CGH's Sleep Lab team monitors your sleep GOOD NIGHT, SLEEP ... · offered, email [email protected] 2 CARING ISSUE 3 2019 ISSUE 3 2019 CARING 3 HEALTH NOTES Hearing loss can affect

A HEALTHIER, HAPPIER LIFE

ISSUE 3 2019

中文由 23页起

BONE STRENGTHVERTEBRAL FRACTURES AND YOUR MOBILITY

GET MOVINGWHY EXERCISE IS MEDICINE FOR SENIORS

GOOD NIGHT, SLEEP TIGHT

CGH's Sleep Lab team monitors your sleep patterns to help you get much-needed shut-eye

ISSUE 3 2019 CARING 1

CONTENTS

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In the world of social media, everyone appears to live a perfect life. But the reality is far from that. Perfectionism is often an illusion we pursue but find hard to attain, and we get stressed when we can’t get it ‘right’. Read why not being a perfectionist is actually a good thing on page 5.

Meanwhile, many Singaporeans are also losing sleep over lack of quality shut-eye. When was the last time you woke up fresh and full of energy, ready to conquer the day? Meet the professionals who can help you track and understand your sleep patterns, and get tips for a good night’s rest on page 8.

Did you know that besides sleep, exercise is the next best energy booster? But while exercise is important, as we get older, our bones are more fragile. Learn how to prevent osteoporosis and vertebral fractures, and maintain your quality of life on page 12. And with exercise, remember that you are never too old to start! Find out how easy it is to fit in a daily workout on page 15.

In each issue of CARING, we work hard to ensure all articles are engaging and practical, like our regular GPFirst column. However, our content must evolve and the time has come to say goodbye to My GP Answers (page 19). However, you can still receive updates on GPFirst activities via its Facebook. Finally, thank you for participating in our survey — your feedback matters, so do keep them coming.

Till the next issue, happy reading!

Sarah Abdul KarimEditor

Supervising Editor Vivian Song

Editor Sarah Abdul Karim

Contributors Health Wellness Programme Team Robing Ng Sarah Abdul Karim Dr Fadzil Hamzah Dr Juliana Bahadin Dr Linsey Utami Gani Dr Shravan Verma Dr Teo Zhen Ling

Translators Yip Laimei Alan Li

Photographer Be Still Picture

Design & Production NewBase Content

Media Specialist: Seryn Wee Email: [email protected]

Materials: Doreen Lau Email: [email protected]

MCI (P) 087/01/2019. Company registration number: 198904226R. All rights reserved. Copyright © 2019. No part of this publication can be reproduced in any form or by any means without the permission of the publisher. The views and opinions expressed or implied in are those of the authors or contributors and do not necessarily reflect those of the publisher.

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Caring is published bi-monthly for Changi General Hospital by NewBase Content. It is also available online at www.cgh.com.sg/CARING

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02 HEARING WELL, AGEING WELL Hearing loss and your cognitive health

05 IN PURSUIT OF PERFECTION How to overcome the need for perfectionism

08 SLEEP TIGHT Get deep, restful slumber

12 THE TRUTH ABOUT OSTEOPOROSIS AND VERTEBRAL FRACTURES Signs and symptoms and how to prevent it

15 EXERCISE IS MEDICINE Regular workouts go a long way

17 ALL ABOUT VISION LOSS Types of visual impairment and the importance of screening

19 YOUR GPs CAN TREAT THESE CONDITIONS On adult hand, foot and mouth disease and travel vaccinations

22 HEALTHY EATS Au gratin prawns with orange cheese sauce

23 吃出健康鲜橙乳酪酱脆皮虾

24 听力好，乐龄更快乐听力受损与认知能力

27 追求完美如何克服对完美主义的渴望

30 酣然入梦助您进入梦乡的小贴士

34 如何预防骨质疏松与椎骨骨折及早发现警示与症状

37 消失的视力视力受损的种类与视力检查的重要性

39 您的家庭医生能治疗这些病症！有关成人手足口症与旅行疫苗接种的提问

EDITOR’S NOTE

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CARING goes digital! Scan the code to read the latest issue

ABOUT THE OTOLOGY, BALANCE AND HEARING IMPLANT SERVICE The service started in January this year to provide timely, effective screening and treatment of hearing problems for seniors by bringing these screening tests closer to the community. The community hearing clinic, a collaboration with the Ministry of Health and SingHealth’s Regional Health System, was set up and is located beside the polyclinic at Heartbeat@Bedok.

Taking a multi-disciplinary approach, the service integrates otologists with CGH’s Department of Otorhinolaryngology — Head and Neck Surgery with audiologists, speech therapists, physiotherapists and medical social workers, to better manage diseases of the ear, as well as hearing and balance issues more comprehensively.

To find out more about the services offered, email [email protected]

ISSUE 3 2019 CARING 32 CARING ISSUE 3 2019

HEALTH NOTES

Hearing loss can affect your cognitive health, from memory to judgment and learning ability, so it’s important not to take it for granted

HEARING WELL, AGEING WELL

As we age, our senses grow weaker, including our hearing. However, understanding what causes

hearing loss and knowing what to do can help you prevent your hearing from deteriorating further.

This was the message behind “Hear Well, Age Well”, the first community outreach event by members of CGH’s new Otology, Balance and Hearing Implant Service. Held on 2 June, the event saw Associate Professor Yuen Heng Wai, Dr David Low and audiologists from the Department of Otorhinolaryngology – Head and Neck Surgery, at Heartbeat@Bedok ActiveSG Sport Centre educating participating residents on hearing-related issues.

More than 90 participants had the opportunity to learn more about hearing loss from the team, who spoke on topics ranging from the structure and function of the ear, tinnitus, the association between hearing loss and memory loss as well as misconceptions about hearing health.

“Our hope is that participants will realise that hearing loss is more than a personal health issue,” said A/Prof Yuen. “It can have a far-reaching impact on the family and society. At the same time, hearing loss is potentially treatable; currently, there are many devices and modalities available for the treatment and even restoration of hearing loss.’’

Going by participants’ positive feedback on the event, the message seems to have hit home.

One attendee, 69-year-old Mr Henry Kwek, thought it was a good session as it provided useful information and a chance to clarify questions he had about hearing-related issues. Sharing the same sentiment

Recent studies have shown hearing

loss to be a significant and, arguably, the

single most important modifiable risk factor

in the prevention of cognitive

decline

4 CARING ISSUE 3 2019 ISSUE 3 2019 CARING 5

HEALTH NOTES

was Mr Ganesan Maniam, 57, who has suffered from hearing loss since his younger days. He said, “If I had attended such talks earlier and had a cochlear implant, my life will be much different now!” He never knew such options existed till more recently.

For Dr Low, his main aim was to emphasise that hearing loss has more implications than just being an impediment to communication. He added that recent studies have shown it to be a significant and, arguably, the single most important modifiable risk factor in the prevention of cognitive decline.

So, if you think you may be experiencing hearing loss, don’t suffer in silence — consult a specialist.

Audiologist Joyce Lim offers this observation: “Our sense of hearing is often overworked, underappreciated and taken for granted until it is too late. Hearing loss, unlike blindness, is not obvious to others. This outreach will improve public awareness of the normal physiology of hearing and the devices available to address the degree of hearing loss.”

This health promotion talk is the first collaboration between the Otology, Balance and Hearing Implant Service and the People’s Association at the new Kampong

DID YOU KNOW? Myth: There are no other options for hearing loss besides hearing aids.Fact: For hearing loss that is not responding to hearing aids, options such as cochlear implants and bone conduction now exist.

Myth: Delaying managing hearing loss does not have an impact on one’s life.Fact: Early identification and proper management of hearing loss can prevent cognitive decline and are crucial to one’s mental and social well-being, as well as personal safety.

Myth: I need to clean my ears regularly to get rid of dirt within.Fact: The ear has a self-cleaning mechanism where skin migrates outwards, carrying wax and debris with it. Cleaning with cotton buds risks damaging the thin, delicate skin lining the ear canal and disrupting the self-cleaning mechanism, resulting in ear wax accumulation and infection.

Robing Ng is Manager, Corporate Affairs, at CGH

Chai Chee Community Centre. Participants can look forward to future collaborations currently in the pipeline.

MENTAL WELLNESS

“Congratulations on seeing through such a successful event, John!”

“Oh I don’t know, Kathy. I worked so hard on this that I had sleepless nights for two weeks leading up to the event. Yet, I still don’t think it was good enough.”

“Wow, don’t be so hard on yourself! All the attendees I spoke to seemed to think it was very well-organised. They even expressed interest in our future events!”

“Yes, that’s what others have told me. The feedback has been quite positive, but it bugs me that it could still have been better. I guess I need to work harder next time.”

Why striving for the best can sometimes backfire

Do you know people similar to John — people who frequently feel they are not good enough, no matter how well they do? John is an example of someone who is a perfectionist — one who has high standards and expectations and settles for nothing less than flawlessness. They are commonly critical of themselves and their efforts, and regardless of what they do, they tend to believe they fall short of the standards they set themselves.

Such individuals are often obsessed with achieving what they perceive to be the ideal standard — to the point of losing perspective

IN PURSUIT OF PERFECTION


MENTAL WELLNESS

6 CARING ISSUE 3 2019

of the broader picture. Perfectionism can, therefore, ironically prevent

us from being our best.Some people see

perfectionism as a positive trait — perfectionists tend to have a strong work ethic and appear to be continuously

improving themselves. But such individuals also set standards

so high that they are either impossible to reach or are attained

at great personal cost. Perfectionists commonly suffer from sleep deprivation, have no time for recreational activities and experience high levels of stress.

They also tend to have strained relationships with loved ones, as they often demand that those around them meet their excessively high standards, and can become critical of those who fail to meet them.

The high standards that perfectionists hold themselves to are personally

demanding and unreasonable that it is unsurprising that many of them tend to develop mental health conditions such as depression, anxiety, chronic stress, burnout and suicidality.

Prolonged and heightened levels of stress can also affect physical health in various ways. It increases the risk of hypertension, suppresses thyroid function, decreases bone density and lowers immunity, causing the individual to be more prone to ill health.

Four ways to reduce perfectionism If you identify as a perfectionist, here are some ways to overcome your need for flawlessness.

1 Strive to achieve, but keep your standards and expectations reasonable. It is one thing to strive for excellence, but

quite another to hold yourself to standards that are too difficult to achieve. Tailor your expectations according to what is

reasonably attainable given your skills and the resources available to you.

2 Keep the bigger picture in mind. Remember your ultimate objective and ask yourself if obsessing over every

detail is truly helping you achieve this. In addition to work goals, what other goals do you have in areas such as relationships, personal growth, hobbies/skills, spiritual growth, physical health? Are you neglecting these other aspects in your life? Will what you do now matter in the long term?

3 Allow yourself to make mistakes. Making mistakes is not a sign of weakness and the consequences are

usually never as bad as you think. Mistakes are also necessary in helping us as we learn and grow. It is, after all, through knowing what works and what doesn’t that we get better at what we do. To overcome your fear of making a mistake, tell yourself that even if things don’t turn out the way you expect, you are a better and stronger person for it as you have learnt new lessons.

4 Be kind to yourself. Know that your self-worth doesn’t lie in being able to meet impossibly high standards. Speak

to yourself in the way that you would to the person you love most in this world. You’ll be surprised by how self-love and self-kindness can help you achieve what you truly want — you’ll be just as productive and also more balanced and satisfied as a person.

Having high standards can be a positive thing, as long as those standards are reasonable. And even if you fall short, it doesn’t mean you are weak or a failure. Instead, it is by making room for improvement that we give ourselves opportunities to grow — it is in the process of getting to that end goal that we become better and stronger individuals. There is still perfection in being less than perfect.

Perfectionists commonly suffer

from sleep deprivation, have no time for

recreational activities and experience high

levels of stress

HEALTHY VS UNHEALTHY PURSUIT OF HIGH STANDARDS

By the CGH Health Wellness Programme

Perfectionists

Believe that achieving anything short of the standards they have set for themselves is unacceptable.

Believe that they should never make mistakes because if they did, it would make them a failure.

Chronically stressed, anxious, depressed and dissatisfied with themselves because they are either unable to meet their own expectations or have to put in a lot of effort to do so.

Spend an excessive amount of time trying to “perfect” every detail of a task, such that they become less effective and efficient.

Sacrifice other important aspects of life, like their health and relationships, as they dedicate too much time and energy to attain their high standards.

Those who pursue excellence in a healthy way

Believe that it is normal to fall short of the standards they have set for themselves.

Believe that mistakes are inevitable and that they help them grow.

Able to work hard while remaining positive and having a positive relationship with themselves.

Spend a reasonable amount of time on each task such that more work can be accomplished.

Live a more balanced life, as they give equal attention to their work, relationships, health and other areas.

VS


COVER STORY


The phrase “falling asleep like a baby” seems to be something that rarely happens among Singaporeans. Sleep problems are fairly common

— 13.7 per cent of older adults suffer from at least one sleep disorder, and the top two sleep problems reported are sleep interruptions and difficulties in falling asleep.

Let’s look at the ABCs of having a good night’s rest.

Age: Many people think they must get eight hours of sleep each night. However, there is no fixed amount that applies to everyone, as different people will need different amounts of sleep at different stages of their lives. Others think that as they age and find themselves sleeping a lot less and waking up more frequently at night, something must be wrong. But sleep quality and patterns change as we age — our total sleep time may decrease slightly. Some changes you can expect as you get older are: Lighter sleep, brief awakenings, sleeping earlier or waking up earlier.

Body clock: Parents of newborns know all too well the difficulties dealing with

SLEEP TIGHTGetting a good night’s rest is important, but few of us get this. Here’s what you need to know to get quality shut-eye

their child’s erratic sleep patterns. From the moment we are born, our body clock changes at various stages of our life, depending on the different stresses and challenges we face. No one else knows your body like you do, so listen to it and give it the adequate rest it needs.

Consistency: The childhood practice of going to bed and waking up at the same time is important. Failing to do so may give rise to several sleep problems. That being said, you can allow for the occasional deviation in your sleep schedule, especially if you don’t feel tired at your regular bedtime. If you are too fixated on sleeping at a certain hour, it can create stress and make it harder for you to fall asleep. On such occasions, go to bed only when you are tired.

Disruptions: There are days when you feel you did not get a good rest the night before, and thus compensate for that by waking up much later or taking a longer nap in the afternoon. But this can be counter-effective and disruptive to your sleep schedule. Try to wake up at the same time even if you hadn’t slept well, and take


COVER STORY

If you are too fixated on sleeping at a certain hour, it

can create stress and make it harder for you to fall asleep

a short nap in the day if you really need it. Naps should be less than 20 minutes long; studies have shown that anything more than that will create sleep debt, which is the cumulative effect of not getting enough sleep. A large sleep debt can lead to mental and physical fatigue. A good tip to follow: Don’t nap in your bed, as this could tempt you to oversleep.

Effort: We’ve all thought this: “If I cannot fall asleep, I should try harder, or at least lie in bed and close my eyes so I can get some rest.” Or, “If I cannot fall asleep, I’ll just watch TV or use my phone until I feel sleepy.”

But these tactics often will not help. Most experts agree that if you do not fall asleep within 15 to 20 minutes, you should get out of bed, go into another room and try a relaxing activity like listening to music or reading. Most of all, avoid watching the clock!

So, what are the ingredients for a good sleep?

• Have a relaxed mind and body• Create a conducive environment that

induces sleep• Listen to your body and go to sleep

when it tells you to• Stick to a regular sleep schedule

Getting professional helpIf you find that you’re still not getting quality sleep despite practising good sleeping habits, and your performance in the day is affected by it, you could be suffering from a sleep disorder. To understand your condition, your doctor may refer you to a sleep doctor — and you might find yourself spending a night in the sleep lab with a sleep technologist.

At CGH, sleep technologists are part of the allied health team and are trained to perform polysomnography, or sleep studies, and other tests to diagnose and treat patients suffering from sleep disorders. They work rotating shifts

To diagnose Obstructive Sleep Apnoea (OSA), a sleep physician will arrange for a diagnostic sleep study to be performed. This is usually carried out overnight in the lab. Parameters such as EEG, ECG, body position, airflow, respiratory efforts and oxygen levels will be monitored throughout the night. The sleep technologist will then analyse the raw data, and the sleep physician will create a report that would help diagnose the patient’s condition.

One of the best treatments for OSA is CPAP therapy. Patients will be referred to the CPAP counselling clinic, where a sleep technologist will fill the patient in on the details of CPAP therapy and help him get fitted for the treatment mask. The patient will be loaned a CPAP machine for a trial period, and they can purchase one if they decide to continue with the therapy.

Risk factors for OSA: • Male • Overweight • Large neck circumference • Narrowed airway and/or chronic nasal

congestion • Hypertension • Smoking • Family history

Signs and Symptoms: • Loud, frequent snoring • Choking or gasping while asleep • Breathing pauses noted during sleep • Excessive daytime sleepiness • Morning headache • Awakening with dry or sore throat

OBSTRUCTIVE SLEEP APNOEA

Sarah Abdul Karim is Executive, Corporate Affairs, at CGH

as there are clinics and procedures conducted both during the day and at night. Sleep technologists also run the Continuous Positive Airway Pressure (CPAP) and Non-invasive Ventilation (NIV) counselling clinics.

We speak to sleep technologist Audrey Seow on what her work entails.

What skills do you need to become a sleep technologist?We accept new staff with a diploma or degree in science or nursing. All sleep technologists are required to be certified by the internationally recognised Board of Registered Polysomnographic Technologists (RPSGT) to be fully competent to work in the field of sleep medicine.

Which other departments do you work with?Most of our patients are referred to us by departments such as Ear, Nose and Throat (ENT), Respiratory Medicine, Psychological Medicine, Neurology, Cardiology and more. We work closely with sleep physicians and nurses in both the inpatient and outpatient setting.

What is the biggest misconception about your job?People seem to think that all we do is observe others when they sleep at night. But it is more than that. We are responsible for taking the patient’s readings and analysing the information before they are delivered to the sleep physician.

Why do you think there is an increasing prevalence of sleep disorders now?There is now a greater awareness of sleep disorders among people. More of us also have poor sleep hygiene and habits, bringing about conditions like sleep deprivation and insomnia, no thanks to factors such as our stressful work schedules and increasing use of digital technology.

Tell us more about CGH’s Sleep Lab.The Sleep Lab performs both day and night studies. The night studies we carry out include: Diagnostic sleep studies, positive airway pressure (PAP) studies and transcutaneous carbon dioxide (TcCO2) monitoring. Meanwhile, our day studies include: Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT), actigraphy, oximetry studies and home sleep studies. Patients are usually referred to us from polyclinics and GPs for sleep-related symptoms like loud snoring, apnoea episodes and/or excessive daytime sleepiness.


FEATURE

OSTEOPOROSIS AND VERTEBRAL

FRACTURES This silent disease affects our mobility and quality of life, but when detected early, can be treated more effectively

THE TRUTH ABOUT independently and is thinking of returning to work.

The story of Mdm T is common among patients with spine fractures and osteoporosis. The severe pain and loss of independence associated with back fractures are extremely debilitating and heartbreaking for those who have to care for them. Many such patients will also struggle with deformities in the back and a hunchback. But what exactly is osteoporosis and what does it have to do with our bones and fractures?

What is osteoporosis? Osteoporosis is a condition when bones become more porous and thinner. As a result, patients have a higher risk of sustaining fractures.

Seventy-one-year-old Madam T was independent and working part-time as a cleaner before a fall caused her

to fracture her back, which required her to undergo two surgeries. Because her bones were very fragile, she developed complications from the first surgery, which she underwent a year-and-a-half ago. She was in so much pain that she couldn’t lie down and had to use a wheelchair or scooter to get around. After much intensive treatment for osteoporosis and undergoing rehabilitation, she is today walking

JOIN US!In conjunction with the Singapore Spine Society, CGH will hold a road show on 5th October at CGH Auditorium to educate the public on the different types of spinal conditions and encourage them to get screened for osteoporosis early.

Look out for booth exhibitions from 9am to 10.30am, followed by talks by various speakers from 10.30am to noon. There will also be a live demonstration exercise by our physiotherapists, held at CGH Atrium from 12.20pm to 12.40pm.

To register for the road show, please email [email protected]


FEATURE FEATURE

EXERCISE IS MEDICINEWhy keeping active is more important than ever as we get older

to find activities you enjoy, while ensuring you build on the following:

1 Cardiovascular healthCardiovascular exercises are important in

the management of many chronic medical problems. Exercises include walking, stair climbing, swimming, hiking, cycling, rowing, tennis and dancing.

2 Balance Exercises like yoga and tai chi help you

maintain balance, stability and posture. They can also help reduce your risk of falling.

In 2017, Singapore topped the world as the country with the highest life expectancy at 84.8 years. Yet, we also have the

second-highest proportion of diabetics among developed nations, with one in nine Singaporeans suffering from the condition. Are we really living longer or just dying a slow death? And what can we do about this?

One of the best ways to ensure you remain in good health well into your twilight years is by exercising frequently. But starting or maintaining a regular exercise routine can be a challenge at any age — and it doesn’t get any easier as you get older.

The key is to go slow — if you are someone who simply hates to exercise — and before you know it, you’ll see changes in your health. Think about the daily activities you enjoy doing and how you can incorporate them into an exercise routine.

Some simple activities can include:• Lifting weights or brisk walking while

listening to music• Walking laps at the mall while window

shopping• Going on a nature hike so you can take

photographs

How to build a balanced exercise planMixing different types of physical activity can help keep your workouts interesting and improve your overall health. The key is


• Often a silent disease — in the early stages, there are no tell-tale symptoms that alert you to its presence

• Associated with other conditions such as – Deformity, loss of height and back pain – Mortality and morbidity

• Predicts future vertebral and non-vertebral fractures – Vertebral: 4.4 times. Vertebral fractures are the most common, making up 46 per cent of all osteoporotic fractures – Hip fractures: 2.3 times

KEY FACTS ON OSTEOPOROSIS

Is it life-threatening? No, but osteoporosis can affect patients’ quality of life. It can also cause major fractures in the hip and vertebrae. Such fractures often require surgery. Some patients may also develop complications from the surgery and healing of these major fractures.

How will I know if I have osteoporosis?Osteoporosis is a silent disease and, for most patients, the first time they learn about the condition is after they suffer a major fracture. It is therefore important that you speak to your primary care doctor about getting a bone mineral density scan to screen for osteoporosis. When detected early, this disease can be treated more effectively, reducing your risk of major fractures in the future.

What are some of the treatments for osteoporosis? How effective are they? There are different treatment options for osteoporosis, ranging from oral medication to yearly or twice-yearly injections. Adequate treatment of osteoporosis also includes good nutrition, exercise and fall prevention. Addressing the causes of falls and treating osteoporosis can reduce fracture risk by as much as 80 per cent in patients who have had a fracture.

Am I too old for osteoporosis treatment?As our life expectancy increases, preventing fractures helps us maintain our independence and active lifestyle and contributes to our quality of life.

There is no such thing as being too old for osteoporosis treatment. Discuss your options with your doctor today!

Dr Linsey Utami Gani is Consultant, Endocrinology Department, at CGH


FEATURE

3 Strength Strength training helps prevent loss

of bone mass, build muscle and improve balance. Exercises could include use of machines, free weights or elastic bands.

4 FlexibilityBeing flexible helps your body stay

limber and increases your range of movement for daily activities, such as tying your shoes, shampooing your hair and playing with your grandchildren. Flexibility exercises include stationary stretches and those that involve movement. These will keep your muscles and joints supple and less prone to injury.

So, the next time you visit your doctor, ask how he can prescribe exercise as medicine. Don’t spend your old age popping pills — instead, ride into your golden years in good health.

Common myths bustedHere are some of the most common myths when it comes to exercising when you’re older, as well as the real science that can help you age more gracefully.

MYTH 1: There’s no point to exercising. I’m going to get old anyway.FACT: Regular physical activity helps you look and feel younger and stay independent longer. It also lowers your risk for a variety of conditions, including Alzheimer’s and dementia, heart disease, diabetes, certain cancers, high blood pressure and obesity. You’re never too old to get moving!

MYTH 2: I am not aiming to be an athlete at this age.FACT: Changes in hormones, metabolism, bone density and muscle mass mean that strength and performance levels inevitably decline with age, but that doesn’t mean you can no longer derive a sense of achievement from meeting your fitness goals. The key is to set targets that are appropriate for your age.

MYTH 3: Exercise puts me at risk of falling down and I already suffer from chronic diseases anyway! FACT: Regular exercise actually reduces your risk of falling, by building your strength and stamina, preventing loss of bone mass and improving balance. Exercise also helps reduce the symptoms and impact of chronic medical diseases. In fact, there is evidence to show that physical activity complements medicine in managing chronic medical conditions and preventing their progression and complications.

MYTH 4: I can’t exercise because I’m disabled.FACT: Elderly folk who depend on personal mobility devices face special physical challenges, but can still lift light weights, stretch and do chair aerobics, chair yoga or chair tai chi to increase their range of motion, improve muscle tone and flexibility and promote cardiovascular health.

Dr Fadzil Hamzah is Senior Staff Registrar, Singapore Sport and Exercise Medicine, at CGH

DID YOU KNOW?Exercise is not only good for your body, but also benefits you mentally. It improves sleep, boosts your mood and self-confidence and keeps the brain fit.

HOW MUCH ACTIVITY DO I NEED? Moderate-intensity aerobic activityAnything that gets your heart beating faster counts

and

Muscle-strengthening activityDo activities that make your muscles work harder than usual

Tight on time this week? Start with just five minutes. It all adds up!

at least

150minutes a week

at least

2days

a week

FEATURE

Did you know that globally, 36 million people are blind and 217 million have moderate to severe visual

impairment? However, statistics have shown that 75 per cent of visual impairments are actually avoidable! Prevention is definitely better than cure, so let’s find out more about our vision and how we can care for it.

We start by defining “low vision”. Low vision is defined as a best corrected visual acuity (BCVA) worse than 6/12 in the better-seeing eye. Legal blindness is defined as BCVA worse than 6/60 in the better-seeing eye or ≤ 20 degrees (diameter) of visual field. A person with low vision has impaired visual function that cannot be remediated fully by spectacles, contact lenses or medical intervention.

Common conditions that cause vision lossUncorrected refractive errorA refractive error occurs when the shape of the eye does not bend light correctly to fall onto the retina (the light-sensitive tissue of the eye). It can be corrected by prescription spectacles, contact lenses or surgery.

CataractWe have a natural clear lens in each eye. When the lens becomes cloudy, blurred vision occurs.

Diabetic retinopathyIn diabetic retinopathy, diabetes damages the tiny blood vessels in our eyes. It is initially asymptomatic, but blurred vision can occur. Abnormal growth of new vessels can also bleed or cause tractional retinal detachment, leading to sudden, severe vision loss.

What you need to know about the different conditions that cause visual impairment

ALL ABOUT VISION LOSS

We are officially into the second half of 2019, and we hope your year has been a healthy and fulfilling one. In this issue of ECHO, we discuss a very important organ that is basic to our function — our eyes. The joy we receive from looking at blue skies and other wonders of nature can sometimes be dimmed when our vision becomes impaired. Dr Teo Zhen Ling is an ophthalmology resident who will be sharing with us some of the most common causes of visual impairment. We look forward to your participation in our next health screening. Until then, stay well! Dr Linsey Utami Gani, ECHO Programme Director

Normal vision With cataract

Normal vision With diabetic retinopathy


FEATURE

GlaucomaGlaucoma is a group of eye conditions that damage the optic nerve. It is known as the “silent thief of sight” as initial vision loss is peripheral and not readily noticeable. In untreated cases, central and reading vision are permanently affected.

Age related macular degenerationThe macula is the central point of the retina in our eye. In age-related macular degeneration, damage to the macula leads to progressive loss of central vision and distorted vision (eg. straight lines appear wavy). Small abnormal blood vessels can also grow under the macula. These blood vessels can leak, resulting in scarring and permanent central vision loss.

Retinal detachmentRetinal detachment is the separation of the retina from the outer layers of the eye. Symptoms include a sudden increase in floaters, light flashes and the appearance of a curtain covering the visual field.

Get screened for vision lossWho should get screened?✓ Those aged 40 and above should receive

a baseline eye screen (based on AAO recommendation)

✓ Those with a family history of glaucoma✓ Diabetic patients should have an annual

dilated eye screen✓ Those with any of the warning symptoms

below: • Red eye, blurring of vision and

headache or nausea

Dr Teo Zhen Ling is Medical Officer, Department of Ophthalmology, at CGH

The ECHO health screenings in Kampong Chai Chee, Fengshan, Changi Simei and Kaki Bukit will be held over the next few months! If you have family members, friends or relatives residing in these areas, please encourage them to register to get screened!

FeePioneer Generation $0 CHAS $2 Non-CHAS $5Permanent residents $10 (walk-in only)

Singapore citizens aged 40 and above with no known chronic diseases and who have not been screened within the last three years are eligible for these screenings. Registration via the ECHO website is no longer available. Please bring your NRIC, PG Card* or CHAS Card* and cash for payment to register at the community club or centre listed.*If applicable.

2019 ECHO HEALTH SCREENING

Venue Screening Registration Date Date

Kampong Chai Chee CC 7 Sep (Sat)

Fengshan @Blk 125 Bedok North Rd, 14 Sep (Sat) 1 AugCC Activity Centre

Changi Simei CC 26 Oct (Sat)

Kaki Bukit CC 9 Nov (Sat) 26 Aug

• Sudden vision loss • Sudden increase in floaters/flashes • A ‘curtain’ covering vision • Visual distortion; eg. straight lines

appear wavy • Scotoma; ie. loss of part of the visual field

When and where should I get my eyes screened?• Polyclinic or family practitioner• Community eye-screening clinics, health

screening events• Ophthalmology clinics

FOR MORE INFORMATION on health screenings, please contact ECHO at 67888833 or email [email protected].

Normal vision With AMD

Normal vision With retinal detachment

Normal vision With glaucoma

MY GP ANSWERS

Dr Shravan Verma is CEO and co-founder of Speedoc, a health-tech company that brings house-call doctors to patients. Entering medicine with a goal of bridging technology and healthcare, he has used his varied clinical experience to understand the perspectives of clinicians and patients to provide a platform that improves access to healthcare.

YOUR GPs CAN TREAT THESE CONDITIONS

The GPFirst Programme was launched in 2014 to encourage patients in eastern

Singapore to see their general practitioners (GPs) for mild to moderate medical conditions, rather than head straight to the emergency department. In this regular series, our eastern community GPs offer advice on common ailments Caring readers might face.

In this issue, we focus on hand, foot and mouth disease in adults and travel vaccinations. Do visit www.gpfirst.sg or see your GP for more information on other common conditions such as nausea, headaches, sprains, fevers, cuts and bruises and mild scalds.

I have two children aged 18 months and four years who are enrolled in the same childcare centre. Last week, both came down with fever and suffered flu symptoms before being diagnosed with hand, foot and mouth disease (HFMD) and I stayed home for days to care for them. This morning, I woke up with a slight pain in my throat and noticed a few ulcers on my tongue and blister-like rashes on my ankle and soles. Is it possible for an adult to be infected with HFMD? Should I keep my children away from me at this time and see a GP to assess my condition?

While HFMD is most common in young children, it is also known to affect older

children and adults. Children under five years old, like yours, are most susceptible to the disease as their immune systems are not yet fully developed. The disease is caused by enteroviruses, a group of viruses that cause a number of mild infectious illnesses. Polioviruses, coxsackieviruses and echoviruses are among the most common types of enteroviruses.

HFMD is highly infectious and is most commonly spread through direct contact with bodily fluids like mucus, saliva, faeces and blister fluids of infected people. If you are experiencing flu-like symptoms and noticing red rashes on your hands or feet that are flat or raised, it is likely that you may have contracted the disease.

You should see your GP and let him know when you began feeling unwell, when you first noticed symptoms and if the symptoms have since worsened. Your doctor will check for sores or blisters on your feet, hands and genitals. Sometimes, a lab test for related

ADULT HAND, FOOT AND MOUTH DISEASE


MY GP ANSWERS

CLINIC MART

Dr Juliana Bahadin is Adjunct Assistant Professor at the Duke-NUS Medical School and Adjunct Senior Lecturer at the Yong Loo Lin School of Medicine. She also practises at Saudara Clinic by A+J General Physicians. Prior to this, she was Clinic Director at SingHealth Polyclinic in Bedok, and later completed a fellowship at B.C. Women’s Hospital & Health Centre in Canada.

antibodies or viral materials in the blood may be needed to confirm the diagnosis. Throat swabs and stool samples may also be taken to determine the type of virus that’s causing the disease.

Other than symptomatic treatment, there is no cure or specific treatment for HFMD. Your GP can only prescribe over-the-counter medication to help relieve the pain, fever and other symptoms.

Complications are rare but can develop if HFMD is left untreated in certain individuals, leading to secondary infections that may affect the skin, brain and nervous system. Fortunately, most patients recover without complications, as the disease is mostly self-limiting. For those who are otherwise healthy, HFMD is not a life-threatening disease; even without treatment, it usually clears up within a week or two.

During this time, you should keep your children away from you, especially if they themselves are recovering from the infection, as it is possible for them to fall ill to the disease again. Do also remember to practise good hand hygiene and disinfect shared surfaces regularly.

My husband and I have decided to take a long break from work next year. We love outdoor activities and are planning to go white water rafting and trekking at Mount Kinabalu in Malaysia. What type of vaccinations should we get before we visit Kinabalu Park? Will my GP be able to provide these vaccinations and offer us travel advice?

Rafting and trekking are fun activities, but they can also be dangerous if you are not well-prepared. This includes improving your physical fitness, especially your cardiovascular health. As such, you should embark on a regular cardio training programme that includes activities like long-

TRAVEL VACCINATIONS

ABOUT GPFIRST

distance brisk walking, jogging or climbing before your trip.

If you plan to scale all the way to Mount Kinabalu’s peak, be sure to ascend the mountain gradually. Take time to rest at camp sites along the way to allow your body to acclimatise to the thin air at high altitudes. If you feel light-headed or breathless, it is a sign you are experiencing altitude sickness. Simple measures to fight altitude sickness include:

• Stopping and resting where you are — don’t ascend any higher for at least 24 to 48 hours

• Taking ibuprofen or paracetamol if you have a headache

• Staying hydrated — make sure you are drinking enough water

• Avoiding alcohol• Not smoking

It can also get quite chilly at high altitudes as temperatures drop significantly, especially in the evenings, so bring along sufficient warm clothing. If you do not have a thick winter jacket, simply put on several

layers of warm clothes as this helps to trap heat.

Do also check that your vaccinations are up to date before you leave for your trip. Travellers to Mount Kinabalu are usually recommended to get vaccinated against food- and water-borne diseases like typhoid and hepatitis A. Additionally, you should check that your last tetanus vaccination was taken less than five years ago. If not, you could choose to get tetanus toxoid vaccine or the combination tetanus diphtheria or Tdap vaccines. If you have any chronic disease like diabetes or asthma, it is preferable to also

This will be GPFirst’s final column in CARING. For more updates, follow us on Facebook!

When a fever or a bout of mild diarrhoea hits, where do you first head to? For many, it’s the Accident and Emergency Department (A&E). Started as a pilot in 2014, CGH partnered GP clinics in the east to launch GPFirst, a programme aimed to encourage patients to visit their GPs for conditions that do not require emergency care at the A&E.

get the influenza and pneumonia vaccines.If you plan to trek in forested areas, you

should also get the malaria prophylaxis vaccine. Otherwise, a good dose of mosquito repellent and covering your arms and legs can also protect you against mosquito bites. Make sure you bring along some plasters, antiseptic solution like iodine and alcohol swabs for any minor injuries that might occur along the way.

Your GP should be able to provide you all this information. He or she should also be able to advise you on any additional precautions to take, based on your medical condition. Have a great holiday!

> 200 GP clinics under the GPFirst network in eastern Singapore

10.5%reduction in non-emergency self-referrals at CGH’s A&E since the launch of GPFirst

$50subsidy to offset A&E attendance fee at CGH if patients first go to a GPFirst clinic and is subsequently referred to CGH’s A&E for treatment. The patient will also be given priority over non-urgent cases

CASHIER

20-45 Age group that makes up nearly half of visits to A&E because they view their conditions as critical, even though they can be treated by their GPs


吃出健康HEALTHY EATS

WHAT YOU’LL NEEDPrawns 200g Skewers or satay sticks 8Mozzarella cheese 55gChopped parsley

ORANGE CHEESE SAUCELow-fat cheddar cheese 2 slicesOranges 2, juiced, with 1 grated zest

NUTRITIONAL INFO (PER SERVING)Calories 147kcalCarbohydrate 7.2gFat 6.3gCholesterol 115.3mgFibre 1.6g

30min

PREPARATION TIME SERVES

METHOD• Preheat the oven to 170°C. • Using a sharp knife, slice prawns into

halves along their length. Thread prawns through skewers and set aside.

• To prepare the orange cheese sauce, combine cheddar cheese and orange juice in a pot over low-medium heat. Stir until cheese melts completely.

• Pour a generous amount of sauce over prawns, then sprinkle with mozzarella cheese and orange zest. Bake for 5 minutes or until prawns change colour and cheese is golden brown.

• Sprinkle with chopped parsley, garnish as desired and serve immediately.

This recipe was first

published in A Cookbook

for Diabetics by a Dietitian and a Chef, which is available at all major bookstores. 该食谱于《A

Cookbook for Diabetics by a Dietitian and a Chef》中首

次出版，现已在各大书局出售。

营养信息（每份）卡路里 147千卡碳水化合物 7.2公克脂肪 6.3公克胆固醇 115.3毫克纤维 1.6公克

所需材料虾 200克串肉扦或沙爹棒 8个马苏里拉（Mozzarella）乳酪 55克切碎的欧芹

鲜橙乳酪酱低脂切达（Cheddar）干酪两片鲜橙两粒，把汁挤出，其中1粒的刨皮屑

做法• 将烤箱预热至170°摄氏度（340°华氏度）。

• 用一把锋利的刀，沿着虾的长身将它切成两半。将虾穿过沙爹棒或扦子，放一旁备用。

• 在准备鲜橙乳酪酱时，将切达干酪和橙汁放在锅中，用中低温加热。不断搅拌，直至乳酪完全融化。

• 在虾上淋上大量的乳酪酱，然后撒上马苏里拉乳酪和橙皮。烤5分钟或直至虾变色，乳酪呈金黄色。

• 撒上切碎的欧芹，随意装饰，立即食用。

鲜橙乳酪酱脆皮虾

金黄多汁且带一丝鲜橙味，这道菜是每一餐的必备佳肴！

30分钟

准备时间可供

Succulent and golden brown with a hint of orange tanginess, these prawns are a juicy addition to any meal

AU GRATIN PRAWNS WITH ORANGE CHEESE SAUCE


保健小笔记

失去听觉可影响您的记忆力、判断力与学习力等认知能力

随着社会的老龄化，人们的感官逐渐变弱，而听觉便是其中的“受害者”。

然而，通过了解听力受损的病因与预防措施将有助避免您的听力进一步恶化。

在樟宜综合医院新成立的耳科、平衡和听力植入服务部首次举办的“听力好，乐龄更快乐”（Hear Well，Age Well）社区外展活动中，部门专家成员便与参与者分享了这个重要信息。在这场6月2日举办的活动上，Yuen Heng Wai 助理教授，David Low 医生和耳鼻喉科头颈外科的听力师们在Heartbeat @ Bedok Ac-tiveSG 运动中心与参与的居民分享了许多与听力相关的知识。

出席的超过90名参与者借此机会向专家提问有关听力受损的问题，而专家也大方分享耳朵的结构与功能及耳鸣的相关问题，还讲述了关于听力受损与记忆丧失之间的关系，以及揭开许多有关听力受损的迷思。

Yuen助理教授说，“我们希望参与者了解到，听力受损不仅是个人健康的问题，也会对家庭和社会造成深远影响。与此同时，现在有许多设备和治疗法是可用于治疗听力受损的，有些甚至还能助患者恢复听力。”

乐龄更快乐听力好，

了解耳科、平衡和听力植入服务

该服务于2019年 1 月启动，主要旨在为年长者提供及时、有效的听力受损治疗，并将这些筛查测试带到更接近社区的地方。社区听力诊所是由卫生部与新加坡保健区域卫生系统合作启动的。该诊所位于Bedok Heartbeat 综合诊疗所旁。

该服务是一个多学科服务。它将樟宜综合医院耳鼻喉科（头颈外科）的耳科医生与听力师、语言治疗师、物理治疗师和医疗社工整合在一起，以更好地综合管理耳朵的相关疾病、以及听力和平衡等问题。

欲知更多有关的服务，请电邮至[email protected]。

近期的研究显示，在预防认知能力下降方面，听力受损是最重要的

可改变风险因素


保健小笔记

迷思：除助听器外，就没有其他有助于解决听力受损问题的选择事实：对助听器没有反应的听力受损患者现在可以选择人工耳蜗植入和骨传导等治疗方案。

迷思：延迟听力受损的管理不会对个人生活造成影响。事实：早期识别和妥善管理听力受损对预防认知能力下降、您的心理和社会健康以及人身安全至关重要。

迷思：我需要定期清理我的耳朵，以去除耳屎。事实：耳朵内有自动清理功能，而当皮肤向外移动时，就会将耳屎与残留物带走。使用棉花棒清理耳朵需承担破坏耳道内薄嫩皮肤的风险，以及影响其自动清理的功能，从而导致耳屎的累积及感染。

从参与者的反馈中可看出，活动在一定程度上达到了其目的。

参与活动的69岁Henry Kwek先生便认为，活动中的内容很有意思，不但为他提供了有用的信息，还让他有机会澄清与听力有关的问题。 57岁的Ganesan Ma-niam先生也有同感。他在年轻时就患有听力受损。他坦言：“ 如果我能早些参加类似这样的活动并且植入人工耳蜗，我现在的生活肯定会大不相同！”他最近才知道原来他拥有这项选择。

对Low医生而言，他的主要目的是让参与者知道听力受损的影响不仅是阻碍沟通而已。他补充说，近期的研究显示，在预防认知能力下降方面，听力受损是最重要的可改变风险因素。

因此，如果您认为自己可能拥有听力受损的问题，请不要保持沉默，尽早寻求专家的帮助。

听力师Joyce则分享道：“听觉是五个感官中最常过度劳累、最容易被忽略并且经常被视为理所当然的功能，而当人们要正视它时却为时已晚。与失明不同的是，听力受损对其他人而言并不明显。这项外展活动将提高公众对正常听力物理的认识，并且对可应对不同程度的听力受损的各种设备有了更深的了解。”

这个健康促进活动在新的Kampong Chai Chee民众俱乐举行。这也是耳科、

不说你不知

平衡和听力植入服务部与人民协会之间的首次合作。参与者可以期待这两家机构在未来有更多的合作。

Robing Ng是樟宜综合医院企业事务部门经理。

保健小笔记

恭喜你把活动办的这么成功，约翰！”

“哦，我不知道，凯西。为了这次的活动，我付出了很多心血，以致我在活动前的两个星期里每晚失眠。即便如此，我仍然认为我做得不够好。”

“哇，你不要太为难自己！与我交谈过的与会者都认为活动办得非常好。他们甚至已对我们未来的活动表达了兴趣！”

“是的，其他人也是这么对我说的。反馈的确是相当正面，但我觉得我还可以做得更好。我想下次还需更加努力。”

您认识与约翰相似的人吗？他们经常觉得自己“不够好”。然而，无论他们付出了多少，他们似乎还是觉得“不够好”。约翰是一个完美主义者（一个具有高标准和期望的人）。他们一般会对自己很苛刻，并且不论付出多少努力，都认为自己达不到所设定的标准。

完美主义者经常痴迷于一个“完美”的标准，以致无法顾全大局。讽刺的是，完美主义因此“阻止” 了人们展现其最佳状态。

虽然有些人会认为这是一种积极的特质

追求完美为何有时把事情做到最好可能得不偿失

“

保健小笔记


健康与不健康地追求高标准（例如，良好的职业道德、持续的自我提升），但完美主义者倾向于把标准设定得太高，以致无法达到它们或须付出巨大代价。完美主义者一般都会有睡眠不足、损失休闲时间及承受高压力的问题。

他们与亲人的关系也会变得紧张，因为完美主义者经常要求周围的人达到他们过高的标准。他们也会批评不符合这些标准的人。他们所追求的高标准对个人的要求也是非常苛刻和不合理的。因此，完美主义者一般都会产生心理健康的问题，如抑郁、焦虑、慢性压力，倦怠以及拥有自杀倾向，而这并不令人感到惊讶。

长时间高度的压力也会以各种方式影响身体健康。它会增加高血压的风险、抑制甲状腺功能、降低骨质密度，甚至降低免疫力，从而使人更容易生病。

完美主义者

相信达不到为自己设定的标准是不可接受的。

相信自己永远不该犯错，因为如果犯了错就意味着他们是失败的。

长期紧张、焦虑、沮丧，对自己不满意，因为无法达到自己的期望，或在过程中付出很多努力。

花费大量时间试图 “ 完善”任务的每个细节，使其变得不那么有效和高效。

牺牲生命中的其他重要方面（例如，人际关系），以便投入更多时间和精力达到高标准。

非完美主义者

相信不是每次都能达到自己所设定的标准是正常的。

相信错误是不可避免的。这并不意味着他们完全失败了。

能够在努力工作的同时保持积极的态度，并与自己建立积极的关系。

在每项任务上花费合理的时间，以便完成更多的工作。

过更平衡的生活，认为工作与生活的其他方面一样重要（例如，人际关系、健康等）。

对垒

四种减少完美主义的方法如果您是一名完美主义者，以下方法可

助您克服您对完美的需求。

1 努力追求，但把目标与期望设在合理范围追求卓越是件好事，但设定超高标准

以致无法达到却是另一回事。考量您的技能及所被给予的资源，为您的标准进行适当调整。

2 牢记大局记住您的最终目标，并问自己过度追求每个细节的完美是否真的有助

实现这一目标。除了工作目标，是否还有其他的人生目标（如人际关系、个人发展、爱好/技能、精神生活、健康状况）？您是否忽略了生活的某些方面？从长远来看，您现在所做的事情是否重要？

3 让自己犯错犯错并非软弱的表现，且后果也非您想象中的糟糕。错误是帮助学习

和成长的必要条件。毕竟知道什么能做，什么不能做，才能让自己进步。克服对犯错的恐惧，告诉自己，就算最后事情不如预期，您将从中学习并且成为更坚强的人。

4 善待自己不需要达到不可能的高标准来证明自己的价值。与自己对话的方式应

该和与挚爱说活的方式一样。您会惊讶地发现自爱和自我友善可助您得到您真正想要的东西 – 在达到相近的生产力的同时、却可以拥有更平衡的生活和更高的生活质量。

其实，对工作和个人目标设定高标准是一件好事，但也应退一步告诉自己，实现的少一些并不意味着完全失败。一切总有改进的空间，而实际上，达到最终目标的过程将使其进一步成长。其实不完美中，也存在着完美。

完美主义者一般都会有睡眠不足、损失休闲时间及承受高压力的问题

内容由樟宜综合医院健康与保健计划所提供


封面故事


能安稳地睡觉至关重要，但有多少人能够睡个好觉？要好眠，就跟着这么做！

在新加坡，要像婴儿般入睡似乎并不容易。我们的睡眠问题到底多普遍？据知，新加坡有13.7％

的成年人有至少一种睡眠问题，而最常见的两种睡眠问题是夜间睡眠中断和难以入睡。您是否也无法入睡？现在就与您分享能让您夜夜好眠的小贴士。

年龄：很多人认为自己每晚都须睡8小时。其实，所需的睡眠因人而异，因为不同人在不同的人生阶段都需要不同长短的睡眠时间。随着年龄的增长，有些人可能会感觉，自己睡的少了，晚上醒来的次数也多了，一定是出了问题。睡眠质量和规律将随着年龄的增长而改变，而总睡眠时间可能会略微减少。一些预期的变化包括较浅的睡眠、短暂的觉醒，早睡或早醒等。

生理时钟：所有的父母都知道应对新生

儿不稳定的睡眠规律有多艰难。从出生的那刻起，人的生理时钟便会随着不同的人生阶段所面对的不同压力和挑战而有所改变。没有人会比您更了解您的身体，所以请倾听您的身体且给予足够的休息时间。

连贯性：童年时期养成在固定时间睡觉和起床的习惯至关重要，而无法这么做将产生睡眠问题。然而，虽然每天同一时间睡觉和起床是个好习惯，但偶尔也可有例外，尤其是还没有疲累感的时候。如果您过于执着于一定要准时睡觉，反而会增加压力，使您更难入睡。这种情况发生时，请在您感觉累的时候才上床睡觉。

中断：有些时候，您可能睡不好，因此在隔天选择较晚起床或睡午觉来弥补夜里失去的睡眠。但即使您夜里没睡好，您也应尽量在同一时间起床。若白天真的很困，您可小睡一下。小睡应不超过20

酣然入梦


封面故事

睡眠医生会要求对患者进行诊断性睡眠检查，为阻塞性睡眠呼吸暂停综合征进行诊断。患者一般会被安排进行过夜睡眠测试，并且监测其EEG、ECG、身体位置、气流、呼吸运作和氧气水平等参数。睡眠技术专家会分析原始睡眠数据，并由睡眠医生整合出一份报告。

阻塞性睡眠呼吸暂停综合征的黄金标准治疗之一是CPAP治疗法。患者将被转诊至CPAP辅导诊所，由睡眠技术专家为其讲解CPAP治疗，并进行面罩试戴。患者将在试用期内借用CPAP机器，如果决定继续接受治疗便可购买新仪器。

阻塞性睡眠呼吸暂停综合征的风险因素： • 男性 • 超重 • 颈部周扩大 • 狭窄的气道和/或慢性鼻塞 • 高血压 • 抽烟 • 家族病史

警示与症状： • 经常大声打鼾 • 睡觉时窒息或喘气 • 睡觉时注意到呼吸暂停 • 白天过度嗜睡 • 早晨头痛 • 醒来时喉咙干燥或疼痛

阻塞性睡眠呼吸暂停综合征

分钟，因为研究显示，如果超过20分钟，它将加重您的深睡眠负债。给您一个小贴士：不要在平时的床上睡觉，就能抵抗睡过头的诱惑。

努力：“如果我无法入睡，我应该更加努力，或至少应躺在床上闭上眼，才能休息。如果我无法入睡，我可以看电视或使用手机直至感到困倦。”这些其实都不能助您入睡。多数专家认为，如果您在15至20分钟内没法入睡，您便应该起床到另一个房间进行一些轻松的活动，如听音乐或阅读。最重要的是，避免看时钟！

所以，促进一夜好眠的成分究竟有哪些？

• 拥有放松的身心• 营造能让您入眠且利于睡眠的环境• 跟随自己的生理时钟睡觉• 良好的睡眠习惯

获取专业协助在尝试了所有方法后，您仍睡不好以

至影响您的日常生活，您可能已患上睡眠障碍。现在有很多方法可评估您的情况，不妨让医生将您转诊至睡眠医生。您可能需在睡眠实验室与睡眠技术专家共度一个夜晚。

在樟宜综合医院，睡眠技术专家是综合医疗保健团队的一员，并接受过多导睡眠监测（睡眠研究）和其他测试的专业培训，为睡眠障碍患者进行诊断和治疗。由于日夜都需看诊和运作程序，他们会轮班工作。睡眠技术专家还负责管理CPAP和非侵入性通气（NIV）辅导诊所。

本刊就向睡眠技术专家 A u d r e y Seow了解她的工作性质。

如何才能成为一名睡眠技术专家？睡眠技术专家须具备科学或护理文

凭/学位。所有的睡眠技术专家都必须获得多导睡眠技术专家（RPSGT）委员会的国际认可，证明他/她完全有能力在睡眠医学领域工作。

睡眠技术专家会与哪些部门合作？我们的多数患者是由耳鼻喉科、呼吸

内科、心理医学科、神经科和心肺科等

如果您过于执着于一定要准时睡觉，反而会增加压力，使您

更难入睡

Sarah Abdul Karim是樟宜综合医院企业事务部门的执行员。

部门转诊。无论是住院或门诊，我们都会与睡眠医生和护士密切合作为病人提供治疗。

对睡眠技术专家的最大误解是什么？

人们似乎认为，我们是一个在晚上工作且观察他们睡觉的人。其实，我们的责任更大，因为我们须负责记录病人的数据和分析信息，并且将其转交给睡眠医生。

为何现代人更容易患上睡眠障碍？

公众对睡眠障碍的意识有所提高，同时也有更多人拥有较差的睡眠卫生，以致睡眠不足和失眠。这都是因工作压力太大以及数码科技产品的使用所导致。

可以与我们分享更多有关睡眠实验室的信息吗？

樟宜综合医院睡眠实验室会进行日间和夜间测试。夜间测试包括诊断性睡眠测试、气道正压通气（PAP）测试、经皮二氧化碳（ T C c O 2 ）监测等。日间测试则包括多次睡眠潜伏期测试（MSLT）和维持不眠测试（MWT）、活动记录检查、血氧测定、居家睡眠测试等。睡眠技术专家还管理CPAP辅导和非侵入性通气（NIV）辅导诊所。患者一般从综合诊所或家庭医生转诊至樟宜综合医院睡眠诊所，以评估与睡眠相关的症状，如吵闹的打鼾声、呼吸暂停发作和/或白天过度嗜睡等。


特写

这个“隐形”疾病会影响您的行动与生活质量，但及早发现可提高治疗的有效性

如何预防骨质疏松与

椎骨骨折

一次跌倒意外，让曾经能够行动独立的71岁兼职清洁工T女士不幸背部骨

折，须接受两次手术。由于她的骨头非常脆弱，她在1年半前的第一次手术后出现并发症以致她倍感疼痛，并且无法躺下，只能使用轮椅和踏板车代步。在接受密集的骨质疏松症和复健治疗后，她现在可以独立行走，并且考虑重返工作岗位。

对于椎骨（脊柱）骨折和骨质疏松症患者来说，T女士的经历一点也不陌生。与背部骨折相关的剧烈疼痛和丧失独立性使必须照顾他们的人感到身心疲惫。许多患者也会面对背部畸形和驼背的痛苦。但究竟什么是骨质疏松症？它又与骨骼和骨折有什么关系？

什么是骨质疏松症？骨质疏松症是指骨骼变得既多孔又薄，因而提高骨折的风险。

它会危及生命吗？骨质疏松症可导致严重骨折，如髋部骨折和椎骨骨折。不幸的是，治疗这些严重骨

欢迎参与！(Join Us!)于2019年10月5日（周六），樟宜综合医院与新加坡脊柱学会将在医院礼堂举办路演，并向公众传达不同脊柱疾病的信息，同时鼓励大家及早接受骨质疏松症的检查。

从上午9点至10点半，您可观赏展览，随后在上午10点半至中午12点听听专家的讲解。我们的物理治疗师也会在下午12点20分至12点40分，在医院门厅进行现场运动演示。

有意报名者，请电邮至[email protected]。


特写

• 它是一个“隐形”疾病 - 般在早期都不作声地潜伏在体内

• 与以下疾病有关 - 畸形、身高变矮、背痛 - 死亡率和发病率

• 预测未来的椎骨和非椎骨骨折 - 脊椎：4.4倍。最常见的骨折

（占所有骨质疏松性骨折的 46％） - 髋部骨折：2.3倍

骨质疏松症知多少

折的方案一般需患者接受手术。有些严重骨折的患者还可能在手术后需长期住院和在愈合过程中出现并发症。

我怎么知道自己是否患有骨质疏松症？骨质疏松症是一种“隐形”的疾病，对多数患者来说，他们往往都是在严重骨折后才会发现自己患有骨质疏松症。因此，与您的医生讨论是否需接受骨质密度扫描是非常重要的。及早发现骨质疏松症可提高治疗的有效性，降低未来发生严重骨折的风险。

骨质疏松症的治疗法有哪些？它们有效吗？治疗骨质疏松症的方法很多，其中包括口服药物及每年或每半年接受药物注射。充分的治疗也涵盖良好的营养、运动和预防跌倒等。找出跌倒的导因及治疗骨质疏松症可使患者降低80％的骨折风险。

年纪太大是否不适合接受骨质疏松症治疗？随着国人的预期寿命越来越长，通过预防

骨折来维持其独立性和活跃生活可提高自己的生活质量。年纪并不会影响骨质疏松症的治疗。今天就与您的医生讨论治疗方案吧！

Linsey Utami Gani医生是樟宜综合医院内分泌部门的顾问医生

特写

您对视力受损有多了解？

消失的视力您知道吗？在全球人口中，有3600

万人已失明，而有2.17亿人患有中度至重度视觉障碍。然而，统计数据显示，75％的视觉障碍却是可避免的！预防肯定胜于治疗！现在就一起深入了解您的视力以及如何预防失去它。

到底“弱视”是什么？弱视被定义为视力较好的眼睛所可取得的最佳矫正视力（BCVA）为低于6/12。法定失明则被定义为在视力较好的眼睛所取得的BCVA低于6/60或视野低于或等于20度（直径）。弱视患者的视觉功能因受损，无法通过眼镜，隐形眼镜或医疗干预获得矫正。

视力受损的常见导因有哪些？未矫正的折射误差当眼睛的形状没有正确地将光线折射至

视网膜（眼睛的光敏细胞组织）上时，就会出现折射误差。它可以通过处方眼镜、隐形眼镜或手术获得矫正。

白内障人的眼睛中

都拥有天然清晰的晶状体。当晶状体变浑浊（白内障）时，便会出现视力模糊。

糖尿病视网膜病变

在糖尿病视网膜病变中，糖尿病会损害眼睛中的微小血管。虽然它最初不会呈现症状，但有时也可能会出现视力模糊。新血管的异常生长会导致出血或引起牵引性视网膜脱落，以致严重的突发性视力受损。

我们已正式步入2019年的下半年，我们希望您在过去的半年里过的健康、充实。这一期的《ECHO》中，我们将探讨一个非常重要的器官 – “灵魂之窗”眼睛。我们从看见蓝天、绿草和大自然所带来的快乐可能会因视力受损而被剥夺。 Teo Zhen Ling医生是一名眼科住院医师，她将与我们分享常见的视力受损导因。我们期待您能参与我们下一次的健康检查，要保持身体健康哦！

ECHO计划董事Linsey Utami Gani医生

正常视力患有白内障的视力

正常视力患有糖尿病视网膜病变的视力


特写

Teo Zhen Ling医生是樟宜综合医院眼科部门的医生。

青光眼青光眼是一

组视神经受损的疾病。它被称为 “ 视力的小偷 ” ，因为最初的损害会出现在不易被注意到的外围视力。在未经治疗的病例中，中心和阅读视力会受到永久性影响。

年龄相关的黄斑病变

在视网膜上，黄斑就代表视力的中心。在与年龄相关的黄斑病变中，黄斑受损会导致中心视力逐渐丧失和视力扭曲（如直线显得波浪状）。微小的异常血管也会在黄斑下生长。这些血管可能会外泄，导致疤痕和永久性中心视力受损。

视网膜脱落视网膜脱落

是视网膜与眼睛外层的分离所致。症状包括突发性飞蚊症和闪光以及有一部分的视觉区域被遮盖。

检查是否已视力受损谁该接受检查？✓年龄 ≥ 4 0 岁应接受基线眼图检查

（AAO推荐）✓ 有青光眼家族史的人✓ 糖尿病患者应每年进行一次扩张式眼

科检查✓ 拥有以下警示症状的人： • 红眼、视力模糊、头痛/恶心 • 突发视力下降 • 突发性飞蚊症/闪光 • 视觉被“幕布”遮盖 • 视觉失真，如直线显得波浪起伏 • 正常视觉范围内出现盲点或盲区

（Scotoma）

过去三年未接受检查且无慢性疾病的新加坡公民与永久居民可报名接受健康检查。ECHO网站现已不接受报名。请携带您的身份证、PG卡*或CHAS卡*以及用于付款的现金，前往上述民众俱乐部/联络所报名。

*如适用

2019 ECHO健康检查

Kampong Chai Chee、Fengshan、Changi Simei 和 Kaki Bukit的ECHO健康检查正在进行中！如果您有居住在这些地区的家人、朋友或亲戚，请鼓励他们注册接受ECHO健康检查！

健康检查费用建国一代免费CHAS $2非CHAS $5永久居民 $10（只限当场报名）

检查地点健康检查注册开始日期第一天 (2019)

Kampong Chai Chee 民众俱乐部 2019年9月7日（星期六） Fengshan @ Blk 125 Bedok North Rd, 民众俱乐部活动中心 2019年9月14日 8月1日（星期六）

Changi Simei 民众俱乐部 2019年10月26日（星期六）

Kaki Bukit 民众俱乐部 2019年11月9日（星期六） 8月26日

正常视力患有年龄相关的黄斑病变的视力

正常视力患有视网膜脱落的视力

正常视力患有青光眼的视力

我该在何时何地接受眼睛检查？• 综合诊疗所/家庭诊疗所• 社区眼科检查诊所/健康检查活动• 眼科诊所

家庭医生解答

您的家庭医生能治疗这些病症！

成人手足口症我有两个孩子，年龄分别是18个月和4

岁，而且上同一所托儿中心。上周，我两个孩子都出现发烧及流感症状，最后被诊断患有手足口症。那几天，我都在家里照顾他们。今早，我醒来时发现喉咙轻微疼痛，舌头也有些溃疡，脚踝和足底也有水疱般的皮疹。成年人是否也会感染上手足口症？我是否应该与孩子保持距离，并且去看医生确认我的病情？

虽然手足口症在幼儿当中非常常见，但据知，它也可能影响年龄较大的孩童与成人。手足口症由一组肠道病毒引起，其中包括脊髓灰质炎病毒、柯萨奇病毒和埃可病毒等。

手足口症具有很强的传染性，最常见的传染方式是通过直接接触体液，如感染者的粘液、唾液、粪便和水疱液。如果您已

出现类似流感的症状，并发现身上有扁平或凸起的红色皮疹，您很可能已患有手足口症。

您应该去看家庭医生，并向其告知您是什么时候开始感觉不适、什么时候发现症状，以及症状是否已恶化。医生会查看您的足部、手部和生殖器是否长疮或水疱。在某些情况下，您可能需进行血液中相关抗体或病毒材料的实验室测试来确定诊断。医生也可能收集咽喉拭子和粪便样本，以确定引起疾病的病毒种类。

遗憾的是，除了针对症状进行治疗外，手足口症无法治愈，也没有特定的治疗

东部医疗联盟于 2 0 1 4 年 1 月份推出了“家庭医生首选”计划，为的是

要鼓励居住在新加坡东部的病人在碰到轻微或中度的医疗状况时首先向家庭医生求助。在这个专栏里，东部医疗联盟的社区家庭医生将帮助《关怀》的读者解答一些常见的疾病问题。

浏览www.gpfirst.sg或咨询您的家庭医生更多有关常见的医疗状况，如割伤、撞伤、轻微烧伤、呕吐、流鼻血、伤风、蚊虫咬、头痛、扭伤及发烧。以下是读者发来有关成人手足口症和履行疫苗接种的询问。

塞里范医生是一家保健科技公司 S p e e d o c 的首席执行官兼联合创始人。公司主要进行配对，让医生能到病人家中治疗。他抱着结合技术和医疗保健为目标进入医学领域，并善用其丰富的临床经验，了解临床医生和患者的观点，为医疗保健的整体改善提供平台。

家庭医生解答


法。家庭医生只能为您开些非处方药，以助您缓解疼痛、发烧和其他症状。

并发症很罕见，但某些没有接受治疗的患者可能会出现皮肤、大脑和神经系统的继发性感染。所幸的是，它主要是个自限性疾病，因此多数人会在没有并发症的情况下康复。对于健康良好的人来说，手足口症并不会对生命构成威胁，而且在一两周内不经治疗就能痊愈。

在此期间，您应远离您的孩子，尤其是如果他们正在康复阶段，以免他们再次被传染。请记得保持良好的手部卫生习惯以及定期为共用表面进行消毒。

旅行疫苗接种我的丈夫和我决定明年放个长假。我们

喜爱户外活动，因此计划到马来西亚的京那巴鲁山进行白水漂流和徒步旅行。我们

朱莉雅娜峇哈玎医生是杜克医学院客座助理教授及新加坡国立大学林永禄医学院客座高级讲师。她目前在Saudar-aClinic by A+J Gen-eral Physicians 的诊所从医，并且曾担任新保综合诊疗所（勿洛）的诊所总监，以及在加拿大哥伦比亚妇女医院完成其妇女保健初级护理研究课程。

想知道在出发到京那巴鲁公园前，应该接种哪些旅行疫苗？我的家庭医生能否为我们提供这类疫苗和旅行建议？

漂流和徒步旅行都是有趣的活动，但若没有做好充分准备，也可能变成危险的活动。事先的准备包括增强您的体能，特别是您的心血管健康。因此，在出发前，请开展一个有规律的有氧运动训练计划，例如长途快走、慢跑或攀爬等。

若您打算登上京那巴鲁山的顶峰，请保持一个平缓的登山速度。您应在沿路上的营地休息，以便身体适应在高海拔的稀薄空气。若您感到轻微头晕或气喘，您可能有高原反应。缓解高原反应的简单措施包括：

• 在您所在的地方停下休息 - 在至少24至48小时内不要再往上爬

• 如果您头疼，可服用布洛芬或扑热息痛

CLINIC MART

“家庭医生首选”须知

这将是《家庭医生首选》于《关怀》杂志中的最后一期文章。欲知更多详情，请关注我们的Facebook网页。

当出现发烧或轻微腹泻时，您会到哪里求医？对许多新加坡人来说，他们会到距离最近的医院急诊部门。为了减轻医院的负担，樟宜综合医院与东部的家庭诊所合作，在2014年推出了一项名为“家庭医生首选”的计划，以教育和鼓励患有轻微病痛（也就是需非紧急护理）的公众先到家庭诊所求医。

> 200 位于东部 “ 家庭医生首选 ” 网络中的家庭诊所数量

10.5%自计划推出以来，樟宜综合医院急诊部门的非紧急自我转介病例的减少幅度

$50病人先到 “ 家庭医生首选 ” 诊所看病，再被转介至樟宜综合医院所需支付的急诊费减幅。病人还能比非紧急的病人优先看病。

CASHIER

20-45 以为病况严重到急诊部门求医却可由家庭医生治疗的人中，近半数来自上述年龄层

• 身体要有充足水分 - 确保您补充足够的水

• 避免摄取酒精• 不要吸烟

高海拔地区的温度也会降至非常低，尤其是到了夜晚时分。您需准备足够的保暖衣物。若您没有厚的棉袄，穿多几层衣服可有助达到与单个厚棉袄略同的效果。

在您出发前，您也需查看是否已接种了最新的疫苗。对于多数前往京那巴鲁山的游客来说，通常推荐的疫苗是针对食物和水传播疾病（如伤寒和A型肝炎）的疫苗。除此之外，您也需确保您最后一次接种的破伤风疫苗还未超过5年。如果已超

过5年，您可以接种破伤风类毒素疫苗或破伤风白喉综合疫苗或Tdap（也就是破伤风、白喉和百日咳）疫苗。如果您患有心脏病、糖尿病或哮喘等慢性疾病，您也应接种流感和肺炎疫苗。

若您有意到森林地区徒步旅行，您也可根据您的行程所需，考虑接种预防疟疾的疫苗。否则，使用适量的驱蚊剂和遮盖衣物可保护您免受蚊虫叮咬。除此之外，请务必带上创可贴以及碘和酒精棉签等消毒液，以防途中可能发生轻微伤害。

您可以从家庭医生身上获得以上信息。他还可以根据您的健康状况为您提供额外建议。祝您假期愉快！

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The GPFirst Programme is an initiativeby Changi General Hospital’s Accident & EmergencyDepartment in partnership with over 200participating GP clinics in eastern Singapore.

Patients with mild and moderate symptoms areencouraged to visit their GPs first to seek treatmentat the GP clinics instead of going to the A&E.

Should the patient be referred byhis or her GP via GPFirst:

Accorded higher priority over othernon-emergency cases

$50 programme subsidy* for their A&Eattendance fee

Your GPcan treat it!

Mild to ModerateMedical Conditions?

For more information, visit www.GPFirst.sg

*Terms and Conditions apply

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