dec 2013 - cgh.com.sg · dec 2013 \\ issue 127 a changi general hospital magazine cover story...

$: Dec 2013 - cgh.com.sg · Dec 2013 \\ Issue 127 A Changi General Hospital Magazine COVER STORY ELDERLY DEPRESSION What Are The Warning Signs? PAGE 9 Life Saver Therapeutic Hypothermia$
Nov−Dec 2013 \\ Issue 127

A Changi General Hospital Magazine

COVER STORY

ELDERLY DEPRESSION What Are The Warning Signs? PAGE 9

LifeSaver

Therapeutic Hypothermia for

Heart PatientsPAGE 4

KEEPING BONES HEALTHY ‘Dr Bones’ tells us all!PAGE 14

EDITOR’S NOTEn the blink of an eye, we’re fast approaching the end of 2013. As we reminisce the highs and lows of this year,

the team at CARING would like to extend a warm “Thank you!” for your tremendous support as we grew

and thrived this past year.

As we celebrate the festive season this December, may we ask you to spare a thought for those who might

not have anyone to spend it with. Elderly depression is a real issue, and one which we’ve decided to highlight in

this month’s Mental Health series (page 9). Last year, researchers at the National

University of Singapore conducted a study and found out that approximately one

QV�Å^M�MTLMZTa�XMZ[WV[�QV�;QVOIXWZM�IOML��IVL�IJW^M�LQ[XTIa�[QOV[�WN �LMXZM[[QWV��

Since the holidays are a time for sharing, we hope you would not hesitate to reach

out to those who could do with a little bit of company at this time of year!

��UIZSML�I�[QOVQÅKIV\�UQTM[\WVM�NWZ�\PM�+PIVOQ�;XWZ\[�5MLQKQVM�+MV\ZM��

which turned 10. CARING gives you the lowdown on its 10th anniversary festivities

IVL�PW_�Q\�PI[�JMMV�KPIUXQWVQVO�\PM�ÅMTL�WN �[XWZ\[�UMLQKQVM�QV�;QVOIXWZM�W^MZ�\PM�

past decade (page 12). We’re also pleased to introduce a special guest to you in this

issue. Meet ‘Dr Bones’, who makes no bones in explaining the importance of bone health in preventing

and managing osteoporosis (page 14).

Last but not least, lest you be worried about the holidays throwing a wrench in your healthy eating plans, our

team of dietitians at CGH has prepared recipes for two popular festive treats – all without compromising on your

diet or weight-watching goals (page 22).

What has this year meant to you? Is there something you’d like to achieve in 2014? Tell us about it at

[email protected]. The best letters will be published in the next issue of CARING.

Until then, Season’s Greetings and Happy Holidays!

Supervising EditorLim Ee Guan

EditorTang Pin-Ji

ContributorsCeline Lim Candice Neo

TranslatorYip Lai Mei

PhotographersFoo Chee Chang Joel Lim

Publishing Consultant Publicitas Publishing([email protected])

EDITORIAL GO GREEN!This publication was printed on paper produced by an environmentally-friendly mill and pulp obtained from sustainable forests.

Share your copy of with others or recycle it. CARING is also available online at www.cgh.com.sg/CARING

TELL US!We want to hear from you. Drop us an email at [email protected]

Issue 127November/December 2013

is a bi-monthly magazine published by Changi General Hospital

MICA (P) 146/01/2013. Company registration number: 198904226R. All rights reserved. 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 PG�UIF�BVUIPST�PS�DPOUSJCVUPST�BOE�EP�OPU�OFDFTTBSJMZ�SFÚFDU�UIPTF�of the publisher.

SUBSCRIBE TO CARING! To subscribe, go to www.cgh.com.sg/CARING or email [email protected]

‘Dr Bones’ explains the importance of bone health in preventing and managing osteoporosis

I

SUPERVISING EDITOR, Lim Ee Guan EDITOR, Tang Pin-Ji

Special Report: BONE HEALTH

PAGE 14

CONTENTSNOVEMBER/DECEMBER 2013

低温治疗30心脏停博后施制冷法保存病人脑部功能

保健小笔记28 骨骼健康34如何应付骨质疏松症的专家建议

吃出健康40如何烹煮无罪恶感的盛宴！

22

04 ISSUE 127

CARING NOVEMBER//DECEMBER 2013

14

YOUR SAY24SUBSCRIBE TO CARING25ASK AN EXPERT27

Tackling your questions on diabetes

22 HEALTHY EATSRecipes for waistline-friendly festival treats

HEALTH NOTES02

CSMC TURNS 10!12Pioneering sports medicine in Singapore

STAYING COOL TO PRESERVE LIFE04

Therapeutic Hypothermia for Heart Patients

THE HEALTHY BONES GUIDE14

Expert tips from ‘Dr Bones’ to keep your bones in tip top condition!

DOC NOSE BEST!20

All about allergic rhinitis and its available treatment options

ELDERLY DEPRESSION IN SINGAPORE09

The warning signs and what you can do about them

GET BETTER SLEEP TO AVOID ALZHEIMER’S A new study from the Johns Hopkins Bloomberg School of Public

Health has found that getting less sleep and having a lower quality

of sleep were associated with higher levels of beta-amyloid peptite

compound, which is a hallmark of Alzheimer's disease. Participants in

\PM�[\]La�ZMXWZ\ML�[TMMX�\PI\�ZIVOML�NZWU�TM[[�\PIV�Å^M�PW]Z[�\W�UWZM�

than seven hours. Those who fell on the lower end of the scale were

found to have a greater buildup of beta-amyloid in their brains. These

ÅVLQVO[�IZM�VW\M_WZ\Pa�I[�LMUMV\QI�Q[�UW[\�KWUUWVTa�KI][ML�Ja�

Alzheimer’s disease, and approximately half of the elderly population

displays signs of insomnia.

QUIT SMOKING TO CUT HEART DISEASE RISK Women past their menopausal years can reduce their risk of cardiovascular disease simply by quitting smoking, says a new study by Juhua Luo, an epidemiologist at the Indiana University School of Public Health-*TWWUQVO\WV��0MZ�ÅVLQVO[��_PQKP�_MZM�published in the Journal of the American Medical Association, analysed data for 104,391 postmenopausal women between the IOM[�WN ��\W��!��,M[XQ\M�OIQVQVO�_MQOP\�IN\MZ�stubbing out, there was still a drop seen in the risk for heart disease among these women, regardless of their diabetes status. In other words, it’s never too late to quit smoking to MVRWa�UWZM�PMIT\P�JMVMÅ\[

EAT TOGETHER FOR A HEALTHIER BMI

$ININGÖTOGETHERÖCANÖINÚUENCEÖONElSÖWEIGHT�ÖSAYSÖAÖRECENTÖSTUDYÖBYÖ$RÖ"RIANÖ7ANSINKÖANDÖ$RÖ%LLENÖ

VANÖ+LEEF�ÖWHOÖEXAMINEDÖTHEÖRELATIONSHIPÖBETWEENÖTHEÖ"ODYÖ-ASSÖ)NDEXÖ�"-)ÖOFÖ��ÖPARENTSÖANDÖ��Ö

CHILDREN�ÖANDÖTHEIRÖDAILYÖDINNERÖRITUALS�Ö4HEÖSTUDYÖSHOWEDÖTHATÖPARENTSÖWITHÖHIGHERÖ"-)SÖTENDEDÖTOÖEATÖMOREÖFREQUENTLYÖWITHÖTHEÖTELEVISIONÖON�Ö&ORÖCHILDREN�ÖASÖWELLÖASÖPARENTS�ÖEATINGÖATÖTHEÖDININGÖTABLEÖWASÖLINKEDÖTOÖLOWERÖ"-)S�Ö4HEÖIMPORTANCEÖOFÖTHEÖSOCIALÖASPECTÖOFÖSHARINGÖAÖMEALÖASÖAÖFAMILYÖWASÖUNDERLINEDÖINÖTHESEÖRESULTS�ÖWHICHÖSUGGESTEDÖTHATÖTHESEÖINTERACTIONSÖMAYÖHAVEÖREPLACEDÖOVEREATINGÖWITHÖMOREÖPOSITIVEÖFEELINGS�

03


HEALTH NOTES

COUNTRY LIFE IS BENEFICIAL FOR THE IMMUNE SYSTEM The result of a new research from Aarhus University in Denmark suggests that heading to the countryside might do you good, especially if you suffer from allergies. The study found that the immune systems of farmers are often exposed to many types of bacteria, fungi, pollen and other irritants which may protect them against hypersensitivity. Surprisingly, this effect is observed not only in children, but adults too. This new knowledge takes researchers one step closer to finding a way to prevent allergies among a much broader range of age groups.

SEE NO EVIL TOWARDS ACHIEVING GOALS

If you’re working towards a goal, avoiding temptation that hinders your progress may

increase your chances of success more than relying on willpower does, claims a

new study on self-control. The study, which was conducted by researchers from the

Universities of Cambridge and Dusseldorf, recruited young male volunteers to pick

between an immediately available "small reward", and a delayed "large reward".

Subjects who had the opportunity to pre-commit themselves to avoid temptation before

it became available were found to be more TQSMTa�\W�LMTIa�QV[\IV\�OZI\QÅKI\QWV�NWZ�

the larger reward. This seemed to indicate that pre-commitment is a more effective self-control

strategy than willpower – something that could

LMÅVQ\MTa�JMVMÅ\�\PM�UWZM�impulsive ones among us!

Text by Celine Lim

Cardiac arrest patients stand a better chance of preventing brain damage if therapeutic hypothermia, where body temperatures are lowered by 3°C to 5°C, is carried out after the restoration of heartbeat.

STAYING

TO PRESERVE

LIFE COOL

iSto

ckp

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05

Of 15 patients who survived a cardiac arrest and received therapeutic hypothermia, 12 were discharged from hospital alive.

and Director of the Coronary Care Unit, explained that therapeutic hypothermia helps to slow down and lessen the harmful effects after cardiac arrest by “preserving whatever neurological and other bodily functions were not irreversibly damaged by cardiac arrest”. She added that partially-damaged neurological and bodily functions are also given the chance to recover during the treatment.

Prior to the introduction of therapeutic hypothermia, the chances of survival for cardiac arrest patients were dismal. And of the patients who survived cardiac arrest, the rate of those who made a full recovery was so slight as to be miraculous.

“With the addition of hypothermic therapy, we hope to improve the survival rate and neurological recovery of these cardiac arrest patients by another 15 to 20 per cent, based on

Who is not suitable for hypothermia treatment?

Not all cardiac arrest survivors can undergo therapeutic hypothermia.

Hypothermia is known to affect the blood-clotting process. If the patients’ medical history or blood tests show that they already have active bleeding, a high risk of bleeding or impaired clotting ability, they would be deemed unsuitable for therapeutic hypothermia as it would be too risky.

Therapeutic hypothermia would be meaningless for patients with a terminal illness which greatly limits their life expectancy. Similarly, if a patient was already in a very poor physical states prior to the cardiovascular collapse – a sudden loss of effective blood ÚPX �UIFSBQFVUJD�hypothermia would do nothing to change the patient’s quality of life.

Therapeutic hypothermia may be less useful for

Continued on next page

F�WZ�Å^M�N]TT�UQV]\M[��5Z�6O�

Kim Seong’s heart stopped beating when he suffered a

[]LLMV�KIZLQIK�IZZM[\�QV�5Ia��.WZ�Å^M�N]TT�minutes, the supply of oxygen to his brain was cut off.

Doctors at Changi General Hospital (CGH) managed to restart his heart by shocking it with an automated external LMÅJZQTTI\WZ��)-,��JMNWZM�KIZZaQVO�out an angioplasty-and-stent-insertion XZWKML]ZM�\W�ZM[\WZM�JTWWL�ÆW_��*]\�\PMa�_MZM�_WZZQML�\PI\�5Z�6O��_W]TL�suffer irreversible brain damage.

So, in what seemed like a scene out WN �I�[KQMVKM�ÅK\QWV�ÅTU��\PM�IQZKZIN\�engineering superintendent was injected with cooled saline solution to lower his JWLa�\MUXMZI\]ZM�Ja��+�\W��+�_PQTM�PM�_I[�QV�\PM�1V\MV[Q^M�+IZM�=VQ\��5Z�6O�LWM[�VW\�ZMUMUJMZ�IVa�WN �\PQ[�

*]\�PQ[�LI]OP\MZ��5Q[[�2M[[QM�6O��said, “The doctors explained that this was done to preserve my dad’s brain, like how we preserve our food by refrigerating it.”

IMPROVING RATES OF SURVIVAL AND RECOVERY This procedure, known as therapeutic hypothermia, is an addition to the existing post-cardiac arrest resuscitation management at CGH. It was introduced QV�2]Ta��\W�N]Z\PMZ�QUXZW^M�\PM�overall survival of such patients. Patients who qualify for hypothermic therapy (see info box) will receive it on top of the standard therapy.

Adj. Asst. Prof. Tong Khim Leng, Chief of the Department of Cardiology at CGH

the landmark trials,” said Dr Tong.The early outcome results at CGH

PI^M�JMMV�XZWUQ[QVO��;QVKM�2]Ta��of the 15 patients who survived a cardiac arrest and received therapeutic hypothermia, 12 were discharged from hospital alive – an 80 per cent survival rate.

This is a marked contrast to the typical two to three per cent survival rate of cardiac arrest patients who receive medical attention in time, but did not undergo therapeutic hypothermia, noted Dr Tong. Of the two to three per cent who survived without therapeutic hypothermia, only a fraction was able to return to their usual lives with full functions.

At CGH, 11 of the 12 patients who were discharged were able to iS

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COVER STORY // STAYING COOL TO PRESERVE LIFE

Hypothermia Treatment for Heart Patients

CPR is performed in most cases

DeathCooling blankets are wrapped around the patient’s torso and limbs

Cold saline is infused through the patients’ veins to initiate the hypothermic process

About 1400 patients have a cardiac arrest outside the hospital in Singapore each year

HOW IT WORKS

return to their daily lives and function at their original, pre-cardiac arrest levels. The remaining patient required long-term care and help with his daily activities.

The exact mechanism of how therapeutic hypothermia works is still unclear, said Dr Tong. One possible explanation is that therapeutic hypothermia suppresses free radical reactions, which are generated in response to the temporary deprivation of oxygen to the brain and other parts of the body. Another possible explanation is that therapeutic hypothermia reduces biochemical disturbances within the cells.

HOW THERAPEUTIC HYPOTHERMIA IS CARRIED OUT Whatever the exact mechanism of therapeutic hypothermia, studies have shown that it works. A 2002 collaborative TIVLUIZS�ZM[MIZKP�XIXMZ�NZWU�-]ZWXM�showed that therapeutic hypothermia [QOVQÅKIV\Ta�QUXZW^ML�\PM�ZMKW^MZa�WN �brain function and improved the survival rate of post-cardiac arrest patients who were successfully resuscitated. The treatment was formally recognised as part of post-cardiac arrest care by the American Heart Association Guidelines in 2002 after several multi-centre human trials were KWVL]K\ML�QV�-]ZWXM�IVL�)][\ZITQI�

Doctors and nurses at CGH follow I�_MTT�LMÅVML�XZW\WKWT�NWZ�\PM�XZWKM[[�WN �KWWTQVO�IVL�ZM_IZUQVO��*M\_MMV�2011 and 2012, a group of CGH LWK\WZ[�IVL�I�V]Z[M�NZWU�\PM�5MLQKIT�1V\MV[Q^M�+IZM�=VQ\��51+=��_WZSML�together to draw up this protocol. They included Dr Tong, Dr Ang Shiang Hu WN �\PM�-UMZOMVKa�,MXIZ\UMV\��;MVQWZ�

patients who tended to be drowsy due to a correctable cause, including medication, prolonged BOE�DPOUJOVPVT�ÙUT �and electrolytes disturbance, that led to cardiovascular collapse. These patients are likely to have already TVGGFSFE�TJHOJÙDBOU�neurological injury before cardiovascular collapse, so the CFOFÙUT�PG�UIFSBQFVUJD�hypothermia would be limited. P

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Cold prevents brain damage caused by restarting blood flow

The entire hypothermic treatment process takes at least 50 hours

Typically only 2ɍ3% of cardiac arrest victims who receive timely medical attention are discharged alive

Patients are generally very thankful to be able to return

to their families and jobs. They are literally given a 2nd chance in life after a

catastrophic event.


07

+WV[]T\IV\�,Z�;QI]�+P]QV�WN �51+=��Cardiology Registrar Dr Colin Yeo, and ;MVQWZ�6]Z[M�+TQVQKQIV�<IV�8WP�+PWW��

Patients whose hearts had stopped beating and were subsequently restored \W�[XWV\IVMW][�ZPa\PU�IZM�ÅZ[\�I[[M[[ML�for reversible causes and treated IKKWZLQVOTa��6M`\��\PMa�IZM�I[[M[[ML�for suitability and contraindications for therapeutic hypothermia, to ensure that the procedure would not be harmful to them. These patients are then usually sent to the Intensive Care Unit for further management.

Therapeutic hypothermia is carried W]\�MQ\PMZ�QV�\PM�-UMZOMVKa�=VQ\�WZ�\PM�1V\MV[Q^M�+IZM�=VQ\��)[�QV�5Z�6O¼[�KI[M��KWTL�[ITQVM�Q[�QVRMK\ML�QV\W�the patient’s veins to start the cooling process. A temperature probe is inserted through the patient’s nostril for accurate temperature monitoring. The concentration of the saline is carefully controlled to ensure that once achieved, \PM�\IZOM\�\MUXMZI\]ZM�WN ��+�\W��+�is maintained. An external cooling device

is also used to rapidly lower temperature and to maintain hypothermia.

A central venous line is inserted in the arm or chest and a nasogastric tube is inserted through the nose to the stomach to deliver medication and nutrition to the patient, who is in an induced coma

during the treatment. The re-warming process is a gentle and gradual one, where cooling blankets that are continually ÅTTML�_Q\P�_I\MZ�Ja�\PM�M`\MZVIT�cooling device are wrapped around the patient’s body. In total, the entire process of therapeutic hypothermia takes about 50 hours.


07

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COVER STORY // STAYING COOL TO PRESERVE LIFE

BACK AT WORK A MONTH AFTER CARDIAC ARREST 5Q[[�6O�[IQL�\PI\�PMZ�NI\PMZ�developed a high fever during his hypothermia treatment so doctors decided to stop the cooling after the first night. She added that the process was supposed to last for � �PW]Z[�J]\�Q\�MVLML�IN\MZ�UWZM�\PIV��PW]Z[��5Z�6O�_I[�QV�I�KWUI�NWZ�\PZMM�nights before waking up on the fourth day.

0M�[IQL��¹?PMV�1�ÅZ[\�_WSM�]X��1�wondered why I was there. When my wife asked if I knew how long I had slept, I said, ‘A short while’, but it was three and a half days.”

He was discharged about a week IN\MZ�PM�_I[�ÅZ[\�ILUQ\\ML�\W�+/0��

post-cardiac arrest patient will return to his pre-collapse

state with the use of therapeutic hypothermia, as that may not always be the case. She noted that

therapeutic hypothermia only serves to preserve as

much neurological and bodily function as possible and may not be

able to entirely reverse the damage. The patient’s outcome is still dependent on the underlying causes for the cardiac arrest.

)KKWZLQVO�\W�PMZ��IJW]\��people in Singapore have cardiac arrests outside a hospital setting each year, and are thus dependent on the public’s help to get medical attention – even before therapeutic hypothermia can

be carried out following successful ZM[\WZI\QWV�WN �JTWWL�ÆW_��

Going forward, Dr Tong said, “Large, systematic, randomised trials need to be conducted to determine the optimal speed and duration of hypothermia, from cardiac arrest to initiation of therapy or to the achieving of the target temperature. Trials are also needed to decide if certain subgroups of patients with cardiac arrest UIa�JMVMÅ\�UWZM�\PIV�W\PMZ�OZW]X[�

“Trials will also be useful to assess if particular types of hypothermic methods, such as ice packs, cooling blankets, and invasive cooling systems with thermostat temperature controls, are superior to others. However, there are no conclusive trials to compare these different modalities and all appear to do just as well.”

Whatever the exact mechanism of therapeutic hypothermia, studies have shown that it works.He received a month’s hospitalisation leave so he could rest at home.

¹)\�ÅZ[\��PM�[]NNMZML�[PWZ\�\MZU�UMUWZa�TW[[��.WZ�I�KW]XTM�WN �_MMS[��PM�couldn’t remember what he had done the LIa�JMNWZM�WZ�_PW�PIL�^Q[Q\ML�PQU��5a�UW\PMZ�IVL�1�_MZM�_WZZQML�I\�ÅZ[\��J]\�_MZM�advised to give it a week or so,” recalled 5Q[[�6O��¹0Q[�UMUWZa�\PMV�ZM\]ZVML�JQ\�by bit, and we could see his progress.”

A month later, when he returned to see the doctor for a memory check, PM�_I[�\WTL�\PI\�M^MZa\PQVO�_I[�ÅVM�IVL�\PI\�PM�_I[�Å\�\W�ZM[]UM�_WZS��5Z�6O�[]J[MY]MV\Ta�^Q[Q\ML�\PM�+PIVOQ�;XWZ\[�5MLQKQVM�+MV\ZM�I\�+/0�WVKM�a week to do exercises to strengthen his heart and have his diet checked.

Dr Tong cautioned that it is important to manage public expectations that a iS

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According to a 2007 study

published in the International

Journal of Geriatric Psychiatry,

about 13 per cent of ethnic

Chinese senior citizens in

Singapore develop symptoms

of depression. As the nation

grapples with the ‘Silver Tsunami’

of an ageing population,

elderly depression is a key

health challenge.

ELDERLY DEPRESSION

Text by Candice Neo

IN SINGAPORE

N o study in Singapore has been done

to correlate suicide rates to depression. But in the U.S., the

American Association of Suicidology reports that 14.3 out of 100,000 elderly Americans aged 65 and older attempt suicide, making the link between depression and suicide strong.

Such studies have revealed that depression and other psychiatric disorders, such as anxiety and psychotic disorders, increase the risk of suicide in the elderly. They have also discovered that depression is the link between having a physical illness and suicide attempts, that is, physical illness increases depression, which increases the likelihood of attempting suicide.


9

FEATURE // ELDERLY DEPRESSION IN SINGAPORE

It is more difficult to detect depression in the elderly as compared to younger people

The likelihood of depression increases among single or divorced elderly with more medical illnesses, who are lower in socioeconomic status, income and education.

1\�Q[�UWZM�LQNÅK]T\�\W�LM\MK\�LMXZM[[QWV�in the elderly compared to younger people. Dr Tan Wee Chong, Clinical Psychologist at the Eastern Health Alliance, explained that this is because the symptoms of elderly depression can overlap, be shared or be a result of the many physical illnesses that come in old age.

“Some symptoms of dementia and Parkinson’s Disease are very similar to symptoms of depression, so it is often very hard to tease these two apart, especially if the elderly person has both depression and Dementia or Parkinson’s,” added Dr Tan.

To complicate matters, an elderly person who develops dementia might also develop anxiety, which may then

cause him to fall into depression. When the symptoms of all these conditions feed into one another, it results in secondary depression.

For a diagnosis to be made, your loved one would have to be assessed by several different professionals, which may include psychiatrists, geriatric doctors (to rule out dementia or memory changes), clinical psychologists, and other allied health professionals. A very thorough history of the person’s symptoms must be mapped out and compared to his medical history.

“We might have to interview family members who have observed changes in the elderly person as well, because sometimes the elderly person might not be able to provide as much information to us,” explained Dr Tan. “Only after all other conditions have been ruled out or when the causes of LMXZM[[Q^M�[aUX\WU[�IZM�KTIZQÅML��KIV�I�diagnosis of depression be more certain.”

+ Sadness, or looking

particularly downcast,

tearful frequently

+ Fatigue or frequent

complaints of

tiredness

+ Becoming visibly

agitated or becoming

visibly slow in

movement

+ Loss of interest in

hobbies or pastimes

that they used to

ÙOE�QMFBTVSBCMF�BOE�meaningful Becoming

more isolated and

withdrawing from

contact with others

+ Changes in appetite

resulting in noticeable

weight loss or gain

+ Sleep disturbances

EJGÙDVMUZ�GBMMJOH�asleep or staying

asleep, oversleeping,

or daytime

sleepiness)

+ A noticeable

change in sleep

patterns, which

then affects daily

functioning

+ A reduced sense

of self-worth and/or

recurring thoughts

about negative

themes such as

being a burden

to families, feelings

of worthlessness,

self-loathing,

meaninglessness,

not being able to see

a future for oneself,

guilt, losses in life

+ Decreased

concentration and

increased indecisiveness

over daily or trivial

decisions

+ Increased use of

alcohol, drugs or

medication

+ Fixation on death –

having frequent suicidal

thoughts or attempts to

take one’s own life

WHAT CAN TRIGGER DEPRESSION?+�"�SFDFOU�TJHOJÙDBOU�loss or change, such as

retirement without post-

retirement plans

+ A death of a closed on

or an aged peer

+ Being informed of new

medical diagnosis e.g.,

heart disease, stroke,

cancer, diabetes

WHAT MAKES THE ELDERLY PRONE TO DEPRESSION?

BELIEVE IT OR NOT, DEPRESSION CAN BE PREVENTED! HERE’S WHAT CAN BE DONE:

+ Help your elderly

loved one invest in a

social network (e.g.

joining a Residents’

Committee (RC) so they

can make friends, and

try to get them involved

in volunteer activities

+ Prepare him or

her for life changes

and losses by being

willing to be actively

and openly engaged

in conversation about

these topics

+ Help the elderly

person stay physically

healthy by encouraging

them to engage in more

physical exercise,

to have good sleep and

a healthy balanced diet

SIGNS AND SYMPTOMS OF DEPRESSION*G�ZPV�OPUJDF�BU�MFBTU�ÙWF� of the following changes

in your loved one over a

period of two weeks of

more, they could indicate

that your loved one is

depressed.

LONELINESS 5IJT�JT�CZ�GBS�POF�PG�UIF�NPTU�TJHOJÙDBOU�SJTL�GBDUPST�that contribute to elderly depression, as the elderly

tend not to socialise but keep to themselves.

Some may live alone, while others may not have

BDDFTT�UP�B�TPDJBM�OFUXPSL�BOE�PS�DPOÙEBOU��5IFZ�end up staying at home without much meaningful

human connection, and the cognitive stimulation

that comes from human interaction is reduced.

LACK OF PURPOSEFUL ACTIVITIES AND BOREDOM A lack of cognitive stimulation increases the

likelihood of an elderly person developing

depression. It also increases the sense of

meaninglessness in life. Those who had

previously been meaningfully engaged in

their careers and now face retirement could

become depressed in the absence of purposeful

activities to structure and guide their lives.

LOSS OF FUNCTIONAL DISABILITY Reduced mobility and the

ability to take care of oneself places an elderly

person in a perpetual state of dependence on

others. The loss of control of his or her bodily

functions can also give rise to a sense of

loss, shame, anger and grief, which

can contribute to depression.

CHANGES IN BRAIN STRUCTURES The brain changes as we age, and this

can affect its emotional centres such

as the amygdala and hippocampi.

11

FEATURE // ELDERLY DEPRESSION IN SINGAPORE


Celebrating a decade of pioneering work Text by Tang Pin�Ji

CSMC TURNS10!

n�0GÙDJBM�MBVODI�� 12 September 2003

n *OUSPEVDFE�CFETJEF�.VTDVMPTLFMFUBM�6MUSBTPVOE

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2003

2004n�*OUSPEVDFE�&YUSBDPSQPSFBM�4IPDLXBWF�5IFSBQZ�GPS�QBUJFOUT�XJUI�NVTDMF�UFOEPO�QBUIPMPHJFT�JO�UIF�QVCMJD�IFBMUIDBSF�TZTUFN

2005n�-FE�UIF�4QPSUT�.FEJDJOF�8PSLHSPVQ�UP�QSFQBSF�BOE�FTUBCMJTI�4QPSUT�.FEJDJOF�BT�B�OFX�NFEJDBM�TVCTQFDJBMUZ�JO�4JOHBQPSF

2006n�&TUBCMJTIFE�UIF�4JOHBQPSF�4QPSUT�.FEJDJOF�$FOUSF�q�UIF�MBSHFTU�BOE�NPTU�DPNQSFIFOTJWF�4QPSUT�.FEJDJOF�FOUJUZ�JO�UIF�QSJWBUF�IFBMUIDBSF�TFDUPS

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C hangi Sports Medicine Centre

(CSMC), Singapore’s largest multidisciplinary sports medicine

centre, celebrated its tenth anniversary on 13 September 2013 with Mr Gerard Ee, Chairman of the Eastern Health Alliance as Guest-of-Honour.

The celebrations kicked off early in the morning with more than 350 staff participating in an Active Day Mass Workout in CGH's beautiful, newly-renovated central Atrium, led

Ja�+;5+�[\INN �QV�LQ[\QVK\Q^M�JZQOP\�XQVS�W]\Å\[��A smaller group of intrepid staff continued the active theme with 5km and 10km Fun Runs around the neighbouring Simei-Tampines area to help raise over $24,000 in funds for the Cardiac Rehabilitation Programme.

Said Dr Lee Chien Earn, Chief Executive 7NÅKMZ�WN �+/0��I\�\PM�M^MV\��¹+;5+�XTIa[�a key role in our healthcare landscape. It serves not just elite athletes but also the public, in promoting exercise as a lifestyle as well as a prescription in managing chronic diseases such as diabetes and hypertension. CSMC has grown in leaps and bounds over the past decade to become the leading sports medicine centre in Singapore.”

The main celebration event kicked off later in the mid-morning in the CGH Atrium. The Atrium had various activity stations set up to showcase and introduce people to various types of exercise equipment, rehabilitation

CSMC’S KEY ACHIEVEMENTS TO DATE 1

IPUPT�&SXJO�5BO

13


CELEBRATE // CSMC TURNS 10!

specialities, diet and nutrition, and even featured a Ϻtesting stationϻ where people could try their hand at various feats of strength, agility or endurance.

As part of the celebrations, CSMC also launched a book ‘Boys to Men’, which helps pre-enlistees prepare for National Service. The book can be purchased at CGH pharmacies, the Singapore Sports Medicine Centre and all major bookstores.

The CSMC has come a long way... enabling Sports Medicine to be recognised as a medical specialty in Singapore

Medicine subspecialty training in (year). Earlier this year, Sports Medicine was upgraded to a full medical Department.

As pioneers of sports medicine in Singapore, the CSMC is fully committed to helping individuals to recover quicker from their sports injuries, assisting sedentary people to lead an active lifestyle and supporting patients in managing lifestyle diseases.

In addition, the CSMC continues to be

2009n�1VCMJTIFE�Ϻ3VO�GPS�:PVS�-JGF�ϻ�q�B�TZTUFNBUJD�USBJOJOH�HVJEF�GPS�FOEVSBODF�SVOOFST

n�1SPWJEFE�NFEJDBM�DPWFSBHF�GPS�UIF�"TJBO�:PVUI�(BNFT�IFME�JO�4JOHBQPSF

2012n�1VCMJTIFE�Ϻ4QPSUT�4BGFUZ��*OKVSZ�1SFWFOUJPOϻ NBOVBM�GPS�BMM�QIZTJDBM�FEVDBUJPO�UFBDIFST

n�"QQPJOUFE�BT�B�TQFDJBMJTU�DMJOJD�PG�UIF�4JOHBQPSF�4QPSUT�.FEJDJOF�/FUXPSL

2011n� -BVODIFE�l&YFSDJTF�JT�.FEJDJOF�4JOHBQPSFm�XJUI�UIF�"NFSJDBO�$PMMFHF�PG�4QPSUT�.FEJDJOF

n�4JHOFE�.06�XJUI�4"'�UP�QSPWJEF�QSPGFTTJPOBM�USBJOJOH�JO�.JMJUBSZ�4QPSUT�.FEJDJOF

n�&TUBCMJTIFE�TVCTQFDJBMUZ�SFHJTUFS�GPS�4QPSUT�.FEJDJOF�JO�4JOHBQPSF

2010n�$4.$mT�4QPSUT�.FEJDJOF�USBJOFF�CFDBNF�4JOHBQPSFmT�ÙSTU�MPDBM�HSBEVBUF�PG�UIF�OBUJPOBM�4QPSUT�.FEJDJOF�TVCTQFDJBMUZ�USBJOJOH

n�1SPWJEFE�NFEJDBM�DPWFS�GPS�UIF�:PVUI�0MZNQJD�(BNFT�IFME�JO�4JOHBQPSF

2013n�)JU�UIF��ZFBS�NBSL�XJUI�UIF�WJTJPO�PG�FYQBOEJOH�FYDFMMFODF�OBUJPOBMMZ�BOE�SFHJPOBMMZ

n�1VCMJTIFE�l#PZT�UP�.FOm�q�B�HVJEF�PO�QIZTJDBM�QSFQBSBUJPO�GPS�OBUJPOBM�TFSWJDF

an innovator in the delivery of sports medicine services while actively supporting the national goal of creating a vibrant sports scene. The CSMC's four key areas of focus are:1. Integrating Exercise with Chronic

Disease Management2. Sharing Knowledge with the Medical

and Sports Community3. Playing a Key Role in a Vibrant Sports Scene4. Setting Standards for Medical Training in

Sports Medicine

The festive, carnival atmosphere of the UWZVQVO�]VLMZ[KWZML�\PM�[QOVQÅKIVKM�WN�the milestone being celebrated. The CSMC has come a long way in 10 years, playing an integral role in enabling Sports Medicine to be recognised as a medical specialty in Singapore.

Sports Medicine started out in CGH as a service under the Orthopaedic Department in 2003. However, due to its substantial non-surgical scope of work, it soon branched out as its own medical division within CGH.

¹1\�_I[�VW\�\PI\�TWVO�IOW�\PI\�\PM�\MZU�‘sports medicine’ was unfamiliar to the Singaporean public,” reminisced Dr Ben Tan, Chief and Senior Consultant for the CSMC. “Even doctors were confused between sports medicine and orthopaedic surgery, and the public often thought that sports physicians were physiotherapists.”

<PM�+;5+�_I[�IT[W�\PM�^MZa�ÅZ[\�institution to be fully accredited for Sports

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Best!DocNOSEChances are, you probably have allergic rhinitis

Allergen “avoidance”In the case of HDM allergy, it is worth considering a regular change of bedding, as well as removing carpets and using anti-dust mite products. Nevertheless, it is almost impossible to remove all allergens from the environment. Thus, allergen avoidance alone does not usually result in adequate control of AR.

Medications If your symptoms occur only occasionally and/or are mild, all that may be required is a non-sedating anti-histamine to block them. However, if you experience symptoms frequently and if they affect your sleep, work or limit your participation in sports and leisure activities, long-term control using an intranasal steroid spray could provide better results.

Do you sneeze, live with a runny nose, or suffer from a blocked nose every morning? Do you

often wonder why you keep getting the Æ]'�+PIVKM[�IZM��aW]�XZWJIJTa�PI^M�

allergic rhinitis.Don’t confuse this with sinusitis, [Ia[�,Z�,I^QL�+PQV��I�ZPQVWTWOQ[\�

I\�+/0¼[�-IZ��6W[M�IVL�<PZWI\�+TQVQK�_PW�_I[�

recently awarded the prestigious

NOSY SOLUTIONS Dealing with allergic SIJOJUJT�JT�OPU�EJGÙDVMU�with these tips:

AIPaI�+WPMV�/WTL�5MLIT�Ja�\PM�)KILMUa�WN �5MLQKQVM��;QVOIXWZM��

,Z�+PQV�\MTT[�][�UWZM�IJW]\�ITTMZOQK�rhinitis and its available treatment options.

What is allergic rhinitis? )TTMZOQK�ZPQVQ\Q[��):��Q[�I�KWVLQ\QWV�_PMZM�IV�QVQ\QIT�ITTMZOQK�sensitisation to an allergen (something that KIV�KI][M�IV�ITTMZOQK�ZMIK\QWV��[]KP�I[�XWTTMV��TMIL[�\W�\PM�XZWL]K\QWV�WN �[XMKQÅK�IV\QJWLQM[�that can trigger an allergic response when the person is subsequently exposedto the [IUM�ITTMZOMV��IV\QOMV��)V\QOMV�IV\QJWLa�interaction leads to:

b NERVE IRRITATION Itching and sneezing

b SWELLING IN THE NOSE 6I[IT�KWVOM[\QWV�IVL�WJ[\Z]K\QWV

b INCREASED MUCOUS SECRETIONS��:]VVa�VW[M�IVL�XW[\VI[IT�LZQX

How is this different from sinusitis? Perhaps the biggest confusion IJW]\�):�Q[�\PI\�Q\�Q[�

too often labeled as sinusitis, which is an inflammation

of the nose and sinuses, and often persists due to an unresolved upper respiratory tract

infection, or the flu.

HEART TO HEART // DOC NOSE BEST!

21

How is allergy testing carried out? )TTMZOa�\M[\QVO�Q[�][]ITTa�LWVM�^QI�I�[SQV�XZQKS�\M[\��;8<��QV^WT^QVO�the introduction of a standardised allergen into the top layer of skin, known as the epidermis. This is to assess for the development of an allergic response, such as swelling, redness and itching – much like the reaction to a mosquito bite. )TTMZOa�\M[\QVO�KIV�[WUM\QUM[�JM�based on a blood sample, but this is very uncommon.

How is AR treated? If your symptoms and medical history are very typical, your OMVMZIT�XZIK\Q\QWVMZ��/8��_QTT�][]ITTa�JM�

Surgery Many patients may experience dramatic relief of symptoms with medication alone. However, when nasal obstruction has been present for a long time, the inferior turbinates may be so enlarged, so that medication NBZ�OPU�CF�TVGÙDJFOU��Surgical reduction of the inferior turbinates can be performed in these cases.

Specific immunotherapy The closest we can get to a cure! This treatment method involves administrating minute qualities of allergen over a long period of time, so as to desensitise the immune system and eventually eliminate the inappropriate responses to the allergen. When used in an appropriately-selected patient, three to four years of immunotherapy can offer a very good chance of the patient eventually being symptom-free for at least seven years. Specialist consultation is advised for those considering immunotherapy.

;aUX\WU[�WN �[QV][Q\Q[�\MVL�\W�TI[\�NWZ�_MMS[�\W�UWV\P[�ZI\PMZ�\PIV�Æ]K\]I\M�_Q\PQV�\PM�LIa�TQSM�):�KIV��.]Z\PMZUWZM��sinusitis patients tend to have discoloured nasal discharge or phlegm rather than a clear runny nose. They may even experience facial discomfort, headaches and loss of smell – symptoms which are not \aXQKIT�WN �):�

What causes AR? This is not completely understood. It is partly inherited, so patients with a family history WN �):�IZM�UWZM�TQSMTa�\W�PI^M�Q\�\PIV�those who do not. On the other hand, it also depends on how our immune system interacts with the environment. It

This phenomenon is particularly relevant in children during their developmental yearsis not uncommon to hear of symptoms disappearing completely when someone _Q\P�):�NQZ[\�UW^M[�\W�IVW\PMZ�KW]V\Za��yet they may slowly develop again over a period of time.

0W_M^MZ��XI\QMV\[�_Q\P�[\ZWVO�ITTMZOQK�\MVLMVKQM[�[]KP�I[�):�[]NNMZ[�are at a higher risk of developing more serious conditions such as asthma and atopic dermatitis. This phenomenon is particularly relevant in children during their developmental years, such that the term “allergic march” has been coined to describe it. What should patients with AR be allergic to? The most commonly inhaled allergens are the various types of house dust UQ\M[��0,5��7\PMZ�KWUUWVTa�QVPITML�allergens include cockroaches and pollens. Occasionally, patients do have food allergies \W�[PMTTÅ[P�IVL�MOO[��NWZ�QV[\IVKM�

happy to offer treatment and to evaluate your response to it.

When do you need to see an ENT specialist? If your symptoms are typical WN �):��aW]�PI^M�ZM[XWVLML�_MTT�\W�UMLQKIT�treatment and do not have any unusual NMI\]ZM[��aW]Z�/8�Q[�_MTT�MY]QXXML�\W�PMTX�aW]�UIVIOM�aW]Z�KWVLQ\QWV��-6<�evaluation is only advised when unusual symptoms such as headaches, nasal JTMMLQVO��WVM�[QLML�JTWKSIOM�WZ�I�XMZ[Q[\MV\�loss of smell occur or persist.

+/0¼[�-6<�,MXIZ\UMV\�WNNMZ[�I�comprehensive evaluation and management of allergic rhinitis. Patients have to be at least six years of age to undergo nasal endoscopy, allergy testing, allergy counseling, medications and sublingual immunotherapy, while surgery for nasal obstruction is available to those aged 18 and above.


This succulent turkey breast and asparagus recipe topped with cranberry sauce provides a healthy and nutritious way to get into the spirit of the festive season

FESTIVECOMBINATION

Method1. Using a sharp knife, slice the

turkey breast horizontally almost in two (leaving 1cm of meat on

POF�FOE�BOE�TQSFBE�JU�PVU�ÚBU�

2. Tenderise the turkey breasts by chopping gently using the back of a knife.

Season the meat with salt, pepper and gelatine powder.

3. Place a sheet of seaweed on top of each turkey breast, place the asparagus in the centre then roll turkey up like a Swiss roll.

4. Sprinkle turkey with paprika then wrap tightly with aluminium foil to help rolls retain their shape.

5. Bake turkey rolls at 170°C for 12 minutes or until turkey is cooked.

6. In a bowl, combine mayonnaise and cranberry jelly and mix well.

7. To serve, unwrap chicken rolls and slice. Serve with cranberry mayonnaise.

Preparation time: 20 minutesCooking time: approx. 12 minutesServes four

What you’ll need p��TLJOMFTT�UVSLFZ�CSFBTU�ÙMMFUT� (about 100g each) Saucep� Salt (1 tsp) p� Pepper (2 tsp)p� Gelatine powder (4 tsp)p� 2 sheets of seaweed (nori),

cut into halfp� 4 Thai asparagus spears, trimmed

and blanchedp� Paprika (½ tsp)

Marinadep� Cranberry jelly (50g)p� Low-fat mayonnaise (30g)

Nutitional info (per serving)Energy 220kcal

CHO 6g

Protein 40.7g

Fat 4.1g

Fibre 1.7g

Cholesterol 76mg

HEALTHY EATS // TURKEY BREAST & ASPARAGUS WITH CRANBERRY SAUCE

23


These yummy apple crumble tarts offers a heathier approach to comfort food

FRUITY TREATSMethod��1MBDF�UIF�BMNPOE�ÚBLFT�PO�B�CBLJOH�USBZ�BOE�SPBTU�JO�UIF�PWFO�

BU��Ý$�GPS��NJOVUFT�PS�VOUJM�MJHIU�CSPXO �UIFO�TFU�BTJEF�

��*O�B�MBSHF�CPXM �NJY�UIF�EJDFE�BQQMFT �BQQMF�ÙMMJOH�BOE�MFNPO�KVJDF��"EE�UIF�SBJTJOT �SPBTUFE�BMNPOE�ÚBLFT�and ground cinnamon. Mix well and set aside.

3. In another bowl, cream the butter and icing sugar until light and creamy.

4. Add the remaining ingredients for the short crust pastry. Stir with a spatula until mixture is well combined. Refrigerate for one hour.

5. On a clean work surface, roll out the pastry to the desired size, cut pastry using a round cutter and place the cut round pastry into tart casings.

��%JWJEF�BOE�QVU�UIF�BQQMF�ÙMMJOH�JOUP�UIF�JOEJWJEVBM�UBSU�DBTJOHT

7. In a mixing bowl, combine all the ingredients for the crumble. Put the crumble on top of the tart casings.

8. Bake tarts at 180°C for 20 minutes or until the crust turns brown.

SHORT CRUST PASTRY What you’ll needp� Butter, room temperature (80g)

p� Icing sugar (100g)

p� 1MBJO�ÚPVS��H�

p� Sugar (20g)

p� Ground almond (20g)

p� Egg (½ no)

p� Salt (a pinch)

p� Vanilla essence (1/8 tsp)

p� Lemon zest (¼ lemon)

APPLE FILLING What you’ll needp� "MNPOE�ÚBLFT��H

p� Green apple, diced (75g)

p� "QQMF�ÙMMJOH �DBOOFE��H

p� Raisins (30g)

p� Ground cinnamon (¼ tsp)

p� Lemon juice (½ tsp)

CRUMBLE What you’ll needp� Unsalted butter (15g)

p� Flour (50g)

p� Sugar (20g)

HEALTHY EATS // APPLE CRUMBLE TARTS

Nutitional info (per 46g serving)Calories 163kcalCarbohydrate 23.2g Fat 7.4g Cholesterol 20.3gFibre 0.8g

Preparation time: 20 minutes Cooking time: 20 minutesMakes 15 individual tarts

NOVEMBER//DECEMBER 2013 CARING

WE WANT TO HEAR FROM YOU!What would you like to see in CARING? Which was your favourite story this month? Drop us a message at [email protected] and your letter could be published in next month’s issue! Email us with ‘Your Say’ as the subject header and include your full name, age, address and contact number.

YOUR SAY

ONG BAO LING, TAMPINES

Dear , I used to be an active runner back in my school days and have been thinking about getting back in shape by training for a marathon. However, the recent spate of cardiac arrest cases in long-distance runners has made me wary about doing so. I was glad to come across the piece on running and cardiac arrest, written by one of your doctors in the Sep/Oct issue of . Her advice has allayed my fears and has made me decide to complete a marathon as my goal for 2014!

24

NICHOLAS ENG, ALJUNIED

Dear ,

I was very moved by the stories in your last issue that centred on

caregivers. Being the main caregiver for my father, who suffered from a stroke a few

years ago, has taken a toll on me at times and I found myself identifying with the symptoms of stress faced by caregivers in “What’s On

Your Mind?” I would like to applaud your Hero Caregivers, Mdm Wee and Mdm Wong, for their unfailing dedication in caring for their spouses,

both of whom had a condition similar to my dad’s. Their positivity has spurred me on to be there for him at all times.

Thank you, , for being a magazine with

a heart.

CANDY YEO, SIMEI

Dear , I’ve been a loyal reader of the magazine over the past year and I like how you have articles in both English and Mandarin, making it a popular read in my household among my siblings and parents alike. The cheery look of the magazine, its upbeat content and useful health information give us much to look forward to in every single issue. I personally like the cover stories as it is very inspiring to read about how others overcome their health problems. is LMÅVQ\MTa�I�OZMI\�ZMIL�NWZ�ITT�IOM[

(surname in block letters) (Prof/Dr/Mr/Mrs/Ms) (姓氏以正楷书写) (教授/博士/先生/女士/小姐)

ὁ⟶ਤ旔时⥞痙昫气ɖ۳㫹䇂Ǿᅦ쟢昧ᬦⅸȼʃ痙č뺔Know of someone who would like to read this? Please pass it on.

SUBSCRIBE TO

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Are you currently a patient of CGH? 您目前是不是樟宜综合医院的病人？ Yes 是 No 否

:PVS�QBSUJDVMBST�XJMM�CF�VTFE�TUSJDUMZ�GPS�NBJMJOH�BOE�PS�OPUJÙDBUJPO�PG�$()mT�VQDPNJOH�FWFOUT�BOE�QVCMJD�GPSVNT�� 5IFZ�XJMM�CF�LFQU�DPOÙEFOUJBM� 您的资料只供邮寄之用及/或通知您樟宜综合医院所主办的活动和讲座。您的资料将获得保密。

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I want to update my particulars! (for existing subscribers) 我希望更新我的个人资料！ (仅限现有订阅者)

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Sep−Oct 2013 \\ Issue 126

A Changi General Hospital Magazine

Find out how 67-year-old William managed to overcome Degenerative Disc DiseasePAGE 6

MORE THAN SKIN DEEPGet the skinny on ageing bodiesPAGE 16

HEARTS RACINGDoes running cause sudden cardiac death?PAGE 22

COVER STORY

SICK BAY to SIX-PACK

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《关怀》季刊－


EDITOR, CARING MAGAZINE CHANGI GENERAL HOSPITAL PTE LTD

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ASK AN EXPERTGot a burning health question? Let our experts tell you more. Email [email protected] with your full name and write ‘Ask An Expert’ as your subject header.

This feature is provided for informational purposes only. The answers are not intended to be a substitute for formal medical consultation in diagnosing or treating a health problem. Please consult a physician about your specific healthcare concerns.

SAFE TO SWIM ?

QI used to enjoy swimming but, since starting insulin, I’ve been afraid to go back to the pool. What if I get hypoglycaemia?

Hypoglycaemia during team games or athletics can be inconvenient but hypoglycaemia whilst swimming can

be serious. However, this need not stop you from swimming if you follow these simple rules:o Never swim aloneo Tell your friends or coach to pull you out of the water if you start to behave strangely or MVKW]V\MZ�IVa�LQNÅK]T\ao Test your blood sugar level before entering the pool. A safe level is between 6 to 12 mmol/L. Do test your sugar level after swimming to

understand its effects on your blood sugar levels.o Keep glucose tablets by the poolsideo�/M\�W]\�WN �\PM�XWWT�QUUMLQI\MTa�QN �aW]�NMMT�\PM�ÅZ[\�

signs of hypoglycaemia coming on

TRAVELLING WITH DIABETES

Q This December will be my first

time going on an extended trip since I was diagnosed with diabetes. I’m particularly concerned about how my twice-daily insulin injections will be affected when I cross time zones. Could you provide me with some tips on managing this?

AW]�UIa�ÅVL�Q\�MI[QMZ�\W�SMMX�aW]Z�watch on local time when leaving (or, _PMV�KWUQVO�JIKS��WV�\PM�\QUM�WN �\PM�country you are leaving). Eat your regular meals according to this time until you arrive. Then, you should change your meals to follow the new local time.If you’re travelling eastwards, the day is shorter. Give your normal morning injection as usual but reduce the evening injection by 10% (e.g. give 18 units instead of 20). If your journey lasts more than 24 hours, it may be easier to give yourself insulin more

often, but in lower quantities each time.If you’re travelling westwards, the day is longer and you may still be up and MI\QVO�Å^M�\W�[Q`�PW]Z[�IN\MZ�aW]Z�M^MVQVO�injection at 6 -7 pm local time. You should \PMZMNWZM�\ISM�IVW\PMZ�[UITT�LW[M��M�O��PITN �your usual amount) of fast-acting clear QV[]TQV�[Q`�PW]Z[�IN\MZ�\PM�][]IT�M^MVQVO�injection, followed by a meal. This is important to prevent hypoglycaemia.Don’t forget to test your blood sugar levels regularly and carefully during the trip. Your meter is your best friend. Safe travels!

ASK AN EXPERT

DR FOO JOO PIN is a consultant at CGH’s Endocrinology Clinic and Director of the Diabetes

Centre. He answers this month’s questions

on diabetes.

获得更好的睡眠, 可避免阿尔茨海默病约翰霍普金斯布隆博格公共卫生学院的新研究发

现, 较少以及较低质量的睡眠和较高程度的 β-淀粉样肽化合物有密切关联，而这是阿尔茨海默病的一个特点。参与研究的参加者汇报了介于5小时以下至 7 小时以上的睡眠时间。那些睡眠较少的参与者被发现在他们的大脑里积聚了更高量的 β-淀粉样肽蛋白。阿尔茨海默病最常引发痴呆症，再加上有约一半的年长者人口呈现失眠

的症状，因此这项调查结果值得注意。

戒烟降低心脏病风险过了更年期的妇女可通过戒烟减少患心血管疾病的风险。这是印第安纳州大学公共卫生学院的一名流行病学家 Luo Juhua，在美国医学协会的期刊里所发表的一项新研究结果。她数据分析了 104,391名绝经后、年龄在 50 至 79 岁之间的妇女。尽管戒烟后体重增加，但这些妇女的心脏病患病风险仍然有所减低。换句话说，为了享受更多的健康好处，戒烟永远不嫌晚！

和家人共餐，身体质量指数更健康

根据最近一项由Brian Wansink医生和Ellen van Kleef医生所展开的研究显示，一起用餐可以影响一个人的体重。这是两位医生审查了190名父母和 148 名儿童的身体质量指数（BMI），以及他们的每日晚餐作息后所得出的结论。研究表明那些有较高BMI的父母较常坐在电视机前用餐。在另一方面，那些坐在餐桌前用餐的儿童和父母则有较低的BMI。这项研究的结果强调了一家人一起用餐的社交重要性，并且推断在餐桌前和家人的互动所产生

的正面情感代替了过食的可能性。

29


保健小笔记

乡村生活对免疫系统有益一项由奥胡斯大学所开展的新研究结果表明，搬到农村去生活可能对您有好处，尤其是如果您有过敏体质。研究发现农民的免疫系统经常接触到多种细菌、真菌、花粉和其他刺激物，可能从而预防患上超过敏性病症。出人意料的是，这反应不仅呈现在儿童身上，就连成人也是如此。这项新知识让研究学者在寻找预防过敏反应的工作又跨前了一步，并且能够帮助到不仅是儿童病患，还有之前被认为为时已晚的成年病患。

若想达到目标，切记非礼勿视

根据一项自我控制能力的新研究显示，如果

您正在努力为实现目标，避开可阻碍您进展

的诱惑可能会比单纯的依靠意志力更能增加

成功率。这项由剑桥大学和杜塞尔多夫大学

的研究人员展开的调查招募了年轻的男性志

愿者，让他们在立即可用的“小奖励”和延迟

的“大奖励”之间做选择。那些预先承诺会

有意识的避开受到诱惑的参与者被发现更

有可能压制享受即时满足感的欲望，而更有

能耐等候稍后的大奖励。这似乎表明，预

先承诺是一个比意志力更有效的自我

控制战略。这肯定能让较为冲动的

人群受益！

原文 Celine Lim

病人若在心脏停搏复苏后接受低温治疗将有更高的机率避免脑部受损。该治疗指的是在病人的心跳恢复后将其体温降低3至5摄氏度。

iSto

ckp

hoto

低温治疗心脏停博后施制冷法保存病人脑部功能


31

自2012年7月起，在15个熬过了心脏骤停并且接受低温治疗的病人当中，有12个成功活着出院

加入低温疗法将心脏骤停病人的存活率以及神经功能的恢复率提高15%至20%。＂樟宜综合医院所获得的初步结果叫

人鼓舞。自2012年7月起，在15个熬过了心脏骤停并且接受了低温治疗的病人当中，有12个成功活着出院-这可是80%的存活率！唐医生表示这和平时的2-3%的存活率相比之下呈现出明显的差异。这些心脏停搏的案例都是及时得到医疗照顾但是没有接受低温治疗的病人。此外，在这2-3%没有接受低温治疗

的生还者当中，只有一小撮能够恢复到往日的日常生活。在那12名从樟宜综合医院出院的病人当中，有11名能够恢复到往日的生活习惯和作息，和心脏停搏前一样。剩余的那名病人则需要长期的医疗照顾以及日常生活上需要他人协助。唐医生说低温治疗的确切运作原理

到目前还未完全被参透。其中一种说法是低温治疗能够压制自由基间反应，它们是在大脑和身体其他部位缺氧时所产

谁不适合做低温治疗？

据悉，低体温直接影响血凝固的过程。如果病人的医史或血液测试显示他有活动性出血、高的出血风险、或血凝固功能受损，那他便不适宜接受低温治疗因为风险太高了。

低温治疗对于患有存活率底的晚期病症的病人来说也没有太大的意义。同样的，如果病人在心血管虚脱发生前身体状况已经不太好，那该治疗也无法改善他的生活素质。

此外，对于那些由于可校正因素，如服用药物、长期和持续性的癫痫发作、以及电解质受干扰而导致心血管性虚脱的病人来说，低温治疗也起不了太大的作用。这些病人在心血管性虚脱之前脑部相信已经受到相当大的损伤，因此他们无法从该治疗中受益。

黄锦松先生在五月份突然发生心脏骤停时，心脏停止跳动了五分钟之久。在这五分钟里，供应到他

大脑的氧气被切断了。樟宜综合医院的医生们通过体外自动

除颤器（AED）成功恢复心跳，并且随后为他进行血管成形以及冠脉内支架植入术以恢复血液循环。但医生们担心53岁的黄先生的大脑将由于缺氧而受到永久的损害。接下来所发生的事仿佛像是科幻

电影里的情节：躺在加护病房的黄先生被注入了冷却后的盐溶液，把他的体温降低三至五摄氏度。这所发生的一切黄先生完全没有任何记忆。他25岁的女儿，黄加慧小姐，

则说：＂医生们解释说这样做是为了保存爸爸的脑部，就像我们将食物放入冰箱里保存一样。＂

促进存活和恢复率这项叫做低温治疗的疗法是樟宜综合医院

现有的心脏停搏复苏管理方案里的一项新措施。该疗法在2012年7月份推出，为的是促进这类病人的整体存活率。那些符合接受低温治疗条件的病人（参阅信息小窗）除了接受标准治疗以外也接受该治疗。兼任助理教授唐琴玲,樟宜综合医

院的心脏科主管医生以及冠心病监护病房主任解释说，通过＂保存那些没有被心脏骤停而受损的神经以及其他的身体功能”将有助于减缓和减少心脏停搏所带来的不良影响。＂她补充说那些受到部分损伤的神经和身体功能也能够借助该治疗获得恢复的机会。在低温治疗推出之前，心脏停搏

病人的存活率非常低。此外，在那些侥幸逃过鬼门关的病人当中，能够奇迹般完全康复的也寥寥无几。＂根据测试数据显示，我们希望通过

生的反应。另一种可能性则是低温治疗降低了对细胞所造成的生物化学干扰。

如何执行低温治疗尽管低温治疗的确切运作原理尚未被参透，各研究证明它是一种有效的疗法。在2002年欧洲一项具权威性的联合研究报告显示低温治疗明显的提升了大脑的恢复以及那些成功获得心脏停搏复苏的病人的存活率。该疗法在欧洲和澳洲经过了多方的人体试验后，在2002年被美国心脏协会列入心脏停搏后治疗方案里的一部分。樟宜综合医院的医生和护士们遵

循一套详尽的流程来执行制冷和制热的过程。在2011年和2012年之间，一群樟宜综合医院的医生以及医疗加护病房（MICU）的护士携手合作拟出了这个流程。这个小组里的成员有唐医iS

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to

封面故事 // 施制冷法保存生命

生、急诊部门的洪翔虎医生、医疗加护病房的萧鈞医生、心脏科登记医生杨科宁医生、以及高级临床护士陈宝珠。那些心脏曾停止跳动但随后被恢复到

自然频率的病人首先接受可逆性病因的评估，然后接受适当的治疗。接下来他们接受低温治疗的禁忌征候以及合适评估，以确保该治疗不会对他们有害。之后，这些病人普遍被送到加护病房接受进一步的治疗。病人通常在急诊部门或加护病房里接

受低温治疗。举黄先生的例子说明，冷冻的盐溶液被直接注入到他的静脉里来启动冷却的过程。一个探热器被植入到他的鼻孔里以确保能够准确的测试身体的温

度。盐溶液的浓度则必须紧密接受观察以确保在体温达到理想的32至34摄氏度时能够将体温维持在这个水平。此外还得用上一个外在的制冷仪器以迅速把体温减低以及保持低体温的效果。在治疗过程里，病人通过冬眠药物

被保持在昏迷状态，并且有一条中区静脉线被插入手臂或胸部以及一条鼻胃管通过鼻子被植入肚子里给病人输送药物和营养。病人的身体和四肢被包裹在装满冷水的降温毯里，而那台外在的制冷仪器则不断的给毯子供应冷水，以达到迅速降温的效果。复温的过程则是一个缓慢、逐渐的过程。整个低温治疗过程为时约50小时。

心脏骤停的一个月后回到工作岗位黄小姐说她的爸爸在接受低温治疗的过程当中发高烧，医生们于是决定在第一晚后终止该治疗。她说原定的低温治疗其实应该为时48小时，但最后执行了24小时候后便被终止了。黄先生一共昏迷了三个晚上，到了第4天才醒过来。他说：＂当我醒过来时，我还觉得

惊奇自己怎么会在这里呢。我的太太问我知不知道自己睡了多长时间，我说＂ P

hoto

Foo

Che

e C

hang

给心脏病病人的

低温治疗

制冷后的盐溶液被注入到病人的血脉里以开展低温疗程

病人的身体和四肢包裹在制冷毯子里

在新加坡每年有约1400人在医院以外的场所里爆发心脏病

在大部分病例都使用了

心肺复苏法

死亡

操作原理


33

一会儿＂。但原来是四天半那么久。＂黄先生在樟宜综合医院住了约1个

星期后便出院了。但医生给他开了一个月的住院病假好让他在家中休养。＂刚开始时他有短暂性失意。有一、两

个星期的时间他不记得昨天发生的事情或谁来探访过他。妈妈和我本来还蛮担心他的，但医生建议我们继续观察1个星期左右再看。黄小姐回想起道。＂他的记忆后来渐渐恢复过来，我们发现他的情况有改善。＂一个月后他回医院复诊做记忆测试，

医生说他的身体状况良好，并且可以回去上班。之后，黄先生每星期会去樟宜综合医院的樟宜运动医学中心锻炼以增强心脏功能同时接受饮食检查。唐医生忠告说要慎重的管理好公众

对于低温治疗的期望，不能一味认为经历过心脏停搏的病人只要接受该治疗后便肯定能够恢复到病发前的状态。她指出低温治疗仅用于在尽可能的程度上保存病人的神经和身体功能，并不能完全扭转已经造成的损害。病人的最终结果仍然得取决于心脏停搏的根本原因。据她所说，每年在新加坡约有1,400

个人在医院以外的场所发生心脏停搏的情况。因此他们极度依赖公众的帮助才可

获得医疗照顾。否则被说是低温治疗，就连使得心跳复苏也不可能。唐医生说：“（接下来）我们

需要开展大规模、系统化的随机式测试以断定低温治疗的最理想速度和时间长度、以及从心脏停搏到启动该治疗或达到目标体温的过程。我们也必须通过测试来断定是否某些心脏停搏的病人子群比其他子群还要能够从这个治疗中获益。”“通过测试将有助于评估

某些低温治疗方案，如冰袋、冰毯、以及附恒温器的人工心肺制冷系统是否越胜于其他。但目前并没有确凿的测试能够比较这几种不同的方案，而且它们看似都能发挥其功效。”


33

将身体制冷能够预防由于重新启动血液供应而导致的脑损伤

整个低温疗程耗时约50小时

在那些及时接受医疗照顾的心脏停搏病人当中，通常只有 2ɍ3% 能够活着出院

大多数病人都感到非常庆幸能够再次回到家人身边以及回到工作岗位上。他们可称的算是死而复生。


封面故事 // 施制冷法保存生命

BB

医者心语

// 骨骼健康

我们的运动需求和能力会随着各成长阶段不

断的演变。幼童和青春期间是增加骨骼质量的

关键时期，而青春期也是骨骼增强最迅速的时

期。孩子们应该玩、跑、跳、以及参与团体运动

如足球、篮球、网球、运力操、以及其他需要跳

跃和急速开始和停止的运动。骨骼的发展到了

20来岁的中、晚期便会开始慢下来。成人可选

择跳绳、爬楼梯、跑步、以及举重。老年人则应

该注重预防跌倒以及改善平衡感和直立姿势。

团体运动班如太极非常有助于锻炼平衡感。

对骨骼有益的运动

活动活动筋骨！

站有站时

跑有跑时

39


骨头就像肌肉一样，要常用才

会变强壮。这并不代表您必须

像专业运动员一般做高强度

的运动，反倒是选择一些适

合您年龄和身体状况的运

动以做为预防和管理骨质

疏松症的措施。在这里提

示您不同的运动对骨骼

有不同程度的影响。

不善用骨头

就散了！

跑直线、骑单车、或游泳的运动员的骨密度

比那些每星期2到5天从事30分钟球类运动

和举重的人群还要低。的确，高冲击性运动

或举重锻炼可增强成人骨骼以及改善平衡

感和姿态。举例说明，连续6个月每星期跳

绳2到3次，每次跳100下，有助增加骨骼质

量。您也不妨考虑打网球、爬楼梯、跑步、以

及需要跳跃的运动如有氧踏板操和跳绳。

虽然走路

无法大量的增强脊椎

和臀部的骨质，但研究显示每星期行走

超过4小时比每星期行走少过1小时得臀

部骨折的机率要低41%。这是由于前者

有更好的平衡感，因而较不容易跌倒。

运动

锻炼骨骼的

佳节将至，又到了享受美食的时候了！如何在大快朵颐的同时减轻罪恶感呢？《关怀》和您分享如何以更健康的方式，在自家厨房烹煮两道受人们喜爱的佳节菜肴！

佳节盛宴无罪恶！

做法1. 用利刀将胸肉横切开，不要切断，在尾端余留约1公分的厚度。胸肉打开并铺平。

2. 用刀背捶打胸肉直到嫩化。撒上盐、胡椒粉以及胶粉调味。

3. 在每片胸肉放一片海苔，然后在中间放一条芦笋。把胸肉卷起来，像卷瑞士卷心蛋糕一样。

4. 在胸肉上撒上红椒粉，然后用铝箔将紧紧地

包裹固定形状。

5. 把火鸡胸肉放入烤箱，以170摄氏度烘烤约12分钟直到胸肉烤熟为止。

6. 将蛋黄酱和蔓越莓果冻倒入一个小碗，搅拌均匀。

7 .胸肉从铝箔中取出并切片，搭配蔓越莓酱上桌。

准备时间：20分钟烹煮时间：12分钟供4人份

用料 o 去皮火鸡胸肉 4片，每片约100克酱料o 盐1茶匙oÖ胡椒粉2茶匙oÖ胶粉4茶匙oÖ海苔2片，切半oÖ泰国芦笋4条，修剪后过热水oÖ红椒粉半茶匙

腌料o 蔓越莓果冻50克o 低脂蛋黄酱50克

营养信息（每份）卡路里： 220大卡碳水化合物： 6克蛋白质： 40.7克脂肪： 4.1克纤维： 1.7克胆固醇： 76毫克钠： 541毫克

吃出健康 // 火鸡胸肉和芦笋搭配蔓越莓酱

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这道美味的苹果挞用料既简单又健康。

鲜果美点做法1. 将杏仁片撒在烤盘上放入烤箱，以180摄氏度烤约10分钟直到变成浅棕色，取出备用。

2. 用一个大碗，将苹果粒、罐头苹果馅以及柠檬汁加入后搅拌。加入葡萄干、烤杏仁片以及肉桂粉，搅拌均匀后备用。

3. 用另外一个碗，将牛油和糖粉搅打至松软滑腻为止。

4. 加入剩余的酥皮饼底材料，把材料搅拌均匀。放入冰箱冷却1小时。

5. 在一个干净的台面上将冷冻的饼皮搓平。用圆形模子切出小圆形饼皮，将它们个别放入酥挞模内。

6. 将之前搅拌好的苹果馅均匀地倒入酥挞模内。

7. 把碎酥粒的的材料加入一个碗里后搅拌。将碎酥粒均匀地撒在苹果馅上。

8. 以180摄氏度将酥挞烘烤20分钟，直到饼皮呈棕色即可。

酥皮饼底所需材料o 牛油80克，室温oÖ糖粉100克o 普通面粉150克o 杏仁粉20克o 白糖20克o 鸡蛋半个o 少许盐o 香草精Ɨ茶匙o 柠檬¼个，磨碎

碎酥粒所需材料 o 无盐牛油15克o 普通面粉50克o 白糖20克

苹果馅所需材料 o 杏仁片30克o 青苹果75克，切粒状o 罐头苹果馅75克o 葡萄干30克o 肉桂粉¼茶匙o 柠檬汁半茶匙

�营养信息（每份）卡路里： 163大卡碳水化合物： 23.2克脂肪： 7.4克胆固醇： 20.3毫克纤维： 0.8克

准备时间：20分钟烹煮时间：20分钟可制作15个

吃出健康 // 苹果碎酥挞

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dec 2013 - cgh.com.sg · dec 2013 \\ issue 127 a changi general hospital magazine cover story...

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