Maybe Baby? - Raffles Medical Group

Transcription

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

Maybe Baby? - Raffles Medical Group

Transcription

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