Upload
dinhnguyet
View
217
Download
2
Embed Size (px)
Citation preview
Dr Chee Yu Han
Mr SupapongSupantamart
E-mail your questionsto [email protected] Ask The Expertsas the subject and includeyour name, age, gender,identity card numberand contact details.
Consultant, division of foot & anklesurgery, department of orthopaedicsurgery, National University Hospital
Podiatrist,NUH Rehabilitation Centre
AskTheExperts
Tay Hong Yi
There was no heartbeat detected inher womb, her doctor had said.
It was the second unborn babythat Ms Farnizah Minsawi had lost,due to her frequent falls whenevershe had epileptic seizures.
Ms Farnizah, 40, works at themobile library kiosk of EunosCommunity Club.
She has a son, now 17, and adaughter, now 15, who were bornbefore the two miscarriages.
During her own infancy, a highfever had left her with epilepsy. Atage six, she was diagnosed with thecondition at the National Neuro-science Institute (NNI), where shestill goes for follow-up checks.
Epilepsy is a neurological dis-order characterised by suddensurges in brain electrical activity,which manifest as seizures.
More than 20,000 Singaporeanslive with it and the severity of sei-zures varies between individuals.
For Ms Farnizah, intense seizureslasting up to three minutes are aregular occurrence.
She said through a Malay inter-preter: “After the birth of my firstchild, my seizures started to strikemonthly, always around the sametime as my period.”
Dr Sheila Srinivasan, a consultantat the NNI’s department of neuro-logy, said it is common for seizuresto coincide with the menstrualperiod, due to hormonal changes.
Ms Farnizah’s seizures arecharacterised by a vague feeling ofunease which rapidly progressesinto a fit that dulls her sense of painand balance. Sometimes, the
episodes left her disoriented andwith bruises that she had norecollection of.
But a prominent reminder ofthese episodes is a thick scar acrossher left forearm, pressed into herflesh by the rim of a hot frying pan.
She does not remember the yearbut said she was cooking at herparents-in-law’s home when aseizure struck.
“I tried to suppress it, butcouldn’t,” she added.
Fortunately, her brother-in-lawwas at home and heard the clang ofthe falling pan.
She said: “He turned off theflame, cleaned everything up andwaited for me to recover.”
Despite taking the anti-epilepticdrug Epilim and folic acid supple-ments, her condition is only underpartial control.
In fact, the seizures gradually gotworse after the birth of her firstchild. They have also caused her tobecome incontinent since last year.
Due to her sub-optimal responseto medication, the doctor proposedsurgery, but Ms Farnizah and herfamily objected to the suggestion.
Her epilepsy has caused hermarriage to break down. Herhusband divorced her five yearsago after 10 years of marriage.
She has custody or her twochildren and is left to provide forthem and her parents.
She said: “My father has retired,but he is now working part-time.”
Her salary is between $400 and$500 a month and she is not onsocial assistance.
Her children receive free schooluniforms and education subsidies.
Still, she might not even have a
steady income if not for an interimjob scheme, underscoring thedifficulties faced by epilepsysufferers in getting a job.
She is employed under the NorthEast Community DevelopmentCouncil’s (CDC) Community Em-ployment Programme, which paysa minimal stipend to people seek-ing permanent work.
According to a North East CDCrepresentative, a total of 1,700people have benefited from theprogramme since it started in 2011.
They are employed for up to sixmonths, but Ms Farnizah was givenan extension as she is still unable tofind a job.
She has been under the pro-gramme for most of the last fiveyears.
Her short stints as a petrol kioskcashier would often end when shehad seizures on the job.
She has stopped declaring hercondition on job applications afterrealising that firms are unwilling tohire her, even though the doctor
has certified her fit for work. “Em-ployers said they were concernedabout the insurance,” she said.
Despite the discrimination shehas faced in her search for a job, sheis optimistic that she will find apermanent job.
Has she ever succumbed to nega-tive thoughts?
“I have always wished that I didnot have epileptic seizures,” shesaid with tears in her eyes.
Q I am a 70-year-old man. I havehad pain in my heel for five years.
It started with my left heel.The pain subsided after I usedready-made insoles. But, a yearago, I felt pain in my right heel.
I have tried various ready-madeinsoles. I use slippers withthicker heels and higher arches.But the pain is still there.
I recently bought a pair ofmade-to-order insoles. I was toldI have an arch problem on my rightfoot and I am flat-footed on the left.
I don’t feel the pain in the archbut there is pain in my heel cup.
I have tried to stand on my toesfor one minute daily and swim
once a week. Unfortunately, thepain continues to come and go.
I weigh about 75kg and, based onmy BMI, I should reduce my weightto 67.8 to 71.6kg. What can I do?
A Heel pain can affect everyone.There are many possible causes,such as stress fracture of the heelbone, bursitis and connectivetissue injury.
Treatment options differ, depend-ing on the cause.
You have described takingpositive steps towards treating thecondition.
However, it is unclear if theadvice was given by a trained
healthcare professional. It ispossible that you might haveperformed the steps inaccurately.This could be the reason the pain isstill there.
If you have not sought profes-sional help, we suggest that you seea general practitioner (GP) toassess your condition more accu-rately. The GP will refer you to aspecialist, if necessary.
Specialists like orthopaedic sur-geons will usually ask for an X-rayof the foot to check for the presenceof bony spurs (bony growths)around the heel bone.
The severity of conditions such asplantar fasciitis and Achilles ten-don degeneration can be assessedfrom the size and location of bonyspurs in the heel bone.
The condition that you havecould be plantar fasciitis, whichaffects many people.
This is caused by the degen-eration and inflammation of thethick band of tissue (ligament) thatruns along the sole of your foot.
Painkillers may be prescribedand you may be advised to losesome weight to help reduce thestress on your feet.
You may be referred to thepodiatrist for non-invasive treat-ment to ease the pain.
The podiatrist will do a thoroughfoot assessment, teach you properstretching exercises, provide pre-fabricated or custom-made insoles,give advice on appropriate foot-wear as well as help you modifyyour lifestyle and activities thatmight aggravate the pain.
Alternative treatments, such astherapeutic ultrasound or shock-wave therapy, can be considered ifthe first-line treatment is insuffi-cient.
The rationale of wearing insolesis to support the painful foot andreduce excessive pulling of theconnective tissue that is linked tothe heel bone. However, merelyfitting the patient with a pair ofinsoles will not suffice as it is only asmall part of a comprehensive
heel-pain treatment plan.If the patient does not respond
well to conservative managementmethods and the pain persists, theorthopaedic surgeon will offer aplatelet-rich plasma (PRP) injec-tion – which is drawn from thepatient’s blood – into the areawhere there is maximum pain.
This allows the degeneratedplantar fascia to gradually recoverby regenerating new tissue, whichresults in permanent pain relief.
This procedure carries minimumrisk and is better than using steroidinjections to relieve the pain. Thelatter can result in a weakenedplantar fascia ligament, whichcould then rupture.
Many patients have benefitedfrom this procedure and arerelieved of their pain after three tofour weeks.
Surgery will be offered as the lastresort to “release” the plantarfascia. This involves key-holesurgery to cut the tight bands of thefascia.
GOT A PROBLEM?
Ms Farnizah works at the mobile library kiosk of Eunos Community Club under the CDC Community Employment Programme. ST PHOTO: JONATHAN CHOO
Optimismin the faceof epilepsyMs Farnizah Minsawi still hopes she canfind a permanent job to support the family
HEALTHWISH
I have always wishedthat I did not haveepileptic seizures.
’’MSFARNIZAH MINSAWI, whohashad two miscarriages, and numerousfalls and self-inflicted injuriesdue to the condition.
Insoles not enoughto treat heel pain
English
PSLE
EXAMINATION
O-level O-levelEnglishEnglish
O-level
PSLE
English
EXAMINATION
O-level O-level EnglishEnglish
O-level
Now on sale at www.stpressbooks.com.sgand at leading bookstores for $10.60.
ChecklistGuided practice in oral English,composition, comprehensionand situational writing
Based on the latest PSLE andO-level English examinationformat
Featuring real-life stories andphotographs from newspapers
Filled with tips from teacherson how to score
Developed by the award-winning Straits Times Schoolsteam that publishes Little RedDot and IN
forthe perfect English workbook
THE SECONDARY EDITION
THE UPPER PRIMARY EDITION
BusinessSolutions
| TUESDAY, FEBRUARY 21, 2017 | THE STRAITS TIMES | MIND&BODY B11