Maybe Baby? - Raffles Medical Group
Transcription
Maybe Baby? - Raffles Medical Group
A PUBLICATION BY REGISTRATION No. 198402868E Family Risky Relations Family genetics and illnesses Maybe Baby? Get the family makeup you always wanted Home: The Safest Place on Earth? Accident-proof your home Clean Living, Healthy Places Practical tips for every corner of your house MICA (P) 062/11/2011 COMPLIMENTARY COPY ISSUE 01 / 2012 OrthopaedicCentre Radiofrequency Ablation A treatment for nerve-related pain Radiofrequency (RF) ablation is a procedure for treating chronic pain in the spine or other nerve-related pain. It is also known as radiofrequency thermocoagulation or rhizotomy. RF ablation is a non-surgical, minimally invasive procedure in which RF energy is used to disrupt nerve function. When this occurs, the nerve will no longer carry pain signals. Who will benefit from it? How is RF ablation done? RF ablation is performed on patients suffering from facet joint pain, discogenic pain, sciatica or sacroiliac joint pain. It can also be used to treat certain neuropathic pain conditions such as trigeminal neuralgia and post-herpetic neuralgia (post-shingles pain). Certain cancer pain conditions may also benefit from RF ablation. RF ablation is performed as a day surgery procedure. Sedation is administered to help you relax and local anaesthesia is used to numb your skin. Your doctor will insert a thin needle to the target nerves. Fluoroscopy, a type of X-ray, will be used to guide the needle. Once the needle is properly positioned, local anaesthetics will be administered and RF energy will be applied to disrupt the nerves. How long can I expect the pain relief to last? Radiofrequency ablation of nerve supply to painful joints In general, most patients experience a significant pain relief for about two years. Nerves will be regenerated after RF ablation, but the duration varies from person to person. However, the pain may or may not return when your nerves are regenerated. If pain recurs, RF ablation can be repeated. Needle tip generating heat to denervate painful joints Hospital For more information or to book an appointment, please call 6311 2310 or email [email protected] 585 North Bridge Road | Raffles Hospital | Level 13 | Singapore 188770 Contents NewsRoom 4 The Bag Page Supplements Ask a Raffles Doc Promotions 27 28 29 30 New docs on the block | New Clinics | Clinic Relocation | Raffles Hospital: Committed to Quality and Safety Features Family Activities for the Young & Old6 UpClose Here are some good indoor and outdoor activities that can help bond your family and keep everyone active mentally and physically. A researcher-turned-paediatrician, Dr Lena Motoda sees patients miles away from her homeland of Japan. Read about how she realised her dreams of becoming a doctor and working in tropical Singapore, as well as how she maintains close ties with her beloved family in Japan. Maybe Baby? 8 Planning for a dragon baby? Or are you laying off pregnancy till you are ready? Family planning is important as it strengthens marriage and provides you with the family makeup you want. GP to Family Physician 11 You know the difference between a “specialist” and a “GP”. What about “family physician”? Just who or what exactly is this “family physician”? Risky Relations 12 When it comes to genetic diseases, family history is a significant risk factor. Learn about some common genetic diseases that may run in families, and empower yourself to prevent them. DIRECTORY www.rafflesmedicalgroup.com Corporate Accounts Enquiries Fax No. 6311 1333 6311 2383 www.rafflesmedical.com General Enquiries Fax No. • Anchorpoint • Ang Mo Kio • Anson Centre • Asia Square • Bedok North • Bishan • Capital Tower • Causeway Point* • Centrepoint* • Changi Business Park • Changi City Point • Clementi* • Compass Point* • Harbour Front • Hougang Central • Jurong East • I12 Katong • Lot 1 Shoppers’ Mall • Loyang Point • Mapletree Business City • Marina Square • Millenia Walk • Nex • Ngee Ann City* 6311 6311 6479 6453 6225 6636 6441 6456 6323 6894 6733 6781 6636 6872 6881 6273 6386 6899 6636 6765 6585 6570 6339 6337 6634 6734 2222 2392 3818 2288 2188 0160 1736 7122 5212 0777 8775 7337 1251 9043 7337 3078 7896 6688 3730 3363 3333 6970 6644 6000 2585 7355 • Northpoint • One Marina Boulevard • One Raffles Place* • Raffles Airport Medical Centre Passsenger Terminal 2* Passsenger Terminal 3* Airport Transit 1 Airport Transit 2 Changi Cargo Complex • Raffles City • Raffles Medical@Raffles Hospital* • Robinson Point • Science Park I • Sembawang Way • Siglap Centre • Sixth Avenue • Tampines 1* • TechPlace II • Toa Payoh Central * Clinics near / with X-ray facilities 1118 8818 1113 1118 1038 6911 2233 1188 7155 7703 0488 3426 5116 2318 7667 Raffles Medical Hong Kong Central Li Dong (852) 3168 2102 Taikoo Place (852) 2525 1730 Hong Kong International Airport (852) 2261 2626 Raffles Medical Shanghai Innov Tower Clean Living, Healthy Places 18 Learn how you can keep your home clean and healthy for your family with practical tips for every corner of your house. Family Abuse 20 Experts share on abuse and how it affects the family, as well as tips to deal with it. Home: The Safest Place on Earth? 23 The home has potential danger zones especially for the children and elderly. Here are tips on how you can accident-proof areas in your home from the living room to the bathroom. 6755 0049 6225 2776 6535 2222 6543 6241 6543 6543 6543 6339 6311 6223 6776 6853 6442 6462 6260 6556 6254 16 (86) 21 6197 2300 www.raffleshospital.com General Enquiries 6311 1111 Call Centre Fax No. 6311 2136 24 Hour Emergency 6311 1555 Admissions / Business Office 6311 1888 Raffles International Patients Centre 6311 1666 International Patients Centre Fax No. 6311 2333 24 Hour Appointments Hotline 6311 1222 Fax No. 6311 2136 Email [email protected] Raffles Aesthetics Raffles Cancer Centre Raffles Children’s Centre Raffles Chinese Medicine Raffles Counselling Centre Raffles Dental Raffles Dialysis Centre Raffles ENT Centre Raffles Executive Medical Centre Raffles Eye Centre Raffles Fertility Centre Raffles HealthScreeners Raffles Heart Centre Raffles Internal Medicine Centre Raffles Japanese Clinic Raffles Orthopaedic Centre Raffles Pain Management Centre Raffles Skin Centre Raffles Surgery Centre Raffles UroRenal Centre Raffles Women’s Centre Physiotherapy Centre Radiology Ho Chi Minh City Hanoi Vinh Myanmar 84 84 84 84 95 8 2220 2088 4 2215 3544 4 3715 3826 38 3550 368 1 299 944 Editorial: Dr Prem Kumar Nair, Magdalene Lee, Creative: Joanna Lee, Nur Asykin, Fann Khoo & Edmond Loh Edd Chua, Jenny Cheok & Ho Yeong Shing The information contained in this publication should not be regarded as a substitute for detailed medical advice in individual cases. All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of the publisher. Please address all correspondence to The Editor, Raffles HealthNews, Fax no. 6311 2378 Email: [email protected] Raffles International Office Jakarta 62 21 5785 3979 Raffles HealthNews is published by Raffles Medical Group Ltd 585 North Bridge Road, Raffles Hospital #11-00, Singapore 188770 www.rafflesmedicalgroup.com Liaison Centres Offices Printed by Xpoprint (Asia) Pte Ltd Regional Representative Office Jogyakarta Solo Dhaka Phnom Penh 62 215 7853979 62 271 3020033 88 0 2 8834976 855 17 978 999 Feb 12 4 Newsroom Raffles HealthNews New Docs on the Block Dr Kenneth Oo Specialist in Otorhinolaryngology & Consultant, Raffles ENT Centre Dr Kenneth Oo is an Ear, Nose and Throat Surgeon. He graduated from NUS in 1997 and subsequently obtained his MRCS (Edinburgh) in 2002 and M Med (Otorhinolaryngology) in 2005. He also holds a Masters in Science which was awarded for his time spent on research in the field of tissue engineering. Dr Oo completed a clinical fellowship in otolaryngology, head and neck surgery with the St Vincent’s Hospital in Australia under the supervision of Associate Professor Bernard Lyons. He also underwent a clinical fellowship in facial plastic surgery with the University of Virginia in USA under the supervision of Professor Stephen Park. Dr Oo’s clinical interests include rhinoplasty, otoplasty, reconstruction of facial defects following injury or tumour resection, microtia reconstruction, complementary surgical and office-based procedures for facial rejuvenation, head and neck surgery including thyroid, salivary gland and cancers of the head and neck. Prior to joining Raffles Hospital, he was in charge of the “Nose Clinic” in TTSH which manages patients with nasal allergies and sinusitis, as well as the “Voice Clinic” which manages patients with voice and reflux problems. Dr Daryl Tan Specialist in Haematology & Consultant, Raffles Cancer Centre Dr Daryl Tan is a Haematologist. He graduated from NUS in 1997 and obtained his MRCP (UK) in 2002. He subsequently underwent advanced specialist training in haematology and attained specialist accreditation in haematology in 2005. Prior to joining Raffles Hospital, Dr Tan was practising at SGH. He is now a visiting consultant to SGH and TTSH, and an Adjunct Assistant Professor at the Duke-NUS Graduate Medical School. Having completed a postdoctoral fellowship to train in the sub-specialty of lymphoproliferative diseases at Stanford University in USA, Dr Tan developed an active interest in lymphoid malignancies, including lymphoma, acute lymphoblastic leukaemia, chronic lymphocytic leukaemia and multiple myeloma. He is actively involved in research in these areas and spearheaded clinical trials at SGH for lymphoma and multiple myeloma. He has also received several grants from Singhealth Foundation and Singapore Cancer Syndicate. Dr Lynette Ngo Specialist in Oncology & Consultant, Raffles Cancer Centre Dr Lynette Ngo is a Medical Oncologist. She graduated from NUS in 1996. She further pursued a Master of Medicine degree in Internal Medicine and became a member of the Royal College of Physicians, UK, in 2002. She received her postgraduate Diploma in Palliative Medicine in 2006 and obtained her specialist accreditation in medical oncology in 2007. Dr Ngo has been practising at National Cancer Centre Singapore (NCCS) since 2005. She was also a visiting consultant to both KKWCH Gynaecologic Cancer Centre and Breast Centre as well as Khoo Teck Puat Hospital. She is a clinical tutor at the Yong Loo Lin School of Medicine. In addition, she spent five years caring for patients in hospice home care and inpatient hospice services in the community prior to joining NCCS. Dr Ngo’s areas of interest are in breast and gynaecologic cancers, psychosocial oncology and palliative medicine, in addition to general medical oncology. I12 Katong 112 East Coast Road, #03-17 I12 Katong, Singapore 428802 Tel: 6636 3730 Fax: 6636 3728 Changi City Point 5 Changi Business Park Central 1, Changi City Point, #B1-55/56, Singapore 486038 Tel: 6636 1251 Fax: 6636 1249 Opening Hours Monday to Friday : 8.30am to 1.00pm, 2.00pm to 5.30pm, 6.30pm to 9.30pm Saturday, Sunday & Public Holidays: 8.30am to 1.00pm Opening Hours Monday to Friday: 8.30am - 1.00pm, 2.00pm - 5.30pm Saturday: 8.30am to 1.00pm Robinson Point Relocation With effect from 26 January 2012, our Robinson Point clinic will be relocated to: 80 Robinson Road, #01-00 Singapore 068898 Tel: 6223 1188 Fax: 6223 3166 Raffles HealthNews Newsroom 5 Treating Amblyopia with NeuroVision™ Patients suffering from amblyopia or ‘lazy eye’, a disorder of the visual system characterised by poor or indistinct vision in an otherwise physically normal eye, may now stand a better chance of reversing their vision loss with the introduction of NeuroVisionTM Amblyopia Programme. NeuroVisionTM, the only FDA approved therapy for ‘lazy eye’, is an innovative vision enhancement technology that trains one’s brain to see sharper. This non-invasive and patientspecific treatment can be done at home and uses a series of repetitive computer-based interactive tasks to enhance visual processing in the brain. This will result in improved vision due to better contrast and clarity. JCI Committed to Clinical Quality and Patient Safety: Raffles Hospital achieves Joint Commission International re-certification. In a strong demonstration of its commitment to clinical quality and patient safety, Raffles Hospital has been re-accredited by the Joint Commission International (JCI) following an on-site survey from 21 to 25 November 2011. The hospital performed well on the The NeuroVisionTM Programme is now available at Raffles Eye Centre. For more information or for an assessment with our ophthalmologist, please call 6311 1228 or email [email protected]. accreditation survey, meeting 98 per cent of all the measurable elements in it. JCI is currently the most well recognised international healthcare accreditation body that sets and monitors standards for healthcare organisations internationally. Since it first opened its doors in 2001, Raffles Hospital has established a strong reputation as an international healthcare destination. One third of its patients are from overseas, coming from over 100 countries. “With the globalisation of healthcare services, an international accreditation such as JCI serves as affirmation of the Hospital’s high quality of care and its commitment to patients,” says Mr Lawrence Lim, General Manager of Raffles Hospital. “The success of our JCI re-accreditation has been the result of hard work put in by each and every one of our staff, team spirit and a strong commitment to quality care for our patients,” added Mr Lim. “We are delighted to achieve re-accreditation and will continue to make JCI our way of life in the hospital.” Re-acreditation was approved in December 2011 and will be valid for three years. Raffles Medical Group Bursary Award 2011 Award recipients, parents, and senior management at the bursary award ceremony Raffles Medical Group (RMG) launched its inaugural bursary award in July 2011 as part of the company’s employee engagement initiative that aims to assist lower income staff by subsidising their children’s study expenses. RMG senior management on 3 December 2011, as they joyfully received their bursary awards. Seven children, from the primary and secondary school levels, were proudly accompanied by their parents and the Executive Chairman of RMG, Dr Loo Choon Yong said: “At Raffles, our staff are just like family, and we take care of each other.” With much appreciation and gratitude, Ms Hamidah Begam, Administrative Assistant, International Medical Insurers, said: “I would like to thank Dr Loo and RMG for granting my children the award. It will certainly help to pay part of their school expenses such as textbooks, uniforms and shoes.” 6 Feature Raffles HealthNews Family Activities for the Young Old & W ho says Singapore is a boring island where there’s nothing to do? Activities suitable for the entire family are endless and you are only limited by your own imagination. Our experts share with us some good indoor and outdoor activities to help bond your family and keep everyone active mentally and physically. Board Up Get Crafty or Start a Hobby So, you are lazy to get out of the house. Still, there’s no reason to allow the day to degenerate into a ‘TV day’. Bring out the games! It could be evergreen card or board games such as UNO, Scrabble, chess, Twister, charades and Pictionary – games that never fail to amuse both the young and the old. Handicrafts are a great way to work together as a family. “These activities can mould your children’s character and impart life skills to them,” says Dr Sinnathamby. Moreover, the young would be delighted to be able to complete a project which they could display. “These activities can help inspire your child’s imagination and support his learning in a fun, non-threatening way,” says Dr Wendy Sinnathamby, Specialist in Paediatrics & Consultant, Raffles Children’s Centre. Dr Carol Tan-Goh, Specialist in Geriatrics & Consultant, Raffles Internal Medicine Centre adds: “As these games often require the working out of the mind and involve socialising with the family, they are great for seniors too. If the seniors are adventurous, playing Nintendo’s Wii with the young ones can be entertaining.” Line dancing and ballroom dancing are fun activities to get both the young and old moving. “Dancing to the groove with each other involves working out the mind and body, and is an excellent activity for seniors,” says Dr Tan-Goh. Walk Down Memory Lane So grandpa has one too many stories to tell? The museum is one place where he can tell his poignant war stories and be appreciated for that. Alternatively, make your way to the library with a purpose. It could be researching on trains or the culture of another country. As the saying from Confucius goes: “You cannot open a book without learning something.” According to Dr Sinnathamby: “Visiting the museum is a fun and non-threatening way to imbue in your child the love for history. And history from the textbooks will never look the same after.” Raffles HealthNews Feature 7 The Great Outdoors Farm Life Get out of the house and embrace the great outdoors! Outdoor activities are extremely beneficial to all groups of people, ranging from the elderly to young children and babies. Unknown to many, Singapore has over 200 farms in its six Agrotechnology Parks. These farms grow fruit, vegetables, ornamental plants as well as rear fish and goats. They are a popular destination for children, who will discover how vegetables are grown, get to feed the fish, goats and cows, and learn how to milk some of the animals. Ms Lucie Lamprey, Physiotherapist, Raffles Physiotherapy Centre explains: “Those with pain or reduced mobility should not be deterred, as gentle exercises such as walking has many benefits. Just getting into the outdoors makes you more aware of your surroundings, stimulates your senses, enhances your mood and gives an energy boost. Those experiencing low moods or fatigue, can experience higher sensitivity to pain, therefore I frequently recommend people with pain, such as low back pain to take regular, short walks.” Singapore may be a small city, but it does have places where you can get up close and personal with nature, such as the Botanic Gardens, Bukit Timah Nature Reserve, East Coast Park and MacRitchie Reservoir. “Rather than having your child cooped up at home all day, walks in nature reserves can open your child’s eyes to the amazing world of flora and fauna. Just remember to spray on mosquito repellent and keep your child wellhydrated,” adds Dr Sinnathamby. The seniors can reminisce about the times when they were younger and living in a ‘kampung’, and share those wonderful times of their life with the young in their midst. “Outdoor activities can help protect your child against myopia,” says Dr Lee Jong Jian, Specialist in Ophthalmology & Consultant, Raffles Eye Centre. “They also help improve overall health for everyone in the household.” Enchanting Wild Life If you prefer to see more exotic animals, you can try one of the many wildlife attractions, such as the Butterfly Park and Insect Kingdom, Jurong Bird Park, Night Safari, Singapore Zoo and Underwater World. “Children love animals and being able to see them up close would be a fun and entertaining way to spend the day,” says Dr Sinnathamby. HN 8 Feature Raffles HealthNews Maybe Baby P ? lanning for a dragon baby? Or are you laying off pregnancy till both you and your spouse are ready to shoulder increased responsibilities? Whatever your stage in family life, planning is an important aspect as it can strengthen your marriage and provide you with the family makeup that you have always wanted. We speak to experts in Raffles on what you should do in the various phases of family planning. Raffles HealthNews Feature 9 Phase 1: you. There is no one best method and the final decision on your choice of birth control will largely depend on your character or preference. We are not ready for kids. Best Ages If you are planning a family with two children or more, it would be sensible to have the first pregnancy not long after the mother reaches the age of 30 years, or even earlier. This is according to Dr Sheila Loh, Clinical Director, Raffles Fertility Centre, who explains that the ideal age for fertility for women is between 22 and 26 years old. For every year after 30 years old, the chances of conception declines by 2.5 percent and there is a drastic decline after 40 years of age. “These ages are ideal for fertility as physiological and mental development of the female body has reached its peak, and egg quality and stores are at their best. It is also the safest age for delivering a baby,” she adds. For men, sperm quality begins to decline after 40 years of age and there are higher chances of abnormal sperms so that chances of fertilising the wife’s egg are reduced. “There have been reports of birth defects and genetic diseases associated with advanced paternal age, especially beyond the age of 50. This could be due to the poorer sperm quality,” explaining Dr Koh Gim Hwee, Specialist in Obstetrics & Gynaecology, Raffles Women’s Centre. Hence, men are advised to start procreation at an early age. Dr Chow Kah Kiong, Specialist in Obstetrics & Gynaecology, Raffles Women’s Centre shares some of the common types of contraceptives available. Birth Control If you are planning to put a hold to having kids, the wide array of contraceptive options would dazzle Birth control methods How it works Effectiveness Price Oral Pill Suppress ovulation Claimed to be over 99% Per box costs from a few One regular partner with low risk for STD, baby dollars to $30+ for the spacing, disciplined pill taker. Can regulate latest brand menses. Some types can improve acne. IUS/ IUD Interfere with implantation, suppress ovulation Claimed to be over 99% for five years About $250 (IUD) & $500 (IUS) per insertion (valid for 5 years) Have completed family but keeping a distant desire to have another baby, unable to regularly take pill, dislike or cannot ingest hormones, also single regular partner with low risk for STD. Condom (male) Barrier contraceptive 100% if no breakage or leakage when used Prices per unit vary between a few cents to a few dollars Have more than one partner with increased risk for STD, unable to take pill or have not had any children yet and desires pregnancy later. Condom (female) Barrier contraceptive No study but much less effective than condoms A few dollars per box but Unreliable or uncooperative male partner and not as freely available as unable or advised not to use IUS/ IUD and the male version hormonal contraceptives like the pill. Contraceptive Suppress Patch ovulation Claimed to be over 99% Per box $30 to $40 Single regular partner and low risk for STD, unable to tolerate or be regular with oral pill, helps pre-menstrual tension. Morning after Pill Suppress implantation, helps expel conceptus Much less effective than oral pill A few dollars per box Failure or forgetfulness in using contraceptive. Single partner and low risk for STD. Ligation of Tubes Internal barrier contraceptive Over 99% Expensive as requires day surgery and general anaesthesia It should be considered as irreversible, for completed family or no desire for future pregnancy, not suitable or unable to tolerate other forms of contraceptive. Vasectomy Internal barrier contraceptive Over 99% Expensive as requires day surgery and general anaesthesia Similar to ligation but surgery is simpler and chance of reversal more feasible. Claimed to be over 99% About $30 to $100 per injection and $500 to $600 per implant Unable to be regular in taking the pill, yet do not wish to have IUS/ IUD in the uterus and unwilling to have ligation. Low risk STD. Contraceptive Suppress Implants/ ovulation injectables Best for… 10 Feature Raffles HealthNews Preconception Care Prior to conception, preconception care is an important step in preparing the mind and body for conception or pregnancy. This is for both the wife and the husband which means both of them are psychologically and physically ready to start a family. They should begin to put aside more time for each other, discuss financial and social details and start to prepare their bodies health-wise. “Preconception care can be likened to an athlete preparing for a major race. This preparation begins at least three months before conception as both female gametes (the egg) and male gametes (the sperms) start their development three months earlier. Any major event during these three months can negatively affect the quality of the eggs and sperms. For example, a major infection of the liver like Hepatitis B can reduce both egg and sperm quality,” shares Dr Loh. Preconception health checks are also important before you start a family. Generally, these health checks include screening for anaemia, Thalassemia, blood group and type (Rhesus) and infectious disease tests. For the woman, preconception health checks should include a PAP (cervical) smear test for cervical cancer screening and a basic ultrasound of the pelvic organs to detect cysts and fibroids in the ovaries and uterus, respectively. Phase 2: So, we’re ready. What’s next? Couples can consult their family doctor or obstetrician for these checks. In addition, they may want to check if they are immunised against Rubella and Varicella Zoster viruses. Women should start to increase their intake of folate/ folic acid in their diet or include a multivitamin which contains folate. Folate reduces the risks of neural tube defects in the foetus. Boosting Fertility To boost fertility, a woman should eat healthily, avoid alcohol and consume coffee in moderation. Some studies have associated heavy caffeine intake (more than four cups a day) with a lower chance of conception. Carbohydrates and protein intake should be balanced with a good proportion of fruits and vegetables which contain high amounts of vitamins and folic acid. Avoid smoking totally as the toxins in cigarette smoke are thought to be a cause for ectopic pregnancies and miscarriages. Smoking also causes a woman’s eggs to age faster and she will also lose her eggs earlier. On average, women smokers reach menopause two years earlier than non-smokers. While maintaining a normal weight helps boost fertility, women who are underweight or obese may experience problems in ovulation. For the men, various dietary supplements have been suggested. These include the antioxidant vitamins, calcium, zinc and selenium. There are some new studies which suggest that there may be a role for antioxidants in improving sperm quality. Avoiding smoking, alcohol, recreational drugs, heat (e.g. sauna and steam rooms!) and maintaining a normal weight may boost the individual’s own fertility. In addition, some medications (e.g. medications for hair loss, gastric ulcer or gout, and antidepressants) may lower sperm count and quality. Hence, if a man is on prescription medicine he should also let his doctor know that his wife is trying to conceive. Phase 3: Looks like we may need professional help. These days, there is plenty of help for fertility. Methods such as Intrauterine Insemination (IUI) and In-Vitro Fertilisation (IVF) enjoy good success rates. Dr Loh shares on the two methods and whom they are suitable for. On average, most young couples take about six months to conceive. Older couples in their mid-thirties may take up to one year. Unfortunately for some, conception does not come easy. Infertility is generally defined as not being able to conceive after 12 months of unprotected sexual intercourse. However, women over 35 years old should consider seeking medical advice after trying unsuccessfully to conceive for six months, as their eggs are more prone to ageing and any delay may reduce their chances of being helped. “The purpose of the IUI programme is to place some of the good quality sperms into the uterus at the time the wife releases her eggs. Hence, to ensure optimum chances at IUI, a woman must have a normal uterus and patent fallopian tubes and her husband’s sperms must be of sufficient quality and quantity. Chances are also higher if she is below 37 years old and the treatment is performed together with superovulation (medications to induce more than one egg). The average success rate is about 12 to 15 percent per attempt. IVF is the general term covering all the various programmes that involve the help of a scientist to fertilise the eggs in the laboratory. It is often called the Test-Tube Baby programme. A couple needs this treatment if they have blocked or damaged fallopian tubes, the husband has poor sperm quantity or quality, severe endometriosis or if the doctor suspects a fertilisation problem. IVF outcome is most dependent on the egg quality. IVF is a more lengthy and expensive treatment. Although IVF has a much higher success rate, at an average of 30 to 40 percent per attempt, this must be weighed against its risks - more injections, more stress, higher complication rate of ectopic pregnancies, miscarriages, multiple pregnancy and ovarian hyper-stimulation.” HN Raffles HealthNews Feature 11 General Practitioner to Family Physician W hen it comes to seeing a doctor, everyone has most certainly visited one at a particular point in time. Medical clinics are common places in our lives and most of us know the difference between a “specialist” and a “GP” (general practitioner). However, there is a term that has also been slowly gaining familiarity, which is “family physician” and sometimes we hear others mentioning about seeing their “family physician”. Just who or what exactly is a “family physician”? Dr Chng Shih Kiat, Deputy Medical Director, Raffles Medical, sheds some light on this class of doctors. So what exactly are “family physicians” and how do they differ from GPs? According to Dr Chng, family physicians are primary care doctors or the first point of contact for patients with any health problems. They may be consulted for episodic ailments such as coughs and colds. More importantly, family physicians are also able to assist your family and you in managing any chronic disease issues as well as providing continuity of care for the family. Family physicians are doctors who have undergone recognised training for Family Medicine, which qualify them to be enlisted in the Family Physician Register set up by the Ministry of Health (MOH). Family physicians are trained to take care of the wide spectrum of illnesses and diseases that be present in the primary care setting. They can also help to coordinate medical care and treatment with hospital specialists when the need arises. This is with the intent of providing a holistic and seamless transition of care from the hospital back to the community and vice versa. However, if you think that family physicians are just generalists and are not specialised into any branch of medicine, you have the wrong impression. Dr Chng clarifies this misconception by revealing that family physicians can develop further clinical interests in areas such as occupational, palliative, geriatric or even sports medicine. In fact, they can further develop themselves professionally to become collegiate members of the College of Family Physicians Singapore (CFPS). And the highest honour a family physician can receive in Singapore is to become a Fellow of the CFPS. All this information may be well and new to you, but if you are constantly healthy and leading an ideal lifestyle, is there an actual need for you to have your own family doctor as opposed to visiting a GP or specialist should any medical problems occur? You may think that it’s not necessary, but this is where you’d be mistaken. MOH has advocated a “one patient, one family physician” message for good reason, as the benefits of having a family physician who understands your family history, occupational and social background far outweighs the ease of simply visiting a different GP whenever one falls ill. The prior experience and knowledge a family physician has, can prove to be invaluable during medical emergencies. After reading this, you may need to ask yourself an important question: What should families consider when choosing a family physician? Dr Chng states that the family physician should be able to take care of all the health needs and concerns of the entire family. Secondly, the doctor must also be able to communicate effectively and be a health advocate for the family by understanding each member’s health conditions and suggest ways to better manage them. In conclusion, family physicians are there to help families better manage their medical issues over a long period of time. They should be regularly consulted, when needed, in order to ensure that accurate and proper treatments can be administered. HN 12 Feature Raffles HealthNews Risky W hen it comes to genetic diseases, family history is a significant risk factor that one may not have total control over. Although genes can determine similarities in appearance, they may also lead to a risk in the family for developing certain health conditions. We speak to doctors and counsellors from Raffles Hospital to learn more about some of the common genetic diseases that may run in families, and to empower you with knowledge on how you can prevent illness by being aware of your family health history and by making healthy choices. Like it or not, each and every one of us belongs to a family. You have a mother and a father, grandparents, and perhaps children of your own. You might have gotten your round eyes from your mother and your prominent nose from your grandfather. You may not think of them, but you also have hundreds of ancestors – people you have never met – whose genes you carry and may pass down to descendants in years to come. These are not the only things you may have inherited from your family, however. Many medical conditions including heart disease, cancer and diabetes have also been shown to be passed down through families. Your genetic make-up – that is, the genes you inherited from your parents, holds the secret to your destiny. Not only the colour of your eyes and hair and your musical or athletic abilities but also thousands of other factors related to your appearance, your health, and how you interact with the world are all determined, in whole or part, but your genetics. Most importantly, your genes determine whether you are at risk for specific diseases. Some diseases are caused when there is a change in the instructions in a gene and this is known as a mutation. Every person has many mutations. Sometimes these changes have no effect or are even slightly helpful, but sometimes they can cause disease. Most common diseases are caused by a combination of mutations, lifestyle choices and your environment. Even people with similar genes may or may not develop an illness if they make choices or live in a different environment. On the other hand, some rare diseases are caused by a specific change in the DNA of a single gene. These conditions usually develop when an individual is born with a mutated gene. Did You Know? • A person has two copies of each gene - one from the mother and one from the father. • Genes carry instructions that tell your cells how to work and grow. • A complete set of genes is known as a genome. Humans have approximately 20,000 genes in their genome. • Cells are the building blocks of the body and every part of the body is made up of billions of cells working together. • Genes are arranged in thread-like structures called chromosomes. Humans have 23 pairs of chromosomes and copies of the chromosomes are found in each cell. • Chromosomes are made up of DNA, which is the special code in which the instructions in your genes are written. Raffles HealthNews Feature 13 Relations CANCER Cancer is a genetic disease and cancerous cells arise because the genes controlling cell growth has malfunctioned. The reasons why the genes become abnormal is due to three reasons closely interacting with each other namely the ageing process, environmental factors (smoking and viral infections for example) and inherited genetic syndromes predisposing to cancers. All of us are at risk of cancer and the risk is about one in three in one’s lifetime. Inherited cancer or familial cancers account for less than five per cent of all cancer occurrences. Depending on the type of cancer and how many family members are affected, one may opt to have genetic testing done. If it is a common cancer like colorectal cancer in a first-degree family member, without other members being affected, the risk may not be more than 1.5 to two times the general population. Dr Donald Poon Specialist in Medical Oncology Managing Partner & Consultant Raffles Cancer Centre Many of the cancer-causing gene mutations are known. Some directly result in cancers in specific sites such as breast and ovarian cancers (BRCA 1 and 2). Carriers of these genetic mutations have up to 80 per cent chance of developing these cancers in their lifetime. Many solid and hematological cancers have a genetic basis which may be used to clinch the diagnosis by way of genetic testing of tumors excised during surgery. These genetic changes may also guide therapy by way of utilising targeted therapy. Modification or avoidance of the environmental factors that result in the cancer-related genetic changes will lower risk. The main external factor that causes cancer is smoking. It is estimated that if everyone is to stop smoking immediately, the cancer incidence across all types will drop to less than 50 per cent of current incidence within one generation. Regular cancer screening for breast, colorectal and cervix cancer do help prevent late stage disease from shortening life prematurely and human papillomavirus vaccines do help to prevent onset of cancer of the cervix in females. Prophylactic removal of organs such as mastectomy and ovariectomy in those who are detected to have the cancer genes are controversial; these measures do not completely eliminate cancers from forming. 14 Feature Raffles HealthNews MENTAL ILLNESS KT Soon Counsellor Raffles Counselling Centre DIABETES & OBESITY The prevalence of mental illness among psychological dysfunctional families and those with genetic predisposition is expected to be higher than the general population. Typically, it is noted that families with history of mental illness and of lower socioeconomic status are more at risk. For most, the chance of developing schizophrenia or bipolar disorder is only around one per cent. However, for families with a close relative such as a parent or sibling suffering from mental disorder, the average risk rises to about 10 per cent. The most common view is that mental disorders tend to result from genetic dispositions, environmental stressors and individual’s lack of stress coping mechanism or adequate support. Family-linkage and twin studies have indicated that genetic factors often play an important role in the development of mental disorders. Dr Stanley Liew A good understanding of one’s familyof-origin’s mental health history is crucial as it can highlight any biological predisposition due to possible shared genes. One should review his or her lifestyle to ensure balance and build up his or her mental resilience through psycho-education like mental health awareness talks and counselling. It is important for one to develop positive coping skills to handle stressful life events and have good social and emotional support from loved ones and friends. Diabetes Obesity Diabetes is a chronic disease and those with genetic predisposition may not necessarily develop the condition. Environmental factors such as obesity, lack of physical activity, and unhealthy diet are important in facilitating the development of diabetes. Having a first-degree family history of type 2 diabetes (non-insulin dependent) may increase the chance of developing diabetes by about two to three folds compared to the general population. Obesity is a complex condition and the interaction of genetic and environmental factors is currently believed to be the basis for most cases of obesity. Environmental factors include an unhealthy diet and a sedentary lifestyle. The genetic role of obesity is less well understood. It is very difficult to conclude whether it is genetics or the environment, which are conferring the risks within a family. This is because family members share not just genes, but often also share the same environment. Those who are obese, lack exercise, have unhealthy diet and have family members with diabetes are at risk of contracting the disease. While genetic risks cannot be lowered, environmental factors such as obesity, sedentary lifestyle and poor diet can be improved. If a person is obese, he should reduce weight. Regular exercise and adhering to a low sugar and low fat diet can be useful in preventing type 2 diabetes. Therefore, it is even more important that the person should adopt healthy lifestyle at an early age. Specialist in Endocrinology Managing Partner & Consultant Raffles Internal Medicine Centre Genes associated with mental disorders do not always show the same degree of penetrance, which is defined as the frequency with which a gene produces its effects in a specific group of people. For example, a gene for manic depression may have 20 per cent penetrance, which means that 20 per cent of the members of the family being studied are at risk of developing the disorder. There are many genes found to be linked to type 2 diabetes. However, diabetes is a multi-factorial and polygenic disease. In other words, many genes and their interactions with the environment are responsible in the development of diabetes. Therefore, it is still premature to contemplate the use of genetic testing at present. The risk is obviously greater, but the exact risk is greatly determined by the environmental factors. While we cannot change our genes, we can change our environment. Start adopting an active lifestyle by exercising frequently. Eat well by having a low fat, low sugar and high fibre diet. It is better to know the genetic predisposition so that we can start implementing a healthier lifestyle early. Similar to other chronic diseases, there are many genes linked to obesity. However, these genes and their interactions with the environment are very complex. Raffles HealthNews Feature 15 HEART DISEASE Dr Abdul Razak Bin Omar Specialist in Cardiology & Consultant Raffles Heart Centre Virtually all heart disease result from susceptibility genes, defective single genes, or genes interacting with various environmental factors. One may have been born with a genetic defect, also referred to as a congenital heart defect, that led him or her to develop genetic heart disease or one may have been predisposed to developing this condition due to family history. For instance, if one’s parents developed coronary artery disease at a young age, one has a much higher risk of developing genetic heart disease at a younger age, such as younger than 65 for females and younger than 55 for males. Two of the most common genetic disorders of the heart are coronary artery disease (CAD) and high blood pressure (hypertension). In CAD, the arteries that supply blood to the heart muscle can get hard and narrow due to a build-up or plaque cholesterol on the inner walls. As the heart gets less blood, less oxygen is delivered to the heart muscles and one can develop a heart attack. On the other hand, high blood pressure is a measure of how hard one’s heart is working to push blood through the arteries. Over time, high blood pressure can cause kidney failure, heart attacks, strokes and other health problems. CAD is caused by a combination of genetic background, lifestyle choices and your environment. Since one’s genetic background cannot be changed, some people need additional medical assistance such as medication to lower their risk of having a heart attack. Likewise, a family history of high blood pressure increases one’s risk for developing it at a younger age. Greater risk comes with increasing age, being overweight or having a family history of hypertension. To lower risk, one should ensure that he or she has a healthy diet. Get active and exercise regularly as obesity increases one’s risk. Exercise such as walking or jogging can strengthen the heart and blood circulation throughout the body. Stop smoking and avoid stress because when a person is stressed, the body will release the hormone cortisol, which can cause the blood vessels to become stiff. Know Your Family Health History Although genes are beyond your control, other things – such as what you eat, whether you smoke or exercise and what you do for a living – can be influenced by the choices you make. If you discover that you are at increased risk for a disease, there are actions you can take to decrease the likelihood of getting the disease or to limit its impact on you if it should ever manifest. Looking at your family history may offer a somewhat more accurate predisposition for particular diseases, because members of your immediate family do share some of your genes, and they often share similar habits and lifestyle. It will help you to identify risks due to shared genes, understand better what lifestyle and environmental factors you share with your family, understand how healthy lifestyle choices can reduce your risk of developing a disease, talk to your family about your health and share your family health history with your healthcare provider. Like in the case of cancer, Dr Poon explains: “One cannot choose one’s parents. So knowing family health history can guide one to go for earlier cancer screening and possibly gene mutation testing but these will have to be carefully discussed with an oncologist. We cannot change the genetic disorder and mutations but knowing what cancers the individual is at risk for helps to direct screening and preventive measures with careful counselling and discussion.” Accepting the fact that genetics determine much of who you are is the first step toward outsmarting your genes and conquering disease. The more information you gather about your family health history, the more informed you will be about your medical heritage. Remember, what you learn could literally save your life! HN 16 Upclose Raffles HealthNews UpClose with Dr Lena Motoda Specialist in Paediatrics & Deputy Medical Director, Raffles Japanese Clinic A paediatrician with Raffles Japanese Clinic, Dr Lena Motoda plies her trade at Raffles Hospital, thousands of miles away from her homeland of Japan. Today, she talks to us about how she came to be in this position and her close relationship with her family which she holds dear to her heart despite being so far away from home. Raffles HealthNews upclose 17 Tell us more about yourself. My parents named me after Leonardo da Vinci in Roman alphabets and Ezaki Leona (江崎玲於奈), a Nobel Prize winner in physics, in Japanese characters. I am the eldest child in a family of three daughters. I went to Australia when I was 16 years old as an exchange student for a year. That experience enhanced my consciousness of living not just as a Japanese, but also as a citizen of the world. After graduating from university and passing the national board examination, I wandered around the world for 10 months. To date, I have been to 17 countries. I love tropical countries and this is one of the biggest reasons why I am here in Singapore today! What were you doing before joining Raffles Hospital? Why did you decide to join Raffles? After graduating from the University of Tokyo, I worked in Singapore as a research fellow at the Institute of Molecular and Cell Biology in Biopolis. When I returned to Japan in 2006, I told myself that I would work in Asia as a medical doctor someday. After returning to Japan, I had a difficult time retraining myself to become a full-fledged paediatric specialist as there had been a five-year gap in my medical practice. Once I regained my confidence, I wrote to Dr Onishi, our Medical Director, to see if there were opportunities in Raffles Hospital to realise my dream. The rest, as they say, is history. To date, I have been working at Raffles Hospital for three years. What do you enjoy most about your work? Children have innate instincts to judge whether people are trustworthy or not, and I feel honoured that my ‘little patients’ trust and recognise me as their good friend. I feel privileged to be able to observe the development of their young lives, discover their inscrutable potential and see their beginner parents gain their mark in parenthood. Can you describe some fulfilling times working in Raffles Hospital? As a Japanese doctor working in Singapore, you are very far from home. How do you deal with this distance and how do you and your family bridge this gap? I would say that every moment is fulfilling for me. Even though I know that it is impossible to be perfect, I cannot stop trying my best. That is why even writing good referral letters till midnight or rehearsing my presentation for a business meeting over a hundred times gives me a real sense of fulfilment. I was also given the opportunity to visit Raffles Medical Shanghai on a monthly basis to treat children with developmental disorders or psychological problems. This has been a significant experience throughout my work stint here as I have always dreamt of achieving this goal beyond the borders of Japan. I have a constant wanderlust and like to travel. Thus, my family back home has already gotten quite used to the physical distance between us. Despite the distance, important family and seasonal events such as birthdays, anniversaries or other critical dates such as Christmas or New Year, are all celebrated using the phone or via Skype. We also often communicate our thoughts on current affairs and recent achievements through email. My family also visits Singapore once in a while and we try to arrange our holidays so that we can travel together. Lastly, I also return to Japan every one or two years for a reunion. Why did you choose to become a paediatrician? It’s obvious you’re very close to your family and that they are definitely an important part of your life. Do you have any final words to add about your family? makes me reminisce of the times when my own parents raised, guided and supported me with love. I have always wanted to be a paediatrician since I was three. This is because I was very weak as a child and wanted to help children like myself, when I grew up. Also, I wanted to help provide support to their families as I recalled how my mother suffered so much from my sickness and from the overbearing attitudes of oldfashioned doctors back then. I am also interested in two fields of paediatrics, namely developmental and psychological disorders, both of which are growing concerns in our present society. My experience of being ‘different’ from other children in the past has made me more empathetic towards children who face difficulties and worry about being accepted by their peers. As a paediatrician, I am grateful for all of my experiences, including bitter and challenging ones as it allows me to better cherish the important bonds formed within families. While I am quite independent, I have close ties with my family back in Japan. Despite working in a foreign land and only returning home occasionally, my family trust and supports me in whatever I do as long as I am happy. I cannot stress how important this source of support is for me. If my family had been restrictive of my choices early in life, I do not think I would be the person I am today. I am therefore very thankful to my family for trusting me to live my life fully without any regret. Even though I cannot physically stay close to them, I have been and will always be supported by them through all of life’s challenges. HN I am especially moved when I am able to witness an infant, who can initially only cry, drink and sleep, gradually blossom into a toddler right in front of my eyes. This little child ran into my room one day and gave me a drawing made especially for me! Additionally, being able to see how their parents gradually become more confident in raising their children Dr Motoda (third from left) with her fa mily. 18 Feature Raffles HealthNews Clean Living Healthy places Living room The living room is the first point of contact when you return home. As such, there may be unwanted organisms brought in from the outdoors. Studies have shown that 80 per cent of the dirt in the home comes in through people, stuck to their clothes and feet. Hence, you should encourage your family and guests to take off their shoes whenever they enter the house. When cleaning the living room, you should: • Dust all surfaces including tables, electrical appliances and windowsills. Floors and tops of door frames should be cleaned regularly. All surfaces must be dried after they have been cleaned and rinsed, as damp surfaces attract contaminants. • Always clean the doorknobs as often as possible as they are the first point of assess to your house. • Clean indoor plants regularly as they may carry dust and germs. • Vacuum, sun or dry clean the couches and sofa regularly to remove dust. Areas should include the back cushions, sitting cushions and armrests. • Clean and wipe the phone and remote controls regularly. Make sure one’s hands are clean before picking up these devices. Deputy Medical Director, Raffles Medical, Dr Chng Shih Kiat added, “Viruses such as the influenza bug can survive on non-porous surfaces for up to a few hours. Hence the frequent contact surfaces are easily contaminated by unwashed hands.” Kitchen Within the home, the kitchen causes the most amount of health issues for humans. According to a study, areas that are most touched by people’s hands carry the most germs. Germs are microorganisms or microbes and these tiny living cells that can be seen only under a microscope include fungi, bacteria and viruses. The unwashed hands contain 10,000 bacteria per finger. When someone with unwashed hands touches something, he transfers bacteria to it. Dr Leong Hoe Nam, Specialist in Infectious Diseases & Consultant, Raffles Internal Medicine Centre explains, “Bacteria can enter the human body when a person touches a bacteria-infested surface and then his mouth, eyes or nose. While most bacteria live harmoniously inside the body, they can cause an infection when their total number hits a threshold level. More commonly, bacteria can cause food poisoning, with symptoms of diarrhoea, vomiting or fever.” Studies have shown that bacterial contamination is widespread in the kitchen after food is prepared, with the most bacteria found on the chopping board, followed by the countertop, human hands, fridge handles, draining basin and dish cloth. Here are some tips on how you can keep bacteria at bay from your kitchen: • Wash hands between handling of food and fomites (fridge handles, knives, faucets). • Swipe contaminated areas after use. • Chopping boards – separate their use for cooked and uncooked food. • Do not leave food in the kitchen overnight, especially dirty dishes in the kitchen sink to be washed the next day! • Don’t put uncooked food at the top shelf with cooked food at the bottom shelf as food contamination occurs from top down. Raffles HealthNews Feature 19 Bedroom The bedroom is the room in the house where we spend most of our time. One of the most common problems in the bedroom are dust mites. The mattress and pillows are the key items in the bedroom to be kept clean and maintained in order to be free of dust mites. According to Dr Steve Yang, Specialist in Respiratory Diseases & Consultant, Raffles Internal Medicine Centre, dust mites thrive in beds because of the abundance of food (skin cells shed by humans), warmth (from body heat) and humidity (perspiration and vapour from our breath). It is impossible to eradicate dust mites, but what can be done is to reduce the dust mite allergen level to below a person’s allergy threshold to achieve good symptom control. This can be done by the following methods: • Using a mite-proof encasing for pillows and mattresses. • Use anti-dust mite sprays frequently. • Minimise use of carpets, rugs and cloth curtains (blinds are an alternative). • Use healthcare grade vacuum cleaners. Mattresses and pillows can be sunned regularly to reduce the proliferation of dust mites. Pillows and blankets can also be washed at high heat (>60 o C) with detergents targeted at dust-mites, rinsed and dried in the sun or with dryers. Bathroom The bathroom is one of the most wellvisited places in the home and it also has the most number of germs in the house. It should be washed at least twice a week with disinfectants and the floor flushed with water before leaving them to be air-dried. The bathroom can potentially cause health problems if the user has for instance, an infectious form of diarrhoea, said Dr Leong. The act of flushing can cause these microscopic germs to spew out and land on surfaces within two metres of the toilet bowl, said Dr Leong. These include frequently touched areas such as flush handles, door handles, toilet seats and their covers. To make matters worse, the germs can stay there for several days, and a person who touches these surfaces can contaminate his hands with the germs. And if he touches his mouth with these dirty hands while yawning, eating or drinking for instance, he can become infected. This is especially so if his immune system is weak and if he ingests enough of the bacteria, added Dr Leong. A good hand-washing technique involves washing your hands with soap and water or using an alcohol-based hand sanitiser. Anti-microbial wipes are as effective as soap and water in cleaning your hands but aren’t as good as alcohol-based sanitisers. Regular cleaning can help to reduce the bacteria load as well as minimise the transmission of infection by indirect contact with surfaces contaminated with droplets. As will washing your hands before and after touching anything that goes to the face, mouth and eyes. Start practising the simple tips with your family members to keep your house clean and healthy! HN 20 Feature Raffles HealthNews Abuse, often the elephant in the room that no one talks about, is certainly a topic that is filled with negative undertones. It would naturally therefore, seem like the last thing to be associated with family, a traditional source of support and love. However, family abuse is not uncommon and despite declining incidence rates, 14% from the period of 2001 to 2008, it is still a prevalent problem. Health News sheds some light on this troubling phenomenon, exploring what is abuse, how it comes about and what can be done to avoid this issue. Raffles HealthNews Feature 21 Family Abuse Ms Saras Atre, Counsellor | Raffles Counselling Centre Abuse is defined as “any action that intentionally harms or injures a person, which is often driven by power and a need to control” Does it sound archaic or even barbaric? If it does, then it is important to note that abuse has no boundaries. It can occur anywhere, in low-income families, among the wealthy, college educated or even high school leavers. Ms Victoria Stirling, Counsellor | Raffles Counselling Centre It is imperative to note that every family has disagreements and every member of it will have a bad day, becoming upset or even angry. This is to be expected and is considered healthy. The difference however, lies in the expression of that anger. The “family” is often focused as that eternal pillar of support and strength that is always there for us. However, this is not necessarily always the case and there are times when one’s family becomes the source of a very nasty occurrence known as “Abuse”. Before we delve further into it, let us take a closer look at the various types of abuse and what they constitute. Understanding Abuse Abuse can be broadly classified into three categories. Each with their own signs, some subtle and some not so. However, as Ms Stirling says, “In reality, a person being abused often suffers from a combination of the different types of abuse.” Emotional/psychological abuse According to Ms Atre, this form of abuse is any behaviour, verbal or non-verbal, which causes fear, mental anguish or emotional distress. This includes constantly putting a family member down in front of others, name-calling, giving the silent treatment or even not engaging in the relationship and more. These behaviours impact on the victims’ sense of self worth and beliefs of being a person of value, which in turn affect their self esteem. Tragically, emotional/psychological abuse is the most common type of abuse, and to make things worse, it is also the most difficult to identify as there are no obvious or easily observable signs. Further, while self-esteem issues, especially low self esteem, often results from being emotionally abused, it is just one of the potential causes for low selfesteem and not the only cause, adds Ms Stirling. Still, individuals with low self esteem are more socially withdrawn and are at higher risks for developing mental health problems. Emotional/psychological abuse arises due to a lack of control over one’s emotions. Often, in the case of this type of abuse, the perpetrator has lost control of his/her anger and acts in a passiveaggressive way towards the victim. Physical abuse Physical abuse, usually the most recognisable of the various types of abuse due to the injuries that result from it, usually involves hitting, punching, beating and any other action designed to cause injury or pain. Signs of a person suffering from physical abuse include recurring physical injuries which the victim finds difficult to explain, or which do not receive medical attention or get treated by doctors in various locations. A sudden choice of seemingly strange clothing such as headscarves or long sleeves and showing fear when in the company of the perpetrator may also be tell-tale signs. This type of abuse, similar to emotional/ psychological abuse, arises due to one’s 22 Feature Raffles HealthNews lack of control over their anger. However in this case, the perpetrator has chosen to act on his/her anger using aggressive acts, i.e. physical contact. This lack of control is also usually amplified after a perpetrator has consumed alcohol or taken drugs as they become less inhibited, explains Ms Stirling. distinction lies in separating the emotion from the behaviour. Experiencing or feeling anger is healthy. Acting on this anger in any way that harms a person emotionally or physically is, however, abusive. Sexual abuse Sexual abuse is constituted by any action which hurts the victim sexually or includes unwanted sexual content without the victim’s consent, explains Ms Atre. For example, this includes inappropriate touching, fondling, photographing in sexually explicit ways etc. According to Ms Stirling, because of the nature of sexual abuse and the impact of discovery on the family, it is usually the most ‘secretive’ of abuses. Possible signs of sexual abuse in children include sexualized behaviour and early pregnancies. Other possible signs, regardless of age, include discomfort in the victim when sitting and displays of anxiety and resistance to even the slightest suggestion of being left alone with the perpetrator. Abuse in the Family Abuse is not only indiscriminate of age, gender or ethnicity, it can also occur anywhere, particularly in situations where there is an imbalance of power within a relationship. This extends to any kind of relationship and can therefore affect families as well. The perpetrator and the victim of the abuse are then determined by who has the most and the least power within a relationship. Traditionally, men possess the most power in relationships and so it follows that women have usually been and continue to be predominant victims. However, this trend is gradually changing and more men are now being victimised as well, explains Ms Stirling. Similarly, children also suffer from abuse because of their lack of power within a relationship. Though there are cases where the child can be in a position with greater power than the parents and thereby abuse it, to get what s/he wants, it is usually rare and far less common than spousal and child abuse. As mentioned, abuse often occurs when one fails to curb their anger, resulting in an expression of it in either non-physical (passive aggressive) or physical ways (violence). While this may sound like anyone can fall prey to becoming an abuser, Ms Stirling reminds us that the Dealing with Abuse Abuse is a pervasive and stealthy foe. It can occur unknowingly and become a serious problem over time. The age old adage of, “Prevention is better than cure” certainly applies here. As abuse, once set in motion, is hard to stop, it is far more important to nip it in the bud before it can develop. It is therefore important for family members to identify the aforementioned risk factors as well as characteristics which could indicate a real possibility of a person committing or suffering from abuse and then act upon them. It also helps to be aware of the power differences within a family’s relationships and be conscious of how they are managed. Ms Atre explains that the common characteristics of an abuser are likely to be extremely controlling, manipulative, void of empathy as well as a lack of self-awareness and self-regulation. Some risk factors that could set off abusive behaviour include high levels of stress, provocation between members in a relationship, financial struggles, depression, jealousy or even rage. A number of these risk factors are especially prevalent in a family setting and this is also a reason why abuse is often a common occurrence at home. Ms Stirling adds, “While abuse is clearly a serious problem, it may not appear so to members of the family suffering from it. This is especially true for children, who often think that the abusive acts are normal, that there is nothing that can be done about them, and/or that it’s their fault and the abuse is justified. For these and other reasons, abuse in the family usually goes on undiscovered for long periods over time.” Ms Atre further supports this by explaining that elders in the family are reluctant to discuss the grave issue of abuse because of a lot of mistaken beliefs such as: - Family matters are private and should remain so. - It is perhaps my fault that it happens. - It is too embarrassing and shameful to let anyone know. - The situation may worsen if I speak up. Ms Stirling adds, “Family members should also learn to manage stress levels as well as their emotions appropriately, especially anger. Communication should be kept open and constant nurturing of supportive relationships between members of the family should be present.” For families already experiencing abuse, Ms Atre provides some points on what can be done. For victims, their immediate step should be to seek help, find safety as well as talk about the problem to safe trustworthy people to set up a safe environment. They should seek further help by learning to establish boundaries, assertive communication skills as well as to walk away when a situation becomes a threat. For abusive persons, they need to learn to take responsibility for the abusive behavior, learn to work on “non-violent” conflict resolution. Further help would come in the form of anger management techniques, cognitive reframing as well as learning relaxation skills to help regulate emotions. Professional help should be sought if needed. Ultimately, with help and each family member’s diligence and effort, abuse can be kept away or at bay and the home can become a bastion of support and love for family members once again. HN Raffles HealthNews Feature 23 Home: The Safest Place on Earth? Home is where we can find emotional support, security and feel belonged. In it, we have a space to freely express ourselves and have our basic needs fulfilled. Unfortunately, our homes can also be potential danger zones especially for the children and elderly. We approach Dr Carol Tan-Goh, Specialist in Geriatric Medicine & Consultant, Raffles Internal Medicine, and Dr Rupert See, Senior Physician, Raffles Medical; to give you tips on how you can accident-proof areas in your home from the living room to the bathroom, and make the home a safer place for their well-being. 24 Feature Raffles HealthNews Living Room This is the largest room in the house, which at the same time, consists of different areas. As fall prevention is the top priority of concern for the elderly and children, let’s look at how some of these areas can be further safe-proofed. Windows • Fit window locks or safety catches to stop windows opening more than 6.5 cm (2.5 inches). This should stop children from being able to squeeze through them. • Refrain from placing furniture like chairs or sofas near windows. This will discourage children from climbing and falling out especially if there are no window grills fitted. Lighting + + + • Keep your home brightly lit to avoid tripping on objects that are hard to see. Install night lights in your bedroom, bathroom and hallways. • Turn on the lights before going up or down the stairs especially in the middle of the night. • Consider trading traditional switches for glow-in-the-dark or illuminated switches. • Never leave young children near open windows unattended. Stairs + Kitchen • Always hold on to the hand rail when going up and down the stairs. Special notes for Elderly Children • Install safety gates at the top and bottom of the stairs. • Encourage older children not to play on or run up and down the stairs. On top of the above: • Store flashlights in easy-to-find places in case of power outages. • Keep keys of window grill locks in a safe and accessible place in case of emergency. • Keep steps on stairs dry and nonslippery. • Keep stairs free from clutter like toys or clothes. Raffles HealthNews Feature 25 Bedroom Having a room set up and conditioned for gaining adequate rest is important especially for growing children. Lighting + Curtains and Blinds • Avoid curtains and blinds with cords. Dangling cords create a potential risk of strangulation. Sleepwear • Let your child wear fire-retardant sleepwear that is not oversized to prevent them from tripping. Wardrobes and Bookshelves • Secure wardrobes and bookshelves to the walls so as to prevent them from tipping over onto your child. For the same reason, always remember to close the drawers. There are many layers in a kitchen such as the floors, cupboards, stoves, appliances, overhead cupboards, etc. Tackle one at a time and be wary of dangerous objects and substances that you may take for granted such as cooking oil and seasonings placed near the cooking stove, or even cleaning fluids stored under the sink. If your parent is suffering from a cognitive disorder, you’ll require extra precaution such as unplugging the microwave and placing the kitchen knives in a secured drawer. Floors + • Always keep the floor dry and free from oil to prevent slipping. + • Tack loose rugs on the floor or use those with a slip-resistant backing. Electrical Cords + • Ensure all electrical cords are covered or securely tacked down to prevent accidents. height is not too high for them and can be easily accessible. • Place a lamp within reach of your bed in case you require it in the middle of the night. Make clear paths to light switches that are not near room entrances. • Bunk or cabin beds are unsuitable for children under six years old. However, if you do have them for your kids, teach them never to play on the top bunk. Communication • Attach a list of emergency numbers (in large print for the elderly) to a telephone placed beside the bed. Alternatively, have these numbers stored in a digital phone for easy access. Beds • For the elderly, ensure that the bed + • Place socket covers over electrical sockets when not in use. + • Refrain from having electrical cords dangling over the edge of the counter or lying on the floor. Poisons + • Home products labelled ‘caution’, ‘warning’ or ‘danger’ such as cleaners, flammable liquids and medicines should be stored in a safe and secured place, and away from food and drinks. Sharp Objects + • Install child-proof locks or latches to cupboards, which contain knives, cooking utensils and other objects that may break or cause injury. Cooking Stoves + • Consider removing the knobs from stoves or installing a gas shut-off valve that may be turned off, when they are not in use. Electrical Appliances + • If necessary, remove appliances such as blenders, mixers, toasters or coffee makers to prevent potential accidents. + • Move cords out of the way of other appliances and keep away from sinks and stove tops. Lighting + • Consider installing a night light in the kitchen. On top of the above: • When cooking, turn handles of pots and pans away from the edge of the stove. • Wipe liquid spills or grease immediately. 26 Feature Raffles HealthNews Whether you are at home or outside, here are some general tips to help your elderly parents and young children stay safe and happy. Elderly For most seniors, a good fall prevention plan is deemed important and can save lives. Bathroom One of the most dangerous rooms at home is often the bathroom. This is because electrical shocks, falls, drowning and poisoning can happen. As it is usually slippery, the elderly tend to slip and fall while going about their business inside. Shower Area + • Install anchor grab bars securely for use in and around the shower, bathtub or toilet. • Place non-skid mats on the floor of a shower stall or bathtub, as well as on the floor in front of the tub or shower stall. • Consider placing a stool or shower chair in the shower stall for the elderly who are especially fearful of slipping and falling. • Supervise young children using the sink or tub by staying close to them. Lighting • For elderly with poor vision, a toilet that looks white all around may be challenging. You can place a coloured toilet seat cover on the toilet. This will help provide strong visual cues and reduce the chance of an accident. + • Ensure that there is sufficient lighting. Necessities • A raised toilet seat will provide ease of access for one’s toileting needs as it places less strain on the knees and back. • Ensure adequate space for your elderly parents to sit and take care of their toileting needs such as tooth brushing, hair combing and other needs if they tire easily. Keep Moving • Get active and consider physical activities such as walking, aqua aerobics or tai-chi. Such activities can help to reduce the risk of falls by improving strength, balance, coordination and flexibility. • Consult a doctor if you are in doubt or require further advice and recommendation. Wear Good Footwear • Buy proper-fitting, sturdy shoes with non-skid soles and avoid shoes with extra-thick soles. • Choose shoes with laces instead of slip-ons and keep the laces tied properly. Alternatively, you may select footwear with fabric fasteners if you have trouble tying laces. Children and Babies Young children and babies are usually more active and can move quickly. It is imperative for parents and caregivers to pay special attention to them. • • On top of the above: • • Always keep the bathroom floor clean and dry. • Unplug electrical appliances after use. Look around your home with a very critical eye and consider doing whatever is necessary to keep it safe. Minimising risks and maximising safety, it is the best way to take care of a loved one in any room of the house. HN • When securing a baby in a high chair, pram or pushchair, always use a five point harness (two shoulder straps, two hip straps and a crotch strap). Never leave a baby alone in a baby walker. Once a baby is able to sit up, remove large cot toys from the baby’s cot, as babies can use toys to climb out of the cot. If your baby is in a car seat or a bouncing cradle, put it on the floor and not on a high surface. Playing Outdoors • Avoid using play equipment in old or damaged playgrounds, especially if it is not over a soft surface. • Put play equipment (like swings, slides, etc) over something soft like well-watered grass or a mat; never over pavement, tarmac or concrete. • When riding a bicycle, encourage children to wear a properly-fitting cycle helmet. Raffles HealthNews Special 27 + S ock Supplies to Save Lives! More than merely being identified as an ubiquitous ‘red’ box, a well-stocked first aid kit is a necessity in every home or workplace and comes in handy especially during accidents and emergencies. Dr Bina Kurup, our Consultant Family Physician from Raffles Medical, clues us in on the must-have items of an easy-to-assemble first aid box. Everyone in the household or workplace should know where the first aid box is located, though it must be out of reach of young children. It should not be locked, as in an emergency one would not want to lose precious time searching for keys! The container should be strong and waterproof and should not be kept in the bathroom, as the dampness could ruin its contents. Remember also to check the contents periodically to ensure that none of the items are expired and also to replenish utilised stock. 1 3 10 9 15 8 11 2 7 12 6 4 14 5 13 First Aid Box 1. Dressing set Sterile disposable sets can be bought from pharmacies and are useful. It usually contains gauze, cotton balls, disposable forceps and plastic dressing sheets. 2. Sterile scissors 3. Tweezers (for removing splinters of foreign bodies in skin) 4. Alcohol swabs 5. Adhesive tape (for holding dressings e.g. Micropore) 6. Coban or crepe bandage (with safety pins or clips to hold them in place when used) 7. Triangular bandage sling (useful to rest and support the upper limb, if a fracture or dislocation of the shoulder or elbow is suspected) 8. Tourniquet (usually applied, if and where accessible, as a pressure band above bleeding sites and helps to reduce the amount of bleeding from the wound) 9. Paraffin, netted gauze (for burns and open raw wounds e.g. Jelonet) 10.Torchlight (keep batteries out) 11.Plasters 12.Antiseptic solution (e.g. Chlorhexidine) 13.Antibiotic creams (e.g. Tannic Acid and Mupirocin) 14.Cotton buds (to apply creams and medicaments) 15.Card with important telephone numbers (e.g. Emergency Ambulance (995), regular family doctor, nearest hospital number, regular specialist, insurance, etc.) Excerpt taken from Really Doc?! Medical Facts and Tips authored by Dr Bina Kurup, a well-respected family physician from Raffles Medical Group with more than 25 years of clinical experience. A must-have health guide for every family, the book covers many common health ailments that would have affected most people at some time or other in their lifetime, and aims to debunk and clarify the many misconceptions and fallacies people have about their health. 28 Supplements Raffles HealthNews Health Supplements for The Family It is critical for parents to understand the role of supplements in family health, as many elements of today’s lifestyle such as frequent consumption of fast food, stress, being sedentary, and environmental factors like pollution have a negative impact on our health. To reduce the risk factors for lifestyle diseases, it is important to ensure that each member in the family adhere to a healthy diet, has enough sleep and rest, and exercise on a regular basis. Nutritional supplements may also help one to have the optimum health that he or she deserves and minimise the risk of diseases. The needs of each individual in the family will be different, for example, the needs of a pregnant woman differs from that of a young man, babies and children. The teens have different needs and the elderly, or those who are ill, may have higher requirements for certain nutrients. The following is a suggested list of health supplements that may be helpful for you and your family: Acidophilus Assists in digestion of food and reduces the potential for allergies. Antioxidants Needed for proper immune function and to destroy free radicals. MultivitaminEssential for maintenance of the nervous system, heart, muscle and skin health. Promotions Buy 1 and get the 2nd bottle @70%* off! (mix not allowed) Raffles Adult Multis 60’s (UP: S$56.90) Now: S$36.95* Raffles Probiotic Acidophilus 60’s (UP: S$49.80) Now: S$32.35* Raffles Essential Kidds Gumee Antioxidant 60’s Multivitamins 60’s (UP: S$75.80) (UP: S$39.80) Now: S$49.25* Now: S$25.85* * Prices are valid till 30 April 2012 and are not applicable with other discounts and promotions. * This promotion is only available at Raffles Health Retail Pharmacy, Level 1, Raffles Hospital. For enquiries, please contact us at 6311 1641 or 6311 1108. 585 North Bridge Road | Level 1 | Raffles Hospital | Singapore 188770 Raffles HealthNews Q&A 29 What are the underlying reasons why a child grows to become more attached to the maid than parents? What are the profiles of these families? What are the worrying signs that parents need to look out for? What should they do? One of the key factors in relationship building is that of bonding. Bonding can only take place when meaningful time is spent between persons and this time is translated into trust and dependency. When a maid spends more time with the child doing things for and with the child, invariably, a bond will develop in this relationship. Profiles of families facing such situations range from the upper working class to that of professionals. One of the main warning signs is when the child desires to be comforted more by the maid than the parent. A painful scene I witnessed last Christmas was when a child fell down in a friend’s home. Instead of running to her parents for help and comfort, this child cried for the maid, ran past her parents and into the open arms of the maid. Parents should spend more time with their child! Relationships are not built on a birth certificate. In addition, most parents make the error of stamping their monetary superiority in this situation by thinking that they can buy their child’s love by giving them presents or treating them to things that they desire. Mr Danny Ng, Clinical Psychologist, Raffles Hospital What are some general do’s and don’ts when consuming medication such as antibiotics, vitamin supplements and statins drugs? Like food, drugs taken orally must be absorbed through the lining of the stomach or the small intestine. Consequently, the presence of food in the digestive tract may reduce drug absorption. Often, such interactions can be avoided by taking the drug one hour before or two hours after eating. For antibiotics, the prescribed course must be completed. Dietary supplements, including medicinal herbs, are products that contain a vitamin, mineral, herb or amino acid and that are intended as a supplement to the normal diet. Supplements are regulated as foods, not as drugs, so they are not tested as comprehensively. However, they may interact with prescription or over-thecounter drugs. People who take dietary supplements should inform their doctors and pharmacists, so that interactions can be avoided. The anti-coagulant properties of vitamin E and gingko biloba, for instance, can interact with aspirin and warfarin which will magnify their effects and potentiate a bleed. Although many people do not consider alcohol a nutrient, it affects body processes and interacts with many drugs. For example, taking alcohol with the antibiotic metronidazole (flagyl) can cause flushing, headache, palpitations, nausea and vomiting. Dr Wong Wei Mon, Physician Leader and Senior Physician, Raffles Medical 30 MarketPlace Raffles HealthNews Enhance Your Fertility with TCM Dental Whitening Package Take-home Teeth Whitening Package at $416* Acupuncture has shown to be especially beneficial as a complementary form of therapy for couples undergoing fertility treatments. It helps by regulating the body’s system that aids in blood flow to the reproductive organs and stabilising hormone levels. This in turn increases ovarian function in women and sperm production in men. Two Fertility Programmes to meet your needs General Fertility $416.20 1 Whitening toothpaste does not change the base color of your teeth. 5 3 2 Take-home teeth whitening treatment is fast and minimally invasive. Teeth whitening does not damage your teeth or make it thinner. 4 Teeth whitening gel contains carbamide peroxide, which is an oxidising agent. It releases oxygen to whiten stains within tooth enamel. Take-home teeth whitening system takes about seven to 10 days to see results. Recommended for couples who are planning to start a family ● 5 Acupuncture Sessions IVF Booster $416.20 Designed specially to complement IVF procedures ● 5 Acupuncture Sessions Your TCM Specialist Centre For enquiries or to make an appointment, please call 6311 2388/ 2322 or email [email protected] * Package prices include GST. * Packages must be utilised within six months from date of purchase and are not transferable or refundable. * Raffles Chinese Medicine reserves the right to withdraw or revise the packages without prior notice. * Other terms and conditions apply. Please call for more details. Raffles Specialist Dental Centre 6311 2360/6311 2365 Changi Airport Terminal 3 6241 8866 | Causeway Point 6891 0255 | Marina Square 6339 7800 | One Raffles Place 6533 3640 | Tampines One 6787 0093 www.rafflesdental.com For more information or to make an appointment, please call 6311 2360/ 2365 or email [email protected] * Price is inclusive of GST. * Price does not include consultation and all other dental treatments. * Other terms and conditions apply. Please call for more details. Raffles HealthNews MarketPlace 31 Eye Screening Raffles Healthy Heart Screening $201.16 Preventive cardiac health screening is an effective and affordable way of identifying hidden cardiac disease risks. Raffles Healthy Heart Screening is suitable for individuals who want a baseline assessment of their heart health, or those who are concerned with or have a family history of heart disease or sudden cardiac death. Screen early and take action to avoid heart problems. CLINICAL ASSESSMENT • • Interview and physical examination by cardiologist Body Mass Index Laboratory Lipid Screen Total Cholesterol • HDL Cholesterol • LDL Cholesterol • TC/ HDL Ratio • Triglycerides • Liver Function Test • Bilirubin • Total Protein • Albumin • Globulin • A/G Ratio • • • • ALP SGOT SGPT SGGT Renal Screen • Glucose • Potassium • Sodium • Chloride • Urea • Creatinine TESTS • Electrocardiogram (ECG) EVALUATION OF MEDICAL REPORTS • Review by consultant cardiologist HeartCentre For more information or to make an appointment, please call 6311 1222 (24-hour service) or email [email protected] * Price is inclusive of GST. * Items in package are non-refundable if declined. * Health screenings are strictly by appointments only. Screen early for healthy vision Raffles Eye Centre offers eye screening by our consultant ophthalmologist to assess vision and health of the eyes, and to detect diseases including cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. Do not take your vision for granted. Sign up now for an eye screening package that is best suited to your needs. Basic Eye Screen Package $129 Common eye conditions like myopia, astigmatism, dry eyes, and cataract can over time cause a deterioriation to your eye and vision, which could adversely affect your daily life. Deluxe Eye Screen Package $215 Recommended for adults from 18 years. Suitable for those who are experiencing any of the following symptoms: • Periodic blurry vision • Contact lens intolerance or irritation (dry eyes, redness) • Headaches caused by eye strain • Floaters – dark spots in your line of vision • Increasing myopia Premium Eye Screen Package $488 Recommended for individuals above 50 years of age. Suitable for those experiencing any of the following symptoms: • Diabetes and hypertensive eye disorders • Blurry vision and distorted image • Tunnel vision with glaucoma • Constant eye irritation, redness or eye pain • Floaters – dark spots in your line of vision EyeCentre For more information or to make an appointment, please call 6311 1220 or email [email protected] * Package prices exclude medications and other further investigations. * All prices are inclusive of GST. MedicalGroup Put Your Health In Good Hands Raffles Hospital One-Stop Tertiary Hospital in the Heart of the City Raffles Hospital offers 24-hour emergency and health screening. Its 20 specialist clinics provides services in aesthetics, cancer, counselling, paediatrics, dental, ENT, eye, heart, internal medicine, obstetrics & gynaecology, orthopaedics, skin, and surgery, as well as Japanese Clinic and traditional Chinese Medicine. Raffles Medical Clinics There’s One Near You For general medical services, vaccination or health screening, visit any of our family medicine clinics located across the island. Our Executive Medical Centre offers medical solutions for busy executives. To bring medical services closer to you, we also provide house/ hotel call services. Changi Airport Beyond Basics For medical services at Singapore Changi International Airport, visit any of our six clinics located in the terminals. Our 24-hour clinic at Passenger Terminal 3 also provides executive health screening and dental services. For more information on our services or for an appointment, please call (65) 6311 1111 or email to [email protected]. www.rafflesmedicalgroup.com Connect with us for the latest health tips www.facebook.com/RafflesMedGrp twitter.com/RafflesMedGrp