A HEALTHIER, HAPPIER LIFE ISSUE 3 2019 中文由 23页起 BONE STRENGTH VERTEBRAL FRACTURES AND YOUR MOBILITY GET MOVING WHY EXERCISE IS MEDICINE FOR SENIORS GOOD NIGHT, SLEEP TIGHT CGH's Sleep Lab team monitors your sleep patterns to help you get much-needed shut-eye
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CGH's Sleep Lab team monitors your sleep GOOD NIGHT, SLEEP ... · offered, email [email protected] 2 CARING ISSUE 3 2019 ISSUE 3 2019 CARING 3 HEALTH NOTES Hearing loss can affect
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A HEALTHIER, HAPPIER LIFE
ISSUE 3 2019
中文由 23页起
BONE STRENGTHVERTEBRAL FRACTURES AND YOUR MOBILITY
GET MOVINGWHY EXERCISE IS MEDICINE FOR SENIORS
GOOD NIGHT, SLEEP TIGHT
CGH's Sleep Lab team monitors your sleep patterns to help you get much-needed shut-eye
ISSUE 3 2019 CARING 1
CONTENTS
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2223
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In the world of social media, everyone appears to live a perfect life. But the reality is far from that. Perfectionism is often an illusion we pursue but find hard to attain, and we get stressed when we can’t get it ‘right’. Read why not being a perfectionist is actually a good thing on page 5.
Meanwhile, many Singaporeans are also losing sleep over lack of quality shut-eye. When was the last time you woke up fresh and full of energy, ready to conquer the day? Meet the professionals who can help you track and understand your sleep patterns, and get tips for a good night’s rest on page 8.
Did you know that besides sleep, exercise is the next best energy booster? But while exercise is important, as we get older, our bones are more fragile. Learn how to prevent osteoporosis and vertebral fractures, and maintain your quality of life on page 12. And with exercise, remember that you are never too old to start! Find out how easy it is to fit in a daily workout on page 15.
In each issue of CARING, we work hard to ensure all articles are engaging and practical, like our regular GPFirst column. However, our content must evolve and the time has come to say goodbye to My GP Answers (page 19). However, you can still receive updates on GPFirst activities via its Facebook. Finally, thank you for participating in our survey — your feedback matters, so do keep them coming.
Till the next issue, happy reading!
Sarah Abdul KarimEditor
Supervising Editor Vivian Song
Editor Sarah Abdul Karim
Contributors Health Wellness Programme Team Robing Ng Sarah Abdul Karim Dr Fadzil Hamzah Dr Juliana Bahadin Dr Linsey Utami Gani Dr Shravan Verma Dr Teo Zhen Ling
We want to hear from you. To get in touch, provide feedback or update your subscription details, email us at: [email protected]
Caring is published bi-monthly for Changi General Hospital by NewBase Content. It is also available online at www.cgh.com.sg/CARING
USEFUL NUMBERS
Appointments and general enquiries 6850 3333
Pharmacy enquiries 1800 787 8787
Feedback 1800 850 2823
02 HEARING WELL, AGEING WELL Hearing loss and your cognitive health
05 IN PURSUIT OF PERFECTION How to overcome the need for perfectionism
08 SLEEP TIGHT Get deep, restful slumber
12 THE TRUTH ABOUT OSTEOPOROSIS AND VERTEBRAL FRACTURES Signs and symptoms and how to prevent it
15 EXERCISE IS MEDICINE Regular workouts go a long way
17 ALL ABOUT VISION LOSS Types of visual impairment and the importance of screening
19 YOUR GPs CAN TREAT THESE CONDITIONS On adult hand, foot and mouth disease and travel vaccinations
22 HEALTHY EATS Au gratin prawns with orange cheese sauce
23 吃出健康 鲜橙乳酪酱脆皮虾
24 听力好,乐龄更快乐 听力受损与认知能力
27 追求完美 如何克服对完美主义的渴望
30 酣然入梦 助您进入梦乡的小贴士
34 如何预防骨质疏松与椎骨骨折 及早发现警示与症状
37 消失的视力 视力受损的种类与视力检查的重要性
39 您的家庭医生能治疗这些 病症! 有关成人手足口症与旅行疫苗接种的提问
EDITOR’S NOTE
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CARING goes digital! Scan the code to read the latest issue
ABOUT THE OTOLOGY, BALANCE AND HEARING IMPLANT SERVICE The service started in January this year to provide timely, effective screening and treatment of hearing problems for seniors by bringing these screening tests closer to the community. The community hearing clinic, a collaboration with the Ministry of Health and SingHealth’s Regional Health System, was set up and is located beside the polyclinic at Heartbeat@Bedok.
Taking a multi-disciplinary approach, the service integrates otologists with CGH’s Department of Otorhinolaryngology — Head and Neck Surgery with audiologists, speech therapists, physiotherapists and medical social workers, to better manage diseases of the ear, as well as hearing and balance issues more comprehensively.
To find out more about the services offered, email [email protected]
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HEALTH NOTES
Hearing loss can affect your cognitive health, from memory to judgment and learning ability, so it’s important not to take it for granted
HEARING WELL, AGEING WELL
As we age, our senses grow weaker, including our hearing. However, understanding what causes
hearing loss and knowing what to do can help you prevent your hearing from deteriorating further.
This was the message behind “Hear Well, Age Well”, the first community outreach event by members of CGH’s new Otology, Balance and Hearing Implant Service. Held on 2 June, the event saw Associate Professor Yuen Heng Wai, Dr David Low and audiologists from the Department of Otorhinolaryngology – Head and Neck Surgery, at Heartbeat@Bedok ActiveSG Sport Centre educating participating residents on hearing-related issues.
More than 90 participants had the opportunity to learn more about hearing loss from the team, who spoke on topics ranging from the structure and function of the ear, tinnitus, the association between hearing loss and memory loss as well as misconceptions about hearing health.
“Our hope is that participants will realise that hearing loss is more than a personal health issue,” said A/Prof Yuen. “It can have a far-reaching impact on the family and society. At the same time, hearing loss is potentially treatable; currently, there are many devices and modalities available for the treatment and even restoration of hearing loss.’’
Going by participants’ positive feedback on the event, the message seems to have hit home.
One attendee, 69-year-old Mr Henry Kwek, thought it was a good session as it provided useful information and a chance to clarify questions he had about hearing-related issues. Sharing the same sentiment
Recent studies have shown hearing
loss to be a significant and, arguably, the
single most important modifiable risk factor
in the prevention of cognitive
decline
4 CARING ISSUE 3 2019 ISSUE 3 2019 CARING 5
HEALTH NOTES
was Mr Ganesan Maniam, 57, who has suffered from hearing loss since his younger days. He said, “If I had attended such talks earlier and had a cochlear implant, my life will be much different now!” He never knew such options existed till more recently.
For Dr Low, his main aim was to emphasise that hearing loss has more implications than just being an impediment to communication. He added that recent studies have shown it to be a significant and, arguably, the single most important modifiable risk factor in the prevention of cognitive decline.
So, if you think you may be experiencing hearing loss, don’t suffer in silence — consult a specialist.
Audiologist Joyce Lim offers this observation: “Our sense of hearing is often overworked, underappreciated and taken for granted until it is too late. Hearing loss, unlike blindness, is not obvious to others. This outreach will improve public awareness of the normal physiology of hearing and the devices available to address the degree of hearing loss.”
This health promotion talk is the first collaboration between the Otology, Balance and Hearing Implant Service and the People’s Association at the new Kampong
DID YOU KNOW? Myth: There are no other options for hearing loss besides hearing aids.Fact: For hearing loss that is not responding to hearing aids, options such as cochlear implants and bone conduction now exist.
Myth: Delaying managing hearing loss does not have an impact on one’s life.Fact: Early identification and proper management of hearing loss can prevent cognitive decline and are crucial to one’s mental and social well-being, as well as personal safety.
Myth: I need to clean my ears regularly to get rid of dirt within.Fact: The ear has a self-cleaning mechanism where skin migrates outwards, carrying wax and debris with it. Cleaning with cotton buds risks damaging the thin, delicate skin lining the ear canal and disrupting the self-cleaning mechanism, resulting in ear wax accumulation and infection.
Robing Ng is Manager, Corporate Affairs, at CGH
Chai Chee Community Centre. Participants can look forward to future collaborations currently in the pipeline.
MENTAL WELLNESS
“Congratulations on seeing through such a successful event, John!”
“Oh I don’t know, Kathy. I worked so hard on this that I had sleepless nights for two weeks leading up to the event. Yet, I still don’t think it was good enough.”
“Wow, don’t be so hard on yourself! All the attendees I spoke to seemed to think it was very well-organised. They even expressed interest in our future events!”
“Yes, that’s what others have told me. The feedback has been quite positive, but it bugs me that it could still have been better. I guess I need to work harder next time.”
Why striving for the best can sometimes backfire
Do you know people similar to John — people who frequently feel they are not good enough, no matter how well they do? John is an example of someone who is a perfectionist — one who has high standards and expectations and settles for nothing less than flawlessness. They are commonly critical of themselves and their efforts, and regardless of what they do, they tend to believe they fall short of the standards they set themselves.
Such individuals are often obsessed with achieving what they perceive to be the ideal standard — to the point of losing perspective
IN PURSUIT OF PERFECTION
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MENTAL WELLNESS
6 CARING ISSUE 3 2019
of the broader picture. Perfectionism can, therefore, ironically prevent
us from being our best.Some people see
perfectionism as a positive trait — perfectionists tend to have a strong work ethic and appear to be continuously
improving themselves. But such individuals also set standards
so high that they are either impossible to reach or are attained
at great personal cost. Perfectionists commonly suffer from sleep deprivation, have no time for recreational activities and experience high levels of stress.
They also tend to have strained relationships with loved ones, as they often demand that those around them meet their excessively high standards, and can become critical of those who fail to meet them.
The high standards that perfectionists hold themselves to are personally
demanding and unreasonable that it is unsurprising that many of them tend to develop mental health conditions such as depression, anxiety, chronic stress, burnout and suicidality.
Prolonged and heightened levels of stress can also affect physical health in various ways. It increases the risk of hypertension, suppresses thyroid function, decreases bone density and lowers immunity, causing the individual to be more prone to ill health.
Four ways to reduce perfectionism If you identify as a perfectionist, here are some ways to overcome your need for flawlessness.
1 Strive to achieve, but keep your standards and expectations reasonable. It is one thing to strive for excellence, but
quite another to hold yourself to standards that are too difficult to achieve. Tailor your expectations according to what is
reasonably attainable given your skills and the resources available to you.
2 Keep the bigger picture in mind. Remember your ultimate objective and ask yourself if obsessing over every
detail is truly helping you achieve this. In addition to work goals, what other goals do you have in areas such as relationships, personal growth, hobbies/skills, spiritual growth, physical health? Are you neglecting these other aspects in your life? Will what you do now matter in the long term?
3 Allow yourself to make mistakes. Making mistakes is not a sign of weakness and the consequences are
usually never as bad as you think. Mistakes are also necessary in helping us as we learn and grow. It is, after all, through knowing what works and what doesn’t that we get better at what we do. To overcome your fear of making a mistake, tell yourself that even if things don’t turn out the way you expect, you are a better and stronger person for it as you have learnt new lessons.
4 Be kind to yourself. Know that your self-worth doesn’t lie in being able to meet impossibly high standards. Speak
to yourself in the way that you would to the person you love most in this world. You’ll be surprised by how self-love and self-kindness can help you achieve what you truly want — you’ll be just as productive and also more balanced and satisfied as a person.
Having high standards can be a positive thing, as long as those standards are reasonable. And even if you fall short, it doesn’t mean you are weak or a failure. Instead, it is by making room for improvement that we give ourselves opportunities to grow — it is in the process of getting to that end goal that we become better and stronger individuals. There is still perfection in being less than perfect.
Perfectionists commonly suffer
from sleep deprivation, have no time for
recreational activities and experience high
levels of stress
HEALTHY VS UNHEALTHY PURSUIT OF HIGH STANDARDS
By the CGH Health Wellness Programme
Perfectionists
Believe that achieving anything short of the standards they have set for themselves is unacceptable.
Believe that they should never make mistakes because if they did, it would make them a failure.
Chronically stressed, anxious, depressed and dissatisfied with themselves because they are either unable to meet their own expectations or have to put in a lot of effort to do so.
Spend an excessive amount of time trying to “perfect” every detail of a task, such that they become less effective and efficient.
Sacrifice other important aspects of life, like their health and relationships, as they dedicate too much time and energy to attain their high standards.
Those who pursue excellence in a healthy way
Believe that it is normal to fall short of the standards they have set for themselves.
Believe that mistakes are inevitable and that they help them grow.
Able to work hard while remaining positive and having a positive relationship with themselves.
Spend a reasonable amount of time on each task such that more work can be accomplished.
Live a more balanced life, as they give equal attention to their work, relationships, health and other areas.
VS
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COVER STORY
ISSUE 3 2019 CARING 9
The phrase “falling asleep like a baby” seems to be something that rarely happens among Singaporeans. Sleep problems are fairly common
— 13.7 per cent of older adults suffer from at least one sleep disorder, and the top two sleep problems reported are sleep interruptions and difficulties in falling asleep.
Let’s look at the ABCs of having a good night’s rest.
Age: Many people think they must get eight hours of sleep each night. However, there is no fixed amount that applies to everyone, as different people will need different amounts of sleep at different stages of their lives. Others think that as they age and find themselves sleeping a lot less and waking up more frequently at night, something must be wrong. But sleep quality and patterns change as we age — our total sleep time may decrease slightly. Some changes you can expect as you get older are: Lighter sleep, brief awakenings, sleeping earlier or waking up earlier.
Body clock: Parents of newborns know all too well the difficulties dealing with
SLEEP TIGHTGetting a good night’s rest is important, but few of us get this. Here’s what you need to know to get quality shut-eye
their child’s erratic sleep patterns. From the moment we are born, our body clock changes at various stages of our life, depending on the different stresses and challenges we face. No one else knows your body like you do, so listen to it and give it the adequate rest it needs.
Consistency: The childhood practice of going to bed and waking up at the same time is important. Failing to do so may give rise to several sleep problems. That being said, you can allow for the occasional deviation in your sleep schedule, especially if you don’t feel tired at your regular bedtime. If you are too fixated on sleeping at a certain hour, it can create stress and make it harder for you to fall asleep. On such occasions, go to bed only when you are tired.
Disruptions: There are days when you feel you did not get a good rest the night before, and thus compensate for that by waking up much later or taking a longer nap in the afternoon. But this can be counter-effective and disruptive to your sleep schedule. Try to wake up at the same time even if you hadn’t slept well, and take
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COVER STORY
If you are too fixated on sleeping at a certain hour, it
can create stress and make it harder for you to fall asleep
a short nap in the day if you really need it. Naps should be less than 20 minutes long; studies have shown that anything more than that will create sleep debt, which is the cumulative effect of not getting enough sleep. A large sleep debt can lead to mental and physical fatigue. A good tip to follow: Don’t nap in your bed, as this could tempt you to oversleep.
Effort: We’ve all thought this: “If I cannot fall asleep, I should try harder, or at least lie in bed and close my eyes so I can get some rest.” Or, “If I cannot fall asleep, I’ll just watch TV or use my phone until I feel sleepy.”
But these tactics often will not help. Most experts agree that if you do not fall asleep within 15 to 20 minutes, you should get out of bed, go into another room and try a relaxing activity like listening to music or reading. Most of all, avoid watching the clock!
So, what are the ingredients for a good sleep?
• Have a relaxed mind and body• Create a conducive environment that
induces sleep• Listen to your body and go to sleep
when it tells you to• Stick to a regular sleep schedule
Getting professional helpIf you find that you’re still not getting quality sleep despite practising good sleeping habits, and your performance in the day is affected by it, you could be suffering from a sleep disorder. To understand your condition, your doctor may refer you to a sleep doctor — and you might find yourself spending a night in the sleep lab with a sleep technologist.
At CGH, sleep technologists are part of the allied health team and are trained to perform polysomnography, or sleep studies, and other tests to diagnose and treat patients suffering from sleep disorders. They work rotating shifts
To diagnose Obstructive Sleep Apnoea (OSA), a sleep physician will arrange for a diagnostic sleep study to be performed. This is usually carried out overnight in the lab. Parameters such as EEG, ECG, body position, airflow, respiratory efforts and oxygen levels will be monitored throughout the night. The sleep technologist will then analyse the raw data, and the sleep physician will create a report that would help diagnose the patient’s condition.
One of the best treatments for OSA is CPAP therapy. Patients will be referred to the CPAP counselling clinic, where a sleep technologist will fill the patient in on the details of CPAP therapy and help him get fitted for the treatment mask. The patient will be loaned a CPAP machine for a trial period, and they can purchase one if they decide to continue with the therapy.
Risk factors for OSA: • Male • Overweight • Large neck circumference • Narrowed airway and/or chronic nasal
congestion • Hypertension • Smoking • Family history
Signs and Symptoms: • Loud, frequent snoring • Choking or gasping while asleep • Breathing pauses noted during sleep • Excessive daytime sleepiness • Morning headache • Awakening with dry or sore throat
OBSTRUCTIVE SLEEP APNOEA
Sarah Abdul Karim is Executive, Corporate Affairs, at CGH
as there are clinics and procedures conducted both during the day and at night. Sleep technologists also run the Continuous Positive Airway Pressure (CPAP) and Non-invasive Ventilation (NIV) counselling clinics.
We speak to sleep technologist Audrey Seow on what her work entails.
What skills do you need to become a sleep technologist?We accept new staff with a diploma or degree in science or nursing. All sleep technologists are required to be certified by the internationally recognised Board of Registered Polysomnographic Technologists (RPSGT) to be fully competent to work in the field of sleep medicine.
Which other departments do you work with?Most of our patients are referred to us by departments such as Ear, Nose and Throat (ENT), Respiratory Medicine, Psychological Medicine, Neurology, Cardiology and more. We work closely with sleep physicians and nurses in both the inpatient and outpatient setting.
What is the biggest misconception about your job?People seem to think that all we do is observe others when they sleep at night. But it is more than that. We are responsible for taking the patient’s readings and analysing the information before they are delivered to the sleep physician.
Why do you think there is an increasing prevalence of sleep disorders now?There is now a greater awareness of sleep disorders among people. More of us also have poor sleep hygiene and habits, bringing about conditions like sleep deprivation and insomnia, no thanks to factors such as our stressful work schedules and increasing use of digital technology.
Tell us more about CGH’s Sleep Lab.The Sleep Lab performs both day and night studies. The night studies we carry out include: Diagnostic sleep studies, positive airway pressure (PAP) studies and transcutaneous carbon dioxide (TcCO2) monitoring. Meanwhile, our day studies include: Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT), actigraphy, oximetry studies and home sleep studies. Patients are usually referred to us from polyclinics and GPs for sleep-related symptoms like loud snoring, apnoea episodes and/or excessive daytime sleepiness.
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FEATURE
OSTEOPOROSIS AND VERTEBRAL
FRACTURES This silent disease affects our mobility and quality of life, but when detected early, can be treated more effectively
THE TRUTH ABOUT independently and is thinking of returning to work.
The story of Mdm T is common among patients with spine fractures and osteoporosis. The severe pain and loss of independence associated with back fractures are extremely debilitating and heartbreaking for those who have to care for them. Many such patients will also struggle with deformities in the back and a hunchback. But what exactly is osteoporosis and what does it have to do with our bones and fractures?
What is osteoporosis? Osteoporosis is a condition when bones become more porous and thinner. As a result, patients have a higher risk of sustaining fractures.
Seventy-one-year-old Madam T was independent and working part-time as a cleaner before a fall caused her
to fracture her back, which required her to undergo two surgeries. Because her bones were very fragile, she developed complications from the first surgery, which she underwent a year-and-a-half ago. She was in so much pain that she couldn’t lie down and had to use a wheelchair or scooter to get around. After much intensive treatment for osteoporosis and undergoing rehabilitation, she is today walking
JOIN US!In conjunction with the Singapore Spine Society, CGH will hold a road show on 5th October at CGH Auditorium to educate the public on the different types of spinal conditions and encourage them to get screened for osteoporosis early.
Look out for booth exhibitions from 9am to 10.30am, followed by talks by various speakers from 10.30am to noon. There will also be a live demonstration exercise by our physiotherapists, held at CGH Atrium from 12.20pm to 12.40pm.
EXERCISE IS MEDICINEWhy keeping active is more important than ever as we get older
to find activities you enjoy, while ensuring you build on the following:
1 Cardiovascular healthCardiovascular exercises are important in
the management of many chronic medical problems. Exercises include walking, stair climbing, swimming, hiking, cycling, rowing, tennis and dancing.
2 Balance Exercises like yoga and tai chi help you
maintain balance, stability and posture. They can also help reduce your risk of falling.
In 2017, Singapore topped the world as the country with the highest life expectancy at 84.8 years. Yet, we also have the
second-highest proportion of diabetics among developed nations, with one in nine Singaporeans suffering from the condition. Are we really living longer or just dying a slow death? And what can we do about this?
One of the best ways to ensure you remain in good health well into your twilight years is by exercising frequently. But starting or maintaining a regular exercise routine can be a challenge at any age — and it doesn’t get any easier as you get older.
The key is to go slow — if you are someone who simply hates to exercise — and before you know it, you’ll see changes in your health. Think about the daily activities you enjoy doing and how you can incorporate them into an exercise routine.
Some simple activities can include:• Lifting weights or brisk walking while
listening to music• Walking laps at the mall while window
shopping• Going on a nature hike so you can take
photographs
How to build a balanced exercise planMixing different types of physical activity can help keep your workouts interesting and improve your overall health. The key is
ISSUE 3 2019 CARING 15
• Often a silent disease — in the early stages, there are no tell-tale symptoms that alert you to its presence
• Associated with other conditions such as – Deformity, loss of height and back pain – Mortality and morbidity
• Predicts future vertebral and non-vertebral fractures – Vertebral: 4.4 times. Vertebral fractures are the most common, making up 46 per cent of all osteoporotic fractures – Hip fractures: 2.3 times
KEY FACTS ON OSTEOPOROSIS
Is it life-threatening? No, but osteoporosis can affect patients’ quality of life. It can also cause major fractures in the hip and vertebrae. Such fractures often require surgery. Some patients may also develop complications from the surgery and healing of these major fractures.
How will I know if I have osteoporosis?Osteoporosis is a silent disease and, for most patients, the first time they learn about the condition is after they suffer a major fracture. It is therefore important that you speak to your primary care doctor about getting a bone mineral density scan to screen for osteoporosis. When detected early, this disease can be treated more effectively, reducing your risk of major fractures in the future.
What are some of the treatments for osteoporosis? How effective are they? There are different treatment options for osteoporosis, ranging from oral medication to yearly or twice-yearly injections. Adequate treatment of osteoporosis also includes good nutrition, exercise and fall prevention. Addressing the causes of falls and treating osteoporosis can reduce fracture risk by as much as 80 per cent in patients who have had a fracture.
Am I too old for osteoporosis treatment?As our life expectancy increases, preventing fractures helps us maintain our independence and active lifestyle and contributes to our quality of life.
There is no such thing as being too old for osteoporosis treatment. Discuss your options with your doctor today!
Dr Linsey Utami Gani is Consultant, Endocrinology Department, at CGH
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FEATURE
3 Strength Strength training helps prevent loss
of bone mass, build muscle and improve balance. Exercises could include use of machines, free weights or elastic bands.
4 FlexibilityBeing flexible helps your body stay
limber and increases your range of movement for daily activities, such as tying your shoes, shampooing your hair and playing with your grandchildren. Flexibility exercises include stationary stretches and those that involve movement. These will keep your muscles and joints supple and less prone to injury.
So, the next time you visit your doctor, ask how he can prescribe exercise as medicine. Don’t spend your old age popping pills — instead, ride into your golden years in good health.
Common myths bustedHere are some of the most common myths when it comes to exercising when you’re older, as well as the real science that can help you age more gracefully.
MYTH 1: There’s no point to exercising. I’m going to get old anyway.FACT: Regular physical activity helps you look and feel younger and stay independent longer. It also lowers your risk for a variety of conditions, including Alzheimer’s and dementia, heart disease, diabetes, certain cancers, high blood pressure and obesity. You’re never too old to get moving!
MYTH 2: I am not aiming to be an athlete at this age.FACT: Changes in hormones, metabolism, bone density and muscle mass mean that strength and performance levels inevitably decline with age, but that doesn’t mean you can no longer derive a sense of achievement from meeting your fitness goals. The key is to set targets that are appropriate for your age.
MYTH 3: Exercise puts me at risk of falling down and I already suffer from chronic diseases anyway! FACT: Regular exercise actually reduces your risk of falling, by building your strength and stamina, preventing loss of bone mass and improving balance. Exercise also helps reduce the symptoms and impact of chronic medical diseases. In fact, there is evidence to show that physical activity complements medicine in managing chronic medical conditions and preventing their progression and complications.
MYTH 4: I can’t exercise because I’m disabled.FACT: Elderly folk who depend on personal mobility devices face special physical challenges, but can still lift light weights, stretch and do chair aerobics, chair yoga or chair tai chi to increase their range of motion, improve muscle tone and flexibility and promote cardiovascular health.
Dr Fadzil Hamzah is Senior Staff Registrar, Singapore Sport and Exercise Medicine, at CGH
DID YOU KNOW?Exercise is not only good for your body, but also benefits you mentally. It improves sleep, boosts your mood and self-confidence and keeps the brain fit.
HOW MUCH ACTIVITY DO I NEED? Moderate-intensity aerobic activityAnything that gets your heart beating faster counts
and
Muscle-strengthening activityDo activities that make your muscles work harder than usual
Tight on time this week? Start with just five minutes. It all adds up!
at least
150minutes a week
at least
2days
a week
FEATURE
Did you know that globally, 36 million people are blind and 217 million have moderate to severe visual
impairment? However, statistics have shown that 75 per cent of visual impairments are actually avoidable! Prevention is definitely better than cure, so let’s find out more about our vision and how we can care for it.
We start by defining “low vision”. Low vision is defined as a best corrected visual acuity (BCVA) worse than 6/12 in the better-seeing eye. Legal blindness is defined as BCVA worse than 6/60 in the better-seeing eye or ≤ 20 degrees (diameter) of visual field. A person with low vision has impaired visual function that cannot be remediated fully by spectacles, contact lenses or medical intervention.
Common conditions that cause vision lossUncorrected refractive errorA refractive error occurs when the shape of the eye does not bend light correctly to fall onto the retina (the light-sensitive tissue of the eye). It can be corrected by prescription spectacles, contact lenses or surgery.
CataractWe have a natural clear lens in each eye. When the lens becomes cloudy, blurred vision occurs.
Diabetic retinopathyIn diabetic retinopathy, diabetes damages the tiny blood vessels in our eyes. It is initially asymptomatic, but blurred vision can occur. Abnormal growth of new vessels can also bleed or cause tractional retinal detachment, leading to sudden, severe vision loss.
What you need to know about the different conditions that cause visual impairment
ALL ABOUT VISION LOSS
We are officially into the second half of 2019, and we hope your year has been a healthy and fulfilling one. In this issue of ECHO, we discuss a very important organ that is basic to our function — our eyes. The joy we receive from looking at blue skies and other wonders of nature can sometimes be dimmed when our vision becomes impaired. Dr Teo Zhen Ling is an ophthalmology resident who will be sharing with us some of the most common causes of visual impairment. We look forward to your participation in our next health screening. Until then, stay well! Dr Linsey Utami Gani, ECHO Programme Director
Normal vision With cataract
Normal vision With diabetic retinopathy
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FEATURE
GlaucomaGlaucoma is a group of eye conditions that damage the optic nerve. It is known as the “silent thief of sight” as initial vision loss is peripheral and not readily noticeable. In untreated cases, central and reading vision are permanently affected.
Age related macular degenerationThe macula is the central point of the retina in our eye. In age-related macular degeneration, damage to the macula leads to progressive loss of central vision and distorted vision (eg. straight lines appear wavy). Small abnormal blood vessels can also grow under the macula. These blood vessels can leak, resulting in scarring and permanent central vision loss.
Retinal detachmentRetinal detachment is the separation of the retina from the outer layers of the eye. Symptoms include a sudden increase in floaters, light flashes and the appearance of a curtain covering the visual field.
Get screened for vision lossWho should get screened?✓ Those aged 40 and above should receive
a baseline eye screen (based on AAO recommendation)
✓ Those with a family history of glaucoma✓ Diabetic patients should have an annual
dilated eye screen✓ Those with any of the warning symptoms
below: • Red eye, blurring of vision and
headache or nausea
Dr Teo Zhen Ling is Medical Officer, Department of Ophthalmology, at CGH
The ECHO health screenings in Kampong Chai Chee, Fengshan, Changi Simei and Kaki Bukit will be held over the next few months! If you have family members, friends or relatives residing in these areas, please encourage them to register to get screened!
Singapore citizens aged 40 and above with no known chronic diseases and who have not been screened within the last three years are eligible for these screenings. Registration via the ECHO website is no longer available. Please bring your NRIC, PG Card* or CHAS Card* and cash for payment to register at the community club or centre listed.*If applicable.
2019 ECHO HEALTH SCREENING
Venue Screening Registration Date Date
Kampong Chai Chee CC 7 Sep (Sat)
Fengshan @Blk 125 Bedok North Rd, 14 Sep (Sat) 1 AugCC Activity Centre
Changi Simei CC 26 Oct (Sat)
Kaki Bukit CC 9 Nov (Sat) 26 Aug
• Sudden vision loss • Sudden increase in floaters/flashes • A ‘curtain’ covering vision • Visual distortion; eg. straight lines
appear wavy • Scotoma; ie. loss of part of the visual field
When and where should I get my eyes screened?• Polyclinic or family practitioner• Community eye-screening clinics, health
screening events• Ophthalmology clinics
FOR MORE INFORMATION on health screenings, please contact ECHO at 67888833 or email [email protected].
Normal vision With AMD
Normal vision With retinal detachment
Normal vision With glaucoma
MY GP ANSWERS
Dr Shravan Verma is CEO and co-founder of Speedoc, a health-tech company that brings house-call doctors to patients. Entering medicine with a goal of bridging technology and healthcare, he has used his varied clinical experience to understand the perspectives of clinicians and patients to provide a platform that improves access to healthcare.
YOUR GPs CAN TREAT THESE CONDITIONS
The GPFirst Programme was launched in 2014 to encourage patients in eastern
Singapore to see their general practitioners (GPs) for mild to moderate medical conditions, rather than head straight to the emergency department. In this regular series, our eastern community GPs offer advice on common ailments Caring readers might face.
In this issue, we focus on hand, foot and mouth disease in adults and travel vaccinations. Do visit www.gpfirst.sg or see your GP for more information on other common conditions such as nausea, headaches, sprains, fevers, cuts and bruises and mild scalds.
I have two children aged 18 months and four years who are enrolled in the same childcare centre. Last week, both came down with fever and suffered flu symptoms before being diagnosed with hand, foot and mouth disease (HFMD) and I stayed home for days to care for them. This morning, I woke up with a slight pain in my throat and noticed a few ulcers on my tongue and blister-like rashes on my ankle and soles. Is it possible for an adult to be infected with HFMD? Should I keep my children away from me at this time and see a GP to assess my condition?
While HFMD is most common in young children, it is also known to affect older
children and adults. Children under five years old, like yours, are most susceptible to the disease as their immune systems are not yet fully developed. The disease is caused by enteroviruses, a group of viruses that cause a number of mild infectious illnesses. Polioviruses, coxsackieviruses and echoviruses are among the most common types of enteroviruses.
HFMD is highly infectious and is most commonly spread through direct contact with bodily fluids like mucus, saliva, faeces and blister fluids of infected people. If you are experiencing flu-like symptoms and noticing red rashes on your hands or feet that are flat or raised, it is likely that you may have contracted the disease.
You should see your GP and let him know when you began feeling unwell, when you first noticed symptoms and if the symptoms have since worsened. Your doctor will check for sores or blisters on your feet, hands and genitals. Sometimes, a lab test for related
ADULT HAND, FOOT AND MOUTH DISEASE
20 CARING ISSUE 3 2019 ISSUE 3 2019 CARING 21
MY GP ANSWERS
CLINIC MART
Dr Juliana Bahadin is Adjunct Assistant Professor at the Duke-NUS Medical School and Adjunct Senior Lecturer at the Yong Loo Lin School of Medicine. She also practises at Saudara Clinic by A+J General Physicians. Prior to this, she was Clinic Director at SingHealth Polyclinic in Bedok, and later completed a fellowship at B.C. Women’s Hospital & Health Centre in Canada.
antibodies or viral materials in the blood may be needed to confirm the diagnosis. Throat swabs and stool samples may also be taken to determine the type of virus that’s causing the disease.
Other than symptomatic treatment, there is no cure or specific treatment for HFMD. Your GP can only prescribe over-the-counter medication to help relieve the pain, fever and other symptoms.
Complications are rare but can develop if HFMD is left untreated in certain individuals, leading to secondary infections that may affect the skin, brain and nervous system. Fortunately, most patients recover without complications, as the disease is mostly self-limiting. For those who are otherwise healthy, HFMD is not a life-threatening disease; even without treatment, it usually clears up within a week or two.
During this time, you should keep your children away from you, especially if they themselves are recovering from the infection, as it is possible for them to fall ill to the disease again. Do also remember to practise good hand hygiene and disinfect shared surfaces regularly.
My husband and I have decided to take a long break from work next year. We love outdoor activities and are planning to go white water rafting and trekking at Mount Kinabalu in Malaysia. What type of vaccinations should we get before we visit Kinabalu Park? Will my GP be able to provide these vaccinations and offer us travel advice?
Rafting and trekking are fun activities, but they can also be dangerous if you are not well-prepared. This includes improving your physical fitness, especially your cardiovascular health. As such, you should embark on a regular cardio training programme that includes activities like long-
TRAVEL VACCINATIONS
ABOUT GPFIRST
distance brisk walking, jogging or climbing before your trip.
If you plan to scale all the way to Mount Kinabalu’s peak, be sure to ascend the mountain gradually. Take time to rest at camp sites along the way to allow your body to acclimatise to the thin air at high altitudes. If you feel light-headed or breathless, it is a sign you are experiencing altitude sickness. Simple measures to fight altitude sickness include:
• Stopping and resting where you are — don’t ascend any higher for at least 24 to 48 hours
• Taking ibuprofen or paracetamol if you have a headache
• Staying hydrated — make sure you are drinking enough water
• Avoiding alcohol• Not smoking
It can also get quite chilly at high altitudes as temperatures drop significantly, especially in the evenings, so bring along sufficient warm clothing. If you do not have a thick winter jacket, simply put on several
layers of warm clothes as this helps to trap heat.
Do also check that your vaccinations are up to date before you leave for your trip. Travellers to Mount Kinabalu are usually recommended to get vaccinated against food- and water-borne diseases like typhoid and hepatitis A. Additionally, you should check that your last tetanus vaccination was taken less than five years ago. If not, you could choose to get tetanus toxoid vaccine or the combination tetanus diphtheria or Tdap vaccines. If you have any chronic disease like diabetes or asthma, it is preferable to also
This will be GPFirst’s final column in CARING. For more updates, follow us on Facebook!
When a fever or a bout of mild diarrhoea hits, where do you first head to? For many, it’s the Accident and Emergency Department (A&E). Started as a pilot in 2014, CGH partnered GP clinics in the east to launch GPFirst, a programme aimed to encourage patients to visit their GPs for conditions that do not require emergency care at the A&E.
get the influenza and pneumonia vaccines.If you plan to trek in forested areas, you
should also get the malaria prophylaxis vaccine. Otherwise, a good dose of mosquito repellent and covering your arms and legs can also protect you against mosquito bites. Make sure you bring along some plasters, antiseptic solution like iodine and alcohol swabs for any minor injuries that might occur along the way.
Your GP should be able to provide you all this information. He or she should also be able to advise you on any additional precautions to take, based on your medical condition. Have a great holiday!
> 200 GP clinics under the GPFirst network in eastern Singapore
10.5%reduction in non-emergency self-referrals at CGH’s A&E since the launch of GPFirst
$50subsidy to offset A&E attendance fee at CGH if patients first go to a GPFirst clinic and is subsequently referred to CGH’s A&E for treatment. The patient will also be given priority over non-urgent cases
CASHIER
20-45 Age group that makes up nearly half of visits to A&E because they view their conditions as critical, even though they can be treated by their GPs
22 CARING ISSUE 3 2019 ISSUE 3 2019 CARING 23
吃出健康HEALTHY EATS
WHAT YOU’LL NEEDPrawns 200g Skewers or satay sticks 8Mozzarella cheese 55gChopped parsley
NUTRITIONAL INFO (PER SERVING)Calories 147kcalCarbohydrate 7.2gFat 6.3gCholesterol 115.3mgFibre 1.6g
30min
PREPARATION TIME SERVES
METHOD• Preheat the oven to 170°C. • Using a sharp knife, slice prawns into
halves along their length. Thread prawns through skewers and set aside.
• To prepare the orange cheese sauce, combine cheddar cheese and orange juice in a pot over low-medium heat. Stir until cheese melts completely.
• Pour a generous amount of sauce over prawns, then sprinkle with mozzarella cheese and orange zest. Bake for 5 minutes or until prawns change colour and cheese is golden brown.
• Sprinkle with chopped parsley, garnish as desired and serve immediately.
This recipe was first
published in A Cookbook
for Diabetics by a Dietitian and a Chef, which is available at all major bookstores. 该食谱于《A
Cookbook for Diabetics by a Dietitian and a Chef》中首
樟宜综合医院睡眠实验室会进行日间和夜间测试。夜间测试包括诊断性睡眠测试、气道正压通气(PAP)测试、经 皮 二 氧 化 碳 ( T C c O 2 ) 监 测 等 。日间测试则包括多次睡眠潜伏期测试(MSLT)和维持不眠测试(MWT)、活动记录检查、血氧测定、居家睡眠测试等。睡眠技术专家还管理CPAP辅导和非侵入性通气(NIV)辅导诊所。患者一般从综合诊所或家庭医生转诊至樟宜综合医院睡眠诊所,以评估与睡眠相关的症状,如吵闹的打鼾声、呼吸暂停发作和/或白天过度嗜睡等。
The GPFirst Programme is an initiativeby Changi General Hospital’s Accident & EmergencyDepartment in partnership with over 200participating GP clinics in eastern Singapore.
Patients with mild and moderate symptoms areencouraged to visit their GPs first to seek treatmentat the GP clinics instead of going to the A&E.
Should the patient be referred byhis or her GP via GPFirst:
Accorded higher priority over othernon-emergency cases
$50 programme subsidy* for their A&Eattendance fee