Question by Ms Koh
I'm a 28-year-old runner, and I've got hereditary bunions. They've never given me much problems until recently: The bunion on my left foot is getting bigger, and while it doesn't hurt, it sometimes causes me to feel slightly imbalanced when I'm running or just standing. I've contemplated having it surgically removed, but I've read that bunionectomies typically lead to loss of range of motion in the foot. Is this true?
Reply from Ms Jessie Phua
Senior sports podiatrist, Changi Sports Medicine Centre
Bunions form often as result of progressive misalignment of the big toe joint. The most common causes are faulty foot biomechanics and family history of bunions. It is also often aggravated by ill-fitting footwear.
The increase in the size of the bunion on your left foot is likely to be caused by excessive weight or shoe pressure applied to the area. High impact activities, such as running, put a lot of added stress and extra weight on your big toe joint.
It is true that your big toe joint's range of motion may be limited or reduced after the operation. You will also be put out of action for six to eight weeks. While you can resume normal activities, the foot is at risk for swelling for up to six months.
Other post-op risks include infection, pain, nerve damage, possible recurrence.
Surgery is usually the last option after you have tried other forms of conservative management. If you are contemplating surgery, you should consult an orthopaedic surgeon on the pros and cons of the procedure as it is very important to be realistic about your expectations and the possible outcomes.
Since you feel slightly imbalanced during running and standing, you may want to see a podiatrist, who will conduct an examination to determine if you need prescribed insoles. The insoles can help correct biomechanical abnormalities, improve foot function and slow down progression of the deformity. However, they won't correct misalignment of the joints or the deformity.
The information provided above is for your general knowledge only. You should seek medical advice or treatment for your condition. Email questions to health@newstoday.com.sg.
From TODAY, Plus – Tuesday, 29-Sep-2009
Early detection and treatment can help COPD sufferers breathe better
Eveline Gan
eveline@mediacorp.com.sg
FOR more than three decades, Mr Mohamed Zaid Bin Sahari, a heavy smoker, lived with a chronic cough that he thought was a common smoker's ailment. Then in 2000, he started suffering from breathlessness.
"Every step that I took felt like I just ran 1km," said the 56-year-old, who used to puff 40 sticks of cigarettes daily.
The condition, which affected him so much that he was unable to walk or talk, almost killed him in 2007.
The unbearable breathlessness Mr Mohamed Zaid experienced was a result of chronic obstructive pulmonary disease (COPD), a serious respiratory disease that is the eighth most common cause of deaths in Singapore, according to the Ministry of Health.
Presently, about 64,000 people here suffer from moderate to severe COPD. And the number is expected to rise, according to respiratory specialist Dr Ong Kian Chung, president of the COPD Association (Singapore).
Dr Ong added that sufferers are also expected to exhibit symptoms of the disease at a younger age, as youth are experimenting smoking at an average age of 16.
Smokers, including second-hand smokers, are at risk of the condition because harmful gases from smoking can cause an abnormal inflammatory response in the lungs. Those who are regularly exposed to pollutants, such as industrial dust and exhaust fumes, are also at risk.
Out of breath
The debilitating disease, which generally affects those above 40 years old, causes the patient to gradually lose the ability to breathe. "It restricts the patients' ability to carry out normal activities and is often undiagnosed in the early and moderate stages," said Dr Ong.
For Mr Mohamed Zaid, being out of breath constantly meant that he was unable to keep up with his daily activities. He also had to take medical leave from work often because he felt unwell. Mr Mohamed Zaid is currently unemployed.
"In the worst-case scenario, the patient literally runs out of breath and it can be fatal," said Dr Ong.
The good news is that COPD can be treated, the doctor said.
And the earlier the diagnosis and treatment, the better the end result, added Dr Tan Tze Lee, a general practitioner at The Edinburgh Clinic, and vice-president of COPD Association (Singapore).
According to Dr Tan, early detection and treatment has been shown to improve patients' health and quality of life.
Simply breathe into the mouthpiece of the spirometer to find out if you have the condition.
GPs to offer COPD screening
Presently, 200 local GPs are equipped and trained to offer COPD screening in their clinics using handheld spirometers, which are usually available only at specialist clinics and hospitals. (Visit www.copdas.com for clinic details.) A spirometer is an instrument that measures how well the lungs are working.
Under the "Save Your Breath Singapore" scheme initiated by the COPD Association (Singapore), patients can find out if they're suffering from the disease by taking a breathing test. Screening and consultation fees vary at different clinics.
Smokers and ex-smokers above 40 years old, especially those with chronic cough, lots of phlegm and who suffer from breathlessness, are urged to go for the spirometry test.
Unfortunately for Mr Mohamed Zaid, smoking has caused irreparable damage to his lungs. Although he feels better with treatment, Mr Mohamed Zaid's lung function is currently only at a low 32 per cent. A normal person's lung function is typically above 80 per cent.
"Mr Mohamed Zaid is one example of a COPD patient who suffered the disease for years without knowing it. By the time it was found out, his lungs have severely deteriorated," said Dr Ong, who added that more than half of COPD sufferers are unaware of their condition.
Dr Tan added: "Once the damage of the lungs occurs, it's not reversible. It simply becomes worse over time. If we can 'catch' COPD earlier, we can reduce a lot of suffering and improve patients' quality of life."
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Women with COPD
Women can also get COPD. In fact, female COPD sufferers may be worse off compared with male patients.
According to respiratory specialist Dr Ong Kian Chung, some studies have found that symptoms of the disease may affect women more because they have smaller lungs. Another reason may be due to a later diagnosis, he said.
"Women may suffer more in silence, so by the time they seek medical attention, their lung function would have severely deteriorated."
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From TODAY, Health – Tuesday, 29-Sep-2009
Heart patients who catch a flu may have more than just a fever or the sniffles to worry about: The virus could also spark a heart attack, new research shows.
Amid the global outbreak of Influenza A, it is crucial that patients get vaccinated against both regular flu and the H1N1 virus.
British researchers analysed 39 previous studies of heart patients, and found a consistent link between flu and heart attacks.
Up to half of all unexpected flu deaths were due to heart disease, they said in a study published online yesterday in the British medical journal, The Lancet Infectious Diseases.
Flu viruses cause inflammation, usually in the lungs. But they can also cause swelling in the heart or in the coronary arteries, which could lead to dangerous clots breaking off and causing a heart attack.
Once heart patients get the flu, they become more vulnerable to complications like pneumonia and other infections.
Two of the studies analysed showed that heart patients who got a flu shot had fewer heart attacks than those who didn't.
Flu viruses might also merely act as triggers for heart attacks in cardiovascular patients.
Experts are unsure whether the study results apply to otherwise healthy people with no history of heart disease. But the viruses could potentially trigger heart attacks in people with risk factors like high blood pressure or who are overweight. AP
From TODAY, News – Wednesday, 23-Sep-2009
BENEFITS OF BANS
Heart attacks reduced considerably in countries where lighting up is banned
LONDON - The ban on smoking in public places could reduce heart attacks by more than a third in some parts of the world, say researchers.
Two independent health reviews have found that heart attack rates dropped steeply in areas where bans have been introduced, with one reporting 36 per cent fewer cases three years after smoke-free legislation came in.
Smoking in pubs, restaurants and other public spaces was banned in England and Wales in July 2007, a year after similar laws were introduced in Scotland.
The Scottish ban led to a 14 per cent fall in the number of people being admitted to hospital with a heart attack the following year.
A Department of Health study of heart attack rates in England and Wales is not due to report until next year, but experts believe the number of cases in the regions has already fallen by around 10 per cent as a result of the smoking ban.
The latest reviews, which draw on published studies from the United States, Canada, France, Italy, Ireland and Scotland, suggest heart attacks in Britain will fall even further over the next two years.
"While we obviously won't bring heart attack rates to zero, these findings give us evidence that in the short to medium term, smoking bans will prevent a lot of heart attacks," said Dr James Lightwood, a health economist at the University of California in San Francisco, and co-author of one of the reviews, published in the US Journal Circulation.
Dr Lightwood analysed 13 published reports on heart attacks in countries or states where smoking bans have been introduced.
A year after the bans were introduced, heart attacks had fallen by an average of 17 per cent. After three years, the number of heart attacks had dropped by 36 per cent.
"This study adds to the already strong evidence that second-hand smoke causes heart attacks, and that passing 100 per cent smoke-free laws in all work places and public places is something we can do to protect the public," Dr Lightwood said.
Heart attacks may fall more modestly in Britain than other European countries because many workplaces imposed smoking bans before nationwide laws were passed.
A second review, by Mr David Meyers at the University of Kansas, drew on 10 studies from the same regions.
His report, which is published in the Journal of the American College of Cardiology, found heart attacks had fallen by 17 per cent on average a year after smoking bans were imposed.
Most of the benefit was seen among young people and non-smokers.
While smoking doubles the risk of heart attack, passive smokers, who regularly inhale tobacco fumes from others, have around a 30 per cent higher risk of getting a heart attack. The Guardian
From TODAY, News – Wednesday, 23-Sep-2009
THE next time you dismiss your itchy eyes and congested nose as minor irritations, consider this: Experts say such common symptoms, caused by allergic rhinitis (AR), can affect work and school performance.
AR is caused by an allergic response to certain airborne substances such as house dust mites. Sufferers experience cold-like symptoms affecting the nose, throat and eyes. These range from a stuffy or runny nose to itchy, red and watery eyes, and can occur irregularly or all year round.
"AR is not a life-threatening condition, but many people underestimate its impact on daily activities," said Dr Samuel Yeak, president of the Society of Otolaryngology, Head and Neck Surgery Singapore, at a media conference last week.
According to Dr Yeak, about 730,000 people here suffer from this condition. And 44 per cent of them are children, who are less able to cope with the symptoms, added Dr Lee Bee Wah, an adjunct associate professor at the Department of Paediatrics at the National University of Singapore, and president of the College of Paediatrics and Child Health Singapore.
He said studies have found that adolescents with moderate to severe AR symptoms have a 50-per-cent increased risk of dropping an exam grade.
"Nasal congestion can affect quality of sleep. The symptoms of AR can also be very tiring and adversely affect performance in school or at work. Imagine how exhausting it would be if you kept sneezing or if your eyes were constantly itchy," explained Dr Lee.
However, only about half of AR patients seek medical help, and most of them ask only to be relieved of their nasal symptoms, said Dr Yeak.
"Often, patients are told by their GPs that it's just a runny nose. Many cases are undertreated, and people just live with their symptoms."
Presently, intranasal steroids (INS), a type of nasal spray, is the recommended treatment for relieving moderate to severe AR nasal and eye symptoms, even for children, said both doctors.
For mild cases, anti-histamines can help, said Dr Yeak.
"Many parents are worried that using nasal steroids may be harmful for kids, but the types of INS currently available are actually very safe and have no side effects on children," he added. Eveline Gan
From TODAY, Health – Tuesday, 22-Sep-2009
I'm a 28-year-old runner, and I've got hereditary bunions. They've never given me much problems until recently: The bunion on my left foot is getting bigger, and while it doesn't hurt, it sometimes causes me to feel slightly imbalanced when I'm running or just standing. I've contemplated having it surgically removed, but I've read that bunionectomies typically lead to loss of range of motion in the foot. Is this true?
