Integrated Wellness Services

I am a CHAS Card user. What are some subsidies that come along with being a card user?

The Community Health Assist Scheme (CHAS) enables Singapore Citizens from lower to middle-income households, and all Pioneers will be entitled to receive subsidies for medical and dental care at participating General Practitioners and dental clinics near their homes.

Singapore Citizens who qualify for CHAS will receive an individual blue or orange Health Assist Card, depending on the qualified subsidies tier of each household. Health Assist cardholders will also enjoy subsidised referrals to Specialist Outpatient Clinics (SOCs) located at Public Hospitals or National Dental Care (for dental referrals) when required. Patients are encouraged to check with their doctor or dentist on the likely fees that they will be charged prior to consultation as the treatment might vary according to each patient’s condition.

The amount paid will be based on the fees charged by the clinic, minus your CHAS subsidies. By using your Health Assist or Pioneer Generation card at a CHAS clinic, you are agreeing to allow your doctor/dentist to disclose your personal information to the Ministry of Health, including its authorised agents.

	CHAS Blue	CHAS Orange	CHAS for Pioneer Generation
Eligibility Criteria
Household monthly income per person (for households with income)	$1,100 and below	$1,101 to $1,800	All Pioneer receive CHAS benefits regardless of income or AV of home
Annual Value of home (for households without income)	$13,000 and below	$13,001 to $21,000
CHAS Subsidies
Common illnesses (eg cough and cold)	Up to $18.50 subsidy per visit	Not Applicable	Up to $28.50 subsidy per visit
Chronic conditions under Chronic Disease Management Programme (CDMP) (Simple / *Complex)	Up to $80 / $120 subsidy per visit, capped at $320 / $480 per year	Up to $50 / $75 subsidy per visit, capped at $200 / $300 per year	Up to $90 / $135 subsidy per visit, capped at $360 / $540 per year
Selected Dental Services	$11 to $256.50 subsidy per procedure (dependent on procedure)	$50 to $170.50 subsidy per procedure (for crown, dentures & root canal treatment only)	$21 to $266.50 subsidy per procedure (dependent on procedure)
Recommended Health Screening under Screen for Life (diabetes, high blood pressure, high blood cholesterol, colorectal cancer and cervical cancer)	A fixed fee of $2 with Screen for Life Invitation Letter, for recommended screening test(s) and first post-screening consultation, if required.		Free with Screen for Life Invitation Letter for recommended screening test(s) and first post-screening consultation, if required.

For patients with chronic conditions, CHAS complements the CDMP, which allows for Medisave to be used for outpatient treatment covered under CHAS. Patients can also tap on their Medisave to defray part of the cost of these treats besides enjoying CHAS subsidies for treatment of their chronic conditions.

Health Assist cardholders can also enjoy subsidised rates for healthcare services provided at specified Community Health Centres, which complement the clinical care offered by GPs for chronic conditions. CHC services include Diabetic Retinal Photography (DRP), Diabetic Foot Screening (DFS), nurse counselling, dietetics and physiotherapy.

Information taken from http://www.chas.sg.

My partner and I are preparing for marriage. What kind of health check-ups should we do to protect ourselves and our beloved?

Love is patient, love is kind. It always protects, always trusts, always hopes, always perseveres. Love never fails. With that being said, it is highly essential for couples preparing for marriage to know the importance of pre-martial health screening. Marriage requires a truck load of planning, from starting a family, to ushering in various stages of your partner’s life into your own with this union. Pre-martial health screening will guarantee couples from hereditary and infectious diseases, in order to build a happy, stable home without unexpected surprises.

Pre-martial health screening is not much different from the regular health screening, except that it has additional components that targets the detection of hereditary defects, fertility and other serious health complications. Many a times, individual may not be aware of their own genetic disorders or health complications especially so when it is dormant or does not show any symptoms to indicate. Henceforth, couples who go through this will be able to discuss and better prepare themselves should there by any unexpected results. If situations arise, they will be able to tackle them before tying the knot.

More than 10% of couples face the problem of infertility and without prior knowledge of this, the marriage can be strained and the stress that comes with this can build up. It is always better to allow ample time to know and contemplate what you are getting yourself into as marriage should be a lifelong commitment.

The health screening typically covers genetic disorders such as Thalassemia, and health implications like diabetes, Hepatitis A & B, endocrine profile, venereal profile and immunology. Marriage cannot be purely based on the love for one another and it should also constitute the actions taken to achieve it. A healthy marriage is one where there is a state of agreement and harmony between partners in terms of healthy, psychological, sexual, social and legislative aspects begetting healthy and happy children.

With proper pre-martial screening as part of the marriage planning, it can then limit the spread of genetic blood diseases, reduce financial burden that may come with unforeseen medical treatments, avoid social and psychological stress for families and increase the awareness of a comprehensive and healthy marriage.

For more information on pre-martial health screening, you may contact Integrated Wellness Pte Ltd at 6250 7623 or send an email to appointments@iwell.sg. Our friendly nurses and staff will be glad to assist you in your queries.

FAST: Your knowledge will save a life.

A stroke occurs when blood supply to part of the brain is interrupted, resulting in damage to the brain. Bodily functions that are normally controlled by the affected part of the brain will be implicated. A stroke is potentially life-threatening and early recognition of symptoms and timely medical attention is crucial.

There are two types of stroke: ischaemic and haemorrhagic. Ischaemic stroke is more common and occurs when there is a blockage caused by a blood clot in an artery supplying blood to a part of the brain. Haemorrhagic stroke occurs when an artery in the brain bursts and results in an intracerebral (parenchymal) haemorrhage, or less commonly, the artery bursts into the space surrounding the brain (subarachnoid haemorrhage).

With stroke being the leading cause of adult disability and third most common cause of death worldwide, it is essential to know the symptoms. Time is of the essence in treating a stroke, yet many stroke victims have worse outcome because they do not get help in time.

Patients have to be treated with clot-bursting drug within 4.5hours of experiencing ischaemic strokes which accounts for more than 85% of all strokes. The drug is able to open up blocked vessels and restores blood flow to the brain, to limit damage done to the brain from the lack of oxygen,

Another interventional treatment is the use of a mechanical thrombectomy to remove the clots that block large blood vessel. However, this is can only be used if it is applicable and has only a window of 6 to 8 hours.

Stroke victims will need to get to the hospital as soon as possible but many of them are unaware of the symptoms, therefore, they may opt to take self-prescribed measures such as a taking nap or Panadol to relieve the symptoms.

A good gauge to recognise the symptoms of stroke is to follow the F.A.S.T method.

(image taken from https://www.healthxchange.sg/stroke/essential-guide-stroke/stroke-act-fast)

There is a common misconception that you need to experience a combination of symptoms for it to be called stroke but stroke can happen such that there is slurring of speech, yet the limbs look fine.

A non-intrusive method to detect any build-up of cholesterol plaque in the blood vessel is through the screening using ultrasound carotid scan. This scan is highly recommended for people with high cholesterol and hypertension to prevent stroke and coronary diseases. The ultrasound image is shown instantaneously and practitioners will be able to tell if there is any risks involved at the point of the screening.

Prevention is the best protection. Have regular health screening with follow-up, good control of high blood pressure, high cholesterol and diabetes, have a healthy diet rich in fruits vegetables, whole grains and low in fats, exercise regularly and maintain a healthy weight.

Recognise the signs, remember F.A.S.T and you may save a life.

For more information on health screening and ultrasound carotid scan, you may contact Integrated Wellness Pte Ltd at 6250 7623 or send an email to appointments@iwell.sg. Our friendly nurses and staff will be glad to assist you in your queries.

What are some ways to ovecome my fear of needles?

There is nothing to be embarrassed about when it comes to having a phobia for needles. In fact, it affects up to 20% of the adult population to such an extent that it causes them to avoid much-needed medical care or health screening. The truth of the matter is that nobody likes having injections, but the hurt is a very important part of health care.

Your brain has conditioned your body to fear needles and some of these sensations felt during blood taking may not even pain. Various individuals describe the sensation as creepy to being a disabling sense of impending doom. Identifying this and understand where your phobia derives from can help you overcome the phobia and help yourself receive adequate health care.

Step 1: Change your thinking about injections. You can list down what you hate about injections in one column and counter your hate with something beneficial about injections in another column. For example, if you feel that “Injections are painful,” change that to “Injections are painful but it helps me to find out what is wrong with my body.” Work through your imagination that leads you to imagine a massive pain deriving from the injection. Doing this will allow your anxiety to rise and calm down after. Over time, as much as the fear still exists, you will better be able to overcome it.

Step 2: Learning relaxation and coping techniques. Take deep slow breaths while closing your eyes, holding on your breath for 4 seconds with each breath. This helps you to relax when you feel anxious during blood taking. Another way to cope with this is to request to lie down while keeping your legs elevated. The position ensures that you are in a relaxing position and it prevents you from feeling light headed during the procedure.

Step 3: Speak to a medical profession. You can take the effort to arrange an appointment where you can discuss your fear with a doctor or a nurse. As mentioned above, there is nothing embarrassing about having a phobia for needle. What is more important is to ensure you are getting the health care you require. By talking about it and even looking at the syringes without the injection will put you one more step closer to overcoming your fear.

For more information on health screening and blood taking, you may contact Integrated Wellness Pte Ltd at 6250 7623 or send an email to appointments@iwell.sg. Our friendly nurses and staff will be glad to assist you in your queries.

What is Hepatitis B and what are the side effects?

Hepatitis B is an infection of your liver caused by a noncytopathic virus called HBV which can cause scarring, liver failure and cancer. The virus does not directly cause damage to the liver; however, it results in the immune system reacting aggressively to the virus leading to inflammation and damage to the liver.

HBV is highly contagious and can spread when people come into contact with bodily fluids of someone who has the virus, blood or open sores. It does not spread through food or water, sharing eating utensils, breast-feeding, hugging, kissing, cough or sneezing. The virus can actually live outside the body for at least 7 days and still be potentially infectious.

In most cases, the disease does not last for a long time as the body fights it off within a few months, and your body will become immune for the rest of your life.

When infected, the warning signs include jaundice, light-coloured poop or dark urine, fever, fatigue that persists for weeks or months, joint and/or muscle pain, abdominal pain around the liver, nausea, loss of appetite or vomiting. If an acute HBV is not resolved within 6 months, it will become chronic and people who are contracted with chronic hepatitis B does not experience symptoms unless the liver becomes severely damaged.

The effects of these symptoms are not consistent with every individual. Some people with chronic hepatitis B experience occasional symptoms while others experience symptoms that becomes permanent.

If Hepatitis B is left untreated, it can leave to serious live damage such as liver cancer or cirrhosis. In addition to fatigue, there may be muscle weakness, bruising, poor appetite, nausea, weight loss, itchy skin, cola-coloured urine, grey-coloured stool, jaundice and fluid accumulation in the lower extremities.

Managing Common Symptoms

Symptoms of viral hepatitis, whether acute or chronic, should always be brought to the attention of a health care provider. Bed rest may be recommended during hepatitis B’s acute phase. If you have symptoms from cirrhosis, your health care provider will discuss a plan to manage these. Do not attempt to manage these symptoms on your own.

Appetite loss: Be sure to discuss this with your health care provider. If you are experiencing significant weight loss, you may be referred to a nutritionist or dietitian. Here are some tips to help with your appetite:

Eat small, frequent meals of nutritious, high-calorie foods such as peanut butter, nuts, avocados, protein shakes and smoothies.
Select a variety of foods. Vary the colour, temperature, texture and type of food you eat.
Try new foods or ones that you might not have liked in the past.
Experiment with seasonings and spices.
Choose foods that are high in calories and protein.
Add powdered milk or protein powder to regular milk, milkshakes, casseroles, soups, eggs, mashed potatoes, hot cereal and puddings.
Spread peanut butter or other nut butters on bread, tortillas, waffles, pancakes, fruit and celery.
Add cooked beans or hard-boiled eggs to soups, casseroles and pasta.
Try products designed to promote weight gain, such as nutritional supplements, canned formulas, protein powders, instant breakfast drinks, power bars and high-calorie puddings.

Fatigue: In the acute phase, bed rest and low physical exertion may be advised. In the chronic phase, your medical provider will likely rule out other medical conditions that may contribute to fatigue, such as depression, insomnia, pain, sleep apnea and thyroid problems. Here are some tips to help with fatigue:

Get enough sleep. The National Sleep Foundation recommends seven to nine hours of sleep per night for adults. If sleep is a problem, discuss this with your health care provider.
If you have chronic hep B with mild fatigue, light exercise is a good remedy. Pick an activity and do it for 10 to 15-minute intervals, two to three times daily. If you are not accustomed to physical activity, start with five-minute intervals and increase gradually. Sample activities include walking, biking, swimming, dancing, gardening, yoga and tai chi.
Vary your activities—do not sit or stand too long.
Drink plenty of water. According to the Institute of Medicine, men need about 13 cups (3 litres) of total beverages a day; women need about 9 cups (2.2 litres) daily. If you are drinking enough liquids, your urine will be pale yellow or colourless.
Reduce stress and find ways to relax.
Take short naps of 20 minutes or less. Don’t nap close to bedtime.
Use caffeine. Coffee and tea may give you a lift, plus coffee may protect the liver. Do not drink caffeinated drinks late in the day, as this may interfere with sleep.

Gastrointestinal complaints: Some people feel discomfort in the right upper part of the abdomen around the liver area. Always discuss pain with your medical provider, particularly when pain is constant, severe or interferes with your quality of life. Call your medical provider if you have severe or chronic stomach pain. Eat small, frequent meals, as stomach pain may be caused or worsened by hunger.If you feel nauseous, try to eat a small portion of food at regular intervals. Hunger can intensify nausea, so try eating a cracker or other small piece of food every hour or two. Ginger helps with mild to moderate nausea. Peppermint, chamomile or raspberry leaf tea may also alleviate nausea.

Muscle and joint aches are common symptoms of hepatitis B; pain is not. Both require medical evaluation. Research tells us that moderate exercise and staying active are the best way to manage physical discomfort. Other tips that may provide relief are:

Hot baths
Stretching
Massage, whether done by a friend, a professional or yourself
Avoid prolonged sitting or reclining.

(Section: Managing Common Symptoms is adopted from www.hepmag.com)

You do not wish to rely on symptoms to appear before deciding to check on your liver. You can now have a peace of mind after making sure you do not have the virus in your body by doing your annual health check-ups.

For more information on health screening and liver function tests, you may contact Integrated Wellness Pte Ltd at 6250 7623 or send an email to appointments@iwell.sg. Our friendly nurses and staff will be glad to assist you in your queries.

Why do you have to fast before blood taking?

It is the morning of your health screening that you have signed up for. You have been given a reminder to fast at least 8 hours prior to the blood taking. But your stomach is growling and without caffeine, you are feeling very cranky and irritable early in the morning. A thought comes to your mind: Perhaps consuming a slice of bread and a nice little cup of espresso will not cause much difference to the health screening results.

Unfortunately, even if you take only a piece of biscuit or a sip of tea, it will still affect your results. In fact, you are also supposed to fast from smoking, stop taking your regular vitamins and even exercise 8 hours prior to the health screening. These can rev up your digestion and the results will not be accurate. However, if you have prescription medications, do take them regardless of the fasting, unless your doctor has cleared you to skip it. This is especially so for participants diagnosed with high blood pressure and/or diabetics. Be reminded to inform the health screening staff that you have taken these medications so that they are aware should there be any anomaly in the results.

Not all blood test requires fasting. Below is a list of tests that you will strictly need to fast:

Blood glucose test
Cholesterol test
High density lipoprotein test (HDL)
Low density lipoprotein test (LDL)
Triglyceride level test
Gamma-glutamyl transferase (GGT)

Drinking water, from the tap or the bottle is completely fine. However, carbonated water, or a squeeze of lemon is off-limits. Having water during fasting actually helps your veins to become plumper and more visible, allowing the phlebotomists to locate the point of entry for the needle easily.

What if you forget and slip up? Do inform the health screening staff so that the results can be interpreted accurately. For the blood tests that require fasting, it is recommended to reschedule it as the results will be skewed and there is no point in getting pricked by the needle.

Not to worry, the moment you finish taking your blood, your fast is over. You may want to bring a snack or a drink to consume the moment you finish the health screening.