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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

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.

How to Cope with Financial Stress? 

Feeling stressed is a natural human emotional that can unfortunately be enhanced when a person is going through financial problems. It is important to remember that you are not alone, financial stress is something many people experience at some point in their life. Luckily, there are easy ways that stress and anxiety can be eased. Here are several ways you can cope with stress and overcome your financial problems once and for all.

Understand the cause of stress
The climate in the world today is undoubtably stressful. The coronavirus pandemic has caused major economic fallouts all around the world. As a result, many people are experiencing financial stress due to mounting debt, loss of employment or unexpected expenses arising. The stress caused by these problems may present itself in a variety of different ways. You may be experiencing trouble sleeping, feeling depressed, anxious, or wanting to withdraw from society.

The bigger the financial problem, the bigger toll it takes on our mental health. When you have poor mental health, it is harder to manage your money, it is a vicious cycle.

In order to break this cycle, it is helpful to identify the main problems in your life and understand those which are causing the most stress. By highlighting the issue, you will be better equipped to deal with it, eliminate the problem and help ensure it does not happen again in the future.

Talk to someone
When it comes to financial stress, chances are you are not alone. It helps to talk to someone close to you or even a trained professional. Vocalizing your problems may help put things into perspective and make your issues feel much less intimidating. The person listening doesn’t need to fix your problems, they can just be used as a sound board to listen without any judgment or criticism. They may even provide a fresh perspective and come up with a solution to your problem that you never thought of. Just remember that asking for help is not a sign of weakness, sharing your worries with someone you trust can be incredibly beneficial.

If you don’t feel comfortable talking to family or friends, there are many professionals available who specialize in dealing with financial problems. There are also a number of free resources on how to manage debt such as Credit Counselling Singapore (CCS), which is an independent, non-profit, Social Service Agency. CCS is the only organisation recognised by The Association of Banks in Singapore (ABS) for their commitment in helping debt-distressed individuals address their unsecured debt problem through counselling, education and facilitating debt repayment arrangements. https://ccs.org.sg/

Track your finances
It is incredibly useful to come up with a detailed plan outlining your monthly income, expenses, and debt. Laying everything out in front of you will allow you to clearly see the reality of the situation you are in so you can solve it as soon as possible. In addition to an old fashioned excel sheet, there are plenty of websites and smartphone apps that can help you easily record and track your finances.

Recording everything will allow you to identify your spending patterns and allow you to make the necessary changes. Small helpful changes include cutting down on nonessential spending like
eating out at expensive restaurants, getting takeout instead of cooking or indulging in a little online shopping. By eliminating some unnecessary expenses, you can free up some extra cash to pay off bills, cover an unexpected expense or treat yourself or a loved one to something special.

Make a plan
Once you can track your finances you can easily make a plan to address your specific money problems. Whether the problem is high credit card debt, overspending or not enough income, there is a solution!

You can try lowering the interest rate on your credit card debt, live within a stricter budget, find a new source of income, or seek out government benefits. With whatever course of action you choose, don’t forget to monitor your progress. Regularly review your financial plan and see if the changes you have made are working. You will be amazed at how small changes can allow you to take control of your financial situation.

Live within a budget
Creating a monthly budget for yourself will help eliminate overspending. We are all guilty of indulging in unnecessary things whether it be travel, takeout or online shipping. Creating a monthly budget will allow you to track these expenses and cut down on them when you are in financial hardship. Some months it becomes a priority to pay a bill, or an unexpected expense may come up. By sticking within a budget, you will be better equipped to cover these expenses.

Take care of yourself
During the process of dealing with financial stress it is important to have good mental health by taking care of yourself. There are many techniques you can use to improve your mental wellbeing and better deal with anxiety resulting from money problems.

You can brighten your mood by doing a little bit of exercise every day. Getting your body moving is a sure-fire way to ease stress and improve your mood. Another helpful technique is meditation or breathing exercises. Take some time out of your day to truly relax and give your mind a break from stressful thoughts.

In addition to exercise it is necessary to get at least seven to eight hours of sleep every night. Sleep is so important to get both the mind and body working at their best. It is also important to eat healthy foods and drink lots of water daily. Keeping your body healthy by getting a good night’s sleep, doing exercise, and eating right will improve your outlook and allow you to cope with any financial stress you may be experiencing.

Managing your finances may seem like a daunting and stressful task. Take it one step at a time and you will be better equipped to manage your stress and deal with challenges in the future. It is a good idea to talk to someone you trust about your problems, keep track of your finances, come up with a plan and stick to a budget. Above all, take care of yourself and try not to be overwhelmed with worry. There are many ways to tackle your money problems and ease your stress levels. No situation is completely hopeless and there is always help available.

Image by tirachardz on Freepik

Health Connect – November Edition 

Frozen shoulder is a common cause of shoulder pain in the community and is characterized by shoulder pain, joint stiffness and restricted range of motion. It can last from weeks to months.

Frozen shoulder can be broadly classified into primary or secondary. In primary frozen shoulder, there is no known cause but is commonly associated with other medical issues such as diabetes, thyroid disease and more. In secondary frozen shoulder, there is usually a history of prior shoulder injuries such as bone or tendon injuries.

The diagnosis of frozen shoulder is primarily a clinical one, based on the clinical history and physical examination. Nonetheless, imaging is routinely performed in patients who present with shoulder pain to assess for other conditions that can cause shoulder pain.

The management of frozen shoulder is dependent on several factors including severity of symptoms, patient’s characteristics, goals etc. Common non-surgical management techniques include physiotherapy and medications. Surgical intervention is also done for some. 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.