AHA Magazine Apr - Jun 2024

the power of positive living

ontents

8 COVER STORY

The Power Of Positive Living –Triumphing Over Loss And Illness

Through self-care, an active lifestyle and keeping up with a regular screening regimen, Mdm Doreen Ho is the picture of resilience and positivity. She shows how positive living and gratitude has empowered her to live her best life, despite its challenges

4 WHAT’S UP Community events, outreach efforts, and more

7 YH IN THE NEWS

16

A roundup of Yishun Health appearances in the media

14 Q&A Health and wellness questions asked and answered!

16 EVERYDAY HEROES

Bringing Sunshine Into The Wards Kandy Ling brings cheer to patients as an Eldercare Companion

20 LIVE WELL

Embracing End-Of-Life Conversations Through Art and Active Ageing

These active seniors showcase what ‘living well and leaving well’ means to them

Part 3 of 5

Our Journeys in Health series has been a showcase of resilience, hope and strength. In this third instalment, we share a story of how a positive attitude, proactive self-care and practice of acceptance and non-attachment can not only enable us to take charge of our health and cope with loss and illness - but rise above life’s challenges to pursue a fulfilling, healthy life.

24 SPOTLIGHT

Insights from Inside Our Endoscopy Centre

Patients come first at Yishun Health’s Endoscopy Centre

28 5 THINGS ABOUT…

Obesity

Obesity is a multifactorial problem. Deepen your understanding of its contributing factors

30 DAILY DOSE

Mammograms save lives!

Regular breast screening can detect cancer early and increase the chance of recovery

32 MAKAN TIME

Tempeh Three-Ways

Make the most of this plant-based protein with these three delicious recipes

34 FIT & FAB

The Lowdown on Lower Back Pain

Pain in your lower back? Learn how to manage it yourself – and when to see a doctor

WScan here to subscribe to aha online for regular updates and stories from Yishun Health!

hy aha?

The name aha holds much significance for us at Yishun Health. In part, it is a nod to our history; it also stands for ‘Advocates for Health in Action’. Through these pages, we hope to empower you to take charge of your own health and discover those ‘aha!’ moments that lead to a healthier, happier you.

PUBLISHER

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. It comprises Khoo Teck Puat Hospital, Yishun Community Hospital, and community extensions such as Admiralty Medical Centre and Wellness Kampung.

EDITORIAL TEAM

Nur Amalina

Hannah Wong

Jack Lau

Sabrina Ng

Sharon Ng

Albert Foo

EDITORIAL COMMITTEE

The editorial committee — made up of clinical, nursing, allied health, population health & community transformation, and administrative heads of department — advises aha’s direction.

A/Prof Tan Kok Yang

Bastari Irwan

Fatimah Moideen Kutty

Shirley Heng

Teresa Foong

www.ktph.com.sg/ about-us/media/publications

aha@ktph.com.sg

PUBLISHING AGENT

THINKFARM PTE LTD

www.thinkfarm.sg

MANAGING DIRECTOR

Christopher Tay

EDITOR

Sunuja Naidu

CONTRIBUTING EDITOR

Sheralyn Tay

HEAD, CREATIVE

Lee Lily

HEAD, CLIENT RELATIONSHIP

Jessie Kek

CONTRIBUTORS

Justin Loh & Ruey Yong

It’s TEMI to help!

First introduced at Yishun Community Hospital (YCH) in November 2022, TEMIs are autonomous robots that can move around wards to do simple tasks. On 8 January 2024, more TEMIs were rolled out at KTPH.

These robots have been used to deliver small items, make announcements, display videos and even enable patients to video call nurses for speedier response times. Another useful function is to orientate new admissions by showing them informative videos about their stay.

These robots come with voice recognition, making it

easy for nurses to give instructions. Nurses can also use applications such as Google Translate to better communicate with patients.

Driving our culture of sustainability

In December 2023, Yishun Health marked our annual Clean & Green Week to raise awareness of sustainability and the 4Rs – ‘Refuse, Reduce, Reuse and Recycle’. Numerous activities were held that week, including an exhibition and Green Bazaar at the KTPH Lobby that ran from

These capabilities allow nurses to save more time to focus on clinical care and help to improve patient communication, engagement and education.

6 to 8 December 2023. As part of the week, CEO Prof Chua Hong Choon and COO Ms Yen Tan launched eight electric vehicle (EV) charging points, making Yishun Health the third public healthcare institution to support EV charging. To better engage staff, the week also included competitions, among them a Sculpture Competition.

Upcycling used bottles and other materials, teams presented unique and creative pieces of art.

Staff also took part in the ‘Flintstones Challenge’ to construct vehicles from used cardboard boxes, plastic scraps and unconventional items. They then raced their vehicles along the promenade in a fun and exciting race.

Yishun Health CEO Prof Chua Hong Choon and COO Ms Yen Tan launched eight EV charging points

Staff taking part in the ‘Flintstones Challenge’!

Staff expressed their creativity, creating green-related upcycled sculptures!

TEMIs are autonomous robots that can also serve as a channel of communication

Empowering our seniors to live active & meaningful lives

Our Occupational Therapists celebrated Occupational Therapy Day on 11 January 2024 with an exhibition at the KTPH lobby. Emphasising the importance of functional health and its role in enabling active ageing and ageing in place, they showcased educational posters and activities that help to boost cognitive, physical, and psychological abilities.

This aligns with the goals of occupational therapy, which is to use activity and/or environmental rehabilitation to ensure people can continue to participate in daily activities and live meaningfully as much as possible despite age, illness or impairments.

To this end, the exhibition also

Gardening is also a meaningful activity that seniors can participate in

Our Occupational Therapists play an essential role in patient care

included interactive stations that showcased ways to enhance memory, motor skills, concentration and hand-eye coordination. There was a reminiscence table of nostalgic

Let’s talk about colorectal health

Yishun Health, together with Chong Pang CC and Montfort Care, organised a series of colorectal health talks for seniors in the community to raise awareness on colorectal cancer screening and prevention. Across two sessions, close to 130 participants turned up

to hear from our clinical experts.

At the talks, Dr Lee Yao Zong, Consultant, and Dr Brian Ip, Associate Consultant, from KTPH’s General Surgery department spoke about how to reduce colorectal cancer risk. They highlighted the importance of starting colorectal screening at the age of 50

items, colouring books and crafting supplies, as well as a mini garden. This was a popular station with passersby, who carefully repotted plants to take home.

and knowing one’s family medical history, adding that a healthy lifestyle with regular exercise, avoidance of excessive alcohol consumption and tobacco products were also important in lowering health risks.

KTPH’s Senior Dietitian Hazel Yeong then shared recommendations such as eating a diet rich in wholegrains, fruits and vegetables. She also stressed the link between red and processed meats and foods, as well as sugar-sweetened foods and beverages to an increased risk of colorectal cancer.

Participants at the colorectal health talks

A health talk being held at Goodlife Studio

Ushering in longevity and celebrating belonging in the dragon year

Yishun Health’s Regional Health Office (RHO) and Population Health & Community Transformation (PHCT) held a Lunar New Year celebration on 23 February 2024, welcoming some 100 community partners, NHG guests, as well as Yishun Health staff and senior management for a lively and warm gathering.

Themed ‘Longevity and Belonging (龙gevity& Be龙ing)’, the event was off to a roaring start with an exhilarating festival drums performance by students from Chung Cheng High School (Yishun).

CEO Prof Chua Hong Choon expressed his gratitude for the collaboration and compassion of all our community care partners, including nursing homes, GPs and various agencies and thanked them for their support in making care more accessible to residents. With the opening of Woodlands Health in May 2024, which will expand capacity across the northern region, Prof Chua

shared his hopes to be able to serve our patients better and continue to be a trusted healthcare provider for the population in the north.

Adding to the celebratory spirit of the day, guests took part in activities like zentangle, Chinese calligraphy and HAPPY exercises, and a joyous lohei tossing session to shouts of wishes for health, harmony and prosperity.

Prof Chua presented a zentangle drawing of a dragon designed by residents at the Wellness Kampung to the students

Close to 100 community partners, NHG guests as well as Yishun Health staff and senior management joined in the festivities to usher in the Year of the Dragon

Tossing for health, unity and prosperity

… in Vulcan Post

While mid-career transitions may seem daunting, they can also lead to more fulfilling opportunities. At the age of 30, Nurse Manager Faith Tan felt something was amiss. The satisfaction she once derived from work was waning. With a newfound desire to search for life’s meaning and purpose, Faith left the private sector to accept a role at a caregiver support centre where she dedicated herself to caring for the less fortunate. She later moved to Khoo Teck Puat Hospital after receiving a sponsorship offer to complete the Accelerated Diploma programme to become a qualified nurse. Today, Faith has clocked 20 years of nursing experience. She currently works at Yishun Community Hospital where she helps patients prepare for life at home.

Scan the QR code to read the full story on Vulcan Post

Hotpots have become an increasingly popular option at social gatherings and reunion dinners because they are flavourful, filling and fun. While there is no harm in occasionally enjoying a meal of hotpot, Senior Dietitian Seow Vi Vien shared that watching out for one’s sodium intake is key to eating healthily, especially during the festive period. Tune in to the interview to learn about the different types of soup bases, hotpot items, and dipping sauces with the highest sodium content.

…on KTPH Instagram

In conjunction with Occupational Therapists’ Day, we hopped on the viral “of course” trend which saw two of our occupational therapists gently poke fun at stereotypes associated with their profession. Watch as they take a humorous approach to the

trend by candidly sharing about their roles and debunking common misconceptions.

H…on KTPH Facebook

ave you always been passionate about helping others? If so, this may be your sign to make it a career! We welcome you to embark on a life-changing adventure where compassion and skills converge, and every action is a ripple of positive change. Join the ranks of nursing today and experience excitement, fulfilment, and growth across different specialisations. At Yishun Health, we take pride in providing our nurses with a dedicated and supportive community that values their expertise, supports their aspirations, and empowers them to make a lasting impact!

Scan the QR code to watch the short and quirky video Scan

Photo: Vulcan Post

Photo: Capital 958

Facebook

Cover Story

Triumphing Over Loss and Illness The Power of Positive Living –

Mdm Doreen Ho has experienced loss, grief, and more than her fair share of illness. Taking each episode in her stride, she has shouldered each one with quiet strength, continuing to live an active lifestyle. Accepting the challenges of life, she faces each day with gratitude, cherishing the present and celebrating each moment.

We hear time and again that early detection saves lives.

Mdm Ho’s case serves as a prime illustration underscoring the critical significance of regular and early screening. In 2023, she was diagnosed with stage 1 breast cancer during a routine mammogram she had booked under the Health Promotion

Board’s Screen for Life programme (read more about mammogram screenings on page 30).

“Ever since I was diagnosed with colon cancer in 2005 during one of my regular scopes, I have been keeping up with all my scans and screenings,” she shares. Her colon cancer was picked up at stage 0 at one of these regular scans. “For me, that really reinforced the importance of

Keen to see as much as she can of the world, Mdm Ho embarked on a series of travels last year

screening, and I would also do a mammogram every two to three years too. I never expected that this time, it was the mammogram that saved my life.”

In fact, at the point of diagnosis, the lump was only about 8mm in size – about the size of a dried soybean. According to Dr Clement Chia, Head of Breast Surgery Service, General Surgery, Khoo Teck Puat Hospital (KTPH), a tumour this size is “very small” and cannot be detected through a physical examination.

“We can only feel a tumour when it is about 1.5cm to 2cm big,” he says. “The fact that this was picked up at this size stresses the importance of going for screening.” He adds that the

benefit of catching breast cancer early is being able to do breastconserving surgery. “We just have to remove the cancer, not the breast.” Mdm Ho also did not need to undergo chemotherapy. Instead, she underwent radiotherapy, which is more localised and has relatively more manageable side effects.

PAIN IS TEMPORARY; LIFE GOES ON

Sharing her story at a public event held by KTPH as part of the Breast Cancer Awareness Month, Mdm Ho acknowledges that the diagnosis made her feel a little sad. “But I told myself, I had to accept the truth and face it, get my doctor’s advice and just go through it. I reminded myself

that the pain is only temporary.”

She recovered quite quickly after her surgery and was able to “get on with life” after about three months, starting line dancing and making travel plans. In July 2023, the week after her final radiotherapy session, she went on a snorkelling trip to Sabah.

Last year, the 66-year-old embarked on a series of travels — a 16-day trip to Italy, followed by one to Japan, another to China and a repeat trip to Tawau in Sabah. “Although I could not carry heavy things, I managed by splitting my luggage and getting the help of my friends,” she says.

Her experience of living well despite her cancer diagnosis is a

“After my colon cancer diagnosis in 2015, this really reinforced the importance of keeping up with all my scans and screenings. I never expected that this time, it was the mammogram that saved my life.”

Mdm doreen ho

goal that Dr Chia hopes for every patient. “Cancer treatment is not just about curing the cancer. More importantly, we want patients to regain function, go back to their work and their lives, and be able to do what they used to love to do,” he says. “Specifically, an active lifestyle can be helpful in alleviating the side effects of treatment, and contribute to mental wellness, which enhances health outcomes and overall quality of life.”

This is why KTPH’s Breast Clinic takes an all-of-person approach to

its cancer treatment regimen. Its team of compassionate and trained staff and volunteer befrienders offer guidance and support to newly diagnosed patients and those undergoing treatment.

At the clinical level, the medical team drives early rehabilitation, starting exercises as early as the first day after surgery. According to Dr Chia, even though there may be some discomfort, it is very important to start moving early, so that patients are able to retain their full range of motion. This rehabilitation approach

has resulted in good outcomes, with patients regaining their baseline function about six weeks after surgery in a research study published by KTPH Breast Surgery Service on breast cancer patients who underwent surgery.

“A POSITIVE MINDSET IS VERY IMPORTANT”

These days, Mdm Ho – who is semiretired – keeps herself busy with a little work, volunteering, a rich social life, regular exercise and travelling. She goes on morning walks and makes the most of the free exercise classes conducted at Bishan Park. Apart from taking hormonal therapy post-cancer to reduce the risk of recurrence, her overall health is good. “This is another chance at life,” she shares, emphasising that “life goes on” and a “positive mind is very important”.

This resilient nature is something she developed since childhood, she reflects. “I have gone through a few setbacks,” she shares candidly. As a child, the second youngest of seven siblings, she had a strict

Mdm Ho (middle in the first row) keeps herself busy by participating in activities like line dancing

upbringing that required her to be self-reliant. “My mother loved us, but did not pamper us — we were expected to help with the housework, go to school on our own and take care of ourselves even as young children,” Mdm Ho says. “When I was 12, I was put on the train to travel from Malaysia to Singapore alone. This trained me to be very independent and my character was built from there.”

She also suffered a mysterious debilitating illness at the age of 28. Plagued with exhaustion and weakness, she became bedbound for almost three years. “Doctors could not figure out what was

wrong so there was no way to treat it conventionally,” she recalls. Eventually, with a series of Traditional Chinese Medicine (TCM) treatments, she slowly recovered and regained her strength.

“That was the hardest part of my life because there was no solution,” Mdm Ho says. “This was the time I began to build a very positive outlook on life,” she elaborates, “I told myself to do whatever exercise I could. Even if it meant walking for just a few minutes each day, I would do it; and the next day, I would try to do more. It was worse than cancer, because with cancer, at least it can be removed or treated; there is a plan.”

UNDERSTANDING BREAST CANCER STAGES

Cancer stage is based on several factors. One common system is the TNM system which assesses the cancer stage based on:

This experience, she says, taught her that while many physical ailments are out of one’s control, “mentally, you can be well, so be strong and lift yourself up”.

ACCEPTANCE, MINDFULNESS AND LETTING GO

This optimism has not always been easy to maintain. When she was 55, her husband passed away from cancer just three months after being diagnosed. “We had a very happy marriage. He was a great husband and I could not ask for more, but our 10 years together was just too short.” This was a “very painful”

Different T, N and M in combination determines the stage of the cancer. Cancers treated in earlier stages usually have better outcomes, while more advanced cancers will need more aggressive treatment.

Stage 0 or Ductal Carcinoma in Situ (DCIS):

Stage 3: Stage 4: Stage 1:

The tumour is up to 2cm in size and is still largely confined to the breast with little lymph node involvement. Cancer cells are limited to the ducts and have not entered the duct lining or surrounding breast tissue. DCIS is not life-threatening, but it can increase the risk of developing an invasive breast cancer.

Stage 2:

The tumour is 2cm to 5cm in size and has spread to 1 to 3 nearby lymph nodes.

The cancer has spread to distant parts of the body such as the lungs, liver or bones. The tumour is more than 5cm with more extensive involvement of the lymph nodes and/or adjacent tissues (chest wall, skin), but has not spread to other parts of the body.

A summary of breast cancer staging is as follows:

Metastasis: whether the cancer has spread to other organs

Lymph node involvement

Tumour size

“Cancer treatment is not just about curing the cancer. More importantly, we want patients to regain function, go back to their work and their lives, and be able to do what they used to love to do.”

Dr Clement Chia Head of Breast Surgery Service, General Surgery, KTPH

part of her life, and she sought relief for her grief.

This led her to learning about the Buddhist principle of acceptance and non-attachment. “Letting go is not easy, but I try to practise it.” Cultivating an acceptance that everything is transient and suffering comes from holding on to emotions, desires and

possessions, Mdm Ho is better able to deal with change and foster a greater sense of inner peace and freedom. “I am more aware of the importance of living in the moment,” she says.

And as much as these challenging life experiences have helped her be more mindful in the moment, she also embraces the idea that death

is inevitable because “anything can happen”. “I have thought about how I’d like to ‘celebrate’ my death and make it a party with all my friends, good music and a delicious vegetarian meal.” (to read more about other seniors’ perspectives on ‘living well and leaving well’, turn to page 20.)

Reframing challenging topics and experiences into learning points and an opportunity for personal growth is what keeps Mdm Ho going. “Be positive and take charge of your own life – there are so many ways we can take care of ourselves, physically and mentally,” she says. One very practical way is to simply go for regular health screenings, she adds. “Screening is very important. Even if it is uncomfortable, it can save your life.”

Mdm Ho (middle) shared her experiences at a talk, accompanied by her doctor, Dr Clement Chia, Head of KTPH Breast Surgery Service (right), and Chia Li Yong, Senior Breast Radiographer, Department of Diagnostic Radiology, KTPH

DEBUNKING MYTHS ABOUT EAR CLEANING hear, hear:

Yishun Health experts answer your frequently asked questions about health, well-being and medical conditions.

In consultation with Dr Jane Lim, Consultant, Ear, Nose & Throat (ENT), KTPH

My husband has a habit of using cotton swabs to clean his ears.

Is this a safe practice?

The use of cotton swabs to ‘clean’ the ears is a dangerous habit as it can cause injury to the ear canal and ear drum and increase the risk of infection. Even though cotton swabs can sometimes remove earwax, they often cause earwax to be pushed further into the ear canal, causing the ear to be blocked.

Earwax is a natural substance secreted by the body to clean, protect and lubricate the ear canal. The ear has a self-cleaning mechanism and most people do not need to worry about earwax removal. If you do notice some

earwax just outside your ear canal, you may use a clean cloth or tissue to remove it. A simple rule to follow is to not insert anything smaller than your little finger into your ear canal.

If you experience ear blockage, do see a doctor to assess the cause of your symptoms as not all ear blockages are due to earwax. If it is due to excessive earwax, your doctor may prescribe wax-softening ear drops first to facilitate the normal self-cleaning mechanism of the ear.

In some cases, excessive earwax may need to be professionally removed. Safe and professional earwax removal methods include:

Ear syringing/irrigation: This uses a syringe to flush the ear with water and dislodge plugs of earwax. However, it is not recommended if there is an existing ear infection or perforated ear drum.

It is also not suitable for those who have had ear surgery in the past. Some polyclinics and general practitioners (GPs) offer such services.

Manual removal with instruments: This is performed mostly by ENT specialists. Various instruments are used, including a microsuction, which is a small suction device to suck out any earwax. A microscope is used during the procedure to give the doctor a clear view of the ear canal.

This method not only allows the removal of impacted earwax, but pus and any foreign bodies as well.

On some weeks, I find that I have more earwax build-up than usual. Why is this so and is it concerning?

Some people tend to produce more earwax than others because of their age, work environment or lifestyle. Earwax builds up faster if you:

• Dig your ears often

• Use earphones frequently

• Wear hearing aids

• Are of an older age

• Have ear canal stenosis (narrowing)

If you find that your earwax build-up is causing issues with hearing, do seek medical attention. Look out for symptoms such as ear discomfort, the sensation of blockage, loss of hearing, ear discharge, tinnitus (ringing in the ears), or ear pain. These signs may suggest other ear conditions such as an infection.

Recently, my neighbour recommended ear candling to me as she has tried it and had her ears cleaned. Is this method safe?

Ear candling claims to be effective in cleaning the ears by using a hollow candle to draw out earwax and other debris. The burning candle is said to warm the earwax to soften it, while creating a slight suction which pulls wax out of the ear.

However, these claims are not scientifically proven. On the contrary, research indicates that the procedure could cause more harm than good. These studies show that there is no negative pressure created during ear candling, which means that there is no suction that draws wax out of the ear. The residual debris post-ear candling is not from the ear, but from the candle itself.

Besides being ineffective, ear candling poses a danger as the hot wax and heat can damage the delicate tissues of the ear and cause burns to the face and ears, puncture the eardrum and even clog the ear canal with candle wax.

Bringing sunshine into the wards

With a nature as sweet as her name, Kandy Ling spreads joy as an Eldercare Companion, proving that kindness is the best medicine. With her empathetic approach, she is a beacon for patients with dementia, delirium, and depression.

With her cheerful smile and singsong laugh, Kandy Ling is a ray of sunshine at Khoo Teck Puat Hospital (KTPH)’s Ward D87. She can be seen sitting with patients, chatting with them and helping them at mealtimes. Whenever possible, she wheels patients around the hospital grounds for jaunts to the food courts and gardens.

Kandy is one of 13 part-time Eldercare Companions (ECCs) at KTPH who look after the socioemotional needs of patients with dementia, delirium and depression. Ward D87 is known as the CARMIE (Comprehensive Assessment & Rehabilitation of the Mentally Infirm Elder) ward, and it takes a personcentred no-restraint care approach towards patients with dementia. The ECC programme – launched in January 2022 – plays an important role in upholding this care philosophy.

Daniel Seah, Executive, Geriatric Medicine, KTPH, explains that the programme was started to

“I just focus on building rapport and keeping them comfortable and happy.”

Kandy LING Eldercare Companion, KTPH

provide better care for patients with dementia and/or who have diminished mental faculties as they need more attention but are unable to readily express their needs.

This is where ECCs like Kandy come in. They look out for patients, help them with daily routines, engage them in activities

and build rapport. This enhances the day-to-day care and improves patients’ emotional well-being during their stay in hospital.

The ward nurses and ECCs work as a ‘tag team’, where both complex clinical and socio-emotional needs are better looked after.

FROM PERSONAL CRISIS TO PROFESSIONAL COMPASSION

Kandy started working as an ECC in September 2023, ‘converting’ from her previous role as a Patient Care Assistant (PCA), a role implemented during the pandemic. The former salesperson shares that she had always found healthcare work meaningful but never had the formal training to join the profession.

During the pandemic, when the opportunity to become a PCA came up, she decided to give it a shot. It was a role she took up naturally. “My sales background also enabled me to interact easily with people.”

Converting to her ECC role was a natural progression as she already had the people skills and enjoyed the nature of the work. Kandy also appreciates the fact that helping these patients keeps her active and emotionally uplifted.

Her empathy for others comes partly from her own life experience. In her late 30s, Kandy had a personal crisis and suffered a bout of depression for about two years. At that time, she felt numb, tired and unmotivated. She worked hard to get out of her depressed state, with a wish to go back to feeling in touch

Kandy engaging a patient with a board game

with her emotions and connecting with people again. Shortly afterwards, she faced adversities in her marriage, which she has since managed to overcome. All these experiences have equipped her to better connect, empathise with and encourage patients who also face depression.

MEETING PEOPLE WHERE THEY ARE

It is this compassion for people that has helped Kandy build a rapport with patients. Even as she attends to physical needs such as feeding, bathing and toileting, it all starts with creating a positive emotional connection. “We must connect with them first, then we can help them,” she explains.

“We have to really listen to their stories and try to understand how they wish to be treated when they

are sick. Some people want a lot of attention, but others want to be left alone. We just do our best to engage with each of them accordingly.”

One of the biggest challenges Kandy faces in her role as an ECC is dealing with behavioural issues associated with dementia. This requires learning and applying specific skillsets, techniques and strategies for responding to all kinds of challenging behaviour.

For Kandy, this means taking the approach of meeting people where they are at instead of prescribing what she thinks they need. She recognises that as patients have no control over their circumstances, it is important to give them autonomy and dignity.

Once, she met a patient who stubbornly refused any assistance. Prone to falls because of fainting spells, he was fiercely independent

By building rapport with her patients and honouring their need for independence, Kandy is able to help them be more receptive to nursing care

and would push back at anyone trying to help him. Over time, Kandy got to know him better and found discreet ways to help him walk with minimal assistance. She also bought his favourite food for breakfast every morning, such as savoury Teochew kueh or soya bean curd with glutinous rice balls. These acts built rapport and trust with the patient, and helped to achieve his care goals.

In another instance, a patient was adamant about leaving the ward and taking the bus home. Instead of dissuading him, Kandy asked him questions about where he lived, what bus he would need to take and who he would call to inform them about his arrival. Unable to answer these questions, he was persuaded to stay another day and wait for his relatives to fetch him home.

There are also patients who have a habit of wanting to get out of bed from time to time. One patient once drew all the curtains to keep out prying eyes before jumping up and down on his bed. With supervision from the ECCs, patients’ independence and autonomy can be honoured without compromising their safety.

Such situations admittedly make the work of an ECC challenging. Nevertheless, Kandy does her best for her patients, in the hope that a breakthrough in care can be achieved. “I just focus on building rapport and keeping them comfortable and happy,” she adds cheerfully.

This, she says, makes it easier for patients to accept care such as improving their oral intake. In fact, Lee Suhui, Nurse Clinician, says that the nursing team has noticed an improvement. With the insight

FUN FACTS ABOUT ELDERCARE COMPANIONS AT KTPH

ECC is a part-time role that runs in four-hour shifts, from 9am to 1pm in the morning, and 2.30pm to 6.30pm in the afternoon. All ECCs have to commit to at least two shifts a week.

ECCs do not need to have a medical background as every ECC undergoes five days of training to familiarise themselves with the work and equip them with useful skillsets.

Their job responsibilities include:

• Running appropriate activities for patients

• Assisting in patients’ Activities of Daily Living (ADL) e.g. walking and toileting

• Engaging patients in conversation to learn about their likes and dislikes, hobbies and other personal interests and preferences

• Assessing the emotional and physical well-being of patients

• Maintaining vigilance at all times when caring for patients

To be an ECC, you should have some life and work experience, good people skills, be a keen observer, and enjoy working in a team.

COMMUNICATING WITH COMPASSION

Persons with dementia often experience memory loss and confusion and their reality may not correspond with ours. One way of addressing this is to use validation theory to comfort and reassure them instead of opposing their viewpoint.

Step 1: Acknowledge or validate feelings. E.g. “You sound upset/worried/ angry…”

Step 2: Offer to help by providing emotional support and reassurance.

E.g. “I would be worried too if…”

Step 3: Gently redirect attention to something else or change the environment, topic or activity

Source: https://www.dementiahub.sg/dementia-practice/communicationapproaches-in-dementia-care/

Scan the QR code for more information on caring for persons with dementia

from the ECCs on each patient, the healthcare team is able to come up with suitable care interventions and plans that best cater to the patient. “Patients are less agitated and are more receptive to our care. This is a direct result of honouring

the patient’s freedom of choice for independence,” says Suhui.

For Kandy, the best evidence that she’s making a difference is clear –it’s all in the welcoming smiles and happy faces of the patients she sees each day.

EMBRACING END-OF-LIFE CONVERSATIONS THROUGH ART AND ACTIVE AGEING

End-of-life conversations may seem too early until it is too late.

Overcoming the taboo of talking about death, eight seniors at Wellness Kampung @ 765 Nee Soon Central embarked on a journey of exploring their lives, leisure and legacies. Through conversations, interactions and activities, they reflect on what gives them meaning in both living and leaving well.

Mdm Devi Maniam stepped into her first ‘Both Sides, Now: Living Well, Leaving Well’ session with trepidation. She did not expect to embrace the topic with as much interest as she did. “I was not so keen at first because I did not want to think about such things, but I told myself to just go in and listen,

and keep an open mind,” she recalls.

As the concept of ‘living well and leaving well’ was explained, she began to see the importance of talking about such issues. “Life is not permanent; one day we will all have to go,” muses the 70-year-old grandmother of four. “By talking about it, we can express what is inside our hearts.”

TURNING END-OF-LIFE CONVERSATIONS INTO ART

Mdm Devi became one of the eight seniors at Wellness Kampung @ 765 Nee Soon Central who took part in this year’s ‘Both Sides, Now’ (see sidebar) programme.

Deciding to express herself through her passion for cooking,

Mdm Devi came up with a project, ‘From Atha* to You’, a series of images featuring her grandchildren’s favourite dishes. Photographed by her daughter, each print of her homecooked food features handwritten messages expressing her love for her grandchildren. In turn, her grandchildren wrote her notes as well. “It was nice to read what my

grandchildren wrote to me and about me,” she says, “I am touched that they appreciate what I do for them, and how I take care of them.”

For Mdm Chia Yim Fong, Mdm Koh Tong Cheng and Mdm Michelle Sim, their participation in the project took the form of a short film that portrayed how they learnt how to swim. Buoyed by each other’s support,

they found that they were not only able to overcome their fear of water, but were also able to rise above the social taboo of talking about death.

Mdm Koh, 82, shares, “When I started, I was even scared of standing in water. But I motivated myself and persevered.” Today, she is able to swim with confidence and does so several times a week.

*grandmother in Tamil

The seniors (1st row) at Wellness Kampung @ 765 Nee Soon Central together with the programme artists and Yishun Health staff

“When you swim, you leave all your troubles behind - it just washes away in the water,” she says. This form of exercise has also helped improve her stamina and trained her to breathe well.

Mdm Sim, who also took up swimming lessons to address her breathlessness, has found waterbased exercise very beneficial. As she became more water-confident, she found confidantes with whom she shared even deeper insights.

Together with ‘Both Sides, Now’ lead artist Salty Xi Jie Ng, the three ladies devised their short film ‘Float Free’, scripting and acting in the film. Enabling this collaborative process, which included other residents and staff who appeared in the film and helped behind-the-scenes, is a key focus of Both Sides, Now’s community development approach. The project has provided these seniors a safe space to talk candidly, explore ideas and choose how they would like to be engaged on difficult topics such as death – including what they want for their end-of-life plans. “Making plans now is important so you don’t have any worries about what will

happen when the time comes,” says Mdm Sim.

Mdm Chia echoes this sentiment, “There is nothing to be pantang (superstitious) about, death is something we must face,” she says, “If you are not open about these things, then who will know what you want? It brings me peace of mind because what I want - whether I am sick or whether I am gone - has all been said, so my family knows what to do.”

“I am very clear about what I want [regarding my endof-life decisions] and I don’t want to burden anyone.”

MDM KOH tong cheng, 82

OVERCOMING THE TABOO OF TALKING ABOUT DEATH

‘Both Sides, Now: Living Well, Leaving Well’ is a programme by ArtsWok Collaborative. Since 2013, this initiative has held activities, exhibitions and engagements to facilitate endof-life conversations. Through the arts and creative approaches, the programme encourages individuals, families and communities to explore, express and enact what living well and leaving well might mean to them.

‘Tides’ is part of this year’s edition of ‘Both Sides, Now’,

a mixed media community exhibition from 6 to 20 March 2024 at Wellness Kampung @ 765 Nee Soon Central.

In June 2023, Lead Artist Salty Xi Jie Ng, along with Assistant Artist Stacy Huang, engaged seniors in workshops and intimate conversations to cocreate artwork that revealed deeply personal insights into what living and leaving well mean to them.

According to Salty, “Over the past year, we’ve explored remembrance, ageing struggles, end-of-life priorities, and more, while building trust and community. Driven to join

‘Both Sides, Now’ by their desire to find connection over taboo subjects, the seniors are emerging on the other side to lead tours and end-of-life conversations.”

As part of her artwork, Mdm Devi Maniam worked hard to whip up all her grandchildren’s favourite dishes, which were then photographed

Mdm Koh has always kept an open mind about such issues. Almost a decade ago, Mdm Koh started on her Advance Care Planning, making decisions on what she wanted for her care should she become critically ill or unable to make decisions for herself.

“I am very clear about what I want and I don’t want to burden anyone.”

“It doesn’t matter how old you are, and at what age you go; the most important thing is to have lived well,” she emphasises. And part of this, she says, is to prepare well for the end of life. In fact, she has already made arrangements for her own funeral, including her coffin, altar items and more.

LIVING WHILE THE LIVING’S GOOD

Even as the project explored issues of end-of-life, it also became a

“There is nothing to be pantang (superstitious) about, death is something we must face.”

MDM Chia YIM Fong, in her 70s, semi-Retired

celebration of living a life welllived. The various activities and conversations gave the participants greater clarity and appreciation of the beauty of life and the warm and welcoming community around them.

Mdm Chia, who is semi-retired, expresses how grateful she is to be active and financially

“Making plans now is important so you don’t have any worries about what will happen when the time comes.”

MDM MICHELLE SIM, 59 RETIred

independent. For a long time, she has experienced pain in her legs and has had difficulty walking. To alleviate that, she taught herself to swim. Recent lessons have also developed her swimming skills and she now swims three times a week. “So many people helped me to improve, and I am so grateful!” she shares, “I never imagined I would learn to swim or be this active in my 70s.”

Mdm Sim, 59, looks up to these ladies in their 70s and 80s, admiring their tenacity and vigour. Retired, she keeps herself busy learning languages, gardening and volunteering. “I love learning new things with my friends. It is important to keep the mind active to prevent cognitive decline.”

She, like Mdm Devi and the rest of her friends, finds that the activities and open-door concept of the Wellness Kampung support their active ageing goals well. Whether it is simply hanging out to read the papers, sharing news or taking part in exercise classes or educational talks, there is joy in participating in their community and building bonds with each other. “Before we leave well, we must live well by keeping active and finding ways to enjoy life,” says Mdm Sim, “Being positive is the driving force to life.”

(L-R) Mdm Koh Tong Cheng, Mdm Chia Yim Fong and Mdm Michelle Sim built bonds of friendship through their shared experience of learning how to swim

Insights from inside our endoscopy centre

Getting an endoscope screening can be worrying for some –but Khoo Teck Puat Hospital’s (KTPH) Endoscopy Centre strives to make the experience as pleasant as possible with smooth care flows, patient-centred touchpoints and a focus on creating an environment of comfort.

There is an old saying in medicine that “all diseases begin in the gut”. And this may well be the case as research is proving that many aspects of our physical and mental health correlate to what is going on in our digestive system.

There are also other reasons to pay attention to our gut health, as diseases of the stomach and gut can cause serious complications if undetected for too long. All this underscores the importance of screenings such as gastroscopy and colonoscopy.

PROPER PREPARATION FROM THE START

The team at KTPH’s Endoscopy Centre not only recognise that these screenings are essential, but that people also find them a little intimidating. “Most patients express that they feel a bit anxious and worry that it will hurt,” shares Staff Nurse Alicia Sim. With this in mind, the team has developed a smooth and seamless process from referral to recovery (read about the direct access programme with polyclinics on page 25).

Launched in 2010, the Endoscopy Centre has focused on creating a hassle-free patient journey from start to finish, explains Rachel Chua, Senior Nurse Manager. When a patient is referred for a scope and attends the preliminary financial counselling session, they are given patient education brochures as well as materials they require to prepare for the procedure.

For example, if a patient is going for a colonoscopy, they are given the bowel preparation solution on the spot. “This means they do not need to make an extra trip to the pharmacy to collect it,” she says.

The team at KTPH’s Endoscopy Centre

“To reduce our patients’ anxiety and worries of undergoing an endoscopy procedure, we focused our efforts on creating a hassle-free patient journey from start to end.”

RACHEL CHUA

SENIOR NURSE MANAGER ENDOSCOPY CENTRE, KTPH

A FASTER ROAD TO SCREENING

KTPH’s Endoscopy Centre has partnered with NHG Polyclinics for the past 10 years to offer direct access to scopes. Typically, the wait from an external provider to KTPH requires an appointment at the Specialist Outpatient Clinic before a scope can be booked. This process does away with the additional consultation. Patients who meet the criteria can immediately be booked for an endoscope procedure, cutting down the waiting time from a few months to just two weeks.

The team makes sure patients are well taken care of before, during and post-procedure or continue any medication. This ensures they are properly prepared for their procedure,” Rachel shares.

Patients can also refer to an instruction booklet, complete with a pictorial guide, for advice on what to do, expect and look out for during the bowel clearing process that happens the day before the procedure. “A nurse will give them a call the day before the procedure and reinforce any instructions on the preparation, and whether to stop

This systematic and comprehensive process applies for all the scopes conducted at the Centre. Some of the most common procedures include gastroscopy, colonoscopy, gastroscopy with colonoscopy, the ligation of piles and sigmoidoscopy.

FOLLOWING THROUGH WITH PERSONAL TOUCHES

On the day of the scope, this attention to detail continues. For continuity of care, patients are tended to by the same nurse who conducted the pre-procedure call. This, says Rachel, helps to create a better sense of familiarity, increase safety and reduce repetition.

Alicia adds, “We do pre-procedure explanations so patients – especially those who are doing it for the first time – know what to expect. By giving them an idea and summary about what each step involves, they feel more at ease.”

During the procedure, the nurses also pay close attention to the patients to assess their comfort level. “We may reinforce relaxation techniques, give them warm blankets or adjust them to a more comfortable position,” she says. “These may seem like small efforts but they make a difference to our patients.”

For post-procedure, patients are also well taken care of as they come

“We do pre-procedure explanations, so patients – especially those who are doing it for the first time – know what to expect. By giving them an idea and summary about what each step involves, they feel more at ease.”

ALICIA SIM STAFF NURSE ENDOSCOPY CENTRE, KTPH

INNOVATION WITHIN THE DEPARTMENT

Apart from patient experience enhancements, the Endoscopy Centre has also implemented various improvements to their work environment and work flow.

One of these is a height-adjustable sink (right) that aids staff in the decontamination of equipment after each procedure. The sink caters to all heights, so that nurses can do their work more comfortably. This promotes workplace safety and lowers the risk of injuries.

Another innovation is the use of a special device for flushing scopes during the cleaning process. This device automatically dispenses the right amount of detergent and chemicals to ensure thorough and consistent cleaning, promoting accuracy in the dispensation of disinfectant, resulting in safer outcomes.

out of their mild sedation. Apart from monitoring their vitals in the recovery bay, the team offers patients a light snack and a hot beverage that is specially aimed at alleviating the gassiness and bloating that is a normal part of the procedure.

“We have created two kinds of special teas to help ease their bloatedness,” says Alicia. “Patients are given a choice of lemongrass tea or ginger tea, which they have said is both tasty and helpful for them.”

Before discharge, patients are also debriefed about their recovery, what to expect and any complications to look out for. Should they have any prescriptions, their medications are dispensed at their bedside to save them an extra trip to the pharmacy.

Follow-up calls are made after the procedure to ensure that all is well. These personal touches, says Rachel, have been very

well-received. “Patients say they appreciate the effort and that they feel less anxious.”

Take patient Mr Tan (not his real name), who was wow-ed at every touchpoint. He felt that he was in good hands throughout the procedure.

THE IMPORTANCE OF COLONOSCOPIES

“From the minute I walked into the centre until I got discharged, I had a delightful and pleasant experience despite my initial anxieties,” he shares. “The genuine professionalism, care and concern were clearly evident.”

Regular colonoscopies are recommended for people over the age of 50. This screening is becoming of great importance as it helps with early detection of colon cancer.

Colon cancer is becoming more common, not just around the world, but in Singapore as well. It is the leading cancer in both men and women, with over 1,800 cases diagnosed each year. This is because of rising risk factors such as obesity, smoking, drinking, a sedentary lifestyle and Type 2 diabetes.

Colorectal cancer usually starts as a non-cancerous growth of tissue called a polyp. These grow on the inner lining of the colon or rectum and may develop into cancer over time. A colonoscopy is helpful not only in detecting these growths, but also allows the doctor to remove them on the spot.

Things About... OBESITY

Each year, we mark World Obesity Day on 4 March. As public awareness rises on the significance of this disease on health outcomes and quality of life, the medical community is also learning more about its contributing factors and evolving in the way obesity is managed and treated.

In consultation with Dr Tan Bo Chuan, Consultant, General Surgery, KTPH

As our understanding of obesity grows, we have developed many ways to address the disease from multiple aspects. Obesity is a multifactorial problem and tackling it starts with acknowledging its impact on people, and extends to addressing it from a place of mutual ownership and collective and sustained effort. Obesity is not a problem that is confined to individuals. We need to understand the role of society and how other factors come into play.

OBESITY IS A PUBLIC HEALTH CRISIS

Obesity is a growing problem worldwide and is linked to serious health problems. Obesity – having a Body Mass Index (BMI) higher than 27.5 – is linked to 1 in 6 deaths. Obesity can lead to heart attack, stroke, cancer, chronic lung disease and diabetes – preventable non-communicable diseases that contribute to 75% of all deaths worldwide. It is also associated with shorter life expectancy, more years of poor physical function, higher healthcare spending and discrimination.

In Singapore, 10% of adults aged 18 to 74 and 16% of children and youth aged 6 to 18 suffer from obesity. The latter statistic is significant as childhood obesity rates are set to double in the next 10 years and 70% of children who are overweight at the age of seven grow up to be overweight adults.

OBESITY IS A COMMUNITY ISSUE

Obesity is not a choice, nor is it an individual lifestyle problem. Even though it can be due to poor dietary choices and inactivity, these are not the sole causes of the disease. In fact, many complex factors leading to obesity are beyond our control. Obesity has numerous roots, including heritable factors (genetics, sociocultural, environmental risks), biological factors (hormones, metabolism, gut health), medical conditions, external factors (food, sleep, stress, life events, access to healthcare) and more. To date, over 50 genes have been identified to have a role in the risk of developing obesity.

If you are craving something a little less nutritious, manage the quantity of it. This may mean sharing a dessert, ordering a smaller portion of fried food or simply enjoying your snack mindfully and stopping when you are satisfied. You can also watch the frequency of your favourite treats. It is perfectly fine to give in to indulgences occasionally. You may consider planning your meals and social events so that you eat healthier, quality meals most days with one or two treats in a week. 5 2 3

WEIGHT LOSS IS NOT JUST A NUMBER

Losing weight is not just about eating less or the numbers on a scale. Sustainable, healthy weight loss comprises regular physical activity and long-term dietary and behavioural modifications. In obesity treatment, this may also involve medication and/or surgery.

The goal of obesity treatment is not just to achieve a target weight, but also to lower the risk of cardiovascular

and metabolic diseases like diabetes and hypertension, and improve one’s sleep and mental health, among other benefits.

The good news is that a modest amount of weight loss of 5% to 10% can lead to improvements in many health conditions.

THE QQF METHOD OF SUSTAINING A HEALTHY DIET

Deprivation and crash diets do more harm than good. One way to maintain a healthier relationship with food is the Quality, Quantity, Frequency (QQF) method.

First, focus on the quality of food by opting for more nutritious foods. Follow the Health Promotion Board’s ‘My Healthy Plate’ as a visual guide to ensure a balanced diet. This means filling half your plate with vegetables, one-quarter with protein and one-quarter with a wholegrain carbohydrate.

JUST KEEP MOVING

Physical activity together with diet and behavioural modifications form essential pillars in the treatment of obesity. All activity counts – even housework, gardening, walking the dog or using a standing desk. Integrating short bouts of movement in your day is a good way to overcome sedentary behaviour and ease into a more active lifestyle. Think about how you can move more each day, whether it is taking a longer walk to the bus stop or taking the stairs instead of the lift. Start any exercise regimen slowly and progressively increase the duration and intensity. As you build up your strength and stamina, aim for 150 or more minutes of moderate aerobic activity a week, twiceto thrice-weekly moderate resistance training and daily stretching.

SAVE LIVES! MAMMOGRAMS

A screening mammogram could be life-saving. It is the best way to detect early-stage breast cancer that cannot be felt during a routine breast self-examination which significantly increases the chance of recovery from the disease.

In consultation with Dr Clement Chia, Head of Breast Surgery Service, General Surgery, KTPH

In Singapore, breast cancer incidence is one of the highest in Asia. Over the last 50 years, the rate has more than tripled, affecting 74 per 100,000 women currently. Each year, about 2,500 women are diagnosed with breast cancer and it is the most common cause of cancer deaths in women here.

According to guidelines from the Health Promotion Board, women aged 50 and above should go for a mammogram once every two years. For women between 40 and 49, annual screening is recommended.

The earlier breast cancer is detected, the more likely the chance of recovery. Early-stage breast

cancers also typically require less invasive surgeries and in some cases, avoid the need for chemotherapy.

For many women, one of the biggest obstacles to screening is anxiety over feeling pain during the screening. This is because during the scan, compression needs to be applied to the breast for a clear and accurate X-ray of the breast tissue.

Each compression lasts about 20 to 30 seconds and each breast is compressed twice to obtain a sideways and top-down view. This can cause discomfort in some women.

To make your next mammogram appointment more pleasant, try these tips.

Time your appointment with your cycle. If you are still having periods, schedule your mammogram one week after your period as this is when your breasts are less tender and sensitive.

Avoid using any talcum powder, perfume, lotion or deodorant on the day of examination. These products may contain metallic particles that can confuse the results. You can try to time your appointment in the morning or bring these with you to apply afterwards.

Wear a comfortable bra and a two-piece outfit for ease of changing. You will need to remove your blouse and bra and be given a gown to wear. Consider wearing a soft, non-wired bra on the day so that you will feel more at ease after the procedure.

Take some painkillers ahead of time. If your breasts are more sensitive, take an over-thecounter pain reliever such as Panadol about 45 to 60 minutes before your appointment.

Cut down on salt and caffeine a week before your appointment. The intake of these can lead to water retention, bloating and increase breast tenderness.

Highlight your concerns with your radiographer. If you are anxious or have experienced an uncomfortable mammogram in the past, let your radiographer know before the procedure. They can make adjustments as necessary to ensure that the experience is as pleasant as possible.

Learn to manage any post-mammogram discomfort.

Some people may feel sore after the test. Rarely, there may be bruising. These will ease over time and you may take a painkiller or use an ice compress to alleviate any lingering symptoms.

Don’t let fear hold you back from a mammogram. Even though a mammogram can feel uncomfortable, there are many strategies that can make the screening experience more pleasant. Your doctor and the healthcare team are there to support you during the process so that you can take charge of your health.

WHERE TO GET MAMMOGRAMS

Health Promotion Board Screen for Life

Subsidised mammogram screenings for women aged 50 and up

• $50 for Singapore citizens

• $75 for Permanent Residents (PRs)

• $37.50 for Merdeka Generation Cardholders

• $25 for Pioneer Generation Cardholders

For eligible Healthier SG (HSG)-enrolled Singapore Citizens, screening mammograms will be fully subsidised.

Find out about your eligibility for subsidised mammograms here:

The Singapore Cancer Society

Free mammography services at $0 for women aged 50 and above who have:

• Not gone for this screening in the last two years

• A valid Blue or Orange Community Health Assist Scheme (CHAS) card

Women who are between 40 to 49 may opt for the Community Mammobus Programme. This initiative brings mammograms to residential areas, making it easier and more convenient for screenings to be done.

Fees range from $0 to $35

Find out when the Mammobus will be in your neighbourhood and book an appointment!

TEMPEH, THREE WAYS

High in protein, probiotics and minerals, tempeh is not only packed with nutrients, but flavour as well. This trio of recipes make the most of this nutty-tasting, umami-rich protein.

Recipe provided by Mohd Nazri bin Johan, Chef de Partie, Food Services, in consultation with Nutrition & Dietetics, KTPH

BEANCURD STUFFED WITH SAMBAL TEMPEH

INGREDIENTS

Serves 4

• 40ml cooking oil

• 320g tau kwa, cut into circles

• 230g tempeh, diced

• 70g shallots, diced

METHOD

1. Trim the tau kwa into 4 circles

• 40g garlic, diced

• 30g chilli paste

• 3g salt, lower in sodium

• 5g sugar

2. In a heated frying pan, add 20ml cooking oil and shallow fry the tau kwa circles until golden brown. Remove from pan and cool

3. Create a shallow well in the tau kwa circles by scooping out the centre with a small spoon. Set aside the scooped out tau kwa

4. Dice the scooped out tau kwa into small pieces

5. In a heated pan, add 10ml cooking oil and pan-fry the diced tau kwa, shallots, garlic and tempeh till fragrant. Push to the side of the pan

6. In the same pan, add in 10ml cooking oil and sauté the chilli paste till fragrant. Mix well with the tau kwa-shallot-garlic mixture

7. Add salt and sugar and stir until thickened

8. Stuff this filling into the hollowed out fried tau kwa

9. Serve hot and enjoy!

KICAP SAUCE TEMPEH

INGREDIENTS

Serves 4

• 15ml cooking oil

• 200g tempeh, diced

• 70g shallots, minced

• 30g ginger, minced

• 30g garlic, minced

• 5g dark soya sauce

• 30g chilli paste

• 40g kicap manis (sweet soy sauce)

METHOD

1. Air-fry the diced tempeh at 200 for 7 mins

2. In a heated pan, add the cooking oil and sauté the shallots, ginger and garlic

3. Add the air-fried tempeh and toss to mix

4. Add dark soya sauce, chilli paste and kicap manis and mix well to evenly coat the tempeh

5. Serve hot and enjoy!

The lowdown on lower back pain

Affecting more than 8 in 10 people, lower back pain is one of the most common causes of pain and disability and can disrupt daily activities and one’s quality of life. Learn about the causes, different techniques on how to manage it and the options when it comes to medical interventions.

By Dr Asela J B Ratnayake, Clinical Fellow, Sports & Exercise Medicine Centre, KTPH

It can present itself as a dull ache, sharp pain, radiating discomfort or even numbness in the legs –whatever form it takes, lower back pain can affect anyone at any age and be a significant cause of loss in quality of life.

In fact, the World Health Organisation considers chronic lower back pain as a global public health problem because of its impact on workplace and social participation. About 70% to 80% of lower back pain is acute, meaning it lasts for a few days and usually resolves within three months while 20% to 30% is chronic and lasts for longer than three months, and comes with persistent disabilities and complications. There is also a third type of lower back pain known as acute-on-chronic, where the symptoms aggravate at different intervals throughout its longstanding period.

CATEGORIES OF LOWER BACK PAIN

Lower back pain is usually classified into three categories:

1. Non-specific

2. Specific condition-related

3. Serious or systemic conditionrelated

NON-SPECIFIC LOWER BACK PAIN

The most common type of lower back pain reported is non-specific and the exact cause is not known. However, it can be related to common issues such as:

• Incorrect ergonomics

• Fatigue

• Obesity

• Psychosocial stress

• Sleep deficit

• Smoking

• Lack of physical activity

• High volume of physical activity

SPECIFIC CONDITIONRELATED LOWER BACK PAIN

Another kind of lower back pain occurs less frequently and is typically related to specific conditions such as spinal injuries and/or structural pathological conditions. A few examples are:

• Fractures due to trauma

• Disc prolapse (also known as slipped disc)

• Lumbar spondylosis

• Facet joint arthritis

SERIOUS OR SYSTEMIC CONDITION-RELATED LOWER BACK PAIN

In other cases, lower back pain is due to conditions that require advanced and specialised care. This may include:

• Tumours

• Infections

• Systemic Inflammatory Diseases

• Trauma

With such conditions, lower back pain may also occur in conjunction with other symptoms.

Keep an eye out for red flags such as:

• unexplained weight loss

• fever

• non-mechanical pain (pain that is unaffected by movement, position, or activity)

• back pain that worsens at night

• numbness or weakness of the lower limbs

• altered bladder or bowel function

• a history of cancer, cortico-steroid use, spinal procedures, or illicit injectable drug abuse

If your lower back pain is accompanied by some of the above symptoms and factors, or if the pain worsens over time, seek prompt medical advice.

MANAGING AND PREVENTING LOWER BACK PAIN

Depending on the severity, lower back pain can be managed either through various medical interventions such as medication, scans and rehabilitation, or on your own at home. Do keep in mind that the intensity of your pain is an unreliable indicator of the cause or seriousness. If your condition is long-running and disrupts your daily activities, seeking medical advice is a priority.

It is also possible to manage lower back pain by yourself if your symptoms have no red flags. In the initial stages, avoid pain-aggravating movements. Rest and ice the affected area three times a day for about 10 to 15 minutes each time. Following that, you can switch to heat therapy, gentle stretching, and exercises such as yoga and tai chi to relax and loosen tight back and leg muscles. Lower back pain can take time to recover and heal, so do not rush the process.

Here are some exercises that can gently stretch the tight muscles that cause lower back pain

Bridging

You can also manage and ease lower back pain by sleeping in a neutral position. This means supporting your spine to alleviate excess strain and maintain its natural curvature. It is best to take steps in your daily life to prevent such pain from happening in the first place. Some back-healthy tips include:

• Maintaining good posture and ergonomics in your daily routine

• Engaging in regular physical

activity that includes adequate warm up and cool down

• Maintaining good form and technique when exercising

• Keeping a healthy body weight

These are key lifestyle measures that can prevent strain on the lower back. You should also avoid smoking, get adequate sleep, and adopt healthy methods of managing psycho-social stresses.

Side-to-side bent knee drops

Bottom to heel stretches

Tabletop leg and arm raises

Back extensions