LIFE AT ITS BEST!
2014ISSUE
4
YOU R Q UA RT ER LY H EA LT H & WEL L N ES S J OU R N A L
We profile the men and women who support you in your journey to health
Battling BIGDisease
Chronic disease is on the rise, but new healthcare models are pushing against the tide
• Senior / Associate Executive (Logistics)
Connecting with you through our Employee Value Proposition…
• Senior / Assistant Technician A. Central Sterile Supply Department B. Operating Theatre
• Senior / Dental Assistant (AH/JMC) • Senior / Ophthalmic Technician • Administrative Assistant A. B. C. D.
Human Resource Major Operating Theatre Medical Records Office (JMC) Referral Management and Evaluation (JCH)
• Associate Executive A. Pharmacy B. Procurement
• • • • • • •
Associate / Patient Service Coordinator Clinical Coder Engineering Assistant (Biomedical) Logistic Associate Patient Care Assistant (AH/JCH) Patient Information Associate (Call Centre) Patient Service Associate A. Emergency Medicine B. Specialist Outpatient Clinics (AH/JMC) C. Wards (AH/JCH)
• • • • • •
JurongHealth is Singapore's public healthcare cluster for the West. JurongHealth is building the new integrated healthcare hub comprising the 700-bed Ng Teng Fong General Hospital and 400-bed Jurong Community Hospital (JCH) to provide holistic care for patients from 2014. JurongHealth is currently managing Alexandra Hospital (AH) and Jurong Medical Centre (JMC) with a comprehensive range of clinical services for the community.
Winner of: • Leading CEO Award • Leading HR Leader Award • Leading HR Practices in Employee Relations & People Management (Special Mention) Award • Leading HR Practices in Quality Work-Life, Physical & Mental Well-Being (Special Mention) Award
Pharmacy Assistant Pharmacy Technician Plaster Technician Principal / Senior / Enrolled Nurse (AH/JCH) Supervisor (Wards) Triage Specialist (Call Centre)
Apply now at
www.juronghealth.com.sg/careers Or email us at
careers@juronghealth.com.sg Join us on Facebook
www.facebook.com/JurongHealthServices Follow us on LinkedIn
www.linkedin.com/company/jurong-health-services We regret to inform that only shortlisted candidates will be notified.
“ The good physician treats t h e d i s e a s e ; t h e g r e a t p h y s i c i wa hn o t hr eaas t st hteh ed ips ae at iseen. t ” - William Osler
Preventing chronic disease, detecting it early and ensuring patients live well despite being afflicted is one of our key priorities. Chronic diseases if poorly managed, may result in even more serious consequences, affecting not just well-being, but social, emotional and financial health as well. In this issue, we look at four of the top chronic diseases that affect Singaporeans today. These diseases are of special concern because they can affect anyone, especially with our lifestyle which increases the risk of getting them. The BattlingBigDisease special explores some causes, risks and treatments for these conditions. It also looks at how innovations in healthcare models and advancements in technology are helping to better manage these conditions and offer better outcomes for patients. At JurongHealth, we are looking at new holistic approaches to tackle the inevitable rise of chronic diseases. One way has been to leverage the expertise of a multi-disciplinary healthcare team in patient-centric care delivery. This issue, we showcase some of the people who play a key role in these teams. The AlliedHealthSpecial introduces the dedicated men and women who work to support every patient, their families and caregivers in attaining their health goals. Don’t forget to turn to our regular features for more. In HealthBUZZ, read about the progress of Ng Teng Fong General Hospital; and in FOODforLIFE!, learn about healthy ways to dine out, snack and prepare a yummy breakfast. Finally, turn to HealthBites for tips on how to be prepared for the haze should it return!
T h e e dit oria l t e a m
ONE HE A LT H
O1
C NTENTS P UBLISH ER JURONG HEALTH SERVICES PTE LTD EDITOR -IN-CH IEF CASEY CHANG DEPUTY EDITOR AARON LOH E D ITOR IA L A SSISTA NT WU WANWEN CO NTR IBUTING EXP ERTS DR ERIC CHONG DR ENG SOO KIANG DR KURUMBIAN CHANDRAN DR LUKE LOW DR NANDAKUMAR RAMASAMI DR NIKOLAS WANAHITA DR SEOW CHOON SHEONG ELISA MAK PUBL I S H ING CONSULTA NT THINKFARM PTE LTD M ANAGING DIR ECTOR CHRISTOPHER TAY E DITOR IA L & DESIGN SHERALYN TAY AUDREY PERERA SHARON HO JOHNNY TAN WANTENG TAN DEWON SWEE PEI FOONG WRI T I N G & P H OTOGR A P H Y ADAM KOH BELLA LIM LOUISA FOO JUSTIN LOH CL I ENT R ELATIONSH IP JESSIE KEK
HealthBUZZ 04 OF MILESTONES & GREEN SPACES
A look at the building progress and greenery of the upcoming Ng Teng Fong General Hospital
HealthSense 07 ASK THE EXPERTS
Health questions answered
The information in this publication is not meant to take the place of healthcare or services you may need. Please see your doctor or primary healthcare provider about any personal health concerns. All information is correct at time of print. ONEHEALTH IS PUBLISHED QUARTERLY BY JURONG HEALTH SERVICES PTE LTD. COPYRIGHT IS HELD BY THE PUBLISHER. REPRODUCTION IN PART OR WHOLE WITHOUT PERSMISSION IS PROHIBITED. ALL RIGHTS RESERVED. MCI (P) 090/06/2014 PRINTED BY KHL PRINTING CO PTE LTD. For general enquiries, email
onehealth@juronghealth.com.sg
O2 ON LTH O N EHE E HE A ALT H
WeCARE
10
We profile the men and women who support you in your journey to health
ALLIED HEALTH SPECIAL
2014 • ISSUE 4
26
BATTLING BIG DISEASE The fight for health
Chronic disease is on the rise, but new healthcare models are pushing against the tide
30 HIGH PRESSURE SITUATION Understand your risk of hypertension and learn how to protect yourself
34 ALL CLOGGED UP Learn about the good, the bad and the deadly roles of cholesterol
38 SUGAR CRISIS Watch your weight and diet to prevent diabetes and a range of serious problems
41 COLON CANCER RISING
Be vigilant for one of Singapore’s top cancers and learn about prevention and detection
FOODforLIFE! 44 HEALTHY HAWKER EATS Dining out? Make these healthier meal choices
46
SNACKING SMART
48
A TOAST TO REMEMBER
HealthBites 49 HAZE AWARE
When smoke or smog gets in your eyes, be armed with this handy guide
Nibble on these smarter, more nutritious treats Flip out for this tasty, protein and fibre-filled French toast recipe
ON ONE HE A LT HH ONEHEALT EHEALT
O3 O3
HealthBUZZ THE FINAL CEMENT SLAB IS RAISED TO TOP-OUT THE BUILDING STRUCTURE
JURONG RESIDENTS SIGN THEIR WELL-WISHES FOR NTFGH AND A HEALTHIER COMMUNITY
ALBIZIA SAMAN (RAINTREE)
will provide shade with its broad leafy canopy
A construction milestone
From commemorating the topping out construction milestone to planting the seeds for a green environment, here’s a snapshot of the progress of Ng Teng Fong General Hospital (NTFGH)
The final one-tonne cement slab hoisted to the top of NTFGH earlier this year marked the completion of the building structure. This cement slab, now an indelible part of the hospital’s physical infrastructure, bears more than 4,000 signatures and well-wishes, collected at a community event at JEM shopping mall, a future neighbour to NTFGH and Jurong Community Hospital (JCH). The capstone is a symbol of the community that lies at the “heart” of NTFGH. With the completion of this building milestone, the 900,000-strong community in the west will soon be served by the new hospitals when NTFGH opens from December this year, followed by JCH in 2015.
Of Milestones & Green Spaces O4 O N E HE ALT H
BAUHINIA BLAKEANA (HONGKONG ORCHID)
adds beautiful colour to the gardens ALSTONIA SCHOLARIS
will give screening along the perimeter and general areas
PLUMERIA RUBRA (FRANGIPANI RED)
provides a sweet scent and hue
A healing sanctuary With approximately 22,600 square metres of green areas in NTFGH, landscaping will be one of the hospital’s many unique architectural features. These green sanctuaries, in the form of ward planters and vertical greening to green roofs and community gardens will add to the hospital’s healing environment. According to Stella Khoo, Horticulturist, JurongHealth, what makes the green spaces in NTFGH unique is its choice of sustainable native plants. “The proposed plant palette was referenced from local species which are easy to source, procure, hardy and easy to maintain. Careful design planning is built in to make these green elements as sustainable without compromising hospital operations.” Ensuring that its greenery remains truly green in an ecological sense, rain catchment systems have been designed. These will be able to supplement half of the irrigation system requirements for planting areas. Most importantly, the creation of various healing gardens will help in providing a comfortable and healing environment for patients and their loved ones.
Know your greens coming your way… SOME OF THE LUSH BEAUTIES THAT YOU WILL SEE AT NTFGH BRACHICHYTON ACERITIFOLIUS
or Illawarra Flame Tree, blooms vibrant red for a splash of colour CHRYSOPHYLLUM CAINITO
also known as ‘star apple’, will take root in the community garden COCOLOBA UVIFERA
commonly called the ‘sea grape’, will offer shade for common areas DYERA COSTULATA
or ‘jelutong’, will provide large leaves for vertical screening of noise STERCULIA PARVIFOLIA
known as ‘kelumpang burung’, will green the perimeter grounds COLA GIGANTEAN
will provide shade for walkways and common areas
ONE HE A LT H
O5
HealthSense
Q
Recently, I’ve been feeling unhappy and stressed out at my workplace. Because of this, I’ve been giving excuses to skip work and it’s affecting my work performance. How do I know if it is depression and if I need to seek help? Do I see a Family Physician or Psychiatrist?
A
Most people may feel unhappy in reaction to stressors. However, when such emotional responses are severe, it results in depression. This form of sadness affects daily function and impedes activities which were previously enjoyable. You may feel fatigued and physically drained; have difficulty focusing on simple tasks; be more irritable, short-tempered, aggressive or negative. Some people may turn to excessive alcohol intake. In the worst case scenario, a depressed person may have thoughts of suicide or self-harm. Do see a family physician or psychiatrist if you experience any of these signs.
Dr Luke Low, FAMILY PHYSICIAN (ASSOCIATE CONSULTANT)
Q
Some of my friends swear by colon cleansing. What is this procedure, what are the benefits and is it safe? Are there other ways to keep the colon “clean” and healthy?
A
The colon has many types of bacteria (called gut flora) that produce byproducts that contribute to the health of the intestines. In some diseases, this dynamic is disturbed. Colon cleansing is currently a topic of intense scientific research and is thought to be beneficial by some because it rids the gut of its bacteria, and presumably unhealthy products. However, its use in the general population has not been supported by the medical community due to a lack of scientific evidence. There have been rare cases where the procedure has led to the puncture of the colon, causing harm. Generally, a healthy lifestyle – regular exercise; keeping a healthy weight; cessation of smoking or alcohol; a diet high in vegetables and fibre, low in salt, sugar, processed meat and animal fat – is more useful in keeping the colon healthy.
Dr Seow Choon Sheong, SENIOR CONSULTANT, GENERAL SURGERY
Q&A
O6 O N E HE ALT H
Ask the expert!
Have a burning health question? Send your question, name and contact number to onehealth@juronghealth.com.sg
BE THE FIRST TO
MAKE A DIFFERENCE TO OUR PATIENTS
VOLUNTEER WITH NG TENG FONG GENERAL HOSPITAL!
Be the first face to welcome and to guide our visitors and patients around our new hospital when we open our doors in December 2014! We invite caring and out-going individuals to volunteer with us as greeters and guiders.
ROLES OF GREETERS & GUIDERS
(Commencing December 2014)
• Help with way-finding • Guide visitors / patients to their destinations • Assist patients on / off wheelchairs • Assist with patients and visitors registration • Assist with hospital tour requests
REQUIREMEN TS • Minimum Age: 16 • Shift Time: Mon to Sun, 9am to 1pm / 12pm to 4pm / 4pm to 8pm • Best Suited for: Retirees, home-makers, shift workers and students
VOLUNTEER RECRUITMENT Meet our volunteer coordinators at Jurong Medical Centre to find out more! 60 Jurong West Central 3, S648346 (Opposite Jurong Point Mall / Boon Lay MRT)
DATE
TIME
17 July, Thu
10am to 2pm
18 July, Fri
2pm to 6pm
19 July, Sat
10am to 12pm
ENQUIRIES / REGISTRATION Please contact our friendly volunteer coordinators at 6370 6827 / 6830 or email volunteers@juronghealth.com.sg
ONE HE A LT H
O7
AlliedHealthSpecial
Life Best! AT ITS
They are there for you when you’re getting back on your feet, looking for help or need a supporting hand. As a critical aspect of your healthcare journey, allied health professionals support the diverse range of your healthcare needs. Some work behindthe-scenes to aid your diagnosis and treatment, while others work directly with you to offer advice or conduct therapy. In honour of the significant role they play, we showcase some of the men and women who make it their job, passion and life’s ambition to care for, support and guide you to health and wellness
LIGHTING & PHOTOGRA P H Y DAVID LEE STEVEN FOO S TY L IN G, H AIR & M A K E- U P PHOEBE PONG ALEX HO JING LIM CLOTHES, SHOES & ACC ES S ORIES ALDO BANANA REPUBLIC CELIO* DOCKERS GAP NEW LOOK ROBINSONS TM LEWIN UNIQLO
O8 ON O NE HE ALTH ALT H
Soundcheck! More than just diagnosing hearing problems, Shijitha plays a critical role in enabling people to communicate and connect with the world around them Audiologist Shijitha Chenicheri
Shijitha diagnoses, treats and manages hearing and speech disabilities to help people connect with their loved ones. “Hearing impairment is a dual disability,” she pointed out. It’s not just ‘hearing’ but communication. “If we cannot hear, our ability to talk to someone else is also affected.” There is also a lesser known side to the job. “Not many people are aware that the primary function of our ear is to assist with our balance. In my work, I also assess balance to see if conditions such as giddiness are caused by inner ear problems.” A major part of her work is fitting hearing aids and this is a favourite aspect of her job. But the satisfaction goes beyond merely deploying technology, she said. “There is a very human side to it. I believe audiology is a perfect combination of science and human interaction. Apart from hearing science and technologies, there is ‘heart’ involved. I listen to patients’ needs and concerns, counsel them about different options, help them choose a suitable hearing aid and overcome their challenges in adapting to it.” Whether it is to help an elderly person hear again or play a role in teaching a hearing impaired child to speak his or her first words, she finds great satisfaction in knowing her work makes an impact. “Hearing is an essential part of communication, safety and entertainment and it is exciting to bring ‘sound’ back to life. The reactions of patients’ eyes lighting up when wearing a hearing aid for the first time and hearing their loved ones’ voices more clearly is a fulfilling experience.” ––––––––– AUDIOLOGISTS are professionals who diagnose, treat, and manage hearing loss or balance problems in people of all ages. When needed, they refer patients to doctors should a problem require medical or surgical evaluation or treatment. ––––––––
ONE HE A LT H ONEHEALTH
O9
AlliedHealthSpecial
The science of eating well Food is an essential and pleasurable part of life – and it is Elisa’s job to ensure that eating is both healthy and enjoyable for all Dietitian Elisa Mak The study of dietetics is both science and art. It involves specialised knowledge, but also the skills to 'translate' the complex science of nutrition into easy-to-understand information. “I help people to make appropriate lifestyle and food choices to help them stay well and improve the current medical or health problem,” explained Elisa. “Dietitians are trained to work in a hospital setting to interpret nutritional science and blood results, give practical dietary advice and look out for any adverse food-drug interactions to meet our patients’ nutritional needs while also managing their chronic conditions.” She plays detective, looking for clues in a patient’s eating habits, acts as counsellor to give tailored dietary advice and takes on the role of a menu planner to develop specific diets for people based on their needs. Her interest in healthy eating is exceeded only by her love of empowering others with knowledge of good nutrition. “What makes me most passionate about my work is the encounters with different people.” She added that “good communication skills are a crucial aspect of my work.” Beyond this love for nutritional sciences and interacting with people is a simple and enduring love for all things delicious and how she can integrate these into dietetics. “Discovering different foods, food cultures, food beliefs as well as nutrient benefits continuously fuel my interest in the field.” ––––––––– DIETITIANS are qualified allied health professionals who assess, diagnose and treat dietary and nutritional problems for those with chronic conditions or specific health needs. They often work in healthcare institutions to provide medical nutrition therapy or consultations that help prevent and/or manage various medical conditions. –––––––––––
O10 O NEHE E HEAALT LTHH 10 ON
A helping hand Providing the link to community services or assistance, Krutika works to ensure patients and their families find the help they need on their road to wellness Medical Social Worker Krutika Menon It takes more than a kind heart to be a medical social worker. A combination of empathy, resourcefulness and the ability to tap on a multi-disciplinary array of services are what make Krutika’s work both rewarding and challenging. As a medical social worker, she deals with patients who – because of their illness and/or hospitalisation – experience emotional, psychological, social and care difficulties. “My role is to assess the psychosocial functioning of patients and families and intervene as necessary,” she explained. This may include connecting patients and families to necessary resources and support in the community; providing financial assistance; psychotherapy; supportive counselling; or grief counselling. Working in the field, she not only enjoys helping people, but also thrives in the fast-paced and dynamic sector of public healthcare. “The most interesting aspect of my job is meeting diverse individuals and learning more about their lives. Each patient has a different story to tell and each one inspires me to continue in this profession. Supporting them in times of need further enhances the satisfaction I receive from my job.” One patient, an elderly gentleman who needed major surgeries on his foot, was particularly memorable. “The process of recovery and rehabilitation was an uphill task for him and I had to support him through counselling, liaising with community organisations for long-term support and also applying for financial assistance.” This underscored the breadth of her work. “Seeing him go home safely and happily reinforced in me the passion for my job.” –––––––––––––– – – – MEDICAL SOCIAL WORKERS work with patients and families who face difficulties coping due to ill health and hospitalisation. They assess emotional, psychological, social and care challenges and offer support. This often means connecting patients and families to necessary resources and support in the community; providing financial assistance; psychotherapy; supportive counselling; or grief counselling. –––––––––––
O11 11
ONE HE A LT H ONEHEALTH
AlliedHealthSpecial
The lifeblood of medicine You may not ever get to meet Gloria during your medical treatment, but the medical technologist is the one who unlocks the information that is key to your diagnosis and cure Medical Technologist Gloria Chen
She works behind-the-scenes in the clinical laboratory, processing, testing and recording the results of tests on blood, bodily fluids and tissue. Her work supports doctors in detecting, analysing, monitoring, and treating diseases and medical conditions. “It was an interest in clinical sciences and preference for hands-on work that steered me towards this field,” Gloria shared. She may not be on the frontline interacting face-to-face with patients, but she gets to know patients very well in other ways – through their specimens. “As medical technologists, we play an important role in patient care,” she said. “Laboratory test results are vital in helping clinicians with their diagnosis and treatment, and we are the ones providing these test results.” In fact, nearly 70 per cent of clinical decisions about a patient’s diagnosis and treatment rely on laboratory test results. Her area of specialty and interest is the life-saving field of transfusion medicine. “Working in Blood Transfusion Services requires one to be agile and to multi-task, especially in situations like massive transfusion protocol activation and emergency transfusions,” she said. “I have always thought how amazing it is that different components of a human being can be transfused or transplanted into others to save lives!” –––––––––––––––– MEDICAL TECHNOLOGISTS are qualified professionals who perform technical and scientific duties in a clinical laboratory. They receive, process, test and report the results of different types of specimens such as blood, body fluids and tissues, playing an essential role in the detection, analysis, monitoring, and treatment of diseases and medical conditions. ––––––––––––––
O12 O NEHE E HEAALT LTHH 12 ON
Empowering everyday life As an occupational therapist Nur Hafizah helps patients of all ages regain the ability to tackle everyday tasks for themselves – building not just independence, but quality of life Occupational Therapist Nur Hafizah Mohd Amin It’s only when we are injured or ill that we start to miss our ability to do simple tasks independently – whether it is bathing or cooking a meal. As an occupational therapist, Nur Hafizah works with people who – for different reasons – experience difficulties in doing their daily activities. “My work ranges from observing a patient’s ability to shower safely and training domestic helpers to care for patients at home, to ensuring a patient can reintegrate into their community and teaching them how to manage household chores. I may also prescribe exercises or advise on suitable safety/mobility aids for the home.” The goal, she said, is to customise therapies so patients maintain, restore and improve their independence in the activities which are important to them. This is important in maintaining or enhancing their health and wellbeing. Her particular passion is upper limb rehabilitation for stroke patients because each one faces unique challenges. Sometimes, all it takes is a little creativity. She recalled the case of a patient who was paralysed from the waist down. “We used a paper punch holder to support his iPad cover at the right angle so he could continue a favourite activity – surfing the internet!” Experiencing the resilience of the human spirit and the ability of the brain to adapt inspires her. “Seeing patients re-learn skills over time, persevering through the tough times and moving forward in life never fail to amaze me.” ––––––––––––––––– OCCUPATIONAL THERAPISTS work with people who experience difficulty engaging in their daily activities due to physical disability or mental or developmental problems resulting from an accident, illness or ageing. They teach skills, offer rehabilitation and give advice on modifying behaviour or physical surroundings to improve independence and safety so people can engage in purposeful activity. –––––––––––––
O13 13
ONE HE A LT H ONEHEALTH
AlliedHealthSpecial
Looking out for your eyes In a world of digital cameras accessible at a touch, optometrist Bee Fang cares for the most precious ‘seeing’ device we have – our eyes Optometrist Ng Bee Fang When she began her studies in optometry it was a relatively new course at Singapore Polytechnic. Today, the field of optometry is a critical one for ageing Singapore – with growing demands and advancements. Bee Fang explained, “Optometrists are primary eye care practitioners who provide a wide range of primary eye care services.” This includes checking visual acuity, prescribing prescription glasses, performing eye tests and diagnosing eye diseases. They are also the only trained and licensed eye care practitioners who can assess and prescribe spectacles for children below eight. “I also work with other healthcare professionals such as eye doctors and general practitioners in the management of chronic disease. In fact, sometimes, an eye examination can lead to the first diagnosis of a disease. For instance, diabetes and hypertension can affect the eye. Hence, regular eye screenings by a trained optometrist can prevent or delay the onset of eye diseases,” she pointed out. Bee Fang maintains her passion for her work because of the people she helps and the empowering information she imparts. “The most interesting aspect of the job is that I get to meet people and share my knowledge so they can take charge of their eye health.” ––––––––––– OPTOMETRISTS provide primary eyecare such as assessing the type and levels of low vision. Optometrists are also the only licensed eye care practitioners who can determine visual acuity or the degree of low vision for children below eight years old. They play a role in diagnosing eye diseases such as conjunctivitis (red eye), cataracts and glaucoma. ––––––––––
O14 O NEHE E HEAALT LTHH 14 ON
The power to move Helping you regain your physical wellness on the road to recovery, physiotherapists like Mark play an important role in managing pain and preventing future injuries Physiotherapist Mark Anthony Chan
Physiotherapist Mark makes it his goal to empower, educate and enable others to manage and reduce their pain, regain their mobility and tackle life. “As a physiotherapist, I help people affected by injury, illness or disability,” he explained. This involves using movement and exercise, manual therapy and education on lifestyle changes to help people remain active. Physiotherapy is often associated with musculoskeletal function, but there are other specialities, Mark pointed out. “There are physiotherapists who specialise in cardiorespiratory problems and work in intensive care units with critically ill patients. They offer therapies to minimise lung secretion retention, maximise lung oxygenation, re-expand collapsed lung tissue and help patients on ventilators to wean off the machine.” Physiotherapists also work in neurological and geriatric areas. One memorable encounter for Mark was with a 90-year-old patient who suffered chronic knee pain and required a walking aid. “Though most might have considered that at her age, the goal of walking without an aid to be unrealistic or unnecessary, my experience had taught me that age should never be a limiting factor. In fact, her tenacity and dedication to her exercise programme saw her free from her walking aid in three months.” It shows the body’s amazing ability to adapt, he reflected. “Seeing the resilience of people facing adversity, and how they – despite stumbling blocks – are able to dig deep into their reserves to find a way to get back on their feet, is inspiring. It is a privilege to be able to guide them through the recovery process.” –––––––––––––– PHYSIOTHERAPISTS help people affected by injury, illness or disability through therapies involving movement and exercise, manual manipulation, education and advice. These therapies aim to alleviate pain, facilitate recovery, enhance physical dexterity and maintain optimal health. Apart from physical rehabilitation, they also work in areas such as cardiopulmonary, respiratory, neurological and geriatric health. ––––––––––––––
O15 15
ONE HE A LT H ONEHEALTH
AlliedHealthSpecial
The dose is right He’s not just a face behind the counter. Pharmacist Javin ensures you’re taking the right medicine in the right dosage and in the most effective way Pharmacist Javin Tang If you’re ever confused about the pill you’re taking for a certain condition, Javin’s job as a pharmacist is not only to dispense it, but to give you the information you need to take it safely and effectively. While a large part of a pharmacist’s work is in dispensing medicines, they play other critical roles in the healthcare spectrum as well. “We serve as a crucial drug information resource for other healthcare professionals and we work closely in multi-disciplinary teams, advising on the selection, dosages, interactions, and side effects of medications,” he explained. “We also place great emphasis on medication safety. Did you know, a single drug has to be checked thrice by three different staff before it can be dispensed?” The dynamism of his work and its ever-changing challenges range from addressing enquiries from patients, customers or doctors; sourcing for substitute medications; community outreach; and even planning and setting up of systems for the upcoming Ng Teng Fong General Hospital. It all keeps the job interesting. Pharmacists also monitor the health and progress of patients and review medications for safety, effectiveness and efficacy; provide holistic advice on health and disease; run clinics to monitor patients on certain medications; and participate in outreach programmes for home-bound patients. All this underscores what lies at the heart of the job: ensuring the health and wellness of people. ––––––––––––––––––––– PHARMACISTS are healthcare professionals with specialised knowledge in the science and clinical use of drugs. They deal with every aspect of medicines, including drug manufacture, drug supply, drug therapy management and monitoring, as well as research and development of new drugs. In hospitals, pharmacists work closely in multi-disciplinary teams, giving advice on the selection, dosages, interactions, and side effects of medications. –––––––––––––––––––
O16 O NEHE E HEAALT LTHH 16 ON
Minding your emotional health Psychology is not only the fascinating study of the human mind and behaviour. To psychologist Hui Fang, it is the key to personal growth and emotional wellness Psychologist Sam Hui Fang It was the drive to understand more about human behaviour and to help promote positive change for those in psychological distress that inspired Hui Fang to develop a career in the field of psychology. As a psychologist, she uses scientific methods to study how people think, act, react, and interact and deploys evidence-based treatments to help people deal with their emotional problems. Psychologists are distinct from psychiatrists, who are medical doctors able to prescribe medication. Rather, she said, psychologists often use ‘talk therapy’ (also known as psychotherapy), behavioural change methods and cognitive therapy (changing perceptions) to help and empower people to cope and find solutions. Seeking help from a psychologist can be a good way to overcome life’s challenges, she said, and should not be perceived as a bad thing. “The stigma that having a mental health problem equates to being crazy makes people unwilling to seek help early.” But psychological help can tackle many practical issues. “We can help people who feel anxious, angry, depressed, or those who suffer insomnia, stress or grief. We can also help people manage chronic illness or pain. “The most interesting aspect of my job is the unpredictable nature of our cases. The multi-faceted nature of human thinking and behaviour continues to puzzle me and engages me in continuing education,” she reflected, “But it is the recovery process and change in my clients that motivates and keeps me passionate about my work.” ––––––––––––––––––––– PSYCHOLOGISTS are experts in human behaviour and use scientific methods to study how people think, act, react, and interact. They assess, diagnose, treat or prevent mental health problems and play an important role in helping people who feel anxious, angry, or depressed. They also play a role in assessing brain function and diagnosing neurological problems. ––––––––––––––––
O17 17
ONE HE A LT H ONEHEALTH
AlliedHealthSpecial
Best foot forward Dianne ensures that your faithful yet overlooked feet are in prime condition to carry you through life Podiatrist Dianne Yap Dianne always wanted to be in the healthcare profession because she wanted to help keep people healthy and well. As a podiatrist, she literally does so from the ground up! She explained, “Podiatrists are specialists in the management of foot and ankle conditions. We assess, diagnose and treat foot and ankle problems.” This may include the management of skin and nail conditions of the feet; assessment of the biomechanical function and abnormalities of the foot; prescribing functional orthoses for support, padding and strapping; and the management/treatment of diabetic foot ulcers. Podiatrists like Dianne play an especially important role in the latter. “Diabetes, especially when poorly controlled, can affect the blood supply and the sensation of the foot, increasing the risk of ulceration, infection, and amputation. Dealing with high risk diabetic feet has always fascinated me. The thin line between saving and losing a limb is immensely crucial for these patients,” she shared. New treatment options keep the field interesting and hold new hope for patients too, she added. One of these is placing sterilised live maggots into non-healing wounds. “The maggots clean up the dead tissue so that the healing process is improved.” This lowers the risk of infection and gangrene. Treatment advancements aside, her patients give Dianne a deep sense of fulfilment. “Seeing them get better or improving in their foot and general health never fails to encourage me. Moreover, life as a podiatrist is never boring as no two feet are the same. You never know what type of feet can walk into the clinic.” –––––––––––– PODIATRISTS are specialists in the management of foot and ankle conditions. They assess, diagnose, and treat foot problems such as foot pain; walking/running abnormalities; fungal infections; painful growths and in-grown toenails. They also play a critical role in the management of chronic diseases such as diabetes. ––––––––––––
O18 O NEHE E HEAALT LTHH 18 ON
X-ray vision Joshua’s skill with advanced machinery helps to capture what goes on inside your body – so that doctors can make sense of, and find the clarity in, that picture of you Radiographer Joshua Yap It is Joshua’s job as a radiographer to take ‘pictures’ of your insides. These images are an important part of the diagnosis and help doctors figure out what’s underneath a patient’s skin – whether it is a broken bone, a tumour or a foreign body. Using imaging technologies such as x-ray, computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound, radiographers obtain images of the body’s internal structures – both bony and soft tissue. “Apart from obtaining a clear readable image, radiographers need sound knowledge of a body's different anatomical structures,” said Joshua. Advancements in medical technology mean very little radiation is now needed to get clear images and this is an area that holds great promise. In fact, the amount of radiation in a common test like a chest x-ray is only a fraction of that received during a seven-hour flight. “It is also now possible to obtain certain types of CT thorax scans with the same amount of radiation used in a chest x-ray,” Joshua enthused. “This is of great interest to me because we are always looking to reduce dose while improving image quality for the benefit of all our patients.” What drives him is simple: a compliment or smile after a job well done. “It is enough to make me feel that this job is indeed fulfilling and meaningful, and reason enough to want to improve myself to better serve.” ––––––––– DIAGNOSTIC RADIOGRAPHERS work in the field of medical imaging, using different non-invasive devices such as x-rays and ultrasound to provide a view of what goes on inside a patient’s body. They combine technological skill and clinical knowledge to produce diagnostic images of various organs and body regions and play a role in the diagnosis and management of diseases. –––––––––––––––––
O19 19
ONE HE A LT H ONEHEALTH
AlliedHealthSpecial
Breathe easy When the essential act of breathing ceases or is impaired, respiratory therapist Clariza steps in to ensure you can breathe easy Respiratory Therapist Ma. Clariza Bandong
Clariza works daily to make sure that patients suffering from respiratory disorders continue to find comfort and relief in an act we take for granted – breathing. She explained, “As a respiratory therapist, I help patients who have difficulty breathing. They range from those with a chronic disease to those who are in critical condition and are in the intensive care unit (ICU). We use various methods to make sure oxygen can reach the lungs. This includes treatment such as oxygen therapy, mechanical ventilation, and non-invasive ventilation.” Respiratory therapists are also specialists in cardiopulmonary resuscitation (CPR) and play an important role in emergency care. Apart from these clinical aspects, Clariza is also involved in patient education, educating family members on how to take care of patients at home and how to take care of respiratory equipment. It’s an interesting mix of knowing her equipment and communicating with people, she said. “I get the best of both worlds. I enjoy the technical aspect of working with the various machines. At the same time, I also get to take care of people.” One of the most interesting aspects of her work is its range, from critically-ill patients in ICU to patients who are stable enough to go home and manage their condition. She’s also continuously learning new things, such as new patient care modes and better technologies, “I find it amazing how these machines can help support or extend life.” ––––––––––––––––––– RESPIRATORY THERAPISTS specialise in respiratory care and are qualified to perform respiratory care modalities such as oxygen therapy, mechanical ventilation and CPR. Respiratory therapists work in acute as well as critical care and are often part of a multidisciplinary team involved in the management of the critically ill in a hospital. ––––––––––––––––
O20 O NEHE E HEAALT LTHH 20 ON
State of your heart Your heartbeat may hold the clue to a heart condition – and cardiac technologist Pamela is the person who records the ‘music’ of your beating heart to identify any abnormalities Cardiac Technologist Pamela Tan
The lines and squiggles we see on a monitor or electrocardiogram (ECG) are not just keeping pace with your heartbeat; they tell your doctor just how well your heart is working. As a cardiac technologist, Pamela is trained to perform diagnostic procedures for patients with cardiac disease. “While a cardiac technologist does not diagnose patients, we work with physicians to do so and assist in a variety of diagnostics for heart and blood vessel disorders,” she explained. This includes working with echo-cardiography, treadmill stress tests, 24-hour ECG monitoring, and blood pressure monitoring. Her area of speciality is in performing ECGs. The device uses ultrasound waves to create a black and white picture of the heart without the need for any invasive surgery. Reflecting on her role, Pamela said, “As a cardiac technologist we can benefit the lives of people in many ways, particularly in aiding early diagnosis, so that treatment can start and help people live healthier, more productive and independent lives.” One important skillset apart from technical knowledge is interpersonal communication, she explained. “We have to convey relevant information to the doctors and build excellent staff-patient relationships. I like meeting patients with different backgrounds and helping the physicians to diagnose their conditions. The new and improving technologies that help in diagnosing heart conditions are of great interest to my learning needs.” ––––––––––––––––––– CARDIAC TECHNOLOGISTS are trained to perform different diagnostic tests on the heart and blood vessels to help evaluate, diagnose, and treat patients with cardiac disease. They perform both invasive and non-invasive procedures to aid the early diagnosis and/or treatment of heart diseases. –––––––––––––––––––
O21 21
ONE HE A LT H ONEHEALTH
AlliedHealthSpecial
Help to say ‘hello’ We take the simple act of saying hello or eating for granted. For those who have lost these abilities, Aileen works to help them communicate, eat, swallow and regain their quality of life Speech Therapist Aileen Kelly Speech therapy isn’t just about helping children with speech defects. “Speech therapy,” said Aileen, “also plays a role in the rehabilitation of swallowing difficulties.” She explained, “Speech therapists provide assessment, diagnosis and therapy services for people of all ages who suffer from problems in speech, language, voice and swallowing.” Her work plays a big role in helping people regain their quality of life. After all, communication and eating are important aspects of living well. She shared an inspiring case, “I recently had a young patient who was unable to eat or drink at all after a stroke so he had to receive nutrition via a tube in his stomach.” Working with him daily to improve his ability to eat and drink, he was soon able to enjoy a regular diet. “Patients who make a complete recovery in such a short amount of time are rare,” she said. “Great things can be achieved with the patient’s hard work at their rehabilitation programme.” She added, “The most interesting aspect of my job has to be the people that I meet; not just patients but the healthcare team of doctors, nurses, physiotherapists, occupational therapists, medical social workers, therapy assistants, and administrative assistants.” Going forward, she hopes to help develop more standardised assessments in languages apart from English, so that the field can adequately address the diversity of patients and offer them better care. ––––––––––––––– SPEECH THERAPISTS are professionals who assess and treat speech, swallowing, language or communication problems. In infants and children, they may deal with speech and language disorders, learning difficulties or hearing impairment. In adults, it is common to tackle difficulties in speech, language and/or swallowing difficulties due to stroke or brain injury, brain/head/neck tumours or degenerative neurological diseases such as Parkinson's disease. –––––––––––––––
O22 O NEHE E HEAALT LTHH 22 ON
Brain wave reader Chee Chong taps the secrets of the human brain with a wide array of sophisticated equipment to diagnose and ‘read’ what’s going on in the body’s control centre Neurodiagnostic Technologist Ong Chee Chong The brain, the seat of human knowledge, emotion, thinking and individuality, is one of the most complex organs in the body. It is also an electrochemical organ that sends tiny charges of electricity via its synapses to relay information. As a senior neurodiagnostic technologist, Chee Chong can tap into and record these messages. This provides valuable data to physicians who analyse the data to determine the cause and effect of brain disorders such as epilepsy, stroke, neuromuscular, nerve and spinal cord disease. “We record and study the electrical activity in the brain and nervous system,” he explained. One of most common tests is electroencephalography (EEG), where Chee Chong attaches specialised electrodes to the head in order to amplify and record real-time electrical brain activity. He elaborated, “These electrodes monitor brain activity and we read the data to detect any abnormal firing of the brain cells, which in turn may affect the functioning of the brain.” These diagnostic investigations help the multi-disciplinary team of medical researchers, clinicians and physicians to evaluate, diagnose and treat neurological conditions. There is great satisfaction in making sense of the complicated looking wave readings on his screen. “It is through the use of these modern technologies that early diagnosis and/or prompt and timely treatment of brain diseases are made possible so people can lead healthier, productive and independent lives,” he reflected. “I’m passionate about my work because I can provide accurate clinical diagnosis for the physician, which may in turn help in the right treatment of patients.” ––––––––––––––––––––––––––– NEURODIAGNOSTIC TECHNOLOGISTS record and study electrical activity in the brain and nervous system. They use a range of high-tech equipment to help doctors in the evaluation, diagnosis and treatment of brain disorders such as epilepsy, stroke, neuromuscular, nerve and spinal cord diseases. –––––––––––––––––
O23 23
ONE HE A LT H ONEHEALTH
AlliedHealthSpecial
Air supply If you’re feeling breathless, Wai Chun can help find out why – he’s trained to perform specialised respiratory diagnostic procedures and tests to review the health of your lungs Respiratory Technologist Wong Wai Chun Working in one of the newest fields in medicine today, Wai Chun is excited to be part of a growing number of respiratory technologists to help tackle the increase in respiratory conditions. He explained, “A respiratory technologist is a professional who is trained to perform specialised diagnostic procedures and tests for respiratory disease.” Many of these involve assessing how well your lungs function and how much oxygen you are getting. “We diagnose and monitor diseases that affect the lungs and make breathing difficult, such as asthma or cystic fibrosis. The tests also find out the cause of shortness of breath, coughing or wheezing, monitor treatment of respiratory problems and evaluate lung functioning before surgery,” Wai Chun said. A common test is spirometry, where a patient blows into a device called a spirometer to measure his/her breathing ability. It is one of the main diagnostic tests for chronic obstructive pulmonary disease (COPD), a growing concern among Singapore’s ageing population. Spirometry is also used to diagnose or manage asthma and other respiratory conditions. “The most interesting aspect of my job is patient education,” he reflected. “Using various equipment and techniques, we help patients who have difficulty breathing. Being a part of the healthcare team providing care to patients drives my interest and passion for my work.” –––––––––––––––––––––– RESPIRATORY TECHNOLOGISTS perform specialised respiratory diagnostic procedures and tests to evaluate, diagnose, and treat patients with breathing diseases. They play a key role in the diagnosis and monitoring of diseases such as asthma, cystic fibrosis and COPD. The tests they conduct can also be used to find out the cause of shortness of breath, coughing or wheezing, and they also evaluate lung function before surgery. ––––––––––
O24 O NEHE E HEAALT LT HH 24 ON
While you are sleeping Nothing beats a good night’s sleep. Beating insomnia and other energy-draining sleep disorders is sleep lab technologist Victoria, whose mission is to make your rest count Sleep Lab Technologist Ma. Victoria Parot Victoria watches people while they sleep. The job description may sound a little odd, but it is actually an important part of diagnosing sleep disorders. A sleep lab technologist, explained Victoria, is a healthcare professional who conducts diagnostic procedures for people with suspected sleeping disorders and provides the relevant therapies. “Everything about my job is interesting,” she enthused. “For instance, one of the main diagnostic tests is a sleep study, a sleep recording to measure how well a patient sleeps and how his/her body responds to sleep problems. The data from these tests is then used to diagnose and treat the problem.” The most satisfying part of the job is seeing the impact and positive outcomes from the right therapies, she added. “We often see people suffering from severe sleep apnea, a condition where the airway collapses during sleep cutting off oxygen flow. Once we initiate therapy with a continuous positive airway pressure machine that keeps the airway open, we can see the marked difference in the results and in the benefit to patients.” Victoria is also passionate about raising awareness of sleeping disorders. “Many are not aware of the risk and hazards of having sleep disorders, but sleep is a very essential part of health,” she said. “My job is not only to help diagnose and treat sleep problems, but promote health and wellness through better sleep.” –––––––––––––––––––––––––– SLEEP LAB TECHNOLOGISTS work as part of a team to assist in the education, evaluation, treatment and follow-up of sleep disorders. They are specially trained to perform sleep studies to measure the quality of sleep and diagnose the presence and severity of a sleep disorder. Apart from this, sleep technologists play a key role in patient education about the importance of sleep. ––––––
O25 25
ONE HE A LT H ONEHEALTH
BattlingBigDisease
Battling BIGDisease
Our modern lifestyle has brought us greater convenience, more affluence and access to all manner of healthcare advancements. Even so, many chronic diseases are on the rise. In this issue, we look at the major illnesses that affect Singaporeans and what is being done to win the fight By Adam Koh O26 O NE HEALT HE ALTH 26 ON
The rise of chronic disease
Here in Singapore, we enjoy a multitude of modern conveniences, a high standard of living, growing affluence and ready access to technological advancements, including medical care. But even as we benefit from these privileges, there is also a negative side. The modern lifestyle, with its stresses, long working hours, and hectic activity means that our general health may face greater health risks despite improved access to healthcare. As Dr Luke Low, Family Physician, Lakeside Family Medicine Clinic – a healthcare collaboration with JurongHealth – pointed out, “Singapore has become a first world country very successfully and our populace is now leading a more sedentary lifestyle.” With many of us working in offices and air-conditioned, comfortable environments, we do less physical activity compared to our forefathers who worked the fields and farms, and this increases the risk of health problems, he added. While healthcare advancements mean we are able to live longer and more productive lives, it also means an increase in age-related illnesses.
A changing landscape In Singapore, the profile of diseases that affect us today is different from those in the 1960s and 1970s, and this has shaped the way our healthcare landscape has evolved, said Dr Low. “[Then], infectious diseases plagued our population. The answer to that was to have a primary care model that was easily accessible, and the polyclinics and general practitioners (GPs) did well to respond to such needs.” Because infectious diseases usually took just one or two consultations to cure, the model called for clinics to be open to the public and did not require an appointment system. “Fast forward to our current climate. The management of chronic diseases involve long-term, often hospital-based, care with recurrent appointments involving a multi-disciplinary team of doctors, nurses, dietitians, therapists, and pharmacists for every patient.” This shift means the healthcare model has been transformed from ad hoc treatments to a more long-term and holistic approach. Said Dr Low, “Patients with long-term chronic diseases often have to adapt their eating, lifestyle habits, and even comply with complicated medication regimes on a permanent basis. Such a drastic change requires time to adapt and understand on the part of the patients.” This call for robust patient education and empowerment has resulted in a more multi-disciplinary approach. This consultative model where our team becomes the patients’ partners in health takes the place of the previous paternalistic approach where the doctors dictate and the patients merely follow orders.”
O27 27
ONE HE A LT H ONEHEALTH
BattlingBigDisease
First world illnesses There is an overall increase in chronic or long-term diseases. For instance, the Ministry of Health (MOH) records hypertension, high cholesterol, diabetes and obesity to be among the most common diseases among adults aged 18 to 69. Cancer too is on the rise and is responsible for the largest number of deaths in Singapore each year. Around 50,000 cases of cancer were diagnosed between 2006 and 2010 compared to 12,000 cases between 1968 and 1972. As most cancers are more likely to affect older people, Singapore’s ageing population will inevitably register an increase in cancer incidence. Of the top cancers, colon cancer is the most prevalent cancer among Singaporean men and women and is among the top three fatal cancers for both gender groups. Many of these diseases – if not managed well – can lead to complications, even disability and death. They also take a toll on the social and emotional health of patients and their loved ones. Dealing with chronic illness is a challenge almost all first world economies deal with, and Singapore is no different.
O28 O NE HEALT HE ALTH 28 ON
SINGAPORE’s
TOPILLNESSES
1 2 3 4
0
5
10
15
20
25
1992 1998 2004
Hypertension
2010
1992 1998
High Cholesterol
2004 2010
1992 1998 2004
Diabetes
2010
1992 1998 2004
Obesity
2010
While early detection and medical intervention have helped to improve the prevalence of some chronic diseases, the incidence of these diseases remain high. Lifestyle diseases such as diabetes and obesity are of critical concern as these increase the risk of many other problems such as stroke, heart disease, kidney failure and cancer.
2003 - 2011
2003 - 2011
60% Breast
Colon
40%
Lung
39%
Prostate
27%
2003 - 2011
29% Colon 2003 - 2011
15% Lung 2003 - 2011
12% Uterine
2003 - 2011
4
2003 - 2011
2003 - 2011
Liver
17%
LEADING CANCERS IN SINGAPORE (2007 – 2011)
A community to tackle chronic disease Dr Eng Soo Kiang, Family Physician, Lakeside Family Medicine Clinic, highlighted the recent shift to focus on community care, an approach that will improve chronic disease management and move it away from hospital-based care. “MOH has recently reach out to untapped community resources such as GPs and retired nurses. New Family Medicine Clinics such as the Lakeside Family Medicine Clinic also provide solo-practitioners like GPs with more scale and resources. Patients get to see the same few doctors, nurses and allied healthcare professionals who help manage their illness.” This model means that patients and caregivers can be more closely supported in their healthcare and sick-care journey from home to specialist outpatient clinics to hospitals and back home again, added Dr Eng. The shared care programme between the Lakeside Family Medicine Clinic and JurongHealth means patients seeing family physicians at the former will have their care parameters tracked and reported back to specialist colleagues via care coordinators. In the event that such patients need to return to JurongHealth as part of their annual follow-up with specialists, or due to a deterioration in their condition, their medical conditions and summaries are transmitted back to hospital specialists for timely consultation and intervention, explained Dr Low. He went on, “This ensures that our patients get optimal care, be it in the hospital or the community.”
The shift towards more integrated community care will improve chronic disease management and move it away from hospitalbased care.
>
O29 29
ONE HE A LT H ONEHEALTH
BattlingBigDisease
Push against something with enough force and it is bound to give way over time. In hypertension or high blood pressure, the pressure that the blood exerts on the blood vessel walls is too high, causing damage. Dr Nandakumar Ramasami, Consultant, Department of Medicine, JurongHealth, elaborated, “High blood pressure develops when the walls of the large blood vessels (arteries) become rigid as they lose their elasticity with time and when the smaller blood vessels become narrower.� High blood pressure affects almost a third of the adult population of Singapore, added Dr Nandakumar, but because there are few overt symptoms, many do not realise they suffer from it.
When the pressure is on IN CONSULTATION WITH DR NANDAKUMAR RAMASAMI, CONSULTANT, DEPARTMENT OF MEDICINE
When the pressure of blood flowing through its pathways becomes too intense, it can increase the risk of many health problems By Adam Koh
O30 O NE HEALT HE ALTH 30 ON
A silent killer Though there are no symptoms in a vast majority of people, high blood pressure is a deadly disease. “Having high blood pressure greatly increases the risk of heart attack or stroke. If untreated, high blood pressure can lead to kidney failure and even damage your eyesight,” said Dr Nandakumar. The condition can also make the heart muscle become abnormally thick and stiff. In a condition known as left ventricular hypertrophy, the heart becomes enlarged and less able to pump blood around the body, leading to heart failure. The only way to tell if you have hypertension is to get your blood pressure measured. There are, however, some factors that may indicate that you are at risk, such as:
∞ ∞ ∞ ∞ ∞
Not getting regular physical activity Being overweight A diet high in sodium or alcohol A family history of high blood pressure Diseases of the kidney or adrenal gland
Taking certain medicines and herbal remedies may also elevate blood pressure. Dr Nandakumar also said that high levels of stress are known to be associated with high blood pressure, although scientific evidence has not established a clear link.
O31 31
ONE HE A LT H ONEHEALTH
BattlingBigDisease
We all need a certain amount of pressure in our arteries to keep blood flowing through the body. When the heart contracts, it sends oxygenated blood flowing through the arteries; when the heart muscles relax, the heart refills with blood.
Making sense of
BP 120 76 Blood pressure
Systolic pressure pressure of blood in the arteries when the heart contracts
is the measurement of the blood’s pressure in these two phases and is recorded as two numbers:
Diastolic pressure pressure of blood in the arteries between heart beats
Blood Pressure
Systolic BP
Diastolic BP
Normal blood pressure
Under 130
Under 80
Borderline high blood pressure
130 to 139
80 to 89
High blood pressure
140 or higher
90 or higher
The unit of measurement for blood pressure is mmHg (millimetres of mercury)
O32 O NE HEALT HE ALTH 32 ON
There is no known cure for high blood pressure, but the good news is that blood pressure can be kept under control. Apart from medicine, blood pressure can be managed and lowered with lifestyle and diet changes.
Tackling hypertension Lose weight
Physical activity
The more weight you carry, the bigger a toll it takes on the body and the higher the risk of hypertension. Ideally, keep your weight within a healthy BMI range of 18 to 25.
Aim for at least 30 minutes a day, five times a week. Regular exercise helps lower blood pressure and reduce the risk of other chronic diseases as well.
Cut down on salt
Sodium contributes to high blood pressure. Keep within a teaspoon of salt a day, avoid processed food, and use herbs and spices instead of salt.
Reduce alcohol, stop smoking
Both these habits are significant contributors to hypertension and other ailments.
This multi-faceted approach to managing high blood pressure is important as it not only treats the condition, but addresses the risk factors that lead to it. “In order to ensure adequate treatment for life, it is important that patients and their medical team work as partners in managing the condition,” noted Dr Nandakumar. To this end, JurongHealth is setting up a Hypertension Clinic which will offer the full scope of assessment, counselling, investigations, and intervention for hypertension. Here, patients with resistant high blood pressure will be assessed to optimise their therapy, and may be considered for a novel therapy known as renal denervation (see box story).
The team will also help patients understand the disease process, progression, treatment plans and goals. “This ensures compliance, which is crucial, especially in a chronic disease which can be easily managed, but if untreated can lead to significant morbidity and mortality.”
New hope for stubborn hypertension Renal denervation (RDN) is a new and promising therapy for patients who are resistant to multiple drug therapy for their hypertension. It is a minimally invasive procedure that uses radiofrequency waves to destroy one of the nerves that runs along the renal arteries. This nerve, when overactive, plays a role in causing high blood pressure. The procedure has few side-effects and only requires patients to stay overnight in the hospital. “The RDN service is an excellent example of a collaborative approach by a multi-disciplinary team consisting of cardiologists, radiologists, nephrologists, and specialist nursing staff,” added Dr Nandakumar.
O33 33
ONE HE A LT H ONEHEALTH
BattlingBigDisease
All clogged up
Not all cholesterol is bad for you but when the bad outweighs the good, the risk of heart attack and stroke increases. Learn how to keep your blood vessels and heart healthy By Sheralyn Tay IN C ONSULTATION W ITH DR N I K OL A S WA N A H I T A & D R ER I C CH ON G , C O NSULTANTS, DEPARTM E N T O F M E DICIN E
O34 O NE HEALT HE ALTH 34 ON
Imagine thick chunky sludge travelling through a pipe and the residue it will inevitably leave on the inside surface – that’s a good illustration of how ‘bad’ cholesterol can affect the blood vessels, the transport infrastructure of your body. “Cholesterol consists of many different particles,” explained Dr Nikolas Wanahita, Consultant, Department of Medicine, JurongHealth. “When our body has a high level of low-density lipoproteins (LDL) cholesterol and a low level of high-density lipoproteins (HDL) cholesterol, this becomes an important risk factor for various diseases.” This is because LDL particles stick to the blood vessel walls – causing it to become narrowed – and become the precursor of what we called plaque that blocks our blood vessels. “When this plaque became unstable and eroded, it may detach from the blood vessel wall and cause complete blockages downstream in our arteries.” High levels of LDL can also cause inflammation and hardening of the blood vessels, a condition known as atherosclerosis, added Dr Eric Chong, Consultant, Department of Medicine, JurongHealth.
“High cholesterol is a significant problem because it is the forefather of many cardiovascular diseases such as stroke, heart attack, and peripheral vascular disease (blockages in the leg arteries).”
STAGES OF ATHEROSCLEROSIS
Healthy artery
Build up of plaque forms
Plaque ruptures; blood clot forms
The facts about cholesterol Cholesterol is a type of fat in the bloodstream that is essential to all animal life. It is a vital component of our cell membranes and plays a role in intracellular transport, signalling and nerve conduction. In addition, cholesterol is an important part of the way our bodies make steroid hormones, bile acids and vitamin D. Cholesterol comes in two forms of proteins known as lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). High levels of LDL cholesterol can lead to fatty deposits in the artery walls that cause them to harden and narrow. This form of cholesterol is sometimes referred to as ‘bad’ cholesterol. HDL cholesterol is ‘good’ cholesterol that helps remove excess cholesterol from the body, reducing the risk of heart disease. In the right amounts, cholesterol is normal and essential for good health. But if blood cholesterol levels are too high, your risk of developing health issues such as heart disease and stroke can increase.
O35 35
ONE HE A LT H ONEHEALTH
BattlingBigDisease
Risk factors and detection Cholesterol levels are determined by inherent factors as well as lifestyle choices
Genetics determines the amount of cholesterol you naturally produce. A family history of high cholesterol is an indication that you may be at higher risk of developing high cholesterol
A diet high in saturated fat, trans fats and high-cholesterol foods may raise your cholesterol levels
Being overweight and inactive contributes to increased LDL cholesterol
As Dr Wanahita noted, it
is important to focus on risk factors within our control by eating a healthy diet high in fibre, avoiding diets high in saturated and trans fats, and maintaining a routine of moderate exercise.
Early detection can also play a role in reversing the problem.
Though it is not possible to tell from physical signs that your cholesterol levels are too high, a simple blood test can determine your cholesterol levels. Dr Wanahita recommends regular cholesterol screening for men aged 35 and above and women aged 45 and above. Anyone with a risk of coronary heart disease should begin screening earlier at 25 years old. The risk factors for heart disease include smoking, family history of heart disease, hypertension, diabetes, history of stroke, and a sedentary lifestyle.
A holistic approach Like many other chronic illnesses, the treatment of high cholesterol is not just focused on taking medication. “We term it chronic disease management because we aim to address the root of the problem,” said Dr Chong. At JurongHealth, the disease is managed as a partnership, added Dr Wanahita, with allied health specialists educating patients on self-management, lifestyle/diet changes and the importance of complying with their treatments. “This empowers patients and gives them ownership of their own well-being,” he said. Ultimately, this is a more effective approach to reduce complications and improve the quality of life.
O36 O NE HEALT HE ALTH 36 ON
4
Tips for cholesterol control
A better diet and routine exercise play important roles in lowering cholesterol levels. Move it, move it Regular physical activity – even moderate exercise such as brisk walking – can make a dent in high cholesterol levels. This is because exercise not only lowers bad cholesterol, it also raises good cholesterol. It all makes an impact, whether it is a 45-minute walk after dinner, clocking 10,000 steps a day or just getting up from your desk to walk for 5 minutes each hour.
Go green Studies reveal that the antioxidants in green tea called catechins can have a cholesterol-lowering effect. When brewing your daily cup, don't use boiling water as it may kill the catechins. For a boost, add lemon as the vitamin C makes the compounds easier to absorb.
Load up on fibre Oatmeal, wholegrain bread, fruit and vegetables have a reputation for being healthy for a reason –they contain cholesterol-lowering dietary fibre. Soluble fibre helps lower cholesterol because it absorbs cholesterol in the digestive tract.
Eat the right fat Dietary cholesterol (foods high in cholesterol) is not the main culprit of high cholesterol, but saturated animal fat is, so cut back on meat and animal fats. Don’t avoid fats altogether though — good fats from canola oil, olive oil and oily fish such as salmon, tuna and cod have omega-3, which is good for lowering cholesterol.
O37 37
ONE HE A LT H ONEHEALTH
BattlingBigDisease
When the body cannot convert sugars into essential energy, glucose concentrates in the blood, wreaking havoc on delicate tissues and organs By Adam Koh IN CONSULTATION WITH DR KURUMBIAN CHANDRAN, CONSULTANT & DIRECTOR, DIABETOLOGY
Sugar Crisis Diabetes mellitus may have a sweet-sounding origin to its name – diabetes is Greek for ‘to pass through’ and mellitus is Latin for ‘sweet as honey’ – but its effect on the body can be deadly. According to Dr Kurumbian Chandran, Consultant & Director, Diabetology, JurongHealth, it is one of the top chronic diseases of concern in Singapore.
“Singapore has one of the highest rates of diabetes in the
developed world and the prevalence has increased from 8.2 per cent in
2004 to 11.3 per cent in 2010.”
This condition is significant because it can lead to a host of problems, explained Dr Kurumbian. “Diabetes is associated with long-term complications that affect almost every part of the body. Poorly controlled diabetes may lead to blindness, heart and blood vessel diseases, stroke, kidney failure, amputations, and nerve damage. The impact of complications associated with diabetes is more pronounced, especially if the diabetes is uncontrolled.” In addition, diabetes reduces both a person's quality of life as well as life expectancy and can pose a large economic burden on caregivers and families.
O38 O NE HEALT HE ALTH 38 ON
What causes diabetes? Diabetes occurs when insulin is insufficient or cannot be used adequately. Insulin acts as a ‘key’ that binds with insulin receptors found on every cell surface, telling the cell to absorb any glucose that is present in the bloodstream. Only then can cells use glucose as fuel. Diabetes occurs when there is a problem with this process of turning glucose into energy. There are two types of diabetes. A less common form is Type 1 diabetes when the body cannot produce insulin at all. Patients – who are typically diagnosed in childhood – need insulin replacement for life. Type 2 diabetes, a more common form of the condition, accounts for 9 in 10 of all diabetes cases. “This type of diabetes results from failure of the body to use insulin effectively combined with the inadequate production of insulin,” explained Dr Kurumbian. When cell receptors are insulin resistant, they cannot access glucose for fuel and they starve. Glucose builds up in the bloodstream and over time, affects the blood vessels in the whole body, especially in the nerves, eyes, kidneys and heart.
HIGH CHOLESTEROL LEVELS HIGH BLOOD PRESSURE
SMOKING
2
TYPE DIABETES SEDENTARY LIFESTYLE
HIGH FAT DIET
OBESITY
1 in 3 Singaporean diabetics are over 70 years old
12.3% 10.4% 15%
7th
12—14 years
of Singaporean men are diabetic of Singaporean women are diabetic of Singaporeans are estimated to have diabetes by 2015
leading cause of death in Singapore in shortened life expectancy Source: Ministry of Health
SYMPTOMS OF DIABETES
RISK FACTORS FOR INSULIN RESISTANCE
• Frequent thirst despite drinking water
• A family history of diabetes
• Constant hunger
• A history of gestational diabetes
• Constant tiredness
The dangerous aspect of Type 2 diabetes is that symptoms do not occur until after many years of onset. So it is important to be screened regularly for diabetes so it can be detected and treated early.
• Itchy skin, especially around the genital area • Excessive passing of urine • Weight loss despite good appetite
• Excess weight and/or central obesity – fat that collects around the torso • A sedentary lifestyle • High blood pressure • High cholesterol
• Slow healing cuts and wounds
O39 39
ONE HE A LT H ONEHEALTH
BattlingBigDisease
Living well with diabetes
Though diabetes cannot be cured, it can be well-managed with adjustments to lifestyle, diet and regular screening for complications, said Dr Kurumbian. Apart from tests to monitor blood sugar, cholesterol and blood pressure levels, annual foot screening is mandatory to check for and treat foot ulcers or infections to prevent future major amputation of the leg. “Annual eye screening is also crucial to avoid permanent visual loss,” he added. To better manage the disease, JurongHealth has formed an Integrated Care Pathway (ICP) for Diabetes. “The cornerstone for the effective treatment of diabetes is a multi-disciplinary approach,” noted Dr Kurumbian, who heads the multi-disciplinary committee and works with a team of physicians, diabetes nurse educators, dietitians, physiotherapists, and other allied health professionals to right-site diabetes patients. “We strongly feel that patients whose diabetes, blood pressure and cholesterol levels are on target should be managed by family doctors located close to their homes. We can then partner family doctors to help co-manage patients who have difficulty achieving these targets.” All these initiatives will translate into cost-savings for the patient in the long run, while delaying the risk of complications so patients can enjoy better outcomes, he added.
O40 O NE HEALT HE ALTH 40 ON
BattlingBigDisease
Colon Cancer Rising Lurking deep in the bowels – often with no clear symptoms – colon cancer is one of the most common and deadliest cancers in Singapore By Bella Lim IN CONSULTATION WITH DR SEOW CHOON SHEONG, SENIOR CONSULTANT, GENERAL SURGERY
O41 41
ONE HE A LT H ONEHEALTH
BattlingBigDisease
What causes diabetes? For a cancer that is
one of the most fatal in Singapore, colon cancer presents few signs
– especially in its earliest stages. Yet the cancer is of particular concern because it is the most common in Singapore and is hard to treat, especially if it is discovered in its later stages, said Dr Seow Choon Sheong, Senior Consultant, General Surgery, JurongHealth. This underscores the importance of early detection to discover the presence of cancerous growths in the colon. Dr Seow explained, “The cancer occurs when normal cells in the large intestine transform into a sinister, uncontrolled growing mass capable of interfering with the function of the colon. These cells later invade nearby organs and spread.” Each year, almost 1,200 new cases of colon cancer are discovered. Numbers are expected to rise as the population ages because cancer risk, in general, increases as one gets older.
Each year, almost 1,200 new cases of colon cancer are discovered. O42 O NE HEALT HE ALTH 42 ON
INFLAMMATORY BOWEL DISEASE Healthy
Crohn’s disease
Ulcerative colitis
fat wrapping
Muscle hypertrophy
Fissures
Cobblestone appearance
Ulceration within the mucosa
Signs of change While it is commonly believed that chronic constipation is a cause of colon cancer, Dr Seow said this may not be the case. “There is no evidence that chronic constipation leads to cancer. However, colon cancer may result in a change in bowel habits and these may include constipation or loose stools.” Most often the cancer does not present any outward signs. In advanced stages though, the cancer can cause acute bowel obstruction which results in symptoms similar to constipation as well as other signs such as abdominal swelling, pain, weight loss, nausea and vomiting. Blood in the stool is also not necessarily a symptom of colon cancer, Dr Seow said, although a history of persistent bloody stools in older people, especially those over 50, warrants investigation. Keep in mind, he added, that there are also other less threatening causes of bloody stools such as infection, piles, diverticular disease and inflammation.
Detection and treatment
COLORECTAL CANCER SYMPTOMS • Change in bowel habits • Bloody stool • Chronic abdominal discomfort/pain • ‘Thin’ stools • Pain while passing motion • Unexplained weight loss • Anaemia
Those at risk • Adults above 50 • Those with a family history of colon or rectum cancer • Those with a history of colon polyps • Those with a history of ulcers in the lining of the large intestine or Crohn’s disease
OTHER RISK FACTORS include smoking, alcohol, insufficient exercise, a diet high in preserved meat, processed sugar, red meat and animal fat as well as obesity. Colon cancer is slightly more common in men but it is not clear why this is so.
If you are at risk The best way to screen for colon cancer is a faecal occult test. This is a simple, cheap and common screening that detects even the smallest traces of blood in your stools. All you need to do is request for the test from your general practitioner or a hospital to collect a sample of your stool. You may also opt for colonoscopy, where a doctor uses a long flexible tube inserted through the anus to study the colon for any dangerous growths. If colon cancer is detected in its early stages, the good news, said Dr Seow, is that it is potentially curable. “The cure of colon cancer is highest in the early stages where the cancer is confined to the bowel wall only. This has a cure rate of nearly 100 per cent.” The treatment options include surgery, chemotherapy, and radiotherapy, and can be given in different combinations, he explained. “Surgery to remove the colon remains the mainstay of treatment as it offers the best chances of cure.” While it remains a challenging cancer to treat, advancements in medical research are making colon cancer easier to detect and treat. “This includes using aspirin to prevent primary or secondary colon cancer; new special chemotherapy drugs called 'biologics' that target the molecular pathways of cancer growth and development; and innovative methods of colon cancer surgery such as laparoscopic, robotic, and single port surgery,” Dr Seow explained. “Many such advances are readily adopted into our medical practice in Singapore once they have been shown to be beneficial to patient care.”
O43 43
ONE HE A LT H ONEHEALTH
FOODforLIFE!
One way to truly experience Singapore’s multicultural diversity is to walk through a hawker centre or food court. Here, you are bound to find cuisine inspired by the various ethnic groups: Chinese, Malay and Indian. According to Elisa Mak, Dietitian, JurongHealth, eating out often poses more barriers to eating healthily because of 4 Cs: Culture, Constraint, Convenience and Cost.
more protein but less fat, have
For
skinless chicken breast with plain rice or porridge
For one, many food vendors prepare foods based on established tradition or routine rather than the knowledge of healthy nutrition. This may mean unconsciously using more oil or seasoning, making food higher in fat, salt and calories. Another reason, said Ms Mak, is time constraint, “When you are in a hurry, fast food may be more convenient or you may choose your meal based on where the shortest queue is – not necessarily the healthiest one. Busy people may also skip meals and snack on convenience food – often fried snacks or sugary buns – leading to unwanted calories.” Sometimes, our food options may also be due to convenience. Having dry-style noodles – an option higher in calories than the soup version – is often preferred because the soupy form is often more uncomfortable to eat in our humid weather. Cost is the fourth issue. “We all try to save money and go for the cheapest options when eating out and sometimes those options may not be the healthiest,” Ms Mak added.
Healthy hawker eats
In a food paradise like Singapore, with convenient and affordable food options, eating out is a way of life Here are some ways to make better choices By Louisa Foo IN CONSULTATION WITH ELISA MAK, DIETITIAN
44 O44O N E HE ALT H
fibre-rich
Ditch roti prata for chapatti or thosai. Ask for dhal and tomato chutney instead of creamy curry or coconut chutney
rice-based noodles in clear soup rather than fried, dry or
Choose
gravy laden options. Fresh fish noodles, wanton noodles or yong tau foo without fried items are light, healthier choices
Instead of fried noodles, opt for congee without fried shallots for a breakfast
low-fat, but comforting
End your meal with something
sweet, but light.
Choose cheng tng or soya bean curd with less sugar syrup
Trim the fat with a bowl of mee soto instead of mee rebus or mee goreng
O45 45
ONE HE A LT H
FOODforLIFE!
That tea-time treat to perk you up and boost your energy levels has a bad reputation – but not all snacks are created equal. Here’re some healthier treats to tame the mid-day munchies! By Louisa Foo IN CONSULTATION WITH ELISA MAK, DIETITIAN
Snacking smart Snacking can be healthy as long as you choose the right snack and if it helps you meet your nutrient requirements without exceeding your total caloric requirements for the day. Elisa Mak, Dietitian, JurongHealth, explained, “Whether snacking is unhealthy depends on the type of snacks you choose, the amount you eat and if the snacks add on to those excess calories that you require for the day.” In fact, it is common to feel a little peckish in-between meals when our blood sugar dips. “During our hunger pangs and our search for an energy fuel, we will possibly grab the most convenient snack, and that is likely to be an unhealthy one,” Ms Mak said. “Convenience foods such as potato chips or curry puffs may be an easy on-the-go food during hunger pangs but these snacks are high in sodium, high in fat and calorie dense. In the long run, these do not provide much nutritional benefit and only lead to potential weight gain.” To snack smarter, plan ahead, she advised. “If you notice a trend of a specific time of day when you feel hungry, plan ahead to have a healthy snack before encountering the hunger pangs.” Alternatively, drink some water first as we often confuse the cue for thirst with hunger. Snack only when you need it and avoid mindless snacking due to boredom, stress or habit. Resist urges to nibble when watching television or working at your desk,” Ms Mak added. “It’s also important to watch portion sizes when snacking to avoid too much of a good thing.”
46 O46O N E HE ALT H
Have
low-fat yoghurt
for a creamy comforting way to bump up your calcium intake
Grab a handful of unsalted roasted nuts such as almonds or cashews Jazz up your fruit. Have a
small spoonful of low-fat peanut butter with apple slices or celery sticks for a flavourful protein boost!
wholemeal crackers
Pair with low-fat cheese
small steamed vegetarian pau or all-veggie Nyonya popiah
Make it meatless; opt for a
with less sweet sauce
soy green tea latte
Prepare a with a glass of reduced-sugar soy milk and green tea powder
steamed
Have a handful of They’re low in fat but high in fibre, protein and vitamins
chickpeas.
soya bean curd
Reach for a bowl of with less sugar syrup
Have a few slices of grilled lightlyseasoned chicken breasts and eat with cucumber sticks
Prepare fresh vegetable sticks and dip them into plain yogurt mixed with herbs
O47 47
ONE HE A LT H
FOODforLIFE!
Hearty French Toast Preparation Time: 30min Serves: 6 Nutrient value (2 slices) Calories Protein Fat Fibre
229 kcal 12g 4g 4g
Ingredients 3 Eggs ¼ cup Plain flour ½ tsp Ground cinnamon 1 tsp Vanilla extract ¾ cup Low fat milk 1 tbsp White sugar 1 pinch Salt 12 slices Wholemeal bread
Method 1. In a large bowl, add flour and slowly whisk in the milk
2. Add salt, eggs, cinnamon, vanilla extract and sugar and whisk until smooth 3. Heat a lightly oiled frying pan over medium heat 4. Soak bread slices in the egg mixture until saturated 5. Cook the bread on each side until golden brown 6. Serve hot with a little honey and fresh fruit
A toast to remember
Easy to prepare and delicious to boot, this healthy French toast recipe is perfect for a quick breakfast or brunch CONTRIBUTED BY DIETETICS AND NUTRITION DEPARTMENT, JURONGHEALTH
48 O48O N E HE ALT H
HealthBites
Arm yourself with the proper protection and knowledge to combat the haze if it strikes
Haze aware With reports warning that the haze may return later in the year, Dr Luke Low, Family Physician (Associate Consultant), JurongHealth, advises all individuals to reduce their exposure. Fine haze particles may irritate the eyes, nose, throat, heart and lungs. People with asthma, heart or lung conditions should take extra care and ensure they have enough medication on hand.
healthy adults
the elderly, children and expectant women
people with chronic lung or heart disease or stroke
*minimise
*minimise
*avoid all
*minimise
*avoid
*avoid all
*minimise
*minimise
*avoid all
long periods of active and/ or outdoor activity
long periods of active and/ or outdoor activity
going outdoors
long periods of active and/ or outdoor activity
outdoor activity where possible
going outdoors
outdoor activity
outdoor activity
outdoor activity
HAZE LEVEL
(24HR PSI)
101200 201300
*Use the
right mask If you must be outdoors during the haze, use a respirator mask of N95 standard or equivalent. N95 masks are at least 95% efficient against super fine particles. Seal your N95 mask against your face so that air has to pass through the filter. You can re-use your N95 mask, but remember to replace it when it becomes soiled or distorted in shape. It should not be shared.
above
300
Remember, surgical masks do not effectively filter fine haze particles.
O49 49
ONE HE A LT H
Have you downloaded the JurongHealth Digital Library? Download today and access
JurongHealth’s publications, including ONEHealth and the Commemorative Report, in an interactive and dynamic e-magazine format. CONGRATULATIONS to our 'early bird' downloaders!
You've won an iPad Mini!
Koo Joon Ngien NRIC: SXXX4591D Wee Keng Lip NRIC: SXXX1388D Zhang Jingjing NRIC: SXXX9523A And thank you to the other 200 downloaders who have won a ONEHealth first aid kit! All winners are notified by email. Prizes not collected before 30 June 2014 will be forfeited.
O50O N E HE ALT H