~ Weekly Health Advice from PMGH – Asthma – Part 3 of 4 ~

How is Asthma Diagnosed?
If you suspect, you may have asthma talk to your doctor. A diagnosis of asthma is more likely if you have eczema or hayfever or have close relatives with allergies and/or asthma, and if your symptoms: keep coming back, or happen at the same time each year, are worse at night or in the early morning, are clearly triggered by exercise, allergies or infections, or improve quickly with reliever medication according to Asthma Australia. The most certain way to diagnose asthma is with a lung function test, a medical history, and a physical exam. However, it’s hard to do lung function tests in children younger than 5 years and doctors must rely on children’s medical histories, signs and symptoms, and physical exams to make a diagnosis. Doctors also may use a 4–6 week trial of asthma medicines to see how well a child responds. In diagnosing asthma, your doctor will ask about your medical history as well as:
Physical examination: During a physical examination your doctor will listen to your breathing and look for signs of asthma or allergies such as wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema). Keep in mind that you can still have asthma even if you don’t have these signs on the day that your doctor examines you.
Spirometry tests: Spirometry is the most accurate breathing test for asthma. It measures the amount of air you can breathe in and out of your lungs, and how hard and fast you can breathe out. The machine used to do the test is called a spirometer and tests your overall lung function. Doctors use a spirometer to: check whether the airways in your lungs are narrower than they should be, confirm whether you have asthma, work out how severe your asthma is, see if your asthma is getting worse, see if your asthma is getting better with treatment. The test results help you and your doctor to decide whether you need any medicines, or to work out whether the type or dose of your current medicine needs to change. Most adults and children over 7 years of age can do the spirometry test correctly.
Peak flow test: A peak flow test is done with a peak flow meter. It measures the maximum (or peak) speed at which you can blow air out. This gives an idea of how narrow your airways are. It also shows how much your airways are changing. However, a peak flow test cannot be used to confirm whether you have asthma. Your doctor may ask you to use a peak flow meter to check your asthma at home.
Allergy testing: Asthma is strongly linked with allergies, many people will be required to have allergy testing usually through skin prick or blood (RAST) tests. Talk to your doctor.
Treatment and Management of Asthma
Centre’s for Disease Control and Prevention (CDC): You can control your asthma and avoid an attack by taking your medicine exactly as your doctor tells you to do and by avoiding things that can cause an attack. Not everyone with asthma takes the same medicine, some medicines can be inhaled or breathed in, and some can be taken as a pill. Asthma medicines come in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you need to use your quick-relief medicines more and more, you should visit your doctor to see if you need a different medicine. Long-term control medicines help you have fewer and milder attacks, but they don’t help you if you’re having an asthma attack. Asthma medicines can have side effects, but most side effects are mild and soon go away. Ask your doctor or other medical professional about the side effects of your medicines. The important thing to remember is that you can control your asthma. With your doctor’s or other medical professional’s help, make your own asthma action plan (management plan) so that you know what to do based on your own symptoms. It is important to see your doctor for regular check-ups to ensure you are on the right track with your asthma management.

~ Three PMGH staff to undergo Operation Open Heart Training in India ~

Three hard working staff of the Port Moresby General Hospital are thankful to the Operation Open Heart (OOH) Foundation for funding three months of further training in India.

Two nurses, Sister Noelyn Wangi and Sister Jean Boie will undergo cardiothoracic nursing training while Perfusionist and Anaesthetic Technician, Norman Kambo will undergo paediatric perfusionist training.

The three left the country last Saturday to undergo training at Dr. Cherian Heart Foundation in Chennai, South India. Sister Wangi, who works as a senior nurse in the critical care unit of the Port Moresby General Hospital is thankful to the sponsor, for the great opportunity to undergo overseas training for the first time. “It will be a new experience for me to gain new knowledge and I am happy and proud to be part of the training. When I return my goal is to support the cardiac team of the hospital and help improve the cardiothoracic nursing care of heart patients” Sister Wangi said.

Sister Boie, who also works in the critical care unit said it was a great opportunity to expose to new knowledge and experience. “Thank you, Operation Open Heart Foundation, for the great opportunity. I will do my best, and when I come back, I will teach other colleagues what I have learned so we can work as a team to contribute to the cardiac team and improve heart service of PNG”, Sister Boie said.

Technician, Mr. Norman Kambo who has performed anesthesiology for 16 years and perfusion for three years said “when you have a perfusionist it is a complete heart surgery discipline, when performing Operation Open Heart, It is a technical area where a skilled and trained person controls the flow of blood into patient’s body when undergoing OOH surgery with the use of artificial heart and lung machine. In previous years of OOH, the procedure was performed voluntarily by our overseas counterpart. Now it’s time we take over and do it ourselves. I am thankful for this second round of training; it will give me the confidence to perform it myself, and I am prepared to take the challenge, Mr. Kambo said.

~ Weekly Health Advice from PMGH – Asthma – Part 2 of 4 ~

Missed part 1? Head to the PMGH Facebook timeline and scroll down.

Symptoms of Asthma
Common symptoms of asthma include:
– Coughing (especially at night, during exercise or when laughing)
– Chest tightness
– Shortness of breath
– Wheezing (a whistling or squeaky sound in your chest when breathing, especially when exhaling)
Tip: If you’re experiencing any of the symptoms above talk to your doctor. If diagnosed with asthma develop an asthma management plan with your doctor. Any asthma symptom is serious and can become deadly if left untreated.

Asthma Emergency
Asthma Australia: Any person with asthma can have a flare-up or worsening of asthma symptoms at any time. A sudden or severe flare-up is often called an asthma attack. An asthma flare-up or attack may develop very rapidly over a few minutes, or it may take a few hours or even days to happen. Having good control of your asthma means this is less likely, but it can still happen. Reduce your risk of an asthma flare-up by taking your asthma medicine as advised, being aware of your symptoms and responding quickly when they get worse, following a written asthma action plan, having regular reviews with your doctor and asking them to check you’re using your inhaler well.
You may be having an asthma flare-up or attack if:
– You have asthma symptoms that are getting worse
– Your reliever puffer isn’t helping or is lasting less than four hours
– Your symptoms are making it difficult to eat, speak or sleep
– You feel like you can’t get your breath in properly
– Children may complain of a sore tummy or chest, or be more restless
(Start asthma first aid as soon as possible)

Asthma First Aid:
Step 1: sit the person upright
– be calm and reassuring
– do not leave them alone
Step 2: give 4 separate puffs of reliever puffer
– shake puffer
– put 1 puff into spacer
– take 4 breaths from spacer
– repeat until 4 puffs have been taken
Remember: shake, 1 puff, 4 breaths
Step 3: Wait 4 minutes
if there is no improvement give 4 more puffs as above
Step 4: If there is no improvement seek emergency assistance.
Keep giving 4 separate puffs every 4 minutes until emergency assistance is sought.
Please note: If your symptoms improve you still need to make an appointment to see your doctor, preferably the same day.

You should seek emergency assistance if the person:
– is not breathing
– the person’s asthma suddenly becomes worse or is not improving
– the person is having an asthma attack, and a reliever is not available
– you are not sure if it’s asthma
– the person is known to have Anaphylaxis – follow their Anaphylaxis Action Plan, then give them Asthma First Aid (see above)

~ Weekly Health Advice from PMGH – Asthma – Part 1 of 4 ~

Welcome to another health update from the Port Moresby General Hospital, this week we are focusing on Asthma, what are the symptoms of asthma and when is it a medical emergency?

What is Asthma?
Asthma is a chronic condition that causes inflammation and narrowing of the bronchial tubes, the passageways that allow air to enter and leave the lungs. According to Asthma Australia, the causes of asthma are not fully understood, although people with asthma often have a family history of asthma, eczema, and hay fever. Research has shown that exposure to tobacco smoke (especially as a baby or young child), obesity and some workplace chemicals can increase the risk of developing asthma. Although there is currently no cure for asthma, with the right knowledge and good management, most people with asthma can lead full and active lives. According to the National Asthma Council of Australia, many people think they have asthma only when they have asthma symptoms. In fact, the airways are sensitive all the time, and most people with asthma have permanently irritated (inflamed) airways when not taking regular preventer treatment. From time to time, the airways tighten or become constricted, so there is less space to breathe through, leading to asthma symptoms. Asthma causes three main changes to the airways inside the lungs, and all these can happen together:
– the thin layer of muscle within the wall of an airway can contract to make it tighter and narrower – reliever medicines work by relaxing these muscles in the airways
– the inside walls of the airways can become swollen, leaving less space inside, preventer medicines work by reducing the inflammation that causes the swelling
– mucus can block the inside of the airways; preventer medicines also reduce mucus.

Asthma symptoms can be triggered by different things for different people however, common triggers include colds and flu, allergies, and cigarette smoke. An asthma flare-up is when asthma symptoms start up or get worse compared to usual. These flare-ups can happen quite quickly (e.g. if you are exposed to smoke) but they can also come on gradually over hours or days (e.g. if you get a cold). An asthma flare-up can become serious if not treated properly, even in someone whose asthma is usually mild or well controlled. A severe flare-up needs urgent treatment by a doctor or hospital emergency department.

Asthma Triggers
Triggers can cause the airways to become narrow and inflamed, leading to asthma symptoms. Avoiding triggers, if possible, can help to control asthma. Anything that causes a reaction can set off your asthma symptoms, these triggers differ between individuals. It is not always possible to avoid your triggers, however, reducing exposure to your asthma or allergy triggers may make your symptoms easier to manage. Work with your doctor to work out what your triggers are and get some helpful advice on how to avoid these.

Common Asthma Triggers:
Colds and flu: Colds and flu are the most common trigger for asthma flare-ups, while you can’t always avoid them you can reduce your risk by washing your hands regularly and talking to your doctor about a flu shot.

Cigarette smoke: People with asthma have even more reason to avoid smoking than those without asthma. Your lungs are extra sensitive when you have asthma and they are especially vulnerable to the damaging effects of cigarette smoke. In the short term, smoking and asthma makes you more likely to have asthma attacks or flare-ups. In the long term, you’re at higher risk of developing smoking-related diseases like emphysema. If you smoke, please talk to your doctor about quitting.

Allergies: Allergy occurs when a person’s immune system (the body process that protects against disease) reacts to substances in the environment that are usually harmless to most people. These substances are known as allergens. Examples of allergens include house dust mites, pollen, mould, and pet dander. If you have asthma that is triggered by allergens, you may have asthma symptoms when you vacuum or dust (as this causes house dust mite allergens to become airborne), visit a house where a pet lives, are outdoors in late spring and early summer, and when there are high levels of pollen in the air or are exposed to mould.

Exercise: is a common asthma trigger however exercise is great for your health. If exercise triggers your asthma symptoms, talk with your doctor so you can find the treatment that works best for you.

Other triggers: There are a number of other triggers that may affect individuals at various times such as weather e.g. cold air, change in temperature, thunderstorms, work-related triggers e.g. wood dust, chemicals, metal salts, irritating substances breathed in the air such as burning wood or grass, certain medicines, e.g. aspirin, some blood pressure drugs, stress and high emotions, such as crying.

~ Port Moresby General Hospital receives K110,000 from PNG Malaysian Association ~

The Port Moresby General Hospital was one of the recipients of the funds raised last Saturday (Oct 29th), during the exclusive dinner held at the newly opened Stanley Hotel in Port Moresby.

PNG Malaysian Association presented a cheque of K110,000 to Port Moresby General Hospital CEO, Mr. Grant R. Muddle from the funds raised during the event. CEO Mr. Grant R. Muddle thanked the MAPNG on behalf of all recipients “the support offered specifically to PMGH has assisted in the improvements and change that has happened over the past few years, thank you for supporting PMGH.”

MAPNG president, Mr. Chew Pang Heng who spoke during the presentation dinner said this charity drive had come a long way, and thanked the sponsors for their invaluable efforts in supporting MAPNG to this far. “This year’s event marked the 16 years, since its inception. Having come this far, MAPNG strives to expand from this year’s event, come next year,” Mr. Chew said.

~ Weekly Health Advice from PMGH – Potassium – Part 3 of 3 ~

Health Benefits of Banana’s
While there are foods that contain higher levels of potassium than a banana they still have amazing health benefits. Don’t ditch banana’s just yet, according to Live Science banana’s assist with:

Heart health: Bananas are good for your heart, they are packed with potassium, a mineral electrolyte that keeps electricity flowing throughout your body, which is required to keep your heart beating. Bananas’ high potassium and low sodium content may also help protect your cardiovascular system against high blood pressure, according to the FDA.

Depression and mood: Bananas can be helpful in overcoming depression “due to high levels of tryptophan, which the body converts to serotonin, the mood-elevating brain neurotransmitter,” Flores said. Plus, vitamin B6 can help you sleep well, and magnesium helps to relax muscles.

Digestion and weight loss: Bananas are high in fiber, which can help keep you regular. One banana can provide nearly 10 percent of your daily fiber requirement. Vitamin B6 can also help protect against type 2 diabetes and aid in weight loss, according to Flores. In general, bananas are a great weight loss food because they taste sweet and are filling, which helps curb cravings. They also help sustain blood sugar levels during workouts.

Vision: Carrots may get all the glory for helping your eyes, but bananas do their share as well. The fruits contain a small but significant amount of vitamin A, which is essential for protecting your eyes, maintaining normal vision and improving vision at night, according to the National Institutes of Health. Vitamin A contains compounds that preserve the membranes around your eyes and are an element in the proteins that bring light to your corneas. Like other fruits, bananas can help prevent macular degeneration, an incurable condition, which blurs central vision.

Bones: Bananas may not be overflowing with calcium, but they are still helpful in keeping bones strong. According to a 2009 article in the Journal of Physiology and Biochemistry, bananas contain an abundance of fructooligosaccharides. These are nondigestive carbohydrates that encourage digestive-friendly probiotics and enhance the body’s ability to absorb calcium.

Cancer: Some evidence suggests that moderate consumption of bananas may be protective against kidney cancer. A 2005 Swedish study found that women who ate more than 75 servings of fruits and vegetables cut their risk of kidney cancer by 40 percent and that bananas were especially effective. Women eating four to six bananas a week halved their risk of developing kidney cancer.

~ 15 paediatric heart patients lined up for Operating Open Heart in February next year (2017) ~

The fifteen paediatric heart patients are ready to undergo Operations Open Heart (OOH) at the Port Moresby General Hospital in February next year (2017).

PMGH cardiothoracic surgeon and surgery coordinator, Dr. Noah Tapaua said these patients had been screened and are ready for heart operations.

“The PMGH heart specialist team will be assisted by the Open Heart International team of Australian doctors,” Dr. Tapaua said. “The team visits PNG twice annually to perform operations mainly on children who have heart problems. Their two visits will be in February and August.

Dr Tapaua said since the establishment of the OOH 23 years ago, visiting doctors had been training local doctors who are now trained and capable of conducting most of the operations themselves. “The visiting team members have become smaller and smaller because local doctors and nurses at PMGH are getting more skilled and can do the operations themselves,” Dr. Tapaua said.

Dr. Tapaua added that PMGH also received two visits annually from another team of heart specialist from Singapore to perform operations on adult heart patients. The Singapore team will visit PMGH in April and October next year.

Dr. Tapaua further stated that the funding raised for this year went towards buying consumables, equipment and drugs and supporting doctors and nurses’ trainings to continue the heart operations at PMGH.

~ October- Heart-Felt program ~

This October’s Heart felt program came alive with dancing from critical care nurses at the Port Moresby General Hospital, adding to the excitement 86 staff birthday’s were also celebrated with cake.

A very big thank you to the Critical Care department staff of PMGH for leading the heart felt program last Friday. Some of the nurses, doctors and general services staff of PMGH received certificates for their hard work. Nursing services division, Sister Theresia Miae, who looks after patients at TB ward, picked up two awards, nurse of the month and the employee of the month.

The critical care department also acknowledged the blood bank department for working tirelessly,
and recently broke a record of most blood collected at PMGH in one day with a total of 107 bags of blood. The critical care department presented the blood team with a gift to show their appreciation. CEO, Mr. Grant. R. Muddle added that the blood bank has done very well in this month’s blood collection due to several Youth Blood drives and Corporate blood drives being conducted.

“We know, we need to collect blood now and as much as we can while we can as we coming near to Christmas, schools start closing, business houses start closing and we know that there is low amounts of blood collected during this time, thank you for all your efforts”. Mr. Muddle said.

~ Weekly Health Advice from PMGH – Potassium – Part 2 of 3 ~

Potassium Deficiency
Potassium deficiency (hypokalemia) has many causes the most common being excessive potassium loss in urine due to prescription water or fluid pills (diuretics), excessive laxative use, chronic kidney disease, diabetic ketoacidosis, diarrhea or vomiting, eating disorders, low magnesium, and excessive alcohol use. A small drop in potassium level often does not cause symptoms or may be mild, when symptoms do occur they can include: constipation, palpitations, fatigue, muscle weakness or spasms, tingling or numbness. A large drop in potassium level may lead to abnormal heart rhythms especially in people with heart disease which can cause you to feel lightheaded or faint. If you are experiencing any of the above symptoms, talk to your doctor at your local urban health clinic. Please note that while potassium supplements are available it is best to obtain any vitamin or mineral through food unless otherwise advised by a doctor. It is not the individual vitamin or mineral alone that make certain foods an important part of our diet, but the synergy of the foods nutrients working together. If a potassium supplement is suggested only take as advised by your doctor.

Tips for Getting Enough Potassium in Your Diet
While bananas have a reputation for being the food with the highest level of potassium according to the United States National Nutrient Database, one medium banana contains 422mg of potassium compared to an avocado which contains 975mg of potassium. Try to include some of the following foods into your diet:
Avocado: One avocado contains 975mg of potassium
Banana: One medium banana contains 422mg of potassium
Potato: One medium potato contains 896.7mg of potassium, 1 cup of sweet potato 448.2mg
Leafy Greens: 100g of Swiss chard contains 379mg of potassium, spinach 558mg per 100g.
Beans: white beans 1,004mg per cup, lima beans 955mg per cup, edamame 676mg per cup.
Lentils: 1 cup of lentils contains 731mg of potassium
Butternut Squash: A cup contains 352mg of potassium
Coconut Water: 1 cup of coconut water contains 600mg of potassium
Dates: Consuming 1 date contains 46.6mg of potassium.
Yogurt: a 170g container of non-fat Greek yogurt contains 239.7mg of potassium
Tuna: 100g tuna will give you 323mg of potassium
Cantaloupe: 1 cup of cantaloupe contains 427.2mg
Papaya: This fruit contains 264mg of potassium per cup
Dried apricots: 1,162mg of potassium per 100g
Mushrooms: 100g contains 318mg of potassium
Eggs: 1 boiled egg contains 63mg of potassium

~ Weekly Health Advice from PMGH – Potassium – Part 1 of 3 ~

Welcome to another health update from the Port Moresby General Hospital this week we are focusing on Potassium. Are you getting enough to meet daily requirements for optimal health?

What is Potassium?
Potassium is a very important mineral for the proper function of all cells, tissues, and organs in the human body. It is also an electrolyte, a substance that conducts electricity in the body, along with sodium, chloride, calcium, and magnesium. Potassium is crucial to heart function and plays a key role in skeletal and smooth muscle contraction, making it important for normal digestive and muscular function. Cardiovascular diseases (CVDs) are the leading cause of death globally according to World Health Organization (WHO) An estimated 17.5 million people died from CVDs in 2012, representing 31% of all deaths worldwide. High blood pressure (hypertension) is a major risk for CVDs, especially heart attack, and stroke. Evidence shows that increasing potassium intake significantly reduces blood pressure in adults. Dr. Gregg Fonarow, spokesman for the American Heart Association and professor of cardiology at the University of California, Los Angeles, added that “clinical trials have established that a diet high in potassium and low in sodium can significantly lower blood pressure.” Because high blood pressure is one of the major risk factors for heart disease and stroke, it follows that higher-potassium diets would be linked to lower risk of stroke and heart attacks, he said. “However, a higher potassium diet potentially has other mechanisms of benefit, including protecting blood vessels from oxidative damage and limiting thickening of the blood vessel wall,” Fonarow said. Increasing potassium in the diet while limiting sodium may help to reduce the risk of stroke and confer other cardiovascular benefits, he said. “Fruits such as bananas, cantaloupe, grapefruit, oranges, vegetables like tomatoes and low-fat dairy products are a good source of dietary potassium,” he said. One study also found that participants that took in 5,266 milligrams of potassium per day maintained an average of 3.6 more pounds of lean tissue mass than those with a potassium intake 50% lower. Some studies also show an increase in bone density with high potassium intake.

How Much Do You Need?
The National Health and Medical Research Council states that the adequate intake of potassium is:
0-6 months – 400mg/day
7-12 months – 700mg/day
1 – 3 years – 2,000mg/day
4 – 8 years – 2,300mg/day
9 – 13 years (boys – 3,000mg/day) / (girls 2,500mgs/day)
14 – 18 years (boys – 3,600mg/day / (Girls – 2,600mg/day)
19 + (Men 3,800mgs/day) / (Women 2,800mg/day)
Pregnancy – 2,800mg/day
Lactation – 3,200mg/day

Tip: the easiest way to meet the daily requirements for potassium is to eat a healthy well-balanced diet. If you feel you may not be meeting the daily requirements talk to your doctor.

We will be posting more useful information on potassium tomorrow. Please check back soon.