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A PUBLICATION OF THE NATIONAL UNIVERSITY HOSPITAL
ISSUE 2 / 2016
A member of the NUHS
NUH’s Mobile Hearing Clinic brings hearing tests to the community
&Loud Clear
STEPS TO HEALTHY FEETWHAT DOES YOUR HEADACHE MEAN?BEAT IRRITABLE BOWEL SYNDROME
10
LIFELINE LIFELINE
MY LIFE 3
IN THIS ISSUE...
CONTACT DETAILS
The Editor, Lifeline,
Corporate Communications,
National University Hospital, 1E Kent Ridge Road,
NUHS Tower Block, Level 13, Singapore 119228
Tel: 6772 4695 • Fax: 6774 0936
Email: [email protected]
Read Lifeline at nuh.com.sg
PUBLISHING AGENT
Publicitas Publishing • Email: [email protected]
Information in this publication should not be used as a substitute for
medical diagnosis or treatment. Contents in this publication may be
reproduced with the permission of the National University Hospital.
MCI (P) 051/09/2015
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03 MY LIFE Deputy Director of Nursing Joann
Pang believes a good mentor listens to her team
04 NEWSBEAT l NUH Sports Centre opens l Convenient, cashless ZOOM
payment l Caring for children of patients
with cancer
08 COVER STORY Mobile Hearing Clinic: Hearing
screening in the heartlands
11 NEWSBEAT New Ronald McDonald Family
Room offers respite for more families
12 ON THE PULSE First successful living paired
kidney exchange transplant in Singapore
14 WELLBEING l Headaches: Signs to look out for l Keep your feet healthy
18 IN THE KNOW Easing Irritable Bowel Syndrome
20 10 MINUTES WITH... Senior psychologist Terri Chen
20
12
18
CO
VE
R P
HO
TO: W
ILS
ON
PA
NG
; GE
TT
Y IM
AG
ES
ven as a young staff nurse,
Joann Pang always believed
in guiding others who were
less experienced – like the
time she assisted a houseman who
was having difficulty setting a drip for
a patient.
It was only later that Joann found
out the significance of that action. “The
houseman still remembers the moment
after all these years,” says Joann with
a smile.
Interestingly, the deputy director
of nursing at the NUH only chose
Enursing at her mother’s urging, but
almost gave it up in her first year. The
nurse manager who was her supervisor
then, encouraged her to stay on. “She
said that I could make a difference in
healthcare,” she recalls.
One person who made a difference
in Joann’s career is nurse veteran Tan
Chwee Eng, with whom Joann worked
for over a decade. “Chwee Eng stands
up for what she believes in and her
courage to speak up for nurses has
inspired me to be a better leader.”
Through mentoring and leadership
courses, Joann also picked up
techniques that have changed her
coaching style. “I used to tell people
what to do, but I realised it is more
important to listen to what someone
is saying and guide people to find
the answer.”
Adds Joann, “I want to come across
as a friend, someone here to help them
rather than just fulfil a role.”
By interacting regularly, Joann says
she’s learned a lot from her nurses as
well. “I learn to see things from their
perspective – the ability to see and feel
what they go through has helped me in
becoming a better mentor.”
Her nurturing approach has
clearly paid off. “I was grateful when
one of my nurses thanked me for
encouraging her not to be afraid to
pursue her dream of becoming a
registered nurse,” she shares. “It made
me realise how we can all touch lives,
sometimes without knowing the impact
we’ve made.”
“Don’t be afraid to try, and stand up for your beliefs”
NEWSBEAT NEWSBEAT4 5
LIFELINE LIFELINE
he NUH has introduced
a time-saving payment
system, ZOOM, where
patients no longer need
to queue at payment counters and,
instead, have selected treatment fees
deducted from their preferred credit or
debit card.
Patients can register for ZOOM
at the hospital’s specialist outpatient
clinics and their accounts will be
activated on the same day.
Following treatment, their fees will
Tbe charged to the designated credit or
debit card, and deduction should take
place the next working day. Patients will
usually receive a bill within 10 working
days for their reference.
There is no expiry date for ZOOM,
but patients will be notified by the NUH
to update their account’s credit or debit
card details prior to the expiry date of
their card.
For enquiries about ZOOM, please call
6772 6111 from Mon-Fri, 8.30am-9pm
ZOOM can be used for
services at the NUH’s specialist outpatient clinics, pharmacies (for prescription medication), the Rehabilitation Centre, Dietetics, and Diagnostic Imaging”
A FASTER,MORE CONVENIENTWAY TO PAY
hen 20-year-old Cheong
Hong Wei experienced
intense pain in his ankle last
October, likely stemming
from a fracture playing rugby in junior
college three years ago, he consulted
a doctor at the NUH. “I was surprised
there was a sports clinic there,” he said,
“I had my follow-up just three weeks
after my first appointment.”
With the opening of the NUH Sports
Centre, patients like Hong Wei have
access to a suite of sports treatment
services under one roof. “We have
sports physicians working with sports
surgeons, physiotherapists, radiologists
and cardiologists,” said the centre’s
director Dr Lingaraj Krishna. “In the
past, we saw patients with sports and
exercise-related injuries at different
places in the hospital. What we have
done is to put all these different
services under one roof.”
This integration is instrumental
in helping people recover quickly, so
they can return to their sport as soon
as possible. The NUH Sports Centre
expects to treat over 10,000 patients
a year.
In operation since last July, the
facility also provides team physician
services for various varsity teams
under teamNUS, and is committed
to promoting an active lifestyle
among Singaporeans. The centre has
supported events such as the annual
OCBC Cycle, where its specialists
organised workshops, health screenings
and sports-injury consultations to help
participants improve their performance.
Accredited by Singapore’s Joint
Committee on Specialist Training to
groom future generations of sports
physicians, the centre will also play an
active role in sports medicine education
and research.
In addition, there are plans
to collaborate with DSO National
Laboratories in assessing the potential
of technology in enhancing training and
performance in a military setting.
NEW CENTRE TO FOCUS ON SPORTS-RELATED CONDITIONS
SH
UT
TE
RST
OC
K
W
NEWSBEAT 7
LIFELINE LIFELINE
NEWSBEAT6
hen a cancer patient is also
a parent, he or she often
faces a dilemma: What do I
tell my children?
According to Yvonne Cai, a senior
medical social worker at the NUH,
many may not realise the importance
of telling their children about their
condition. “They may feel their children
are too young, or they may want
to shield them from ‘unnecessary’
information to avoid frightening them.”
While the decision to reveal their
illness ultimately rests with the parents,
children are likely to learn the truth
on their own. “Today’s children are
very savvy,” Yvonne explains. “They
can gather information implicitly by
watching their parents, or they may
overhear discussions about the cancer
and form their own conclusions, which
can cause more anxiety.”
WTEACHING EMOTIONAL RESILIENCETo support the emotional wellbeing
of children of patients with cancer,
Yvonne and her team launched the Kids
Connect support group in 2013. The
two-day session is targeted at children
aged 7-12, whose parents (or primary
caregivers) have been diagnosed with
cancer. Through activities such as art
projects and storytelling, the support
group aims to build resilience in the
children by giving them a safe space to
express themselves.
“One activity that we have is called
the ‘Before And After Door’, where
children make an art piece depicting
what life was like before the cancer
and after,” says Yvonne. “It’s a way for
them to process their observations
and feelings.”
Within this safe and supportive
environment, participants are also
encouraged to open up and express
their thoughts, even identify and
verbalise their feelings using an emotion
wheel. “When someone in the family is
sick, the whole family feels the impact,”
says Yvonne, “Children feel the impact
most with family activities that may
be meaningful to them, but which
adults may overlook. With cancer in
the equation, there may be fewer or no
outings, and special occasions such as
birthdays may no longer be celebrated
as their parent struggles with their
condition.” The adults may also seem
more irritable
because of the
stress and this
affects their
children, who
ultimately may
feel a sense of loss.
“So when children
share in a group setting, they realise
that they’re not alone and that what
they’re experiencing is common for
families afflicted by cancer,”
says Yvonne.
Children are also taught coping
strategies such as relaxation techniques.
If they experience difficulties during
the session, the medical social worker
will follow up by alerting the parents,
as well as the school and other support
agencies if necessary.
CONNECTING FAMILIESThe Kids Connect sessions are
conducted twice a year during
the school holidays. Says Yvonne,
“Participants must be made aware of
their parents’ illness because they will
discuss issues related to their parent’s
condition.” Feedback about the support
group sessions – run by oncology
medical social workers trained in
counselling, group work and art
therapy skills – has been positive.
Some parents have reported
that as a result of the sessions,
they are more comfortable discussing
cancer-related subjects with their
children and feel reassured knowing
their kids are equipped to manage their
emotions and fears.
Yvonne recalls a
mother who had
reservations about
revealing her
condition to her children aged 9 and 11
– she was afraid they would be sad and
worried. Yvonne advised the mother on
how to break the news to her children
before they attended Kids Connect. Says
Yvonne, “After the session, the mother
felt she could talk openly to her kids
about her illness as she could see they
were able to cope.”
CARING FOR CHILDREN OF PATIENTS WITH CANCER
GE
TT
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AG
ES
COVER STORY8 COVER STORY 9
LIFELINE LIFELINE
magine noticing you have
blurry vision – you can’t see
the bus number until the
bus is almost here, and you
see an eerie glow around street lights at
night. Most people would get their
eyes checked.
Now, what would you do if you
noticed you were losing your hearing?
It turns out that in Singapore, many
people do not seek treatment when
the world around them gets softer or
sounds become indistinct.
For some, the reason could lie
in a stigma attached to hearing loss, or
the sight of people with hearing aids.
For others, the hassle of having to visit
the hospital makes them reluctant to
seek help. There are also those who are
not aware that help is available.
Mr Alex Wong, a 67-year-
old freelance tour guide,
first noticed he wasn’t
hearing clearly a few
years ago. “My family
said I turned the
volume all the way up
when I was watching
TV and listening to
songs,” he said. “Also,
when I was talking to my
tour group from the back
DON’T SUFFER IN SILENCEIf you’re 40 and above, one-stop hearing screening is close at hand with the NUH’s Mobile Hearing Clinic
of the coach, I realised I couldn’t hear
them properly.” Fortunately, Mr Wong
came across a notice about the NUH
Mobile Hearing Clinic (MHC) at a Senior
Activity Centre near his home last year.
SUPPORTING BETTER HEARINGLaunched last December and funded
by the Ministry of Health’s Health
Services Development Programme,
the MHC provides hearing tests for
residents aged 40 and over. To date,
two roving clinics have served residents
in Tampines West, Yuhua, Bukit Panjang,
Nee Soon Central and Queenstown.
The MHC services will be expanded
in phases to serve more than 20
Community Centres/Clubs or Residents’
Committee Centres across the island.
Mr Wong is one of over 500 seniors
screened by the MHC so far. The mobile
hearing clinic has fitted hearing aids
for some 80 residents who came for
hearing screening since its launch.
The statistics indicate that hearing
loss is more common than most people
realise. Of those screened, 82 per cent
suffer from some degree of hearing
loss, and out of this group, 70 per cent
had mild to moderate hearing loss,
which could potentially progress to a
more severe condition.
I
ARE YOU
LOSING IT?
l You can’t make out song lyrics or dialogue on TV without cranking up
the volumel People complain that you
speak too loudlyl You keep asking people to
repeat themselvesl There’s a persistent ringing in your ears
An NUH audiologist with the Mobile Hearing Clinic explaining the features of a hearing aid to a resident
COVER STORY10
LIFELINE
Hearing loss is like an invisible
barrier that cuts a person off from his or her loved ones and the outside world”
For Mr Wong, not only did he get
his hearing tested, audiologists with the
MHC helped get his hearing aids fitted.
He said: “They taught me how to use
them and shared tips, such as moving
to a quiet place when I need to
discuss something.”
An initiative with the People’s
Association to bring affordable
screening services to the community,
the MHC hopes to raise awareness of
the negative effects of hearing loss.
“Many residents who have been
diagnosed with hearing loss did not go
to a hospital for a hearing check-up,”
said Ms Chong Sheue Lih, Programme
Director with the MHC and an audiologist
at the NUH. She believes that one of
the factors may be a lack of awareness
of the negative effects of hearing loss.
“Although not life-threatening, hearing
loss causes communication difficulties
and affects the quality of life of
individuals and their families.”
WHEN YOUR WORLD GOES QUIETHearing loss is inevitable as we age, but
there are ways to prevent it from getting
worse – the key is early detection. Says
Dr Lynne Lim, Clinical Advisor to the
MHC, “Patients should fit hearing aids
early, rather than when the hearing loss
is severe, as the brain has had less sound
deprivation and adapts faster.”
This is important because not being
understood can affect a person. Hearing
loss is like an invisible barrier that cuts
one off from his or her loved ones and
the outside world.
The result is social isolation and
withdrawal, depression and loss of
memory and cognitive ability. Studies
show that seniors with hearing loss are
more likely to develop dementia and
Alzheimer’s disease. Other associated
conditions include loss of balance, falls
and fractures, not to mention stress on
caregivers and loved ones.
Mr Wong is glad he sought help
before it was too late. “Before this, I had
to guess what people were saying. Now,
I can hear much better with my hearing
aids. My family members are also
happier as I don’t need to turn up the
volume when I watch television!”
WHAT TO EXPECT:
l The hearing diagnostic test lasts one hour and includes video-otoscopy (a small video camera is used to look into the ear canal and eardrum); middle ear analysis; and pure tone audiometry, which assesses the extent and type of hearing loss.
l Based on the test results, ENT specialists will provide a diagnosis and treatment plan. Patients who require hearing aids go through a hearing aid evaluation, followed by hearing aid fitting, two sessions of aural rehabilitation and a follow-up session to fine-tune the hearing aid.
l Costs: $5 for initial screening and an additional $15 for those requiring further evaluation. Hearing aids range from $1,800 to $3,200 and eligible individuals can enjoy at least 90 per cent in financial assistance (capped at $2,700 or whichever is lower) through the Seniors’ Mobility & Enabling Fund (SMF) and the Health Services Development Programme (HSDP) fund.
For more details, visitwww.nuh.com.sg/ent/mobile-hearing-clinic.html
NEWSBEAT 11
amilies with children who
are hospitalised in the
Paediatric Intensive Care
Unit/High Dependency
ward (PICU/HD) at the NUH now have a
place to rest in between tending to
their children.
Fully funded by the Ronald
McDonald House Charities (RMHC)
Singapore, the Ronald McDonald Family
Room is located just steps away from
the PICU/HD ward and can comfortably
accommodate 14 persons at any one
time. The room has a kitchen equipped
with a fridge, microwave ovens and a
water dispenser. Shower facilities are
available, along with clean towels and
basic toiletries. There are also areas for
dining, reading or watching television,
and a rest corner for relaxing or
napping, as well as access to free WiFi.
“It’s common to see parents keeping
vigil by their children’s bedside, with
some spending many sleepless nights
at the hospital,” said Pamela Tor Das,
president of RMHC Singapore. “When
families walk through the doors of the
Family Room, we want them to feel
like they are no longer in a hospital,
but rather, in a room of a caring,
peaceful home.”
The Family Room is part of the
NUH’s recent expansion works for its
PICU/HD ward.
Apart from the Family Room, there
is a four-bedroom Ronald McDonald
House at the NUH, which was opened
in 2013 to provide a “home away from
home” for families of children in the
PICU/HD ward. The facility offers four
ensuite bedrooms, a reading room,
living and dining rooms, a laundry area
and a kitchenette.
More than 300 families have
benefitted from the House, and with the
new Family Room, more will be able to
seek respite in a comforting space.
Ms Noor Karmilah Sauji, 43, had
stayed in both the Ronald McDonald
House and Family Room while her
16-year-old daughter was being treated
for a brain infection. “I got to spend
more time with my daughter this way,”
she said. “I also saved money and
travelling time.”
Said Associate Professor Daniel
Goh, head of the NUH’s Paediatric
Cluster, “Research shows that a family’s
presence in the hospital helps children
heal and cope better.”
F
RONALD MCDONALD FAMILY ROOMOPENSIt’s a welcome sanctuary for families of young patients
RO
NA
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SIN
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LIFELINE
ON THE PULSE ON THE PULSE12 13
LIFELINELIFELINE
iti Rasyidah binte Lokman
Hadan has had more to deal
with than most people. Born
with abnormal kidneys and
bladder, she was diagnosed at age 13 with
Systemic Lupus Erythematosus (SLE),
an autoimmune disease that caused her
antibodies to attack her organs. Two
years later, her kidneys failed and she
had to start on dialysis, which eventually
caused calcium salts to accumulate in
her soft tissues, gradually hardening
them. Siti also developed heart and
bone diseases. Pain was her constant
companion for years. “I could feel the
pain in my nerves and bones even with
painkillers, even in my sleep,” she recalls.
“Because of the pain, I couldn’t focus on
anything to get my mind off it.”
For a teenager who had led an
active life despite her illnesses, being
wheelchair-bound was unbearable.
“Siti used to be one of the most active
dialysis patients we had. She was doing
breakdancing and helping to organise
our camps,” shares Professor Yap Hui
Kim, Head & Senior Consultant, Division
of Paediatric Nephrology, who has been
taking care of Siti since 2006. “After
she was wheelchair-bound, she couldn’t
even go to school. You could see a big
difference. Without a kidney transplant,
her condition would have deteriorated
progressively.”
FIRST TRANSPLANT PROCEDURE OF ITS KINDAccording to Professor A Vathsala, Co-
S
The first-ever living paired kidney exchange transplant successfully performed in Singapore was, for one young woman, the best gift she could have wished for
director, National University Centre for
Organ Transplantation (NUCOT),
the average waiting time on Singapore’s
National Kidney Transplant waiting
list is eight to nine years. All potential
donors must go through a battery of
tests to determine medical fitness
and compatibility.
For Siti, only her mother Mdm Noor
Rafidah binte Nasir was medically fit to
donate to her, but they were deemed
medically incompatible. The only option
was a living paired kidney exchange
transplant in which Siti would receive a
kidney from a non-family living donor,
while Mdm Rafidah would donate her
kidney to someone else on the national
waiting list. This form of transplant
was legally approved in Singapore
back in 2009, but had never been done
before here.
For Siti, good news came shortly
after she was listed on the paired
exchange registry in August 2014 – an
anonymous donor had approached the
Ministry of Health’s (MOH) National
Organ Transplant Unit and the person
was found to be a suitable match.
But challenges still lay ahead.
“Our biggest challenge was making
Siti medically fit for the transplant,”
says Professor Yap. Besides getting
the necessary approvals, there were
medical and logistical issues to work
out, including ensuring that all the
transplant surgeries – Siti’s, her donor’s,
her mother’s and that of the recipient
of her mother’s kidney – began at
the exact same moment. It took the
multidisciplinary team of surgeons, renal
and transplant physicians, anaesthetists,
transplant coordinators and nurses
months to iron things out, down to
the tiniest details.
A LIFE-CHANGING OPERATIONIn April 2015, Siti received her new
kidney after a successful six-and-a-half-
hour surgery. “By matching two or more
donor-recipient pairs to create matches,
more patients can receive organs,”
adds Professor Vathsala. “We hope that
through Siti’s example, more patients in
Singapore will see the benefits of paired
exchange transplants.”
Today, Siti is making full use of her
second chance at life. Months after her
discharge, she joined an NUH camp as a
chief organiser – minus the wheelchair.
Siti also registered for “A” Level classes
at a private institution, with hopes of
becoming a teacher. She also plans to
visit South Korea’s Jeju island, which
she’s only ever seen in TV dramas. “But
being able to walk is the biggest thing
for me,” says the bubbly 24-year-old.
“Just for that, I’m thankful.”
GIFT OF LIFE
By matching two or more donor-
recipient pairs to create matches, more patients can receive organs”PROFESSOR A VATHSALA, CO-DIRECTOR, NATIONAL UNIVERSITY CENTRE FOR ORGAN TRANSPLANTATION (NUCOT), NUH
This page: Siti with her mother Madam Rafidah, who donated a kidney to a compatible recipientFacing page: Siti with the team involved in her kidney transplant
WELLBEING WELLBEING14 15
LIFELINELIFELINE
GE
TT
Y IM
AG
ES
the discomfort, most people can carry
on with their daily routine without any
issues,” says Dr Ong.
WATCH OUT FOR:l Tightness in the muscles at the back
of the neck and over the scalp. Factors
such as poor posture and mental and
physical stress may worsen
tension headaches.
l Consuming too much caffeine
or alcohol.
MIGRAINEThis type of headache is usually
characterised by a one-sided,
throbbing pain. It can last a
few hours or up to three days.
Sometimes, a chronic form of
migraine may develop. Common
causes include physical and mental
stress, hunger, eating certain
foods, irregular sleep patterns and
dehydration. Movement or physical
exertion could also aggravate the pain.
“Often, one would need to stay in bed
to try and sleep off the migraine,” says
Dr Ong.
WHEN DO I SEE A DOCTOR?
l If you are experiencing headaches for the first time, especially after age 50.
l If the intensity, quality or location of the headache has changed.
l If you get visual blurring, persistent nausea and vomiting. These symptoms may indicate an increased level of brain pressure.
l When you get headaches upon waking which worsen with changes in posture or position, coughing or sneezing, or are accompanied by limb weakness or numbness, or changes in speech.
l When headaches strike while you have other underlying medical conditions (e.g. immuno-compromised states, cancer etc).
l If a fever and neck stiffness accompany the headache.
“These symptoms require early medical evaluation for more serious causes such as brain tumour, inflammation and infection,” says Dr Ong. If these indications arise, usually a detailed neurological assessment followed by a brain scan will be conducted. If a brain tumour is suspected, a neurosurgeon may be involved. “Generally, benign brain tumours have a better diagnosis and are more responsive to various treatments,” adds Dr Ong.
While most will ease after some time, other conditions may require medical attention
MAKING SENSE OF HEADACHES
6 WAYS TO FIGHT THAT PAIN IN THE HEAD
✔ Drink plenty of water✔ Reduce stress✔ Do 30 minutes of exercise at least three
times a week✔ Maintain regular sleep patterns✔ Eat your meals at regular times and stick
to a healthy diet✔ Keep to the treatment plan prescribed
by your doctor to avoid overuse of pain relieving medications
WATCH OUT FOR:l A heightened sensitivity to bright
lights, sounds and odours during
episodes of migraine.
l Nausea and vomiting.
l Seeing flashing lights or zig-zag lines.
About one-third of migraine sufferers
experience this “aura” before a migraine
kicks in.
CLUSTER HEADACHEOne of the most excruciating types of
primary headaches, it occurs in periodic
patterns or clusters, with men being
more susceptible to it. Cluster headaches
tend to strike around the same time like
clockwork. “A single attack may last from
15 to 180 minutes. Bouts of frequent
attacks, known as cluster periods, may
last from weeks to months, followed by
remission periods when the attacks stop
completely,” says Dr Ong. There is no
known cause for cluster headaches, but
once it strikes, consuming alcohol can
quickly trigger a splitting headache.
WATCH OUT FOR:l An intense pain in or around one eye
on one side of the head.
l Excessive tearing, redness of the eye,
congested or runny nose, dropping
eyelid, sweating or pale skin on the side
affected by the headache.
HORMONAL HEADACHESHeadaches in women, particularly
migraines, are tied to shifts in the levels
of the female hormone oestrogen
throughout the reproductive cycle.
Migraine headaches are most likely
to occur in the two days leading up to
a period, or the first three days during a
period. “This is due to the natural drop
in oestrogen levels at these times. The
attacks are typically more severe than
migraines at other times of the month,”
Dr Ong explains.
Women approaching menopause
may also experience worsening
headaches because of disruption to
the normal hormone cycle. Headaches
could also intensify during the first few
weeks of pregnancy, but they usually
ease or stop completely during the last
six months.
SECONDARY HEADACHESUnlike primary headaches, secondary
headaches are linked to an underlying
illness or injury, and these conditions
should be evaluated by a doctor (see
tips on the right). One such headache
is the sinus headache. Caused by
inflammed sinuses, sinus headaches
usually occur after a cold or an upper
respiratory viral infection. “You get a
constant, throbbing pain in the face, a
pressure and ‘full’ sensation in the cheek
or forehead, or an achy feeling in the
upper teeth coupled with a congested
nose,” says Dr Ong.
“Whatever your headache, there are
quick, effective ways to ease the pain,
or consult your doctor.”
Is it a sign of something
serious if you wake up with
dizziness and a throbbing
pain in your head? Almost
everyone would have experienced
headaches at some point in their life,
but most headaches are not triggered
by threatening conditions, says Dr
Jonathan Ong, an associate consultant
with the Division of Neurology, NUH.
“These are known as primary headache
disorders,” he explains. “Common
primary headaches include tension-
type headaches and migraine. Other
less common primary headaches
include cluster headaches.” Here,
we list types of headaches you
should know.
TENSION HEADACHEPeople who suffer from this
often experience a squeezing
or pressure sensation on
the head. The headache
can last from a few hours to
several days. Occasionally, it
may become more persistent
and last for months. “Despite
WELLBEING WELLBEING16 17
LIFELINELIFELINE
We tend to ignore aches and pains in
our feet, often thinking they will go
away – but sometimes, they are signs
that our feet are in need of attention. By
putting the following tips to practice,
you can give your feet the care they
deserve, says Kate Carter, senior
podiatrist at the NUH.
Always wear shoes that fit well. Foot problems
are usually caused by
years of wearing ill-
fitting footwear. Women
in particular are prone to this. Studies
show that nine out of 10 women wear
shoes that are too small. To get the
right fit: shop for shoes later in the day,
as your feet tend to swell during the
day. To know if shoes fit well around the
heel, a heel counter should fit snugly
around the back of the heel to stop
it from slipping out. A
firm heel counter
increases the
stability of
the foot by
securing it
in the shoe.
To check
if your
toes have
enough wriggle space, there should
be a thumb’s width between the tip of
your longest toe and the end of
the shoe.
Keep moving. Leading
an active lifestyle helps
keep feet healthy, as it
tones muscles, strengthens
arches and stimulates blood circulation.
Limit wearing slip-ons and flip-flops. Backless, slip-on
footwear should be worn
in moderation as they force
your toes to claw as you walk, which
can strain foot muscles. Wearing a shoe
with a strap or lace in front of the ankle
holds the foot securely and
prevents it from sliding
forward. Many people,
especially older folk,
wear slippers if their
feet are hurting,
but this can
make matters
worse as slippers
encourage you to
shuffle rather than allow the joints to
work as they should. Also, slippers don’t
provide much support for the feet and
may even lead to slips and falls.
Exercise your calves. Calf
stretches keep feet supple,
so they can maintain a
good range of movement.
To stretch your calf:
1. Stand facing a wall with your feet
hip-width apart.
2. Take one step forward, and using
your arms to support against the
wall, keep the front leg bent
and the back leg straight.
Both feet should be flat on
the ground.
3. Lean in towards the
wall. As you do, you
should feel a stretch
along your calf and heel.
COMMON FOOT PROBLEMS
HEEL PAIN is often caused by repetitive stress at the heel. Here’s what to do:
l Wear shoes with good heel cushioning and
arch supportl Avoid walking or
exercising on hard ground. Rest often, don’t walk or run too fast
l Wear low heels
BUNIONS are a deformity of the big toe, where the big toe excessively angles towards the second toe, leading to a bony lump on the side of the foot. Your podiatrist may recommend:
l A custom-made insert for the shoe
l Padding under the forefootl Exercises
TIPS FOR LITTLE FEET
Children’s feet grow about two sizes per year in the first four years and one size per year thereafter, until growth is complete. However, a child’s feet may not grow for a period of time and then grow several sizes within a short period. Check their feet regularly – pressure marks on the toe joints, below the ankle bone and at the back of the heel may indicate they are wearing ill-fitting shoes.
10 easy ways to keep them in top shape
HEALTHY, HAPPY FEET
4. Hold the position before slowly
returning to a standing position.
5. Do this five times daily with each leg.
Moisturise. If you have dry
skin, applying moisturiser
before bedtime keeps the
skin on your feet supple
and more resistant to scratches
or abrasions.
Don’t neglect your nails. Trim toenails regularly
with proper nail clippers.
Cut them straight across,
and make sure they’re not too short or
trimmed down at the corners, as this
can lead to in-grown toenails.
Treat foot-related wounds with care. Minor cuts or
abrasions on your feet
should be covered with a
clean, dry dressing, while blisters should
be left to dry out on their own. If blisters
burst, apply a clean, dry dressing – do
not burst them yourself. If there is
redness or swelling around your wound,
seek treatment immediately. This is
important if you have diabetes.
Maintain clean feet. You
can’t go wrong with
good hygiene. Wash your
feet every day in warm,
soapy water and dry them thoroughly,
especially between the toes. But don’t
soak your toes – this may strip the skin
of its natural oils.
When in doubt, see a podiatrist. A podiatrist
helps ensure your
feet are functioning
properly. They can also treat foot
pain, infections and other issues
such as skin, nail, and soft tissue
problems. They’ll even advise you on
footwear, so it’s a good idea to take
your walking shoes with you when
you visit your podiatrist.
1#
2#
4#
6#
7#
5#
10#
9#
8#
Change up your heels. If you must
wear heels every
day, keep heel
heights to 4cm or
less and vary your
heel heights – wear
low heels one day
and slightly higher
heels the next. But if
you’re experiencing
foot pain, avoid heels
until you have fully
recovered.
3#
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IN THE KNOW 19IN THE KNOW18
LIFELINELIFELINE
Livingwith
irritablebowel
syndromeDespite the discomfort, the condition can be managed with the right treatment and lifestyle changes
WHAT CAN I DO?Presently, there is no permanent cure for IBS. But there are ways to relieve the symptoms and improve quality of life.
l Take probiotics. Several studies suggest probiotics
f you’ve been experiencing
chronic abdominal pain
or cramps, bloating or
constipation, you may be
suffering from Irritable Bowel
Syndrome (IBS).
A common disorder that affects
the large intestine (colon), IBS affects
one in 10 Singaporeans, says Dr Kewin
Siah, Associate Consultant, Division of
Gastroenterology & Hepatology at
the NUH.
“Unlike in the West, where this
disease is more common among
women, in Asia, IBS affects both
men and women. It also has a higher
occurrence rate in those below 50
years old,” says Dr Siah, adding that
the reasons why IBS affects these
demographics are yet unknown. The
findings are based on epidemiological
studies from different Asian countries,
where the patterns, causes and effects
of IBS are studied.
The good news is that IBS is
not a life-threatening condition and
usually does not worsen over time.
Among its common signs is abnormal
bowel symptoms such as diarrhoea.
“Sometimes, patients may experience
alternating bouts of constipation and
diarrhoea. The discomfort will usually
ease after passing stool or gas," Dr Siah
explains. Patients may also experience
bowel urgency after meals.
WHAT ARE THE TRIGGERS?l The intestine walls are lined with
layers of muscle that contract as they
move food from your stomach through
your intestinal tract to the rectum. With
IBS, the contractions may be stronger
and last longer than normal, causing
gas, bloating and diarrhoea.
l About 10 per cent of patients
contract the disease due to serious
gastroenteritis, a severe diarrhoea
caused by bowel infection. “When
it occurs, an overreacting immune
system may cause injury to the nerves
responsible for gut motility and
sensation, resulting in irregular bowel
movements,” says Dr Siah.
l Changes in the normal gut flora or
bacteria that help maintain a healthy
digestive system.
l Increased intestinal permeability or
leaky gut can lead to IBS “as the
damaged protective lining of the
I
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digestive tract means toxins can enter
the body and compromise bowel
function,” Dr Siah explains.
l Poorly coordinated signals between
the brain and the intestines can make
your body overreact to the changes
that normally occur in the digestive
process. This overreaction can cause
pain, diarrhoea or constipation.
WHAT TO AVOIDSome herbal slimming and detox tea
contain a laxative known as senna,
which some patients drink to help
clear their bowels and reduce bloating.
But frequent purging can lead to
dehydration and electrolyte depletion,
which can harm the kidneys and heart.
If you experience any other signs or
symptoms such as rectal bleeding,
abdominal pain that worsens or occurs
at night and unexplained weight loss,
this may indicate other conditions
such as colon cancer or inflammatory
bowel disease.
With the appropriate treatment and
lifestyle changes, IBS can be alleviated.
But when in doubt, it’s important to
consult your doctor.
may ease bloating and flatulence in IBS while reducing intestinal inflammation.
l Use laxatives for constipation relief, but consult your doctor as regular use may damage the colon’s nerve endings or result in sluggish bowels due to over-reliance on laxatives.
l Take antispasmodics recommended by your doctor to control colon muscle spasms and stop
abdominal pain.
l Consult your doctor about using low doses of antidepressants as these may help relieve IBS symptoms, including abdominal pain.
l Cut back on foods such as apples, broccoli and tofu as they are high in FODMAPs – substances that are poorly absorbed by the small intestine, which can worsen IBS symptoms.
l Limit gas-producing foods like beans, onions, carrots
and prunes. Avoid dairy products, cereals, chilli and curry, which may upset a sensitive gut.
l Learn to relax. Stress can throw your body off balance and trigger IBS. Listen to music or meditate. A good night’s sleep is also important in ensuring a healthy body.
l Get more exercise. Studies show that exercise helps diffuse stress and promotes wellbeing, including healthy bowel function.
10 MINUTES WITH...20
dolescence can be a
confusing and challenging
life stage, with some
teenagers needing more
guidance than their loved ones can
offer. That’s where senior psychologist
Terri Chen can help.
What drew you to psychology?As a child, I thought being a mind
reader would be pretty cool. When
I tell people what I do now, some
think I can read minds. Since that’s
not possible, psychology is the next
closest thing. We learn what motivates
people and why they respond the
way they do. It’s fascinating that you
can tell 10 people one thing and get
10 different responses. I observe how
people respond by picking up on verbal
and non-verbal signs.
What does a psychologist do?I teach my patients skills that help them
become the person they want to be.
They will already have ‘tools’ to cope
with problems – and it’s important to
acknowledge that – but these may
not always be the most helpful. So
I offer them new ‘tools’ to deal with
behavioural and emotional issues more
positively. Therapy is not about turning
them into obedient model children.
You work with adults too. Are the problems and interventions
different for teens and adults?Depression and anxiety are
common among both. However,
for adolescents, the causes are
usually problems with peers,
difficulty keeping up with
schoolwork and conflict with
parents. They may also face
problems forming their own
identity as well as navigating
transitional phases, like
deciding on career paths
and their life purpose,
all of which make them
more vulnerable. In adults, stress often
stems from family issues, relationship
problems and work.
Most adults come to my clinic
by choice and are therefore more
receptive. But many adolescent
patients come because their parents
insist. I have to put in greater effort to
build rapport and engage them. But
after a couple of sessions when they
start seeing the benefits, they’re more
willing to open up.
How different is being an adolescent psychologist now than, say, 10 years ago?The key difference is in managing the
impact of social media. Teenagers
now have easy access to things like
Facebook and Instagram and feel
constant pressure to participate. When
we’re trying to instil a greater sense
of self-worth and something negative
happens on social media, it causes
the house of cards to collapse quickly.
It’s not as easy as telling them to stay
away from social media.
What keeps you going?When my patients return to school,
stop hurting themselves or begin to
gain confidence – it’s a great sense
of achievement.
Interested in a career in healthcare?
Visit nuh.com.sg to find out more.
A
I offer my patients new ‘tools’ to deal with
behavioural and emotional issues more positively”
SENIOR PSYCHOLOGIST
TERRI CHEN
