A PUBLICATION BY

‘Know’Bones

About ItWeight Bearing Exercises

Lifting your way to better bone health

Pg 28

Love Your SkeletonFacts and myths of bone health Pg 12

A Love Letter from Buddy BoneFoods for the bones Pg 16

Dangerous EleganceHidden dangers and tips of wearing heels Pg 22

Good Posture, Why Bother?Benefits and tips for good postures Pg 25

Osteoporosis, the“silent disease”

REGISTRATION No. 198901967K MICA (P) 091/11/2012 COMPLIMENTARY COPY ISSUE 04 / 2012

EndoscopicCarpal Tunnel Release

Carpal Tunnel SyndromeThere is a space located in the middle of our wrist, and this space is called the carpal tunnel. There is one major nerve (the median nerve) and nine tendons that pass through this. The carpal tunnel is made up of a very strong ligament that forms the roof of the tunnel while the base is formed by bones. As this space is limited, any relative decrease in space for the nerve will result in carpal tunnel syndrome.

Symptoms may include some or all of these:• Pain in the hand while sleeping• Numbnessinthefingers• Tinglingsensationinthefingers• Burningpaininthefingers• Painthatmayextendupthearm• Weaknessingrippingnewspapers,chopsticksorcups

These symptoms may occur while performing daily activities such as using the phone, reading, driving or household chores. A weakening of the grip indicates increased severity in the condition.

The SolutionA single portal endoscopic carpal tunnel release could be the solution to the problem.

This is done by making a small incision at the crease of the wrist, allowing the scar to be “hidden” by the skin crease. A minimally invasive device, which contains a camera and a small blade, is placed through this incision, that allows the surgeon to view the ligament and release it without having to cut through the skin or muscles of the palm. This will result in less scarring and pain. As the scar is along the skin crease, it will be inconspicuous after it heals.

After SurgeryOn the average, one can expect the following after the surgery:

• Handlemodifiedwork(lightduties)withinthreetofivedaysandregularwork,usingnondominanthand,within28daysafterthesurgery.

• Performgentlehandexercisesandregulardailyactivities.• Progressivepainreliefwhilesleepingeelaborate)• Progressiverecoveryfromnumbnessinthefingers.

Contact us to understand more about our services available at Raffles Orthopaedic Centre.RAFFLES ORthOpAEdic cENtRE585 North Bridge Road | Raffles Hospital, Level 13 | Singapore 188770Tel: (65) 6311 2310 | Fax: (65) 6311 2373 | Email: specialist@raffleshospital.com

Hospital

Opening hours: Monday - Friday: 8.30am - 6.00pm Saturday: 8.30am - 1.00pm

OrthopaedicCentre

dr Lim Yeow Wai MBBS (S'pore), MRCS (Edin), M Med (Surgery), FRCSEd (Ortho)Specialist in Orthopaedic Surgery & ConsultantRaffles Orthopaedic Centre

LIVEWELL EATSMART GETGORGEOUS SHAPEUP

8 it’s Getting porous in here Osteoporosis is the leading cause of vertebral fractures in the world and affects an estimated 200 million people around the world. We take an in-depth look at this “silent disease” and learn just how serious it is in this issue of HealthNews.

12 Love Your Skeleton

Bones play many roles within our body. We gathered some facts and myths you need to know about bone health, and how to prevent bone loss before it begins.

16 A Love Letter from Buddy Bone We explore in this story on what are some of the calcium rich foods and how you should consume them in your daily diet to keep your bones strong and healthy.

19 Baked potato with Vegetables Maintaining optimal bone health requires a complex mix of nutrients, hence calcium alone is insufficient. Here, we teach you a simple dish that you can prepare for yourself or your loved ones that can aid in calcium absorption.

22 dangerous Elegance It has been said that high heels can make a woman look and feel sexy. However, are they really worth it? HealthNews finds out the hidden dangers of wearing them and share tips to protect your feet.

25 Good posture, Why Bother? We usually wouldn’t imagine or know the kind of damage that is done to our spine until we sense the warning signals from our body. Here, HealthNews explores the reasons behind why good postures are important for your bone health.

28 Lifting Our Way to Greater health Have not been exercising for the longest time? Our physiotherapist recommends some weight-bearing exercises that not only keep you in shape, but at the same time, keeps your bones and muscles at its optimum.

4 Social Media #AskRMG Winners5 Editor’s Note6 NewsroomNew Docs on the Block | Relocation of Raffles Executive Medicine Centre and Raffles Health Screeners | Raffles Dental bring ‘smiles’ to Mister Singapore 2012 | Seminar: Tackling The Top 4 Cancers | Rebranding of IMI to RHI (Raffles Health Insurance)

20 Upclose Miss Janna Tan is a Staff Nurse at the Raffles Orthopaedic Centre. Get UpClose with her as she debunks some myths about nurses and speaks about her work experience at the centre.

33 Ask the Experts34 Marketplace

Contents19

20

8

22 28

Social Media

4 HealthNews

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Editorial Dr Emily Pwee

Writers Joanna Lee, Juliana Yeo, Edmond Loh, Jacquelyn Tan & Shazana Saini

creative Edd Chua, Jenny Cheok, Ho Yeong Shing

Advisory panel

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September #AskRMG Dr Steve Yang Ms Luah Moi Kee

My husband is keen to return to running after having 18 months off due to an ankle injury. however, it seems that his asthma is holding him back. it never used to be too much of a problem but now he complains that he seem to suffer a lot more when doing exercise.

First, he needs to establish whether he has active asthma as it appears to be not well controlled. Using an inhaler (I presume a reliever) before exercise can help but lasts only for a short time. If he already has an active asthma even before exercise, he would need inhaled steroids and not a reliever. Another possibility is that he has exercise induced asthma. This can be tested and treated...

August #AskRMG Dr Tony Tan Mr LaVon ho

hi doctor tan, how much higher is the risk associated with down syndrome when the mother is above the age of 35? does it make a difference if it is a first child or a second / third child?

When the mother is at age of 35, the risk of having a Down syndrome baby is about 1:300 (or 0.3%). This risk increases if mother’s age increases and if there is a past history of having a Down syndrome pregnancy. In general, Down syndrome babies result as random errors in the female reproductive system. That means even if one had 9 previous normal pregnancies, it does not mean that the risk of Down syndrome is reduced for the 10th pregnancy…

July #AskRMG Dr Chong Yong Yeow Mr Robin Ang

i had lower back pain months ago which i initially dismissed as just a momentarily thing. however, it gradually got worst, till to the point that I couldn’t flip myself when I am sleeping, and also i couldn’t get up from the bed without support from my arms. i also experienced muscle spasms as i am walking. Basically it felt like throbs of pain as i walk.

The most important symptom here is whether the back pain is associated with stiffness as prolonged stiffness (more than 30mins). If you’re young (less than 30) and have such symptoms, it is important to exclude an inflammatory back condition such as ankylosing spondylitis…

#AskRMG

An initiative by Raffles to bring us closer to our social media fans, #AskRMG is a monthly online chat session between our Facebook and Twitter fans and our Specialist of the Month. Every last Wednesday of the month, fans can log on to Facebook or Twitter to post questions to our specialist for a unique LIVE “1-to-all” chat. The best question gets to win shopping vouchers.

Congratulations to our winners for July, August and September!

The information contained in this publication should not be regarded as a substitute for detailed medical advice in individual cases.

All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of the publisher.

Please address all correspondence to The Editor, Raffles HealthNews, Fax no. 6311 2378

Email: healthnews@rafflesmedical.com

Raffles HealthNews is published by Raffles Medical Group Ltd585 North Bridge Road, Raffles Hospital #11-00, Singapore 188770

www.rafflesmedicalgroup.com

Printed by Xpoprint (Asia) pte Ltd

Issue 04 - November 2012

Orthopaedic Surgery Dermatology (Skin & Aesthetics)

Physiotherapy Medical Oncology Gastroenterology

Paediatrics Obstetrics & Gynaecology

Urology General Surgery

Psychiatry Ear, Nose & Throat

Cardiology

Dr Andrew DuttonDr Chris FooMr Lim Hun TeckDr Lynette NgoDr Kelvin ThiaDr Wendy SinnathambyDr Tony TanDr Lim Kok BinDr Wong Kutt SingDr Joshua KuaDr Stephen LeeDr Abdul Razakjr

Editor's Note

5HealthNews

Dear Readers, Bones are literally the support system of the body and therefore it is important to keep them strong. Although weak bones may seem like an old age problem, there is plenty that we can do early in life to make sure that our bones stay healthy.

About 22,000 Singaporean women between age 50 and 80 suffer from osteoporosis. This may manifest as hearing loss, teeth loosening and, most obviously, as fractures sustained from minor traumas. Children and young adults can effectively build up their bone mass with a good diet, and with lots of exercise. This effect typically peaks at about age 30. Therefore, our bone mass attained at this point, is our reserve against bone loss in later life.

As we age, a good diet, good health and exercise will help retard the rate of bone loss.

Our specialists share more in our Cover Story on the “silent killer”, osteoporosis and how seriously it may affect your health.

Additionally, read about how one can prevent bone loss and improve bone health through a diet with enough calcium and vitamin D, together with weight-bearing exercises that you can do every day to strengthen your bones.

Last but not least, how do you find our revamped issue thus far? Do let us know your feedback by connecting with us on Facebook and Twitter.

Remember, you are never too young or too old to improve your bone health. Start NOW!

Dr Emily PweeGuest Editor

Resident Physician Raffles HealthScreeners

NewDocs on the Block

Newsroom

6 HealthNews

Dr David Lau Pang ChengSpecialist in ENT & Consultant Raffles ENT Centre

Dr Lau has many years of experience in the management of a broad range of general ENT conditions including nasal allergy, nasal polyps, sinus disorders, nasopharyngeal cancer screening, snoring, hearing loss, dizziness, acute & chronic ear disease, and neck lumps including thyroid nodules and salivary gland disorders.

In addition, Dr Lau has a special interest in the diagnosis and management of disorders involving the throat, larynx, voice and swallowing, including sore throat and tonsillitis, chronic cough, globus pharyngeus, chronic laryngitis, irritable larynx, hoarseness, occupational voice disorders, swallowing problems, breathing difficulties and early cancers of the voice box including laser surgery. He is experienced in the field of voice surgery in Singapore including office-based laryngeal surgery, use of botulinum toxin in the larynx, surgical treatment of vocal fold paralysis, and microsurgery & laser surgery of the larynx.

Dr Lau was also a Senior Clinical Lecturer at Yong Loo Lin School of Medicine. He currently sits on the examining board of the Master of Medicine and Academy of Medicine otolaryngology examinations.

Dr David ChanSpecialist in Opthalmology & Consultant Raffles Eye Centre

Dr Chan is a fellowship trained refractive surgeon in Singapore. He also has expertise in laser and intraocular surgical techniques in the management of refractive errors (e.g. myopia, astigmatism, hyperopia and presbyopia) as well as complicated cataract conditions.

On top of this, Dr Chan has extensive surgical experience and has been invited on humanitarian missions to perform ocular surgery in centres around the region. Before joining Raffles, Dr Chan practiced ophthalmology at Singapore National Eye Centre. He has also spoken at international conferences, and has co-authored book chapters on Ophthalmology.

Dr Raymond KwahSpecialist in Dermatology & Consultant Raffles Aesthetics and Raffles Skin Centre

Dr Kwah subspecialises in aesthetic dermatology, skin cancers, Mohs micrographic surgery, hair transplant and laser surgery in addition to general dermatology. Upon completion of his specialist training in dermatology, he was awarded a one-year fellowship training in Mohs micrographic surgery, skin cancer, skin and nail apparatus surgery and reconstruction surgery and lasers at the Royal Victoria Infirmary UK.

Dr Kwah was practising as a dermatological and laser surgeon at the National Skin Centre’s Laser and Dermatologic Surgery Unit. He was also a visiting consultant at Khoo Teck Puat Hospital.

Dr Joshua Kua Specialist in Psychiatry & Consultant Raffles Counselling Centre

Dr Kua has interests in adult psychiatry (including stress, depression, anxiety and psychosis) and geriatric psychiatry (including cognitive and memory problems). He is also experienced in the field of psycho-oncology, medico-legal / forsensic issues (especially mental capacity assessment), counselling and psychotherapy.

Dr Kua has worked in various ministry-level committees such as MOH Medical Workgroup on Dementia (2004), MCYS Mental Health Workgroup on Mental Capacity Bill (2008), National Mental Health Workgroup for the Elderly, the National Dementia Network, and Medical Advisory Board of Agency for Integrated Care.

Before joining Raffles Hospital, Dr Kua was practising at the Institute of Mental Health as its Chief of Department of its Geriatric Psychiatry department.

HealthNews

Newsroom

7

Heralding in a new chapter, International Medical Insurers (IMI) undergoes a transformation into Raffles Health Insurance (RHI)

A fresh new look and location for all your Health Screening and Executive Medical needsHave you had to visit Raffles Executive Medical Centre or Raffles HealthScreeners lately? If so, you were probably surprised at the sight of an empty clinic area on level 2. We are pleased to announce the relocation of Raffles Health Screeners and Raffles Executive Medical Centre to level 12 of Raffles Hospital.

Apart from the aesthetics and feel of the new area, patients will find this move to be more convenient as regularly utilised radiological equipment now share the same premises in the new location. This means that they do not have to travel between level 2 and 12 for check-ups and can simply get everything done in one location. If you have not, be sure to drop by and check out this refreshing new space.

An afternoon with Raffles Hospital and learning about CancerThis August, the public joined Raffles Hospital doctors for an afternoon of sharing on the latest breakthroughs and treatments for cancer.

Over 700 people had registered for the Raffles Hospital and Channel News Asia Cancer Seminar: Tackling the Top 4. Participants learnt a great deal from the eight speakers who touched on the top 4 cancers in Singapore.

The feedback were positive. One participant commented, “It was a very educational talk. Thanks to all the Raffles doctors for keeping us informed and up to date. Overall, it was an excellent seminar.”

Raffles Dental helps put best smiles forward for Mister Singapore 2012This October, Raffles Dental played host and even helped further the dreams of this year’s 13 Mister Singapore 2012 finalists. The gentlemen’s teeth whitening and scaling sessions, sponsored by Raffles Dental, provided an evident boost to their confidence levels, as seen from the barrage of pearly white smiles during the visit to Raffles Hospital. The whole experience was then made complete with a talk on dental care provided by Raffles Dental’s team of dentists as well as a complimentary take-home teeth whitening kit for each of them.

28 year old Muhammad Ozzy, one of the finalists, gave us his views on teeth whitening and how he has been pleasantly surprised by it.

“Being a pageant participant, all aspects of our bodies must be in tip-top condition and our smiles are no different. Participating in this talk has really been an eye-opener and I am grateful for this opportunity.”

On 11th October 2012, Raffles Medical Group’s subsidiary insurance arm, International Medical Insurers (IMI) was officially renamed Raffles Health Insurance (RHI). This day was commemorated with the official signing-in of RHI’s first corporate client, Raffles Medical Group.

This announcement was a welcomed and timely arrival. As with an ever evolving healthcare landscape, the need for a total solution to healthcare services and financing has never been greater.

Leading Raffles Health Insurance forward in this new chapter is Mr Danny Yap, General Manager of RHI, with effect from 1st October 2012.

It’s Getting Porous In Here

8 healthNews

CoverStory

Osteoporosis is the leading cause of vertebral fractures in the world and it affects an estimated 200 million people around the world. In fact, in the six seconds that it has taken you to read this, osteoporosis would have caused another two bones somewhere in the world to break. In this issue of HealthNews, we take an in-depth look at this “silent disease” and just how serious it is.

9healthNews

CoverStory

Osteoporosis, derived from the Greek words of ostoun (bones) and poros (pore) literally means “porous bones” and that is exactly what the disease does. A disease which causes our bones to deteriorate, therefore making it porous and reducing its capability to support our body in times of daily needs. Osteoporosis is steadily on the rise and already affects 44 million of Americans in the U.S. The projected figures for Asians are similarly gloomy with an estimated 3.2 million people being affected by hip fractures annually by 2050.

Osteoporosis: The root of the problem

So how does osteoporosis occur and how do we identify it before it becomes a problem? The causes for osteoporosis are hard to pinpoint as the disease is caused by a number of factors and occurrences which can lead to the disease.

Dr Andrew Dutton, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre explained: ”Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. Calcium, which is stored in the bones, is required for proper functioning of various organs in the body such as the brain and

heart. When needed, this calcium is reabsorbed from the bone and into the blood; this explains why there is a need for bone reabsorption.”

“When a person is in his/her youth, bone formation (which requires calcium and phosphate) exceeds bone resorption. However, in a person’s later years, this is reversed and bone resorption exceeds formation. If calcium intake is insufficient during this period of time or there is a lack of calcium for the body to absorb from bones, bone production and tissues will suffer. This results in brittle and fragile bones that break easily.”

Unfortunately, this is a process which does not exhibit any symptom. Most of the time, people only realise that they are suffering from osteoporosis after they’ve experienced a bone breakage (fracture) often in their wrists or hip. This is also the reason why osteoporosis has been termed as a “silent disease”.

However, if you think that osteoporosis is simply caused by a lack of calcium intake, you would be wrong. There are several other factors which can result in osteoporosis.

Dr Stanley Liew, Specialist in Endocrinology & Consultant, Raffles Internal Medicine Centre explained:”One of the leading causes of osteoporosis is the lack of certain hormones. Particularly, estrogen for women and testosterone for men. That is why post-menopausal women are at higher risk of osteoporosis.”

It would seem that the fairer gender has it worse off when it comes to osteoporosis. Dr Carol Tan, Specialist in Geriatrics & Consultant, Raffles Internal Medicine Centre, added a little further: “Osteoporosis is more common in women than men because males usually have a larger skeleton, experience bone loss

Normal bone matrix

Bone with osteoporosis

healthNews10

CoverStory

slightly later and slower while having no normal rapid hormonal change in their lives (menopause).”

“However, this does not mean that males do not suffer from osteoporosis. As bone loss is a natural part of the ageing process, several other risk factors may still result in a male suffering from osteoporosis. Some of these include a family history of the disease, low testosterone levels and a generally inactive lifestyle.”

The risk factors of osteoporosis unfortunately do not stop here, Dr Chong Yong Yeow, Specialist in Rheumatology & Consultant, Raffles Internal Medicine Centre tells how one particular disease raises a person’s risk of suffering from osteoporosis.

“Rheumatoid arthritis (RA), which is the autoimmune disorder whereby the body attacks its own healthy cells and tissues, is also a risk factor for osteoporosis. RA patients therefore have a naturally higher risk of osteoporosis. This is further compounded when you consider the treatment for RA. This is because the glucocorticoid medication often prescribed for RA can actually trigger significant bone loss. Another reason is that the pain often caused by rheumatoid arthritis can hinder physical activity in a person. This therefore translates into lower physical activity and weaker bones subsequently.”

Osteoporosis: Realising you have it and risk factors

You’ve now learnt a bit more about the various risk factors of osteoporosis and its “silent” nature. If any of what has been mentioned so far seems to resonate personally with you, fret not. You will not have to undergo a painful fracture in your body before being diagnosed with osteoporosis.

Dr Emily Pwee, Resident Physician, Raffles HealthScreeners described one of the tests used to detect osteoporosis: “As is the usual practice, a comprehensive medical history is always initially taken from patients who come to see the doctor. After a comprehensive medical history, patients with high risk factors for developing osteoporosis are advised to determine their bone mineral status with bone densitometry test.

A bone mineral density test (BMD) is a safe and painless scan which involves the patient lying down on a soft table as a scanner passes over their spine and hip.”

BMDs calculate the amount of calcium a person has within an area of their bone. This in turn predicts one’s risk of bone fracture. BMD results are interpreted with a T score, which compares your bone density with that of a healthy young person and a Z score, which compares it with bone densities of other people your age, gender and race.

Diagnoses of osteoporosis are made based upon a person’s T score and these are measured in units of standard deviations (SDs). SDs are differences between one’s BMD and that of a healthy young adult.

The table below shows the definition of the T scores:

Level Definition

NormalBone density is within 1 SD (+1 or −1) of the young adult mean.

Low bone massBone density is between 1 and 2.5 SD below the young adult mean (−1 to −2.5 SD).

OsteoporosisBone density is 2.5 SD or more below the young adult mean (−2.5 SD or lower).

Severe (established) osteoporosis

Bone density is more than 2.5 SD below the young adult mean, and there have been one or more osteoporotic fractures.

World Health Organization Definitions Based on Bone Density Levels

11healthNews

CoverStory

Treatment, Management & Implications

Osteoporosis, despite its severity, can be well managed through a variety of methods to allow sufferers a better quality of life. Always remember “CDEF” and one would be well on their way to keeping osteoporosis in check.

C for CalciumDr Chong recommends a diet rich in calcium and vitamin D for strong and healthy bones. Calcium, a key ingredient for bone formation, can be found in dairy products such as cheese, low-fat milk and yogurt. Green vegetables such as broccoli and fish like sardines and salmon are also great sources for calcium.

D for Vitamin DVitamin D (yes that same one from the sun!) is also important for osteoporosis sufferers as it aids in the absorption of calcium into the bones. The good news for this is that your skin creates its own vitamin D when it is exposed to sunlight. If you do not spend too much time outdoors, consider eating fish, such as salmon and tuna or egg yolks.

E for Exercise“As osteoporosis is caused by our bones becoming brittle and weak, exercise is a key component to strengthening the bones. This helps to lessen the risk of falls and fractures, which can be fatal to an elderly person, especially if it occurs to the hip,” said Dr Dutton.

The best exercises for strengthening bones are those that forces the body to work against gravity. Dr Dutton recommends these following exercises: walking, stair climbing, dancing and weight-lifting.

F for the Prevention of FallsA serious and possible outcome of suffering from osteoporosis is a fall leading to a fracture in the body. The most fatal of such would definitely be a hip fracture. Dr Tan explains why it is so dangerous and what can be done to help prevent falls from occurring. “Hip fractures usually occur to older patients due to a variety of reasons, including osteoporosis. The danger lies not within the actual fracture itself. Rather, it is the long period of immobilisation which they undergo in the healing process. During this period, they can develop various complications such as bedsores, pneumonia and even hospital acquired infections. On top of this, the surgical treatment for hip fractures also has its own set of risks.

Therefore, the focus should be on preventing a fall from occurring in the first place. Some ways to do that are:

When outdoors:

- Use walking cane or walker - Wear rubber-soled shoes for

more traction - Walk on grass if the pavement

is wet

When indoors:

- Do not walk in socks, stockings or slippers

- Keep rooms free of clutter, especially on the floor

- Install grab bars in bathroom walls near the shower and toilet

- Use a non-skid bath mat in the shower or bathtub

The Extra Letter - MLast but not least, there are various medications available which can help to strengthen and promote bone formation bettering the quality of life for sufferers. Dr Liew elaborated: “As the onset of osteoporosis is usually brought about by low levels of estrogen and testosterone, there are medications available which mimic the effect of these hormones. Hormone Replacement Therapy (HRT) used to be more commonly employed as the medical treatment of choice against osteoporosis, but this has changed given the long term effects of HRT.”

Life with Osteoporosis

While there is no immediate cure in sight, doctors agree that the condition is now much more manageable than before. Dr Chong concluded: “With advances in medicine as well as greater awareness of the disease, the effects of osteoporosis can now be mitigated or even stopped if warning signs are detected early enough. With due diligence, this “silent killer” can be prevented.” HN

14 HealthNews

LiveWell

When you think about staying healthy, you would probably think about changing your lifestyle to prevent conditions like diabetes or cancer. Therefore, keeping your bones healthy to prevent bone diseases (e.g. osteoporosis) may not be on your top priority. Well, it should be!

Bones play many roles within our body – protecting organs, providing structure, storing essential minerals and anchoring muscles. Although it is particularly important to build healthy and strong bones during adolescence and childhood, we should also take the initiative during adulthood to protect and improve our bone health. Therefore, to prevent bone loss before it begins, we’ve gathered some facts and myths you need to know.

13HealthNews

LiveWell

Bone It Up

Fact : Start Building Bones EarlySkeletal mass can be seen as a retirement account. The more bone mass we have, the longer it will last into the later years. According to Dr Wendy Sinnathamby, Specialist in Paediatrics & Consultant, Raffles Children’s Centre, building bone mass begins in childhood and is particularly critical during adolescence, when nearly half of an adult bone mass is gained. “The skeleton is a dynamic organ with ongoing processes of bone resorption and formation. During the pre-pubertal and adolescent years, bone formation dominates over resorption with resulting net bone gain. More than 90% of a person’s bone mass develops before age 20, and half of that bone mass develops from age 11 to 15. Therefore, this time defines the window of opportunity for us to maximise our skeletal reserves that will last our body a lifetime,” she said.

Fact : ‘Know’ Bones About ItAccording to Dr David Wong, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre, bones may seem like hard and lifeless structures, however they are, in fact, living tissues. “Old bone is constantly broken down (i.e. resorption) by our bodies, and new

bone is deposited. Anytime a bone is broken down faster than it is deposited, bone weakness and diseases (e.g. osteoporosis, a condition that causes bones to become weak and brittle) can occur,” he said.

Bones are made from collagen and non-collagen proteins, and are fortified with calcium. Miss Janice Chong, Healthcare Executive from Raffles

Fact : Frame Size, Race and Family HistoryAccording to Dr Andrew Dutton, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre: “One is at a greater risk if he or she is extremely thin (i.e. with a body mass index of 19 or less) or has a small body frame because of lesser bone mass from which to draw from as one’s age increases.” One is

also at a greater risk of contracting osteoporosis if he/she is of an

Asian descent. Research from the Health Promotion

Board of Singapore showed that

osteoporosis has begun affecting

more Asians. Previously, the majority of osteoporotic fractures happened in the Western countries. However, due to demographic

changes and an ageing

population, it is projected that

more than 50% of all osteoporotic

fractures in the world will be in Asia by the year

2050. Dr Dutton also added that having a sibling or parent

with osteoporosis puts you at a greater risk.

Fact : Hormone LevelsEspecially in women, bone loss increases dramatically at menopause due to dropping estrogen levels. Dr Shamini Nair, Specialist in Obstetrics & Gynaecology & Consultant, Raffles Women’s Centre said: “Early menopause can predispose one to osteoporosis. There is temporary bone loss during pregnancy and breastfeeding due to hormonal changes. However, this is usually

Internal Medicine Centre said: “If a person does not consume sufficient calcium in their diet, the body will in turn extract calcium from the bones. When bone resorption exceeds new bone formation, it will result in reduced bone mass and strength. This can ultimately lead to fragile, thin bones and osteoporosis.” Even after age 20, a person can help protect his or her bones. Bone mass can still be built up till early 30s. After which, bone remodelling continues, however, one loses slightly more than you gain.

14 HealthNews

LiveWell

Separating Myths from FactsOur bones define us, supply leverage for movement and allow us to stand upright. We build bones almost until our third decade. After that, a steady loss begins, like sand slipping through an hourglass. Nonetheless, while osteoporosis has become a major public health problem, it is not inevitable. Here, we debunk some myths that are associated to bone health.

Myth : Osteoporosis is not a serious health problem compared to heart disease or cancerHaving this mindset is incorrect as osteoporosis can be a deadly health condition. Dr David Wong, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre shared: “Osteoporotic bones are at higher risk of having low impact fractures, commonly known as compression fractures. Such fractures (i.e. incidences that result from minimal trauma) can trigger a series of health problems including cardiovascular, neurological and even psychological conditions. Consequences through declined mobility resulting from fractures and pain can significantly depreciate a person’s quality of life.” Research has shown that about only 15% of elderly hip fracture victims resume their initial mobility levels and independence. Unfortunately, many will die within a year.

Myth : I experience pain in my bones and this is surely osteoporosisAbsurdly, the attack of osteoporosis is one thing you cannot feel through your bones. In your entire life, your bones are continually restructuring and dissolving; which will reach its peak strength in early adulthood. You will look and feel just fine, until an unexpected loss of height or fractures serve as an alarm.

reversible and can be minimised by taking adequate calcium and vitamin D and by doing weight bearing exercises.” In men, low testosterone levels can also cause a loss in bone mass as well.

Fact : Bone Density Scan – is there a need?According to Dr Amogh Hegde, Specialist in Diagnostic Radiology, a bone density scanning, also called dual-energy X-ray absorptiometry (DXA) is an enhanced form of X-ray technology that is used to measure bone loss. DXA is today’s established standard for measuring bone mineral density (BMD) and usually takes less than 15 minutes to complete. “DXA is often used to diagnose osteoporosis and is effective in tracking the effects of treatment for osteoporosis and other conditions that cause bone loss. The DXA test can also assess an individual’s risk for developing fractures,” he said.

Dual-energy X-ray absorptiometry (DXA) is an enhanced form of X-ray technology that is used to measure bone loss

15% of elderly hip fracture victims resume their initial mobility levels and independence;

more than 50% of all osteoporotic fractures in the world will be in Asia by the year 2050.

1. When you were born, you had over 300 bones. As you grow up, some of these bones began to fuse together and now you have 206 bones.

2. 14 bones are in your face, eight bones are in each wrist and 26 bones are in each foot including the ankle.

3. Your bones consist of 50% water and 50% solid matter.

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According to Dr Lim Yeow Wai, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre, osteoporosis is defined as a progressive systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequence increase in bone fragility and susceptibility to fracture. “The end point of treating or preventing osteoporosis is to prevent fracture. The three most common areas of fragility fracture are at the spine, wrist and hip.” he said. Favourably, doctors now can view bone density scanning as a highly reliable mechanism to foresee if one is likely to develop osteoporosis, and thereafter introduce risk-reducing treatments that can be administered early for best outcomes.

Myth : Osteoporosis – this is only an elderly problemDespite loss of height and bone fractures usually occuring in old age, 80% of osteoporosis risks are genetically based. Due to this reason, it is never too early to maintain a “bone-building” lifestyle, particularly if you have a family history of osteoporosis. Dr Emily Pwee, Resident Physician, Raffles HealthScreeners said: “To make sure that your bones are as strong and healthy as possible, ensure a sufficient supply of calcium and vitamin D through your daily diet, get an adequate amount of sunlight, conduct resistance-based exercises, avoid smoking and consuming excessive amounts of alcohol.”

Myth : Osteoporosis only occur in womenThe bones in a man’s body are generally stronger and less susceptible to fractures compared to the women’s. However, according to studies, for every four women with osteoporosis, there will be one man diagnosed with this disease. Male osteoporosis is less likely to surface at times because unlike women during menopause,

men do not experience a striking decrease in hormone levels. Dr Tony Tan, Specialist in Obstetrics & Gynaecology & Consultant, Raffles Women’s Centre said: “In women, a decrease in estrogen can cause an impact in rapid bone loss. Risks are also higher in women with cessation of menstruation due to eating disorders or early menopause.” Nonetheless, low level of estrogens and testosterones can make elderly men prone to fractures as well. In addition, men or women who have undergone hormone altering treatments for certain cancers (e.g. prostate or breast cancer) can also be at a greater osteoporosis risk, shared Dr Lynette Ngo, Medical Oncologist & Consultant, Raffles Cancer Centre.

Myth : After being diagnosed with osteoporosis, I should not exercise to prevent further fracturesRegular exercise not only prevents osteoporosis, but also decreases the

Image credit: U.S. Department of Health and Human Services. The Surgeon General’s Report on Bone Health and Osteoporosis: What It Means To You, 2012.

rate of bone loss once it has begun. Exercise is therefore necessary to improve our balance, helping us to avoid falls and strengthen our muscles. According to Mr Lim Hun Teck, Principal Physiotherapist, Raffles Physiotherapy Centre, evidence showned that exercising helps to build and maintain bone density at any age. Studies have seen bone density increase by doing regular resistance exercises, such as lifting weights two or three times a week. “This type of weight bearing exercise appears to stimulate bone formation and the retention of calcium in the bones that are bearing the load. The force of muscles pulling against bones stimulates this bone building process. So, any exercise that places force on a bone will help to strengthen it,” he said.

Love Your BonesProtecting your personal bone health is much easier than what you think. So, start taking baby steps in understanding how diet, physical activities and other lifestyle factors can affect your bone mass. Better bone health is simple to maintain and can be easily achieved. HN

Are you considered slim, sporty and often experience missing periods? Keep a watch on that. You may be suffering from Osteopenia.

Osteopenia is defined as low bone density caused by bone loss. It is often a precursor to osteoporosis, a common condition of brittle bones that can result in fractures.

The Bone Threat

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How time f lies. Looking back, we’ve been good buddies since the day you sta rted forming in

you r Mummy’s womb. We’ve gone through many ups a nd downs together. Remember that yea r

when you accidently fe ll from you r bicycle while cycling in the pa rk, a nd la nded on you r right

hip? Ouch! That hu rt me too. Thankfu lly, you have listened to you r mummy and dra nk you r

glass of milk every morning to mainta in you r ca lcium intake (Phew). Please continu e doing that,

so that we ca n enjoy doing you r favou rite activities together.

As a living stru ctu re, I experience a consta nt coordinated action by cells ca lled osteoclasts

(remova l of bone) a nd osteoblasts (deposit of bone) in the body. Ca lcium is what I need to bu ild

up my mass a nd density as I’m mainly made up of it. However, through you r bodily waste,

sweat, shedding of skin, ha ir a nd na ils, it is continuously lost. When the ca lcium level in you r

blood a nd tissu es is low, I will natu ra lly become the sou rce of this minera l to be drawn from in

order for other pa rts of the body to fu nction properly.

So, have you been eating right to make me strong a nd du rable?

Dear Me,

A Letter from BuddyBone

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Are You Absorbing Well?In the ideal situation, your body absorbs all the calcium that you consume fully. Unfortunately, this isn’t so in reality. Do you know that most adults are only able to absorb about 30 percent of ingested calcium and rarely as much as 60 percent? So, how can you better increase the amount of calcium absorbed by your body?

According to Miss Janice Chong, Healthcare Executive, Raffles Internal Medicine Centre, calcium absorption varies according to the food that we eat and it is absorbed only if it is present in an ionic form. Therefore, calcium is best absorbed when calcium-rich food is taken in a meal instead of being consumed alone. This is because calcium absorption is increased when the pH level in the duodenum (the first part of the small intestine where foods and stomach acids move to after they have been mixed) is low.

Miss Chong advised: “Calcium’s absorbability can be reduced if it is accompanied with another dietary constituent such as oxalate and

phytate. Oxalic acid (oxalate) in rhubarb, spinach, beans, berries and teas forms insoluble calcium oxalate in the digestive tract. For example, only five percent of the calcium in spinach is absorbed. So, do not take oxalate-rich food and calcium-rich food together in one meal. Instead, you should eat them separately.”

She added that Phytic acid (phytate), which is found mainly in brans and most cereals, combines with calcium to form calcium phytate is also insoluble and cannot be absorbed. These unabsorbed forms of calcium are excreted in the faeces. However, it only seems to influence those with unbalanced diet, for example high-fibre strict vegetarian diet lacking dairy products.

Dietary fibre might decrease calcium absorption. However, this may only pose as a problem for those who consume large amounts of fibre. For example, more than 30g a day, which is less likely to be achieved by most people.

Calcium alone doesn’t make strong bones. It must be combined with other nutrients such as vitamins D, K and C, protein, phosphorus and magnesium, which play their own important roles, to maintain good bone health.

“We must not forget the importance of vitamin D, which facilitates the absorption of calcium,” advised Dr Stanley Liew, Specialist in Endocrinology & Consultant, Raffles Internal Medicine Centre. “Moreover we should not only consume adequate amount of calcium-rich foods alone, but rather, coupling it with adequate vitamin D in our daily diet. If we cannot get calcium and vitamin D naturally, we should consider taking them in the form of supplements.”

What’s Recommended?The recommended daily intake of calcium for adults between 19 and 50 years old is 800mg. Dr Liew said that vitamin D can be obtained through sun exposure at sufficient intensity, and eating food such as mushrooms, eggs, and oily fish like salmon, mackerel and

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tuna. In addition, vitamin D-fortified food, such as cereal products and soymilk with added vitamin D, is now readily available in the market.

He further advised that besides getting enough nutrients for the body, one shouldn’t forget to perform weight bearing exercises to keep bones strong. Ms Chong added that doing sports such as brisk walking, jogging, climbing, rope jumping, aerobics, tennis and badminton, three to four times a week for 30 to 45 minutes each time, will help in strengthening our bones and maintain its density.

Ms Chong cautions against taking too much of the following:

• Caffeine - This can be found in coffee, tea, chocolate and cola drinks. Heavy coffee drinkers have less bone mass and suffer more calcium loss.

• Alcohol - Take alcoholic drinks in moderation. It reduces bone formation and disrupts body’s ability to absorb calcium.

• Smoking - It increases the risk of fracture and contributes to osteoporosis. HN

Food Serving Size Calcium Content (mg)

Dairy products

High-calcium milk powderLow-fat milkFull-cream milkLow-fat yoghurtLow-fat cheese*

4 scoops (25g)1 glass (250ml)1 glass (250ml)1 carton (150g)1 slice (20g)

500380300240200

Non-dairy foods

Canned sardine (with bones)Dried ikanbilis (with bones)Silken tofuTau kwaDhal (raw)Baked beans, canned*Kai lan, cookedSpinach, cookedChye sim, cookedBroccoli, cooked

1 fish (80g)2 tablespoons (40g)package (150g)1 small cake (90g)mug (50g)can (210g)mug (100g)mug (100g)mug (100g)mug (100g)

2702701001508511019514014050

Calcium-fortified productsHigh-calcium soybean milkEnriched breadCalcuim-fortified orange juice

1 glass (250ml)2 slices (60g)1 serving (240 ml)

450100350

Here is a list of calcium-rich foods that you should include in your daily diet.

*Item may be high in saltSource: Health Promotion Board

So buddy, if you want to mainta in good bone

hea lth, eating smart is key. And you ca n cou nt

on me to remain strong in you for a long time.

With love, Buddy Bone

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Baked Potato with Vegetables

Ingredients (4 servings)- 6 medium-sized potatoes- ½ teaspoon salt- ½ teaspoon pepper- ½ heat broccoli (cut into florets)- 1 cup cauliflower (cut into florets)- 1 small red pepper (cut into finger slices)- ½ cup eggplants (slice into strips)- ½ medium carrot (cut into cubes)- 1 tablespoon of sesame seeds- 1 handful of sliced almonds- 3 tablespoons of olive oil

Preparation time: 15 minutes

Cooking time: 60 minutes

Methods1. Preheat the oven to 400°F. Wash and scrub the potatoes

under tap water. Cut out any eyes or bruises on potatoes. 2. Cut potatoes into half and rub with olive oil, then with salt

and pepper.3. Place the potatoes in the preheated oven at 350°F for about

45 to 60 minutes or until it is done. When cooked, the potatoes should be golden-brown on the outside and very soft on the inside. You should be able to pierce through easily.

3. Meanwhile, wash the broccoli, cauliflower, red pepper, eggplant and carrot.

4. Heat water in saucepan to a boil. Place vegetables in the steaming basket and steam for about 10 minutes. Put in the saucepan until the potatoes are done.

5. When potatoes are done, put them on to a plate.6. Heat up olive oil in a small saucepan. Stir fry steamed

vegetables for about one minute. Arrange vegetables on the side of plate. Sprinkle with sesame seeds and sliced almonds for garnishing.

Maintaining optimal bone health requires a complex mix of nutrients, hence calcium alone is insufficient. The baked potato in this dish contains vitamin C and magnesium which makes it beneficial for people who have brittle bones as it aids in calcium absorption. With the regular consumption of baked potatoes, it can slow down the onset of osteoporosis. Potato is also a rich source of phosphorus as it is integral for bone building.

Nutritional informationcalories: 1458kcalcarbohydrates: 246.6gproteins: 34.6gFats: 37g

- Bake the potato instead of frying or boiling, as high

temperature will destroy the nutrients within.

- Use less oil when cooking.

- Remember to poke a few holes in the potatoes during

the baking process.

Cooking Tips:

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UpClose with Miss Janna Tan Shue Yin

Staff Nurse | Raffles Orthopaedic Centre

You may remember nurses as ‘fierce’ and some others who claim them to be more ‘powerful’ than doctors. Some might remember the name ‘mee-see’ or have ‘memorable’ encounters with them. Are they truly what you’ve been hearing? Here, we get up close with staff nurse Janna Tan as she debunks retain myths about nurses and speaks about her working experience at the Raffles Orthopaedic Centre.

PHOTO BY EDD CHUA

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Finally, we managed to steal some time away and hide out in one of the consultation rooms in the Orthopaedic Centre for an interview. Entering into the room we were greeted by a sea of documents, hence we decided to sit away from the table just in case we mess up her case notes. “So sorry to keep you waiting, the last consultation was longer than expected. Every consultation is unique and requires different attention; we cannot promise that the time can be observed even with the scheduled appointment.” She further explained that a patient could complain about pain at the back but the cause of it could range from a benign or chronic pain to a malignant or spinal problem. Hence, each patient has to undergo thorough assessment even if patients come ready with their x-ray films.

Prior to registering as a patient at the centre, Janna shares that care and assistance would already be given. “We want to assist them as best as we can. We understand how patients feel. When you are unwell, the very last thing you want is unhelpful and nonchalant nurses.” This is Janna, going the extra mile for her patients and giving them all the care (and even more than what) they require.

Gone were the days of fierce nurses. Do you reckon nurses function very differently in the past? Are patients still very afraid of nurses now?Fierce? I guessed the right word should be assertive. Perhaps the only time we are assertive is when patients instruct us on how we should dress their wounds. Patients should be assured that we have no intention to ‘torture’ them as we know what we are doing and what needs to be done for them to get better.

To be honest, as busy as we get, we never allow ourselves to ‘lose it’. No matter how many nasty patients I encounter, they don’t affect my day. To me, I understand that patients just want to be attended to quickly. So I

will go to them before they come to me, (haha) that’s my secret! I will be proactive and assist them. Basically, we want to seek their understanding. Like I said previously, we can never tell whether the consultation needs a longer time. There was once, a patient was too early for his appointment and the day’s appointments were very much delayed. Immediately I sought his understanding and told him to go to the cafe downstairs for a bite.

while her mum was in Indonesia. She would take a plane to Indonesia to fetch her mum to come over to Singapore for follow ups every three months. As it was really tiring for her, the doctors advised her to find other specialists in the States. However, she refused as she said that she would not be able to find nurses who are so committed to their patients. Through this, it reminded me of why I chose to be a nurse and I felt very satisfied.

Are there any other centres that you work closely with?Yes, Raffles HealthScreeners and… Physiotherapy Centre! Physiotherapy Centre is like our wife. They help our patients to recover after surgery. We essentially function like a couple - husband can’t do without the wife.

We understand that foreign workers often come and seek treatment here, so how do you communicate with them?Oh you mean the ‘brothers’? We call them ‘brothers’ because they call us ‘sisters’.☺As there’s language barrier, it maybe a little tough communicating with them but we still go the extra mile. We usually keep it to the point, it’s going to sound funny, “Paining, many? Or paining, small?” They respond better that way so it helped both the doctors and nurses to understand how they felt and prevented the doctors from giving the wrong diagnosis.

Lastly, if you could change something in Raffles Orthopaedic Centre, what would it be? Currently, I think our team is doing a great job but there’s always room for improvement. Personally, I would like to continue to give our patients with the best care experience in that short time that we have with them, making every encounter they have with us counts. HN

Right, so what were you working as before this and what made you decide to join Raffles?I was working as a cardiac scrub nurse for five years at a major operating theatre. As I wanted to learn about patient care from a holistic approach, i.e. starting from admission, I joined Raffles. Also, orthopaedic patients usually need to be followed by Physiotherapists during their post-surgery, so patients do not have to be referred all around Singapore as Raffles offers seamless service.

What’s the main difference of working here as compared to working as an OT nurse?In the beginning, it was challenging for me as the doctors here are very senior and they have a different school of thought. It’s literally old vs new school! Besides that, as an OT nurse, I was attached to one surgeon and only required to handle one case at a time. Whereas here, we work as a unit and I’m required to attend to several different patients with different cases seeing different doctors. What’s more, every doctor has his likes and dislikes. Hence, it was tough adapting to the change. But that was INITIALLY. I grew to enjoy it after understanding the working styles of each doctor.

Can you tell us one of the most fulfilling times you’ve experienced so far?Let me recall… Yes! There’s a particular patient who was staying in the States

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The Love Hate Relationship

with High Heeled Shoes

Dangerous elegance:

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Yes… the men don’t get it. Women feel especially good and attractive when they wear heels as it accentuates their curves at the right place by changing their posture, making them taller and slimmer i.e. having longer and toned legs. By elongating the legs, it makes the calves appear more shapely and it changes the centre of gravity from the heel to the ball of the feet therefore, forcing the butt and chest out for balance. This not only boosts women’s self-confidence but it also makes them look more attractive to men.

It probably comes as no surprise that the same pair of high heels forces your back to arch and make the muscles in your back work overtime. This can leave the spine subject to injury or damage as it can significantly affect your natural posture and your spine. The muscles that support the lower back can become strained and cause aching or pain to arise. The common complaints that women have about back pains are largely caused by wearing high heel shoes.

According to Dr David Wong, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre, putting your foot into a high heeled shoe can have detrimental consequences on the overall health of your feet. High heel shoes place the heels unnaturally high above the toes and throw the whole body (knees, hips and back) totally out of alignment. In the long run, it can cause severe lower back pain and knee arthritis. This is when the spinal nerves can become pinched and pain, tingling and numb.

When the heel is constantly elevated, the entire weight of the body will be directed onto the ball of your foot, this can be especially dangerous for those who are overweight, causing the ball of your foot to experience additional pressure. The joint cartilage, which

cushions the bones and allows the knee to move and bend, wears away. When bones rub against each other, it causes inflammation, resulting in pain and swelling in the joints. In addition, the calf muscle and Achilles tendon can contract and shorten which increases the chances of Achilles tendinitis or shin splints. How sexy!

Dr Wong added: “Habitual wearing of extremely high heels can cause a woman to be intolerant of wearing flat shoes. High heels, especially

High heeled shoes have been a part of women’s fashion for many years and they can accentuate a good outfit. It has been said that high heels can make a woman look and feel sexy. But, are they really worth it? Read on to find out the hidden dangers of wearing heels and some tips to protect our feet when wearing them.

73% of Singaporeans are at risk of having knee osteoarthritis* because of certain lifestyle habits.

About 50% of Singaporeans have been or are affected by chronic knee pain.

Nine out of 10 women are wearing shoes that are too small for their feet.

Eight out of 10 women say that their shoes are painful.

More than seven out of 10 women developed a bunion, hammertoe, or painful foot deformity.

Women are nine times more likely to develop a foot problem because of improper fitting shoes than a man.

Nine out of 10 women’s foot deformities can be attributed to tight shoes.

Dancing in heels—no matter the height—triple the amount of pressure on the toes.

*Osteoarthritis is a disorder affecting the joints of the skeleton, and it is a degenerative condition that it is likely to worsen over time.

If wearing high heels are uncomfortable and they make walking difficult, THEN WHY IN THE WORLD DO WOMEN KEEP WEARING THEM?

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stilettos and Lady Gaga type of shoes, will cause overall imbalance and instability when walking, and it increases the risk of ankle sprains. On top of that, the tight fit of many heels will force the toes to conform to its shape. This added pressure on the toes can exacerbate bunions and hammertoes.” The long term risk include a permanent shortening of the Achilles tendon that runs up the back of the lower leg as constant wearing of high heels encourages the tendon to assume this shortened position permanently. Furthermore, Dr Wong said: “The compression of the

Although this is serious and shouldn’t be taken lightly, we know you still love wearing your high heels, so we won’t even try to get you sneakers. The key is to be selective in the types of shoes you wear and how often you wear them. Here are some tips to protect your feet.

1 �Get�the�best-fitting� high�heel�possible

Dr Wong said: “High heels that don’t fit properly will cause the front of the foot to slide forward, creating more pressure and pain on the toes.” Look for narrow heels with a snug but not tight fit to correct the problem. To avoid toe injury and pain all together, pay attention to the shape of your shoes; square boxed heels will allow your feet to sit more naturally than in pointed ones. While some 4-inch heels will give you a straight drop down to the flatbed portion of the shoe, others will be a more gradual slope. This may be easier on the arch and may help relieve some pain in the ball of the foot. Physiotherapist, Miss Lucie Jessica Lamprey, Raffles Physiotherapy Centre, added: “Wedges are preferred as they provide more stability for the foot and less likely to injure as compared to stilettos and thin heels. Strapped heels are also better as it puts less pressure on your toes.”

2 Cushion,�cushion,�cushion

While soft insoles can give a little more support and cushioning for the foot and heel, if you feel pain in the ball of the foot or you will be standing in your heels a long time, invest in silicone metatarsal pads. They look like flattened gummy bears, but they do a super job of shock absorption.

3 Choose�a�thicker� heel�for�stability“It is safer to use platform shoes or thicker heels of about two inches as it allows more comfort and it provides more stability,” Dr Wong advised. A thicker heel will give you better balance and may help relieve some pressure by distributing the weight on your foot more evenly. Alternating heel heights can also help reduce problems with the Achilles tendon. According to Miss Lamprey, reducing the use of heels by wearing a pair of flats to travel to work, and slipping on heels when in the office is recommended. As rushing around in heels can become uncomfortable very quickly, use high heels for special occasions rather than on a regular or daily basis. Carrying a pair of flat comfortable shoes with you to change into after hours of wearing heels also helps. Using them less frequently will reduce the long-term effects of high heels.

metatarsal bones can cause pressure on the nerves that run between them.”

A Morton’s neuroma, which is a growth and inflammation of the nerve, can form due to pressure. The toenails are not spared either. Toenails are also at risk from wearing high heels as the incidence of ingrown toenails and nail infections is higher in heel wearers than those who do not wear them as often. Ingrown toenails can be very painful, unsightly and require surgery to correct.

4 �Wear�open-toe�high�heels�to�relieve�pressure�on�corns� and�calluses�

See a podiatrist to have corns and calluses professionally removed, and correct the problem that’s causing them. But if that’s not possible, opt for open-toe shoes to take pressure off inflamed areas.

5 Be�sure�to�stretch�Not only good for preventing

osteoporosis, exercise is essential in maintaining general functions in the body. Miss Lamprey said: “By doing weight-bearing exercises, minerals in bones will have to work harder, and over time, it will become stronger. Hence, allow your calf to stretch when you are sitting at your desk.” Doing poses such as high and low lunge and standing forward fold will stretch your calves, hip flexors and hamstring muscles. Taking part in resistance exercise helps to strengthen the muscles and ligaments that support the skeleton, which in turn will help to strengthen the bones. These exercises will especially benefit older generations who may not be able to participate frequently in weight-bearing or high impact activities. HN

Protect Your Feet When Wearing High HeelsTips

bunions

hammertoes

ingrown toenails

Posture, Why Bother?

Good

It is absolutely good advice when your mother told you not to slouch in your chair and hunch your back when you walk. We usually wouldn’t imagine or know the kind of damage that is done to our spine until we experience the warning signals from our body. So, why bother with good posture?

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• Place your weight mostly on the balls of the feet, and not on the heels.

• Do not lock your knees.• Avoid over-extending your neck.

Tuck your chin in a little to keep your head level.

• Imagine a plumb line running through your ear and all the way down to the front of your shoulders, middle of your hip and knee, and in front of the bone outside your ankle.

• Stand straight and tall with your shoulders upright and relaxed.

• Let your arms hang naturally by the sides of your body.

• If you’re standing for a long period of time, shift weight from one foot to the other, or rock from heels to toes.

• Test yourself by standing against a wall with your shoulders and bottom touching wall. In this position, the back of your head should also be touching the wall.

Sitting PostureFor those of us who have a deskbound job that requires us to sit for hours every day in front of a computer screen. Check to see if you are already doing the following:

• Ensure your hips and back are placed snugly against the backrest of the office chair. Avoid slouching or leaning forward, especially after sitting for a long period of time.

• When sitting at a desk, your arms should be flexed to a 75 to 90 degree angle at the elbows. If this is not the case, the office chair should be adjusted accordingly.

• Your legs should be placed approximately 90 degrees to the floor. If they are not, try placing your feet on a footrest.

• Ensure that your shoulders are straight when seated.

Dr David Wong, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre highlighted that prolonged sitting even with good posture can be harmful to your health. “Scientists at the University of Missouri have found that the act of sitting seems to shut off the circulation

There are many benefits to staying in the right posture. By looking at your posture alone, it can send out either a positive or negative message about yourself to others. And did you know that poor postures take a serious toll on your spine, shoulders, hips, and knees? In fact, it can reduce your flexibility, compromise your muscles, limit your ability to build strength and burn fat; worst of all - leading to back and joint pain.

Mr Lim Hun Teck, Principal Physiotherapist, Raffles Physiotherapy Centre, would like to share with you on what to look out for in each of the following postures. Start checking the mirror to see if your body is in the correct alignment.

Standing PostureThis is something that we almost never thought about as it is so natural to us. Pause, look at yourself in the mirror and feel the pressure on your feet. Which part of your feet are you resting most of your body weight on?

Consider these points:

• Keep your feet about shoulder-width apart.

of a fat-absorbing enzyme called lipase. They found that standing up engages muscles and promotes the distribution of lipase, which prompts the body to process fat and cholesterol, independent of the amount of time spent exercising. They also found that standing up uses blood glucose and may discourage the development of diabetes,” said Dr Wong.

He added that clerical workers who use a computer for extended periods are at greater risk of upper extremity and neck pain, especially on the side where the mouse is used.

Therefore, take one or two walking or standing breaks for every hour of sitting to reduce the health risk of prolonged sitting.

Scan this QR codeto watch a video about office ergonomics.

Benefits of a Good PostureIn general, Dr Wong lists the following benefits of having a good posture.

• You reduce the abnormal wear on your joint surfaces that can eventually lead to arthritis.

• Less stress is placed on the ligaments that hold the joints of the spine securely together.

• Your muscles can work correctly and efficiently when you keep your joints and bones in good alignment. This also helps to prevents fatigue.

• The chances of muscle pains, backaches and strain are reduced.• It makes you look good. HN

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• Avoid pushing your head forward.• Ensure that your shoulders are

properly aligned with the rest of the body.

Driving Posture• Drivers, do you consider the way

you sit when driving? Read the tips below:

• Sit with your back firmly against the seat for proper back support.

• The seat should be adjusted to a comfortable distance from the pedals and steering wheel to avoid overly leaning forward.

• The purpose of the headrest is to support the middle of the head by keeping it upright. Try tilting the headrest forward if possible to ensure that the head-to-headrest distance is not more than four inches.

Dr Wong warned: “Studies have shown that drivers of trucks and public transport vehicles are at a greater risk of lower back and neck pain syndromes as well as other musculoskeletal disorders as compared to clerical workers, partly because of their poor sitting posture and lack of breaks.”

Sleeping Posture with Mattresses and PillowsWe spend about one-third everyday in bed. Good quality of sleep is also affected by what you sleep on. Do you ensure that your sleeping posture is right with the support of a good pillow and mattress? Take note of the following for quality sleep:

• A relatively firm mattress is generally the best choice for proper back support, even though this is subjective and up to individual preference.

• Use a pillow to provide proper support and alignment for the head and shoulders.

• Sleeping on the side or back is usually more comfortable for your back than sleeping on the stomach.

• Place a rolled-up towel under the neck and a pillow under the knees to better support the spine.

• If you prefer sleeping on the side, place a relatively flat pillow between the legs as this helps in keeping the spine aligned and straight.

Postures for Lifting and Carrying Heavy ObjectsWe need to lift heavy objects off the ground from time to time and most of us tend to do it wrongly, leading to injuries on our lower back. Here is how to protect yourself:

• Always bend at the knees and not at the waist.

• Pull the object close to you, when bending your knees, before lifting it up.

• When carrying a heavy or large object, keep it close to your chest.

• Use the larger muscles of the leg and stomach for lifting, not your lower back.

• Switch from one arm to another frequently if you need to carry the object with one arm.

• When carrying a backpack, avoid leaning forward or rounding the shoulders. Balance the weight on both sides of the shoulders as much as possible. If the weight is over bearing, consider using a rolling backpack with wheels.

• If necessary, get a supportive belt to help maintain good posture while lifting.

Walking PostureCheck if you’re standing tall and walking with the right posture:

• Keep your head up and eyes looking straight ahead.

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Remember how our mothers would constantly remind us to drink milk in order to have healthy bones? True enough, calcium intake, be it via food or supplements, is a great way to maintain our bone health. However, even though popping pills seem like the easiest way out, is there any other way for us to keep our bones at its optimum?

In this issue, we uncover the benefits of weight bearing exercises to our bone health. So what are you waiting for? Suit up and work that body!

Weight bearing exercises refer to any activity, that work our muscles and bones against gravity while on our feet and legs. These activities include brisk walking, yoga, dancing and strength training.

In this section, we focus on weight training. Research has shown that weight training or resistance training can help strengthen our bones, improve our balance and help us lose weight. Weight training is not just for bodybuilders lifting weights in a gym. In fact, it can benefit people of all ages. So kick that common misconceptions and revel in the benefits of weight training!

Lifting Our Way to Greater Health!

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Benefits of Weight Training ExercisesBetter, Faster, Stronger!As we grow stronger after several weight training routines, we will feel more energetic and would not tire as easily. Studies have shown that exercise, be it in the form of weight bearing or not, decreases depression and anxiety as well as boosts self esteem. Weight training is also known to reduce stress and release hormones that may improve our sleep.

Develops Better Body MechanicsWeight training not only keeps our muscles toned and our bone health at its optimum, it also improves our balance, coordination and posture. Studies have also shown that for those with poor balance, weight training would help to reduce our risk of falling. This is a crucial benefit, especially when we get older.

Many of us may think that weight lifting is simply just, well, lifting. However, there are certain guidelines that we should follow in order to fully reap in the benefits of weight training.Below are some tips for an enjoyable and safe workout:

• Warm up and cool down before each exercise routine

• Keep the back straight when lifting to prevent any risk of injuries

• Gauge your own ability. Do not lift more than you know you can lift safely

• Do not continue to lift when feeling unwell

Safety First!

Increases Bone Density and Muscle MassAccording to Dr David Wong, Specialist in Orthopaedic Surgery & Consultant, Raffles Orthopaedic Centre, the amount of bone tissue in the skeleton, known as bone mass, can keep growing until around age 30. At that point, our bones have reached their maximum strength and density, otherwise known as peak bone mass. Our bone mass will start to decrease after that.

That being said, studies have also shown that we lose about one percent of our bone and muscle strength every day. This is more prevalent as we age. When we cultivate weight bearing activities as a regular part of our weekly exercise routine, we are actually slowing down the loss of bone density. This can help us to remain active and independent further into old age, as well as help reducing our risks for bone related diseases, such as osteoporosis.

Reduce Risk of InjuriesDr Wong agreed that when we do weight training, we are not only working out our muscles, but also our ligaments and tendons that are connecting our bones, muscles and other tissues. Thus, this reduces our chances of injuring ourselves when we participate in physical activities.

Tones Our Muscles and Aids in Weight LossGood news for the ladies! Weight training exercises actually help to tone our muscles and control our weight. When we gain muscle mass, our body burns calories more efficiently, eventually leading to weight loss. The more toned our muscles are, the easier it is for us to maintain and manage our weight. In addition, weight training will eventually help to increase our stamina. Also, from an aesthetic point of view, toned muscles look nice and boosts our self-confidence.

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tart Lifting!

The next time you hit the gym for a workout session, do include weight lifting as part of your routine. Ms Lucie Lamprey, Physiotherapist, Raffles Physiotherapy recommends the following exercises that not only keeps you in shape, but at the same time keeps your bones and muscles at its optimum.It is now time to suit up, grab that dumbbell and working our way out to a greater health!

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Tip: Do the following exercises in front of a mirror so that you can monitor your posture. For those with a personal trainer, it is best to get him or her to evaluate your technique.

Standing Bicep CurlTo do this, begin by standing straight. Ensure that you do not lock your knees. This is to prevent unnecessary stress on the joints, thus reducing the risk of injuries.

1 Hold a dumbbell on your hand along the side of your body, palm facing your leg. 2 To get your muscles working, curl in the dumbbell by bending your elbow so that your palm is now facing your shoulder. Be sure to maintain your elbow and shoulder at the same place without any sudden movements. Bring the dumbbell back to the starting position.

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Reverse LungeNow that you have worked your arms out, it is time to work those legs! In this move, always remember to keep your upper body steady throughout.

1 Stand up and hold a dumbbell on each hand along the sides of your body, with your palms facing your body. 2 Step backwards and bend your knees in order to bring down your body until your knees form a 90 degree angle. Raise yourself back up after a short pause.

Dead LiftThis is one of the most beneficial strength building exercises as it affects a wide range of skeletal muscle groups in one functional movement.

1 Stand up and grab a dumbbell with each of your hand. 2 Flex your knees and hips. 3 Lower the dumbbells straight down and raise yourself back up after a short pause.

Do remember to breathe in when lowering the weight and breathe out when returning to the starting position. HN

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Osteoporosis is a hot topic for many women and men as they age. Understanding the disease and the risk of getting osteoporosis is the first step in slowing bone loss and preventing deterioration. Older men and women are at a greater risk of fracturing their wrists, hips, or spine when they trip or fall. The broken bones that result can cause loss of mobility and may even lead to death.

Unfortunately, most people have no obvious symptoms of osteoporosis until the disease progresses to more advanced stages. For this reason, osteoporosis is often referred to as a “silent” disease. When you’re diagnosed with osteoporosis, it is only natural to wonder if there is anything you can do to help or maintain your bone health. Fortunately, the answer is yes. The moment you leave the doctor’s office, you can start making smarter food choices that will benefit your bone health.

Here are some simple dietary recommendations for better bones:

1) MilkCalcium is the cornerstone of strong bones. Adults up to age 50 need 1,000 milligrams per day. However, at age 51, men and women need 1,200 milligrams every day. The pop star of calcium sources is undoubtedly milk. A single eight-ounce cup of milk, whether skimmed, low-fat, or whole, contains 300 milligrams of calcium.

2) Calcium SupplementsGet your recommended daily dose of calcium. Calcium is key to maintaining healthy bones. Eating supplements is an easy way to boost your calcium intake. Some calcium supplements, such as calcium carbonate, are better absorbed if taken with meals. Adults should aim for 1,000 milligrams (mg) of calcium per day, but if you are over age 50, you need 1,200 mg of calcium every day.

3) Yoghurt and CheeseNot a milk drinker? A cup of yogurt has about as much calcium as an eight-ounce cup of milk. And one ounce of Swiss cheese has nearly as much. Even if you’re lactose intolerant, yoghurt and hard cheeses are low in lactose.

4) Nuts and SeedsNuts and seeds can bolster bone health in several ways. Walnuts and flaxseeds are packed with omega-3 fatty acids. Peanuts and almonds

Simple Tipsfor Better Bones

contain potassium, which protects against the loss of calcium in urine. Nuts also contain protein and other nutrients that play a supportive role in building strong bones.

5) Reduce Salt IntakeSalt is a major culprit in depriving the body of calcium. The more salt you eat, the more calcium gets carried away by urine. Sticking to a low-salt diet can help you retain more calcium to strengthen your bones.

6) GreensYou might be surprised to learn that calcium is plentiful in many vegetables. Go for dark leafy greens such as bok choy, Chinese cabbage, and kale. The traditional soul food favorites, collard and turnip greens, offer a lot of calcium, too. One cup of chopped, cooked turnip greens has about 200 milligrams of calcium.

7) Weight-Bearing ExerciseTo get the most out of your bone-boosting diet, you might consider doing regular weight-bearing exercises. This includes any activity that uses the weight of your body or external weights to stress the bones and muscles. The result is that your body lays down more bone material, and your bones become denser. Brisk walking, dancing, tennis, and yoga have all shown to benefit your bones.

Raffles Women’s Calcium 50’s(U.P. $50.80 for 2 bottles)

Now: $35.90 for 2 bottles (29.33%)

Raffles Bone Calcium 60’s(U.P. $39.80 for 2 bottles)

Now: $28.00 for 2 bottles (29.64%)

How do you know when you have sprained

your joint or torn a ligament, and what are the signs and symptoms? More

importantly, what should you do to give your joint first aid

before going to a doctor, (if neccessary)?

What are some ways that people who are suffering

from osteoarthritis still do exercises and sports activities that reduces the pain brought about

by the disorder?

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You may hear or feel a snap or “pop” during the injury. Subsequently it may become sore and swollen. A bruise may also develop in the area. However it is not uncommon to develop ache or pain some four to five hours after the injury or activity. The trauma may be not be significant enough to result in a complete tear of the ligament or tendons, but it may result in a partial tear. As the inflammation sets in, so will the pain. This will usually manifest about four – five hours later.

The immediate treatment for any injured joint is RICE. The acronym stands for Rest, Ice, Compression and Elevation. In the acute event, it is important to immobilise the joint and compress it with ice. The cold temperature helps to constrict the blood vessels around the joint so as to check the inflammation process. Ice it for 20 mins every two hours. Elevation also helps to bring down the swelling in the joint, hence reducing the discomfort.

Exercise provides a good deal of relief for those who suffer from the osteoarthritis and also helps prevent further deterioration.

The aim of exercise is to reduce pain and disability by strengthening muscle, improving joint stability, increasing the range of movement and improving aerobic fitness. This allows for less load bearing on the joint, which reduces pain and inflammation.

Osteoarthritis (OA) at different sites requires different approaches. Thus, an individual exercise programme should be formulated with the patient in consultation with a doctor or physiotherapist.

Although there is no evidence available from well-designed trials to support the efficacy of walking sticks in OA, they are widely recommended. Patients should be encouraged to wear shock-absorbing footwear with good support and adequate arch support.

dr Lim Yeow WaiSpecialist in Orthopaedic Surgery & Consultant Raffles Orthopaedic Centre

Mr Lim hun teckPrincipal PhysiotherapistRaffles Physiotherapy Centre

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According to Traditional Chinese Medicine theory, pain can be caused by “Qi” and blood stagnation, dampness-cold obstruction in the meridians and kidney deficiency. A combination of acupuncture, acupressure and herbal medicine can restore the above imbalances to promote natural healing.

World Health Organization recognises the use of acupuncture for more than 70 types of conditions, including acute spine pain, neck and back pain, rheumatoid arthritis, sciatica and temporo-mandibular joint dysfunction.

Arthritis ManagementFor managing inflammation due to osteoarthritis, rheumatoid arthritis and other damages to the joints.

• 6 acupuncture sessions $321

Spine and Joint Pain ManagementFor relief of pain due to scoliosis, osteoporosis, facet disease, and other spine and joint conditions.

• 6 acupuncture sessions $321

Slipped Disc and SpondylosisFor relief of pain due to spondylosis, herniated disc, and sciatica.

• 6 acupuncture sessions $385.20

Option of Herbal Medicine at $10.70 and above per day.

For enquiries or to make an appointment, please call 6311 2388/2322 or email specialist@raffleshospital.com

* All package prices are inclusive of GST. * Other terms and conditions apply. Please call for more details.

For enquiries or to make an appointment, please call 6311 2388/2322 or email specialist@raffleshospital.com

* All package prices are inclusive of GST. * Other terms and conditions apply. Please call for more details.

Your TCM Specialist Centre

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Skin allergies commonly show up as symptoms of red itchy rashes, eczema and hives (urticaria). Apart from causing discomfort or itchiness, the symptoms may be unsightly and become the cause of social embarrassment and inconvenience.

Early detection and correct diagnosis of the cause of your skin allergy will help you in receiving the appropriate treatment and control the symptoms and appearance of your skin.

Skin Allergy Screening PackagesEach package comprises a skin prick test as well as blood tests for the allergens listed.

Optional tests for additional allergens that are not listed here are also available.

Inhalant Allergy Packages Package A $529.65* / Package B $631.30*

Food Allergy Packages Package A $577.80* / Package B $738.30*

Children Food Allergy Package $395.90*

Seafood Allergy Package $401.25*

Skin Allergy Screening Identifying the causes of your allergies

Muscle Pain Screening Package @$428Package includes:1. Specialist consultation2. Physical assessment3. Blood test: Full Blood Count, Thyroid Function Test,

Rheumatoid Factor, Creatinine Kinase, Erythrocyte Sedimentation rate, Serum Iron, Vitamin D, 25-hydroxy and Vitamin B-12.

4. Review consultation with specialist

For more information or to make an appointment, please call 6311 2310 or email enquiries@raffleshospital.com

* Price is inclusive of GST. * Package excludes medications, radiological investigations

and additional blood tests recommended by a specialist.

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For enquiries or to make an appointment, please call 6311 1140 or email specialist@rafflesmedical.com* Terms and conditions apply.** For Singaporean and Permanent Resident.

Early ScreeningEarly ScreeningEarly Cancer DetectionEarly Cancer Detection

Colorectal cancer is the commonest cancer among men in Singapore, and second commonest cancer among women.

Polyps in the colon and rectum are common among individuals 50 years and above, and show no symptoms. A screening colonoscopy can help save your life by detecting polyps so that they can be removed before they turn cancerous.

For peace of mind, you may either choose to do a screening colonoscopy on its own, or screening colonoscopy and screening gastroscopy in a single session.

A screening gastroscopy can diagnose conditions such as gastritis, stomach and esophagus cancers, as well as conditions associated with abdominal pain and bleeding.

With or without a family history of cancer, a screening colonoscopy and screening gastroscopy are recommend for those above 50 years of age.

Screening Packages Package Prices * (Include GST)

Colonoscopy $1,250Gastroscopy $642Colonoscopy & Gastroscopy $1,600

covers all the procedures

in fullMedisave **

Put Your Health In Good Hands

Raffles Hospital One-Stop Tertiary Hospital in the Heart of the CityRaffles Hospital offers 24-hour emergency care and executive health screening services. Its 21 specialist clinics provide services in Aesthetics, Cancer, Counselling, Paediatrics, Dental, ENT, Eye, Heart, Internal Medicine, Neuroscience, Obstetrics & Gynaecology, Orthopaedics, Skin, and General Surgery, as well as Japanese Clinic and Traditional Chinese Medicine.

Raffles Medical Clinics There’s One Near YouFor 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 BasicsFor 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.comwww.rafflesmedicalgroup.com

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