MyHEALTH

MyHEALTH
JOURNEY TO BETTER HEALTH
COMPLIMENTARY MAGAZINE
OCTOBER 2016
Chest pain and
heart attack
CARDIOLOGIST EXPLAINS WHY
URGENT CARE IS NECESSARY
Is Lasik safe
for you?
FREEDOM FROM GLASSES
AND CONTACT LENSES
Managing
Back Pain
A SURGICAL PERSPECTIVE
The best care
for your little
angel
NEONATAL INTENSIVE CARE
UNIT
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1
MyHEALTH
JOURNEY TO BETTER HEALTH
CONTENTS
World Heart Day - 29th September 2016
Journée Mondiale du coeur , le 29 septembre 2016
Cardiovascular diseases have
gradually grown to be at the heart
of our health concern in Mauritius. In today’s fast paced
world, heart diseases are becoming a worrying trend
due to changes in people’s diet, environment and lifestyle. For a healthy heart you should keep your cholesterol level and salt intake low, exercise regularly to keep
a healthy weight and avoid smoking. Preventive cardiac
health screening is an effective and affordable way of
identifying hidden cardiac disease risks.
Les maladies cardiovasculaires se sont progressivement placées au centre de nos préoccupations de santé
à Maurice. Dans ce monde où tout semble aller plus
vite, les maladies cardiaques sont une vraie menace en
raison des multiples changements dans notre régime
alimentaire, notre environnement et notre mode de vie.
Pour un coeur en bonne santé, vous devez maintenir un
faible taux de cholestérol, limiter votre consommation
de sel, faire des exercices régulièrement pour garder un
poids de forme, et éviter le tabac. Le dépistage préventif
est un moyen efficace d’identifier les risques cachés de
troubles cardiaques.
In this issue
2
MYHEALTH
4
Never underestimate chest pain!
6
Breast Reconstruction Surgery
8
What is LASIK eye surgery?
10
Comment vous protéger de la conjonctivite
11
Beware of hypertension
12
HPV Vaccine : protecting women from
cancer
13
Exercise : myths & facts
14
Pour travailler à la NICU, il faut avoir des
compétences spécifiques
16
Why breastfeed your newborn?
18
Managing back pain
20
Mieux identifier les douleurs à l’épaule
21
10 ways of keeping your heart healthy
22
This month’s receipe
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MyHEALTH
JOURNEY TO BETTER HEALTH
CARDIOLOGY
Chest
discomfort
Arm or back
discomfort
Neck or jaw
discomfort
Never underestimate
What should one expect at the Chest Pain
Clinic ?
Chest pains can sometimes be benign such as heart burn,
but sometimes it can be much more serious like a heart
attack! So how do you distinguish chest pains?
C
What are the signs of a Heart Attack?
Dr Mahesh Krishna Kumar
Senior Consultant
Interventional Cardiology,
Apollo Bramwell Hospital,
speaks on chest pain.
Characteristics of a heart attack are often described
as a pressure or heaviness or tightness or squeezing in the chest that can radiate up to the shoulders or the arms and sometimes the jaw or even
the teeth. It can also go into the back. But it doesn’t
have to have all these characteristics! Also associated symptoms such as shortness of breath, a feeling
of nausea, sweatiness, light-headedness, or feeling
like the heart is racing or skipping. Now it is very
important to understand that it doesn’t need to
have all these characteristics. But if you have these
characteristics of chest pain... you should be very
concerned, it may be a heart attack!
So what should you do in such situations?
ACT FAST!
•
Do not try to drive or walk!
•
Call for help immediately. Or simply dial 132
for our ambulance hotline.
•
Or ask someone to take you to our Chest Pain
Clinic where facilities are available to do complete diagnosis of your chest pain and a stateof-the-art 24/7 catherisation Lab to unblock
arteries.
Bear in mind that a heart attack happens because
of blockage of artery or a blood vessel which supplies blood to the heart muscle. So the most important treatment is to unblock that blood vessel
so that the blood supply is restored as quickly as
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heaviness and if you have it longer than 1 – 2 minutes lasting for 5 – 10 minutes, then you should call
for help or dial ‘132’ for our advanced cardiac life
support ambulance.
REMEMBER...THE SOONER YOU ACT,
THE BETTER !
Chest Pain!
hest pain is a common symptom. It is very difficult to tell when you are having such symptoms exactly what’s going on! Sometimes it
can be benign such as heart burn, but sometimes it
can be much more serious like a heart attack! Many
people are concerned whether chest pain is heart
related or not!
CARDIOLOGY
possible. Therefore It is very important that you
go to a medical centre which has the ability and
facility to do this on a 24/7 basis as quickly as possible. If not, you are going to lose time and in that
process you are also going to be losing precious
heart muscles. The longer the delay to ensure optimal blood supply, the more the damage to the
heart is likely to happen.
Recognise the signs of a Heart Attack
Trouble breathing
with or without
chest discomfort
Feeling light
headed or breaking
into cold sweat
Feeling sick or
discomfort in
your stomach
The Chest Pain Clinic is located at the emergency
department of the Apollo Bramwell Hospital. Here,
further tests are perfomed to evaluate the chest
pain and to check whether they are heart related or
not. The centre has formalised processes and protocols in place to evaluate patients quickly and a Senior Cardiologist on standby to treat patients more
effectively for a better outcome. Emergency heart
attacks require an angiography followed by balloon angioplasty or stenting in a catherisation lab.
Sometimes the patient’s heart disease is so severe,
they require a bypass surgery. Chest pain is a medical emergency and time is of the essence, therefore
don’t ignore it! Call the emergency cardiac ambulance hotline number ‘132’ or visit the Chest Pain
Clinic at the Apollo Bramwell Hospital. It could be
your nearest path to survival!
What happens when you call the ‘132’
ambulance hotline?
Non-Modifiable and Modifiable
risk factors of cardiac arrest:
We send our advanced cardiac life support ambulance. The emergency doctor & paramedics
who come to your house in the ambulance can do
an ECG right in your house and find out if you are
having a heart attack. Then they alert the Apollo Bramwell Hospital so that the cardiac team is
ready to receive you for heart attack care.
What could happen if your care is
delayed?
If you go to a health care centre that doesn’t have
the critical care needed for treating a heart attack
or it doesn’t have the facility to unblock arteries
on a 24/7 basis, your care will be delayed! During
a heart attack, the heart muscles are dying every
minute because there is lack of blood supply to
the heart muscles. So it is important to restore
the blood supply to the heart as quickly as possible. Every minute your care is delayed, more and
more of the heart muscles are getting damaged.
Sometimes the damage is permanent. Therefore
it is absolutely critical that the blood supply to the
heart is restored as soon as possible. Remember,
the minimum amount of heart muscle lost , the
better the efficiency of the heart and better the
protection. Time is of essence when it comes to a
heart attack. We therefore say, ‘ TIME IS
MUSCLE’. When the muscles of the heart are
lost, the heart is going to get damaged. Therefore
if you have such episodes of chest discomfort or
•
AGE, GENDER, GENETIC FACTORS,
ETHNICITY
•
HIGH BLOOD PRESSURE, SMOKING,
DIABETES, PHYSICAL INACTIVITY
OBESITY, HIGH BLOOD CHOLESTEROL
Catherisation lab
“Cardiologists emphasize
that during a heart attack,
the heart muscle is dying
every minute and the
longer you delay, the
greater the difficulty for
you to recover and return
to a normal life afterwards”
MYHEALTH
5
NIC Health Plan
MyHEALTH
JOURNEY TO BETTER HEALTH
PLASTIC SURGERY
BREAST
Médical • Chirurgical • Dentaire • Auditif
• Ophtalmologique • Maternité • Troubles de
la fertilité • Services ambulance • Assurance
catastrophe et plus encore.
October is the Breast Cancer awareness month
Reconstruction
SURGERY
care
for my
family
W
ith more than 500 cases of breast cancer detected
per year in Mauritius, that is to say nearly one new
case per day, plastic surgery needs more than ever
to be a major element in the treatment of breast cancer and
breast reconstruction.
Currently, three methods of breast reconstruction are of standard reference in the medical world. The choice of methodology depends on the patient’s desires, the stage of the illness
and the joint opinion of an oncologist and a plastic surgeon.
Conservative therapy:
Conservative therapy occurs through lumpectomy, which includes removal of the tumour and a small quantity of the tissues surrounding it. Such surgery can be carried out by way
of an incision around the areola or vertically below the breast.
For the sake of symmetry, the other breast will then be reduced and modelled. The only drawback to this therapy is that
it can’t be carried out when the cancer is multifocal or when
the patient has already undergone radiotherapy.
Immediate reconstruction:
This procedure starts right after mastectomy (surgical removal, partial or total of one breast or both). The immediate reconstruction can be carried out with prosthesis or body tissue
(from the back or the abdomen), or even both, as per the surgeon’s advice. The prosthesis used is made of two parts, one is
in silicone gel and the other is gradually filled with a physiological serum until it reaches the desired curvature to recreate
a harmonious vision of the bosom. The reconstruction then
follows two steps: firstly the positioning of the prosthesis and
secondly, once the latter stabilises, the surgeon recreates
the nipple and then the areola.
Differed reconstruction:
It entails the same steps as immediate reconstruction, but is
carried out from one to one and a half years after the radiotherapy sessions, if the latter had been necessary.
A
vec plus de 500 cas de cancers du sein détectés par an à
Maurice, soit près d’un nouveau cas supplémentaire par
jour, la chirurgie plastique doit plus que jamais se placer
comme acteur majeur du traitement du cancer du sein et de
sa reconstruction. Aujourd’hui, trois façons de reconstruire le
sein font référence dans le milieu médical. Le choix de la
méthode dépend des désirs de la patiente, du stade d’avancée
de la maladie et de l’avis émis conjointement par l’oncologue
et le chirurgien plasticien.
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MYHEALTH
La thérapie conservatrice:
La thérapie conservatrice passe par la tumorectomie, qui
consiste à enlever la tumeur et une petite quantité des tissus
qui l’entourent. Cette chirurgie peut notamment être réalisée
grâce à une incision autour de l’aréole et une autre, verticale en dessous du sein. Par souci d’harmonie, l’autre sein sera
ensuite réduit et modelé. La seule limite à cette thérapie est
qu’elle ne peut être proposée lorsque le cancer est multifocal
ou que la patiente a déjà bénéficié de radiothérapie.
La reconstruction immédiate:
Cette méthode débute immédiatement après la mastectomie
(l’ablation partielle ou totale d’un ou des deux seins). La reconstruction immédiate peut se faire avec prothèse ou lambeaux,
voire les deux, selon l’avis du chirurgien. La prothèse utilisée
a la particularité d’être fabriquée en deux parties, l’une en gel
de silicone et l’autre, raccordée à une pipette, est remplie progressivement de sérum physiologique jusqu’à atteindre le galbe voulu pour recréer une vision harmonieuse de la
poitrine. La reconstruction se fait alors en deux étapes : d’abord
le positionnement de la prothèse et ensuite, une fois celle-ci
stabilisée, le chirurgien recrée le mamelon et ensuite l’aréole.
La reconstruction différée:
Celle-ci implique les mêmes étapes que la reconstruction immédiate, mais elle s’effectue entre 1 an à 1 an et demi après la
fin des séances de radiothérapie, si celles-ci se sont avérées
nécessaires.
Dr Van Den Broeck
Plastic & Cosmetic Surgeon, Apollo Bramwell Hospital
Parce qu’il vaut mieux prévenir les hasards de la vie,
la NIC vous propose des assurances santé innovantes
et élaborées en fonction de vos besoins et de ceux de votre famille.
Pour votre confort, une souscription rapide et pas d’avance
de frais en cas d’hospitalisation vous permettront de profiter
pleinement de nos tarifs très compétitifs.
Alors, soyez prévoyant et appelez nous dès aujourd’hui au
602 3000 pour plus d’information.
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| www.nicl.mu
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The NIC General Insurance Co. Ltd is licensed by the Financial Services Commission.
MYHEALTH
7
MyHEALTH
JOURNEY TO BETTER HEALTH
OPHTHALMOLOGY
OPHTHALMOLOGY
Do you want freedom from
glasses and
contact lenses?
LASIK is the
solution
for you!
Dr Bharti Sharma
Senior Ophthalmologist
Apollo Bramwell Hospital gives a
complete update on LASIK
and its advantages.
L
ASIK (Laser in-situ Keratomileusis)
is a laser eye surgery technique
that reshapes the surface of the eye
(cornea) to correct nearsightedness, farsightedness and astigmatism.
LASIK surgery is performed on individuals suffering from myopia (short-sighted),
hypermetropia
(longsighted),
astigmatism (unevenly curved cornea),
and offers them freedom from glasses
and contact lenses. LASIK is a great option for many individuals considering
laser vision correction for a variety of
very personal and professional reasons.
We have invested in the only 100%
bladeless refractive laser technology
in Mauritius thus benefitting patients
who wear glasses. The Alcon Wavelight
Refractive Suite performs blade-free
LASIK (Laser Eye Surgery), which is safer
and more advantageous than the conventional Lasik surgery.
The basis for successful Lasik treatment
is an accurate diagnosis. We offer high
precision diagnosis with the one and
only Allegro Oculyzer on the island.
The benefits of this industry leading
equipment are advanced safety and increased comfort due to the high speed
eye tracking precision of the laser ensur-
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MYHEALTH
ing reduced chances of corneal ectasia
and lower risk of infections. The Refractive Technology offers our patients best
outcomes with quicker recovery times.
What are the advantages of Blade
Free Lasik and how safe is it?
Femtosecond LASIK / BLADE FREE LASIK
is generally safe, effective, and has very
few side effects. It is a highly successful
procedure that can at the very least reduce a person’s dependence on glasses
or contact lenses. The lifestyle benefits
can be tremendous for active and social
people. These benefits can enable people to more freely pursue their hobbies,
sports activities or career options.
How is the procedure carried out?
LASIK combines the accuracy of the
Femtosecond laser to cut a flap in the
cornea along with excimer laser to reshape the cornea.
Femtosecond assisted LASIK :
In usual LASIK surgery, a surgical instrument called a microkeratome is used to
create a flap of the corneal tissue. A microkeratome is a tool with a blade that
cuts a circular flap of tissue from the surface of the cornea. This thin flap of corneal tissue, attached by a hinge, is fold-
ed back exposing the inner layer of the
cornea (stroma). Next, the excimer laser
is used to reshape the cornea (stroma).
After the inner tissue of the corneal is reshaped, the flap is repositioned, without
the need for stitches. In Blade Free LASIK
/ Femtosecond LASIK, femtosecond laser is used to cut a flap of the corneal
tissue (usually with a thickness of 100120 microns). Femtosecond (FS) laser
is an infrared laser with a wavelength
of 1053nm. It works by producing photo disruption or photoionization of the
optically transparent tissue such as the
cornea. Application of Femtosecond Laser results in the generation of a rapidly
expanding cloud of free electrons and
ionized molecules. The acoustic shock
wave so generated results in disruption
of the treated tissue.
What about LASIK flap creation with
femtosecond laser ?
A suction ring is centered over the cornea and suction is applied. The docking
procedure is then initiated while keeping the suction ring parallel to the eye.
An applanating contact lens is used to
stabilize the globe and to flatten the
cornea .The surgeon administers the FS
laser treatment. Each pulse of the laser
generates free electrons and ionized
molecules leading to formation of microscopic gas bubbles dissipating into surrounding tissue. Multiple pulses are applied
next to each other to create a cleavage plane and ultimately the LASIK flap. Suction is then released. A spatula is carefully
passed across the flap starting at the hinge and sweeping inferiorly to lift the flap for excimer laser ablation
What are the major advantages of FS laser?
1. Reduced incidence of flap complications like buttonholes, free caps, irregular cuts etc.
2. Greater surgeon choice and control over flap diameter and thickness, side cut angle, hinge position and length.
3. Increased precision with improved flap safety and better thickness predictability.
4. Capability of cutting thinner flaps to accommodate thin corneas and high refractive errors.
5. Other advantages over microkeratome assisted LASIK include stronger flap adherence, better contrast sensitivity, decreased
incidence of epithelial ingrowth, less increase in intraocular pressure , lesser incidence of dry eyes, hemorrhage from limbal vessels less likely and the ability to retreat immediately if there is incomplete FS laser ablation. Loss of suction during FS laser LASIK
flap creation is easier to handle and the suction ring may be reapplied and treatment resumed immediately in many cases.
What are the disadvantages associated with Femtosecond assisted LASIK?
1. Opaque bubble layer (OBL): Gas bubbles may accumulate in the flap interface during FS laser treatment. There is a significant
reduction in the incidence and extent of OBL when novel LASIK flap ventilation canal parameters of width and spot line separation are used as in Alcon FS 200.
2. Transient light sensitivity syndrome (TLSS): Also called as good acuity plus photosensitivity (GAPP). TLSS usually occurs days
to weeks after FS laser LASIK. Patients present with photophobia and good visual acuity with paucity of clinical findings on
exam. It resolves without sequel but requires aggressive topical steroids for weeks.
Are there any other alternatives to LASIK?
I would say Photorefractive keratectomy (PRK). In this procedure only epithelium is removed (so no flap is created) and Excimer
laser is given to the cornea. Recovery time is longer with PRK than with LASIK, though the final outcome is about the same (very
good). However the disadvantage is that this procedure cannot be performed for higher refractive errors.
Implantable collamer lens or ICL :
In patients with thin corneas, where LASIK / PRK cannot be done, another option would be ICL. Implantable collamer lens or
ICL is a soft, flexible gel-lens for the permanent correction of myopia (nearsightedness). The ICL procedure is an intraocular
procedure where an ICL is implanted inside the eye . ICLs consists of a small biocompatible intraocular lens (IOL), also known as
a posterior chamber phakic intraocular lens (PIOLs), with distinct footplates, called haptics, to hold the lens in place within the
cilliary sulcus inside the eye and the anterior vault designed to
minimize contact with the eye’s crystalline lens.
Who are the patients suitable for an ICL ?
Moderate to high myopia(nearsightedness) of -3 to -20 diopters who are not good candidates for LASIK because of thin
corneas.
What are some of the disadvantages of ICL ?
•
Infection - Like any intraocular surgery there is a potential
of an infection.
•
Increased intraocular pressure - Pressure may build in the
eye after an ICL procedure. The sooner a surgeon is alerted to this complication, the greater the
chance of avoiding serious
damage.
•
Repositioning or removal of lens -ICLs
have the potential, however slight, of
needing to be repositioned. The frequency of this complication may vary
by implantable
contact lens
models.
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JOURNEY TO BETTER HEALTH
INTERNAL MEDICINE
OPHTHALMOLOGY
Disadvantages of ICL ( continued)
• Damage to crystalline lens - Because implantable contact lenses are implanted into the eye,
there is a potential that the eye’s natural lens may be damaged during the procedure. If the
damage is severe, the crystalline lens may need to be replaced with an intraocular lens.
• Cataract development - Over 50 percent of the population will develop cataracts by the age
of 65, however, it is believed that the use of some implantable contact lenses may cause
cataracts at an earlier age.
Conjunctivitis:
How to protect yourself?
C
onjunctivitis is an inflammation or infection of the
conjunctiva, the thin transparent layer of tissue that
lines the inner surface of the eyelid and covers the
white part of the eye. Conjunctivitis, often called “pink
eye”, may affect one or both eyes. Some forms of conjunctivitis can be highly contagious and easily spread in
schools and at home. While conjunctivitis is usually a minor eye infection, sometimes it can develop into a more
serious problem.
Comment vous protéger de
la conjonctivite ?
L
a conjonctivite est une inflammation ou une infection de la conjonctive, la fine couche transparente
de la membrane qui tapisse la face postérieure des
paupières et recouvre le blanc de l’oeil. Elle peut affecter
un oeil ou les deux yeux à la fois. Certaines formes de la
maladie peuvent être hautement contagieuses et peuvent
se répandre rapidement dans les écoles et à la maison. Le
plus souvent un trouble oculaire mineur, la conjonctivite
peut parfois aboutir à un problème de santé plus grave.
What are the different types of conjunctivitis?
As per Dr Bharti Sharma, Consultant Ophthalmologist
there are different types of conjunctivitis:
• Viral
• Bacterial (such as gonorrhea or chlamydia)
• Allergic such as dust and pollen, contact lens wearers.
Quels sont les différents types de conjonctivite?
Selon le Dr Bharti Sharma, ophtalmologue, il y a différents
types de conjonctivite :
• Viral • Bactérien (comme la blennorragie ou la chlamydia)
• Allergique (à la poussière et au pollen, pour ceux portant
des lentilles).
Viruses are a common cause of conjunctivitis in patients
of all ages. A variety of viruses can be responsible for conjunctival infection; however, the adenovirus is by far the
most common cause. Viral conjunctivitis, although usually
benign and self-limited, tends to follow a longer course
than acute bacterial conjunctivitis, lasting for approximately 2-4 weeks.
Les virus sont une cause fréquente de la conjonctivite chez
les patients de tout âge. Une pléthore de virus peut être responsable d’infections conjonctivales ; toutefois, l’adénovirus est de loin la cause la plus fréquente. La conjonctivite
virale, bien que généralement bénigne et spontanément
résolutive, a tendance à suivre un plus long cours que la
conjonctivite aiguë bactérienne,avec une durée de deux à
quatre semaines approximativement.
Who is at risk?
Anyone who is in close contact with a person who already
has conjunctivitis or with contaminated swimming pools.
How to avoid contracting the virus?
Dr Bharti Sharma says that practicing a good hygiene
is the best way to control the spread of conjunctivitis.
Avoiding close contact with infected patients and washing
hands frequently will greatly reduce the risks of infection.
Measures and Precautions
Once an infection has been diagnosed, follow these steps:
• Don’t touch your eyes with your hands.
• Wash your hands thoroughly and frequently.
• Change your towel and washcloth daily, and don’t share
them with others.
• Discard eye cosmetics, particularly mascara.
• Don’t use anyone else’s eye cosmetics or personal eye
care items.
• Follow your eye doctor’s instructions on proper contact
lens care.
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MYHEALTH
Qui sont les personnes à risque?
Quiconque est en contact rapproché avec une personne
ayant déjà la conjonctivite ou nageant dans des piscines
contaminées.
Comment éviter d’attraper le virus?
Le Dr Bharti Sharma affirme que pratiquer une bonne
hygiène est le meilleur moyen de contrôler la propagation
de la conjonctivite. Éviter un contact rapproché avec des
patients infectés et se laver régulièrement les mains
réduira le risque d’infection.
Mésures de précautions une fois une infection
diagnostiquée, suivez les consignes suivantes :
• Ne touchez pas vos yeux avec vos mains.
• Lavez vos mains fréquemment et abondamment.
• Changez de serviette et de gant de toilette quotidienne
ment et ne les partagez pas avec autrui.
• N’utilisez pas de produits de beauté pour les yeux, en
particulier le mascara.
• Ne faites pas usage des produits de beauté d’une tiers personnes ou ses produits personnels pour les yeux.
• Suivez les consignes de votre ophtalmologue concer- nant l’entretien convenable de vos lentilles de contact.
Beware of hypertension
Dr Arshad Peerbux
Consultant Internal Medicine
U
nfortunately hypertension is very
common in Mauritius and worldwide. In Mauritius, hypertension
(HT) is prevalent amongst 35-40% of
the adult population. Therefore it is very
common for us to see patients with HT.
Sadly we see many patients coming to
us with untreated and uncontrolled HT.
This leads to many complications.
Based on the statistics, it would be right
to say that one person per family is suffering from HT.
These results are alarming given that
HT leads to many complications, notably cardiovascular diseases. I feel that
the public are not taking enough precautions to monitor, discover and treat
HT. Further statistics show that most
patients are not achieving normal BP
despite taking medications. The causes
could be :
Not following up with the doctor, not
taking enough medications, non-compliance with tablets and poor diet.
1. What is hypertension?
Hypertension is defined as a blood pressure more than 140/90.
Stage 1: systolic 140-159, diastolic 90-99
Stage 2: 160 systolic or diastolic >
100mmHg
2. Who is most affected?
As per NCD survey conducted in
Mauritius :
•
HT increases with age
•
HT is higher in men than in women
3. What are the causes?
Primary HT- develops because of
genetical and environmental factors.
By far the MOST common ones are :
Genetic- high Bp: has a substantial
heritable component from 33-57% in
Framingham study.
Environmental factors - obesity,
smoking, lack of exercise, poor diet,
alcohol.
Secondary factors :
Due to other diseases such as :
1. Renal disease
2. Vascular disease
3. Endocrine problems (imbalances
hormone)
4. Neurogenic causes
5. Obstructive sleep apnoea
6. Medications: alcohol, OCP, COCAINE,
NSAIDS, erythropoietin, nasal
decongestants, some herbal
remedies containing liquorice,
nicotine.
4. What are the adverse effects on
long-term and short term health?
Long term problems include cardiovascular problems and risk factor associated with acute problems such as myocardial infarction (cardiac arrest) and
stroke. HT also causes end organ damage like hypertensive nephropathy and
cardiomyopathy. In the short term, we
only worry about hypertensive emergencies. That is, an acute uncontrolled
high blood pressure can lead to neurologic end damage such as stroke or
intracranial haemorrhage, cardiac damage, renal problems and eye problems.
Engage in aerobic exercises at least
30min on most days (Decrease of 4-9
mmHg).
Promote consumption of fruits, vegetables and low fat dairy products.
If lifestyle is inadequate then medications are needed. The choice of medication will depend on your other medical
problems. Patients also need an assessment of their cardiovascular risk factors
such as smoking, obesity, cholesterol,
diabetes and appropriate treatment will
be given.
5. What are the remedies and solutions?
To lower the blood
pressure we can do
lifestyle changes and
use appropriate
medications.
Lifestyle: Weight
loss 5-20 mmHg
drop in HT per
10kg loss.
Limit alcohol
intake.
Reduce sodium
intake.
Maintain adequate
intake of potassium.
Stop smoking.
MYHEALTH
11
MyHEALTH
JOURNEY TO BETTER HEALTH
HPV Vaccine,
protecting
women from
cancer
EXERCISING:
MYTHS AND
FACTS
Cervical cancer is the 4th most common cancer in women. It can be even prevented entirely
by early vaccination and regular pap tests. Dr Shilipa Sinha, Obstetrician & Gynaecologist,
explains why vaccination is recommended.
H
PV vaccine is safe, effective vaccine which protects people from
most of the cancer caused by human papilloma virus infection.
What is HPV infection and what
do they cause?
HPV is the most common sexually
transmitted infection. More than 100
varieties of Human Papilloma Virus exist but around 40 HPV types can infect
the genital areas of males and females. They can also infect the mouth
and throat. Most people with HPV never
develop symptoms or health problems.
Most HPV infection (9 out of 10) go away
by themselves within 2 years .
But sometimes HPV infection will exist
and can cause:
- Cancer of cervix, vagina and vulva in
women.
- Cancer of penis in men.
- Cancer of anus or back of throat
including base of tongue and throat
(oropharynx) in women and men.
- Cause genital warts in men and
women.
The types of HPV that can cause genital
warts are not the same as the types of
HPV that can cause cancer.
What is the importance of HPV
vaccine?
Vaccins can protect against the strains
of HPV likely to cause genital warts and
cervical cancer.
Why does my child need HPV
vaccine? How HPV vaccine
prevents young girls from getting
Cancer?
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HEALTH & WELLNESS
GYNAECOLOGY
Various strains of HPV spreads through
sexual contact and are associated with
most cases of cervical cancer and genital
warts. Vaccines can prevent most cases
of cervical cancer if given before a girl
is exposed to HPV. Hence girls should
receive all doses of HPV vaccine long
before they begin any type of sexual activity and are exposed to HPV. Also HPV
vaccine produces a higher immune response in pre-teens than it does in older
teens and young women.
Is the vaccine still effective if you
have sexual relations?
Yes, even if someone has already had sex
they should still get HPV vaccine. You
may have one strain of HP virus, the vaccine can protect you from other strains
that you haven’t been exposed.
What are the side effects of
vaccine?
Vaccines like any other medications may
have side effects. Many people who get
HPV vaccine have no side effects at all.
Some people report mild side effects
like
- Pain, redness or swelling in the
arm where shot was given
- Fever
- Nausea
- Headache or feeling tired
- Muscle or joint pain. Sometimes dizziness or fainting spells
(remaining sitting or lying for 15
minutes after vaccination helps
preventing this)
- Rarely severe (anaphylactic)
reaction can occur if allergic to any
component of vaccine
Why do you think parents are
reluctant when it comes to
vaccination?
Safety concerns about HPV vaccine and
worries about the side effects prevents
some parents from giving the vaccine.
Some parents believe that this vaccine
is not needed. Some parents put off the
HPV shots because their daughters are
not sexually active - a mistaken justification because doctors recommend giving the vaccine at age of 11 or 12 years
before a teen becomes sexually active.
Some parents are afraid that giving
vaccine acts as a sort of permission for
teens to be sexually active.
What can you say to parents who
have refused to vaccinate their
daughters?
It is rightly said “ prevention is better
than cure”. So all parents should vaccinate their daughters at 11 or 12 years of
age. Those who did not get when they
were young should get it now. Young
women can get HPV vaccine through
age 26 years.
Myths: “Physical activity is time
consuming!” “I am too busy!”
Fact: Physical activity takes less time
than we think. You can exercise without making any drastic changes in
your routine. Making easy targets
and accommodating them in your
life will make you active. Gradually,
it will become easier to follow the
recommended 30 minutes of daily
physical activity. And if you exercise
regularly, your efficiency will go up
and you will gain more time for other activities because of your fitness
condition.
Myth: “Exercising is for weight
loss”
Fact: Weight loss is not the only benefit. Exercise improves our quality of
life, helps us to work `more efficiently and to enjoy our days better. We
are able to carry out meetings and
office tasks with greater efficiency.
Myth : “Exercising is too hard!”
Fact: You should keep physical activity easy. You could, for example,
get off the bus one stop earlier and
add a little walk to work. Or you
could park your car a little further
from the shopping mall and get in
a small stroll while shopping. Climbing stairs, instead of using elevators
would help burn a few extra calories.
Myth: “I don’t know how to
exercise!”
Fact: Getting help is easy. At Apollo
Bramwell Hospital, exercise sessions
are tailor-made and customized for
every patient. At the Health and
Wellness Centre of the Apollo Bramwell hospital prevention is the key
word. We help patients be aware of
their health but also arm them with
important tools that help fight stress
and lifestyle-related diseases.
HEALTH & WELLNESS
Kinesiologist Ismael
Malleck wants to make
physical activity an essential part of people’s
lives. He reveals some
myths and facts about
exercising.
Exercices
physiques :
fini les idées
reçues!
Ismael Malleck, kinésiologue, souhaite que l’activité physique devienne
un élément central de nos
quotidiens. Il réfute les idées
reçues qui nous découragent souvent à faire des
exercices.
Idée reçue: « L’activité physique
prend trop de temps! » « Je suis trop
occupé ! »
L’activité physique prend moins de
temps que nous le pensons. Nous pouvons nous exercer sans changement
drastique dans nos habitudes. Identifier des cibles faciles à atteindre et qui
intègrent facilement notre routine nous
rendra de plus en plus actifs. Peu à peu,
il sera plus facile alors d’atteindre les 30
minutes d’activité physique quotidienne
recommandées. Si vous vous entraînez régulièrement, votre efficacité augmentera et vous gagnerez donc plus de temps pour
vos autres activités en raison de
votre condition physique.
et ainsi mieux profiter de son temps. Les
réunions et autres activités de bureau,
par exemple, deviennent beaucoup
moins épuisantes !
Idée reçue: «C’est trop dur! » L’activité physique doit rester à votre portée.
Au début, vous pouvez, par exemple,
descendre du bus un arrêt plus tôt que
d’habitude et faire un peu de marche
avant d’aller au travail. Pour brûler
quelques calories supplémentaires,
vous pouvez aussi garer votre voiture un
peu plus loin du centre commercial, ou
encore, prendre les escaliers plutôt que
l’ascenseur.
Idée reçue: “Je ne sais pas comment
faire!” Il est facile de se faire aider. À
l’hôpital Apollo Bramwell des séances
d’exercices sont conçues « sur mesure
», personnalisées pour chaque patient.
Au ‘Health & Wellness Centre de l’hôpital Apollo Bramwell, la prévention est
le mot clé. Nous aidons nos patients à
être conscients de leur état de santé,
mais nous les aidons aussi à acquérir les
connaissances et les techniques qui leur
permettront de combattre le stress et les
maladies liées au mode de vie.
Idée reçue: « C’est pour perdre du poids… » La perte de
poids n’est pas le seul avantage
de l’activité physique. Faire des
exercices, c’est aussi améliorer sa
qualité de vie, être plus efficace
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JOURNEY TO BETTER HEALTH
PAEDIATRICS
PAEDIATRICS
les gestes techniques pour la réanimation
néonatale, notamment la ventilation au
masque, le massage cardiaque externe, l’intubation trachéale et savoir cathétériser le
nouveau-né. Il est impératif de savoir faire
face à toute urgence néonatale tant en salle de naissance qu’au cours du séjour du
nouveau-né à l’hôpital.
“Pour travailler
à la NICU,
il faut avoir
des compétences
spécifiques”
Dans la maternité où vous allez accoucher, vous entendrez peut-être parler du
service de néonatologie. Quels bébés y sont accueillis et quel personnel soignant y rencontre-t-on ? Dr. Faeza Soobadar, ‘Senior Consultant in Paediatrics
and Neonatology’, nous propose une incursion dans l’unité de pédiatrie et de
néonatologie qu’elle a mise en place en 2009.
Qu’est-ce que la pédiatrie ?
La pédiatrie est la spécialité médicale concernant
les enfants, notamment tout ce qui englobe la
maladie de l’enfance et les traitements, et tout ce
qui touche au bien-être de l’enfant. A titre d’exemple, nous proposons des conseils sur l’alimentation, des vaccins et la médecine préventive,
entre autres. Les maladies que nous traitons au
quotidien sont les rhino-pharyngites, les otites, la
gastro-entérite, la bronchiolite, les bronchites, les
laryngites, les crises d’asthme et d’autres urgences
pédiatriques telles les convulsions.
Et jusqu’à quel âge un enfant va-t-il chez le pediatre ?
A l’île Maurice c’est généralement jusqu’à l’âge de
13 ans, mais dans certains pays c’est jusqu’à l’âge
de 16 ans.
Les enfants prétendent-ils souvent être
malades ?
J’appellerai cela la somatisation. Cela se produit
lorsque l’enfant a une angoisse ou est sous un
stress quelconque. Et c’est ce qui lui cause des
symptômes comme le mal de ventre ou des maux
de têtes. Ainsi, au lieu de lui faire faire une série de
tests qui le traumatiseront davantage, nous essayons de discuter avec l’enfant pour comprendre la
source du problème.
Qu’est-ce la néonatologie ?
La néonatologie est une branche de la pédiatrie,
voire une sous-spécialité, qui touche aux maladies
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affectant les nouveau-nés. Médicalement parlant,
ce sont les soins intensifs pour les bébés qui sont
gravement malades, notamment les nouveau-nés
prématurés, les bébés qui ont contracté une infection au cours de la grossesse ou encore ceux qui
présentent une malformation congénitale. Toutefois , la prématurité est la cause la plus fréquente
d’hospitalisation en néonatologie. La néonatologie requiert l’utilisation de technologies et comprend beaucoup de traitements et d’interventions
invasifs.
Quels sont les services de l’unité de pédiatrie et
de néonatologie ?
Apollo Bramwell est le seul hôpital privé qui offre
un service complet en pédiatrie et néonatologie,
cela avec une salle de pédiatrie d’une capacité de
20 chambres uniquement pour les enfants, mais
on permet aussi à la maman de rester avec son
enfant malade. Nous avons un OPD (Out-Patient
Department) qui est ouvert tous les jours, du lundi
au samedi de 8h30 à 20 heures. Mais toutefois les
consultations se font sur rendez-vous uniquement,
sauf en cas d’urgence. Le département de néonatologie fonctionne en étroite collaboration avec
le département de la maternité. Il y a une nursery
pour les bébés en bonne santé et aussi une unité
de soins intensifs de néonatologie (NICU) qui accueille les bébés qui ont besoin de soins médicaux
particuliers.
En quoi consistent les interventions ?
En tant que néonatologue, il faut savoir pratiquer
Quelles sont les causes d’hospitalisation
les plus fréquentes ?
Chez les prématurés, une des maladies les
plus fréquentes est celle de la membrane
hyaline (RDS) qui est occasionnée par une
déficience du surfactant causant des troubles respiratoires chez le bébé. Dans les
premières heures de vie, l’enfant subit une
intubation trachéale (une sonde est placée
dans sa trachée) pour sa ventilation pour
les jours qui suivent sa naissance. Pour ce
faire, le personnel soignant doit absolument avoir les compétences nécessaires et
bien comprendre les particularités physiologiques et pathologiques du nouveauné.
Et les complications ?
Le couple place tant d’espoir dans la naissance de leur enfant. Si l’accouchement se
passe bien pour certaines mamans, pour
d’autres, c’est très difficile d’accepter que
son enfant naisse avec des complications.
Nous, en tant que médecins, nous savons
ce qui est possible ou pas. Ainsi à ABH ,
nous assurons aussi un service de conseil
pour les parents afin de les préparer à surmonter certaines épreuves. Il faut savoir
également gérer le stress des parents à cet
effet. De nos jours, lorsqu’on effectue le
suivi de la grossesse d’une future maman,
il y a des fois, le foetus montre certaines
complications. Le gynéco-obstétricien peut
recommander ainsi la naissance par césarienne pour une meilleure chance de survie
du bébé. Nous, en tant que néonatologues,
nous faisons notre maximum pour sauver
l’enfant. Si nous rassurons les parents, nous
les préparons aussi au pire en cas d’échec.
Car dans certaines cas, l’enfant peut surmonter les complications et nécessite d’autres soins pour être en bonne santé. Toutefois, l’unité des soins intensifs, c’est là où les
bébés frôlent aussi la mort.
Un petit bout de chou qui vous a le plus
marqué ?
Je me souviens d’un bébé qui était à terme
mais qui souffrait de troubles respiratoires.
C’était lorsque je travaillais à l’hôpital du
Nord. En dépit des soins qu’on avait administrés à l’enfant, son état continuait à se
détériorer et son coeur avait commencé à
flancher. Les parents ont été alertés de la
situation et on les avait preparés au pire. Et
ces derniers ont décidé de faire une prière
spéciale pour leur enfant car ils gardaient
toujours espoir que leur enfant survive. Le
même soir l’enfant a commencé à montrer
des signes d’amélioration et il s’en est sorti.
Aujourd’hui, cet enfant est âgé de 10 ans et
il est en pleine forme.
Qu’est ce qui cause la mort des nouveau-nés ?
C’est triste à dire mais ce sont les cardiopathies congénitales la plus part du temps.
A Maurice, on n’a pas les facilités pour des
interventions chirurgicales appropriées
pour les nouveau-nés. Pour cela, il faut
donc se rendre à l’étranger. Cette pratique
est toutefois à risque car l’état de santé du
nouveau-né est souvent instable. On n’a
pas les personnes avec les compétences
requises pour ce genre d’opération au pays.
On a des ‘foreign teams’ qui effectuent le
déplacement pour le faire mais on n’a pas
au pays des personnes spécifiques pour ce
genre d’intervention. Mais il est à noter que
la néonatologie à Maurice a bien progressé
depuis les 15 dernières années.
Quelles sont les qualités requises pour
faire ce métier ?
Pour etre pédiatre, je dirais qu’il faut avoir
beaucoup de patience, être à l’écoute et
faire preuve de beaucoup de disponibilité.
Il faut savoir amadouer l’enfant quand il
pleure et aussi bien répondre aux multiples
questions des parents sur leur enfant et les
rassurer. Quant à la néonatologie, c’est un
métier exigeant et éreintant. Pour le faire,
il faut de la passion et un bon esprit d’équipe. Et j’insiste sur le fait que le personnel
soignant doive être formé et avoir les compétences nécessaires.
Parlez-nous de votre équipe...
L’équipe médicale et soignante d’Apollo
Bramwell Hospital est composée de deux
pédiatres employés à plein temps, avec les
compétences requises, épaulés d’une équipe d’infirmières . Cependant, nous collaborons aussi avec des ‘visiting doctors’ pour
offrir un service de qualité. Nous avons, à
l’hôpital Apollo Bramwell, une équipe d’infirmières douées qui nous assistent pour
chaque cas. Elles sont toutes formées et
ont les compétences nécessaires pour administrer les soins, que ce soit à l’enfant
en pédiatrie ou au bébé en soins intensifs.
Notre équipe comprend des infirmières
étrangères et Mauriciennes.
Faeza Soobadar
a été boursière du
‘Junior Scholarship’
en 1975. De 1976 à
1982, elle entame
des études secondaires au Queen
Elizabeth College où
elle sera lauréate de
la filière scientifique.
Elle met le cap sur
l’Angleterre où elle
effectue des études de
médecine de 1983 à
1988 à l’université de
Manchester. De 1989
à 1998 , elle se spécialise en pédiatrie et
néonatologie (MRCP
en 1993 et CCST en
1998). De
retour au pays en
1998, elle crée l’unité
néonatale de l’hôpital
Sir Seewoosagur
Ramgoolam et y
travaille jusqu’en
2009. Par la suite, elle
se retrouve à l’hôpital
Apollo Bramwell
où elle a mis en place
l’unité de pédiatrie et
de néonatologie. Elle
y travaille désormais
à plein temps en tant
que ‘Senior Consultant in Paediatrics
and Neonatology.’
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JOURNEY TO BETTER HEALTH
PAEDIATRICS
Dans l’ombre, elles sont les anges gardiens...
Le Dr. Faeza Soobadar insite sur le fait que les
infirmières et auxiliaires, bien qu’elles soient souvent dans l’ombre, jouent un grand rôle dans les
soins intensifs des nouveau-nés. “J’ai une grande
admiration pour elles, pas seulement pour celles
d’Apollo Bramwell Hospial, mais aussi pour celles
affectées aux NICU de Candos et de SSRN”, ditelle. Et d’ajouter que ce sont elles les anges gardiens des bébés en quelque sorte.
WHY BREASTFEED YOUR NEWBORN?
1st to 8th August was the international breastfeeding week.
To mark this event, world’s
leading infant nutrition brand,
‘NUTRICIA‘ organised an awareness talk during which Dr. Faeza
Soobadar explained why
breastfeeding is necessary.
What are the advantages for you?
• It is a natural food designed for your
baby.
• Numerous health benefits for baby.
• Health benefits for mother.
• It is free.
• Available whenever needed.
• Right temperature.
• Free from contamination.
• Encourages bonding.
What are the health benefits for
your baby?
• Contains protective factors : IgA, Mac rophages, Antibodies, oligosaccha
rides, Lactoferrin.
• Reduces Gastroenteritis in babies, Ear
infections, and Chest infections.
• Protects children from Obesity & Type2 diabetes, Eczema, Higher scores in
cognitive function testing.
Health benefits for the mother :
• Short-term:
• Suckling increases oxytocin which leads to uterine contraction and
reduction in PPH.
• Breast feeding is also a Natural contra
ceptive.
• Uses 500 calories/day therefore can
lead to some weight loss.
• Long-term: • Reduces the risk of breast
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and ovarian cancer.
• Lowers the incidence of osteoporosis
and hip fractures over the age of 65.
What should mothers eat during
breast feeding?
• 5 portions of fruit/veg
• Starch – wholemeal bread, pasta, rice
potatoes.
• Fibre – cereals, pulses, wholemeal
bread.
• Protein- lean meat, chicken, fish, eggs,
pulses.
• Dairy food – milk cheese yogurt.
• Plenty of fluids : water, milk, fresh fruit
juices.
Foods to Avoid
FISH:
• Only 2 portions oily fish (fresh tuna,
sardines, mackerel, trout) allowed per
week.
• Only 1 portion of shark or swordfish or
marlin (Hg) allowed per week.
CAFFEINE:
• Tea, coffee, chocolate, energy drinks.
• Drink occasionally – not daily.
• Try decaffeinated tea/coffee, herbal
teas.
from someone else other than the
mother.
• It is best to try giving a bottle when the mother is not present.
• Something that smells of the mother
nearby may help.
Expressed breast milk and storage
• At room temperature (no more than 25 degrees C), for up to six hours.
• In a cool box, with ice packs, for up to 24 hours.
• In a fridge (at four degrees C or colder),
for up to five days. Store it at the back
of the fridge, where it’s coldest, away
from meat, eggs, or uncooked foods.
• In a fridge’s freezer compartment, for
two weeks.
• In a home freezer (at minus 18 degrees
C or lower), for up to six months.
Expressed breast milk
• Frozen expressed breast milk should
be defrosted in the fridge and should
not be re-frozen once thawed.
• Breast milk should be warmed by
standing the feed in a jug of hot water
for a few minutes.
ALCOHOL:
• 1 or 2 units once or twice per week
• AVOID GETTING DRUNK
Returning to work
• Continuing baby-led feeding before
and after work is possible.
• Mother can express milk so that the infant can be fed by cup or bottle
when she is away.
• The baby is more likely to take a bottle
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JOURNEY TO BETTER HEALTH
ORTHOPAEDICS
ORTHOPAEDICS
combination of steroid plus anaesthetic
medication can help to decrease the
pain.
• Micro-discectomy
This surgery is selective for young individuals with significant disc prolapse
compressing the nerve. The remaining
disc should be normal and without any
arthritis of joints of the spine. Micro-discectomy is done by removing the
portion of the disc that has prolapsed
and pressing against the nerve.
Sometimes these patients can have a
recurrent disc prolapse from the remaining disc.
Managing
Back Pain
Dr. S Karunagaran,
Orthopaedic &
Spine Surgeon
speaks on back
pain management
1.Back pain is common and often
results from bad posture. How
can we avoid this?
90% of back pain is non-structural (or)
postural, associated with poor posture
at work or home. The most common
mistake is to sit with a bent posture for
a long time. Repetitive bending forward
and/or lifting heavy objects can also
cause back pain. The best way to prevent back pain is to sit up straight in a
chair with good back support to match
the curvature of the spine. If you are
sitting in a chair for more than an hour,
you are strongly advised to stand up every 45 minutes to one hour and go for a
walk or stretch yourself for 3- 5 minutes
before sitting again. Avoid bending forward and lifting weight. If you are carrying heavy shopping bags, always ensure
you distribute the weight evenly in both
hands.
2. Can abdominal and back exercises help to prevent back pain?
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Prevention is always better than cure.
Proper posture and regular back and abdominal muscle strengthening exercises will often help prevent back pain to a
great extent. Other forms of exercise including aerobics, aqua gym or yoga are
also beneficial. It is important to note
that sufferers of back pain are advised
to take great care when performing
strenuous physical activity. One should
consult a spine surgeon who will guide
you regarding the most appropriate exercises for your particular back problem.
It is good practice for everyone to perform back exercises, more so for people
who sit at a work-station for a prolonged
time, and/or people who use heavy machinery in the workplace.
3. What are the consequences of
bad posture in the long run?
Bad posture in the long term will almost
certainly cause back pain. The current
working environment usually means
that we often sit and work in one posi-
tion for a long time. Using modern
day technology notably laptops,
tablets and smartphones, whilst sitting in the wrong position or lying
down can have long-term health
consequences on the spine. Sitting
on the sofa with a hunched back,
the so-called ‘couch-potato’ position
can also cause back pain. At first bad
posture causes non-structural back
pain or sprain, but in the long run it
may lead to disc dehydration, disc
prolapse, and arthritis of the joints
in the spine. This will eventually lead
to severe and persistent back pain
with nerve problems.
have a severe back problem requiring some kind of intervention in one
or more of the following situations:
• If the back pain is consistently very
severe and persistent, even after
use of medications and physiotherapy for a considerable period.
• If the pain is severe enough to affect your daily routine.
• If there is radiating pain to one or
both legs with numbness and/or
weakness.
• If there is an inability to sit, stand or
walk for a reasonable period.
• If there is a disturbance in your
usual bowel and/or bladder habits.
4. Under what circumstances
does back pain require
surgery?
5. What are the types of interventions that are practised for
disc problems?
90% of back pain will get better
with-in 2 – 4 weeks, following prescribed medications, physiotherapy
and exercises, and most cases are
non-structural. 10% of patients may
Types of spine interventions
• Epidural injection
This procedure can be useful in
individuals with early disc problem not affecting the nerves. The
• Laminectomy
The procedure involves removing
the bone coverage and the thickened
ligament which presses against the
spinal cord and nerves. The disc is not
removed; more room is made for the
cord and nerves. It is done for elderly patients with a stable spine and a
reduced life expectancy.
Laminectomy can also be useful in a severely compressed spine needing surgery, where the patient is not anesthetically fit to undergo a long surgery.
• PLIF – Posterior lumbar interbody
fusion and TLIF – Transforminal Lumbar interbody fusion:
These surgical procedures involve both
decompression of the spine and also address the stability of the spine by placing pedicle screws connected by rods.
The disc is removed completely and the
space is filled with a spacer device and
bone graft. The procedure will ensure
that the spine is not only decompressed
but also stabilised.
• Other interventions like endoscopic
spine surgery, minimally invasive spine
surgery and Robot-assisted spine surgery essentially give the same result as
more traditional procedures, but the
surgeries are done with the latest equipments.
6. Is surgery helpful for disc problem, and what are the post-operative results?
Yes, surgery really does work wonders
for the quality of life of the patient. If patients are selected carefully, and the appropriate procedure is performed at the
right time, as per the condition demands
and by a specialized spine surgeon, 99%
of cases can stand and walk the next day
following surgery, and even go home
after 3 days. Successful surgery, carried
out at the right time, makes a huge difference to the quality of life of both patients and close family members, and it
can even avert paralysis.
7. What are the risks or complications associated with such surgical procedures?
There are predictable and unpredictable
risks in all types of surgeries. The associated risk of any possible infection can
be avoided by following standard sterile
precautionary measures and clean operating room practices. Antibiotics also
help to prevent infection. The patient’s
age and other medical illness related
factors can be well controlled following
advice of experts. The most feared complication amongst the public is neurological paralysis following surgery, and
it is the main deterrent that prevents
many patients from having a timely intervention. Sometimes patients end
up with paralysis prior to even seeing
a specialist since their fear of paralysis
is such that they want to avoid surgery
altogether. It is extremely important to
consult a spine surgeon as early as possible, in order to avoid any such complications. Please be assured that if surgery
is done by a well-trained, professional
and competent spine surgeon, paralysis
can be avoided and almost all of our patients go home walking.
8. How much time is needed before the patient can resume daily
activities?
Normally the patient can walk as from
the first day after surgery. They can go to
the toilet unaided and eat independently. It is strongly advised for the patient
not to bend forward nor lift weights for
6 weeks to 3 months, depending on the
type of surgery they have undergone.
Generally, one can resume light work
after 6 weeks. They can drive for short
distances as from 6 weeks post-surgery.
After 3 months they can resume their
normal activities, such as working and
driving. It is always advisable to continue good back care practices and exercises to prevent disc problems in other
parts of the spine in the future.
Article by Dr S. Karunagaran
Apollo Bramwell Hospital.
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ORTHOPAEDICS
Mieux
identifier les
douleurs
à l’épaule
La pathologie de l’épaule est mieux appréhendée depuis le
développement de l’arthroscopie qui permet une approche plus
précise des affections couramment liées à cette articulation.
En introduisant dans l’articulation un
petit tube rigide, l’arthroscope, relié à
Une caméra qui va permettre au chirurgien de visualiser la région intra-articulaire sur un écran de contrôle, les affections de l’épaule sont identifiées plus
finement. Il s’agit principalement de
tendinite, de rupture du tendon, de
déboîtement de l’épaule, d’arthrose, de
rhumatisme et de fracture.
La tendinite du susépineux, - l’un des
quatre tendons de la coiffe des rotateurs
– est souvent due à au frottement de
l’os acromial sur le tendon. Saviez-vous
que cette pathologie touchant l’adulte
d’âge moyen peut être aussi calcifiante.
Il faut entendre par là, qu’un dépôt de
calcium, situé le plus souvent au niveau
du susépineux, entraîne de très fortes
douleurs lorsque cette calcification se
rompt. Dans le cas des tendinitis inflammatoires et calcifiantes, la première
étape du traitement est médicale. Il repose sur la prescription d’antalgiques,
d’anti-inflammatoires, associés à des
protecteurs gastriques, ainsi que plusieurs séances de physiothérapie. Si ce
traitement aboutit à un échec, les infiltrations constituent alors la solution
pour soulager la douleur, mais limitée
à trois uniquement car les corticoids
presentent de vrais risques pour les tendons.
Dans le cas où les traitements médi-
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caux s’avèrent infructueux, qui plus est
lorsqu’une rupture de la coiffe des rotateurs – un ensemble de tendons qui «
coiffe » l’articulation - estavérée, le traitement chirurgical est tout à fait indiqué
et peut se faire sous arthroscopie. Les
etudes menées dans ce sens indiquent
que celle-ci permet une récuperation
plus rapide de la fonction et les suites
opératoiressont le plus souvent, moinsdouloureuses.
L’instabilité de l’épaule, l’autre pathologie fréquemment rencontrée, est un
mal qui touche surtout l’adulte jeune
lorsqu’il pratique un sport. En cas de luxation répétée - plus de deux, voire trois
-, le traitement chirurgical est une alternative à l’échec de la physiothérapie. Ce
traitement de stabilization peut se faire
sous arthroscopie, lorsqu’il est pratiqué
suffisamment tôt, et en l’absence de
lesion osseuse. Lorsque les lesions osseuses sont associées aux lesions ligamentaires, alors l’opération de la butée
d’épaule de vient indiquée.
Pour les autres pathologies fréquentes
chez les patients plus âgés, l’arthrose,
- appelée omarthrose pour l’épaule après l’échec d’un traitement médicalsur du très long terme, peut conduire à
l’impotence fonctionnelle douloureuse
avec mobilité réduite et justifiant, chez
le patient demandeur, d’une arthroplastie avec pose de prothèse.
Bien entendu, les maladies inflammatoires touchant toutes les articulations
– la polyarthrite rhumatoïde par exemple – peuvent ells aussi toucher l’épaule
et justifier d’un geste chirurgical, qu’il
passe par l’arthroscopie ou la pose
d’une prothèse lorsque la maladie est
très avancée.
La souffrance du sportif par surcharge
micro-traumatique s’exprimera surtout
par une instabilité de l’épaule ou par une
lésion du bourrelet - le stabilisateur de
l’épaule - pouvant aussi être traité par arthroscopie. Bien entendu toute fracture
survenant encas de traumatisme direct
ou indirect du member supérieur, - et
l’épaule n’échappe pas à cette situation
– peut être traitée chirurgicalement lorsque cette fracture est très déplacée.
Vous souhaitez
être éclairé sur votre
type de douleur à
l’épaule, contacter
le Dr Philippe
Soubrane au
6051000.
10
T
NUTRITION
Ways of
keeping
your heart
healthy!
he circulatory system comprises
of the heart and blood vessels and
failure of these to function correctly affects major parts of the body which
can become deprived of nutrients and
oxygen.
Cardiovascular Diseases are the leading
cause of death in the US according to the
American Heart Association. In Mauritius, several factors including stress, unhealthy diets, cigarette consumption directly impact on the occurrence of heart
disease. Many pre-disposing conditions
exist like uncontrolled hypertension,
diabetes mellitus and obesity which altogether add to increased risk of cardiovascular diseases.
Unfortunately many young adults and
adolescents are nowadays diagnosed
with hypertension which, if uncontrolled, develop into complications at
an early age. Fast food consumption
has been on the increase in many developed and developing countries including Mauritius either due to time scarcity
or as part of our shopping culture and
leisure.
The high salt content and accompanied myriad of processed sauces, and
processed foods aggravate the condition for hypertensive patients. It is thus
advisable to cut down on sodium from
hidden sauces besides just table salt.
Soya sauce, food enhancers, monosodium glutamate, packet cubes and
gravies, canned foods in brine, smoked
meats need strict surveillance in the
effort to fight high blood pressure and
heart diseases.
Coronary heart Disease or Coronary
Artery disease where the main artery
supplying blood to cardiac muscles become blocked is often encountered. Besides high blood pressure and cigarette
smoke, elevated blood cholesterol concentrations, mainly LDL-cholesterol (bad
cholesterol) is a major risk factor to heart
diseases.
A
Healthy Heart
For Life!
Dietary intervention against bad cholesterol therefore aims at reducing intakes
of saturated fats and trans fats, adds on
good quality fats-monounsaturates and
polyunsaturates (Omegas 3 and 6) in order to protect the cardiovascular system.
It is important to note that the arousal
and progression of cardiovascular diseases rest on inflammatory processes at
arterial level. Many superfoods on their
side possess highly anti-inflammatory
properties which can protect our blood
vessels.
Adding a variety of multi-coloured fruits
and vegetables in the daily diet can
therefore do the miracle. Vegetables like
broccoli, capsicum, cabbages, asparagus as well as berries, cherries, pomegranate and most locally available fruits
are packed with these molecules apart
from antioxidant vitamins A and C from
most veggies and fruits.
Adequate intakes of antioxidants and
good fats – from olive oil, avocado,
seeds and nuts altogether scavenge and
synergistically promote healthy blood
vessels and the heart.
Many studies have demonstrated positive effects of B-complex vitamins also
in management and prevention of cardiovascular diseases and their relapse.
It is undoubtedly beneficial to add on
wholewheat cereals likes- multigrain
breakfast cereals, brown breads,/pasta/
flour/oats which apart from the high
fibre content, also contain B vitamins
at all ages is a priority that has to be
inculcated from an early childhood.
The key tips for a healthy heart are :
1. Avoid too much salt/sodium
from processed, fast foods, commercial sauces
2. Limit the intakes of palm oil or
trans fats from biscuits and cakes
3. Choose lean meats- with fish and
chicken as priority
4. Choose low fat milk and dairy
products.
5. Boost your HDL-good cholesterol
with oily fish (salmon, mackerel,
herring), olive oil, nuts and seeds
and avocado to protect your
heart!
6. Minimise the amounts of butter/
margarine use
7. Avoid deep frying of foods- grill,
bake, steam most of them!
8. Snack on fruits, nuts and seedssunflower, pumpkin, chia, safflower, flax seeds.
9. Make vegetables of different colours the major part of your plate
at each meal!
10. Do not forget to exercise!
Dietary control is a strong modifiable
factor that can fight against the occurrence of overweight, diabetes and
cardiovascular disease and to reduce
associated morbidity rate. Our sedentary lifestyle coupled with a lack
of time for healthy food preparation
directly influence our health and immune system. Therefore the need for
a balanced meal.
Article by dietician Amiirah Hosenbux
Apollo Bramwell Hospital.
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JOURNEY TO BETTER HEALTH
NUTRITION
THIS MONTH’S RECEIPE
From our dietician
LES RECETTES DU MOIS
De notre diététicienne
Banana shake
Ingredients (4 servings)
• 2 bananas
• ½ litre of fresh orange juice
• 2 tablespoon of honey
• 250 ml of water
Preparation:
1. Peel and chop the bananas.
2. Place all the ingredients in a
blender and blend until a creamy
mixture is obtained.
3. Serve the shake in goblets with
crushed ice and drink immediately.
Suggestions from the dietician:
Water may be substituted with soy,
almond or non-fat milk to obtain a
creamy and nutritious drink with a
touch of distinction.
Nutritional Value
(per serving):
Energy = 143kcal
Protein = 1.45g
Carbohydrates = 34.1g
Total fat = 0.5g
Saturated fat = 0.1g
Cholesterol = (nil)
Sodium = 2.28g
LE BANANA SHAKE
Ingrédients (4 portions)
DID YOU KNOW?
Bananas are rich in potassium
and poor in sodium. They are
known for their vitamin B content,
as well as magnesium and fibre. They
also contain small amount of serotonin, a vasodilating substance, i.e.,
which improves blood circulation in
the arteries. This banana and orange
shake is thus very helpful to
keep a healthy heart!
• 2 bananes
• Un demi-litre de jus d’orange frais
• 2 cuillères à soupe de miel
• 250 ml d’eau
Préparation:
1. Peler et hacher les bananes
2. Placer tous les ingrédients
dans un mélangeur et l’activer
jusqu’à obtenir un mélange
crémeux.
3. Servir le shake dans des gobelets
avec de la glace pilée et consommer
immédiatement.
Suggestion de la diététicienne:
LE SAVIEZ VOUS?
Les bananes sont riches en
potassium et pauvres en sodium.
Elles sont réputées pour leur teneur
en vitamine B, ainsi qu’en magnésium
et en fibres. Elles contiennent aussi
des petites quantités de sérotonine,
une substance vasodilatatrice, c’est à
dire, qui améliore la circulation du
sang dans les artères. Ce shake à la
banane et à l’orange est donc très
utile pour un coeur en bonne
santé!
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L’eau peut être remplacée par
du lait de soja, du lait d’amande
ou du lait écrémé, afin d’obtenir
une boisson nutritive crémeuse et
avec une touche distinctive.
Valeur nutritive (par portion)
Energie = 143kcal
Protéines = 1,45 g
Glucides = 34,1g
Graisses (total) = 0,5 g
Graisses saturées = 0,1 g
Cholestérol = (zéro)
Sodium = 2,28 g
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JOURNEY TO BETTER HEALTH
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