MyHEALTH

MYHEALTH 1
MyHEALTH
JOURNEY TO BETTER HEALTH
Chest pain and
heart attack
Managing
Back Pain
The best care
for your little
angel
Is Lasik safe
for you?
CARDIOLOGIST EXPLAINS WHY
URGENT CARE IS NECESSARY
COMPLIMENTARY MAGAZINE
OCTOBER 2016
FREEDOM FROM GLASSES
AND CONTACT LENSES
NEONATAL INTENSIVE CARE
UNIT
A SURGICAL PERSPECTIVE

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JOURNEY TO BETTER HEALTH
In this issue
CONTENTS
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 spéciques
16 Why breastfeed your newborn?
18 Managing back pain
20 Mieux identier les douleurs à l’épaule
21 10 ways of keeping your heart healthy
22 This month’s receipe
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 life-
style. For a healthy heart you should keep your choles-
terol level and salt intake low, exercise regularly to keep
a healthy weight and avoid smoking. Preventive cardiac
health screening is an eective and aordable way of
identifying hidden cardiac disease risks.
Les maladies cardiovasculaires se sont progressive-
ment 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 ecace d’identier les risques cachés de
troubles cardiaques.

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“Cardiologists emphasize
that during a heart attack,
the heart muscle is dying
every minute and the
longer you delay, the
greater the diculty for
you to recover and return
to a normal life afterwards”
CARDIOLOGY CARDIOLOGY
Never underestimate
Chest Pain!
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?
Chest pain is a common symptom. It is very dif-
cult to tell when you are having such symp-
toms 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!
What are the signs of a Heart Attack?
Characteristics of a heart attack are often described
as a pressure or heaviness or tightness or squeez-
ing in the chest that can radiate up to the shoul-
ders 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 associat-
ed 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 com-
plete diagnosis of your chest pain and a state-
of-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 sup-
plies blood to the heart muscle. So the most im-
portant treatment is to unblock that blood vessel
so that the blood supply is restored as quickly as
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 pos-
sible. 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 op-
timal blood supply, the more the damage to the
heart is likely to happen.
What happens when you call the ‘132’
ambulance hotline?
We send our advanced cardiac life support am-
bulance. The emergency doctor & paramedics
who come to your house in the ambulance can do
an ECG right in your house and nd out if you are
having a heart attack. Then they alert the Apol-
lo 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 possi-
ble. 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 eciency 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
heaviness and if you have it longer than 1 – 2 min-
utes 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 !
What should one expect at the Chest Pain
Clinic ?
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 proto-
cols in place to evaluate patients quickly and a Se-
nior Cardiologist on standby to treat patients more
eectively for a better outcome. Emergency heart
attacks require an angiography followed by bal-
loon 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 medi-
cal emergency and time is of the essence, therefore
don’t ignore it! Call the emergency cardiac ambu-
lance hotline number ‘132’ or visit the Chest Pain
Clinic at the Apollo Bramwell Hospital. It could be
your nearest path to survival!
Non-Modiable and Modiable
risk factors of cardiac arrest:
• AGE, GENDER, GENETIC FACTORS,
ETHNICITY
• HIGH BLOOD PRESSURE, SMOKING,
DIABETES, PHYSICAL INACTIVITY
OBESITY, HIGH BLOOD CHOLESTEROL
Catherisation lab
Dr Mahesh Krishna Kumar
Senior Consultant
Interventional Cardiology,
Apollo Bramwell Hospital,
speaks on chest pain.
Feeling sick or
discomfort in
your stomach
Chest
discomfort
Arm or back
discomfort Neck or jaw
discomfort
Trouble breathing
with or without
chest discomfort
Feeling light
headed or breaking
into cold sweat
Recognise the signs of a Heart Attack

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MyHEALTH
JOURNEY TO BETTER HEALTH
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 proter
pleinement de nos tarifs très compétitifs.
Alors, soyez prévoyant et appelez nous dès aujourd’hui au
602 3000 pour plus d’information.
ServingYou
ServingTheNation
| www.nicl.mu
Follow us | NIC Mauritius
The NIC General Insurance Co. Ltd is licensed by the Financial Services Commission.
care
for my
family
NIC Health Plan
Médical • Chirurgical • Dentaire • Auditif
• Ophtalmologique • Maternité • Troubles de
la fertilité • Services ambulance • Assurance
catastrophe et plus encore.
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 proter
pleinement de nos tarifs très compétitifs.
Alors, soyez prévoyant et appelez nous dès aujourd’hui au
602 3000 pour plus d’information.
ServingYou
ServingTheNation
| www.nicl.mu
Follow us | NIC Mauritius
The NIC General Insurance Co. Ltd is licensed by the Financial Services Commission.
care
for my
family
NIC Health Plan
Médical • Chirurgical • Dentaire • Auditif
• Ophtalmologique • Maternité • Troubles de
la fertilité • Services ambulance • Assurance
catastrophe et plus encore.
PLASTIC SURGERY
Immediate reconstruction:
This procedure starts right after mastectomy (surgical remov-
al, partial or total of one breast or both). The immediate re-
construction can be carried out with prosthesis or body tissue
(from the back or the abdomen), or even both, as per the sur-
geon’s advice. The prosthesis used is made of two parts, one is
in silicone gel and the other is gradually lled with a physio-
logical serum until it reaches the desired curvature to recreate
a harmonious vision of the bosom. The reconstruction then
follows two steps: rstly the positioning of the prosthesis and
secondly, once the latter stabilises, the surgeon recreates
the nipple and then the areola.
Diered reconstruction:
It entails the same steps as immediate reconstruction, but is
carried out from one to one and a half years after the radio-
therapy sessions, if the latter had been necessary.
Avec 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.
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, vertica-
le 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 bénécié de radiothérapie.
La reconstruction immédiate:
Cette méthode débute immédiatement après la mastectomie
(l’ablation partielle ou totale d’un ou des deux seins). La recon-
struction 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 pro-
gressivement de sérum physiologique jusqu’à atteindre le gal-
be 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 diérée:
Celle-ci implique les mêmes étapes que la reconstruction im-
médiate, mais elle s’eectue entre 1 an à 1 an et demi après la
n des séances de radiothérapie, si celles-ci se sont avérées
nécessaires.
Dr Van Den Broeck
Plastic & Cosmetic Surgeon, Apollo Bramwell Hospital
With 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 stan-
dard reference in the medical world. The choice of methodol-
ogy 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 in-
cludes removal of the tumour and a small quantity of the tis-
sues 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 re-
duced 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.
October is the Breast Cancer awareness month
BREAST
Reconstruction
SURGERY
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 proter
pleinement de nos tarifs très compétitifs.
Alors, soyez prévoyant et appelez nous dès aujourd’hui au
602 3000 pour plus d’information.
Serving You
ServingTheNation
| www.nicl.mu
Follow us | NIC Mauritius
The NIC General Insurance Co. Ltd is licensed by the Financial Services Commission.
care
for my
family
NIC Health Plan
Médical • Chirurgical • Dentaire • Auditif
• Ophtalmologique • Maternité • Troubles de
la fertilité • Services ambulance • Assurance
catastrophe et plus encore.

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JOURNEY TO BETTER HEALTH
OPHTHALMOLOGY
LASIK (Laser in-situ Keratomileusis)
is a laser eye surgery technique
that reshapes the surface of the eye
(cornea) to correct nearsightedness, far-
sightedness and astigmatism.
LASIK surgery is performed on individ-
uals suering from myopia (short-sight-
ed), hypermetropia (longsighted),
astigmatism (unevenly curved cornea),
and oers them freedom from glasses
and contact lenses. LASIK is a great op-
tion 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 benetting patients
who wear glasses. The Alcon Wavelight
Refractive Suite performs blade-free
LASIK (Laser Eye Surgery), which is safer
and more advantageous than the con-
ventional Lasik surgery.
The basis for successful Lasik treatment
is an accurate diagnosis. We oer high
precision diagnosis with the one and
only Allegro Oculyzer on the island.
The benets of this industry leading
equipment are advanced safety and in-
creased comfort due to the high speed
eye tracking precision of the laser ensur-
ing reduced chances of corneal ectasia
and lower risk of infections. The Refrac-
tive Technology oers 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, eective, and has very
few side eects. It is a highly successful
procedure that can at the very least re-
duce a person’s dependence on glasses
or contact lenses. The lifestyle benets
can be tremendous for active and social
people. These benets can enable peo-
ple 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 ap in the
cornea along with excimer laser to re-
shape the cornea.
Femtosecond assisted LASIK :
In usual LASIK surgery, a surgical instru-
ment called a microkeratome is used to
create a ap of the corneal tissue. A mi-
crokeratome is a tool with a blade that
cuts a circular ap of tissue from the sur-
face of the cornea. This thin ap of cor-
neal 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 re-
shaped, the ap is repositioned, without
the need for stitches. In Blade Free LASIK
/ Femtosecond LASIK, femtosecond la-
ser is used to cut a ap of the corneal
tissue (usually with a thickness of 100-
120 microns). Femtosecond (FS) laser
is an infrared laser with a wavelength
of 1053nm. It works by producing pho-
to disruption or photoionization of the
optically transparent tissue such as the
cornea. Application of Femtosecond La-
ser 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 ap creation with
femtosecond laser ?
A suction ring is centered over the cor-
nea and suction is applied. The docking
procedure is then initiated while keep-
ing the suction ring parallel to the eye.
An applanating contact lens is used to
stabilize the globe and to atten 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 ap. Suction is then released. A spatula is carefully
passed across the ap starting at the hinge and sweeping inferiorly to lift the ap for excimer laser ablation
What are the major advantages of FS laser?
1. Reduced incidence of ap complications like buttonholes, free caps, irregular cuts etc.
2. Greater surgeon choice and control over ap diameter and thickness, side cut angle, hinge position and length.
3. Increased precision with improved ap safety and better thickness predictability.
4. Capability of cutting thinner aps to accommodate thin corneas and high refractive errors.
5. Other advantages over microkeratome assisted LASIK include stronger ap adherence, better contrast sensitivity, decreased
incidence of epithelial ingrowth, less increase in intraocular pressure , lesser incidence of dry eyes, hemorrhage from limbal ves-
sels less likely and the ability to retreat immediately if there is incomplete FS laser ablation. Loss of suction during FS laser LASIK
ap 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 ap interface during FS laser treatment. There is a signicant
reduction in the incidence and extent of OBL when novel LASIK ap ventilation canal parameters of width and spot line sep-
aration 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 ndings 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 ap is created) and Excimer
laser is given to the cornea. Recovery time is longer with PRK than with LASIK, though the nal 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, exible 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
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.
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 diop-
ters 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 alert-
ed 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 fre-
quency of this complication may vary
by implantable
contact lens
models.