AHA magazine Mar-Apr 2016

Mita (P) 147/08/2003 Co. Reg. No. 52929306D

Mar-Apr

2016

A l e x a n d r a

H e a l t h

i n

Touching Lives, Pioneering Care, Making a Difference

A c t i o n

Beat colorectal cancer!

C

experiences in a video at the forum, proving there is life after cancer.

olorectal cancer is one of the easiest cancers to manage if detected and treated early.

Unfortunately many patients leave it too late because they either don’t recognise the symptoms or are too shy to see a doctor.

and was found to have blood in his stools. Mr Lim was sent to KTPH where he had further tests and was diagnosed with colorectal cancer. He underwent surgery and chemotherapy and is now back to his normal routine of swimming and regular walks. Mr Lim shared his

So the Colorectal Surgery team from Khoo Teck Puat Hospital (KTPH) joined forces with the People’s Association and Singapore Cancer Society (SCS) to teach the public how to protect themselves from colorectal cancer.

I would advise those people who are of age to go for screening because there is nothing to lose and everything to gain.

Early detection gives you a very good chance of cure.

About 400 Yishun residents attended the ‘Beat Colorectal Cancer’ public forum, which was held in both English and Mandarin at Nee Soon East Community Club on 6 March 2016.

The event included a health fair run by nurses, physiotherapists and dietitians, with talks on colorectal cancer screening and treatment by colorectal specialists. SCS also distributed stool screening kits to people aged over 50 years.

Seventy-four year old Michael Lim says one of these kits saved his life. He had no symptoms but did the test last year

Mr Louis Ng, MP for Nee Soon GRC – Nee Soon East, (centre), and a participant learning about the signs of colorectal cancer from Ms Goh Kwee Yen, Senior Staff Nurse, KTPH.

Find out the signs and symptoms of colorectal cancer, if you are at risk, and how you can eat your way to better bowel health (see next page).

Mr Lim, who found out about his colorectal cancer through screening and received timely treatment.

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Signs and symptoms of colorectal cancer

Change in Bowel Habits

Blood in Stool

Unexplained Weight Loss

Persistent Abdominal Discomfort

Are you at risk?

Under 50 years old

Under 50 years old

Over 50 years old

Over 50 years old

No family history of colorectal cancer

With family history of colorectal cancer and/or:

No family history of colorectal cancer

With family history of colorectal cancer and/or:

No inflammatory bowel disease

Inflammatory bowel disease

No inflammatory bowel disease

Inflammatory bowel disease Intestinal polyps

No intestinal polyps Low risk

At risk

At risk

High risk

Look before you flush to check for signs of colorectal cancer.

Look before you flush to check for signs of colorectal cancer.

Look before you flush to check for signs of colorectal cancer.

Look before you flush to check for signs of colorectal cancer.

Speak to your family doctor about when you should start screening.

Do the FIT test every year to check for blood in stools.

Do the FIT test every year to check for blood in stools.

• • • •

Ask your doctor for advice on further screening.

Inflammatory bowel diseases include ulcerative colitis and Crohn’s Disease.

Irritable Bowel Syndrome (IBS) is not an inflammatory bowel disease.

Intestinal polyps are non-cancerous growths in the bowel wall that can turn into cancer.

The FIT test (Faecal Immunochemical Test) checks for blood in the stools.

Singaporeans and PRs aged over 50 years old can pick up a free kit from Guardian or Watson’s stores.

For more details, visit: www.singaporecancersociety.org.sg

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Eat your way to better bowel health Get in Shape!

1

Eat 2 portions of fruits + 2 portions of veggies

2

Go for whole grains & beans

3

¾ mug/ 100g cooked vegetables 150g raw leafy vegetables 1 small apple, orange or pear (130g) 1 wedge of watermelon, papaya or pineapple (130g)

Obesity increases the risk of colorectal cancer

Limit red meat consumption

4

Cut down processed meats

5

Limit your alcohol

6

Eat less than 500g of cooked red meat in a week.

No more than 2 standard drinks a day

That’s less than 5 palm-sized portions of red meat weekly.

No more than 1 standard drink a day

Pork

Beef

Lamb

Eating 100g red meat every day increases your risk of colorectal cancer by 17%

Eating 50g processed meat every day increases your risk of colorectal cancer by 18%

330ml 175ml 1 can ½ glass regular beer wine

35ml 1 nip spirits

04

Boosting workplace health and productivity Singaporeans are living longer and working longer.

With the retirement age of 62, a supportive health-promoting work environment helps employees live healthily and age well. This results in increased productivity and the retention of professional knowledge and experience that older staff can share with their junior colleagues.

Here are six tips from the Workplace Health Promotion Forum held at KTPH on 3 March 2016.

1 3 5

Create a health-promoting work environment

Motivate staff to form healthy habits

Build it around the five pillars of health – ‘Eat Wisely, Exercise Regularly, Be Happy, Stop Smoking and Practise Personal Hygiene’. For example, have a smoke-free policy at work, make healthier choices easily available at the staff canteen and encourage staff of similar interests to get together to exercise or play sports.

Encourage them by helping to make it easier for them to pick up and maintain healthy habits.

This will in turn help them be more empowered and in control of their health.

Organise regular team-building events

Promote healthy ageing

Such activities bring employees of all ages together to achieve common goals. These can also help staff of different generations to better appreciate each other’s strengths and even correct some misconceptions.

Support older workers better Through simple but effective interventions, such as paying attention to office ergonomics to reduce the risk of musculoskeletal injuries and being mindful of any changes in their visual and auditory requirements, older workers can be better supported.

Resources such as the Positive Ageing Toolkit developed by the Council for Third Age (C3A) are available to workplaces.

They have been designed to help seniors understand and reflect on their thoughts, feelings and values about their personal well-being.

Encourage all employees to be Fair@Work They can start by making their individual commitment to be fair and inclusive at the workplace at www.tafep.sg/fairatworkpromise.

2 4 6

05

Words of wisdom

D

id you know that 1 out of 10 staff in Alexandra Health System is aged 50 and above? Three of our oldest (but young at heart!) employees share with us what keeps them going.

I eat well, exercise and have no problems with my health but this job does involve a lot of walking between gardens around the campus. I get the occasional aches and pains but otherwise I’m quite fit to continue working and contributing.

Rosalind Tan, ‘Chief Gardener’, 75 years old

What keeps me motivated are good health and the blessings I have had so far. I love my job and I get a great sense of satisfaction from doing a good job in the Operating Theatre after each patient’s successful operation.

Sister Theresa Chan, Senior Nurse Clinician, 65 years old

I don’t think there’s any issue working with the younger staff because we complement each other. If there’s a heavier patient they will take over or they will come and help me when necessary, whereas I will sometimes take over their older patients because I can relate better to them than they do.

Mrs Ng Chai Ming, Principal Physiotherapist, 73 years old

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Signing of MOU between Alexandra Health System and Republic Polytechnic

A

lexandra Health System signed a Memorandum of Understanding (MOU) with Republic Polytechnic (RP) on 15 March 2016, strengthening the existing partnership and collaborations since 2011.

The signing of the MOU paves the way for initiatives such as student internships and employment opportunities, industry talks and

training workshops, industrial projects, applied research and the set-up of joint labs and mutual development opportunities for both organisations’ employees.

For KTPH Sports Medicine Centre and RP School of Sports, Health and Leisure, this MOU formalises a working relationship that already exists between the two organisations.

Dr Teoh Chin Sim, Director of Sports Medicine Centre and Senior Consultant, KTPH shared, “We plan to continue with the sharing of expertise in education and research. Further to this, we want to explore how our Sports Medicine Centre could better serve the needs of the physically active and sporting fraternity at Republic Polytechnic, especially for the athletes’ training and preparation for the inter-varsity games.”

From left: Dr Teoh Chin Sim (Director of Sports Medicine Centre and Senior Consultant, KTPH), Mrs Chew Kwee Tiang (CEO, KTPH), Mr Seto Lok Yin (Deputy Principal, Industry Services, RP) and Ms Goy Soon Lan (Director, School of Sports, Health and Leisure, RP)

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08

Herbal chicken brown rice congee

T

INGRED 3 cu p

IENTS

d salt c s reduce

he recent battle against diabetes has waged war on a Singaporean staple – white rice.

As such, brown rice is being advocated as an alternative to white rice. Research has shown that replacing just one fifth of our white rice with brown rice lowers the risk of diabetes by 16%.

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ater 3 c u ps w lfberries dried Wo n o o p s root) 1 table Angelica e s e in h i (C ong Kwa d 3 slices T e, washe brown ric d e ix m strips 1½ cups liced into s , h ig th ken less chic 350g skin rnish ns, to ga io n o g n ri Sp

DS M E TH O

When we eat starchy white rice, its high carbohydrate content is broken down in our bodies into sugar, which goes quickly into the blood stream.

The pancreas has to work harder to help absorb all this sugar. Frequent sugar spikes may cause the pancreas to become inefficient and reduce the body’s ability to absorb sugar from the blood stream, heightening the risk of diabetes.

pot an a medium

50 min Serves 4

Here we share a recipe to show you how mixing brown rice into your meal can be just as delicious!

Nutritional Information d bring

ients in all ingred e in b m o 1. C inutes. r for 40 m e to a boil. m im s to uce heat serving. iling, red o b e c n s before n io n 2. O o g rin pp e d s p with cho h is rn a 3. G

Whole grains such as brown rice, barley and oats are rich in fibre. It promotes healthy bowel function and makes you feel fuller longer.

(per serving) Energy

393 kcal

Protein

21.9 g

Total Fat

6.2 g

Saturated Fat

1.6 g

Cholesterol

69 mg

Carbohydrate

61.4 g

Dietary Fibre

2.0 g

Sodium

460 mg

Brought to you by the Nutrition and Dietetics, and Food Services departments of Khoo Teck Puat Hospital.

Supported by Tong Seng Produce Pte Ltd’s community service initiative.

09

Ask the Pro Q.

My elderly father had bowel surgery and the next day the physiotherapist told him she wanted to help him get up and out of bed. I was so shocked! Isn’t bed rest best for patients after surgery?

Bed rest after an operation is no longer the best way to recover after most operations because it puts patients at risk of complications and can delay healing.

At KTPH, we usually start them walking the day after their operation.

Walking strengthens the muscles and improves blood flow which can help operation wounds heal faster. Moving also prevents complications such as blood clots and chest infections that

can affect the patient’s recovery and prolong their hospital stay.

Many patients worry that it will be painful when the physiotherapist first talks to them about getting out of bed.

They may also be concerned about attached IV lines or tubes becoming dislodged when they walk. However, the doctor will prescribe pain relief medication so they can move around comfortably. A physiotherapist will also be with them to ensure they are safe.

If the patient is unsteady on their feet, we will start them off walking using a walking frame or other gait aid to ensure they don’t fall. The physiotherapist also teaches patients breathing exercises to help clear their lungs and techniques to cough and clear phlegm effectively.

Studies have also shown that the fitter you are before an operation, the easier it is for your body to recover and heal.

So if you or your loved one is going for a planned operation: • Stay active – going grocery shopping, practicing tai chi and climbing stairs are easy ways to improve your muscle strength.

• Exercise at least three times a week brisk walking, swimming and cycling can help improve your stamina and blood flow.

Reply by Kylie Siu, Senior Physiotherapist, Rehabilitation Services, KTPH Here is a chance to ask any question you may have about various health topics or health conditions. Write in to AHA@alexandrahealth.com.sg with your full name and address and receive our special AHS dragonfly thumb drive if your letter is published.

Kylie Siu, Senior Physiotherapist, KTPH, helping a patient with walking after his surgery.

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A new approach to dementia care Putting Montessori into practice Dr Cameron’s mother-in-law has dementia and came to stay with him and his wife temporarily when her usual caregiver, Dr Cameron’s brother-in-law, Christopher, needed to study. The first day Christopher left for classes, she repeatedly asked where he was despite being told every time.

Dr Camp’s thought-provoking presentation sparked many questions from the audience.

P

eople with dementia can learn how to care for themselves if they are taught in a way that focuses on their abilities rather than their disabilities.

American psychologist Dr Cameron Camp says engaging people with dementia in meaningful activities improves their quality of life and reduces responsive or ‘challenging’ behaviours such as asking the same questions repeatedly or wandering out of the house.

Dr Camp created a new way of caring for people with dementia based on the principles of the Montessori teaching method, which was originally created for children (see side bar).

Speaking at the ‘New Dimensions of Dementia Care’ forum, organised by the Lien Foundation and KTPH on 20 February 2016, Dr Camp stressed that

this method was not about treating people with dementia like children.

“The Montessori approach is based on treating people with respect, dignity and equality,” Dr Cameron told the 300-strong KTPH auditorium. “It’s important to enable people with dementia to display ability, competence, provide a reason for them to wake up in the morning and grow in the family and society. This is our treatment for dementia.”

So the next day before leaving, Christopher wrote her a note saying where he was going and what time he would be back.

The family checked that she could read it then taped it down on the counter. Whenever she asked where Christopher was, Dr Cameron’s wife told her about the note and brought her to read it.

Seeing the note allayed her fear that she had been abandoned.

Over time, she learnt to go to the note on her own when she was feeling anxious and that way she was able to reduce her anxiety herself.

Forget Us Not Recognising the need to develop empathy and foster inclusive communities for persons with dementia (PWD), KTPH collaborated with Lien Foundation for the Forget Us Not campaign.

Launched on 20 January 2016, Forget Us Not is fostering dementiafriendly communities all around Singapore, and has started with the Yishun neighbourhood. By improving awareness and understanding of dementia, it aims to destigmatise and improve acceptance of PWDs. Dr Philip Yap, Director of KTPH’s Geriatric Centre said, “With everyone chipping in, we hope Yishun will be a place where PWDs feel included, respected and valued. Here, they can get around safely and continue to participate meaningfully in their usual routines because members of their community, be it a favourite neighbour, shopkeeper or local policeman, can understand and assist them.

Having such community support is a boost for PWDs and their families. It can help PWDs age in place and continue to stay plugged into society.”

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Activity Engagement As a caregiver, you play an important role in keeping the older person mobile and active at home. You can encourage the older person to engage in self-care and leisure activities and reduce time spent lying down or watching T.V.

My mother usually gets up for meals.

Other than that, she spends her day in bed!

I worry that my dad will fall down while bathing, so I prefer to do everything for him.

My grandma loves cooking for her family.

Now that she’s old, it wouldn’t be safe.

Outdoor activities

Self-care

Cooking

Engage the older person’s sense of smell, touch and sight by:

Encourage the older person to participate in self-care tasks (brushing teeth, combing hair, bathing, dressing) by:

Involve the older person in the process of making their meals or snacks by:

Going for regular walks around the park

Encouraging them to perform tasks in a stable, seated position

Making trips to the nearby market or coffeeshop

Providing just enough assistance

Chopping or peeling vegetables Stirring a pot of soup

Engaging in simple gardening tasks (e.g. watering plants, potting plants)

Mixing or kneading mixture Providing a safe environment (e.g. grab-bars, good lighting, dry flooring)

Brought to you by Occupational Therapists, Rehabilitation Services, KTPH

Measuring the correct amount of ingredients

12

When small bumps cause big bruises

U

sing sunscreen doesn’t just keep skin fair and stop sunburn – it also helps to prevent wrinkles and paper-thin skin in old age. Years of exposure to the sun damages the skin, worsening the effects of the natural ageing process.

“An 80 year old’s skin is more fragile than a newborn baby’s,” says Dr Priscilla Ng, Senior Resident Physician with KTPH Geriatric Medicine. “As we age, both the skin and the layer of fat underneath become thinner.

Fragile skin that tears easily is a common problem in the elderly. Start protecting your parents’ skin and your own today.

The sweat and sebaceous glands dry out so skin is less lubricated and less collagen is produced so the skin loses its elasticity.”

Skin tears and bruising can occur even with minor injuries because the skin and its blood vessels weaken with age. That’s why bruising is common when blood samples are taken from the elderly.

Dr Ng says, “People with diabetes and hardening of the arteries, or frail elderly with reduced mobility, immunity or nutrition, can be prone to wounds and infections which may not heal easily.”

Never fear, there are ways you can improve and protect your parents’ skin (see right). Don’t forget to look after your skin too – use sunscreen every day!

Chronic medical conditions which are more common in the elderly can also worsen the condition of the skin.

Food Therapy for Skin Sunflower, corn and soybean oils are rich in Vitamin E and good for stir-fries. But go easy on them if you’re watching your weight as they are high in calories.

T

o nourish the skin, KTPH Dietitian Magan Ho recommends eating at least two portions of fruit and vegetables every day and adding skinfriendly foods to meals.

Being well-hydrated is also important, says Magan. So drink 6-8 glasses of water a day unless your doctor has told you to limit your intake.

Broccoli is rich in Vitamins C & E. Steam or stir-fry small pieces as they are easier for the elderly to chew.

Pumpkin seeds and almonds are rich in Vitamin E but can be hard to eat with dentures. Sprinkle sesame seeds on cooked vegetables or serve sesame paste desserts instead.

Spinach is rich in vitamins C & E. Chop up tough stalks before cooking if your parents have difficulty chewing.

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Top 10 Skincare Tips for the Elderly 1

Go soap-free Use soap-free body washes such as aqueous creams when bathing as soap can dry out the skin. A pH 5.5 level is best for sensitive skin and try to avoid products that contain sodium lauryl sulphate.

2

Quick change!

Urine and faeces irritate the skin, so check diapers regularly and change them as soon as possible when soiled. Clean and dry the buttocks and genitals and use a barrier cream before putting on a fresh diaper.

3

Check the meds!

Steroid creams for eczema and psoriasis can thin the skin if over-used. Use steroid creams during flare-ups and stop when in remission.

4

Cushion corners Use foam or guards to cover sharp corners and edges in the home to prevent injuries.

5

Eat well Eat a healthy balanced diet with foods rich in skin-friendly vitamins C and E.

6

Keep skin dry Pat skin dry with a towel after bathing (do not rub) and check skin folds are clean and dry at the groin area, armpits and under the breasts.

7

Moisturise daily Gently apply a urea-based moisturising cream to the body at least once a day to make the skin more supple. Check the cream is absorbed before dressing.

8

Protect skin Apply sunblock before going into the sun and wear long-sleeved tops and pants that end just above the ankle.

9

Bed-bound precautions The bed-bound are at high risk of bruising and skin damage.

Turn them at least once every two hours, use an air mattress if possible and cushion boney body parts such as ankles and knees with pillows and foam.

10

Keep nails short Trim and file fingernails and toenails to prevent accidental scratches.

For a selection of suitable soap-free body washes, moisturisers and barrier creams, please visit: Outpatient Pharmacy, Level 1, Tower C, KTPH or shop online at www.theablestudio.com.sg.

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15

Keeping our water clean!

P

utting litter in bins doesn’t just keep the environment clean and tidy, it also prevents water pollution.

Heavy rain flushes litter into storm drains where it ends up collecting in reservoirs and ponds.

This year’s launch of Singapore World Water Day on 13 March 2016 included litter picking as well as sharing of water saving tips.

The event was held at Lower Seletar Reservoir Park and was co-organised by the national water agency, Public Utilities Board, Nee Soon South Constituency Office and KTPH. Over 500 residents and grassroot members took part in the celebrations, participating in the clean-up activity and learning trail, including Guest-of-Honour Er Dr Lee Bee Wah, MP for Nee Soon GRC (Nee Soon South).

Members of KTPH Green Committee share recycling tips and ideas with participants who attended the launch of Singapore World Water Day.

How water-wise are you?

Take this quiz to find out!

When showering, you: a) Turn off the water while soaping and set a timer to keep showers to 5 minutes. b) Try to take 5 minute showers but lose track of time and end up showering for 10 minutes. c) Soak under a power shower for as long as possible – it’s your favourite way to relax!

When brushing your teeth, you:

When washing dishes, you:

a) Use a tumbler halffilled with water to rinse your mouth and toothbrush.

a) Fill two basins with water – one for washing and the other for rinsing.

b) Turn off the tap while brushing your teeth then let the water run when rinsing to wash the spit away. c) Leave the tap running the whole time – it’s only two minutes and it keeps the sink clean while brushing.

b) Fill a basin with water for washing then rinse the dishes under a running tap. c) Wash and rinse under running water – it’s less troublesome.

Your results: All As: Your water-wise habits are saving you money and the environment. Keep it up!

Mostly Bs: It looks like you’re heading in the right direction. Pick up some water-saving tips from the ‘A’ answers to save more water and money.

Mostly Cs: You might as well be flushing dollar bills down the toilet with the amount of money you’re wasting! A 10 minute power shower uses about 150 litres of water compared to a 5 minute regular shower which uses about 40 litres. If you must use a power shower, turn the water off while soaping, set a timer and limit yourself to five minutes. Pick up more water saving tips from the ‘A’ answers.

16

Continuing Medical Education for Doctors Continuing Medical Education (CME) plays an important role in keeping medical professionals current with changes in medicine.

Khoo Teck Puat Hospital organises regular Continuing Medical Education Programmes to update you of the latest trends and practice.

Venue: Kaizen 1 or Auditorium, Tower B Khoo Teck Puat Hospital, 90 Yishun Central S768828 For more information, please call our GP Engagement Office at 6602 3016

Scheduled CMEs for 2016* Date (Sat, 1pm - 5pm)

Presenting Department

9 July 2016

General Surgery (Breast)

23 July 2016

Endocrine

30 July 2016

Urology

20 August 2016

DDR

3 September 2016

Orthopaedic Surgery

10 September 2016

Renal

17 September 2016

Family Medicine

1 October 2016

General Surgery (Endocrine)

8 October 2016

Nutrition and Dietetics

22 October 2016

General Medicine

5 November 2016

General Surgery (Endocrine)

*Info correct at time of publishing.

For an updated listing, please visit https://www.ktph.com.sg/gpcme.