Health Check

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How much alcohol is too much? Is snoring a sign of poor health? Is bird flu still a risk? Singaporean health experts answer your burning questions.

I seem to be drinking more alcohol since moving to Singapore due to business entertaining and a full social calendar. I’ve heard a few glasses of wine can improve health, but a few too many can have the opposite effect, especially for women. How much is too much?
Dr Robin Janke: Moderate alcohol consumption can indeed provide certain health benefits, particularly regarding heart disease. It decreases the risk of heart attack, ischemic stroke (the most common kind), and arterial blockages in the legs. However, heavy alcohol use is associated with high blood pressure, heart failure, liver and pancreatic disease, osteoporosis, birth defects, and injuries.

The answer isn’t as simple as sticking to moderate drinking. For some people, even moderate (and sometimes minimal) alcohol intake has been shown to increase the risk of haemorrhagic stroke, head and neck cancer, digestive tract cancers, and breast cancer. So, alcohol use has some benefits, but also some significant risks.

Women who are pregnant, women with a personal or strong family history of breast cancer, people with a previous haemorrhagic stroke, current liver or pancreatic disease, a precancerous condition of the digestive tract, and people with a history of alcoholism should avoid alcohol completely. Obviously, people who will be driving any vehicle or operating dangerous equipment should avoid alcohol, too.

Everyone else should use alcohol in moderation. Unfortunately, moderate intake is somewhat less than what most people think. One unit of alcohol is usually defined as a 150ml glass of wine, 350ml of beer or, 45ml of 80-proof distilled spirits. The American Heart Association recommended in 2006 that “if alcoholic beverages are consumed, they should be limited to no more than two drinks per day for men and one drink per day for women.” Based on available data, the ideal intake of alcohol is likely to be even lower: half to one alcoholic drink daily.

My husband and I joke about his snoring, but after hearing that it is actually a sign of poor health, I’m worried. Can snoring lead to serious medical problems? What should we do?
Dr CC Lau: Snoring occurs when something obstructs airflow during sleep. When air squeezes past the obstruction, it makes a whistling or rattling sound. Potential obstructions range from medical conditions such as rhinitis to anatomical obstructions, including polyps, enlarged tonsils or excessive fat in the neck.

Some snorers produce a noise during sleep, but their bodies are not medically affected by their snoring. In other cases, however, snorers could have obstructive sleep apnoea (OSA). where obstruction is so severe that air to the lungs is greatly reduced and the heart and lung muscles must work harder for an adequate oxygen supply. The lung muscles become so tired that they take a break and simply stop breathing. A non-breathing period that lasts more than 10 seconds is called an apnoea.

OSA has many undesirable effects. Oxygen levels in the blood drop and there may be inadequate oxygen supply to the brain and other organs, which can lead to brain suffocation adversely affecting the body’s performance. To compensate for lowered oxygen levels, the heart increases its rate, cardiac output and blood pressure. Left uncorrected, OSA could increase the risk of hypertension, heart attack or stroke.

If your husband is a severe snorer, this probably indicates that there is a significant obstruction somewhere in his airway and he should have a detailed evaluation by an ENT specialist to determine the severity, cause of the problem and appropriate treatment.

Treatment depends entirely on the cause of the snoring or OSA. Just as there is a wide range of potential obstructions, there is almost as wide a range of treatments, including medical and surgical options. A machine-assisted breathing device called CPAP can also be used.

A sleep study called a polysomnogram should be done to determine the severity of snoring or OSA. This is a study where a person’s vital signs, oxygen saturation, and severity of apnoea are recorded during a night’s sleep. This study can be done in a hospital or in the comfort of your own home.

Family observations are also invaluable for the ENT specialist’s diagnosis. Spouses of OSA sufferers often report that the snorer sometimes seems to stop breathing, then gasps or chokes before heaving in a breath. Video recordings are also very useful.

I suffer from niggling back pain and it’s beginning to interfere with my fitness programme. What’s the best form of exercise for back pain sufferers?
Eric Samonte: While there can be several causes, back pain is usually associated with weak abdominal muscles. The best way to repair the problem is to strengthen these core “powerhouse” muscles and elongating your back muscles. Your posture will be improved with stronger stabilising muscles for the spine. Proper carriage is achieved, thus relieving undue stress and tension on your back.

Every Pilates exercise is an abdominal exercise because the abs are always engaged. At the same time, Pilates works to strengthen and lengthen the muscles supporting your spine evenly and uniformly. By rebalancing the muscles that support your spine, you can reverse the discomfort of an aching back.

Whatever the condition of your back, you would benefit from Pilates exercises as they restore strength and keep the spine flexible, while maintaining the natural curves of the neck and the middle and lower back.

I am developing bunions. They don’t bother me now, but will they get worse? Should I do something about them now?
Dr Yung Shing Wai: Generally, surgery for bunions is only needed when symptoms such as pain, numbness, and difficulty wearing shoes are present. It may also be necessary when there are changes developing in the second and other lesser toes, such as a crossover toe. Delay in this case may result in additional surgical procedures to correct the other toes. Bunion surgery is not done for cosmetic reasons.

My current surgical technique is a combination of several procedures including reshaping bones, soft tissue releases and balancing. Every patient is different and the combination is tailored to the individual. Most of these procedures are done generally in day surgery and allow immediate walking. By four weeks, patients can walk normally. Return to sports takes a minimum of three months, as the bone needs time to mature and strengthen.

My mother had terrible varicose veins and I’ve always been afraid I would get them too. Is this a genetic problem? I’m 40 and haven’t developed them yet; am I in the clear?
Dr John Tan: Varicose veins are a genetic problem, and you are not in the clear yet. Varicose veins form when valves in the leg veins fail. This allows gravity to pool blood in the leg veins, stretching and dilating them.

Your mother may have had a weaker set of veins and she may have passed this to you. However, whether or not you develop varicose depends on how much stress your veins have been subjected to. Stress to the veins could come in the form of multiple pregnancies, prolonged standing and sitting, and wearing high heels and tight clothing. Ladies who have multiple pregnancies and those who stand a lot at work tend to get varicose veins at an earlier age. With your family history, you could be prone to it and you may get it at a later stage of your life.

You can reduce this chance by reducing the amount of stress you put on your veins. Follow these tips:

• Exercise regularly to improve circulation and strengthen veins. Focus on exercises that work your legs,
like walking or running.
• Watch your weight. Obesity can put a lot of pressure on the legs.
• Do not cross your legs when sitting.
• Elevate your legs when resting or sleeping.
• Try not to sit or stand for long periods. When you sit for a long time, take a walk every now and then.
• If you must stand for a long time, shift your weight from one leg to the other or do tip-toeing exercises to
improve circulation in the leg.
• Wear elastic support stockings as much as you can.
• Avoid wearing tight clothing and high heel shoes as they can constrict your waist and legs and impede
circulation.
• Eat a balanced diet with sufficient fibre and cut down salt intake.

If you do develop varicose veins, we now have an advanced method for removing them called endovenous laser treatment. It is done in a clinic and there is no requirement for general anaesthetic, no scars and no overnight stays.

Is avian flu still a concern?
Dr Kim Hayes: A global outbreak of avian flu is still a concern. A pandemic starts when three conditions are met: a new influenza virus subtype emerges; it infects humans, causing serious illness; and it spreads easily and sustainably among humans. Avian flu (the H5N1 virus) amply meets the first two conditions. It’s a new virus for humans and it has infected more than 100 people, killing over half of them. No one will have immunity should an H5N1-like pandemic virus emerge.

Fortunately, the virus has not yet shown efficient, sustained human-to-human transmission. The risk remains that it could acquire this ability as long as chances for human infections occur. These chances will persist as long as the virus circulates in birds, which could endure for years to come. The more human infections occur, the more opportunities the virus has to improve its ability to transmit among humans and develop into a pandemic strain.

Further concerns include: domestic ducks excrete highly pathogenic viruses without showing illness, which complicates control efforts; today’s virus is more lethal when tested on mice and ferrets; it appears to have expanded its host range, infecting and killing mammalian species that were once resistant; and the behaviour of the virus in its natural reservoir, wild waterfowl, may be changing.

I’m five months into my first pregnancy and am experiencing extremely uncomfortable leg and back pain. Is there a natural, safe way of dealing with it?
Dr David Tio: Manipulation therapies, such as osteopathy, are generally effective in treating lower back pain as well as other musculoskeletal aches and pains afflicting various parts of the body. Back pain associated with pregnancy, however, requires very specific treatments that, perhaps, not many practitioners are familiar with.

Normal pain in the lower back pain usually requires manipulation to be applied. For a pregnant mother, the manipulation is applied at the shoulders and directed towards the lower back.

My clinical experience is that such manipulation can be highly effective in treating lower back pain during pregnancy. Usually, two or three sessions are enough to provide long-term relief. Regular osteopathic treatment can help ensure a comfortable pregnancy and easier childbirth. The added advantage, of course, is that such treatment is totally natural.

I’m a middle-aged woman who takes calcium supplements daily. Is that enough to prevent osteoporosis?
Dr Leslie Leong: Calcium supplements are a good way to maintain calcium stock in your bones. However, in some people, it may not be sufficient to ward off osteoporosis. In our teenage years to early adulthood, the body accumulates calcium to build strong bones.

Beyond the age of 30, the calcium stock is maintained, but cannot be increased. As we age beyond 50, the bones start to lose calcium. When the loss becomes excessive, as is often the case in post-menopausal women, this leads to osteoporosis. Genetics also plays a role. People who have direct relatives with osteoporosis are at greater risk of developing it. Other precipitating factors include a sedentary lifestyle, excessive caffeine and alcohol intake, certain drugs like steroids and certain chronic diseases like hyperthyroidism.

Calcium is only part of the solution. There has to be sufficient daily vitamin D intake. Without vitamin D, calcium cannot be absorbed in sufficient quantities by the body. In countries with prolonged winters, the elderly have been shown to be more prone to osteoporosis. This should not be a problem in sunny Singapore, unless you stay indoors or use sunscreen liberally. If you do, a vitamin D supplement would help.
The daily requirement of calcium is about 800mg a day, and the required daily intake of vitamin D is 800 international units. Most of these can be obtained from a balanced diet. Foods that contain a high amount of calcium include dairy products, green leafy vegetables, tofu and whitebait.

Like hypertension and diabetes, osteoporosis is a silent disease, and often manifests itself dramatically in a fracture after a minor trauma. In the elderly, a hip fracture can be a death sentence, not from the osteoporosis itself, but from the complications of prolonged immobility that the fracture causes. Hence, it is important to ensure not only an adequate daily intake of calcium and vitamin D, but to have an active lifestyle and get a medical check-up if you are at risk.

Meet the Experts

Dr Lau Chee Chong, of the Ear Nose & Throat Centre CC Lau, has been a consultant ENT specialist for 18 years. He treats adults and children, covering all ENT, head and neck issues. www.entcentrecclau.com

Dr John Tan is a consultant vascular surgeon at the Vein Clinic. He graduated from NUS Medical School and obtained his postgraduate degree in Edinburgh. His subspecialty training is in varicose vein and aneurysm surgery. www.theveinclinic.com.sg

Dr Robin Janke, of International Medical Clinic, is certified by the American Board of Family Medicine. A graduate of the University of Michigan Medical School, she trained in family medicine in Minnesota and in preventive medicine at the Mayo Clinic. www.imc-healthcare.com

Dr Leslie Leong obtained his Master of Medicine (Surgery) and FRCS (Edinburgh), and he trained at Toronto Western Hospital in the field of adult hip and knee replacement. He practises at Island Orthopaedic Consultants. www.iog.com.sg

Dr Kim Hayes, of Body With Soul, graduated from Monash University, Australia and is experienced in a range of family medical sub-specialties including emergency medicine, women’s health, and paediatrics. In the United Kingdom, she gained diplomas in family planning and obstetrics and gynaecology. www.bodywithsoul.com

Dr Yung Shing Wai has undergone advanced orthopaedic training in Singapore as well as subspecialty training in foot and ankle surgery, and shoulder surgery at University of Washington in Seattle, USA. He is now consultant orthopaedic surgeon at The Foot and Shoulder Clinic. www.md-sh.com

Eric Samonte, Pilates and dance instructor at PowerMoves Pilates Studio, is a certified trainer with Michael King Pilates Institute in London and Stott Pilates in USA. He is also a nutrition and wellness consultant with American Fitness Professionals and Associates. www.powermoves.com.sg

Dr David Tio, founder of the Osteopathic Treatment Centre, is a practising osteopath with broad interests in alternative and complementary medicine. He graduated from the European School of Osteopathy in England, and is a Master of Applied Science in Musculoskeletal Management. www.osteopathy.com.sg

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