中文由第27页起

A H E A LT H I E R , H A P P I E R L I F E

MY GP ANSWERS Our General Practitioners talk about acute gout and nosebleed

WHAT IS COPD? The respiratory disease you’ve never heard of

ALL ABOUT THE SWEET KILLER What you need to know about diabetes

CGH Dietetic and Food Services team creates tasty, ready-to-eat foods for patients with dysphagia

NOV−DEC 2016 Changi General H o spi t al Magazine

MEALSTEXTURE-MODIFIED

EDITOR’S NOTE

Supervising Editor Lim Ee GuanEditor Cherry LuiContributorsJean AngusNg Ming ChuenTranslatorsYip LaimeiAlan Li Photographer Andy HoDesign & Production Publicitas ContentEmail: yourcontent@publicitas.comMedia Specialist: Mey LeongEmail: mey.leong@publicitas.com Materials: Doreen LauEmail: doreen.lau@publicitas.com

Go Green!This publication is printed on paper produced by an environmentally friendly mill with pulp obtained from sustainable forests.

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is also available online at www.cgh.com.sg/CARING

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is published bi-monthly for Changi General Hospital by Publicitas Content

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MCI (P) 051/01/2016. Company registration number: 198904226R. All rights reserved. Copyright © 2016. No part of this publication can be reproduced in any form or by any means without the permission of the publisher. The views and opinions expressed or implied in are those of the authors or contributors and do not necessarily reflect those of the publisher.

USEFUL NUMBERS

Pharmacy enquiries 1800 787 8787

Feedback 1800 850 2823

Appointments and general enquiries 6850 3333

Feedback 1800 850 2823

The CGH20 logo denotes our commitment to our patients and communities (the hearts), and our unending desire toward integration and collaboration within and without the organisation (the overlapping hearts). These aspects are emphasised through our use of blue (providing quality healthcare), fuchsia (care for our staff), and yellow (our stand on professionalism, innovation and continual improvement).

A Note fr om the Editor It’s that time of the year again. The holiday season is upon us, and with it

comes merriment, joy, celebrations with family and friends, and the thing that unites us all: food!Speaking of celebrations, this issue is packed with fantastic ideas to help

you adopt a healthier approach to eating during the end of the year (page 20). For the elderly with dysphagia (swallowing difficulties), say goodbye to bland, tasteless and boring food with the first ready-to-eat texture-modified meals in local flavours, created by Changi General Hospital (page 7). These delicious food options are nutritionally balanced and appeal to the Asian palate.

In this issue, you will also find interesting features on Chronic Obstructive Pulmonary Disease (COPD) as we debunk some of its misconceptions (page 12), simple steps to prevent diabetes (page 2), understanding prostate cancer (page 14), and many more stories to help you take charge of your health.

Enjoy the holidays with your loved ones. We are extremely thankful to all of you, our readers. You inspire us to keep on doing what we love – and delivering care that matters. We hope you will continue to enjoy our magazine and celebrate life with us every day.

Happy holidays! Cherry Lui Editor

CONTENTSISSUE 145

NOV – DEC 2016

02 ALL ABOUT THE SWEET KILLER Facts about diabetes

06 NEW YEAR, NEW GOALS Making reasonable resolutions

07 NEEDS OF THE AGEING PALATE Texture-modified meals

for the elderly

12 THE TRUTH ABOUT COPD Shedding light on this

respiratory condition

14 UNDERSTANDING PROSTATE CANCER

What you need to know about this cancer among men

16 WHAT'S NEW SNEC Eye Clinic @ CGH, EHA

Scientific Meeting and more

20 HOLIDAY EATING TIPS Food swaps and eating

healthy at parties

22 YOUR GPs CAN TREAT THESE CONDITIONS!

A GPFirst series

24 HEALTHY EATS Berry yoghurt surprise

25 SUBSCRIBE TO CARING

27 新年新计划如何设定合理的保健计划

28 甜蜜杀手知多少 窥探糖尿病如何掀起本世

纪最大的保健危机

30 年长者的味蕾需求 为年长者而设的易吞餐食

34 慢性阻塞性肺病背后的秘密 让我们一同粉碎此病症的迷思

36 深度了解前列腺癌 进一步认识这个男性专属的癌症

38 新鲜事 樟宜综合医院设全国眼科中心诊所

39 吃出健康 浆果酸奶

40 您的家庭医生能治疗这些病症！

“家庭医生首选”系列

Feedback 1800 850 2823Feedback 1800 850 2823

12 34

07 30

02 28

14 36

2 N O V – D E C 2 01 6 C A R I N G

A quick guide on what you need to know about diabetes

ABOUT

THE

Text by Cherry Lui

SWEET ALLDiabetes, often referred to by doctors as

diabetes mellitus, is a chronic disease in which the body is unable to maintain

healthy levels of glucose (a form of sugar) in the blood. For our bodies to function well, we need to convert glucose from food into energy. Insulin, a hormone produced by the pancreas, is essential for this conversion. When the body does not produce sufficient amounts of insulin or cannot use insulin properly, this causes glucose to build up in the bloodstream. Therefore, when a diabetic patient eats carbohydrates, which is present in foods such as bread, rice, fruit, yoghurt and sweets, it cannot be converted into energy.

Early detection and prompt treatment can help prevent complications associated with diabetes.

KILLERFEATUREHEALTH NOTES

TYPES OF DIABETES

TYPE 1 DIABETESType 1 diabetes can develop at any age and it usually affects children or young adults. The causes of type 1 diabetes are highly complex but it is believed to involve a combination of inherited genes and environmental factors. In most people with type 1 diabetes, the body’s own immune system mistakenly destroys the insulin-producing cells in the pancreas. Currently, there is no prevention or cure for it, and the only treatment is insulin therapy.

TYPE 2 DIABETESType 2 diabetes primarily develops as a result of family history, physical inactivity, obesity and poor diet. People with this type of diabetes can go undiagnosed for years as many of its symptoms, such as excessive urination, fatigue, blurry vision and wounds that are slow to heal, usually

start only when glucose levels have been high for a long period of time. Very often, a person with type 2 diabetes does not feel different from normal. It is largely preventable through early detection, healthy diet and lifestyle modifications.

GESTATIONAL DIABETESThis type of diabetes occurs when an expectant mother without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes can be managed through healthy diet and regular exercise. There are some cases where insulin therapy is necessary to help manage the condition. Women who experienced gestational diabetes may face a greater risk of developing type 2 diabetes later in life and are advised to be tested every two years.

UNDERSTAND YOUR RISK OF DIABETES Non-modifiable risk factors for type 2 diabetes: Family history Race or ethnic background

Age 45 and above History of gestational diabetes

Modifiable risk factors for type 2 diabetes: Overweight or obesity Sedentary lifestyle Unhealthy diet

WARNING SIGNS & SYMPTOMS Extreme fatigue Excessive urination Blurred vision Cuts or wounds that are slow to heal Frequent infections A tingling sensation or numbness in the hands or feet

4 N O V – D E C 2 01 6 C A R I N G

EAT MORE Beans such as black, kidney, soy and pinto Healthyfatsfromfishoils(salmon) Dark green leafy vegetables High-fibercerealsandbreadsmadefrom whole grains

High-quality proteins such as eggs, milk, cheese and unsweetened yoghurt

EAT LESS Fast foods, especially those high in sugar Sugary cereals Sugary drinks such as fruit juices, soda and soft drinks

Processed meat

EAT RIGHT & LOWER YOUR RISK OF DIABETES

FEATUREHEALTH NOTES

DIABETES MYTHS & FACTS

MYTH: Eating too much sugar causes diabetes.

FACT:The causes of diabetes vary depending on the individual and the type of diabetes. Sugar is naturally found in fruits and vegetables. Eating too much sugar, however, can contribute to weight gain and being overweight increases a person’s risk of developing diabetes.

MYTH: People diagnosed with diabetes can’t eat tasty foods and must follow a bland, boring meal plan.

FACT:An important part of managing diabetes is to adopt a healthy, balanced diet. However, not all low carbohydrate, low sugar foods are tasteless. There are many simple, affordable and flavourful recipes that are diabetic-friendly.

MYTH:Diabetic patients should avoid carbohydrates at all cost.

FACT:Moderation is the key to good health. People with diabetes need to follow a diet that contains the right amount of carbohydrates, so they have enough energy for the body to function well while keeping their blood sugar levels under control. A guide to a balanced meal would be the Health Promotion Board's “My Healthy Plate”. See hpb.gov.sg

LIVING WELL WITH DIABETES:

CGH DIABETES SUPPORT GROUP

At Changi General Hospital (CGH), we understand that a diabetes diagnosis can be stressful for you and your family. To help you manage and understand your condition, The CGH Diabetes Centre will be organising a support group programme to share knowledge on blood glucose management during the festive season.

The next session will cover the following topics: Festive eating: meal tips and

overcoming cravings Lifestyle modification and

management of blood glucose levels

Date: 17 December 2016, SaturdayTime: 9:00am – 11:30amVenue: Seminar Room, Level 2, Main Building, Lift Lobby D, Changi General Hospital

For registration, please send your name, identification number, phone number and email address to: Lakshmy: +65 8121 1346 Jennie Chua: +65 9639 0285 Win Nie: +65 6850 4639

Admission is FREE and light refreshments will be provided.

6 N O V – D E C 2 01 6 C A R I N G

WELLNESS

Did you, like millions of other people, vow to improve your health and mental wellness in 2016? Perhaps you

resolved to eat more fruits and vegetables every day, work out five times a week (at least!), or give up chocolate.

If it did not go as well as expected, there’s still plenty of hope for positive change next year. Changing your habits and daily routine to include activities known to improve mood, energy, and physical and mental health is easy and can be very enjoyable. MAKE REASONABLE RESOLUTIONS The problem with New Year resolutions is that they raise expectations by appearing to offer short-term fixes for long-term problems. In addition, the end of the year may be the worst time to make resolutions because you’re tired from the holidays and probably not thinking straight.

When you feel guilty about overeating and not exercising in December, your resolutions reflect that. Strict New Year resolutions, including the kind that restrain you from eating all your favourite foods, typically don’t make it past the end of January when Chinese New Year happens. You are probably tempted to delay dieting due to irresistible festive foods during this time. SPRING INTO ACTION If sticking to your resolutions seems hard, follow these tips to get back on track:• Avoid resolution overload. Make a short

list of three habits to change.• Keep resolutions positive. Focus on what

to add, not what to delete. For example, add 30 minutes of walking to your day five times a week, add one serving of vegetables to your daily diet, or drink more water.

• Plan for success. Break down bigger goals like losing 10 pounds into manageable goals, such as eating 100 fewer calories by replacing your typical snack of three chocolate cream-filled sandwich cookies with an apple.

• Find what works. Don’t give up on failed resolutions but do find a different strategy. For example, you resolved to join a gym and go every day. You joined the gym but decided that approach to exercise isn’t for you. Perhaps you’d rather work out at home with exercise DVDs instead, or walk or run outside with a friend on a regular basis.

• Monitor yourself. Check your resolutions’ list every month to see how you’re doing with your goals.

NEW GOALS

Text by Cherry Lui

Forget grand promises that are hard to achieve. It’s time to focus on simple health resolutions

NEW YEAR,

COVER STORY

The silver years can be immensely fulfilling as the elderly discover the joy of pursuing personal interests, developing social networks, and bonding with grandchildren

and other family members. However, there are also physical inconveniences that are a direct result of ageing. Of the many changes that the elderly experience, their inability to enjoy food has a great impact on their sense of wellbeing.

COVER STORYCOVER STORY

Coarsely minced steamed dim sum chicken

N E E D S O F T H E A G E I N G

PALATEThe elderly face a variety of age-related issues when it comes to eating. Dysphagia, or difficulty in swallowing, is one. To address this, CGH introduces texture-modified meals that are big on flavours, but go down easy

Text by Jean Angus & Ng Ming Chuen

8 N O V – D E C 2 01 6 C A R I N G

Digestion slows down with age, causing food to move slowly through the gastrointestinal tract.

As a result, more water is absorbed from food waste, leading to constipation. The elderly are also more susceptible to diverticulosis, a condition in which pouches form in the wall of the colon. While many people with diverticulosis experience no symptoms, pain may occur if the pouches become infected.

An elderly’s experience of eating is also affected by changes in sensory perception. A drop in the number and sensitivity of taste buds causes loss of ability to perceive sweetness, saltiness, bitterness and sourness. A decline in the sense of smell means less appreciation of the aroma of their favourite foods.

ABOUT DYSPHAGIA Besides the aforementioned sensory and physical changes, old people may also face difficulties in chewing and swallowing as their saliva production falls, or if they have dental problems such as tooth loss or poorly fitted dentures. In addition, they may experience dysphagia (swallowing difficulties) due to stroke, dementia or age-related loss of muscle tone along the food passage. It can lead to complications if choking occurs and food is inhaled into the respiratory tract.

Dysphagia may result in poor nutrition if the person is averse to eating unpalatable food that has had its texture modified to facilitate swallowing

Right: CGH Dietetic and Food Services team

Bottom right: Coarsely minced seafood otak

• Ensure that their diet is well-balanced and contains the necessary nutrients, fluids and fibre to minimise the risk of undernourishment and constipation.

• If chewing is difficult, consult a speech therapist for advice on how to cope. Specific meal textures may

be prescribed to make swallowing easier and safer.

• Pay close attention to their oral health by brushing and flossing daily, and going for regular dental check-ups.

• Seek help if they experience problems with eating, digestion or oral health.

HOW TO TAKE CARE OF PATIENTS WITH DYSPHAGIA

COVER STORY

Dysphagia may also result in poor nutrition, especially if the person with dysphagia becomes averse to eating or refuses to eat unpalatable food that has had its texture modified to facilitate swallowing. This can be

a challenge to manage given their specific nutritional requirements. While the body

requires lower amounts of nutrients such as sodium, it requires more

iron, Vitamin D, Vitamin B, folate and calcium. Deficiencies in these essential nutrients can

lead to anaemia, increased risk of stroke and dementia, and osteoporosis.

1 0 N O V – D E C 2 01 6 C A R I N G

COVER STORY

TEXTURE-MODIFIED MEALS For people with dysphagia and those who prefer soft meals, Changi General Hospital (CGH) has put joy back into mealtimes by creating the first ready-to-eat, texture-modified meals in local flavours. The meals are nutritionally balanced, and appeal to the Asian palate. They are convenient for caregivers as only simple heating is required before consumption. Fourteen varieties (see sidebar), including braised ginseng chicken, seafood otak, and kicap fish, are available in three different textures – blended, coarsely minced and finely minced.

It took the CGH Dietetic and Food Services team six months to identify the ideal formula to thicken the food while ensuring acceptable taste and texture. Thereafter, the team developed, tested, and refined the first batch

A range of delicious, texture-modified meals in local flavours

Malay• Kicap fish• Seafood otak• Ayam kurma• Ayam masala

Western• Chicken patty

with orange cheese sauce

• Chestnut chicken patty with Neapolitan sauce

• Poached fish fillet with tarragon sauce

Chinese• Healthy Nonya chilli fish• Steamed dim

sum chicken• Steamed fish with

oriental sauce• Five-spice

chicken• Braised ginger

chicken with onion carrot

• Braised ginseng chicken

• Healthy sweet-and-sour fish

WHAT'S ON THE MENU

of recipes. These have been licensed to local specialist nutrition company Health Food Matters (HFM), which has signed a patent-licensing agreement with CGH to produce and market the meals.

“Dysphagia occurs most commonly among the elderly. But there are also young men and women who have the same difficulties, such as those with dental issues, nasopharyngeal cancer and people who simply prefer soft food. Regardless of the situation, we hope that our texture-modified meals enable people with dysphagia to enjoy foods that meet their nutritional requirements,” said Ms Magdalin Cheong, Deputy Director, Department of Dietetic and Food Services, CGH.

The meals are expected to be available for sale at healthfoodmatters.com.sg in early 2017.

FEATURE

C

M

Y

CM

MY

CY

CMY

K

1 2 N O V – D E C 2 01 6 C A R I N G

Busting myths about Chronic Obstructive Pulmonary Disease (COPD)

THE TRUTH ABOUT

Text by Jean Angus

COPD

Do you or someone you know have smoker’s cough? If so, you shouldn’t ignore it. While smoker’s cough is

considered by many to be the result of smoking, it could actually be a symptom of COPD.

This disease, which obstructs airflow from the lungs, afflicts 5.9 per cent of Singaporeans and was the 10th cause of death in Singapore in 2014. However, awareness about this disease is low. A recent survey of 160 Singaporeans conducted by the Department of Respiratory and Critical Care Medicine (RCCM) at Changi General Hospital (CGH) showed that 65 per cent had never heard of COPD. Although smoking is its biggest risk factor – with half of all long-term smokers likely to develop COPD in their lifetime – 91 per cent of smokers surveyed were unaware of the disease.

“Patients diagnosed with COPD can experience significant negative impact on their quality of life due to persistent symptoms. Early detection and treatment can offer relief, ward off complications and lead to a return to an active lifestyle,” said Associate Professor Augustine Tee, Chief and Senior Consultant Respiratory Physician, RCCM CGH.

2. Breathlessness is a result of ageing.Ageing brings with it slow physiological changes that may affect lung capacity. However, breathlessness should not be ignored as it is a primary symptom of COPD and can be caused by many other health conditions. If you experience breathlessness, see a doctor.

3. COPD is like asthma.Asthma and COPD result in the same symptoms, such as chronic coughing, wheezing and shortness of breath, but are considered separate respiratory diseases. Asthma is typically diagnosed in childhood, while COPD usually affects adults 40 years and older who are current or former smokers. Lung function in asthma usually improves with medication, whereas lung function worsens as COPD progresses.

4. There is no treatment for COPD. To slow down the progression of the disease, doctors recommend quitting smoking and avoiding triggers such as air pollution. Medications can limit symptoms such as shortness of breath, and prevent and treat flare-ups. People with COPD are also encouraged to improve their health with regular exercise and a nutritious, balanced diet.

Lung function worsens as COPD progresses

FEATURE

WHAT YOU NEED TO KNOW Here are some misconceptions about COPD: 1. There is no point in quitting smoking once a smoker develops COPD.You may think that quitting will make no difference to your health since your lungs have already been damaged by COPD. However, kicking the habit and avoiding secondhand smoke can slow the progression of COPD and help you maintain your lung function. Consult your doctor for available options to help you quit.

UNDERSTANDING

What you need to know about the third most common cancer among men in Singapore

Text by Cherry Lui

1 4 N O V – D E C 2 0 1 6 C A R I N G

WHAT IS PROSTATE CANCER? The prostate is a gland in the male reproductive system located below the bladder and in front of the rectum. The walnut-sized gland produces some of the fluid that is part of the semen. Prostate cancer happens when cells in the prostate gland become abnormal and start multiplying uncontrollably, and eventually grow and invade nearby tissues. Patients who are diagnosed with prostate cancer have a better chance of successful treatment and very high survival rate if the disease is detected early. WARNING SIGNS & SYMPTOMS Though the cancer is usually asymptomatic during its early stage, the following signs and symptoms may indicate advanced prostate cancer: Problems with urination Blood in the urine or semen Loss of weight and appetite Discomfort in the pelvic or kidney area Bone pain

PROSTATE CANCER

FEATURE

reserved for elderly patients in poor health.

Radiation therapy to the prostate. Surgery to remove the prostate.

For advanced prostate cancer, treatment options include:

Hormone therapy Radiation therapy to relieve symptoms Surgery to relieve symptoms Chemotherapy

WHEN TO SEE A DOCTOR In Singapore, prostate cancer is the third most common cancer and the sixth leading cause of cancer death among men. It’s always a good idea to consult your doctor if you are concerned about prostate cancer or experience its symptoms. After discussing with your doctor, a simple blood test called the Prostate Specific Antigen (PSA) test may be performed to assess your risk of having prostate cancer. Early detection saves lives.

RISK FACTORS AND CAUSES Currently, very little is known about the causes of prostate cancer. It is common in men above the age of 50. A man with a family history of prostate cancer is twice as likely to develop the disease as a man with no family history of it. If two close male family members or relatives are diagnosed with it, a man’s lifetime risk of developing the disease increases five-fold.

Managing prostate cancer depends on the stage and aggressiveness of the disease as well as the patient’s age and health. The patient should have an in-depth discussion with his urologist with regards to his treatment options.

Heard of Movember? It is when men around the world grow a moustache during the month of November to raise awareness and funds for men’s health, particularly prostate cancer. This annual campaign aims to promote the importance of early cancer detection and treatment, in the hopes of reducing the number of preventable deaths. In addition to health check-ups, Movember also encourages men to be aware of risk factors, including family history, and to live a healthier lifestyle.

MOVEMBER!

PROSTATE CANCER

Generally, for early prostate cancer, treatment options include:

Active surveillance – Delaying treatment for the time being with cure as the aim should the cancer progress. Only suitable for early and less aggressive prostate cancer.

Watchful waiting – Treat any symptoms arising from prostate cancer. Usually

1 6 N O V – D E C 2 01 6 C A R I N G

Changi General Hospital (CGH) and the Singapore National Eye Centre (SNEC) launched the SNEC Eye

Clinic @ CGH to deliver a wider range of specialised eye care services, with particular focus on the ageing population in eastern Singapore. The clinic enhances eye care services that have already been provided at the hospital by SNEC clinicians since 2002.

Residents living in the east who are 45 years and above will benefit from a full range of services for common eye conditions, including cataract, glaucoma, corneal diseases and retina-related conditions such as diabetic retinopathy. Those with conditions affecting the eye can also tap on CGH’s capabilities as an advanced medical facility for geriatric medicine in handling complex cases. For example, patients with diabetic retinopathy can see a doctor for the condition at the SNEC Eye Clinic @ CGH in addition to regular check-ups at CGH’s Diabetes Centre to ensure that their diabetes is well controlled.

Text by Jean Angus

INTRODUCING THE SNEC EYE CLINIC @ CGH

1What excites you about

the SNEC Eye Clinic @CGH?It allows us to deepen our services to better address eye care needs. We now offer a full suite of subspeciality eye care, including corneal surgery, and surgical and medical retina, uveitis/ocular inflammation, neuro-ophthalmology, and oculoplastic services.

2 How will the clinic address

the eye care needs of the elderly?We have ophthalmologists who specialise in common eye problems among the elderly such as low vision, cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. Procedures are available to address these conditions.

3 Do patients need referrals

to visit the clinic?Polyclinics and GPs can refer patients to the eye clinic. We also accept private patients and referrals from CGH’s Accident & Emergency.

90 SECONDS WITH...

Adjunct Associate Professor Rahat Husain, Senior Consultant and Head of SNEC Eye Clinic @ CGH

The SNEC Eye Clinic @ CGH will also provide patients with new treatment possibilities through multi-disciplinary programmes developed in collaboration with other clinical departments in CGH. For instance, eye and otorhinolaryngology (ear, nose and throat) specialists will work together to treat eye and facial trauma cases on-site. They will jointly perform endoscopic surgery to treat excessive tearing due to blocked tear ducts, and perform functional facial surgery such as facial nerve reanimation for brow and lid ptosis (drooping) with visual field defect.

“We are very pleased to be able to enhance our long-standing partnership with SNEC to offer people in eastern Singapore better access to speciality eye care. We will continue to pursue similar collaborations with other speciality centres to enhance our capabilities as a regional tertiary hospital,” said Dr Lee Chien Earn, CGH CEO and Eastern Health Alliance Group CEO.

FROM LEFT: Adjunct Associate Professor Rahat Husain, Senior Consultant and Head of SNEC Eye Clinic @ CGH; Professor Wong Tien Yin, Medical Director of SNEC; Singapore Minister for Health, Gan Kim Yong; and Professor Teo Eng Kiong, CGH Chairman Medical Board, officiating the opening of SNEC Eye Clinic @ CGH

WHAT'S NEW

FROM TOP: Singapore Minister for Health Gan Kim Yong at the opening ceremony; Tong Shao Chuen (left) Senior Analyst, EHA, Health Services Research talks to Minister for Health Gan Kim Yong

The Eastern Health Alliance’s annual Scientific Meeting has grown from strength to strength since its inception

in 2011. This year, it was held from 10 to 12 November at Changi General Hospital (CGH), drawing more than 700 delegates from Singapore and other Asian countries.

The theme of this year’s meeting, Transitions of Care, reflected the pressing need to better integrate patient care across all the various care settings, from General Practitioner (GP) clinics and polyclinics, to acute hospitals and nursing homes.

In a speech delivered at the meeting's opening ceremony, Minister for Health Gan Kim Yong highlighted the new challenges for healthcare in Singapore in light of the ageing population, and a related increase in chronic diseases such as diabetes and hypertension. He also talked about the need for patients to receive coordinated and seamless care as the system shifts from the traditional acute hospital-centric care model to a more patient-centric, community-based one.

The meeting’s scientific programme included tracks on community palliative and mental health, innovation, integrated care, healthcare education, and redesigning care processes. Workshops were conducted to build knowledge in areas such as research programme evaluation, grant writing, systematic reviews, and community nursing skills.

Delegates visited St Andrew’s Community Hospital to understand how patients’ rehabilitation is maximised through person-centered care. They also visited The Salvation Army - Peacehaven Nursing Home to view the Life We Know programme, which

Sixth Eastern Health Alliance Scientific Meeting focuses on integrated care

Text by Jean Angus

empowers residents to return to normal life in the community by replicating real-life activities. These include going to a hair salon, playing games such as mahjong, and shopping at a mini mart.

The meeting was met with much enthusiasm and positive feedback from participants, providing a platform for healthcare professionals to enhance professional knowledge in the continued pursuit of clinical excellence against the changing healthcare landscape.

1 8 N O V – D E C 2 01 6 C A R I N G

TRAINING FAMILY PHYSICIANS TO MANAGE RESPIRATORY CONDITIONS

The session aims to enhance the primary care ability and knowledge and patient assessment skills of trainees

The Department of Respiratory and Critical Care Medicine (RCCM) at Changi General Hospital (CGH) recently

conducted a respiratory tutorial session in support of the Master of Medicine in Family Medicine programme of the College of Family Physicians Singapore. This session for family physician trainees aims to enhance their primary care ability and knowledge, and patient assessment skills.

This has been held annually since 2011 through strong ties between CGH and the College of Family Physicians Singapore.

“The CGH RCCM Department has been improving this programme year after year as we see the importance of the Master of Medicine in Family Medicine to our local community. Being part of the teaching staff gives us the opportunity to continue to build strong relations between our family physician colleagues and our hospital,” said Dr Alvin Ng Choon Yong, Consultant Respiratory Physician, RCCM CGH.

The importance of managing respiratory

diseases in our local ageing population is increasing due to the prevalence of respiratory conditions such as Chronic Obstructive Pulmonary Disease. Equipping the family physicians to manage such respiratory conditions through the programme is an excellent step towards a better integrated healthcare system between primary care practitioners and the hospital.

“The increasing burden of respiratory disease in Singapore is a cause for concern. There is a need to provide high-quality, evidence-based care for patients who are out in the community. The delivery of this care should not be compartmentalised but should be a collaborative effort between respiratory specialists and family physicians; the training of the latter is an important component of the training. We are pleased to have the support of our specialist colleagues in CGH RCCM for this,” said Dr Chong Tsung Wei, Family Physician and Senior Consultant at St Luke’s Hospital.

CSSD's innovative device improves instrument management

Gift of music to ease the soul

TRAINING FAMILY PHYSICIANS TO MANAGE RESPIRATORY CONDITIONS Every hospital has a centralised

department that manages medical devices, equipment and consumables

used in the operating theatres, clinics and wards. At Changi General Hospital (CGH), the Central Sterile Supply Department (CSSD) is responsible for doing so. It provides instruments and ensures that the sterile requirements of surgical and medical equipment are met in a timely and cost-effective manner while upholding quality-care standards. It also reprocesses reusable items to all areas in patient care, which includes sterilising surgical instruments for reuse after being contaminated, assembling, packing and storing of instrument sets. Such processes are resource-intensive as they have to adhere to strict infection-control measures for quality care and patient safety, and avoid disruptions to scheduled surgeries and medical procedures.

A team from CGH CSSD and Republic Polytechnic recently participated in the Health Innovation Technology (HIT) Challenge 2016, a nationwide contest for health professionals to present solutions to real healthcare problems. The team’s low-cost mobile device, which aims to better manage the laborious task of counting and identifying instruments at CSSD and clinics, was awarded the second runner-up in the competition.

Music has been proven to reduce anxiety and stress, and is particularly beneficial for those who are ill. With

this in mind, Er Seow Tiang Keng donated a grand piano to CGH. It now stands at the atrium of the Main Building, and staff members volunteer to play uplifting tunes at various times throughout the week.

Er Seow Tiang Keng is a cancer survivor, and an engineer who played an integral role in the development of hospitals in Singapore, including Singapore General Hospital. He donated the piano in memory of his son Justinian, an accomplished pianist who passed away earlier this year. He hopes that the piano will bring joy to patients and staff alike.

The team’s prototype features imaging capabilities to identify and count instruments. Users simply lay instruments on a surface for the device to take a snapshot. Within seconds, a report is generated, providing a physical count of the identified instruments. The solution improves productivity while adhering to infection-control practices. More tests are being conducted to further develop and broaden the prototype’s functionality, and enhance its accuracy.

The CSSD team at HIT Challenge 2016

Er Seow Tiang Keng (left) donated the piano to CGH in memory of his son Justinian, an accomplished pianist who passed away earlier this year

WHAT'S NEW

2 0 N O V – D E C 2 01 6 C A R I N G

Fend off weight gain by substituting fatty foods with these healthier options

FOOD SWAPS FOR THE HOLIDAYS5

Text by Cherry Lui

3 OPT FOR MUSHROOM SAUCE, NOT CANNED GRAVYCanned gravy is high in sodium and it can harm your health when

consumed excessively. According to the Harvard School of Public Health, excess sodium can increase your blood volume and with it, strain your heart and blood vessels. Mushrooms, on the other hand, are a good source of vitamin D and B,

which help increase your metabolism. Make your own mushroom sauce by sautéing diced mushrooms and adding one cup of no-

added-salt chicken stock and a tablespoon of sour cream, which

adds creaminess and has fewer calories compared to regular gravy.

2 CHOOSE SALSA OVER CHEESE DIPWant to add more flavour to

those chips without gaining an extra pound? Choose fresh salsa over

cheese dip. Get creative and make your own chunky salsa with some tomatoes, onions, chillies and fresh herbs. This

is an easy way to increase your vegetable intake and save you

more than a hundred calories.

1USE OLIVE OIL INSTEAD OF BUTTERBeyond the flavourful taste, olive

oil is rich in monounsaturated fat (good fats that can help lower LDL cholesterol). It contains zero trans fat (bad fat) and is free of cholesterol, sugar, salt and gluten, making it a good alternative to butter. Studies found that dunking your bread in olive oil could cut your heart attack risk in just six weeks.

5 POPCORN FOR POTATO CHIPSIf you can't decide

between popcorn or chips, our advice is to grab the popcorn. However, the type of popcorn you choose makes a big difference. Skip the buttery kind and opt for plain air-popped popcorn. Inexpensive and filling, it is a healthier alternative.

4 PICK WATER OVER SUGARY DRINKSWater infused with fresh fruits or

vegetables is the perfect substitute for sugary drinks such as cordials, sweetened ice teas, soft drinks and fruit juices. All you need to do is toss in some sliced fruits or vegetables into a pitcher with some ice, and enjoy!

With these handy tips, you won't have to worry about unwanted calories at that Christmas party

'TIS THE SEASON TO BE

FEATURE

Text by Cherry Lui

1DON’TGOTOAPARTYHUNGRYHaving some light, healthy snacks

before heading out to a party will help curb your appetite and control your snacking on high-calorie appetisers. Try a quick salad or fruit of your choice.

3BALANCE YOUR PLATEWalk around the buffet before filling

your plate. Instead of piling it with foods that you don’t really like, fill half of your plate with fruits and vegetables and the rest with your favourite foods that give you true enjoyment.

4EAT MINDFULLYBeware of unconscious eating. This

may sound silly but many people don’t realise what they are eating. Slow down and enjoy the smell, taste and texture of the food. You will end up satisfied with a smaller portion and avoid overeating, which is key to weight management.

5DRINK MODERATELYGo easy on alcohol as it supplies a

great amount of calories. Drink slowly and stay away from salty foods as they will make you thirsty. If it’s hard to avoid alcohol altogether, choose red wine as it contains antioxidants that may help prevent heart disease.

2COOK HEALTHY FOODS

If you’re hosting a party, make sure that you have healthy options for your guests. Incorporate healthier food choices such as whole grain pasta and brown rice, or make something simple such as fresh tomato sauce.

HEALTHY

2 2 N O V – D E C 2 01 6 C A R I N G

In January 2014, Eastern Health Alliance (EHA) launched the GPFirst programme to encourage patients in eastern Singapore to

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

Visit www.gpfirst.sg or see your GP for more information on common conditions such as cuts, bruises, mild scalds, nausea, headaches, sprains and fevers. Read on to learn more about acute gout and nosebleed.

YOUR GPs CAN TREAT THESE CONDITIONS

ACUTE GOUTQuestion: I am a 34-year-old male, and a week ago I started experiencing pain and stiffness in my right big toe. Over the next few days, the pain spread to other parts of my foot, which is now swollen. I am in excruciating pain and it has impacted my mobility. As a seafood restaurateur, I spend most of my time at my restaurant, therefore my meals comprise mainly of seafood and red meat; I also enjoy drinking. Will I be able to get it treated by my GP or is my condition so severe that I need to visit the Accident and Emergency (A&E) department at the hospital?

Answer: Your symptoms show that what you are experiencing is likely an acute gout attack.

A visit to the GP is advised as he will be able to help you manage the pain and follow-up closely with you on your condition.

Gout is a form of arthritis caused when excessive uric acid is present in the blood. The uric acid build-up forms uric acid crystals that will cause the joints to swell and become inflamed. This disease typically occurs in the big toe but other areas such as the ankles, insteps, heels, knees and other joints may also be affected.

Uric acid is produced when the body breaks down purine, a substance that is found naturally in our body’s tissues, and also in high-purine foods, including red meat (e.g. beef and pork), organ meat (e.g. liver and kidney), seafood, vegetables such as cauliflower and asparagus, and alcohol (mainly beer due to the yeast). Besides uric acid and food intake, genetics, obesity, metabolic syndrome and consumption of certain medications (e.g. Thiazide diuretics) can also cause gout.

An early visit to the GP is advised should there be no improvement to your condition after 2 to 3 days. Your GP will ask you to answer a series of questions to rule out other causes of joint inflammation such as infection and trauma. He will likely ask you to undergo uric acid and renal function tests. You will then be prescribed anti-inflammatory painkillers to ease the pain. Preventive medications such as Allopurinol are available for recurrent gout attacks.

Changes in lifestyle and food intake are very important to help prevent and lower the risk of gout. Increase your intake of vegetables, poultry and water, and concurrently minimise alcohol consumption and reliance on red meat and seafood. Regular exercise is also recommended as it is a measure to counter obesity.

Dr Wicky Wong

Dr Wicky WongisafamilyphysicianpractisingatRafflesMedicalGroup(KatongI12).HegraduatedfromtheUniversityofSydney,andisaFellowoftheRoyalNewZealandCollegeofGeneralPractitioners.HeisalsoaDesignatedAviationMedicalExaminerfortheCivilAviationSafetyAustralia.

NOSE BLEED Question: I am an 18-year-old male student, generally healthy with no underlying medical condition. Lately, I started to experience nosebleeds. In one occasion, it happened while I was in class, another while I was walking home, and sometimes when I was watching TV. I’m unsure what caused the bleeding, but it occurred almost every other day for slightly more than a week now. This morning, while I got up from bed, I felt something trickling down my throat. I tried to cough and was shocked to see blood-stained phlegm. My mother is rather worried about my condition and has urged me to head to the A&E. However, I didn’t go as I feel totally all right despite the nosebleeds. Why does it happen so often, and when should I visit the A&E?

Answer: There are many causes of nosebleed. The common reasons for recurrent nosebleed may be frequent trauma such as nose picking, lack of humidification in the environment, allergies and infections.

Most nosebleeds are usually minor and will respond to these first-aid measures: 1. Blow your nose gently to clear up any blood

clots formed inside the nostrils.

2. Sit down and lean your head forward to prevent back flow of blood into the throat.

3. Breathe through your mouth and firmly pinch the entire soft part of the nose just above the nostrils.

4. Hold the position for 10 minutes (5 minutes for children).

5. Decongestant nasal sprays such as Oxymetazoline would be helpful. You can apply it to the affected/bleeding side of the nose and then repeat steps 2 to 4 above. However, this should not be a long-term remedy if the problem persists for more than 3 days.

Based on your experience, you have had about five to six nosebleed episodes. It will be ideal to seek a GP’s help for initial assessment, and he can advise further investigations or referral for specialist attention, if necessary. He will ask you more thorough questions related to your family’s health background, your lifestyle and habits. For instance, he will ask you about any conditions that cause easy bleeding in your family, whether you may have other conditions previously unnoticed, or had adopted a new pet which may be causing allergies. It may also be related to frequent use of air-conditioning, which results in a dry environment. He will also examine if you have signs of sinusitis or any lumps in the deeper sections of the nostrils.

If you find that the blood trickles down the back of your throat even when you lean forward, it may be more of a concern and requires medical attention at A&E. If you are unsure whether your condition requires urgent treatment, it is advisable to consult your GP first so that he can advise you on your next course of action.

Here is some advice you can take note of to prevent nosebleeds:• Avoid repeated traumatising of the nose

such as nose picking and excessive blowing.• Ensure adequate humidification of the

environment. You may want to keep containers of water in your room at night if you sleep in an air-conditioned room.

• Keep your nose moist by using saline nasal spray or apply petroleum jelly to the nostril with cotton swab.

Dr Desmond Yang

FEATUREMY GP ANSWERS

Dr Desmond Yang is currently a resident physician at Bedok Family Medicine Centre. He received his MBBS from the University of Melbourne and has worked for the Ministry of Health.

24 N O V – D E C 2 01 6 C A R I N G

HEALTHY EATS

Yoghurt, a good source of calcium, gets a refreshing twist in this must-try dessert

PREPARATION TIME1 hour

SERVES

WHAT YOU’LL NEED Low-fat strawberry yoghurt (200g/7 oz) Strawberries (4, medium, cleaned, hulled and sliced)

Sugar-reduced soy milk (100ml/ 3 fl oz/ cup)

Gelatine powder (1 tsp) Hot water (1 tbsp)

TOPPING Strawberries (85g/3 oz, cleaned, hulled and sliced)

Gelatine powder (½ tsp) Hot water (2 tbsp) Basil seeds (selasi) (¼ tsp, soaked until double in size and drained)

METHOD In a mixing bowl, combine yoghurt, strawberries and soy milk. Mix well and set aside.

Mix gelatin with hot water until completely dissolved. Stir into yoghurt mixture, then pour into 4 serving glasses. Set aside to cool.

Prepare topping. Blend strawberries with 1 tbsp warm water until fine. Set aside. Mix gelatin powder with hot water and stir until completely dissolved. Add basil seeds and blended strawberries and mix well. Spoon on top of yoghurt mixture and refrigerate for 1 hour or until topping has set.

Garnish as desired and serve chilled.

Tip: For the yoghurt topping, strawberries may be substituted with 55g (2 oz) strawberries and 30g (1 oz) strawberry purée.

NUTRITIONAL INFO (PER SERVING)Calories 58 kcalCarbohydrates 9.2gFat 1gCholesterol 3mgFibre 0.7g

This recipe was first published in A Cookbook for Diabetics by a Dietitian and a Chef, which is now available at all major bookstores

BERRY YOGHURT SURPRISE

24 N O V – D E C 2 01 6 C A R I N G

您是否认识希望阅读这份刊物的人士？请帮我们传阅下去。Know someone who would enjoy reading this? Please pass it on.

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YOUR TRUSTED GUIDE FOR A HEALTHIER, HAPPIER LIFE 《关怀》季刊助您迈向健康美好生活

中文由第27页起

A H E A LT H I E R , H A P P I E R L I F E

MY GP ANSWERSOur General Practitioners talk about acute gout and nosebleed

WHAT IS COPD? The respiratory disease you’ve never heard of

ALL ABOUT THE SWEET KILLERWhat you need to know about diabetes

CGH Dietetic and Food Services team creates tasty, ready-to-eat foods for patients with dysphagia

NOV−DEC 2016 Changi General H o spi t al Magazine

MEALSTEXTURE-MODIFIED

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忘掉难以实现的宏伟承诺，是时候专注于简单的保健计划咯

新年新计划

原文：雷雪瑩

您是否也像全球上百万人一样，在2016年下定决心要改善自己的身心健康？您或许立志要每天多吃蔬果、

每星期至少运动5次、或是戒掉吃巧克力的习惯？

如果计划没进行的如预期中顺利，别灰心，明年还是有很多机会让您做正面的改变的！改变习惯和日常生活的规律，并进行可以改善情绪、能量和身心健康的活动，是既简单又有趣的。您从今天起便可让心情更舒畅！做合理的计划新年计划的问题在于它们看似能在短期内为长远的问题提供解决方案，从而提高了人们的期望。此外，在年底期间做新年计划或许是最差的时候，因为您在假日期间玩到累了，思路也会变得不清晰。

若您为自己在12月份暴饮暴食、没做运动的行为感到愧疚，您所做的新年计划就会反映出这种愧疚感。苛刻的新年计划，包括限制您吃所有自己喜爱的食物，通常不到1月底就会破功，尤其是在农历新年期间需面对让人无法抗拒的美味佳肴。

心动不如行动若您觉得依据计划行事似乎有困难，以下就提供一些小贴士，助您回返“正途”：

• 避免做过多的计划。列出3个您想要改变的习惯。

• 对计划保持正面态度。专注于“多”，而不是“少”。举例来说，在每天的日程里多走30分钟的路，每星期5次；在每天的餐食多加一份蔬菜；或养成多喝水的习惯。

• 把成功纳入计划中。把大计划如减重10磅，划分为日常生活里的小目标，如把零食里的3个巧克力夹心饼换成一粒苹果，便可少摄取100卡路里。

• 找出可行的方法。不要因计划“失败”便放弃，而应另找方法。举例来说，您决定加入一家健身俱乐部并每天健身。您加入了健身俱乐部后，却发现这样的锻炼方式不适合您。您或许可选择在家里看着健身光碟做运动，或是定期和好友去步行或跑步。

• 自我监督。每月查看您的计划清单，以跟进自己的进度。

保健

2 8 N O V – D E C 2 01 6 C A R I N G

窥探糖尿病如何掀起本世纪最大的保健危机

甜蜜杀手知多少

原文：雷雪瑩

糖尿病，也是医生们常说的diabetesmellitus，是一种慢性疾病。它指的是我们体内血液里的葡萄糖（一种糖

类）水平无法维持在健康的水平。我们人体若要能正常运作便须将食物里的葡萄糖转化成能量，而由胰腺所生产的胰岛素就是这个转化过程中的关键组成部分。

当一个人被诊断患有糖尿病时，这意味着其身体无法生产足够的胰岛素，又或者是其身体无法正常使用胰岛素，进而导致葡萄糖累积在血液里。因此，当一名糖尿病患者吃下含有碳水化合物的食物如面包、米饭、水果、酸奶和糖果时，其身体就无法把这个营养物转化成能量。

及早检测和即时治疗可帮助预防与糖尿病相关的并发症.

了解您患上糖尿病的风险二型糖尿病的不可改变风险因素有： 家族病史 人种或种族渊源 年龄45岁及以上 曾经患有妊娠糖尿病

二型糖尿病的可改变风险因素有： 体重超标或肥胖 久坐不动的生活方式 不良的饮食习惯

预防糖尿病的简单步骤虽然目前尚未有任何确切的方法可以预防一型糖尿病，但许多二型糖尿病的案例是可以通过生活方式上的调整来加以预防或延迟发病的。 定期做运动 健康的饮食习惯 定期做身体健康检查 控制酒精的摄取 戒烟

警示征兆和症状 多尿 极度疲劳 视力模糊 伤口要长时间才愈合 经常受感染 手脚有刺痛和酸麻的感觉

FEATURE保健小笔记

糖尿病的类型

一型糖尿病一型糖尿病可以在任何年龄发病并且普遍出现于幼童或年轻人身上。导致一型糖尿病的原因高度复杂，但一般相信是由于遗传基因和环境的综合性因素所致。在一型糖尿病患者当中，大部分是因免疫系统错误地将胰腺里用来生产胰岛素的细胞给杀死所致。到目前为止，一型糖尿病尚未有任何可预防或治愈的方法，而胰岛素治疗是唯一的治疗法。

二型糖尿病

二型糖尿病主要是由家族病史、运动量低、肥胖和不良饮食所导致。二型糖尿病患者在过了很长一段时间都不会察觉到自己患病，这是由于此病的多个症状，如多尿、疲劳、视力模糊和伤口愈合时间长，通常都是在葡萄糖水平在长时间里升高后才会出现。很多时候，二型糖尿病患者不会察觉到自己的身体有任何异样。通过及早发现、健康的饮食和生活习惯上的调整，二型糖尿病一般上是可

以预防的。

妊娠糖尿病

还有第三种糖尿病是妊娠糖尿病，这是妇女在怀孕期间所患上的糖尿病。原本没有糖尿病的妇女在怀孕期间可能出现血糖指数升高的现象。妊娠糖尿病可以通过健康的饮食和定期做运动来得到良好的控制。有些患者则需要接受胰岛素治疗来控制病情。那些曾经患有妊娠糖尿病的妇女到了晚年会有更高患上二型糖尿病的风险，因此建议她们每两年

做一次相关的检查。

迷思摄取过量糖分会导致糖尿病

事实糖尿病的导因和患病的类型因人而异。水果和蔬菜里都含有天然的糖分。然而，吃过量的糖分可使得体重增加，而肥胖则会提高一个人患上糖尿病的风险。

迷思糖尿病患者不可以吃美味的食物，并且必须遵照一个淡而无味的饮食法

事实管理糖尿病的其中一个关键是拥有健康均衡的饮食。然而，并不是所有低碳水化合物和低糖分食品都是淡而无味的。坊间有许多既简单又价格合理，同时美味可口的食谱供糖尿病患者选择。

迷思糖尿病患者需尽可能避免摄取碳水化合物

事实适量地摄取碳水化合物是保持良好健康状态的关键。糖尿病患者须遵照一个碳水化合物含量饮食，这样才能确保他们在控制好血糖水平的同时也能够获得充足的能量让身体正常运作。保健促进局所出版的“我的健康盘子”（MyHealthyPlate）是让您获得均衡饮食的推荐参考资料。

识破糖尿病的饮食迷思

3 0 N O V – D E C 2 01 6 C A R I N G

年长者的黄金岁月可以是多姿多彩的。他们可以从追求个人兴趣中获得乐趣、扩大自己的社交圈子、以及与孙

儿和家人共享天伦。然而，年龄的增长却同时带来生理上的不便，而这是由老化所直接导致。在年长者面对的多种变化中，无一有比无法享受美食更影响其身心健康的了。

随着年龄的增长，我们的消化功能也随之放缓，促使食物通过胃肠道的速度也慢了下来。这些未消化食物中的水分会被吸收，从而导致便秘。年长者也较容易患上憩室病（diverticulo-sis），以致结肠内侧出现突起的囊包。虽然许多憩室病患者不会呈现出任何症状，但若这些囊包开始发炎，便会给患者带来疼痛。

年长者的用餐体验也会因感官知觉的改变而受到影响。味蕾的功能与敏锐度下降，使年长者无法分辨酸、甜、苦、辣。嗅觉功能的退化也使年长者无法享受其钟爱的美食所散发出的香味。

关于吞咽困难除了上述感官与生理变化，咀嚼和吞咽也会随着唾液量的减少或牙科问题，如牙齿脱落或假牙装不好等，而变得困难。此外，中风、失智症或老化引发的食道肌肉松弛也可能造成年长者出现吞咽困难（dysphagia）。当食物哽在患者的喉咙里，并且掉入呼吸道，就可能引发并发症。

吞咽困难也可能导致营养不良，尤其是当吞咽困难所带来的不便使年长者对进食感到厌烦，或他不愿吃淡而无味的易吞软性食物。若还得照顾到年长者的特定营养需求，那可真是一项难度极高的挑战。年长者的身体对各种营养素的需求并非一致，例如他们需要较少量的钠，但却需要较多的铁质、维生素D、维生素B、叶酸和钙质。如果身体无法

•确保饮食均衡，并包含所需营养素、液体和纤维，以减低营养不良和便秘的风险。

•如果吞咽出现困难，不妨寻求语言治疗师的协助，学习如何应对。他们可能会建议把餐食做成特定口感，以

方便及安全吞咽。

•应当注意口腔卫生，每天固定刷牙和使用牙线清理牙缝，以及定期做牙科检查。

•若进食、消化或口腔卫生出现问题，请及早寻求帮助。

如何照顾吞咽困难患者

年长者的 味蕾需求年长者在饮食上会面对许多老年所带来的 问题，吞咽困难就是其中一样。为了应付 这项挑战，樟宜综合医院推出 既可口又易吞咽的美味佳肴， 让他们也能吃出滋味

原文：Jean Angus与Ng Ming Chuen

封面故事

樟宜综合医院饮食服务部

年长者的 味蕾需求

3 2 N O V – D E C 2 01 6 C A R I N G

从上图起：一系列融入本地口味的美味易吞餐食；粗块状 点心蒸鸡

马来口味• Kicap鱼• 海鲜乌达• Ayamkurma• Ayammasala

西式口味• 鸡肉饼配鲜橙

乳酪酱•栗子鸡肉饼配蛋

黄酱• 水煮鱼柳配龙蒿

酱

中式口味• 健康娘惹辣椒鱼• 清蒸肌肉点心• 清蒸鱼配中式酱

料• 五香鸡• 姜焖鸡配洋葱红

萝卜• 人参焖鸡• 健康酸甜鱼

餐食 选择

封面故事

吞咽困难可能导致营养不良，尤其是当吞咽困难所带来的不便使年长者对进食感到厌烦，或他不愿吃淡而无味的易吞软性食物

摄取足够的主要营养素，就可导致贫血、提高中风和患上失智症及骨质疏松症的风险。

容易吞咽的食品对于吞咽困难患者及较偏爱软性食物的年长者，樟宜综合医院要让他们重拾进食的快乐，通过创造首个融入本地口味的即食易吞餐食，让他们吃出滋味。这些餐食不但提供充足的营养，还迎合了亚洲人的口味。它们为看护者提供便利，因为这些餐食只需在进食前加热即可。目前共有14种不同餐食供选择，其中包括人参焖鸡、海鲜乌达和kicap鱼等。您也可从3种不同的食物口感——糊状、粗块状和细块状，来进行选择。

这项任务共花了樟宜综合医院饮食服务部长达6个月的时间完成。他们不断试验，目的是为找出能让食物呈黏糊状的最佳方法，且同时保留食物的美味和口感。当他们确认了一个特定的方案后，小组便开始进行进一步测试和优化这首批食谱。本地专科营养公司HealthFoodMatters已获得院方的许可使用这些食谱。双方签署了一项专利实施许可合同，让HealthFoodMatters生产和销售这些餐食。

“吞咽困难患者主要以年长者居多，但也有不少年轻男女面对同样问题，例如接受过牙科手术及鼻咽癌患者。甚至还有些人就是喜欢吃软性食品。无论是什么原因，我们希望我们改良食物的口感，能让吞咽困难患者在享受我们的餐食的同时，也能获得足够的营养。”樟宜综合医院饮食服务部副总监张爱桃女士说道。

这些餐食预计在2017年初，就会在health-foodmatters.com.sg网站上开始销售。

3 4 N O V – D E C 2 01 6 C A R I N G

原文：Jean Angus

慢性阻塞性肺病让我们一同粉碎有关慢性阻塞性肺病的迷思

背后的秘密

您是否有“烟枪咳”，又或是您的友人拥有此症状呢？若真如此，那您千万不可置之不理。虽然许多人认为，

“烟枪咳”是吸烟的必然后果，但它也可能是因慢性阻塞性肺病所致的症状。

慢性阻塞性肺病（ChronicObstructivePulmonaryDisease）是一个会使通往肺部的呼吸道阻塞的疾病。其在本地的发病率为5.9%并且还在2014年成为了新加坡人的第十号杀手。然而，公众对于此症的意识度却非常底。一项由樟宜综合医院呼吸和重症监护医学部门所展开的160人调查显示，有65％的受访者没有听说过慢性阻塞性肺病。虽然吸烟是慢性阻塞性肺病的最大风险因素，甚至有半数的长期吸烟者在其有生之年里可能患上此病，但却有91％受访的吸烟者对于此病闻所未闻。

“被诊断患有慢性阻塞性肺病的患者会由于持续性的症状而使得其生活质量受到影响。及早发现和治疗有助于缓解症状、避免并发症和让您恢复活跃的生活。”樟宜综合医院呼吸和重症监护医学部首席兼高级呼吸内科顾问医生AugustineTee副教授说道。慢性阻塞性肺病须知以下是人们对此病症的一些迷思与误解：

迷思1：一旦吸烟者患上慢性阻塞性肺病，即使是戒烟也没用了。 您或许会以为戒烟将不会对您的健康状况起到任何作用，因为您的肺部已经被慢性阻塞性肺病给破坏。然而，把烟戒了和避免吸入二手烟将会减缓慢性阻塞性肺病的发展速度，从而帮助您维持肺部的功能。咨询一下您的医生以了解可助您戒烟的方法。 迷思2：气喘是因为年纪大所致 老化会使身体逐渐产生一些生理变化，从而影响到肺部的功能。然而，气喘不应被忽略，因为它是慢性阻塞性肺病的主要症状，同时也是其他健康问题的警示征兆。如果您有气喘的症状，请及早求医。

迷思3：慢性阻塞性肺病其实是哮喘 哮喘和慢性阻塞性肺病所呈现出的临床症状，如慢性咳嗽、哮鸣和喘不过气，有许多相同之处，但它们被视为两种不同的呼吸疾病。哮喘患者通常在其年幼时期就会被诊断出来，但慢性阻塞性肺病则以年龄40岁以上的成年患者较为普遍，而他们都是目前正在吸烟或之前曾经吸过烟的烟

迷思4：慢性阻塞性肺病是无药可医的 针对慢性阻塞性肺病的治疗方案旨在减缓病症的发展速度，其中包括戒烟和避免接触到刺激物如空气污染物。药物也有助于控制一些症状，如气喘及预防和治疗咳嗽发作。慢性阻塞性肺病患者也应通过定期运动和营养均衡的饮食来改善其健康状况。

“慢性阻塞性肺病在本地的发病率为5.9%，并且还在2014年成为了新加坡人的第十号杀手。”

客。哮喘患者的肺功能通常会随着药物治疗而得到改善，但慢性阻塞性肺病患者的肺功能则会随着病情的发展而恶化。

特写

新加坡男性第三大常患癌症须知

原文: Cherry Lui

3 6 N O V – D E C 2 0 1 6 C A R I N G

深度了解前列腺癌

通常适用于健康状况较差的年长患者。 放射治疗 动手术切除前列腺

适合中期或末期前列腺癌患者的治疗方案有： 荷尔蒙疗法 放射治疗来缓解症状 手术来缓解症状 化疗

风险因素和导因到目前为止，前列腺癌的发病因素还尚未确认。前列腺癌以50岁以上的年长男性患者居多。拥有前列腺癌家族病史的男性，如父亲或兄长是前列腺癌患者，与家族病史里无此病例的男性同比的患癌率为两倍。如果一名男性的家族里有2名至亲是前列腺癌患者，那其终身患癌风险便将增加5倍。

应当何时求医？在新加坡，前列腺癌在男性普遍患癌榜上排名第三，并且是患癌男性的第六号杀手。如果您担心自己有患上前列腺癌的风险或有前列腺癌的症状，那您最好还是咨询医生的意见。您可以和医生商讨进行一个名为前列腺特异抗原（ProstateSpecificAntigen）的简单血液测试来评估您患上前列腺癌的风险。及早发现可拯救生命。

什么是前列腺癌 前列腺是男性生殖系统里的一个腺体，它位处膀胱之下，在直肠的前面。这个像胡桃般大小的腺体生产精液里的其中一部分液体。前列腺癌指的是当前列腺里的细胞出现异常变化或开始不受控地增生，而这些异常的细胞会逐渐扩散到周围的细胞组织。前列腺癌在早期通常不会出现任何临床症状。如果及早发现，前列腺癌患者的治愈和存活率都会相对提高。

警示征兆和症状早期的前列腺癌通常不会出现任何明显的症状。中期的前列腺癌则会呈现出以下几种症状： 排尿有问题 尿液或精液里带有血丝 体重和胃口减轻 骨盆或肾脏部位感觉不适 骨骼疼痛

前列腺癌的治疗方案是非常个人化的，取决于病人的患病程度和癌细胞的侵略性，以及其年龄和健康状况。病人应当与其泌尿科医生详尽商讨其个人化的治疗方案。

一般适合早期前列腺癌患者的治疗方案可包括以下几种： 密集监控－暂时延缓治疗，待癌症开始病变

时，进行根治。较适合早期和肿瘤较为良性的患癌者。

观察等待－治疗由前列腺癌所引发的症状。

十一胡子月（Movember）是一个全球性的活动。在这个月里，有许多英勇和乐善好施的男士会留胡子来提高男性健康问题的意识及为其筹款，尤其是前列腺癌。

这项一年一度的活动旨在提高及早发现癌症和治疗的意识，从而减低可预防的死亡率。除了健康检查之外，十一胡子月也鼓励男士们多了解其风险因素如家族病史，以及提倡更健康的生活方式。

十一胡子月

深度了解前列腺癌

特写

3 8 N O V – D E C 2 01 6 C A R I N G

新鲜事

樟宜综合医院与新加坡全国眼科中心携手在樟宜综合医院内增设眼科诊所（SNECEyeClinic@CGH）。这

家眼科诊所将提供范围更广的眼睛专科护理服务，尤其关注新加坡东部老龄化人口所面对的眼科疾病。自2002年起，樟宜综合医院便已有新加坡全国眼科中心的医生在院内提供眼科护理服务，而该诊所的设立将进一步加强医院在这方面所提供的服务。

在这个分区里年龄在45岁或以上的居民将从这一连串治疗常见眼科疾病的服务中受惠，其中就包括白内障、青光眼、眼角膜相关的眼科疾病、以及糖尿病视网膜病变这类与视网膜相关的疾病。患有眼科疾病的居民也可以借助樟宜综合医院做为一家先进老年医学医疗机构和其善于处理复杂老年病例的专长而获得适当的治疗。例如，糖尿病视网膜病变患者除了可以在樟宜综合医院的糖尿病中心接受定期

原文：Jean Angus

1SNEC Eye Clinic @ CGH在哪方面最

值得期待？诊所的设立有助优化我们的服务以更好地应对病人在眼科护理方面的需求。我们现在提供全套的眼睛分科护理，其中包括眼角膜手术、视网膜手术与治疗、眼色素层炎或眼部炎症、神经眼科学、以及眼部整形服务。

2 诊所将如何应对年长者在眼部保健护理

上的需求？我们的眼科医生擅长于年长者的常见眼科问题，如低视力、白内障、青光眼，糖尿病视网膜病变、以及老年性黄斑部退化。我们拥有针对这些眼科疾病的治疗法。

3病人如何能到SNEC Eye Clinic

@ CGH求医？综合诊疗所和家庭医生可以把病人转诊到SNECEyeClinic@CGH。我们也接受樟宜综合医院急诊部门所转诊过来的病人，以及直接登门求医的病人。

与SNEC Eye Cl inic @ CGH主管兼高级顾问医生Rahat Husain副教 授的90 秒问答 对话

检查来良好地控制其糖尿病以外，他们也可在SNECEyeClinic@CGH治疗相关的眼科疾病。

SNECEyeClinic@CGH也将为病人提供新的治疗方案，通过和樟宜综合医院里其他的医疗部门合作，开展多学科项目。例如，眼科和耳鼻喉科的专科医生们将在院内携手合作治疗眼睛和面部受创的病人。他们将一起进行内窥镜手术来治疗由泪腺阻塞所导致的多泪症，以及因眉毛与眼皮下垂导致视野缺损的面部神经缺损修复手术等功能性面部手术。

“我们非常高兴能够加强和新加坡全国眼科中心的长期合作伙伴关系，为新加坡东部的居民提供更方便的眼睛专科护理。我们将继续探讨和其他专科中心开展类似合作的可能性，以强化我们做为一家区域性专科医院的定位。”樟宜综合医院总裁兼东部医疗联盟集团总裁李建恩医生说道。

全国眼科中心 于樟宜综合医 院增设诊所

左起：SNEC Eye Clinic @ CGH主管兼高级顾问医生Rahal Hussain副教授、新加坡全国眼科中心医务总监Wong Tien Yin教授、卫生部长颜金勇以及樟宜综合医院医务委员会主席Teo Eng Kiong教授，一同为SNEC Eye Clinic @ CGH主持开幕仪式

C A R I N G J U L– A U G 2 0 1 5 3 9

含丰富钙质的酸奶，是能让您神清气爽的必尝甜点！

准准准准 1小时

准份

准准准准 低脂草莓酸奶200克（7盎司） 草莓4个、中等大小、清洗干净、去掉叶头后切片 低糖豆浆100毫升（3 液盎司/ 杯） 胶粉1茶匙 热水1汤匙

准准 草莓85克（3盎司）、清洗干净、去掉叶头后切片 胶粉½茶匙 热水2汤匙 明列子（Selasi）¼茶匙、浸泡在水中至双倍大小、滤干水分

准准把酸奶、草莓和豆浆倒入一个搅拌碗里，搅拌均匀后备用。

把胶粉和热水混合在一起，至胶粉完全融化。将其倒入之前搅拌好的酸奶，搅拌混匀后将混合物盛入4个玻璃杯，让其冷却。

准备配料。把草莓与1汤匙的热水搅拌至细滑糊状备用。把胶粉和热水混合在一起，至胶粉完全融化。加入明列子和之前搅成糊状的草莓，搅拌均匀。将其盛入酸奶杯，然后放入冰箱冷藏1小时或至配料沉淀。

随意点缀、适宜冷用。

小贴士：配料里的草莓可以换成55克（2盎司）的草莓和30克（1盎司）的草莓泥。

准准准准准准准准卡路里 58千卡碳水化合物 9.2公克脂肪 1公克胆固醇 3毫克纤维 0.7公克

该食谱首次出版于《ACookbookforDiabeticsbyaDietitianandaChef》现已在各大书局出售。

吃出健康

浆果酸奶惊喜收获

4 0 N O V – D E C 2 01 6 C A R I N G

急性痛风问题：我是一名34岁的男性。一个星期前，我

右脚的大脚趾开始出现疼痛和僵硬的情况。

接下来的几天，疼痛还持续扩散到脚部的其

他部位，现在整个脚部都肿起来了。我感觉疼

痛难忍，就连走路都成了问题。我是一名经

营海鲜餐饮业的商人，我大部分的时间都在

餐馆里，因此我的饮食里主要都是海鲜和红

肉；我也喜欢喝酒。我家楼下的家庭医生可以

医治这个病症吗？还是我的情况严重到必须

到医院的急诊部门求医？

您的家庭医生能治疗这些病症！东

部医疗联盟于2014年1月份推出了“家庭医生首选”计划，为的是要鼓励居住在新

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

浏览www.gpfirst.sg或咨询您的家庭医生更多有关常见的医疗状况，如割伤、撞伤、轻微烧伤、呕吐、流鼻血、伤风、蚊虫咬、头痛、扭伤及发烧。以下是读者发来有关急性通风和流鼻血的提问。

解答：依您的症状来看，您很有可能是患上了

急性通风，建议您去一趟家庭医生的诊所，他

将能够帮助您缓解疼痛，并且密切跟进您的病

情。

痛风是关节炎的一种，主要因血液内累积过

量的尿酸所导致。这些多余的尿酸会形成尿酸

颗粒，从而使关节肿胀和发炎。痛风一般出现

在大脚趾，但其他身体部位，如脚踝、脚背、脚

跟、膝盖等其他关节，都有可能受到影响。

当我们体内的嘌呤氧化时便会产生尿酸。

虽然嘌呤是我们人体细胞里的一种天然有机化

合物，但某些食物也含有嘌呤。嘌呤含量高的

食物就包括了红肉（如牛肉、猪肉）、动物的内

脏（如肝脏、肾脏）、海鲜、某些蔬菜（如菜花、

芦笋）及酒精（主要是啤酒里的酵母）。除了尿

酸和饮食习惯之外，遗传因素、肥胖、代谢综合

症和服食某种药物（如噻嗪类利尿药，英文名

称为ThiazideDiuretics）也可导致痛风。

如果您的情况没有在两三天内好转，我建议您

及早寻求家庭医生的帮助。当家庭医生在进行诊

断时，他会问您一些问题以排除其他导致关节发

炎的可能性，如受细菌或病毒感染和遭受创伤。

家庭医生大多会让您做尿酸和肾功能检测。他也

会给您开一些消炎止痛的药物来缓解您的疼痛。

预防性的药物如别嘌呤醇（Allopurinol）有助应

对复发性的痛风。

生活习惯和饮食上的改变是避免痛风发作和

降低其发作风险的重要因素。您可多吃蔬菜、家

禽类和多喝水，与此同时减少酒精的摄取和改掉

偏爱吃红肉和海鲜的习惯。我建议您定期做运

动，因为这是避免肥胖和体重超标的好方法。

由黄汉威医生提供解答

黄汉威医生 是莱佛士医疗集团（加东l12）的一名家庭医生。他毕业于悉尼大学，并且是新西兰皇家全科医师学院的研究员。他也是澳洲民航安全的指定航空医师。

FEATURE

流鼻血问题：我是一名18岁的男性学生，总的来说

我的健康状况良好，没有任何潜在的病症。但

最近不知何故，我开始流鼻血，一次是当我在

上课的时候、另一次是当我在走路回家的时

候，还有几次是当我在看电视的时候。我不确

定是什么原因导致我流鼻血，但在一个多星

期的时间里，它几乎每两天就会发生一次。今

天早上当我起床时，我感觉到有些什么东西流

入喉咙里。我尝试咳嗽，却赫然发现我竟咳出

带有血迹的痰。我的母亲相当担心我的情况，

并强烈要求我去急诊部门求医。但我觉得没必

要，因为虽然我有流鼻血，但并没有觉得身体

有任何不适。到底是什么原因使我经常流鼻

血，还有在什么情况下我才应该去急诊部门

求医呢？

解答：流鼻血的导因有很多。复发性的流鼻血有可

能是由于鼻部在近期受到创伤，如抠鼻孔、空气中

湿度底、过敏性反应和受细菌或病毒感染。

大多数流鼻血的情况都属轻微，并且一般通过

急救措施就可获得缓解：

1.轻轻地擤鼻子，以清除累积在鼻孔里的血块

2.坐下来，然后把头向前倾以避免血液倒流入

喉咙里

3.用嘴巴呼吸，紧紧捏住鼻孔上方鼻子较柔软的

部位

4.保持这个姿势达10分钟（幼童5分钟）

5.减充血鼻腔喷雾剂，如羟甲唑啉（Oxymeta-

zoline），也有助缓解症状。您可以使用在流血

的鼻孔，并且重复做以上步骤2到4。然而，如

果情况持续三天都不缓，此方法不可做为一个

长远的应对方案。

虽然您没有感觉身体不适，但最好还是让家庭

医生为您做一个初步的检查，看是否需要做进一

步的检查或转诊到专科部门。

根据您所形容的情况，您应该至少已经流了5

到6次鼻血了。您的家庭医生会问您一些更详尽的

问题，主要和您的家族健康背景、生活和饮食习惯

有关。例如，他会问您是否有家庭成员患有容易导

致流鼻血的病症、您本身是否有自己也不知情的

病症、又或者是您最近领养了新宠物从而引发过

敏性反应。流鼻血也有可能是由于您经常处于有

冷气的环境里，从而营造了空气干燥的环境。医生

也会为您做检查，看看您是否有鼻窦炎或鼻孔深

处是否长有硬块。

如果您发现即使把头向前倾但血液仍倒流入

喉咙里，这可能是情况较为严重的征兆并且应当

前往急诊部门求医。如果您不确定自己的情况是

否严重我建议您先咨询家庭医生的意见，让他评

估您下一步应该怎么做。

您可以参考以下一些生活习惯上的建议以避

免发生流鼻血的情况：

• 避免重复性使鼻子受创伤，如抠鼻孔、经常擤

鼻子

• 确保室内环境的湿度处于良好水平。如果您

是在冷气房里睡觉，您可考虑在卧室里放几盆

水。

• 保持鼻孔潮湿，您可使用鼻腔喷雾剂或用棉花

棒在鼻孔里涂一点凡士林油

由杨德振医生提供解答

家庭医生解答

杨德振医生目前是勿洛家庭医疗诊所的驻诊医生。他拥有墨尔本大学的内外全科医学学士文凭，并且曾经在卫生部任职卫生官员。