A newsletter for patients Oct - Dec 2011 MICA (P) 023/07/2011
A Publication By NHG Polyclinics
BELLY TROUBLE...p8 HEALTHY HOLIDAY RECIPES...pg9 Company ...p10
Brain Gym Your chance to win VOUCHERS!
LIVER Healthy Life This festive season, watching your diet not only means saving your waistline but your liver too.
... turn over to page 3
Message from the Chairperson Dear readers,
Seasons Greetings from the editorial committee of ‘What’s Up, Doc?’! We will be bidding
this year goodbye soon and I am sure that most of us are eagerly awaiting the start of next year, and have lined up many year-end celebratory activities to welcome 2012. While we share your joy and wonderful festive mood, we would like to also give you some friendly health advice in this issue. Do refer to the articles and learn how to look after your liver since it is one of the most hardworking organs within our bodies. Gain some tips on how to ease that tension headache (if you find yourself too stressed while clearing up your work before all the partying starts), and how to cope with common gastrointestinal symptoms. In line with our tradition of encouraging you to eat healthily (even more so during the festive periods), we have included some healthy recipes that you can try out at home and impress your family members with. Take some time to read through the health and drug questions which our readers have submitted, and if you have any other health conditions you wish to read about, do drop us a line at [email protected]
om.sg. Lastly, we have included an updated list of treatments for the health conditions you can use your Medisave to pay for. We encourage you to take note of these to ease your out-of-pocket medical expenses. Wishing you happy holidays and a healthy year ahead!
Dr David Tan Chairperson
Editorial Team : Chairperson
Dr David Tan, Jurong Polyclinic
Ms Annie Chua, Corporate Communications
Ms Mariaman d/o Sukumaran, Toa Payoh Polyclinic
We welcome your suggestions on how to improve the newsletter. Write to [email protected]
The information produced is for reference and educational purposes only. As each person’s medical condition is unique, you should not rely on the information contained in this newsletter as substitute for personal medical attention, diagnosis or hands-on treatment. If you are concerned about your health, please consult a healthcare professional. Reproduction of the articles in whole or part without permission is prohibited.
Ms Ainolmardziah Bte Yusof, NHG Pharmacy
Healthy LIVER, Healthy LIFE Overindulging in rich foods and alcohol can take a toll on the body, causing one to gain weight, risk high blood pressure and cholesterol problems. There is also an added burden on the liver. The liver is the largest internal organ and is responsible for a wide range of duties. It takes care of more than 40 biochemical reactions in the body, making it one of the hardest working organs as well. It metabolises sugar to energy, converts protein to usable amino acids, breaks down fat and even neutralises toxins. In fact, the liver processes everything we eat and drink. After going through the digestive system, the nutrient-rich blood is filtered in the liver before travelling to the rest of the body. This means that having too many sinful treats can impact the liver other than adding on the kilograms to your body. In particular, being overweight can lead to a condition known as fatty liver or non-alcoholic fatty liver disease. This occurs when there is an abnormal accumulation of fat in the liver tissues. The liver – the ‘food factory’ of the body – not only converts starch to energy-rich glucose but also stores the excess glucose as a fuel reserve called glycogen. Glycogen is reconverted to energy by the liver when needed, but is left to build up if it remains unused. This causes the development of a fatty liver ultimately. Excessive alcohol can also cause fatty liver because alcohol contains high levels of sugar.
According to Dr Seet Lin Tze, senior family physician at Clementi Polyclinic, conditions that put one at risk of developing non-alcoholic fatty liver disease include obesity, diabetes, high cholesterol, and rapid weight loss/starvation. In most cases, fatty liver can be treated and is reversible with a healthy diet, exercise, safe and sustained weight loss, good management of diabetes and cholesterol levels, and limiting alcohol intake. However, about 10 per cent of fatty liver cases may progress to cirrhosis – a hardening of the liver. This increases the risk of liver cancer and liver failure. Added Dr Seet, “Bearing in mind that cardiovascular disease is the most common cause of illness and death in people with non-alcoholic fatty liver disease, it must be strongly emphasised that lifestyle changes in terms of diet, exercise, weight loss and smoking cessation as well as treating associated diabetes, hypertension and hyperlipidemia are critical in maintaining the health of the liver.”
健康肝脏， 健康生活 在节日期间，注意控制饮食不 仅是为了保持苗条的腰围，更 是为了保护您的肝脏。 暴饮暴食会对身体造成不良影响。这不但会导致体重增
这就是说，吃得太多不仅使您的体重增加，也会影响您的 肝脏。超重可导致脂肪肝，即非酒精性脂肪性肝病。当脂 肪在肝脏组织中异常积累时，人就会产生这种疾病。肝脏 是人体的“食物加工厂”，不仅将淀粉转化为富含能量的 葡萄糖，还将多余的葡萄糖（以糖原的形式）储存起来， 作为能量储备。在需要时，糖原将被转化为能量，但是如 果置之不用，则会积聚最终导致脂肪肝。过多酒精也会导 致脂肪肝，原因是酒精含有很高的糖分。 金文泰综合诊疗所高级家庭医生薛灵芝说:“导致人们患上 非酒精性脂肪性肝病的风险因素包括，肥胖、糖尿病、高 胆固醇以及快速减轻体重／饥饿。”
Hati (Hepar) sihat, Hidup pun sihat Musim perayaan ini, memberi perhatian pada diet anda bukan sahaja dapat menyelamatkan ukuran pinggang anda tetapi juga hati (hepar) anda.
Menikmati makanan berkhasiat tinggi dan alkohol dengan keterlaluan boleh membebankan badan, menyebabkan seseorang itu naik berat badan serta mendatangkan masalah risiko tekanan darah tinggi dan kolesterol. Selain itu, ia juga menambahkan beban terhadap hati (hepar) anda.
Glikogen ditukar semula kepada tenaga oleh hati (hepar) apabila diperlukan tetapi dibiar berkumpul jika ia tidak digunakan. Ini akhirnya menyebabkan keadaan hati (hepar) berlemak. Alkohol yang berlebihan juga boleh menyebabkan hati (hepar) berlemak kerana alkohol mengandungi kadar gula yang tinggi.
Hati (Hepar) adalah organ dalaman terbesar yang melaksanakan pelbagai tugas. Ia menguruskan lebih daripada 40 tindak balas biokimia dalam badan, menjadikannya salah satu daripada organ-organ yang sangat bekerja keras. Ia metabolises (memproseskan) gula kepada tenaga, menukarkan protein kepada asid amino yang boleh diguna untuk memecahkan lemak dan juga meneutralkan toksin. Malah, hati (hepar) memproses semua yang kita makan dan minum. Selepas melalui sistem penghadaman, darah yang kaya dengan nutrien ditapis di dalam hati (hepar) sebelum perjalanan ke seluruh tubuh.
Menurut Dr Seet Lin Tze, doktor keluarga kanan di Poliklinik Clementi, keadaan yang boleh membawa risiko penyakit hati (hepar) berlemak bukan-alkohol termasuk kegemukan, kencing manis, kolesterol tinggi dan kehilangan berat badan yang cepat/kelaparan.
Ini bermakna bahawa menikmati terlalu banyak makanan lazat boleh memberi kesan kepada hati (hepar) selain menambahkan berat badan anda. Khususnya, berat badan yang berlebihan boleh membawa kepada keadaan yang dikenali sebagai hati (hepar) berlemak atau penyakit hati (hepar) berlemak bukan-alkohol. Ini berlaku apabila terdapat pengumpulan lemak yang tidak normal dalam tisu hati (hepar). Hati (Hepar) - ‘kilang makanan’ badan - bukan hanya menukarkan kanji kepada glukosa yang kaya dengan tenaga, tetapi juga menyimpan glukosa yang berlebihan sebagai rizab bahan bakar yang dikenali sebagai glikogen.
Dalam kebanyakan kes, hati (hepar) berlemak boleh dirawat dan boleh dipulihkan dengan amalan diet yang sihat, senaman, penurunan berat badan secara selamat dan berterusan, pengurusan penyakit kencing manis dan paras kolesterol yang baik, serta menghadkan pengambilan alkohol. Walau bagaimanapun, kira-kira 10 peratus kes-kes hati (hepar) berlemak boleh melarat ke sirosis - tisu berserat di bahagian hati (hepar). Ini meningkatkan risiko kanser hati (hepar) dan kerosakan hati (hepar). Tambah Dr Seet lagi, “Perlu diingatkan bahawa penyakit jantung adalah punca utama penyakit dan kematian di kalangan mereka yang berpenyakit hati (hepar) berlemak bukan-alkohol, perlu ditegaskan bahawa perubahan gaya hidup dari segi diet (pemakanan), senaman, berat badan dan berhenti merokok serta merawat penyakit kencing manis, darah tinggi dan hiperlipidemia adalah kritikal dalam mengekalkan kesihatan hati (hepar). “
07 Ease the
Hectic lives, work schedules and the mad rush to clear up as much work as possible before taking that well-deserved year-end holiday may bring on the occasional bout of tension headache. A tension headache - or medically known as a tension-type headache - is the most common type of headache, often described as a sensation of having a tight band around the head.
The exact cause for tension headache is unknown, but the most common reason given is that it develops after an individual had held his head in a fixed position over a long period of time. Prolonged periods of just sitting at the desk while working on the computer, doing fine delicate work with the hands or using a microscope are other known reasons. Other triggers may include: • Sleeping in a cold room or with the neck in an abnormal position • Stress • Depression and anxiety • Poor posture • Working in awkward positions for a sustained period of time • Jaw clenching • Alcohol/Caffeine • Eye strain • Fatigue • Excessive smoking
Soothe the muscles Soothe sore neck muscles with either a hot compress or a cold pack, depending on your preference. A hot-water bottle, a warm towel or a hot bath/shower may help in easing out the aches. If you are using a cold pack, wrap the ice pack/cubes in a towel to protect the skin. A gentle massage to the muscles of your head, neck and shoulders may also help to relieve muscle tension and provide relief from headaches.
Stress management Stress is a common trigger for tension headaches. Try to reduce stress by planning ahead and organising your day. A list of tasks for the day – written down in order of priority – may help. Another way is to adopt a positive attitude and regain your sense of control by changing your expectations. Reframe your problems and view your stressful situations from a more positive perspective. In addition, you can reduce stress in your life by nurturing yourself. Set aside time for fun and relaxation either by yourself or with others. This way, you will be in a better position to handle stressful situations when they arise. Use techniques such as deep breathing exercises and stretching to relax. Regular exercise, a proper diet and adequate sleep help you to maintain good health and reduce stress.
Perfecting your posture Good posture can prevent muscles from tensing up and place minimal strain on your muscles, ligaments, tendons and bones. When standing, hold your shoulders back and keep your head high. Pull in your abdomen and buttocks and tuck in your chin. When sitting, make sure your thighs are parallel to the ground and your head isn’t slumped forward. Get up and take a break from your computer every few hours especially if long hours at the desk triggers headaches.
08 The enjoyment of the festive season – feasting and merrymaking – can take its toll on our tender tummies. We share with you some tips on how to avoid the common stomach problems caused by enjoying too much good food during the celebrations.
Characterised as a ‘burning’ sensation in your lower chest, it may be accompanied with a sour or bitter taste in the mouth. It is often experienced after a big meal or while you are lying down after a meal.
Having to visit the toilet often is no fun. For some people, this may even warrant medical attention, as it could be a sign of more serious health conditions.
Causes: Stomach acid may sometimes escape up the oesophagus (the tube that leads from your mouth to your stomach). This occurs if you overeat, are pregnant or have a condition where part of your stomach is pushed up into the chest. Avoid the ‘burn’: • Avoid caffeine, smoking, alcohol and foods that are too spicy, carbonated, acidic and oily. Don’t lie down too soon after eating. • Lose weight if you are overweight. See a doctor: If you experience heartburn frequently, see a doctor to avoid inflammation from occurring.
Bloated stomach (gas in the stomach) The swollen discomfort of a bloated tummy can be very unpleasant and inconvenient. It can disrupt your social plans and sleep, and may even disrupt your daily activities. Causes: This is a result of a build-up of gas in the intestines during digestion. Certain foods produce gas when they are broken down. It can also occur if you swallow a lot of air during eating. Dispel the gas: • Avoid or cut down on ‘wind’-producing foods such as cabbage, asparagus, cauliflower, potatoes and corn. • Artificial sweeteners and carbonated drinks can also cause gas to build up. • If you are lactose intolerant, avoid dairy products. • Chew well, eat slowly and avoid talking while eating – these habits will help to reduce the amount of air swallowed while eating. See a doctor: If the sensation of a bloated stomach continues for a long time, or if your abdomen has grown bigger and is painful to the touch, please consult a doctor.
Sources: Health Promotion Board and www.familydoctor.org.
Causes: The loose watery stools that are a hallmark of diarrhoea may be due to a viral or bacterial infection, food poisoning, intolerance to food, medication or even stress. Taming the tummy: • Drink plenty of clear fluids such as water, fruit juice and clear soups to replenish lost fluids. • Eat bland foods such as clear soup, rice porridge and plain bread. • Avoid meat, nuts, beans, dairy, oily food, coffee and alcohol. See a doctor: Babies, children, the elderly and anyone with a chronic medical condition should always consult a doctor when they experience diarrhoea. If there is vomiting, severe pain and if stools are black or bloody, you should go to the emergency department of the nearest hospital.
Constipation Everyone moves their bowels at varying frequencies. It may be daily or twice a day, but a disruption in your ‘daily motion’ can be an uncomfortable affair. Causes: A lack of fibre, water or physical activity, certain medications and piles can cause constipation. Promote regularity: • Ensure that you drink about 8 cups of water a day and have fibre-rich foods in your diet (oatmeal, whole wheat bread, fruits). • Prunes and prune juice can help relieve constipation. • Exercise three times a week. Walks, swims or bike rides can help to promote regularity in your bowel movements. See a doctor: Frequent bouts of constipation, tummy pain and swelling, thin stools and weight loss due to constipation can be signs of a more serious illness. Contributed by: Dr Seah Chee Yong Senior Family Doctor, Hougang Polyclinic
09 Thai chicken salad Ingredients • 100g chicken breast • A 1-inch knob of fresh ginger, peeled • 2 tbsp sugar • 2 chili padi (optional) • ½ cucumber, deseeded and thinly shredded • 10 coriander leaves, chopped
• 3 cloves garlic • 2 tbsp fish sauce • Juice of 1 lime • 1 medium carrot, shredded • 2 shallots, halved and thinly sliced
Method • Grill, microwave, steam or poach the chicken breast • Shred with a fork • For the dressing, combine garlic, ginger, fish sauce, sugar, lime & chillies in blender and puree until smooth • In a large bowl, toss the shredded chicken meat & carrot with the dressing, onion and coriander Healthy Tip: Replace chicken with pan fried tau kua (firm tofu) cut to small cubes.
Garlic chicken and basil sandwich Ingredients • 1 tsp canola oil • 1 clove garlic, crushed • Salt & black pepper • 4 leaves fresh basil
• 100g roast turkey or chicken meat, skin removed • 2 slices wholemeal bread • 15g (6 strips) marinated sun dried tomato
Method • Heat a non-stick frying pan and add canola oil • Slice a 5mm thick piece of chicken and rub with garlic • Fry chicken on each side for 2 to 3 mins • Season (if preferred) • Assemble sandwich by stacking toasted bread, chicken, tomato strips and basil Healthy Tip: Use low fat yoghurt as a creamy spread. This is great with leftover chicken or turkey.
Tea-Scented Mandarins Ingredients • 2 cups mandarin orange segments • ½ cup hot black tea • 2 tablespoons honey • Pinch of ground cardamon Method • Place orange segments in a small bowl • Pour tea over them • Drizzle with honey • Sprinkle with cardamom • Serve Healthy Tip: You can replace mandarins with orange, pear or mango.
Healthy Holiday Recipes Low in fat but high in flavour, try these healthy recipes for a cross-continental festive feast.
Grilled Salmon with • balsamic vinegar Ingredients • 2 pieces of 100g salmon fillets • 100g green beans, steamed or blanched • 100g cauliflower, steamed or blanched • Salt & pepper to taste • Olive oil Sauce • 1 shallot, minced • ¼ cup balsamic vinegar • 2 tbsp groundnut or olive oil • 1½ tsp fresh thyme leave Method • Rub salmon with olive oil, salt and pepper • Preheat grill pan and grill fish (skin -side down) for 4 to 5 mins • Turn fish over and cook for another 2 to 3 mins • For the sauce, combine oil, balsamic vinegar, shallot and thyme • Serve the grilled fish with green beans and cauliflower, drizzled with sauce Healthy Tip: Pan fry the fish instead of grill.
Recipes contributed by Mr Won Tin Chiang Dietitian NHG Polyclinics
e Sudoku Puzzl
8 7 1
Answer the simple question below and you could win for yourself $30 worth of Takashimaya vouchers! Hint: The answer can be found in this newsletter.
Question: You can lower your risk of developing a fatty liver by leading a healthy lifestyle. True or False?
Full Name (as in NRIC) :
Contact / Mobile No.
Simply email your answers in the format above to [email protected]
by 15 December 2011. Three correct entries will be selected to win the vouchers! Winners will be notified via email. Hardcopy submissions will not be accepted. Staff members of NHG Polyclinics are not allowed to participate in this contest.
Last Issue’s Quiz Results Question: Name one form of gum disease Answer (either one is correct): Gingivitis or Periodontitis 1. Foo Wee Kiat, NRIC number: SXXXX151H 2. Thow Nan Yien, NRIC number: SXXXX968E 3. Nancy Toh, NRIC number: SXXXX861B You will be notified via email on how to collect your $30 Takashimaya vouchers. The decision of NHG Polyclinics is final.
Company New Services you can now use Medisave for!
• Since November 2010, females aged 9 to 27 years old can use Medisave if they wish to take the Human
Papillomavirus (HPV) Vaccine to guard against cervical cancer. • Since July 2011, women over 50 can use Medisave for mammogram screenings.
You can also use Medisave for the following: Treatment of chronic conditions: • Diabetes Mellitus • Hypertension • Lipid disorders • Stroke • Asthma • Chronic Obstructive Pulmonary Disease (COPD) • Schizophrenia • Major depression *Note: Patients can use their Medisave to pay for consultation, medication and laboratory tests that are related to the chronic diseases mentioned above.
Vaccinations • Hepatitis B
Dental treatment • Removal of roots • Bone graft surgery • Implant surgery • Soft tissue graft • Incision & drainage • Dislocation, re-implantation and transplantation
THE EXPERTS Do you have a burning question on health issues? Drop us an email at [email protected]
Health QUESTION : Drug QUESTION : I am a 29-year-old female and a frequent blood donor. Recently at the blood donation screening station, I was told for the first time that my blood pressure was low and I was not allowed to donate blood. What are the causes of low blood pressure? Should I be concerned and how should I deal with my condition? The main causes of low blood pressure are: 1. Decreased intake of fluids, e.g. if a person is fasting or not drinking enough water. 2. Excessive loss of water because of vomiting, diarrhoea or fever. 3. Excessive loss of blood due to bleeding, heavy menstrual flow, frequent blood donation without supplementation of iron pills. 4. Sickness e.g. heart failure, anaemia. 5. Over-treatment of high blood pressure.
I am in my 30s and of an average weight but I would like to prevent myself from gaining weight during the end of the year festivities. Can I take Xenical to prevent weight gain? Xenical® is commonly used for people who are overweight. You should consult your doctor for a full assessment before embarking on any weight loss programme or diet. The active ingredient in Xenical® is Orlistat, which targets the enzymes that break down fat. This prevents up to 30 per cent of dietary fats from being digested. Xenical® targets the digestion of fat rather than suppressing the appetite and should be taken in conjunction with a wellbalanced, calorie-controlled diet that is rich in fruits and vegetables. For a more holistic approach, this should be coupled with regular exercise. Common side effects of taking Xenical® include oily discharge from the anus; abdominal pain or discomfort; flatulence (wind) with or without discharge; oily, fatty or loose stools; and/or an increased urge for bowel movement.
You should be concerned if the low blood pressure is causing symptoms like shortness of breath, difficulty in breathing when doing simple household chores or giddiness. You should consult your doctor if the low blood pressure is persistent and symptomatic.
These symptoms generally occur at the beginning of treatment, or after an oily meal. They will generally subside after some time. Other side effects that may occur in some patients include headache, anxiety, irregular menses or muscle pain. Stop the medication and see a doctor if you experience severe side effects such as difficulty in breathing, facial swelling, hives/itching/rashes, stomach cramps or pain, or yellowing of the eyes or skin.
Contributed by Dr Yuen Soo Hwa Senior Family Doctor Woodlands Polyclinic
Contributed by Cheryl Char Pharmacist Hougang Polyclinic
On 16 June, I brought my daughters for a dental check-up at Ang Mo Kio Polyclinic and was attended to by Dr Yeo Sze Lynn. I wish to highlight that Dr Yeo was very professional and she used stories to explain the uses of the tools and equipment, so that my girls were not so nervous. Even the dental drill sounded so harmless during this visit. I have had bad experiences with dental visits since young but I must admit that I was also ‘coaxed’ into a comfortable state during this session.
Thank you Dr Yeo for making our visit so enjoyable. We are looking forward to my younger daughter’s next visit to fill her second decay! Mr Lai Sze Hai
*To enjoy the discounts, please present the coupons at the point of purchase.