Blog

Health Connect – March 2023

Anaemia happens when one has insufficient red blood cells and/or has red blood cells that are not functioning properly. It is characterized by low haemoglobin levels. This is important because red blood cells and haemoglobin assist in transporting oxygen around the body to allow the tissues to function properly.

Anxiety Disorders

The stigma surrounding mental health disorders may sometimes prevent individuals who need mental healthcare from seeking it out¹.

There is an increasing prevalence in anxiety disorders in Singapore² and those who suffer from it can present with a variety of symptoms³. Common symptoms include, but not limited to, nervousness, restlessness, sense of impending doom, rapid heart rate, palpitations, chest discomfort, rapid breathing, sweating, trembling, troubles with concentration, gastrointestinal issues, sleep disturbances, neurological complaints and more.

Anxiety disorders can be significantly debilitating and detrimental to those who suffer from it, and it can affect one’s daily activities including school/job performance, social lives and relationships with others.

There are multiple types of anxiety disorders and it can affect children, adolescents and adults. These include generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, specific phobias etc.

Here is a brief explanation of the types of anxieties⁴.

Generalised anxiety disorder – You feel excessive, unrealistic worries and tension with little or no reason.

Panic disorder – You feel sudden, intense fear that brings on a panic attack. During a panic attack you may break out in sweat, have chest pains, and have a pounding heartbeat (palpitations). Sometimes you may feel like you’re choking or having a heart attack.

Social anxiety disorder – Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You obsessively worry about others judging you or being embarrassed or ridiculed.

Specific phobias. You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations.

Agoraphobia – You have an intense fear of being in a place where it seems hard to escape or get help if an emergency occurs. For example, you may panic or feel anxious when on an aeroplane, public transportation, or standing in line with a crowd. 

There are also some medical conditions that can cause the aforementioned symptoms, which may necessitate further investigations. E.g. thyrotoxicosis.

The diagnosis of the anxiety disorder will be made by your healthcare provider. The management of anxiety disorders is dependent on the disease type and several other factors like severity, comorbidities and more. It can include psychotherapy and medications and this will be decided by your healthcare provider.

Mental health and wellness are of fundamental importance to an individual’s well-being and early intervention is key.

_________________________

[1] https://www.psychiatry.org/patients-families/stigma-and-discrimination

[2] https://www.imh.com.sg/Newsroom/News-Releases/Documents/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf

[3] https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

[4] https://www.webmd.com/anxiety-panic/guide/anxiety-disorders

Health Connect – February Edition 2023

We hope that everyone has been staying safe over the festive season!

In this month’s newsletter, we have decided to do something a little different in the spirit of the new year.

Here are 10 interesting medical facts that may be of interest to you:
1. The average adult human has 206 bones
2. The largest bone is called the femur (in the thigh)
3. The body’s largest organ is the skin
4. The Scottie Dog sign, named after the Scottie Dog, is a radiological sign in X-Ray imaging
5. The Hot Cross Bun sign, named after the popular snack, is a sign described in MRI imaging of the brain in certain diseases
6. A fetus’ urine contributes to the amniotic fluid in the womb
7. Breast cancer can affect males too
8. The human heart has 4 different chambers
9. In dextrocardia, the heart is situated on the right side of the body
10. Opposable thumbs play an important role in our ability to grip things

We hope that you have been enjoying these monthly newsletters and do let us know if you have any other medical topics that you wish to read about.

Thank you for all your support and we are happy to be your partner in your healthcare journey.

Prostate Cancer: What Singaporean Men Should Know

About a thousand Singaporean men died of prostate cancer from 2015 to 2019. This makes this illness an important issue in men’s health. The prostate is a small gland found just below the bladder in males. It wraps around the tube, called the urethra, through which urine passes from the bladder to the penis. It produces some of the fluid that forms part of semen. It tends to grow as a man ages, constricting the urethra and decreasing the flow of urine. Sometimes, its cells can grow out of control, and that is when prostate cancer occurs.

Prostate cancer statistics
Prostate cancer was the second most prevalent cancer in men in Singapore from 2015 to 2019. 5,875 men had it diagnosed, accounting about 15.4% of all cancers found. It came in second only to rectum and colon cancers in men, which accounted for 16.9% of all cancer cases. By 2020, prostate cancer was third at 15.1%.

Male Chinese and Indians had prostate cancer at a rate that ranked second among all ethnic groups while it ranked fourth among Malays.
It was the most prevalent type of cancer among people aged 70 to 79 and the second most common cancer among men in Singapore between the ages of 50 and 69. At 80 years of age and beyond, it was the third most common cancer in men after cancers of the lung and cancers of the colon and rectum. It was not one of the common cancers that affected men younger than 50 years old.

Prostate cancer was the fourth most common cancer-related cause of death in Singapore for men during 2015 to 2019. There were 989 such deaths, contributing 6.3% to the total. On a positive note, there is a high rate of avoiding prostate cancer death within 5 years.

Symptoms of Prostate Cancer
Remember that the prostate gland wraps around the urethra, and a growing cancer narrows the passages for urine. So, trouble urinating or a decrease in the force of urine’s flow may be warning signs of prostate cancer. Pain during urination and an increase in the frequency of needing to urinate are also symptoms of prostate cancer. The cancer in the prostate may cause some bleeding, and that may show up as blood in the urine or semen. It is also possible for the cancer to cause problems with a man’s capability to have and maintain an erection.

Like other cancers, prostate cancer can cause weight loss. If the cancer spreads to other parts of the body, it can cause problems in the areas affected. For example, it can cause pain once it spreads into the bones, causing pain in the back, hips, or other affected bony areas.

All these symptoms depend on the kind of cancer present in the prostate. Most of the time, prostate cancer grows slowly and remains confined to the gland. In these cases, it takes several years before the problems become noticeable. In the early part of these cases, symptoms may not be present. In other cases, the cancer is aggressive and can spread quickly.

In any case, seek medical care if you experience the symptoms mentioned. The earlier you visit a men’s health clinic, the earlier you might have the problem diagnosed, and the better the chances of treatment become.

Causes of Prostate Cancer
Although the exact causes of this illness are unknown, there are known risk factors. Age, being 50 years old and above, is the greatest risk factor. As mentioned, Chinese are more likely to have it compared with Indians and Malays. Having a blood relative who had prostate cancer or a family member with genes that increase breast cancer risk both make you more likely to develop prostate cancer.

Lifestyle and diet also matter to men’s wellness in terms of prostate cancer risk. Smoking and a diet rich in fat while being low on fibre both increase the risks.

High testosterone levels increase the risk. Sexual activity does not.

Prostate cancer screening and prevention
Because not all cases can have symptoms, you should visit the medical clinic for your men’s health check up. Have a men’s health screening for prostate cancer if you have symptoms or if you are 50 years old or above. You can ask for earlier screening if you have risks from your family history.

There are no specific means of prevention as there are no specific causes to target. At best, you should strive to remain healthy, avoid smoking, and eat a healthy diet. Watch out for the symptoms, now that you are armed with knowledge, and have yourself screened if necessary.

References
1. Centers for Disease Control and Prevention. Prostate Cancer. https://www.cdc.gov/cancer/prostate/basic_info/what-is-prostate-cancer.htm. Last reviewed 25 Aug 2022.
2. Singapore Cancer Registry, Health Promotion Board. Singapore Cancer Registry Annual Report 2019. National Registry of Diseases Office.
3. International Agency for Research on Cancer. Cancer Today. https://gco.iarc.fr/today/online-analysis-pie?v=2020&mode=cancer&mode_population=continents&population=900&populations=702&key=total&sex=1&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=7&group_cancer=1&include_nmsc=1&include_nmsc_other=1&half_pie=0&donut=0.
4. Mayo Clinic. Prostate Cancer. https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087. 2022.
5. SingHealth. Prostate Cancer. https://www.singhealth.com.sg/patient-care/conditions-treatments/prostate-cancer. 2021.
6. Singapore Cancer Society. Prostate Cancer. https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/prostate-cancer.html#risk-factors. 2016.

HIV / AIDS – What you NEED to Know 

With the prevalence of 9,129 cases of HIV by the end of 2021, the incidence of 171 new cases among Singaporean residents was reported between January and October 2022 by the Ministry of Health on Thursday (Dec 01), 2022. A need for further awareness and screening is the need of the hour.

What is HIV / AIDS?

HIV (Human Immunodeficiency Virus) is the virus that weakens the natural defences of the body by targeting the CD4+ T-Cells (a type of white blood cell) responsible for the immunity while utilising the dying cell as a hotbed of its replication and growth. This entire process culminates in AIDS (Acquired Immunodeficiency Syndrome), a medical condition characterised by an increased susceptibility to a host of otherwise less common infections.

It is important to recognise that it is not the virus itself that results in the syndrome but the lack of immunity it produces and the resultant infections and their complications which cause significant morbidity and mortality. These infections include tuberculosis, herpes simplex (shingles), candidiasis (fungal infection), CMV (cytomegalovirus) infection, bacterial pneumonia, and Kaposi sarcoma to name a few.

How does HIV spread?

The main causes of the spread of HIV are;

• Unprotected Sexual Intercourse – The major cause of HIV spread is unprotected intercourse with an HIV-positive person. The risk of transmission of HIV is significantly higher for receptive anal intercourse (1:100) compared to receptive vaginal intercourse (1:1000) and insertive vaginal intercourse (1:3000-1:10,000).
• Needle Stick Injury – Injection drug use with sharing of contaminated needles or accidental pricks of infected Needles and sharps is another major cause of the spread of HIV (1:300). This is a predominant risk for IV drug abusers and healthcare providers.
• From Infected mother to baby – Vertical transmission from mother to baby significantly contributes to the spread of HIV.
• Oral Sex – Receptive fellatio with ejaculation is also a major cause. The statistics about insertive oral sex, however, are unclear.
• Blood Transfusion – Extremely rare since the advent of screening practices prior to transfusion.
• Tattooing and Body Piercing – Rarely occurs when done so without proper hygiene (when instruments have infected blood on them).

HIV generally does not spread by;

• Through saliva (kissing), tears and sweat.
• Sharing toilets.
• Sexual activities not involving the transfer of body fluids (touching. etc).
• Sharing utensils.
• Coughing or sneezing.

How can HIV / AIDS be prevented?

In light of broad clinical literature and the guidelines provided by the Ministry of Health, Singapore, the following measures are deemed most effective to help prevent HIV and AIDS:

• Protected sexual intercourse using physical barriers such as effective use of Condoms.
• Regular screening for high-risk groups (those engaged in casual sex or with commercial sex workers).
• Screening tests for spouses before engaging in unprotected sex.
• Remaining faithful to one’s partner.
• Avoid sharing needles for IV drug injections.
• Pre-Exposure prophylaxis with medications (anti-retroviral therapy) for engaging in sexual contact with an infected partner.
• Post-Exposure prophylaxis after a possible HIV exposure. This must be started within 72 hours of the exposure after consulting with your healthcare provider.
• HIV in pregnancy – Mandatory screening in pregnancy. Start HIV treatment as soon as possible (even in the first trimester) if tested positive and continue throughout pregnancy to decrease the viral load. This should be followed up by intrapartum (during parturition) injection of anti-retroviral therapy to prevent transmission from the mother to the baby.
• Prevention for the baby of an HIV-positive mother – The baby should also receive zidovudine (HIV medication) during delivery and 6 weeks following delivery to prevent transmission.
• Elective Caesarean delivery for HIV-positive women having high viral load (>1000/µl) at the time of delivery.
• HIV screening at home (confidential) – Anonymous HIV testing at home has recently been made available to the public by certain healthcare providers.

What if I test positive?

If you test positive for HIV, you will be put on antiretroviral medications by your healthcare provider as early as possible provided the indications for antiretroviral therapy which are;

• A CD4+ T-Cell count below 500/µl.
• A high viral load. (>100,000/µl).
• Presence of opportunistic or superadded infections.

Viral resistance testing (genotyping) will be performed before starting antiretroviral therapy. The response to therapy is mostly measured by CD4+ cell count and Viral load (PCR-RNA level)

It is important to note that the early detection of HIV (mostly a result of self-indicated screening) leads to a better prognosis since starting antiretroviral therapy (HIV medication) at an early stage has significant success in reducing viral loads and the life expectancy of an HIV -positive person with the viral load as low as negligible matches that of an HIV-negative person.

References

For Incidence and Prevalence in Singapore:

https://www.moh.gov.sg/news-highlights/details/update-on-hiv-aids-situation-in-singapore-2022-(december-2022)#:~:text=A%20total%20of%20171%20newly,the%20same%20period%20in%202021.

For Medical knowledge, Mechanism, Treatment and prevention:

• Harrison’s Principles of Internal Medicine, 20^th Edition
• Davidson’s Principles and Practice of Internal Medicine, 24^th Edition
• Mastering the Boards by Conrad Fischer, 4^th
• https://www.cdc.gov/

Health Connect – January Edition 

Carpal Tunnel Syndrome (CTS), a condition that we see commonly in the community, is due to the compression of the median nerve as it travels through the carpal tunnel at the wrist due to anatomic compression and/or inflammation (1). CTS is also associated with other risk factors like one’s comorbidities (e.g. diabetes mellitus, thyroid disease) and the environment (e.g. occupation)(2).

Patients who suffer from CTS report a variety of symptoms depending on the severity of disease. Common symptoms include, but are not limited to, pain, numbness, weakness and tingling in the outer 3.5 fingers. CTS can be diagnosed clinically but further diagnostic investigations like nerve conduction studies/electromyography and imaging are commonly performed as well.

The management of CTS is tailored to the individual. It includes medications, activity modification, wrist splinting and management of the comorbidities. Surgery is also sometimes performed for some patients. Do speak to your healthcare provider for further information regarding this.

References

1. https://www.uptodate.com/contents/carpal-tunnel-syndrome-pathophysiology-and-risk-factors
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048004/

Disclaimer: All content in this publication is for informational and educational purposes only. It does not constitute any form of medical advice or clinical care nor is it intended to be a substitute for professional medical care. Please speak to your healthcare provider if you have any questions pertaining to your healthcare.

Health Connect – December Edition 

Allergic Rhinitis (AR), a common condition in the community, results in inflammation of the nasal passages when exposed to an allergen. Common allergens can be found indoors and outdoors, including, but not limited to, dust mites, pollen, fur etc.

Consequently, this results in a constellation of symptoms such as sneezing, nose itching, nasal mucus, post-nasal drip and blocked nose.

In addition, AR may occur together with other allergic conditions, such as allergic conjunctivitis, asthma, eczema and sinusitis etc.

The diagnosis of AR is made by your healthcare provider based on your symptoms and clinical examination. Additional tests to assess the extent and complications of your condition include skin prick testing, scopes or blood tests etc.

Treatment strategies vary widely and are dependent on symptom severity, triggers, and of course, your preferences. They range from allergen avoidance, oral medications, nasal sprays/washes to even surgery. Do speak to your healthcare provider for further information regarding this.

Disclaimer: All content in this publication is for informational and educational purposes only. It does not constitute any form of medical advice or clinical care nor is it intended to be a substitute for professional medical care. Please speak to your healthcare provider if you have any questions pertaining to your healthcare.

Depression in Men 

MAN UP!
You’re not depressed , you’re just sad
Just cheer up mate
Men don’t cry
Just smile
Get over yourself
It ain’t that bad
Could be worse

Annoying right?

MAN DOWN
Would you cry out for help?
Or is pride and ego getting in the way?
If you got shot or stood on an IED you would need help…… wouldn’t you?
Is depression is it even a thing?
Are we just sad ?
Moping around and feeling sorry for ourselves?
Or do we just need to MAN UP?

Look at the images above.

Which one of these blokes would you say is depressed?
Majority of people will say the bloke crouched into a ball holding his head. This is because that’s what we have been told over the years.

However, a lot of the time. Men actually mask their mental illnesses like depression with a ‘smile’ or being that joker in the room. Ironically a lot of male comedians are depressed and use humour to express tragedy.

But here’s what’s not funny. Someone dies from suicide every 40 seconds.

Take a minute to allow that number to sink in, a person would have died from suicide.

The statistics are scary.

But, there is good news!

We can spot the signs of depression now. It’s not just sitting in a dark room, curled up into a ball. Or not wanting to move from our beds. It could be a fully functioning person, leading an everyday ‘normal life’.

So what are the signs then?
Well we can break this down into more sizeable chunks

Emotional
– Low mood
– Little interest in anything
– Feeling of low self worth
– Suicidal thoughts

Physical
– Poor sleep
– Low sex drive
– Fluctuation in appetite
– Energy imbalance
– Agitated and short tempered

Cognitive
– Poor memory
– Lack of concentration

There’s a lot there isn’t there? Feel like less of a man if you felt / feel any of them?

Well you shouldn’t.

At some point we all have these feelings to some degree. In micro and macro proportions. Majority of men can find coping techniques and strategies, which are shared further down. But there is no shame in having these feelings.

We are human. We have feelings and it’s perfectly okay to feel and express them.

Many men have had their own experiences with depression. Suicidal thoughts, self harming physically and mentally. Days where they might be the life and soul of the party but the insides are crying for help and not wanting anyone near them and whatsoever.

But we can build, stronger day by day.

So, what causes depression?
This is a question that can sometimes be hard to answer.

But here are a few causes.

Depression can be:

• Hereditary
• Environmental
• Abuse
• Trauma
• Age
• Gender
• Substance abuse
• Unemployment
• Low income

If you think it may be depression you are suffering with then you need to start talking, speak to your doctor and get ball rolling with some positive steps forward.

What to do if you think you’re depressed or someone you care for is depressed?

• Do a check in on yourself / them.
• Ask yourself / them if you / they are ok.
• Like really ok.
• Are you / they showing any signs and symptoms as laid out above
• If you / they are in immediate danger of harming yourself or others then call the emergency services ASAP.
• Talk to a friend, family member, your doctor.
• Reach out to local charities who can provide free support.

It can sound really old and clichèd but, exercise, healthy balanced diet can really help support you whilst battling with depression. The mind and body are all connected as one. Keep working on both of them and you will be far stronger going forward. Ultimately talking will be the first step to helping you.

It makes you more of a man to talk than not too.

Never underestimate how powerful you are as a MAN and as a HUMAN.

Remember to stay safe.

Here are some helplines that you can reach out to:

• National Care Hotline 8am to 12am 1800-202-6868
• For COVID-19 related mental health distress, Samaritans of Singapore (24 hour)
  1-767 (1-SOS)
  1800-221-444
• Institute of Mental Health (24-hour)
  6389-2222
• mindline.sg – a digital stress management platform that aims to empower and equip individuals with tools, knowledge and pathways to self-care and seek out professional help when needed.

Source: MHC Asia Group ©

MHC at the 3rd Health Insurance Innovation Congress Asia Pacific 2022 

MHC is delighted to be represented by Dr Darren Chhoa as a panel speaker at the 3rd Health Insurance Innovation Congress Asia Pacific 2022. More than 200 people attended this event, allowing us to connect and meet with insurance carriers, healthcare, insur-tech and health ecosystem partners.

Addressing the topic of cost containment strategies and risk management in healthcare and health insurance, Dr Darren shared on how we can eliminate waste in health insurance and healthcare, as well as how we can use AI to improve risk management and using data to improve claims processing. He also advised on the strategies and practices that companies can adopt to increase healthcare quality for employees while reducing costs, and the importance of looking into health engagement solutions.