有时
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病人会出现残余散光和远视的症状， 要看清近处时还是需要配戴眼镜。
极微小的切口 目前，最广泛使用的手术被成为 小切口白内障超音波晶体乳化术 （Phacoemulsification）。 在执行手术时，医生在眼睛表面做 一個1.8毫米的极小切口，将超音波探 针伸入水晶体中，利用超音波共振， 将已经雾化、硬化的水晶体变成数个 小 碎 片 后 ， 利 用 吸 除 的 方 式 将 碎 片 吸出眼睛。最后植入人工水晶体來取 代原有的水晶体。 医生可以通过切口更好地控制术后 散光度并更为精确的将人工晶体置于 正确位置，从而增强其性能。 人工晶体材料也在不断改进，现在 可以通过非常小的切口将可折叠式的人 工晶体植入后又会恢复其完整形状。白 内障去除术的切口越小安全性就越高。
非所有人都适合 徐教授再三强调，并非所有患者都能 从高端人工晶状体植入手术中获益。 手术效果会因个人的眼睛状况而有差 异，某些病患可能还是无法完全脱离 眼镜。 例如，单焦点和散光型人工晶体可 用来治疗任何眼疾，包括散光。多焦 点人工晶体则适用于那些除了白内障 就没有其他眼疾的病患。 高端人工晶体在价格方面通常比其 他的来得高。可幸的是，白内障手术 费用可从保健储蓄户口（有把白内障 手术列入保险计划的）中扣除。医疗 保险也可能会为任何类型的人工晶状 体植入付费。 “所以手术前，我们都要以病人的 眼疾情况、视力需求、生活方式以及支 付方式等因素来做决定，”徐教授说。
人工晶体的作用 近年来白内障手术已不再只是除去 那层混蚀薄膜了，手术同时植入高 端人工晶体矫正其他眼疾，例如近 视、远视和散光等。
新闻
徐纯碧副教授检查病人的视力是否异常。
意见箱 医疗福利。可是，最近我接受了 一个无需住院的日间手术，院方 却要求我按照外国人的收费率缴 费。为什么？ 新加坡中央医医院答复： 自2012 年4月起，新加坡公民的外籍配偶若 符 合 资 格 ， 就 可 取 得 长 期 探 访 附 加 准证（Long-Term Visit Pass–Plus），并 重组医院的病房 级别及服务
无法自行登记 我按照预约时间到综合诊疗所看 医生。我尝试利用自行登记服务 亭，可是系统屏幕却显示我仍有 一张未付清的账单，还指示我到 登记柜台去处理，没让我完成登 记。为什么会这样？ 新加坡保健服务集团综合诊疗所 答复： 服务亭的用途不只是让病人 能够自行获取各种服务的排队编号， 也能向病人提出关于账单或财政问
题，好让我们的职员能够提供必要的 协助，例如理财辅导、津贴等。所以 对尚未付清账单的病人，系统便会指 示 他 门 到 登 记 柜 台 去 处 理 同 时 进 行 登记。
我为何得支付外国人日间手 术费用？ 我是一名持有长期探访附加准证 的新加坡人配偶。据我所知，持 有这种准证的人士可享用本地的
A级 B1级 B2+级 B级 C级 日间手术 专科门诊 急诊
在此计划下长期在本地居住。同时， 他们可在重组医院享用住院病人医疗 津贴，津贴比率与永久居民相近。 不同的病房级别的住院病人医疗津 贴比率各不相同。长期探访附加准证 持有人可享用的津贴比率与永久居民 相近，但他们在接受日间手术、专科 门诊服务和综合诊疗所服务时，均不 可享用津贴。 最高津贴比率
新加坡公民
新加坡永久居民
长期探访附加准证持有人
0% 0% 20% 10% 50% 25% 65% 40% 80% 55% 50% 40% 50% 25% 所有病人的紧急部门收费都是一样的
0% 10% 25% 40% 55% 没有津贴 没有津贴
取材自新加坡移民与关卡局网站 以上信息以出版时为准 若有任何关于入院手续、账单及程序等疑问，可电邮至editor@sgh.com.sg，我们会在这个 栏目里解答您的问题。
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新闻
2014 年1 – 2月刊
捐血 救人
新加坡的 血液使用率
一小时
一天
一年
15 400 100,000
（需要的血液单位）
捐血可以救人，捐献的血液对于意外受伤的人 士，严重贫血（缺乏红血球）的病人，甚至是新 生儿，都可能是一线生机。此外，新加坡的老化 人口和更为复杂的医疗程序，都增加了对血液的 需求。各种大型手术，包括心血管和移植手术， 以及癌症和血液失调症的治疗，都需要血液备 用。如果您想知道自己是否适合捐血，请浏览卫 生科学局的网站（www.hsa.gov.sg）。
捐血类型
您知道吗？ 宗全血捐献 由于捐献的 血液的保存期限十分有限， 因此我们需要不断的捐献。 血液的组成部分的保存期限如下： 血小板 全血 红血球
5天
35 天
如果您
经常出国 到昆虫或动物源性感 染风险偏高的地方，
您不该捐血。
这些感染病症包括 基孔贡雅热症、 疟疾、变异型克雅氏 病（疯牛病）和 西尼罗河病毒。
42 天
24.87%
25.49%
A
B
17,620
如果您需要接受 外科手术，您
降低过敏反应或 感染的风险。
如果您的血型是很罕有 的话，这也确保了您有 合适的血液可用。
资料来源：卫生科学局。除非另有说明，否则所有数字于 2012年1月1日至12月31日期间有效。
捐血站 › 卫生科学局 Bloodbank@HSA › 兀兰 Bloodbank@Woodlands › 多美歌 Bloodbank@Dhoby Ghaut › 您也可以在流动捐血站捐血。请上网浏览 donorweb.org, 以了解即将举办捐血活动的地点。
18,067
70,855
根据血型分类**的 捐献者总人数 2012年
可以先捐血
给自己，以便在需要输 血时使用。这将大大地
宗单采捐献*
43.59%
6.04%
O
AB
30,887
4,281
*单采捐献是指捐献者只捐出特定的血液成分，例如红血球、血小板或血浆。 **两大血型系统分别是A、B、O和AB ( ABO）型和 rhesus ( Rh ) 血型。 ABO血型旁边所标志着的“+”和“-”符号，就代表着不同的Rh血型。 在新加坡，少于1%的人口拥有Rh阴性血型。 Rh阴性血型的人只可接受同样的Rh阴性血型血液。
2014 年1 – 2月刊
新闻
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专家解答
早晨起床后，脚后跟和脚踝就感 到疼痛不已。即便休息后再站起 来时，疼痛依然存在。尽管如 此，我还是每天试着步行至少 30分钟。请问走路会使情况恶化 吗？我应如何减轻或消除疼痛？
频密往返外地会促使高 血压恶化吗？ 我经常需要到国外出差。有时 回国后只呆两天，隔天又得出国 了。最近，我被诊断患上高血 压。我想知道这样频密出国是否 会让高血压病情恶化？我该怎么 从忙碌的工作中维持身体健康？ 马不停蹄的生活对某些人来说不只带 来压力，也会促使高血压症状恶化。 如果高血压病症持续恶化，会引发其 他疾病，例如高胆固醇、心肌缺血症 和肾病。 定期接受医生检查，做心肌缺血症 的心脏评估，监控糖尿病病情以及定 时服药，可以更好地管理高血压的状
况。或者，你也可以利用市面上各式 各样的血压仪器，在家中轻松地管理 和掌控病情。 另外，改善饮食、生活习惯或作息 也会有所帮助，譬如减少盐分、糖分 和脂肪的摄取量和多吃蔬果，做适量 的运动如散步或简单的伸展运动，避 免情绪波动起伏过大，戒烟酒和充足 休息或睡眠等。 新加坡中央医院职业病内科高级顾问医生 邝玉婷
步行时，脚后跟和脚踝 都疼痛不已 我今年25岁，体重超重，平时也 只穿平底凉鞋或拖鞋。最近每天
从叙述的症状来看，这是脚后跟发炎 症。因为血液循环不良而引起的灼痛 或闪痛感，站立 或弯膝的话 会使痛楚加 剧。鞋底过 薄也会让情 况恶化。 其实，脚后 跟的急性炎症 一般只要多 休息便可以复 原。不然， 也可以在脚 上敷冰块或涂 抹消炎药膏，又或者 穿上有支撑作用的鞋子来舒缓发炎或 减轻痛楚。 为了确诊你的状况，你应该进行 临床检查。你可以上网查询足病学诊 所名单并向任何一家预约会诊。网址 是podiatryassociationsingapore.com/ pages/members.php 新加坡中央医院足病学科治疗师王俐雯
如何应付湿疹问题
我从小就有湿疹问题。在患处涂 上处方药膏后，情况虽有改善， 但没有痊愈，手指和脚趾上的湿 疹依旧反复出现。在过去几年 间，我身体的其他部位偶尔也会 出现湿疹。请问如何预防或减少 湿疹？ 湿疹复发是很常见的。要防止复发几 率，你应该： 保持皮肤湿润，使用温水和温性的 肥皂或乳液或非油性的乳液洗手或 洗澡。为了防止皮肤水分和天然油 脂流失，避免长时间或经常在热水 下洗澡或泡澡。必要时，可用海绵 轻轻地擦拭一些部位，如腋下、腹 股沟等。洗澡后，抹上润肤液保留 水分。 穿质地轻柔的衣服。避免质地粗 糙、贴身或会引起皮肤搔痒的衣 服，如纤维或毛织品。 尽量不要摩擦或抓痒。如果搔痒发 生，可用干净的湿冷布或毛巾轻拍 或直接冷敷在湿疹上。 避免处身在温度急速转换的情况 中，例如从炎热的户外直接进入冷 气房间。 避免情绪波动 新加坡保健服务集团芽笼综合诊疗所顾问 医生Shah Mitesh
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年 – 月刊 FA_TheShoeCo_ad_345x260mm.pdf
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3/12/13
8:39 AM