EDITORIAL

Fall 2008
W elcome to this edition of Family Health. As always we strive to keep you informed about
the latest health issues and how they relate to all of you. Obesity is a word that has
received bad press in recent months. From reading some papers, you would think that the
whole world is becoming obese. At the same time, parts of the world are starving and food
prices are increasing. So what is the real truth?

Not a question that has an easy answer, but we have included in this edition an article on
obesity which sets out the basic facts.

The latest figures from the World Health Organisation (WHO) indicate that globally in 2005:

• approximately 1.6 billion adults (age 15+) were overweight;

• at least 400 million adults were obese.

WHO further projects that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese.

At least 20 million children under the age of 5 years were overweight globally in 2005.

Obesity is no longer a problem only in high-income countries, overweight and obesity are now on the rise in low and
middle-income countries, particularly in cities and towns. The even more worrying aspect is that obesity is a major cause
of an increase in chronic conditions such as diabetes and cardiovascular disease. The risk of these conditions increases
as Body Mass Index increases.We will continue to provide information in Family Health that we believe is relevant so that
we can all play our part in improving the outlook for the future.

In this edition we also take a look at a part of our body that we take for granted – our feet. They have to last a lifetime and
we cannot just go to a garage and change them when we wish. Shoe shops can help, but at least you can become an
informed buyer and make sure they do last for as long as you need them.

Finally, I have introduced a new feature, a Question and Answer section that I hope you will enjoy. If there are any medical
or dental topics that you would like answered and you think would be helpful for others, please write in.

Regards,

Rob Grey
Editor

Published by: whether through type-setting, translation, printing or

American Mission Hospital other processes.
P.O. Box 1, Manama, Kingdom of Bahrain
Tel: 17253447 Fax: 17234194 Family Health Editorial and Advertising Team:
E-mail: communications@amh.org.bh • Editor: Rob Grey
Website: www.amh.org.bh • Anne Al Zayani
Production & Photography
Printed with kind permission of the Ministry of Information • Bahnaz Abbas
Registration No. SAMH 444 Sponsorship & Advertising
• Dr. Mohammed Al Khateeb
No part of this publication may be reproduced in printed Arabic Review & Translation
or electronic form without the written permission of (former Regional Advisor for Health Promotion
American Mission Hospital. for the World Health Organization)

Disclaimer: For further details, please contact: 17248136

Although every effort has been made to ensure Issue No. 14 - Fall 2008. Next issue January 2009.
accuracy of information in this publication, AMH cannot Circulation: 20,000 copies
be held liable for any errors that may have occurred Printed by: Union Printing Press

2
 CONTENTS

EDITORIAL 3 WOMAN’S HEALTH RISKS 15 - 18

Rob Grey introduces Discover which
diseases and
the Fall 2008 conditions pose the
issue of Family greatest health risks to
Health Magazine. women. Find out how to
minimize your risk
as explained by
OB/Gyn Consultant
Dr. Alka Gupta

HEALTH NEWS 7-9

KNOW YOUR EYES - 20 - 22
AMH NEWS 11 - 13 REFRACTIVE
BBK supports
ERRORS
AMH’s New
Special Baby Dr. R.P. Sachdeva
Care Unit / explains the different
Riffa Views errors that can affect
sponsors your eye sight.
Pediatric Clinic

3
 CONTENTS

OBESITY - Causes and 24 - 27 WATER a Vital Nutrient 29 - 31

complications
Nutritionist
Obesity is a Christine Zoleta
problem world- explains the
wide as importance of
Consultant / water.
Internal Medicine
Dr. Mathew
points out.

TAKING CARE OF 33 - 35 NEONATOLOGY 37 - 38

YOUR FEET Enhancing Care for
Newborn Babies
Consultant
Orthopedic Surgeon Dr. Lourdes Imperial,
Dr. Juan Magalong Neonatologist,
tells us about the tells us about the
ways to take care new SCBU and
of our feet. how it works.

AMH HEALTH PACKAGES

AMH has introduced several packages to help our patients manage chronic illnesses. Packages include
discounted prices for a year of management of chronic diseases such as Hypertension, Diabetes, ele-
vated Cholesterol or serum lipids and respiratory diseases like asthma. Besides being treated by a phy-
sician, package holders are given counseling sessions by our trained, multi-lingual Nurse Counselors.

AMH also has a special discounted Fitness Package whereby the package holder is coun-
seled by both a dietician for information about foods and their contents, and a physiothera-
pist who offers guidance about appropriate exercise and fitness programs, all for just BD 10.

Pregnant women can avail themselves of the comprehensive Delivery Packages that
AMH offers which include many delivery options and choices of rooms depending on
your birth-plan.Each package includes antenatal visits,breastfeeding and ante-
natal classes and ante and post-natal exercise instruction. Classes are taught
in various languages to suit all nationalities. Women should also
consider the Well Woman Package for com-
prehensive medical check-ups.

AMH offers 5 packages of care for children

based upon their ages from birth up to 6
years of age. These packages include routine
check-ups and age appropriate immuniza-
tions.

For further information about any of the AMH

packages please call 17 248122/123 for
chronic diseases, 17 248115/116 for the de-
livery package and Well woman package, and
17 253447 ext 333 for Pediatrics.

4
 HEALTH NEWS

URBAN
HAY FEVER
A study by Kleenex has found that the pollen
that attaches itself to grasses in the coun-
tryside now also attaches itself to the heavy
exhaust particles from cars, especially die-
sel. Pollen mixed with diesel has a worse ef-
fect on the respiratory system than pollen in
grass. So hay fever is no longer just a coun-
tryside condition. Also, global warming that
causes warmer climates, is extending the
traditional summer season for hay fever to
all year round. Good news for Kleenex and
bad news for hay fever sufferers.

Bedtime CHAMPIONS LEAGUE FOR WEIGHT

Snacks
According to the International Association for the Study of Obesity, the
British are the leaders in the European Overweight League. Almost 60%
of men and women have a BMI (Body Mass Index) which is overweight
25+ or obese 30+.

The table below shows the best and worst countries and Bahrain for
local reference. Figures relate to a BMI of 30+

Country Males % Females %

Bahrain 21.2 35.2

England 24.9 25.2

Switzerland 12.1 18.2

Cyprus 26.6 23.7

USA 36.5 41.8

Having a snack before you go to bed
may not necessarily mean you put
on weight, but your metabolism does
slow down when you are asleep so
you burn fewer calories (60 an hour).
You typically burn between 120 – 150
calories an hour during the day, just to
stay alive. So remember the heavier
the bedtime snack, the more calories
stay with you.
The World Health Organization (WHO) estimates for the USA in 2015 are that
BMI’s will be: Women 54.3 and Men 51.7 and for Bahrain Women 40.7 and 21.2
for Men.
WHO are moving towards implementation of a Global Strategy on Diet, Physi-
cal Activity and Health primarily aimed at obesity - related non-communicable
diseases.
Some facts on Diet
The average Briton eats just over three portions of fruit and vegetables a day,
well under the recommended five.
One in five people in the UK manages to walk for 20 minutes at a stretch once a year
or less - a statistic described recently by Professor Roger Boyle, the British Govern-
ment’s leading cardiac expert, as “the most disgusting thing I have ever heard”.

5
 HEALTH NEWS

HEALTHY SLEEP
Lack of sleep can be bad for your health. In a recent study, the
University of Pittsburgh School of Medicine team found that a
lack of sleep raised the risk of metabolic syndrome which is
a set of symptoms that include high cholesterol, raised blood
pressure, a large waist measurement and problems control-
ling sugar levels,. The syndrome is considered to be an early
warning of diabetes and heart disease and is rising at an
alarming rate around the world. In the study, those sleeping
less than 6 hours a night were more likely to have metabolic
syndrome.

Most nutrition experts contribute the rise in metabolic syn-

drome to the increased fast food and inactive culture of today.
They recommend that we move towards a healthy balanced
diet with lower fat, sugar and salt, more fruit and vegetables
and an increase in physical activity,

BODY FAT Obesity and Exercise

In 2005 there were 400 million people in the world with
a BMI of over 30, so technically obese. There were a
further 1.6 billion who were overweight (with a BMI of
over 25). 2.5 million deaths a year are attributed to over-
weight and obesity worldwide, according to the WHO.

As a footnote to the above, a recent Norwegian study

recommended that 90 minutes exercise a day for eve-
ryone would be necessary to solve the world’s obesity
BMI is a crude way of measuring fat accumulation in problem.
the body. It is merely an indication. Everyone needs
fat to survive and reproduce. Men need 2% – 5%
and women 10% - 13%. The recommended levels
of fat are higher than these because fat protects the
body as well. These levels will vary for each indi-
vidual. GARLIC -
Description Women Men GOOD FOR
Essential fat
Athletes
12–15%
16–20%
2–5%
6–13%
THE HEART
Researchers at the University of Alabama at Birming-
Fitness 21–24% 14–17%
ham, Alabama have solved why eating garlic can help
Acceptable 25–31% 18–25% keep the heart healthy. Garlic contains ‘allicin’ which is
Obese 32%+ 25%+ broken down into sulphur compounds. These react with
red blood cells and produce hydrogen sulphide which
(Figures from American Council on Exercise) relaxes the blood vessels and keeps the blood flowing.
There is no one test for measuring body fat that is This helps to reduce blood pressure. The only downside
100% accurate but several can give an indication, is the smell of hydrogen sulphide – it smells like rotten
for example skinfold, water immersion, X-Ray and eggs. But remember, a balanced diet is the foundation
bioelectrical impedance analysis. to good health.

6
 HEALTH NEWS

New Insurance
Plan for Ladies
Bladder
Semenal Vesicle
Lymph Node
Vas Deferens

PROSTATE

Family Health advocates that you look Rectum

after your health and so it is good to
Anus
see an initiative that encourages pre-
ventative action to detect illness. Testis

Takaful International and Tas’heelat In-

surance have introduced the Heya Plan
designed specially for ladies. It provides
financial protection cover for breast and
vaginal cancer and more importantly
includes an annual medical check as
part of the policy. We know from re-
search that early detection of cancer
dramatically improves the chances of
a full recovery so we welcome this ini-
tiative. We hope that other insurers will
encourage check ups and preventative
measures.
If you over age 50 you should take a simple blood test to check if your
prostate is working normally. The prostate produces protein and by taking
a Prostate Specific Antigen Test (PSA) you can find out if there is anything
abnormal. In your 40’s the reading should be 2.5 mg/ml and it will increase
with age.
Nearly 160,000 men in Europe are diagnosed with prostate cancer each
year. It has become the most common cancer in men overtaking lung can-
cer. With PSA testing on the increase and an ageing population, incidence
is predicted to rise ahead of breast cancer over the next decade.
An abnormal reading by itself does not mean that there is prostate cancer
but it may be an indication. So look after your health and take the test.

The Readers Q and A Corner A: Yes, in certain conditions caffeine and alcohol may increase your
risk of dehydration. But it would be best to consult your doctor or
licensed dietician for this.

STAYING COOL - DEHYDRATION CHICKEN POX

Often, environmental and physical conditions can make it difficult to
stay cool. But being well hydrated may help lower your risk of get-
ting heat-related illnesses.
Q: How much water should I take in a day?
A:, Our bodies are about 2/3rds water and if your water level drops
below that, you become dehydrated. Water needs depend on many
factors like your health condition, how active you are and where
you live. Besides drinking more water and/or beverages, you can
also consume foods that naturally contain water such as oranges,
watermelon and cantaloupe.
A joint convention between US and Canada, Institute of Medicine,
made in February, 2004 suggests the following for healthy seden-
tary adults living in temperate climates:
Men: 125 oz (3.7 liters) of water per day from all dietary sources
Women: 91 oz (2.7 liters) of water per day from all dietary sources
Q: How do I know I’m getting dehydrated?
A: It’s generally not a good idea to use thirst alone as a guide for
when to drink. To gauge your hydration, you should check how of-
ten you urinate. Ideally you should be going every 2 to 4 hours as
most people do. Another indication is the color of your urine. Ideally
it should be almost clear (slightly yellow), the darker it is the more
dehydrated you are.
Q: Will drinking coffee or alcohol increase my risk of dehy-
dration?
Q: What is chicken pox? What are its symptoms?
A: Chicken pox is a common viral infection that causes an itchy rash
and red spots or blisters (pox) all over the body.
The first symptoms of chicken pox are usually fever, headache and
sore throat followed by the typical chicken pox rash after 1-2 days.
The rashes/red spots appear one after another as it goes through
stages of blistering, bursting, drying, and crusting over about 10
days, usually. Some children get the chicken pox rash without hav-
ing a fever or the early symptoms.
Q: Should I see a doctor if I think I have chicken pox?
It would always be wiser to see your doctor. He/she will ask you
about these symptoms and examine you. This usually gives your
doctor enough information to find out if you do have chicken pox.
Q: Is chicken pox a serious illness?
A: Chicken pox is usually not serious in healthy children. But it can
cause problems for pregnant women since the infection may be car-
ried over to the fetus; teens and adults since the blisters may be-
come unwanted scars; and people with immune system problems
as this will make it hard for the body to fight the infection.
Q: I’ve had chicken pox in the past. Will I have it again?
A: After you have had chicken pox, you are not likely to get the ill-
ness again. But the virus stays dormant in your body long after you
get over the illness. If the virus becomes active again, it causes a
painful viral infection called shingles.

7
 AMH NEWS

American Mission Hospital Launches Increased Acuity Unit

Standing From Left To Right: First row: Dr. Ken Kauffmann, Jonathan Crosse, Talal Kanoo, Maya Baradarie, Ghulam Ahmed,
Ali Yakoob,Jonathan Maurice, Dr. Rana Ammadi, Frank McGarry, Redha Faraj. Second Row: Bahnaz Abbas, Khalid Safa,
Robert Grey, Dr. Paul Armerding, Craig Wilson, Mohammed Azzet, Karl Stumke, Gordon Andrade, Yousuf Haider.

A merican Mission Hospital launched

an Increased Acuity Unit on 27th
August 2008. This launch marks yet one
more step in the varied history of the hos-
pital. The Increased Acuity Unit will en-
sure that some of the patients requiring
extra and special care can remain in the
hospital rather than be moved to another
medical facility.

This unit is launched with the support of

the 2007 AMH Island Classic sponsors.
Equipment purchased for this unit in-
cludes Ventilators to control the patients’
breathing, Patient monitors to monitor
blood pressure, body temperature, pulse
and breathing rhythm and special beds
that are easily adaptable to any patient
position required. The total cost incurred
by the unit is BD 127,000/- including
the upgrading of the central gas system
throughout the hospital.

The sponsors supporting this unit are

Aer Rianta International, ALBA, AMEX, BAPCO, BMI Bank,
Chevron Bahrain, Contax, Deeko Bahrain Ltd, E.K. Kanoo,
JPMorgan Chase Bank, Merrill Lynch Bank, Securities & In-
vestment Company, Standard Chartered Bank, United Gulf
Bank and Yateem Oxygen.
Dr. Paul L. Armerding, Chief Medical Officer/ CEO of American
Mission Hospital said, “We are delighted with this development.
The launch of an Increased Acuity Unit means that we can be
sure that when our patients need extra care, we are in a posi-
tion to control and provide that care. Specialized equipment is
employed to ensure that the patient is closely observed and
given the best conditions for recovery. The unit is located in a
totally separate area immediately adjacent to the nursing sta-
tion. We hope to continue to provide even better healthcare for
the community of Bahrain.”
Robert Grey, Director of Communications of American Mission
Hospital said “With the launch of this unit we mean to demon-
strate how quality of care can make a difference for our patients.
Many studies have shown that special care and attention mean
that patients recover quicker and make a better recovery than if
they received standard care.”
Bahnaz Abbas, Marketing & Development Coordinator added,
“I would like to take this opportunity to thank all the sponsors
without whose support the launch of this unit would not have
been possible. The charity golfing event supports this by rais-
ing funds for much needed medical equipment and development
without adding to the patient’s cost. Most of last year’s support
was utilized towards the launch of this unit. We continue to look
forward to support from the sponsors to guarantee quality care
and health service.”

8
 AMH NEWS

RIFFA VIEWS SUPPORTS PEDIATRIC CLINIC

Riffa Views offi-
cially opened the
pediatric clinic of
the American Mis-
sion Hospital, spon-
soring the clinic as
Platinum Sponsors
for the 2007 AMH
Island Classic char-
ity golf tournament
by donating BD
15,000 towards the
unit. Their spon-
sorship funds were
utilized to give the
clinic a totally new
look and purchase
much needed medi-
cal equipment like
Pediatric Ventilator,
Portable Nebulizer,
Infantometer, Bass-
inettes, Opthalma-
scope, Oroscope
& an Alaris Tri-site Standing from left to right: Bahnaz Abbas, Yousuf Haider, Hugh O’Shea, Richard Brown-
Thermometer. ing, Dr. Paul Armerding, Robert Grey, Dr. Ken Kaufmann, Tim Gardner.

Dr. Paul Armerding, CEO, American Mission Hospital
said, “The staff of American Mission Hospital (AMH)
deeply appreciate Riffa Views giving Diamond sponsor-
ship to the AMH Pediatric Clinic. This generous assist-
ance from Riffa Views provides our youngest patients
with up-to-date medical equipment and more attractive
surroundings in which to receive care. “
Richard Browning, CEO, Riffa Views said, “ The continuous
support of initiatives which reach the broader community is
part of the Riffa Views Corporate Culture. There are many
ways in which a company can fund medical support to allow
hospitals to take the next step and provide the best possible
care to those in need. We are pleased that our commitment
in this instance can benefit Bahrain’s youngest generation.”

RIFFA VIEWS VOLUNTEERS PAINT AMH PEDIATRIC UNIT

An enthusiastic group of Riffa Views’ volunteers painted
the reception area of the American Mission Hospital
Pediatric Clinic. The volunteers creatively painted a mu-
ral on one of the Clinic’s walls, depicting the sculpture
which was designed by the pupils of the Umm Salama
Girls Intermediate School that participated in the recent
Riffa Views Eden Challenge. The sculpture won the In-
termediate Category of the event and was also recog-
nized as the overall winning display of the Eden Chal-
lenge Exhibits Stand at the recent Riffa Views Bahrain
International Garden Show 2008.

Bahnaz Abbas, Marketing & Development Coordinator

and Island Classic Organizer said, “I was delighted when
I saw the beautiful drawing in the Riffa Views Eden Chal-
lenge calendar. When I realized that it was the overall win-
ning entry of the event, I couldn’t think of a better theme
for the Pediatric Clinic. The volunteers did a brilliant job Featured: Sara Malik, Noor Zainal, Nazli Tawfiqi, Ameena
and the clinic looks wonderful.” Safi, Hanan Shehabi and Abeer Abdul Latif.

9
 AMH NEWS

American Mission Hospital and Citibank conduct Community Outreach Event

American Mission Hospital and Citi-
bank conducted 5 community outreach
events at social centers around Bahrain
namely Hamad Town Social Center, Isa
Town Social Center, Ibn Khuldoon So-
cial Center, Jidhafs Social Center and
the Sitra Social Center. This event in-
cluded health screening, educational
lectures and distribution of educational
material.

Mr. Abdulhussain Al Dairi, the Director

of Social Centers, Ministry of Social De-
velopment said, “The five events held by
American Mission Hospital and Citibank
have been very successful. All the cent-
ers have returned back with very posi-
tive feedback and we hope to receive Standing from left to right: Bahnaz Abbas, Marketing & Development Coordinator, AMH Robert Grey,
Director of Communications, AMH Yousif Haider, Administrative Consultant, Abdulhussain Al Dairi, Direc-
this sort of support in the future also.” tor of Social Centers, Ministry of Social Development and Zahra Mohd. Ali, Head of Sitra Center.

Bahnaz Abbas, Marketing & Develop-
ment Coordinator, AMH said, “With the
culmination of this event, we have com-
pleted our project with Citibank to cover
5 social centers and provide medical
aid to the patients. We are grateful to
Citibank and the Ministry of Social De-
velopment for all their support and co-
operation in making this event a suc-
cess.”
Mayank Malik, CEO, Citibank said,
“As an international financial servic-
es company, Citi is committed to help
people improve their lives, business
to grow and communities to prosper
around the world. Therefore Citi’s
support to the Community Outreach
Event will definitely improve the
general health and wellbeing of the
people.”

BBK supports American Mission Hospital’s New Special Baby Care Unit
BBK is actively involved in com-
munity development projects. As
part of this commitment, BBK last
year donated BD10,000 to the
American Mission Hospital’s Ob/
Gyn Unit. The support was used
to launch a Special Baby Care
Unit and purchase key medical
equipment. With the launching
of this unit, in the future AMH
will be able to handle emergency
and complicated cases internally
without having to transfer the pa-
tients to other medical facilities. (Standing from left to right) Yousuf Haider, Administrative Consultant, AMH, Bahnaz Abbas, Marketing & De-
velopment Coordinator, AMH, Abeer Swar, Corporate Communications, BBK, Dr. Paul L. Armerding, CEO/
BBK Chief Executive Officer Mr. Chief Medical Officer, AMH, Abdulkareem Bucheery, Chief Executive Officer, BBK, Sister Caroline Black,
Abdulkrim Bucheery said, “BBK Charge Nurse, AMH, Reyadh Sater, Deputy General Manager, BBK, Robert Grey, Director-Communications
& Development, AMH, Dr. Lourdes Imperial, Neonatologist, AMH.
is proud to be actively involved
in many projects that benefit the
community in a number of ways and we are pleased to support Bahnaz Abbas, Marketing & Development Coordinator, AMH
AMH once again in its endeavors to help meet healthcare needs said, “We highly appreciate it that BBK has once again support-
in Bahrain.” ed our main fundraising event of the year. Their continuing sup-
port has helped us to mark improvements and developments in
Dr. Paul Armerding, CEO/ Chief Medical Officer, AMH said,” For the ob/gyn unit of AMH without having to add to the costs of the
the last few years, BBK has taken a keen interest in our Ob/Gyn patients. This has ensured a rise in the number of patients utiliz-
services and have supported this clinic tremendously. We are ing these services. With the launch of the Special Baby Care
grateful for their continuing support which has helped us launch unit, we are looking forward to providing the best possible medi-
the Special Baby Care Unit this year.” cal care to even more patients.”

10
WOMEN’S HEALTH RISKS
Discover which
diseases and
conditions pose
the greatest
health risks
Dr. Alka Gupta
to women. Consultant Obstetrician
/ Gynecologist, AMH
Find out how
Dr. Alka was born in a family of
to minimize physicians in the large indus-
trial Indian city of Nagpur. Her

your risk. father was a civil surgeon and

her mother a professor of Ob-
stetrics and Gynecology in the
Medical College there. She was
the third child of 4 children, and
her elder brother and sister had
taken medicine so it seemed
logical to become a physician.
(Her younger sister is also a

D o y o u w orry e xce ssi vel y ab out developing br east or gynecologist and runs a busy
practice)
ovarian cancer? Your anxiety may be misplaced. Although
these cancers can cut your life short, your risk of having either She graduated with top hon-
one is far lower than your risk of having — and dying of — ors from the Medical College
cardiovascular disease. in 1985 getting a gold medal in
Obstetrics & Gynecology and
her Post-graduation in 1989.
That’s not to say you should forgo regular mammograms or
She subsequently joined the
ignore symptoms that may suggest ovarian cancer, particularly college as a lecturer for a year.
if you have a high-risk family history. But it does mean you
might benefit from a realistic appraisal of your true health risks Her areas of interest are high
risk pregnancies and laparo-
— if only to put your mind at ease. Better still, understanding
scopic surgery. Juggling be-
your top health risks is the first step toward reducing them. tween home and work has be-
come a habit as the pressure of
To that end, the leading causes of death for women in managing 3 children and hospi-
the United States are listed below, in order of prevalence. tal means she has literally two
full time jobs.
Of course, every woman is unique, so you should always
discuss your personal risk profile and preventive plan with
your own doctor. These figures serve as a reference for that
discussion.

11
 All Females, All Ages Percent
1) Heart disease 27.2
The third-lead-
ing cause of cancer
2) Cancer 22.0
death for women in
3) Stroke 7.5
the United States is
4) Chronic lower respiratory diseases 5.2 colorectal cancer.
5) Alzheimer’s disease 3.9 Like heart disease,
6) Unintentional injuries 3.3 colorectal cancer
7) Diabetes 3.1 is often mistaken-
8) Influenza and pneumonia 2.7 ly thought of as a
man’s disease, but
9) Kidney disease 1.8
equal numbers of
10) Septicemia 1.5
men and women die
No. 1 — Heart disease common cause of cancer death in of colorectal cancer
U.S. women is lung cancer. It’s esti- each year. Many
Heart disease is responsible for more mated that more than 70,000 women
deaths in women than all forms of in the United States die of lung cancer cancer deaths are
cancer combined. Heart disease is
the most significant health concern
each year, with the majority of these
deaths linked to cigarette smoking.
related to nutrition
for women in the United States today, Breast cancer is the second-leading and other controlla-
causing nearly 350,000 deaths each cause of cancer death in U.S. women,
year. responsible for about 40,000 deaths ble lifestyle factors.
each year.
But doesn’t heart disease affect most-
ly men? No and that’s a dangerous The third-leading cause of cancer
myth. In reality, more women than death for women in the United States
men die of heart disease in the United is colorectal cancer. Like heart dis-
States each year. ease, colorectal cancer is often mis-
takenly thought of as a man’s disease,
The good news is that heart disease but equal numbers of men and women
is one of the most preventable health die of colorectal cancer each year.
conditions. You have the power to re- Many cancer deaths are related to nu-
duce some of your risks: trition and other controllable lifestyle
factors. Do all you can to reduce your
• Avoid smoking and secondhand risk:
smoke and limit the amount of alco-
hol you drink. • Don’t smoke or chew tobacco.
• Eat a diet rich in fruits, vegetables • Exercise regularly.
and whole-grain products.
• Eat a healthy diet.
• Exercise regularly.
• Avoid excessive sun exposure.
• Control other health conditions that
increase your risk of heart disease, • Limit the amount of alcohol you
such as high blood pressure, diabe- drink.
tes and high cholesterol.
• Have regular preventive health
If you’re at increased risk of heart dis- screenings.
ease, your doctor also may suggest a
daily low dose of aspirin. • Know your family medical history
and review it with your doctor.
No. 2 — Cancer
No. 3 — Stroke
It’s easy to believe cancer is a ma-
jor threat to women’s health, but the Nearly 160,000 people in the United
kinds of cancer women are dying of States die of stroke each year, and
might surprise you. According to the almost two-thirds of them are women.
American Cancer Society, the most Stroke not only is women’s No. 3 killer,

12

but also is one of the leading causes
of disability in America.
Smoking and uncontrolled high blood
pressure are important risk factors for
stroke. Although stroke is highly pre-
ventable, certain risk factors — such
as family history, age, sex and race
— can’t be controlled. Even if you’re
at increased risk of stroke, you can
still take steps to prevent it:
• Don’t smoke.
• Control your blood pressure.
• Lower your cholesterol.
• Limit saturated fats.
• Exercise regularly.
No. 4 — Chronic obstructive
pulmonary disease (COPD)
COPD is an overall term for a group
of chronic lung conditions, including
bronchitis and emphysema. The main
cause of COPD is smoking, and it’s
strongly associated with lung cancer,
the No. 1 cause of cancer death in
women.
About 65,000 women in the United
States die of COPD each year. The
quality of life for a person with COPD
diminishes as the disease progresses.
As shortness of breath and activity
limitations increase, you may eventu-
ally require oxygen use or even me-
More women than
men have Alzhe-
imer’s. In fact, ap-
proximately 45,000
women die of Alzhe-
imer’s disease each
year — more than
twice the number of
men. One reason
more women may
be affected is that
women generally
live longer, and the
risk of Alzheimer’s
increases with age.
chanical respiratory assistance to
breathe.
How do you reduce your risk of dy-
ing of COPD? This one’s easy: Don’t
smoke and avoid secondhand smoke.
No. 5 — Alzheimer’s disease
Alzheimer ’s disease is a progressive,
degenerative brain disease that goes
beyond simple forgetfulness. What
may start as slight memory loss and
confusion eventually leads to irrevers-
ible mental impairment.
More women than men have Alzhe-
imer ’s. In fact, approximately 45,000
women die of Alzheimer ’s disease
each year — more than twice the
number of men. One reason more
women may be affected is that women
generally live longer, and the risk of
Alzheimer ’s increases with age.
No. 6 — Accidents
Each year, more than 38,000 women
die from accidents (unintentional inju-
ries). Although the statistics on acci-
dental death are unclear, these trends
may surprise you:
• Motor vehicle accidents. Traffic-
related accidents were responsible
for more than a third of all accidental
deaths for women in 2003. You can re-
duce your chances of a fatal crash by
routinely using your seat belt, keep-
ing your speed within limits and not
13
driving while sleepy or under the in-
fluence of drugs or alcohol.
• Falls. About 8,300 women in the
United States die from falls each year.
Women of any age can fall, but the
risk increases as you get older. The
majority of falls occur in the home,
so common-sense safety measures,
such as avoiding throw rugs and in-
stalling handrails, can reduce the risk
substantially. Regular eye exams help
too, as does routine exercise, which
maintains your strength and mobility
and may improve your balance.
No. 7 — Diabetes
Diabetes, a group of diseases that
affect the way your body uses blood
sugar (glucose), is a serious health
condition that affects about 18 mil-
lion Americans, 5 million of whom are
unaware that they have the disease.
Many people learn they have diabetes
only when they develop one of its life-
threatening complications. Advanced
diabetes can cause blindness, kid-
ney failure and severe nerve damage.
People with diabetes are also two to
four times more likely to die of heart
disease and experience stroke.
The most common type of diabetes
is type 2 diabetes. This type of dia-
betes, generally developing after age
40, can often be prevented. Follow
these steps to reduce your risk:
Maintain a healthy weight.
• Eat a healthy diet.
• Exercise regularly.
• Get your fasting blood sugar level in real terms. For example, the 2003
checked periodically.
No. 8 — Pneumonia and influenza
Pneumonia and influenza combined
are the eighth-leading cause of death
for women in the United States today.
Together they take the lives of more
than 36,000 women each year.
When associated with other chronic
health conditions, pneumonia and in-
fluenza can be life-threatening. Peo-
ple with COPD, asthma, heart dis-
ease, diabetes and conditions that
suppress the immune system are at
high risk. Because both pneumonia
and influenza affect the lungs, smok-
ing increases the danger of these two
diseases.
Women of any
age can fall, but the
risk increases as you
get older. The ma-
jority of falls occur in
the home, so com-
mon-sense safety
measures, such as
avoiding throw rugs
and installing hand-
The risk of both pneumonia and in- rails, can reduce the
fluenza can be reduced by immuniza-
tions. A yearly flu shot can be 70% to
risk substantially.
90% effective in preventing influenza Regular eye exams
in healthy adults. The pneumococcal
vaccine can reduce the risk of getting help too, as does
pneumonia by more than half. Stay
healthy — get those shots.
routine exercise,
which maintains
Putting health risks into
perspective your strength and
This ranking of health risks applies to
mobility and may im-
the entire population of adult women prove your balance.
in the United States — all ages in-
cluded. But for specific age groups,
the leading cause of death can shift.
For instance, it’s true that during the
course of your entire lifetime, heart
disease is your No.1 health threat.
However, in your 20s, your risk of dy-
ing from an accident is your top health
threat. Likewise, from ages 35 to 64,
your greatest risk is cancer.
Whenever you read about health
risks, think about the cited numbers
total of nearly 350,000 heart disease
deaths in women in the United States
seems enormous. But if you consider
the total number of women in the Unit-
ed States that year — more than 149
million — the number represents just
a small fraction of the female popula-
tion as a whole.
The bottom line? Be concerned about
health risks, but don’t panic. Do what-
ever you can to lead a healthy lifestyle
— including eating healthy foods,
staying physically active, getting reg-
ular checkups and paying attention
to your environment. Such measures
can reduce your risk factors for these
conditions and help you lead a long
and healthy life.
14
 Dr. R.P. Sachdeva, MD
Ophthalmologist
AMH

Dr. R.P. Sachdeva started the

Ophthalmology Unit at AMH in
2003.

After graduating medical Sci-

T he eye is a complex optical system – very similar to a camera.

Vision begins when light enters the eye through the cornea, a
powerful focusing surface. From there, it travels through clear aqueous
ence (MBBS), he did his post
graduation in Ophthalmology at
AIIMS, New Delhi, a prestigious
institution of Medical Science in
fluid and passes through a small aperture called the pupil. As muscles India. After working as a clini-
in the iris relax or constrict, the pupil changes size to adjust the amount cal registrar in a Retina Unit
for 3 years, he settled into a
of light entering the eye. Light rays are focused through the lens and
practice in Delhi with an attach-
proceed through a clear jelly like substance in the center of the eye ment to private and charitable
called vitreous, which gives it form and shape. The light rays finally hospitals. He has been active
in academic exercises with
land on the retina, part of the eye similar to film in a camera, where
ophthalmic organizations. He
they form an upside-down image. The retina converts the image into has visited Japan and the USA
an electrical impulse that travels along the optic nerve to the brain, for clinical surgery. He is a life
member of All India Ophthalmic
where it is interpreted as an upright image.
Society. He is always keen to
A refractive error is a mismatch be- We reach our normal vision between the ages keep pace with advances in
tween the power of the eye’s opti- of 5 and 8, so all refractive errors should be Ophthalmology.
cal system and its length. It gener- corrected during this period.
ally results in either blurred vision
or symptoms such as eyestrain and MYOPIA
headaches. The common types of re-
fractive errors are: In myopia, light rays are focused in front of
the retina, so that objects in the distance ap-
1. Myopia – Nearsightedness. pear blurry and near objects appear clear.
This is because the eye is too long or there
2. Hyperopia – Farsightedness. is excessive focusing power. This condition
is often inherited or associated with prema-
ture birth. It may appear at any age, but most
3. Astigmatism. commonly it is diagnosed in the early years
and progress is gradual and stabilized by the
4. Presbyopia. late teens or early 20s. There is currently no

15
widely accepted treatment to stop its progres- Irregular astigmatism frequently occurs with
sion. Spectacles or contact lenses may be such conditions as keratoconus (a degenera-
worn to correct myopia. After 18-21 years, la- tive non-inflammatory disorder) and corneal Correction of all
ser surgery may be considered provided the
refractive error is stable. Glasses prescribed
scarring, which need special attention.
types of refractive
in early age should be checked annually up error can generally
to puberty.
be achieved with
spectacles. High in-
dex lenses in both
glass and plastic
have a higher re-
fractive index and
lenses are thinner,
PRESBYOPIA flatter and lighter.
Throughout its life, the lens of the eye gradu-
It is important that
HYPEROPIA
ally hardens, becomes less pliable, and pro- lenses are fitted
Hyperopia is present when light rays focus gressively increases its resistance to changes
behind the retina so that near objects appear in shape. This leads to greater difficulty in
in the frame with
blurry. The eye is either shorter than normal focusing close up. By around the age of 45, the correct optical
or there is too little focusing power. A small most people require reading correction, as-
amount of Hyperopia is normal in childhood suming their vision is corrected for distance. center.
and correction is typically not required. A This condition is known as Presbyopia.
large amount of Hyperopia may require cor-
rection with spectacles especially if there is Most patients with Presbyopia first notice
crossing or turning of the eyes. Hyperopia difficulties while attempting to perform near
usually increases in early childhood and then distance tasks, such as reading. There may
decreases toward preteen to early teenage be blurring of near objects or discomfort and
years. Contact lenses and laser surgery are fatigue with attempted near vision tasks.
alternatives to spectacles at the appropriate
age. Most patients in the presbyopic age range will
opt for a pair of thin glasses or bifocal glasses
though many other options are present, like
multi-focal and progressive glasses. Contact
lens wearers may wear reading glasses when
needed. Many patients who undergo a refrac-
tive surgical procedure such as LASIK will be
offered monovision, i.e., a planned surgical
approach in which one eye is left near sighted
to minimize dependence on reading correc-
tion. Conductive keratoplasty (surgery using
radio waves) may also be used for Presbyo-
pia correction.

What treatment is there for refrac-

ASTIGMATISM tive errors?

In astigmatism, light rays are distorted as they
enter the eye. Some rays may be focused
behind the retina and others in front. Usually
the front part of the eye (the cornea) is curved
more in one direction than in the other. The
shape of the eye is more similar to a rugby
ball or American football than a basketball. Vi-
sion is blurred for both near and far objects.
Glasses are prescribed if the astigmatism is
significant. Contact lenses and laser surgery
are alternatives to spectacles at the appro-
priate age. Astigmatism of some degree is
present in approximately 30-40% of individu-
als who wear glasses or contact lenses.
Correction of all types of refractive error can
generally be achieved with spectacles. High
index lenses in both glass and plastic have a
higher refractive index and lenses are thinner,
flatter and lighter. It is important that lenses
are fitted in the frame with the correct optical
center. Contact lenses correct refractive error
and are either hard or gas permeable, which
float on the surface of the eye on the tear film
or soft lenses that allow oxygen through them
due to the relatively high water content. There
are a number of different types and they are
all applied directly to the surface and mold
to the shape of the eye. They can be used

16

on a disposable daily basis, monthly dispos-
able, extended wear or standard daily lens.
The most important consideration in contact
lens wear is hygiene. Contact lenses must be
sterilized correctly and not handled without
thoroughly washing your hands as corneal in-
fection can be very serious resulting in loss of
vision. Extended wear lenses have a higher
risk of corneal infection and many contact
lens practitioners do not recommend their
use. Contact lenses must always be removed
as soon as redness or discomfort occurs and
not worn again until you have seen an eye
specialist.
Refractive errors can be corrected by laser
refractive surgery when the refractive error is
stabilized, usually by the age of 21, by photore-
fractive keratectomy and by LASIK. It is now
a well standardized safe procedure. However,
there is a risk with any form of treatment of
this type and make sure you are fully informed
of the potential risk to your eyesight.
If you have a refractive error, you should have
your lens prescription incorporated in your
sunglasses to gain maximum visual benefit
during summer to avoid the harmful effects of
Ultra Violet radiation.
Parents with
children at school
should have at
least one check-
up to see if a child
needs glasses, es-
pecially if you wear
glasses. If your
child does not copy
properly from the
blackboard, sits
very close to the
TV, squeezes or
rubs their eyes, or
has frequent water-
ing of the eyes, it is
always better to
see an eye special-
ist to rule out any
refractive errors.
Refractive Errors in Children - Be Alert
Parents with children at school should have
at least one checkup to see if a child needs
glasses, especially if you wear glasses. If
your child does not copy properly from the
blackboard, sits very close to the TV, squeez-
es or rubs their eyes, or has frequent water-
ing of the eyes, it is always better to see an
eye specialist to rule out any refractive errors.
Between 3-5 years of age, their eyes must be
examined or earlier if there is any squinting of
the eyes. If glasses are not given when need-
ed, then amblyopia sets in. This is a condition
where the eye is normal, but vision does not
improve even with glasses. Amblyopia com-
monly occurs when one eye has normal focus
and the other eye has a significant error, usu-
ally hyperopia or astigmatism. The dominant
eye develops good vision and the second eye
remains poor. If this is identified early enough,
generally by the age of 18 months, and the
error corrected with glasses and a patch (oc-
clusion therapy) this defect can be corrected.
Regular monitoring is necessary until the child
is eight years old.
So make sure you care for yours and your
children’s eyes.
17
 CAUSES AND COMPLICATIONS
O
besity is an excess of body fat that frequently results in a significant
impairment of health. A normal sized person has between 30 and
35 billion fat cells. When a person gains weight, these fat cells increase
in size and later in number. One pound of body fat represents about
3500 calories.
When a person starts losing weight, the cells
decrease in size, but the number of fat cells
generally stays the same. This is part of
the reason that once you gain a significant
amount of weight, it is more difficult to lose it.
A method was developed that closely corre-
lates with body fat and the metabolic compli-
cations of obesity. This is the BODY MASS
INDEX (BMI) and it is calculated as follows:
BMI= Weight (in kg)/Height (in meters)
squared (ht x ht)
For example, a man who is 5’10’’ (1.78meters)
tall and weighs 285lbs (~130kgs) would have
a BMI of 130/ (1.78 x 1.78) =~41
CAUSES OF OBESITY
Obesity results when you consume more cal-
ories than you expend in your daily activities.
Weight gained during certain critical periods
in life more commonly lead to an increased
number of fat cells and make obesity more
difficult to treat. These time periods are:
• Between 12 and 18 months of age
• Between 12 and 16 years of age
• Adulthood - when a person gains in excess
of 60% of their ideal body weight
Dr. Mathew George,
MBBS, MD
Consultant Internal
Medicine, AMH
Dr. Mathew George studied at
Christian Medical College, Lu-
dhiana, India where he went
on to achieve his MD in internal
medicine and be Assistant Pro-
fessor of Medicine. He joined
AMH in 2002 as a Consultant
in Internal Medicine, working in
the hospital’s busy Overkamp
Clinic. As part of his role, he also
coordinates the newly-launched
Hypertension Clinic.
• Pregnancy Dr. Mathew is a dynamic educa-
tor, advocating the importance of
Age patients managing their chronic
Metabolism slows down with advancing age. diseases from home and work-
People frequently state that they eat the same ing closely with their doctor to
and do the same activities as they did when maximize their quality of Life.
they were 20 years old, but at 40 are gain-
ing weight. Males have a higher resting me-
tabolism rate than females, so males require
more calories to maintain their body weight.
When women enter menopause, their meta-
bolic rates decrease significantly. That is part
of the reason why women start gaining weight
after menopause.
Activity level
Active individuals require more calories than
less active ones. Physical activity tends to
diminish appetite in obese individuals while
increasing the body’s ability to metabolize fat
as an energy source.
Body Weight
Heavier people require more calories to
maintain their body weights than lighter ones.
For example, a middle aged man weighing
250lbs. doing minimal amounts of physical
activity may require 2700 calories to main-
tain his body weight. If this person goes on a
2000 calorie – per-day diet, he will lose weight.
Eventually, if he stays with a 2000 calorie daily
diet, his weight will stabilize because his met-
18
 High fat foods
are obesity pro-
moting in humans.
The ready avail-
ability of high fat
foods (such as ‘fast
foods’) combined
with the decreased
requirements from
decreased physi-
cal activity, is felt
to be the major
factor in the sharp
rise in the preva-
lence of obesity.
abolic rate will gradually decrease. When this gy. Depression is commonly associated with Thus, the current
man reaches approx. 200lbs. he will require loss of appetite, but in a significant minority,
only about 2000 calories per day to maintain it is associated with increased appetite and ’low carb, high fat
his new weight. weight gain. Medications used to treat de-
pression are generally very effective, but can diet craze’, which
Food preferences lead to an even greater weight gain. encourages intake
High fat foods are obesity promoting in hu-
mans. The ready availability of high fat foods Binge eating disorder (“compulsive overeating”) of fatty meats in-
(such as ‘fast foods’) combined with the de-
creased requirements from decreased physi- This disorder is characterized by the following
stead of vegeta-
cal activity, is felt to be the major factor in the diagnostic criteria: bles (‘carbs’) will in
sharp rise in the prevalence of obesity. Thus,
the current low carb, high fat diet craze’, which • Eating in a discrete period of time (within the long run result
encourages intake of fatty meats instead of
vegetables (‘carbs’) will in the long run result


a two hour period) an amount of food that
is larger than what most people would eat
in an even sharper
in an even sharper rise in obesity and prob- in a similar period of time under similar cir- rise in obesity and
ably heart disease, as well. cumstances.
probably heart dis-
Medications
Certain medications prescribed for inflamma-
• A sense of lack of control----that is, a feel-
ing that one cannot stop eating or control
ease, as well.
tory conditions, seizures and mental illness what or how much one is eating.
tend to increase appetite and may also de-
crease metabolic rate. The binge eating episodes are associated
with three or more of the following:
Hereditary factors affect appetite and me-
tabolism. • Eating much more rapidly than normal.

Obesity is related to metabolic processes in- • Eating until feeling uncomfortably full.
herited primarily from the biological mother.
If the biological mother is heavy as an adult
• Eating large amounts when not physi-
there is approximately a 75% chance that her
children will be heavy. cally hungry.

Psycho-social and other factors • Eating alone because of being embar-

Depression
Depression is not just feeling blue for a day,
but is the result of actual chemical changes
that take place in the brain, causing profound
episodes of sadness, crying and loss of ener-
rassed by how much one is eating.
• Feeling disgusted, depressed or guilty.
Smoking and obesity
When people smoke, this increases the

19
 The risk of dia-
betes is increased
over 53 times the
normal rate with se-
vere obesity. 90%
of Type 2 diabetics
generally develop
their diabetes in
their middle years.
This type is almost
always associated
with obesity and ap-
pears to be related
to hormonal sub-
stances (cytokines)
produced by adi-
pose tissue and
body weight and an avoidance of excessive
caloric requirements by increasing the rest-
ing metabolic rate. If you stop smoking but salt intake can normalize blood pressure and
to the increased
maintain constant food intake and exercise, reduce or eliminate the need for blood pres- amounts of blood li-
your body weight will increase 5% to 10%. An sure medications.
excellent way to help counter this decrease pids (fats) that occur
in metabolic rate is to increase lifestyle activ-
ity. That is, instead of the multiple cigarette
Diabetes in diabetes. Reduc-
The risk of diabetes is increased over 53
breaks, make use of that time as ‘walking times the normal rate with severe obesity. ing body weight by
breaks’. These periods of physical activity 90% of Type 2 diabetics generally develop
have a cumulative effect and will improve their diabetes in their middle years. This type
10% can eliminate
your mood and health while helping to mini-
mize weight gain.
is almost always associated with obesity and or reduce the need
appears to be related to hormonal substances
(cytokines) produced by adipose tissue and for oral medications
Injuries and obesity
A professional athlete, laborer or office clerk
to the increased amounts of blood lipids (fats)
that occur in diabetes. Reducing body weight
or insulin injections.
who had been physically very active but sus- by 10% can eliminate or reduce the need for
tains an injury and is now no longer able to do
oral medications or insulin injections.
so, will gain weight. When activity decreases,
the body does not automatically reduce calo-
Elevated cholesterol (hypercholesterolemia)
rie intake but one has to take a conscious ef-
fort to monitor food intake. If obesity is estab- On an average, every 10lbs. of excess fat
lished, it is very unlikely that the person will produces 10mg of cholesterol per day. Cho-
return to the pre-injury weight. lesterol levels are determined by both genet-
ics and diet. Most people can successfully
Complications of Obesity control their cholesterol by reducing both their
fat intake and weight.
Though obesity affects virtually every organ
system, some of the more commonly seen Fatty liver (NASH)
obesity conditions are discussed. Fatty liver disease (Non-Alcoholic Steato-
Hepatitis) is caused by excessive fat deposi-
Hypertension tion in the liver. Excess calorie consumption
Around 30% of individuals who are at least can lead to excess liver fat which results in
30lbs. overweight, have mildly elevated blood silent inflammation of liver, usually detected
pressure. The etiology appears to be related by abnormal liver function tests. If untreated it
to substances produced by adipose (fat) tis- can develop into cirrhosis or liver failure. The
sue and to increase in the hormone insulin most effective treatment is weight reduction
that occurs with obesity. A 10% reduction of and increase in physical activity.

20
Metabolic Syndrome (Syndrome X)
To be diagnosed with metabolic syndrome
three or more of the following criteria are re-
quired:
Waist circumference > 40 inches in men or
35 inches in women.
i. Triglycerides >150mg/dl
ii. HDL cholesterol <40mg/dl in men or < 50
in women.
iii. Blood pressure >130/85mm Hg.
iv. Glucose (fasting) >110mg/dl.
The most effective treatment of metabolic
syndrome is weight reduction.
Cancer
Obesity results in an increased risk of cancer.
In females, there is up to a threefold increase
of breast, uterine, cervical and ovarian can-
cer. The risk of endometrial cancer (cancer of
the inside lining of the uterus) is up to seven
times higher. For men, there is an increased
incidence of colon and prostate cancer.
Degenerative arthritis (osteoarthritis)
Increased weight causes more wear and tear
on the joints. Adipose tissue also produces
cytokines that ‘destroy’ the normal cartilage
in joints. If a person loses weight, the wear
and tear gradually diminishes and the amount
of cytokines released from the adipose tissue
diminishes.
Gallstones
Approximately 25% of obese individuals have
gallstones, often resulting in surgery. The in-
crease in cholesterol that results from obesity
is one of the major reasons for the increased
incidence of gallstones.
Heart attacks and strokes
The increased incidence of stroke and heart
attacks in obese individuals appears to be
related to substances produced by adipose
tissue that makes it easier for blood clots to
form. Overall, obesity can result in premature
death.
Sleep disorders
When people gain weight they feel tired all
the time and may have problems with sleep
which may be indicative of a severe condi-
tion called Pickwickian Syndrome (sleep ap-
nea). For such people, it becomes more dif-
ficult to breathe especially during sleep, as
their weight increases. They typically snore
severely and have episodes when they stop
breathing completely even up to one minute
at a time. During these apneic (not breathing)
periods, heart rhythms may become very ir-
regular and this can lead to a fatal heart at-
tack. The best method of treatment is weight
reduction.
The most impor-
Treatment options tant thing to remem-
a. Diet therapy ---- Lifestyle modifications ber is that weight
such as increasing physical activity and de-
creasing calorie intake are recommended in-
loss takes time and
stead of “dieting”. Crash diets should definite- effort. It is important
ly be avoided. The best approach to change
your diet is by talking to your doctor to find to set goals as it is
out what is best for you. Another approach
to reduce weight gain is to record your food
a lifelong process.
intake. When you write down what you eat Sensible weight
before eating you will be aware of what you
consume. loss does not oc-
b. Exercising ---- Exercising is important
cur overnight and it
to any good weight loss program. An aerobic takes major chang-
exercise program reduces weight regardless
of any change you make in your diet. es in your lifestyle
c. Behavioral therapy ---- Behavioral modifi-
before significant
cation includes strategies that aid individuals changes in weight
to overcome barriers to comply with dietary
changes and physical activity. Most modifica- may be observed.
tion programs encourage self-monitoring of
both diet and exercise to increase one’s own
Permanent weight
awareness of the activities. Modification strat- loss can be reached
egies may include stress management, social
support and stimulus control. by continued life-
style changes.
d. Drug therapy --- This may be considered
for some individuals as a supplement to a
comprehensive weight loss program that in-
cludes diet, exercise and behavioral therapy.
Medications can be used to stimulate weight
loss by either decreasing the appetite or in-
hibiting the absorption of fat from the intes-
tines.
Many health food and supplement stores pro-
mote various ‘natural’ or herbal products for
weight loss. Even though they claim to be ef-
fective and ‘natural’, these products can be
associated with certain harmful side effects.
The U.S. Food and Drug Administration (FDA)
has stringent rules pertaining to the safe-
ty, efficacy and quality that pharmaceuti-
cal manufacturers must follow in order to
market drugs. Manufacturers of herbal sup-
plements do not have to follow these rules
to sell their products. For this reason, there
is limited research evaluating supplements’
safety and efficacy in the human body. As a
result, anyone who takes these substances
does so at his own risk.
The most important thing to remember is that
weight loss takes time and effort. It is impor-
tant to set goals as it is a lifelong process.
Sensible weight loss does not occur overnight
and it takes major changes in your lifestyle
before significant changes in weight may be
observed. Permanent weight loss can be
reached by continued lifestyle changes.
21

B esides oxygen, the other element we cannot live without
is water. We each use over 100,000 litres of water a year
through various activities including washing, cleaning and
drinking, but what does water actually do for our bodies?
Water makes up 60% of average body
weight and every system in the body
needs water to function. This percentage
varies depending on body composition,
age and gender. Lean tissue holds more
water than fat, so the leaner you are, the
higher proportion of water in your body.
Men have a higher percentage of water
in their bodies than women. Young people
usually have more than adults. A baby’s
weight is about 75% water and falls to
50% in the elderly.
Body Tissue
Blood
Lean Muscle tissue
Body Fat
Bones
How much water do we need?
The average adult loses about 2 1⁄2 liters of
water daily through perspiration, urination,
bowel movements and breathing. In hot,
humid weather or strenuous physical activ-
ity, fluid loss is higher. In healthy people,
water intake and water loss balance out
so if you drink more than you need, your
kidneys eliminate the excess. When you
don’t drink enough, you feel thirsty.
Thirst tells you that your body needs more
fluids to perform its functions. But thirst
isn’t foolproof, especially for elderly peo-
ple, children, during illness, hot weather or
strenuous physical activity, so don’t wait
until you feel thirsty, you may already be
dehydrated.
% of water
83%
73%
25%
22%
Your water needs depend on the amount
of energy you use: An adult will use 1 to 1
1⁄2 milliliters of water per calorie of energy
expended. That’s 1 to 11⁄2 liters for every
1,000 calories. As the average adult uses
2,000 – 3,000 calories daily that means 3
– 4 liters of water. This is affected by:
22
A VITAL
NUTRIENT
OF LIFE
Christine Zoleta
Nutritionist-Dietician
AMH
Christine Zoleta works as Nu-
tritionist-Dietician at AMH. She
holds a B.Sc in Foods and Nu-
trition from St. Paul’s College of
Manila and finished her Dietetic
Internship at the University of
Sto. Tomas, Manila.
She has extensive experience
in the food service industry, was
active as a government coun-
selor in public health nutrition
in the Philippines and was a di-
etician for a medical center in a
Canadian-owned copper mining
company.
Christine spearheads the Nutri-
tion and Food Services section
and plays an active role by tack-
ling nutrition implementation
of the Diabetic, Hypertension,
Cholesterol and OB-Gyne spe-
cial packages. The AMH Get
Fit package is Christine’s brain-
child, the first-of-its-kind, 2-in-1
personalized wellness, diet and
exercise regimen ever offered in
the island.
• Extreme temperatures - hot or cold. Liquid assets

• Strenuous work or exercise. So what can you drink? Plain water is the It’s harder to
most valuable fluid. Juice and milk supply
• Exposure to heated or re-circulated air. other nutrients. For example, juice offers vi-
cool your body in
That’s why you become dehydrated on
aircraft.
tamins A or C, or both, and milk is calcium- hot, humid weath-
rich. Drinks such as coffee, tea, soft drinks
and alcoholic drinks don’t offer the nutrient er than in hot,
• Pregnancy and breast-feeding increase benefits of milk, fortified soy milk or juice.
the amount of fluid a woman’s body needs. dry weather be-
• Sicknesses such as fever, diarrhea and
1) What about fruit juices, juice drinks cause perspira-
and fruit drinks?
vomiting. tion doesn’t eva-
A refreshing, fruity drink is tasty, but all of
• If you eat a high-fiber diet, you need these are fluid replacements and contain porate from your
extra water to process the additional calories. Strictly speaking only 100% juice
roughage and prevent constipation. can be called “juice”. Otherwise it should be
skin but makes
called “juice drink” or a “juice cocktail. it feel sticky and
The Water Test
Is a 100% juice better, with more vitamin C
hot. Cool, re-
To see if you’re drinking enough fluid, check than a juice drink? Not necessarily. For ex-
your urine. A small volume of dark-colored ample, some 100% fruit juices contain less
freshing drinks
urine indicates that you aren’t drinking than 100% of the Daily Value (DV) for vita- may help cool
enough fluid. Ideally your urine should be min C, while some juice drinks are fortified
almost pale and colorless. to supply at least 100%.
your overheated
Drinking for Health
body.
2) How about juicing vegetables?

You need to consume 8 – 12 cups during
the day. Milk, juice and some other drinks
count toward your daily water intake. So
does water from solid foods, although you
can’t really measure it. For example lettuce is
95% water, cheese is 37% and honey 17%.
Caffeinated beverages- coffee, tea and soft
drinks aren’t the best sources of water. Caf-
feine acts as a diuretic, causing you to lose
water through increased urination. Alcohol
has the same effect.
Some juice-machine promoters may per-
suade you that juicing makes fruits and
vegetables healthier. True, their juices are
healthy, offering most of the vitamins, min-
erals, and phytonutrients in the whole fruit
or vegetables but they have less fiber; it
gets left behind in the pulp.
3) Bottled waters
The US Food and Drug Administration de-
fines bottled water as:

To increase your water intake: • Mineral water: contains minerals at a

• Take water breaks not coffee breaks.
• Keep a glass of water on your desk.
• Drink water, milk or juice with your meals.
• When you are near a water fountain, take a drink!
• At social gatherings, substitute or alter-
nate sparkling water for alcoholic drinks.
• When physically active, drink water every
fifteen to twenty minutes.
• Keep a bottle of water with you in the car.
Hot and Cold Weather
standard level, no less than 250 parts
per million (ppm) of total dissolved
solids, or minerals. These minerals
must be naturally present, not added.
• Purified water: is processed to remove
minerals and other solids. The process
may be distillation, deionization, reverse
osmosis or another suitable process.
• Distilled water: which is one type of puri-
fied water, has been evaporated to steam,
and re-condensed to remove minerals.

It’s harder to cool your body in hot, humid
weather than in hot, dry weather because
perspiration doesn’t evaporate from your
skin but makes it feel sticky and hot. Cool,
refreshing drinks may help cool your over-
heated body.
In cold weather, most people head indoors.
There, heated air evaporates the moisture
on your skin. Although you may not feel
thirsty, you still need to replace water loss.
Even if you are outside in the cold, you per-
spire and you need water to maintain your
normal temperature.
• Sparkling water: is water with a
“fizz”. Either carbon dioxide is add
ed, or water is naturally carbonated.
• Spring water comes from an underground
source and naturally flows to the surface.
It must be collected at the spring or through
a bored hole that taps an underground
spring.
... and what about ...
...flavored waters? Flavored waters may
have a hint of flavor, derived from a natural

23
 FUNCTIONS OF WATER IN THE BODY In the Middle
East, exposure to
Regulates high temperatures
Moistens tissues body temperature
such as those in can cause heat
the mouth, eyes exhaustion or the
and nose
Lubricates risk of heat stroke.
joints To keep your body
Protects body functioning nor-
organs and tissues
mally and to avoid
Helps prevent Lessens the burden dehydration, your
on the kidneys and
constipation
liver by flushing out body needs a
waste products steady water sup-
ply. Drinking wa-
Helps dissolve ter makes you feel
minerals and good and makes
other nutrients Carries nutrients
to make them and oxygen to you look good! It
accessible to the body cells
moisturizes your
skin by keeping it
hydrated thereby
giving you this
fresh, younger
looking skin all
fruit essence. If they contain sugar, other 6) Alcoholic Beverages
sweeteners and artificial flavors, they’re
the time.
soft drinks . These are a source of water but only if con-
sumed “in moderation”, that is no more than
... oxygen-enhanced drinks? Do they really one drink a day for women and no more
offer benefits such as a boost in athletic per- than two drinks daily for men. Evidence
formance? Probably just marketing hype. suggests that moderate drinking may lower
the risk for heart disease, but a healthy life-
4) Soft Drinks style is part of the equation too.

The basic ingredients of a soft drink are
water, sweetener, acid and a flavor. Op-
tional ingredients often include fruit and / or
fruit juice, carbon dioxide, preservative and
coloring. They are typically around 90% wa-
ter. Seltzer, tonic water and club soda are
considered soft drinks, not sparkling water,
and may contain sugar and calories. Soft
drinks are considered a contributory factor
in increasing obesity in children.
5) Sports & Energy Drinks
Both of these are sources of water but the
two are often confused. Sports drinks are
designed to meet particular sporting re-
quirements, such as replacing not just liq-
uids but also minerals and carbohydrates
whille energy drinks usually contain high
caffeine levels to stimulate alertness.
The Gulp in the Gulf
In the Middle East, exposure to high tem-
peratures can cause heat exhaustion or the
risk of heat stroke. To keep your body func-
tioning normally and to avoid dehydration,
your body needs a steady water supply.
Drinking water makes you feel good and
makes you look good! It moisturizes your
skin by keeping it hydrated thereby giving
you this fresh, younger looking skin all the
time.
There is no excuse as bottled water is easy
to buy and easy to carry whether to the of-
fice, the gym or the shops.
Water is life. Live your life to the fullest by
drinking more of this healthy beverage.

24
 TAKING CARE OF
YOUR FEET

DR. JUAN UY MAGALONG,

Orthopedic Surgeon
AMH

Dr. Juan Uy Magalong, Jr. “Dok

Jun” or “Dr. J” holds a B.S. in
Medical Technology (Board
Certified) at the University of
Santo Tomas, Doctor of Medi-

T he average person takes 8,000

to 10,000 steps a day, that’s about
11 5 , 0 0 0 m i l e s i n a l i f e t i m e . T h a t ’ s
cine at the Virgen Milagrosa
University – Medical Founda-
tion, Pangasinan and a Master
enough to go around the circumference of Arts in Public Administration.
of the earth four times! After graduating, he underwent
Medical Internship training at
The foot contains 26 bones, 33 joints, 107 ligaments and 19 St. Luke’s Medical Center, re-
muscles so there’s a lot that can go wrong. ceiving an Award of Merit for
research entitled, “Dengue
Your feet mirror your general health, so foot ailments Shock Syndrome, A Look into
can be your first sign of more serious medical Pathogenesis”, and pursued
problems. Remember that if you have diabetes or his career into General Prac-
tice of medicine and surgery
another condition that causes poor circulation, you and completed his Residency
are at greater risk of complications. training in Orthopedic Surgery
and Traumatology at the Philip-
Feet and ankles are complex load bearing pine Orthopedic Center.
structures with many interconnected moving
parts and many problems can be treated He is Board Certified, a Diplo-
mate of the Philippine Board
effectively by addressing mechanical
of Orthopedic, a Fellow of the
function. Philippine Orthopedic Asso-
ciation, Fellow of the Philippine
Many foot problems occur because of College of Surgeons, Interna-
improper function of the foot during walking tional AO Spine member and
or running. An orthopedic doctor can active International member,
evaluate each movement of your walking or running pattern American Academy of Ortho-
pedic Surgeons.
to help you. Biomechanical care may include orthotic devices,
shoe modifications, physical therapy and other modalities. He held several positions in
both private and government
Knowing your foot type comfort, posterior tibial tendonitis High Arch hospital institutions in the Phil-
and /or bunions. (Pec Cavus)
ippines, as Active Consultant in
feet
Low arch or flat feet are very com- Orthopedic Surgery of New Era
mon. In most cases, these feet are Medium arch feet are biomechani- General Hospital, Attending Or-
flexible and over pronated where cally efficient transferring pressure Medium arch
thopedic Surgeon and Chief of
feet
the arch begins to collapse upon from the outside of the heel, roll- Hospital II of the Romblon Dis-
weight bearing causing the arch to ing inward and then to the forefoot. trict Hospital.
flatten and adding stress to other However, they are still susceptible Low arch or
parts of the foot. As a result, over to injury caused by badly fitting flat feet

pronation often leads to plantar fas- shoes or repetitive stress injuries

ciitis, heel spurs, medial knee dis- from everyday pounding. To pre-

25
vent injury, orthotics can be form on the joint at the base of
used to support the arch and your big toe or at the little toe
provide cushioning. (bunionettes). Over time, your
High arch (Pes Cavus) feet Tight heel cords. Tightening
feet become wider
have an elevated arch, causing and shortening of your Achilles and longer and the
the heel and toes to turn slightly tendon-the strong fibrous cord
inward. When walking or exer- that connects your calf muscle natural padding
cising, shock is disproportion-
ately absorbed by the heel and
to your heel bone. Wearing high
heels prevents your heel from
under your heel
the ball-of-the foot leading to repetitive stress regularly coming in contact with the ground, and forefoot thins.
problems, including pain in the knees, hips and stops your Achilles tendon from fully
and lower back. Foot problems often develop stretching. Over time, your Achilles tendons Years of standing
in the heel and forefoot such as heel pain syn- contract to the point that you no longer feel and walking flat-
drome, arch strain, metatarsalgia and claw comfortable wearing flat shoes.
toes. The solution is to provide longitudinal ten your arches
arch support which fills in the arch cavity. Pump bump (Haglund’s deformity) A bony
enlargement on the back of your heel can be-
and stiffen your
How old are your feet? come aggravated by the rigid backs or straps feet and ankles.
of your heels.
Over time, your feet become wider and When you wear
longer and the natural padding under
your heel and forefoot thins. Years of
Neuromas.
high heels- shoes
standing and walking flatten your arches Morton’s neuroma with a heel 2 inch-
and stiffen your feet and ankles. When or plantar neuro-
you wear high heels-shoes with a heel 2 ma is an inflamed es or higher- your
inches or higher- your foot slides forward
in your shoe, redistributing your weight,
nerve tissue that
occurs in the ball
foot slides forward
creating unnatural pressure points and of the foot; usually in your shoe, re-
throwing your body’s natural alignment between your third and fourth toes, as a re-
out of order. sult of wearing tight fitting shoes. A neuroma distributing your
causes a sharp, burning pain in the ball of weight, creating
High heels are one reason why women have your foot accompanied by stinging or numb-
about four times as many foot problems as ness in your toes. unnatural pres-
men. Following fashion can cause:
Joint pain in the
sure points and
Corns and calluses. Thick, hardened layers ball of the foot throwing yours
of skin develop in areas of friction between (Metatarsalgia).
your shoe and your Increased pres- body’s natural
foot. sure, strain and
pain in your fore-
alignment out of
Toenail problems. foot due to weight order.
Constant pressure shifting to the ball
on your toe and of the foot.
nail beds from be-
ing forced against Stress fracture. Tiny cracks in one of the
the front of your bones of your foot. Generally a result of re-
shoe by a high petitive stress.
heel can lead
to nail fungus Heel pain is extremely common.
and ingrown
toenails. It often begins without injury and is felt un-
der the heel, often while standing or walking.
Hammertoe. Usually worse first thing in the morning and
A deformity in which inflammation on the sole of the foot (plantar
the toe curls at the fascia) where it attaches to the heel bone is
middle joint as a re- the likely cause.
sult of tendon imbal-
ance. Plantar warts occur on the sole of the foot.
They result from an infection by a specific
Bunions. virus. They grow inward and are extremely
Bo ny b u m p s t h a t difficult to treat.

The good news is these problems don’t

happen overnight, but rather develop over
time. It’s not just your feet that are in jeop-
ardy. High heels have also been linked to
overworked or injured leg muscles, osteoar-
thritis of the knee and low back pain. You

26
also risk ankle injuries if you lose your bal- idea to recheck your shoe size every
ance and fall off your high heels. few years or so. Stand up when being
sized because your feet expand when Research has
So is it time to surrender high heels? you step on them.
been shown that
Ladies keep your high heels, but avoid wear- Other common foot problems the most effective
ing them all day to minimize your risk of de-
veloping foot problems. • In-grown toenails way to decrease
Wear more comfortable
shoes, high heels with Left untreated or un-
force on the ball
dress shoe orthotics. detected, an ingrown of the foot and
toenail can infect the
Research has been underlying bone and reduce pain un-
shown that the most ef- lead to a serious bone der the ball of the
fective way to decrease infection. Even worse
force on the ball of the it could become gan- foot and the heel
foot and reduce pain grenous and lead to
under the ball of the amputation.
is to use special-
foot and the heel is to ized custom or-
use specialized custom • Corn and Calluses
orthotics that transfer pressure off of the pain- thotics that trans-
ful area of your feet and provides extra cush-
ion under the forefoot.
Treat only if they cause discomfort.
fer pressure off of
• Nail fungus the painful area
Wear high heels with comfort, how?
These infections usually develop on of your feet and
• Select shoes with low heels and a wide nails continually exposed to warm, moist
environments,
provides extra
heel base.
such as sweaty cushion under the
• Put something in the shoe to transfer the shoes or show-
force of the ball of your feet, a product er floors. See
forefoot.
that incorporates Insolia technology. your doctor at
Put something in your shoe that provides first sign of nail
cushion with air pads. fungus, which
is often a tiny
Shoe shopping tips to minimize foot prob- white or yel-
lems low spot under the tip of your nail. This may
cause permanent damage to your nails.
• Shop for shoes late in the afternoon or in
the evening. Your feet swell during the • Diabetic foot
day. A shoe that feels fine when you try it
on in the morning could feel tight later. Nervous sys-
tem impairment
• There’s no such thing as a ‘break in’ (neuropathy) is
period. Shoes should feel comfortable a major com-
right away. plication that
may cause you
• Pay attention to materials and style. Se- to lose feeling
lect materials that breathe and allow flex- in your feet or
ibility, such as leather or nylon mesh. hands. This means you won’t know right away
if you hurt yourself. The problems affect 60-
• Try on both shoes before buying. Many 70% of people with diabetes. “It is very impor-
people have one foot larger than the tant for diabetics to take the necessary pre-
other. So select shoes that fit the larger cautions to prevent all foot related injuries.
foot. Make sure you have at least a
finger’s width between your longest toe Tips for taking care of your feet
and the end of your shoes.
• Wash and check your feet everyday
• Don’t rely on shoe size alone. Gauge
proper fit by how the shoes feel when • Don’t cross your legs for long periods
you try them on. Sizes can vary from one of time
manufacturer to another and from one style
to another. Don’t worry about the • Be more active
stated ‘size’ of the shoe. Worry about
the fit. Don’t buy shoe if it feels too • Don’t disregard foot pains.
tight. It will not stretch to fit your foot.
Be kind to your feet, they will return the favor.
• Check your shoe size. Your feet get Don’t let your sense of style cripple your abil-
longer and wider as you age. It’s a good ity to stand, sit or step pain-free.

27
NEONATOLOGY
Enhancing Care for newborn babies at the American Mission Hospital

Dr. Ma. Lourdes S. Imperial

Neonatologist
AMH

Dr. Ma. Lourdes S. Imperial ob-

tained her Bachelor of Science
in Biology degree from the Uni-

F or over a hundred years, American Mission Hospital has capably

met the needs of expectant mothers with normal pregnancies,
and the walls of our Obstetric Unit are lined with framed photographs
versity of the Philippines in Dili-
man. She graduated from the
UERMMMC College of Medicine
of healthy, beaming infants and toddlers who first saw the light of then proceeded to complete
her Pediatric Residency and
day in our delivery room. The mothers who deliver their babies here Neonatology Fellowship train-
experience “tender loving care” from our staff and, more often than ing at the Philippine General
not, they choose to come back for their succeeding pregnancies Hospital. She is a Fellow of the
because they are confident of receiving the same care. Philippine Pediatric Society and
a Diplomate of the Philippine
But not all pregnancies proceed as planned, this, we have added neonatology as one of Society of Newborn Medicine.
and in the past we have had to refer some the specialized services that the hospital has She is a certified instructor of
high-risk pregnancies, where we identified po- to offer. Neonatology is the medical specialty both the Neonatal Resuscitation
tential problems, to a larger medical center for of taking care of newborns, especially sick or Program and the S.T.A.B.L.E.
the delivery. Or sometimes we have delivered problematic babies, as well as premature ba- Program for post-resuscitation/
babies who are not the normal bouncing kind bies. “Neonatology” basically means “science pre-transport stabilization of
but show signs and symptoms of distress. In of the newborn”, coming from the root words the neonate. She is also an ac-
these instances, we’ve had no alternative but “neo” = new, “natal” = birth, and “ology” = sci- tive member of the Newborn
to transfer these sick babies to other institu- ence of. Now that the hospital has the most Screening Society of the Philip-
tions because we were not equipped to man- modern medical equipment for monitoring and pines and the Community Pedi-
age such problematic newborns. One can ventilation, we are now able to provide more atrics Society of the Philippines.
then imagine the disappointment and anxiety comprehensive care to these ailing newborns Before joining the AMH family,
that strikes the parents when the newest, most in a fully-equipped Special Care Baby Unit she was affiliated with several
fragile member of their family has to be trans- (SCBU). teaching hospitals as a lecturer,
ferred to unfamiliar surroundings, away from and was an active consultant
the mother, for specialized medical care. What is the Special Care Baby Unit? and newborn screening coordi-
nator in numerous private hos-
We have delivered increasing numbers of ba- The SCBU is a special area of the Obstetrics pitals in different provinces in
bies in recent years (over 600 in 2007), and Ward that is devoted to the care of critically the Southern Luzon area in the
therefore we expect to encounter more high- ill babies. It is staffed round-the clock by the Philippines.
risk pregnancies and deliveries, and we rec- neonatologist (which is just a fancy techni-
ognize the necessity of being able to address cal term for “baby doctor”), pediatricians and
the needs of these babies who require more nurses who are skilled at neonatal resuscita-
than routine newborn care. In anticipation of tion and management of newborn problems

28

and conditions. It is here where the sick ba-
bies are closely monitored and where they
undergo more intensive evaluation and man-
agement. Typically a SCBU is completely
separated from the nursery for healthy new-
borns, and for this reason, it is often divided
by partitions into several distinct regions: a
true “intensive care” area (Level III) where
the nurses and doctors spend most of their
time at the babies’ bedsides, an “intermediate
care” area (Level II) for babies that are still
on IVs or extra oxygen, and a quieter area
for the “growers.” The SCBU at AMH has fa-
cilities which provide complete cardio respira-
tory monitoring and respiratory support to 2
babies on ventilators, and can accommodate
up to 10 babies more in the intermediate care
and step-down areas.
What Kinds of Problems Do Babies Have?
In the SCBU, we can admit both full-term ba-
bies and premature babies (who are born be-
fore reaching 37 weeks age of gestation).
Premature babies are not really “sick” -- at
least, not when they are first born. They need
to be in the SCBU because the various sys-
tems and organs of their body are not yet fully
developed, which can lead to a host of prob-
lems. In the unit, we can support their need
for oxygen, provide assistance with breathing
for their underdeveloped lungs using a venti-
lator, maintain body temperature with an in-
cubator, as well as manage jaundice (which
develops earlier due to the baby’s immature
liver) using phototherapy units to prevent
central nervous system damage. Premature
babies are also very susceptible to infections
because their immune system is not fully de-
veloped. We can give intravenous nutritional
support to very small babies whose digestive
systems cannot handle milk adequately, or
give orogastric tube feedings to growing pre-
mature babies who are not yet able to suck,
swallow and breathe in a coordinated manner
on their own.
The problems of the full-term babies that are
admitted to the unit are typically very different
to those of premature babies, and in some
Premature babies
are not really “sick”
-- at least, not when
they are first born.
They need to be in
the SCBU because
the various systems
and organs of their
body are not yet ful-
ly developed, which
ways are much more complicated and less can lead to a host
predictable. Difficult deliveries can cause
perinatal asphyxia (which is a lack of oxy- of problems. In the
gen), leading to multiple problems in differ- unit, we can support
ent organ systems such as seizures, kidney
failure, heart failure, and so on. Congenital their need for oxy-
defects or “birth defects” (abnormalities of
development, such as congenital heart de-
gen, provide assist-
fects, brain malformations, or gastrointes- ance with breathing
tinal malformations) will need additional di-
agnostic and imaging examinations such as for their underdevel-
2-D echocardiography, cranial ultrasound oped lungs using a
or serial x-ray examinations. Pneumonia,
meningitis, or generalized infections in the ventilator, maintain
blood (“sepsis”), either acquired before birth
or shortly afterwards, also need special di-
body temperature
agnostic procedures like lumbar puncture. If with an incubator,
the baby develops hyperbilirubinemia from
certain types of blood disorders, or has an as well as manage
infection, or if the mother’s immune system jaundice (which de-
makes antibodies against the baby’s blood
type, the jaundice can be very severe and velops earlier due
this may require intervention in the form of
whole-blood exchange transfusion. All these
to the baby’s im-
diagnostic and therapeutic procedures can mature liver) using
be done in the SCBU if deemed necessary
by the neonatologist. phototherapy units
to prevent central
The American Mission Hospital SCBU will
provide the essential care needed by these nervous system
sick babies to help them overcome the initial
problems that develop in the immediate new-
damage.
born period. If the baby has a congenital syn-
drome or other anomalies these require much
more specialized care than what is available
at the hospital (maybe from other subspecial-
ties such as Genetics, Cardiology or Pediat-
ric Surgery). The advantage of admitting the
baby to our SCBU is that we can stabilize
his condition first, then afterwards we
can make arrangements for transferring
him to centers that have the expertise to
manage his condition. On the whole, we
can help these newborns make a smooth
transition to normal extra uterine life so that
when they are well enough and big enough
to go home, we are able to put them back
on track to becoming healthy babies. We can
then look forward to having their photographs
hanging on our walls.
29
 DOCTORS, DENTISTS & SPECIALITIES
DR. PAUL ARMERDING - Chief Medical Officer
GENERAL PRACTITIONERS (OPD) MANAMA
DR. P. RICHARDSON
DR. SUSAN ISAAC
DR. CECILIA SOLIVEN-EDROZO
DR. SAMUEL ISAAC
DR. MOHAMMED AL KHATEEB
DR. EDMUND EDROZO
DR. MARY JAYA GANAPATHY
DR. SOLOMON VINAY KUMAR
DR. JOEL SURENDER
DR. NATESAN NEHRU
DR. WESAM SALEEM MUSTAFA
DR. VIRGINIA PAZ BRAGA
DR. ANITA DAVIS
DR. JOBEL LAPINID
RESPIRATORY MEDICINE
DR. BABU RAMACHANDRAN
DR. SUAD AL MUNFARIDI
DR. KALYAN SUBRAMANYAM
OVERKAMP CLINIC ( INTERNAL MEDICINE )
DR. M.D.V.N. NAGESH BABU
DR. K. MATHEW GEORGE
DR. ANABETH LIM SAKHRANI
DR. NEIL DE JESUS RANGEL
DR. EMERITA CO - DE LEON
DR. BHANU VASUDEVAN
DR. ALKA GUPTA
DR. C. S. SHOBHA
DR. JULIET PREM
DR. CECILIA PACHECO
DR. SUSAN QUIJANO
DR. PAULITA BARETTO-ABASILLAS
DR. SANJAY GUPTA
DR. NANIK SAKHRANI
DR. JENNIFER A. GARCIA
DERMATOLOGY CLINIC
DR. BHARTENDU MEHTA
NUTRITION & FOOD SERVICES SECTION
CHRISTINE ZOLETA
P.O. BOX 1, Manama, Kingdom of Bahrain • Tel: (+973) 17253447 • Fax: (+973) 17234194 • email: info@amh.org.bh • website: www.amh.org.bh
DR. KEN KAUFMANN - Chief of Medical Staff
ENT CLINIC
GENERAL PRACTITIONER 17248110 / 17248121 DR. E. KRISHNAN ENT SURGEON 17248148
GENERAL PRACTITIONER 17248110 / 17248121
DR. ELMER ESPINOSA ENT SURGEON 17248148
GENERAL PRACTITIONER 17248110 / 17248121
DR. STANLEY KWIK ENT SURGEON / ALLERGIST 17248148
GENERAL PRACTITIONER 17248110 / 17248121
AUDIOLOGIST /
MS. SHEIK NAZIYA BATUSHA SPEECH THERAPIST 17248148
GENERAL PRACTITIONER 17248110 / 17248121
ORTHOPEDIC CLINIC
GENERAL PRACTITIONER 17248110 / 17248121
DR. ABRAHAM GEORGE ORTHOPEDIC SURGEON EXTENSION: 330
GENERAL PRACTITIONER 17248110 / 17248121
ORTHOPEDIC SURGEON/
DR. BASHEER AHMED SPORTS MEDICINE EXTENSION: 330
GENERAL PRACTITIONER 17248110 / 17248121
GENERAL PRACTITIONER 17248110 / 17248121 DR. JUAN MAGALONG ORTHOPEDIC SURGEON EXTENSION: 330
GENERAL PRACTITIONER 17248110 / 17248121 PEDIATRIC CLINIC
GENERAL PRACTITIONER 17248110 / 17248121 DR. KAMLESH RAISINGHANI PEDIATRICIAN 17248113
GENERAL PRACTITIONER
ASSIST. CHIEF MEDICAL STAFF 17248110 / 17248121 DR. RAVINDRA E. BHINGARE PEDIATRICIAN 17248113
GENERAL PRACTITIONER 17248110 / 17248121
DR. PREETHA ACHUMON PEDIATRICIAN 17248113
GENERAL PRACTITIONER 17248110 / 17248121
DR. MARIAM KOSHY PEDIATRICIAN 17248113
DR. MA. CRISELDA DIVINA-NAVARRO PEDIATRICIAN 17248113
GENERAL PRACTITIONER /
SMOKING CESSATION 17248110 / 17248121
GENERAL PRACTITIONER /
DR. RENE ALLAM PEDIATRICIAN 17248113
PULMONOLOGY EXTENSION: 374
Sub Speciality
PAIN CLINIC
PEDIATRICIAN / PEDIATRIC
GP ANESTHESIOLOGIST /
EXTENSION: 353 DR. MARIA LIZA ESPINOZA PULMONOLOGIST 17248113
PAIN MANAGEMENT
DR. JUDY PIPO DEVEZA PEDIATRICIAN / NEUROLOGY 17248113
INTERNIST 17248122 / 17248123 DR. LOURDES IMPERIAL PEDIATRICIAN / NEONATOLOGY 17248113
INTERNIST 17248122 / 17248123 ANESTHESIOLOGY
INTERNIST 17248122 / 17248123 DR. HEMANGINI RAJU AL MOULA ANESTHESIOLOGIST EXTENSION: 315
Sub Speciality DR. KANUBHAI PARMAR ANESTHESIOLOGIST EXTENSION: 315
INTERNIST / ENDOCRINOOGIST 17248122 / 17248123
OPHTHALMOLOGY CLINIC
INTERNIST / CARDIOLOGIST 17248122 / 17248123
DR. RAJINDER PARKASH SACHDEVA OPHTHALMOLOGIST EXTENSION: 263
OB / GYN CLINIC
RADIOLOGY DEPARTMENT
OBSTETRICS / GYNECOLOGY 17248142
DR. BEULAH ISAACS RADIOLOGIST 17248117
OBSTETRICS / GYNECOLOGY 17248142
OBSTETRICS / GYNECOLOGY 17248142 DR. V GANESAN RADIOLOGIST 17248117
OBSTETRICS / GYNECOLOGY 17248142 DR. CHARITO K. MANGUERRA RADIOLOGIST 17248117
OBSTETRICS / GYNECOLOGY 17248142 PHYSIOTHERAPY DEPARTMENT
OBSTETRICS / GYNECOLOGY 17248142 MS. ZAITOON MALOO PHYSIOTHERAPIST 17248140
OBSTETRICS / GYNECOLOGY 17248142
MS. GLENDA BARBACENA PHYSIOTHERAPIST 17248140
GENERAL SURGERY
MS. JIYA SARAH ITTICHERIA PHYSIOTHERAPIST 17248140
GENERAL SURGEON /
ASST. CHIEF OF MED. STAFF EXTENSION: 351
DENTAL DEPARTMENT
GENERAL SURGEON /
LAPAROSCOPIC SURGEON EXTENSION: 351
GENERAL DENTIST / CHIEF OF
DR. ZAHRA MAJEED DENTAL SERVICES, MANAMA 17248145 / 17248146
GENERAL SURGEON EXTENSION: 351
DR. HUSSAIN AL WEJDANI GENERAL DENTIST 17248145 / 17248146
DERMATOLOGIST / DR. NOSHEEN HUSSAIN GENERAL DENTIST 17248145 / 17248146
VENEREOLGIST EXTENSION: 354
DR. ANDLIB TARIQUE GENERAL DENTIST 17248145 / 17248146
GENERAL/PERIDONTICS/
NUTRITIONIST - DIETICIAN 17248145 / 17248146 DR. SAJNI VAIDYA COSMETIC DENTISTRY 17248145 / 17248146
 SAAR MEDICAL
and DENTAL CENTER
General practice, Pediatrics, Obstetrics Gynecology, ENT (Ear, Nose and Throat),
Dermatology, Psychiatry and Physiotherapy. General Dentistry, Implantology,
Endodontics, Orthodontics and Cosmetic Dentistry.

The AMH Saar Medical and Dental Center is a department of the American Mission Hospital. It functions as a satellite clinic
which provides quality medical and dental services to the community.
The clinic provides general and specialty clinics to ensure that each patient is seen by a competent physician or dentist.
In addition, the clinic has a mini laboratory wherein minor tests and phlebotomy service are available. The clinic also has a
pharmacy which stocks a wide collection of medications for dispensing. There is a furnished children’s play area and
spacious car parking area.

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Telephone: (+973) 17790025 Opening Hours 8:00 a.m. to 10:00 p.m. (7 Days a week)