Better Health magazine

Associate Professor
Dr. Somsak Chaovisitsaree
Medical Director and Contributing Editor
Contents
Welcome to BETTER Health, the magazine for patients and friends of Bumrungrad
International Hospital. Our magazine’s main mission is to provide
useful and timely health-related information for our readers, in order to
promote better health.
We begin this issue with a look at osteoarthritis and its treatment options, with
a focus on arthroplasty. Arthroplasty is the latest innovation in osteoarthritis
technology, and it’s proving to meet patients’ higher expectations for successful
outcomes. We also explore the topic of preparing for a triathlon, an increasingly
popular sport for those who want to stay in great shape while also challenging
their minds and bodies. Additionally, we present you with useful facts about
shingles, a common malady affecting the elderly. We have also done our best to
pack the rest of the magazine with our usual columns with useful, interesting, and
timely information regarding your better health.
This issue’s special feature is an interview with a doctor on our medical team
who has performed congenital heart disease operations for over 700 children over
the past 13 years under the auspices of the Rak Jai Thai program. Last month,
Bumrungrad organized a special campaign, “Against All Odds,” to educate the
public about congenital heart disease and heart disorders in children, as well as
to encourage people to support the program and its important work. For more
information, please visit www.bumrungrad.com.
As always, please e-mail your comments and questions to betterhealth@
bumrungrad.com. We look forward to hearing from you. Here’s to wishing you
better health.
8 Special
Scoop
13 years of Rak Jai Thai
(Healing Hearts) program:
735 hearts healed
4Arthroplasty Technology:
When traditional surgery is not
enough for treating osteoarthritis
10 The Case
The critical hour
14 Sports Medicine
Triathlon? You can do it!
18 Staying Healthy
Protect yourself from shingles
20 M.D. Focus
Get to know our doctors
22 The Nutrition Experts
Diet choices to boost bone
and joint health
26 Health Briefs
28 Q & A
30 Bumrungrad News
Better Health magazine is published by Bumrungrad Hospital Public Company Limited and is produced for
Bumrungrad Hospital Public Company Limited by Native Media Limited, 10/162 The Trendy Buiding, 20fl., Room 2001C,
Soi Sukhumvit 13 (Saengchan), Khlongtoey-nua, Wattana, Bangkok 10110. Tel: +66 (0) 2168 7624 Fax: +66 (0) 2168 7625.
www.nativemedia.co.th
No part of this magazine may be reproduced without the written permission of Bumrungrad Hospital Public Company Limited.
2016 by Bumrungrad Hospital Public Company Limited. All rights reserved.
Publication of advertisements or sponsorships shall not constitute an endorsement by Bumrungrad Hospital
Public Company Limited of the products or services promoted, of the company or organization, nor of the claims made.
Contact Bumrungrad Hospital
Telephone: 66 (0) 2667 1000
Facsimile: 66 (0) 2667 2525
Out-patient
appointment: 66 (0) 2667 1555
Website: www.bumrungrad.com

+++++ Osteoarthritis and Joint Replacement
Arthroplasty
Technology:
When traditional surgery
is not enough for
treating osteoarthritis
For many elderly people, Osteoarthritis can be a debilitating
illness that makes everyday activities fraught with
anxiety, fear, and severe pain. Most commonly affecting the
hips and knees, Osteoarthritis can force patients to endure
constant pain with every movement.
The good news is that relief may be in sight. Highlighting the causes,
symptoms, and treatment of osteoarthritis, orthopedic surgeon
Sr. Gp. Capt. Dr. Chumroonkiet Leelasestaporn informs Better Health
readers about new hope for patients with this disease.
What causes osteoarthritis?
“Osteoarthritis is age-related joint deterioration,” says Sr. Gp. Capt.
Dr. Chumroonkiet. “After years of use, it’s inevitable that joints
wear out. As the population’s average age increases, we see more
affected patients. Symptoms of knee osteoarthritis can appear as
early as 45 to 50 years of age but is more common in patients 65 and
older. Hip osteoarthritis usually occurs later, at around 60 to 75.”
In addition to age, there are several other factors that can
accelerate osteoarthritis, including excessive weight, bone and
cartilage weakness, and muscle atrophy. Behavior-related causes,
such as squatting, sitting with legs folded to the side, sitting crossedlegged,
and kneeling exacerbate the condition.
Signs you might have osteoarthritis
Osteoarthritis develops slowly over decades, so most patients do
not feel symptoms in the early stages. “In knee osteoarthritis, the
joint pops or cracks whenever it’s in use, not just sporadically,”
says Sr. Gp. Capt. Dr. Chumroonkiet. “Often, infection in the knee
4

joint causes it to swell with fluid.
Doctors can drain the joint, which helps
relieve the pain, but does not cure the
osteoarthritis.”
Severe knee osteoarthritis deforms
the joint, causing it to bend. It hurts to
walk because the cartilage shock
absorber has worn out. The bones in the
joint then start to rub directly against
each other, which causes excruciating
pain for the patient.
In hip osteoarthritis, swelling of the
hip joint is not visible, but the pain
is very clear and present. Any simple
movement – like sitting down or getting
up – hurts. As the disease progresses,
patients lose agility, then their general
freedom of movement. They walk with
short steps to minimize the pain. Left
unattended, the degenerated hip joint
gets stuck making movement even more
painful and challenging.
2. X-rays must definitively show the necessity for
joint surgery. Although patients may feel acute pain,
if joint degeneration is not severe enough, doctors may
decline to operate.
3. The patient’s age is within the appropriate range.
Artificial joints have a useful life of about 10 to 20
years. Doctors are unlikely to perform joint replacement
surgery for patients under 50 years of age
because artificial joints would likely wear out
requiring more operations. However, some patients
like those with rheumatoid arthritis may need
surgery regardless of their age.
When joint replacement is necessary
Surgery for osteoarthritis can involve osteotomy
to correct deformities such as bow legs or knock knees
with no joint replacement.
There are several joint replacement surgical methods:
+ Conventional surgery: Its success relies on the
surgeon’s expertise and skill, but errors can impact
the artificial joint’s effectiveness and how long it lasts;
Treatment of osteoarthritis
No treatment currently exists that
restores worn out joints back to their
healthy condition. Instead, treatment
focuses on trying to slow deterioration,
while preserving patients’ existing knee
and hip joints for as long as possible.
Doctors commonly recommend corrective
actions to counteract behaviors
that led to the condition. Lowering one’s
weight, changing sitting positions,
frequent exercise of knee and hip
joint muscles, and promoting habits to
strengthen bones all help minimize
the disease’s progression.
For pain management, doctors
usually recommend:
+ Symptomatic drug treatment for
inflammation reduction, pain, and
muscle spasms;
+ Bone stimulants or medication that
suppress joint cartilage damage, such
as glucosamine sulfate, glucosamine
mixed with chondroitin, and diacerein.
Sr. Gp. Capt. Dr. Chumroonkiet notes
that for surgery, doctors must consider
the following indications:
1. Patients must have been treated with
non-surgical methods, but with no
success.
5

“ Today, patients have
increasing expectations
to not only get rid of
pain but also expect the
outcome to be as near
perfect as possible.”
Sr. Gp. Capt. Dr. Chumroonkiet Leelasestaporn
+ Minimally invasive surgery:
A procedure with less impact on
surrounding muscles, a smaller
incision, and a chance for faster
recovery in comparison to conventional
surgery.
+ Computer-assisted surgery (for
knee and hip joints): The computer
helps the surgeon place the artificial
joint in position with up to 94 percent
accuracy. Conventional surgery’s
accuracy rate is only 78 percent. This
method also promotes more precise
equilibration of the joint muscle
function.
+ MAKOplasty ® (robotic-arm assisted
surgery): For partial knee joint
replacement and artificial hip
replacement, this technology helps
doctors place the artificial joint
in the exact optimum position, with
less bone loss from resurfacing the
joint. Consequently, it’s more likely that
the artificial joint will last for the
patient’s life. Additionally, the small
incision enables a quick recovery.
Patient expectations are key
To choose the appropriate joint
replacement surgery method, apart
from assessing the patient’s condition,
doctors must also consider his or her
expectations. “Today, patients have
increasing expectations to not only
get rid of pain, bowlegs or just being
able to walk again, but also expect
the outcome to be as near perfect
as possible,” says Sr. Gp. Capt. Dr.
Chumroonkiet. “Those who played sport
expect to do so again. From a study, we
found that 20 percent of patients who
received joint replacement are not
satisfied with the surgery result due
to their high expectations.”
Doctors must strive to deliver surgical
results that meet patient expectations,
whether through a particular surgery
technique or choice of the most suitable
artificial joint. Doctors must also use
treatments that take into account
patients’ future needs. For example,
where the knee joint is not completely
degenerated, replacing only the affected
part of the joint might be the best
course of action. If the patient needs
a total joint replacement in the future,
the foundation is already in place.
Replacing the whole joint, when a
partial replacement is possible can
make future surgeries more difficult
and more expensive. “Joint replacement
is not just a solution for today,”
says Sr. Gp. Capt. Dr. Chumroonkiet.
“Successful artificial joint replacement
means not only a safe surgery but also
a procedure that helps patients regain
a high quality of life today and in the
future.
Bumrungrad’s Joint Replacement Center
The Joint Replacement Center at Bumrungrad International Hospital is a
JCI-certified medical center under the Clinical Care Program Certification
of Knee Replacement. This accreditation ensures that the center
provides joint replacement medical services with the same standards as
other leading world-class hospitals.
The Joint Replacement Center offers joint replacement surgery performed by
a team of physicians and medical specialists using the latest medical tools and
technologies. We emphasize providing world-class care at every stage of treatment,
from patient registration to post-procedure follow-up. Our commitment enables
us to help patients enjoy their lives again. After a safe procedure, we strive to
meet each patient’s post-surgery expectations, such as minimal post-operative
pain, the ability to return to most normal activities, and only using artificial joints
that last a lifetime.
6

+++++ Special Scoop
13 years of Rak Jai Thai
(healing hearts) program:
735 * hearts healed
“For most children, their world is home and school. My world
is the hospital; I have congenital heart disease. People with
this illness know how easily you get tired, but the person
even more tired than me is my mom.
“For as long as I can remember I’ve been in and out of hospitals.
My mom’s boss gets upset with her when she has to miss so
many days of work to take me to medical appointments and
treatments. When I was diagnosed with infective endocarditis,
it took so much time to care for me she had to quit her job.
“We don’t have much money so how can we afford my
treatment? But my mom never gives up; she fights to the
bitter end so I must fight too, as much as my body can stand.
The doctor said that if I didn’t get heart surgery,
I’d probably only live for two more years.
“But luckily, help came that saved me just in time.
Now my heart is stronger, and so is my mom’s.”
This excerpt is from a short film, “Hua Jai Tong Soo (Against All
Odds),” the true story of Sarayut Samrit, one of Rak Jai Thai’s
(Healing Hearts) young patients with congenital heart disease.
The program paid for his heart surgery, giving him a new life.
Dr. Preecha Laohakunakorn and Asst. Prof. Dr. Thamabovorn Neti
8
Each year, over 8,000 Thai children are diagnosed with
congenital heart disease. Nearly half of them need surgery
to prevent death or serious physical infirmity. Most come
from impoverished families, facing years on waiting lists at
public hospitals for the urgent surgical treatments they require.
To alleviate this suffering, Bumrungrad Hospital Foundation
and Bumrungrad International Hospital created Rak Jai Thai
in 2003 to provide free cardiac operations to underprivileged
Thai children. Better Health talks with pediatric cardiologist
Dr. Preecha Laohakunakorn, one of the doctors on the medical
team who has performed heart operations on over 700
children over the past 13 years.
Better Health: How did Rak Jai Thai get started?
Dr. Preecha: Only a handful of hospitals are capable of
performing the time-sensitive heart surgeries these young
patients need. Because of long waiting lists and limited resources,
many have to wait for years. By the time they get their turn,
the heart defects may progress to cause irreversible damage
to organ systems, especially the lungs render them inoperable.
Prof. Dr. Boonchob Pongpanich, President of the Cardiac
Children Foundation of Thailand under the Royal Patronage
of H.R.H. Princess Galyani Vadhana Krom Luang
Naradhiwas Rajanagarindra, rightly saw that our
hospital had the resources to give assistance to the
Foundation. Pediatric heart diseases require special
surgical skills and rehabilitation protocols. Prof.
Dr. Boonchob requested help from Bumrungrad’s
management team, led by Prof. Dr. Sin Anuras,
Medical Director, and Prof. Dr. Oradee Chandavasu,
Head of the Children’s (Pediatrics) Center. They agreed
to get involved, and that’s when Rak Jai Thai
was born. We have worked with the Cardiac Children
Foundation of Thailand ever since.
Better Health: How does Rak Jai Thai help the
Cardiac Children Foundation of Thailand?
Dr. Preecha: Apart from shortening operation wait
times, the program is particularly useful to newborns
that need urgent life-saving surgeries, which public
hospitals are often unable to deliver. Public hospitals
are always overwhelmed with a large number of
cases. Often they are unable to take in an unplanned
emergency case. Bumrungrad can perform these
*Data as of 10 June 2016

high-stakes operations immediately,
which increases children’s chance of
survival.
We’re delighted that several private
hospitals contribute their services to
the Cardiac Children Foundation of
Thailand to help ensure that patients
get their heart operations as soon as
needed. Now, the number of children
waiting for operations has plunged
dramatically from tens of thousands
to only a few thousand. Bumrungrad’s
medical team, including Assoc. Prof.
Dr. Samphant Ponvilawan, cardiothoracic
surgeon; Asst. Prof. Dr. Thamabovorn
Neti, anesthesiologist; and myself have
performed over 700 Rak Jai Thai
operations to date.
Better Health: How do you select
children for the program?
Dr. Preecha: The Cardiac Children
Foundation of Thailand receives a
list of candidates along with contact
information, and then sends prioritized
cases to hospitals. In emergency cases
such as a newborn that needs immediate
surgery, the public admitting hospital
may contact Bumrungrad directly. Our
program coordinator, Ms. Amornrath
Asavahem, will then coordinate with
the Cardiac Children Foundation for
procedural issues so that the case can
be transferred to us as soon as possible.
Rak Jai Thai covers all expenses,
not just the cost of treatment but also
accommodation and a stipend for
parents or guardians who take time off
from work to care for their children.
Even the most impoverished family
receives Bumrungrad’s start-to-finish
world-class cardiac surgery treatment.
Better Health: How many children
receive Rak Jai Thai-sponsored heart
surgeries annually?
Assoc. Prof. Dr. Samphant Ponvilawan
Dr. Preecha: The number ranges
from 40 to 80 children, depending
on demand and the types of cases.
Complicated surgeries require as much
as three million baht, but the average
cost is approximately 650,000 baht.
Better Health: What are the most
prevalent pediatric heart diseases
you treat?
Dr. Preecha: We see a wide variety
of heart defects, from a very simple
case like a hole in the heart wall to a
very complex one that involves multiple
defects of various parts of the heart.
There are cases which are hard to
treat, but if there’s even a slim chance
of survival, we do our best no matter
the challenge. We utilize all kinds of
advanced technologies including the
most extreme life support machine,
ECMO to ensure the best outcomes.
These technologies are costly, but we
provide the best treatment, regardless
of cost. All children deserve equal
access to the best treatment available.
“ Even the most impoverished
family receives
Bumrungrad’s startto-finish
world-class
cardiac surgery
treatment.”
Dr. Preecha Laohakunakorn
Better Health: What does the future
hold for Rak Jai Thai?
Dr. Preecha: Many underprivileged
children still wait for their operations,
but as long as the Cardiac Children
Foundation of Thailand continues to
support the program we will continue
to provide treatment. Children are
Thailand’s most valuable resource.
Rak Jai Thai wants to give every child
the opportunity to overcome health
challenges and become contributing
members of society. Their good health
helps to ensure our country’s future
success.
Life is the ultimate gift. Will you give new life to underprivileged children with your
contribution to Rak Jai Thai? Make your check payable to Bumrungrad Hospital Foundation
or donate by money transfer to Saving A/C No: 197-0-111157, Bangkok Bank PCL,
Nana Nuea Branch. Fax transfer confirmation to 0 2667 2031. For more information,
please call 0 2667 1398.
9

+++++ The Case
The critical hour
Minimizing the long-term effects of stroke
requires fast action, an important lesson the
Thanaratsuthikul family learned during the
most critical moments of their mother’s stroke.
Better Health chats with Prapai Kittipatwong, a stroke patient
at Bumrungrad Hospital, and her daughter Oranuch
“Bee” Thanaratsuthikul, as they share their experience of
facing the disease commonly known as “the silent killer.”
“Everything seemed normal that day,” 65-year-old Prapai recalls
the events of 19 January 2016. “I got up and did chores around
the house. But in the afternoon I started feeling dizzy like never
before. I felt so unsteady that I couldn’t stand without holding
onto furniture for support. I called my daughter, telling her about
my extreme dizziness and that I was unable to lift my right arm.
I felt drained of energy. I was terrified, and I had no idea what was
causing this.”
Bee suspected that her mother may have had a stroke. “She
sounded strange, tongue-tied,” she says. “I remembered an article
I read about cerebrovascular disease.
I suspected it could be a stroke, but
naively thought I could finish my errands,
then go home to see my mom. I called
my friend who works at Bumrungrad
to get her advice. She told me to drop
everything and call an ambulance
immediately.”
Twenty minutes later Bee arrived
home at the same time Bumrungrad’s
ambulance pulled up. Seeing her mom
so weakened filled Bee with fear. Prapai
could not stand up without assistance,
and one corner of her mouth drooped.
The attending emergency doctor
confirmed it looked like she’d had
a stroke.
On the ambulance ride to the
hospital, Prapai worried the stroke
would paralyze her. Bee adds, “We were
so lucky traffic was light. As I drove
to the hospital, Dr. Roekchai called to
update me on my mother’s condition.
The whole process, from picking her
up to taking her to the hospital and
diagnosing her took only 45 minutes.”
The initial crisis was over
Prapai says the diagnosis was quick.
The CT scan revealed there was no
bleeding in the brain, but there was
thrombosis from a blood clot. She needed
an injection of medication that would
dissolve the blockage, and improve her
condition. With the doctor’s explanation,
Bee gave her consent for the injection.
After a night of close monitoring in the
Intensive Care Unit (ICU), Prapai woke
up the next morning to find that she
was once again able to partially lift her
right arm. Even more function returned
the next day, bringing with it a sense of
relief. Prapai recalls, “I was so relieved
there was no permanent paralysis. I no
longer feared I would be a bed-ridden
burden to my daughter who has so many
other responsibilities in her life.”
The doctor kept Prapai hospitalized
for four days, during which she
started physical therapy (PT). After
10

discharge, she continued PT treatments
at the hospital and home.
Stronger but still on alert
“I feel much better now, just a little
stiff sometimes,” says Prapai. “I can
even do yoga again, after having quit
for so many years. And I’m taking much
better care of myself. I have diabetes,
hyperlipidemia, and hypertension,
but would sometimes skip taking my
medications. Now I take them regularly
and make an effort to cut down on
sugar. No more carelessness! I never
thought I’d endure such a health crisis
because I was very strong before the
stroke happened,” says Prapai.
Bee summarized the fortuitous
conditions that helped Prapai survive
and recover from her stroke: her
immediate call to Bee, light traffic
conditions that allowed the emergency
medical team to reach her quickly,
and the hospital’s expert medical team
that treated her. “I am so grateful to
my mother’s doctors and the other
healthcare providers for their tremendous
response,” says Bee.
“ I think they made
the right decision.”
Dr. Roekchai Tulyapronchote,
a specialist in neurology and
cerebrovascular disease, believes
that the success of Prapai’s stroke
treatment began with the patient’s
and family’s decisive actions.
What was Prapai’s condition when
she arrived at the hospital?
She was conscious but inarticulate, and
with weakness in her limbs on one side.
What are Bumrungrad hospital’s
diagnosis and treatment processes
for strokes?
Our Neuroscience Center follows
international standards in delivering
treatment for patients with cerebrovascular
disease. We have three consecutive
JCI (Joint Commission International)
accreditations for exemplary stroke
treatment and prevention practices.
When a patient arrives at the emergency
room with possible stroke symptoms
we activate the stroke code to notify
our cerebrovascular disease team to
prepare for urgent action. Our specialists
include neurologists, radiologists, laboratory
technicians, and nurses.
We consider the patient’s medical
history, and do a neurological exam
and CT scan to exclude intracerebral
hemorrhage. Using the National Institute
of Health Stroke Scale that measures
stroke severity, we found Prapai suffered
an ischemic stroke with acute cerebral
ischemia. Standard treatment is intravenous
thrombolytic drugs such as
tissue plasminogen activators (t-PA)
within four and a half hours after stroke
symptoms start. They’re highly effective
if given in time, reducing disability
risk by 30 percent. I walked Bee through
our diagnosis of her mother’s condition,
which showed she met the thrombolytic
drug criteria. But there’s a six percent
risk of hemorrhage and three percent
chance of death, so I needed the family’s
consent. Bee agreed that Prapai should
get the medication.
Prapai stayed in the ICU to monitor
her response to t-PA, with the nursing
staff on alert for complications.
Everything went well. We also wanted
to determine what caused the stroke,
enabling us to tailor her aftercare to
prevent another one.
Know the emergency plan for strokes
Time is literally of the essence with
strokes. If you see these signs of
cerebrovascular disease: numbness,
weakness in limbs on one side, incoherence,
inability to speak or understand
words, double vision, dizziness,
headache, swag, or instability, you need
to get help immediately. Symptoms can
suddenly appear all at once.
Get to the nearest hospital that
can treat cerebrovascular disease.
There’s no time to waste transferring
from one hospital to another. But we
must also keep in mind that quick
treatment alone can’t guarantee a
successful recovery. Many factors
come into play with intracerebral
hemorrhage or massive thrombosis.
The good news is experienced doctors
can help patients protect and develop
their remaining strengths.
How would delays in treatment
have affected Prapai?
She could have permanently lost the
ability to use the right side of her body.
Prapai’s successful recovery proves
she and her family took the right actions
and made the right decisions.
12

+++++ Sports Medicine
Triathlon?
You can do it!
When it comes to physical conditioning,
jogging and push-ups are all well and
fine – but the real challenge is in pushing
one’s abilities further than they thought
they could, and a Triathlon can be just the ticket. The word
“triathlon” originates in Greek, meaning three sports.
Triathlons require a rigorous physical and mental
preparedness to ensure safety and fun. In this issue of
Better Health, we’ve gathered the information you’ll need
to put yourself on the track to a successful triathlon.
Swimming, cycling and running:
The ironman regimen
Sometimes referred to as the sport of ironmen, the
triathlon takes many forms depending on the endurance
sports featured. The most popular lineup starts with
swimming, followed by a bicycle portion, finishing with
a race. Distances and cut-off times vary according to the
course’s geographical profile and organizers’ priorities.
Orthopedic Dr. Winyou Ratanachai has high
praise for this sport, saying “triathlon fascinates me,
not only for its ability to test a person’s physical and
mental strength but also because it’s one of a few sports
that equally tests all competitors.” Dr. Winyou adds,
“Whether a newbie or world-class athlete, all must
rise to meet the incredible challenge. Moreover, all
competitors who take up the challenge accept each
other as a fellow athlete.”
Taking part in a triathlon offers
significant health advantages including
cardiovascular strength, sturdy bones
and muscles, and a strong, focused
mind that pushes the body to persevere.
Indeed, the sense of accomplishment
that comes with crossing the finish
line pays big dividends in both mental
and physical health.
Train with dedication and
common sense
Although it requires concerted
dedication and regular exercise, the
triathlon isn’t just for Olympic gods.
Amateur triathlon athletes can take part
in a moderate training program, one
that is suited to their fitness levels. As
the saying goes, everybody must start
somewhere, and then set a clear path
to achieving your goals for success.
It’s also important to remember that
every triathlon athlete isn’t a master
of all three sports. In fact, Dr. Winyou
advises to “use the sport your most
comfortable with as your anchor to
compensate for weakness in the other
two events.” Dr. Winyou continues,
14

“ Physical preparation is
the best way to guard
against injuries.”
Dr. Winyou Ratanachai
“for example, use the cycling portion
to make up for slower running or
swimming times. And if you’re about
the same in all three (swimming 750
meters, cycling 20 kilometers and
running 5 kilometers) tailor training
to improve your scores in each event.
The amount of training depends on
each athlete’s physical condition.”
Athletes who already participate in
single competitions or train regularly
will need two to three weeks to prepare.
Those with no competitive event training
might need six weeks or more to get
in shape for a short-distance race.
To start, clock your performance in each
triathlon event. If you can comfortably
run one kilometer in nine to 10 minutes,
then you’re well on your way. And if
you’re not sure you have adequate
physical strength, get an exercise stress
test (EST) before starting a rigorous
training program.
Consider your current condition
when it’s time to pick appropriate
events. Before participating in timed
events, determine if you’re currently in
good enough shape. Dr. Winyou advises
these criteria for a short-distance
triathlon, or “sprint” competition: the
ability to swim continually for 100
meters within three minutes, cycle
23 kilometers in an hour and run one
kilometer in eight to nine minutes.
but that doesn’t mean that injuries
never happen. It’s important to note
that the majority of triathlon-related
injuries are a result of inadequate
training. Watch out for running injuries
to muscles, tendons and ligaments such
as patellar tendinitis. This knee injury
happens when weak thigh muscles and
ligaments cannot withstand the pull
force exerted on them.
Another ailment is iliotibial band
(ITB) syndrome. Pain starts underneath
the kneecap, radiating at 45 degrees.
Those with tight ITB muscles or who
have never done much running are
prone to this condition. Consistent
stretching to warm up the ITB muscle
helps to avoid this problem.
“Physical preparation is the best
way to guard against injuries,” says
Dr. Winyou. “Training ensures athletes
condition their muscles in the most
beneficial manner to make them able
Types of triathlon races
Period
Swimming
(meters)
to handle the task. When training causes
aches and pains, that’s your body telling
you your physical performance is
ascending to a higher level. Gradually
intensify training to the point where you
almost sustain an injury. After pushing
your body to its limit, it can repair
itself and adapt to increasing stress.
Sufficient rest combined with consistent
training leads to steady improvement.”
However, triathlon athletes must
carefully monitor their bodies. “If you
feel you’ve pushed too hard, stop
immediately,” Dr. Winyou says. “Slow
down. Triathlon requires endurance
more than speed.”
This elusive sport can seem like
it’s better suited to super athletes, but
there’s really no reason that normal
people can’t also join those ranks and
cross the finish line. The key is to train
properly to ensure a sound body and
mind to take on the challenge.
Cycling
(kilometers)
Running
(kilometers)
Team relay 250 to 300 5 to 8 1.5 to 2
Super sprint distance 250 to 500 6.5 to 13 1.7 to 3.5
Sprint distance 750 20 5
Standard distance
(Olympic distance)
1,500 40 10
Middle distance 1,900 to 3,000 80 to 90 20 to 21
Injuries and their prevention
Compared to other contact sports,
triathlon general has fewer injuries;
Long distance
+ Half ironman (ironman 70.3)
+ Ironman
1,000 to 4,000
1,900
3,800
100 to 200
90
180
10.0-42.2
21
42
16
Source: Triathlon Association of Thailand

+++++ Staying Healthy
Protect yourself from
Shingles
According to latest data provided by the Bureau of
Epidemiology, Ministry of Public Health, the incidence
of shingles in Thailand has increased over the past
10 years. People over 65 years are most likely to contract
shingles, but older patients can manage the risk of contracting
this disease and can reduce its severity if it does occur.
Data from the Department of Preventative and Social Medicine
at Siriraj Hospital rates shingles as one of the three most easily
contracted infectious diseases, along with colds and pneumonia.
These three ailments are the most frequent causes of death due to
infection among people over 60 years old. People in this age group
comprise 20 to 30 percent of Thailand’s overall population; the risk
increases to 50 percent in those who are 85 years old and older.
It’s clear that this painful, tormenting disease is even more
dangerous and prevalent than you might think.
Knowing Shingles
Dr. Lily Chaisompong, who specializes in geriatric medicine,
explains that the same virus that causes chickenpox also causes
shingles. When a person recovers from chickenpox, the virus remains
dormant in nerve ganglia tissue. When it detects weakness in the
body’s immune system, the virus can reactivate and attack tissue.
“When a person’s immune system weakens – whether due to
aging, immune-chronic diseases or diseases requiring immunosuppressive
medication – the chance of getting shingles
increases,” says Dr. Lily.
Shingles symptoms are different and potentially more
disabling than those of chickenpox, which produces small red
blisters all over the body. In shingles, similar red blisters appear,
18

“ When a person’s immune
system weakens — whether
due to aging, chronic
diseases or diseases
requiring immunosuppressive
medication — the
chance of getting shingles
increases.”
Dr. Lily Chaisompong
but only on the area of the skin which that
nerve supplies. The disease begins with
red spots, which develop into blisters
that scab over. They often appear on the
waist, back, and face. If it spreads to the
eyes it can cause blindness.
Burning Pain
Besides rashes and spots on the skin,
shingles can cause severe neuropathic
pain, characterized by burning sensations
along the same area of the skin
of the affected nerve. Some sufferers
describe shooting, inflammatory pain
like an electric shock.
“Some elderly feel severe pain at the
red spots; others may feel pain even
without any spots yet,” says Dr. Lily.
“The more spots, the more painful it is;
even the touch of soft, thin clothes is too
much for some patients. Some elderly
are unable to sleep because they find it
impossible to find a comfortable position.
This disease can be quite a torment.”
Some patients also suffer related
complications, such as superimposed
bacterial skin infection. Another debilitating
symptom is nerve pain called
“postherpetic neuralgia.” In this
condition found in 70 to 80 percent
of shingles patients over 50 years of
age*, they experience pain even after
the skin sores have healed. This pain
may last for months or years through
to the end of life.
“The nerve pain can happen to
anybody, but it’s found mostly in the
elderly because they’re the group
with the highest rate of shingles,” says
Dr. Lily. “This considerable pain
severely degrades patients’ quality of
life; they can never get comfortable.
Some must take strong soporific
painkillers that cause drowsiness.
These drugs increase the risk for
falls and the myriad health problems
that ensue from those injuries.”
Treatment and Prevention
In patients with mild cases and no
complications who receive adequate
symptomatic treatment shingles may
last only about a week. Regardless, don’t
ignore shingles. Seek help from a doctor
immediately because fast access
to antiviral agents can reduce the
outbreak’s severity.
“Many elderly patients do not know
they have shingles, assuming instead
that their symptoms are from allergies
or insect bites,” Dr. Lily says. “If they put
off seeing a doctor right away, symptoms
can go to a severe stage. Family members
and caretakers must be on the lookout
for shingles symptoms like skin spots
or rashes accompanied by pain.”
Because shingles treatment cannot
prevent 100 percent of complications,
doctors stress the importance of prevention
by getting the shingles
vaccine. Available in Thailand, it has
reduced shingles incidence by up to
51.3 percent in patients between
60 and 70 years of age*.
Patients 60 years or older should get
the vaccination, but those with chronic
diseases or other conditions that weaken
the immunity may get the vaccination
sooner. One dose of vaccine provides
protection from shingles for about 10
years from the day of vaccination.
“Getting a shingles vaccination does
not mean that you can completely avoid
it, but it helps to reduce by over half the
chance getting the disease as well as
reducing its severity,” Dr. Lily says.
Well Elderly Vaccine
Program, a great
option for Elder Health
Because prevention is better
than cure, the New Life Healthy
Aging Clinic at Bumrungrad
International Hospital encourages
our older patients to enroll in the
Well Elderly Vaccine Program.
This comprehensive vaccine
regimen designed for aged patients
targets preventable infectious
diseases. Vaccinations include:
+ Shingles (Herpes Zoster)
Vaccination
We recommended that persons
60 years and older receive the
shingles vaccination.
+ Tetanus Vaccination
It’s good to get a tetanus
vaccination every 10 years.
+ Influenza Vaccination
(Flu Vaccination)
Get the yearly influenza
vaccination during the rainy
season through the winter.
+ Pneumococcal Vaccination
We recommend two pneumococcal
vaccinations, starting
with the conjugate vaccine for
13 different serotypes, and the
polysaccharide vaccine for
another 23 serotypes.
We advise older patients to
consult with our experienced
medical team at New Life Healthy
Aging Clinic to get information and
appropriate recommendations
for these vaccinations.
For more information,
please contact +66 (0) 2667 2000.
* Department of Preventive and Social Medicine,
Faculty of Medicine, Siriraj Hospital, Mahidol University 19

+++++ M.D. Focus
Get to know our doctors
Providing the highest standard of patient care requires a
hospital-wide commitment and professional expertise. Here are
four of Bumrungrad’s outstanding and internationally-accredited
physicians with advanced training in their sub-specialties
sharing their thoughts on a range of healthcare topics.
Dr. Sira Sooparb
Specializing in Nephrology
(Kidney medicine)
Dr. Sira graduated with honors from
the Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, before
continuing his specialty studies in
Nephrology at St. John’s Episcopal
Hospital and Emory University Hospital
in the USA. He joined Bumrungrad
in 2001.
What is your most memorable
medical-related experience?
Two come to mind. About 10 years
ago I was taking care of a terminalstage
cancer patient in his 70s. He
desperately wanted to go home to see
his grandchildren. We took him there
by 0 ambulance with the nurse. I had to
keep pressing his handheld ventilator
the whole time. His young grandchildren
gathered around him, but because there
was no medical equipment we could
only stay for 15 minutes. The little ones
cried when we left, but the visit delighted
the patient and at that moment I realized
20
how impactful being a doctor can be.
The second was during the aftermath
of the 2004 tsunami. Rescue authorities
delivered many patients to Bumrungrad.
Some large families of 10 or so people
ended up with only one surviving
member; it was such a tragedy. However,
the hospital staff’s cooperative attitude
impressed me as all departments mobilized
to provide patients with excellent
care. That made a vivid impression that
has stayed with me even to this day.
What is it like working at
Bumrungrad?
Bumrungrad is a hospital of high
capability and readiness, thanks to the
skill and dedication of my colleagues.
Working with talented doctors in many
fields has increased my knowledge.
Additionally, Bumrungrad offers an
opportunity to use new technologies
for treating patients and encourages
physicians to conduct medical research.
I do original research on toxic substances
in Thailand, which has helped us discover
that there are high levels of toxins in
Thai patients. This research will be
published soon, and our hope is that
discovering the cause may help increase
treatment options
What is your work philosophy?
Enjoy what you do and don’t get
stressed; life is too short. And, you must
always listen to your conscience – that
sense of shame and fear of doing
something immoral. This fundamental
principle enables us to live peacefully
within society.
Assist. Prof. Dr. Phanida Dusitanond
Specializing in Pediatric Nephrology
After graduating from the Faculty of
Medicine, Siriraj Hospital, Assist. Prof.
Dr. Phanida studied in the USA and the UK
for 11 years before returning to teach at
Siriraj Hospital. Having passed the exams
for both the American Board of Pediatrics
and Membership of the Royal Colleges
of Physicians of the United Kingdom,
Dr. Phanida received diplomas in Pediatrics
from both institutes and she is
currently the head of the Children’s Center
at Bumrungrad International Hospital.
Why did you choose to join
Bumrungrad?
I have worked with Bumrungrad for
more than 10 years. I decided to join
because I found the work challenging.
Bumrungrad has many foreign patients
and some of them come with highly complicated
medical conditions. Therefore, it’s
an excellent opportunity to put into practice
experiences from my studies abroad.
What sparked your interest in
Pediatrics?
Following and observing children’s
development from birth to adulthood is
very rewarding for me. The doctor-patient
dynamic does not end at diagnosis and
treatment but rather develops into a long
relationship. I have many pediatric patients
that I have taken care of from birth through
graduation, marriage, and having children
of their own. They even bring their children
to be under my care. Some study abroad
and when they’ve gotten sick, they call me
long distance for consultation. Many of my
patients just stop by to ask how I’m doing.
It’s such a delight that they still think of me.
What principle guides your work?
Patients are not customers to be
exploited. Taking care of children must
also emphasize including parents in the
process. I must be sincere with them, tell
them the truth, the pros and cons of
treatment. Through our sincerity we earn
their recognition and trust, which leads
to successful treatments.

Assist. Prof. Dr. Varaphon Vongthavaravat
Specializing in Endocrinology
(Diabetes), and Metabolism
Assist. Prof. Dr. Varaphon, head of
the Endocrinology Unit, Bumrungrad
International Hospital, graduated from
the Faculty of Medicine, Chulalongkorn
University. He studied endocrinology, diabetes,
and metabolism at the University
of California, Davis School of Medicine
before returning to become a lecturer
at Chulalongkorn University. Although
a full-time doctor at Bumrungrad since
2005, Dr. Varaphon still finds time to
be a special instructor.
What does an endocrinologist do?
Treating diabetes takes up 60 percent
of my practice. Thyroid conditions take
up 20 percent, and the remainder
concerns patients with pituitary and
adrenal gland problems such as altitude
sickness, obesity, osteopenia, and osteoporosis.
Most are chronic patients who
need comprehensive and ongoing care.
My elderly patients, some of whom are in
their 90s, often face multiple conditions
with interrelated complications. For
example, patients with diabetes
commonly exhibit obesity, hypertension
or hyperlipidemia, while others have
hidden heart or brain diseases, which
we find only after compiling the complete
clinical information and diagnoses.
Frequently, because of our continual
follow-up, patients have found intestine,
lung, and breast tumors that might
have otherwise gone undiagnosed.
What is it like working at
Bumrungrad?
We work as a team comprised of
physicians and nurses specialized in
diabetes, as well as nutritionists, pharmacists,
and physiotherapists who all
take part in the caregiving. Bumrungrad
has provided this extensive care for
a long time now. The Joint Commission
International in the USA has accredited
our center with its Clinical Care Program
Certification in the treatment of diabetes
for the third time in a row (performed
every three years). Without Bumrungrad’s
excellent team, we would not have
achieved this positive assessment.
What is your guiding work
principle?
The medical profession deals with
human life at its most fragile state, so it
requires the utmost prudence. Our guiding
principle is to treat our patients as if they
were our relatives. Furthermore, we must
always seek new knowledge because treatments
and methods get outdated so fast
these days. Finally, we must have an open
mind to listen to our patients; otherwise,
we can’t perform our best for them.
Assist. Prof. Dr. Youwanush Kongdan
Specializing in Surgical Oncology
When medical professionals speak
of specialists treating breast cancer,
they often mention Assist. Prof. Dr.
Youwanush Kongdan. In addition
to treating breast cancer patients at
Bumrungrad, Dr. Youwanush is also a
teacher at the Division of Breast and
Endocrine Surgery, Faculty of Medicine,
Ramathibodi Hospital, Mahidol University,
which has developed many successful
treatments and produced many skilled
doctors.
What is it like being a breastcancer
surgeon?
Surgical treatment for patients with
cancer is different from other diseases.
When patients find out they have cancer,
they feel devastated as all their life plans
collapse. They feel sad and depressed.
Physicians must be able to communicate
compassionately with them at this
terrible time. I tell many patients that
even in misfortune, some luck can be
found. It is bad to have cancer, but to
have breast cancer is better than in
other places because current treatment
methods have improved substantially.
How have treatment methods
changed?
Formerly, when breast cancer was
detected, women had their breast
surgically removed. A patient once told
me that after her mastectomy, her
husband became distant because he
felt as if she were defective. That was a
turning point for me. I knew I had to do
something to make a difference. I went
to Italy (renowned for its advanced
breast surgery technology) for a workshop
in breast-conserving surgery. When
breast conservation is not possible, we
try for breast reconstruction. Our goal
is to provide patients with a better
quality of life.
What is your work philosophy?
Practice professional integrity. With
breast cancer, if we can keep the breast,
it must be kept. If that’s not possible
and I must perform a mastectomy, I ask
patients whether they want us to rebuild
the breast area. We will not suggest a
mastectomy and replace it with implants
right away because such major surgery
is now unnecessary as less invasive
treatments give similar results. Second,
to provide effective treatment, we must
keep in mind the patient’s desired outcome
and plan treatment accordingly.
Finally, I believe in team building; I
share knowledge and techniques with
the support team as well as other
physicians to enhance patient care.
21

+++++ The Nutrition Experts
Diet choices to boost
bone and joint health
Bone and joint pain are often present in the lives of the
elderly, but such problems can’t always be avoided.
Instead, it’s better to strengthen one’s joint and bone
health while still young. Medical experts recommend
individuals in their 30s accumulate as much bone mass as possible
and then minimize loss after that.
Many people have already passed the optimum age for
maximum bone mass accumulation. But there’s still time to
make positive progress towards bone and joint health. Experts
recommend regular weight-bearing exercises, such as walking
or jogging, and eating foods that contain the necessary
levels of calcium and vitamin D.
Diet is the best way to make up for bone loss. However,
daily allowances of required calcium and vitamin D
vary among age groups. Calcium-rich foods include milk,
yogurt, cheese, crispy fried small fish, dried shrimp,
Chinese broccoli, noni leaf, agasta (sesbania grandiflora),
soybean curd (firm tofu), red beans, and black sesame
seeds. In order to get your recommended amount of
vitamin D, in addition to sunlight exposure, make these
foods are part of your diet: vitamin D-fortified milk, fish oil,
egg yolk, and ocean-caught fish.
Bone and joint problems substantially degrade one’s
quality of life, so strengthening and promoting bone
and joint health is a necessity. With good bone and
joint health, you can live happily at any age.
Recommended daily allowance of calcium and
vitamin D for Thai people
Age group
(year)
Calcium
(mg/day)
Vitamin D
(IU/day)
1 to 3 500 200
4 to 8 800 200
9 to 18 1,000 200
19 to 50 800 200
51 and older 1,000 400
Source: Bureau of Nutrition, Department of Health,
Ministry of Public Health
Guidelines for choosing the most effective
and safest calcium supplements
We need different amounts of calcium, depending on age,
health status, and physical condition. Follow these
guidelines to best promote your bone and joint health.
+ First, consult your doctor to find out if you need to
supplement your calcium intake apart from daily meals.
+ Select calcium supplements with sufficient elemental calcium
in the appropriate format and amount from a variety of
available products:
- Choose the right delivery format, whether tablet, capsule
or effervescent tablet (for those who have difficulty
swallowing pills).
- Choose the adequate and appropriate amount of calcium.
There are a variety of supplements that provide different
types of calcium: calcium carbonate, calcium citrate, calcium
gluconate, calcium lactate, etc. Each type of calcium salt
contains different amounts of calcium and different rates
of absorption. Ask your doctor or pharmacist about the best
strength and format for you.
- Vitamin D helps the body absorb and balance calcium,
which is vital for muscle function. When calcium levels are
too low, taking vitamin D activates and stimulates calcium
absorption from food or bone resorption.
+ Be cautious because
- Calcium supplements may interfere with absorption
of some medicines when taken together or
within two hours of each other, such as antibiotics,
mineral products, antihypertensive agents, etc.
- Calcium supplements may cause gastrointestinal
issues such as gas and difficulty in excretion. Patients
should take calcium with high-fiber vegetables and
fruits as well as drinking plenty of water.
Taking too much calcium or in an inappropriate
format can harm the body. Before purchasing any
supplement consult with your doctor or pharmacist
and strictly follow their guidelines.
22

Advertorial
Obesity:
A troubling indicator
of Thai quality of life
Today’s frenetic pace negatively
impacts Thais’ quality of life
in many ways. One of the most
alarming symptoms of modern
living is the growing number of obese
people. From 2008 to 2012 obesity
in working people, aged 20 to 29,
increased an average of 36 percent
in men and 47 percent in women.
Today’s trending treatments for
obesity include surgery, liposuction
and extreme weight loss, but these
methods are only temporary solutions
to reducing obesity. Safe and effective
long-term treatments for obesity require
insight into the causes as well as
controlling the body’s metabolism.
“More than half of the patients we
see are obese and want to lose weight,”
says Dr. Somboon Roongphornchai,
a specialist in anti-aging medicine,
obstetrics and sports medicine for
health and weight loss, from Vitallife
Wellness Center. “The number has
tripled during the past few years while
patients’ mean ages decrease.”
Most of the Center’s patients are
dissatisfied with their figures, their
inability to adhere to physical fitness
regimens and everyday mobility. “We
consider all factors when analyzing
causes and finding the best solutions
for our patients,” says Dr. Somboon.
“We develop individual weight loss
programs for each patient to treat their
immediate obesity problems and put
them on a long-term healthy course.”
Diagnostic methods to find the
cause of obesity begin with a detailed
check-up that measures hormone levels
that affect the patient’s weight, such
as insulin and estrogen. Employing
a holistic approach that combines
prevention and treatment regarding
diet and exercise, patients take food
supplements and minerals such as
chromium, vanadium, and fiber to safely
and efficiently reduce body fat.
“I always advise patients to do a short
fat-burning exercise routine three to four
times weekly, which keeps insulin levels
normal,” says Dr. Somboon. Dietary
recommendations also encourage eating
meat not raised using growth hormones
and pesticide-free vegetables and fruits.
“You want to avoid chemicals that affect
the body’s hormone levels.”
This holistic approach enables patients
to feel better even in the first month and
keep improving after that. The carefully
planned paced program builds patient
confidence and willpower leading to
successful long-term weight control.
Dr. Somboon continues, “Tackling
Thailand’s growing obesity problem
requires changes in eating and exercise
behaviors, a challenging goal that
people can’t achieve in a vacuum.
Our program – along with day-to-day
exercise and dietary plans – shares
knowledge to gain an understanding
of how lifestyle choices affect health.
To get a handle on obesity you have
to understand not only what’s going on
inside your body, but also how to navigate
the pitfalls of modern life.”
Vitallife Wellness Center is part of Bumrungrad International Hospital Public Company Limited.
For further information, visit www.vitallife-international.com or contact 0 2667 2340.
24

+++++ Health Briefs
The more you run, the denser
your bones get
Spanish researchers have analyzed
the effect of endurance running training
on the stiffness index. The results confirm
that longer race distances support
improved bone strength.
In healthy individuals, bone quality –
chiefly determined by bone mineral
density – depends on factors such as sex,
age, race, and diet. However, this can
be modified by making lifestyle changes
such as taking part in regular exercise.
A new study recently published in the
European Journal of Applied Physiology,
led by researchers from Camilo José
Cela University (UCJC), determines
how training to compete in endurance
races (from 10 km to marathons) can
benefit bone density. The changes in
the mechanical properties of the bone
were measured using the stiffness
or rigidity index, a variable that is
directly related to bone density of the
calcaneus (the heel bone that forms the
foundation of the rear part of the foot).
Beneficial changes in bone mineral
quality can be induced using mechanical
stimuli related to the load that the
bones bear, including those that require
greater muscular forces (weight-bearing
exercise) or high impacts (such as
jumping). How running long distances
positively impacts bones is not fully
understood and requires further study.
26
Mother’s Depression
Impacts Baby’s Development
Psychologists at Florida Atlantic
University conducted a study to determine
how levels of oxytocin – widely referred
to as the "love" hormone – might vary
in women with depression.
The research team followed momsto-be
from pregnancy through the first
six months after delivery. Through
surveys, home visits, and urine samples
from mothers and their babies to
determine their oxytocin levels, the
researchers found that higher oxytocin
levels in mothers may indicate higher
oxytocin levels in infants, which
occurs during breastfeeding and
interactive touching.
They also looked at changes in the
babies as they develop. These include
how the baby's left and right sides of the
brain communicate, which research has
associated with emotional experiences
and learning. Babies of depressed
mothers appear to be either inheriting
or developing patterns that are similar
to their mother’s depression. They focus
on negative emotions and withdraw
from stimuli.
Many factors contribute to mental
health. This research confirms that
mothers-to-be should be screened for
depression and treated for their and
their babies’ health.
Stronger Heart,
Younger Brain
Exercise is known to improve heart
health, but did you know it’s also
beneficial to the brain?
A recent study provides new clues
about the heart-mind connection in older
people. Having a fit, healthy cardiovascular
system protects against vascular
dementia because increasing the heart
rate through exercise does more than
just deliver more oxygen to the brain; it
also stimulates the growth of new brain
cells and blood vessels in the brain.
A study published in Neurology
based on data from over 800 adults with
an average age of 65 associated higher
cardiorespiratory fitness levels with
better overall thinking ability, as well as
better performance on memory, motor
skills, and executive function tests. In
another report published in the journal
Neuroimage, participants underwent
functional MRI testing to track changes
when a region of the brain responds
during various tasks. Researchers found
stronger connections between different
brain regions in people with higher
levels of cardiorespiratory fitness.
What these findings tells us is that
exercise can positively affect not only our
physical, but also neurological health.
If you’re 65 or older and even if you have
a chronic health problem, try to be as
active as your abilities allow in order to
achieve optimum heart and brain health.

+++++ Q & A
Q: My niece, who just started kindergarten,
has frequent urinary tract infections
(UTIs). Is there any way to prevent them?
A: UTIs are common among children who
just start school, and it is especially common
among girls. Their new surroundings at
school, including the new bathrooms, can
cause children to be insecure about going
to the bathroom when they need to. Also,
if the bathrooms at school are not as clean as
what they are used to, they may refuse to
use the facilities. Instead, they might have
more instances of holding in their urine.
These challenges make it that much easier
for kids to contract the infection. Additionally,
children who do not yet know how to clean up
properly after using the toilet are at greater
risk of getting infected.
To prevent UTIs in children, explain to
them what causes the infections. Teach them
not to hold urine in and to drink plenty of water.
Also, teach them how to properly clean up
after using the bathroom. Most children at
your niece’s age will understand this information.
Parents should bathe their children as
soon as they get home to remove any accumulation.
These practices help prevent UTIs.
Assist. Prof. Dr. Phanida Dusitanond,
a pediatrician, specializing in
pediatric kidney diseases
Better Health always provides you accurate and reliable
health information. The questions we receive are only
answered by physicians and medical specialists.
Q: I’ve heard that doctors can perform
breast cancer and reconstructive
surgery at the same time. Are there
limitations to this method or long-term
side effects?
A: There are two approaches for
reconstructive breast implantation. One
is to use the patient’s tissue taken from
the lower abdomen or back to make a
flap. The other is to use silicone. These
two methods have their respective
limitations. For example, a tissue flap
from the lower abdomen is not suitable
for obese patients or those with diabetes
or related vascular problems because
it may cause complications. For slim
people, often the skin flap from the back
is too small resulting in an unbalanced
breast shape. Silicone is not suitable for
patients with large tumors, big breasts,
or patients who receive postoperative
radiation therapy. In some cases, a tissue
flap may be used together with silicone.
A breast cancer and reconstructive
surgery operation is a major surgery
that can take longer to perform than
many other types. Side effects include
risk of infection or hemorrhaging. It’s
not a suitable procedure for elderly
patients or those with chronic diseases.
Patients who opt for silicone may get
connective tissue diseases similar
to those found in aesthetic breast
augmentation. Moreover, removing the
patient’s entire breast tissue causes
thinness in the remaining skin. Silicone
implants sometimes do not look or
feel natural. Although aesthetics are
important, and a patient’s ability to feel
good about herself is not to be taken for
granted, it’s important to note here that
the first objective must always be to
combat breast cancer, so taking
unnecessary risks for the sake of
beauty is not always recommended.
Assist. Prof. Dr. Youwanush Kongdan,
a surgeon, specializing in surgical
oncology
Q: I have type-2 diabetes. I’m not that
fat at the moment, but my doctor still
advised me to lose weight, which I haven’t
accomplished yet. Will it be harmful if I stay
overweight? And if I do lose weight, how
much should it be?
28
A: You may not be “that fat,” but this
false sense of security can be a dangerous
thing if you go against a doctor’s
advice to lose weight. Additionally, the
complications associated with obesity
are often related to where the fat is
concentrated. Generally, belly fat is
more dangerous than fat in other parts
of the body, like the hips for instance.
This is because people with belly fat are
at a much higher risk for life-threatening
conditions including heart disease.
The doctor’s advice to lose weight
indicates that your weight is most likely
to cause or exacerbate several diseases
such as diabetes, heart disease, brain
disease, hyperlipidemia, hypertension,
fatty liver causing cirrhosis, as well as joint
diseases, and body pains. Essentially, we
can say that obesity leads to most diseases.
Your doctor determines how much
weight to lose on a case-by-case basis.
The success of obesity treatment
depends on the patient’s willpower. No
matter what people around you may say,
the patient must have a sincere determination
to lose the weight. If you have
that determination and need support,
your doctor’s input on diet and exercise
will definitely aid you to achieve your
weight-loss goals. Bumrungrad has
weight loss programs for prevention of
diabetes and other diseases designed
to ensure success. Once you begin to
feel and see good results, you’ll be
encouraged to carry on.
Assist. Prof.
Dr. Varaphon Vongthavaravat,
a physician specializing in endocrinology
(diabetes) and metabolism

+++++ Bumrungrad News
Bumrungrad Organizes Event
Focused on Joint Health.
Senior Group Captain Dr. Chumroonkiet Leelasestaporn,
Director of Joint Replacement Center and Chief of Knee
Replacement Surgery Program, and Dr. Num Tanthuwanit,
Bumrungrad’s Chief Executive Officer and Director of
Bumrungrad Hospital Foundation, along with the
hospital’s physicians and management co-organized
“Healthy Joint” at the hospital. The event’s goal was to
educate the public about osteoarthritis and to continue
the Knee Surgery Replacement Program using a computerassisted
robotic arm. This program was created in
honor of Her Royal Highness Princess Maha Chakri
Sirindhorn’s 60 th birthday.
This event was part of Bumrungrad’s corporate social
responsibility program to help Thailand’s underprivileged
senior citizens live without pain, allowing them a chance
to improve their quality of life. Another current campaign
encourages people to know the dangers of osteoarthritis
and how to prevent it. The hospital took applications from
elderly people with osteoarthritis who want to participate
in the knee replacement surgery program at no cost.
Photo: from left to right 1, 2. Patients of the Knee Replacement Surgery
Program, 3. Lt. Gen. Dr. Damrong Thanachanan, Senior Director of
Joint Replacement Center, Bumrungrad International, 4. Sr. Gp. Capt.
Dr. Chumroonkiet Leelasestaporn, 5. Dr. Num Tanthuwanit, 6. Patient
of the Knee Replacement Surgery Program 7. Assoc. Prof. Dr. Somsak
Chaovisitsaree, Medical Director at Bumrungrad International
Bumrungrad organizes
“Health Fair 2016: A Better You”
Recently, Bumrungrad International Hospital
held the “Health Fair 2016: A Better You.” The
event consisted of informative exhibits on healthy
living and new medical technologies, a healthy
tips lecture by physicians and specialists from
different fields, as well as offering an exclusive
health checkup and general health checkup
packages at no-cost. During a seminar on the
benefits of breastfeeding to mother and baby,
actress Khun Tanyatanas Vongsawatpapha
shared her experiences as a new mother.
30
David Foster visits children
with congenital heart disease at Bumrungrad
World-renowned musician David Foster was at Bumrungrad on the
occasion of the hospital’s 36th anniversary. He paid a special visit to underprivileged
Thai children who are patients under the “Rak Jai Thai” or
“Healing Hearts” program of Bumrungrad Hospital Foundation and
Bumrungrad International Hospital, in conjunction with the Cardiac
Children Foundation of Thailand under the Royal Patronage of Her
Royal Highness Princess Galayani Vadhana Krom Luang Narathiwas
Rajanagarindra. Since 2003, Rak Jai Thai has provided heart surgeries
that have given new lives to 735 children with congenital heart disease.
Dr. Num Tanthuwanit, Bumrungrad’s Chief Executive Officer, expressed
appreciation to Mr. Foster’s visit to the children, despite his tight schedule.
The children consisted of those who had just undergone surgery as well as
those who have returned to their normal lives thanks to the program. He also
gave encouragement to Rak Jai Thai’s medical team, which is comprised of
pediatric cardiologists in pediatric neonatal and perinatal medicine, cardiothoracic
surgeons, anesthesiologists, and other specialists.