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HEARTTALKSarawak Heart Foundation (383498-P)No.11, 1st Floor, Lot 2343, Block 10 KCLD Bormill Estate Commercial Centre,Jalan Tun Ahmad Zaidi Adruce 93150 Kuching Tel: 082-258 212 Fax: 082-258 303Email: [email protected] Website: sarawakheartfoundation.org.myFacebook: SarawakHeartFoundation

Volume 12KDN No.: PPK434/04/2013 (032273)

Dec 2015

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Volumn 12 - Dec 2015

Chairman

TYT Tun Pehin Sri Haji Abdul TaibMahmud

Deputy Chairman

YB Tan Sri Datuk Amar Dr. James Jemut Masing

BoarD of trustees

YABhg Datin Patinggi Dato Hajjah Jamilah Anu

YB Senator Datuk Prof Dr Sim Kui Hian

YB Dr Annuar Rapaee

YBhg Dato Sri Empiang Jabu

YBhg Dato Anne Teng

YBhg Datuk Dr Stalin Hardin

YBhg Datuk Fong Joo Chung

YBhg Datuk Prof Dr Chew Peng Hong

YBhg Dato Haji Abdillah Haji Abdul Rahim

Dr Mohd Hirman Ritom

Ms Pauline Kon Suk Khim

Mr Eric Lim Swee Khoon

aDvisor

YBhg Datuk Patinggi Tan Sri Dr. Wong Soon Kai

meDiCal aDvisor

Dr. Yii Kie Sing

eDitor

Mr. Eric Lim Swee Khoon

eDitorial BoarD

Ms Jennifer Goh

1 Message - Mr. Eric Lim Swee Khoon is also a Trustee of the Foundation

2 Hari Raya Visit Health screening @ Eastern Mall Boulevard Health Activities

3 Women’s Heart Day

3-6 Comprehensive Cardiac Rehabilitation Program

7-8 World Heart Day 2015

9 Electricity for life WHD thank you dinner Health Awareness @ Lodge School International School Health Screening & Health Talk at Sarikei Health Screening at Julau

10 Upcoming events …………

Content

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Eric Lim Swee KhoonEditor

message from editor

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16/8/15 22/8/15

Activities of 2nd half of 2015

BOULEVARD HEALTH ACTIVITIES-EXHIBITION, SOUVENIR SALES & HEALTH PAMPHLETS

HEALTH SCREENING @ EASTERN MALL, SIBURAN

HARI RAYA VISIT TO SGH HEART CENTRE

7/7/15

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Percutaneous Coronary Intervention

Coronary Artery Bypass Graft Surgery

Cardiac Rehabilitation Program Book Rehabilitation Physician Review

19/9/15 WOMEN’S HEART DAY @ BOULEVARD SHOPPING MALL

Comprehensive Cardiac Rehabilitation Program in Sarawak General Hospital Heart Centre

Coordinated ByDr. Yew Kuan Leong, Dr. Leong Be KimCardiac Rehabilitation Program Directors

CoronarY arterY Disease

Coronary artery disease is a very common disease affecting Malaysian nowadays. Coronary artery disease is caused by a pathological process called atherosclerosis. Atherosclerosis causes plaque build-up in the coronary arteries over time. The risk factors associated with atherosclerosis and coronary artery disease are hypertension, diabetes mellitus, smoking, male gender, high cholesterol, kidney failure, obesity, sedentary lifestyle, strong family history of coronary artery disease and immune-suppressant therapy. Men generally are at greater risk but the risk for female increases after menopause. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or your mother or a sister developed it before age 65.

The narrowing of the coronary artery may limit the blood supply to the heart muscle. If the narrowing happens gradually, the patient will experience increasing chest symptoms such as chest heaviness during exercise and reduced daily functional activity. This is called stable coronary artery disease. The affected patient will stop the physical activity, rest and usually the chest symptoms will disappear. If the narrowing of the coronary artery worsens immediately to the degree of almost total blockage of the blood flow, this is an emergency situation. The most feared scenario is acute myocardial infarction or commonly called “heart attack”.

The affected “heart attack” patient often will be in great distress and must be advised to seek urgent medical attention. The doctor will assess the patient by performing clinical evaluation, electrocardiography and blood test related to the “heart attack”. If confirmed to be “heart attack”, there are two ways to treat it – either with powerful blood thinner or opening up the blockages with metallic stent, a process called angioplasty.

As a consequence of the “heart attack”, there would be permanent damage to the heart muscle. The efficiency of the heart as a vigorous pump is indefinitely reduced. The more damage to the heart, the less efficient it will become. Heart attack patient will be given medications consisting of anti-platelet drug (blood thinner), cholesterol lowering drug, hypertensive drug and heart beat lowering drug.

MuLtifaCeteD CarDiaC rehaBiLitation PrograM

Cardiac Rehabilitation Program (CRP) in Sarawak General Hospital is a comprehensive coordinated, multifaceted program aim to improve functional status of cardiac patient in additional to slowing down the progression of the underlying atherosclerosis process.

Suitable candidates for Cardiac Rehabilitation Program include the following: i. Post myocardial infarction ii. Stable angina iii. Post Coronary Artery Bypass Graft Surgery iv. Post Percutaneous Coronary Intervention v. Compensated Heart Failure

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Volumn 12 - Dec 2015Coronary Artery Bypass Graft (CABG) is a treatment option for selected candidates with coronary artery diseases. CABG surgery involves median sternotomy, in which the sterum is literally cut in two and spread apart, allowing access to the heart. Special catheters are inserted into the heart and large vessel ascending aorta so that cardiopulmonary bypass (CBG) can be performed while the heart is stopped. The number of bypass grafts the patient receives depends on the number of diseased arteries that need to be bypassed as well as suitability of these arteries for being bypassed. After the procedure, patients typically require few days of intensive care management and then up to weeks for further care. Full recovery requires approximately 4 weeks and in some cases significantly longer.


Cardiac Rehabilitation Program Book








Multidisciplinary Team Discussion for Exercise Prescription







Exercise Stress Testing Multidisciplinary Team Discussion for Exercise Prescription

Education Program (Presentation by Dietician)

Education Program on Stress Management (Presentation by Doctor)

Assessment on Activities of Daily Living





Our Cardiac Rehabilitation Program consists of 4 phases, phase I to phase IV. Phase I is early inpatient phase, followed by phase II intensive outpatient program. There are 8 sessions in phase II Cardiac Rehabilitation Program, 2 sessions per week. Patients will be advised to come back for phase III review for management of cardiovascular risk factors three months after completion of phase II. If cardiovascular risk factors are not well-controlled, patients will be given long term follow-up.

Circuit exercise program is an important component, it is crucial to make sure this program is safe and effective. To achieve this, proper risk stratification needs to be conducted before enrolment in the program. Target heart rate will be prescribed to cardiac rehabilitation patients. Education program will cover management of modifiable risk factors. Cardiac Rehabilitation program will also serve as platform for cardiac patients to interact and share their own experience. This peer support may help to improve motivation and adherence to treatment.

Life style intervention is often a neglected treatment for cardiac patients if no formal education or exercise program is provided. Comprehensive Cardiac Rehabilitation Program in Sarawak General Hospital will ultimately improve the quality of life of cardiac patients. Love our hearts to stay healthy and fit.

RehabilitationPhysician Review

Exercise Stress Testing

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DietiCian intervention

During phase I of cardiac rehabilitation, doctors will refer their patients who have diabetes to the dietitian. The dietitian will assess the patients’ anthropometry, biochemical, clinical and dietary. Dietary advice will be given on how to control the blood sugar before procedures are done. If patients are referred for poor oral intake, nutrition support will be given.

During phase II of cardiac rehabilitation, when patients have discharged, they will be told to come back in group. The dietitian will give a talk on how to lose weight, how to control blood cholesterol and how to control blood pressure via dietary modification. Patients will be taught on how to read their food label and how to modify their cooking.

During phase III of cardiac rehabilitation, if patients still fail to compliance to control their diet, the doctors will refer the patients back to dietitian. The dietitian will reassess the patients’ eating habit individually. Dietary advice will be reinforced to this group of patients.

Education Program (Presentation by

Dietician)






aBout stress ManageMent

One hour sessions on stress management are conducted monthly during the Cardiac Rehabilitation Program Phase II. Stress appears to be a buzz word that many seem to be using to denote several unpleasant thoughts/ feelings. What actually constitutes stress? Is stress a normal part of life or is it something that just should not be present at all in one’s life? And, if it’s a normal part of life, when does it become troublesome or pathological? When & how does “stress” actually affect the physical body?

Ideas with regard to the above questions are delved into rather comprehensively during the hour-long sessions that are held. The word ‘stress’ is dissected and situations that are “stressful” are discussed. The mind-body connection and the effects of the mind on the body are discussed. Various examples of mind body connections are provided to illustrate this point. Also, the difference between having a lot to do and yet not “feeling stressed” is discussed. What it is about situation that puts one in a stressful state is deliberated upon.

Once the idea of stress and its genesis is understood, then thoughts about its management are elucidated. The various traditional methods of stress management which are already inherent and well embedded in our culture are drawn upon and discussed. Those present are made aware of the wisdom of our ancient cultures and their abilities to tackle stress even before it surfaces. The wealth and value of our ancient principles and philosophies are brought into awareness. With regard to this, mindfulness is briefly discussed.





innovation of oCCuPationaL theraPY

Occupational therapist (OT) is a profession concerned with promoting health and well-being through occupation. Occupational Therapist achieves this outcome by enabling people to do things that will enhance their ability to participate or by modifying the environment to better support participation.

Occupational Therapist started to involve in Cardiac rehabilitation program (CRP) in early 2011 by visiting from Occupational Therapist from Hospital Umum Sarawak. The therapist-in-charge has focused on phase 1 with education talk about ADL and BADL guideline after surgery to lessen rise in cardiac distress. Beginning in 2014 Occupational Therapists expand their role in CRP for phase I, phase II and phase III.

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For phase I , OTs were added to their service who provide chest binder to all Cardiothoracic cases. That binder was used to maintain a normal pattern of breathing after surgery. It will help to make a faster of wound healing and also to prevent other complication of sternum and ribcage when patient does the active movement especially while cough. Beside that the things that need to be emphasized is to monitor low level self-care activity (in bed) after surgery.

Phase II, OTs were more focussed on work hardening and word reconditioning program and some slots of talk at every end of month. The talk discussed about Ergonomic in ADL and BADL, Energy conservation and Work simplification and also practical session of relaxation therapy technique. There were two task requirement in work training namely lifting activity and carrying activity. In CRP II, patients were divided into three categories likes high risk , moderate risk and low risk. Usually, for high risk patient, they will start to carrying or lifting (0.5kg -1kg), moderate risk (1.5kg-2kg) and low risk (2kg-2.5kg). During training session, blood pressure, heart rate, RPE of patients and other symptoms such as chest pain need to monitor strictly.

Hence, for phase III, Occupational Therapists were more focus to empower the self- monitoring and maintain of balanced life style of patient. Reassessment will be made to monitor whether a patient is able to reinforce and promote the application of skills and knowledge learned in phase II. Otherwise, OTs also identify any changes in personal lifestyle and give recommendation whenever necessary.

A s ses smen t on Activities of Daily Living

T r a i n i n g for Lifting & Carrying O b j e c t s R e l a x a t i o n Technique

Role of Pharmacist in CRP

Post-operative patients, whether percutaneous coronary intervention (PCI) stenting or coronary artery bypass grafting (CABG), will take home a long list of medications at discharge. Although these medications are necessary to maintain the patient’s outcome after discharge, they can cause many unwanted side effects to the patient especially when taken incorrectly. Patients who are not counselled on the side-effects and the proper way to take their medications will experience these unwanted side effects which in

the end compromise on their compliance. Most patients will even choose to ignore their therapy altogether.Following this, the pharmacist’s role in the Cardiac Rehabilitation Program is to give a thorough knowledge via individual counselling and group presentations to all patients post PCI or post CABG. Individual counselling, which is usually given at discharge, provide a one-on-one environment between the patient and the pharmacist. On the other hand, group counselling which is usually given in a form of a presentation, allows the pharmacist to reach out to a greater number of patients. In addition to that, patients are able to share their experiences regarding their therapy. Counselling – group and individual – done routinely enables patients to have full awareness and knowledge on the function, correct administration (before or after meal), common side-effects, and benefits of each and every medication.

This counselling focuses on patients’ concordance to therapy rather than compliance. This means that the interaction between the pharmacist and the patient is an utmost importance to understand each patient’s lifestyle in order to tailor their medication administration times. During these counselling (group and individual), patients are first counselled on the pathophysiology of their disease and the procedures that they have undergone. A complete understanding of the pathophysiology of their disease is necessary prior to the counselling of their medications. From here, patients will be counselled on the different classes of mediations and briefed on the mechanism of action of each drug. Patients will also be educated on the short-term and long-term benefits of the drugs. It is also essential for the patients to understand if the drugs should be taken before or after meal. This will either reduce the side effects or increase the bioavailability of their drugs.Since individual counselling is done at discharge from ward, group counselling is done every month at the second phase of the cardiac rehabilitation program. At the end of the 1 hour session, patients are free to consult the pharmacist regarding their medication therapy. A copy of the slide presentation is also provided at the end of their program. Pharmacists’ counselling focus on concordance to medicationsPhysiotherapists Approach in CRPFor cardio-thoracic patients who are undergoing surgeries; the physiotherapists assess and prepare the patients by giving them the Pump-Talk (pre-operative physiotherapy). Postoperatively, the physiotherapists will treat the patients in Intensive Care Unit to prevent pulmonary, circulatory and musculoskeletal complications (Phase I) CRP, then a home-based program is given and taught to the patients before they are being discharged home. Similarly, Phase 1 CRP is taught to Cardiology






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WORLD HEART DAY @ RESERVOIR PARK, KUCHING27/9/15

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Volumn 12 - Dec 2015 Activities of 2nd half of 2015

5/10/15

7/10/15

LAUNCHING OF ELEC-TRICITY FOR LIFE PROGRAM @ SGH HEART CENTRE

WORLD HEART DAY -THANK YOU DINNER TO VOLUNTEERS @ IMPERIAL HOTEL

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Volumn 12 - Dec 2015 Activities of 2nd half of 2015

21/11/15HEALTH SCREENING @ SARIKEI

HEALTH AWARENESS @LODGE INTERNATIONAL SCHOOL- POSTER EXHIBITION- TALK HEALTHY EATING & OBESITY- SMOKING

11/11/15

22/11/15HEALTH SCREENING @ JULAU

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Tel. No. : .......................................... Fax No. ............................................. E-Mail ..........................................

payment[ ] Cheque No. ................................................... For RM .........................................................................

[ ] Bank Draft ..................................................... For RM .........................................................................

For Direct Remittance, please bank into rhB Bank a/C no. 21104350033342(Please fax or email the bank-in slip to Fax: 082-258303)Email: [email protected]

All donations payable to:

Sarawak Heart FoundationNo. 11, 1st Floor, Lot 2343, Block 10 KCLD Bormill Estate Commercial CentreJalan Tun Ahmad Zaidi Adruce, 93150 Kuching, Sarawak.Tel: 082-258212 ; Fax: 082-258303 Website: sarawakheartfoundation.org.my

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Tel. No. : .................................................................... Fax No. : .......................................................................

E-Mail : .................................................................... H/P No.: .......................................................................

Date : ....................................................................Please specify how you can help? (eg. driver, food runner, general worker, exercise instructor, dancer, mc, photographer etc.)

Sarawak Heart FoundationNo.11, 1st Floor, Lot 2343 Bormill Estate Commercial Centre , Jalan Tun Ahmad Zaidi Adruce, 93150 Kuching Sarawak Tel: 082-258212 Fax: 082-258303 Email address: [email protected]

up- Comingevents

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Donation form

“frienD of the founDation” form

Ref. JHDN 01/35/42.51/179-6.4381

sarawak heart founDation(383498-P)

sarawak heart founDation(383498-P)

how Can you help?If you are someone who is caring and would like to help Sarawak Heart Foundation, you can register as a “Friend of the Foundation” (as a volunteer to help in the various projects undertaken by the Foundation from time to time and especially with fund-raising)

Please fill in the below and send to us.

Thank You.*********************************************************

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All donations are tax exempted.

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