Tuesday, December 31, 2019

Sleepless In Singapore

The 3 amigos
My wife and both two boys recently started wearing an activity tracker. The boys have been very diligent regarding logging 10,000 steps daily. They would even pace up and down the room or hallway just to get more steps to meet this goal.

Actually, I'm much more interested in tracking how much they sleep since it is a well know fact that Singaporeans do not get enough sleep. In fact, a survey showed that 41 percent of Singapore adults get between 4 to 6 hours of sleep a night even though they should be clocking in 7 to 8 hours.

That is bad news as shown by neuroscience Professor Michael Walker in his 2017 New York Times bestseller Why We Sleep. More than 20 large scale epidemiological studies tracking millions of people over many decades showed that "the shorter your sleep, the shorter your life".

In fact Professor Walker suggested that "leading causes of disease and death in developed nations - cue disease, obesity, dementia, diabetes and cancer - all have causal links to a lack of sleep".

The cost to mental health is significant too. Sleep problems may increase risk for developing certain mental illnesses like depression and anxiety disorders, as well as result from them.

Back to kids. It is difficult enough raising a child, but when a child is a student athleteanother layer is added.

My boys and their trackers
I would suggest all student athletes eat five good meals/ snacks a day. This is to help fuel the child's body for long school days. From the time they leave home between 6-7 am in the morning to lessons ending at around 2 pm but most likely extended for training, competitions and tuition.

Think of it like a car. Your student athlete is the car and you need to have good fuel in the car. Parents and child can work together to plan meals based on the student's weekly schedule.

Sleep is the best way for your child's body to recover. It trumps all the compression garments, recovery foodsports drinks etc. With enough sleep there is less chances of your child falling sick and getting injured.

Quality sleep is better than long hours, but good to have both. And it's best to rest without distractions like a mobile phone buzzing through out the night. Also be wary that an activity tracker may overestimate total sleep time (Lee et al, 2019).

One of my patient's child used to be a elite junior triathlete. She would keep the child's phone at bedtime as her child would be using the phone and not sleeping if she didn't.

Conversing with your child athlete while having healthy sit down meals as a family (without your phones) will help touch on many of these points.

Good nutrition, regular, early sleep schedule and physical activity as a family.  Make that your priority in the new year.


XK Lee, Chee NIYN, JL Ong et al (2019). Validation Of a Consumer Sleep Wearable Device With Actigraphy And Polysomnography In Adolescents Across Sleep Opportunity Manipulations. K Clin Sleep Med. 15(9): 1337-1346.

The above article is done by Singapore researchers at the Centre for Cognitive Neuroscience, under the Duke-NUS Medical School.

I love this picture I took from a book - Goodnight Darth Vader which I bought for my son by Jeffrey Brown.

Sunday, December 22, 2019

$677 For A Session Of Acupuncture Or Physiotherapy!!

Posed picture 
Recently I had a patient who rang me up saying he had right shoulder pain and he wanted to go for a MRI scan to rule out anything sinister. He asked if I can recommend him a doctor to hospitalize him and then do whatever necessary tests that was required. I told him that for a MRI he need not be warded. Then he said that if he was not warded he would have to pay for the investigations in full .....

I had to politely decline as I thought it wasn't right to make insurance pay for the scan if a patient does not want to foot the bill.

So I'm not surprised to read that there are mercenary physiotherapists, chiropractors etc who take advantage of the insurance system to bill excessively.

In New Jersey, school employees are covered by the state's School Employees' Health Benefits Program. This plan covering school teachers covers virtually anything the "out-of-network" providers charge.

In 2018, the teachers' plan paid out an average of more than USD $600 a visit to acupuncturists and physiotherapists! This is even higher than out-of-network fees of psychiatrists and gynecologists.

As a result, more than 70 acupuncturists and physiotherapists earned more than USD $200,000 in 2018 from their teacher clients alone. Data also showed that one acupuncturist earned more than USD $1 million dollars!!

To further sweeten the deal, some of these providers are suspected of waiving a co payment by the teachers so there is no out of own pocket payment by the teachers.

The same state fund paid out USD $11.2 million dollars to a clinic -Thompson Healthcare and Sports Medicine for providing chiropractic services, acupuncture and physiotherapy to teachers.
Thompson Healthcare and Sports Med during a school visit
Investigations by the state showed that these payments consumed hundreds of millions of dollars in the last four years. This has possibly affected all residents in New Jersey as homeowners in towns where the schools are located are all paying higher property taxes.

Six people (half are union members) make up the state panel overseeing the benefit plan have not done anything to stop the runaway costs. This is despite meeting transcripts showing discussions regarding this since 2014.

All these data and documents, along with interviews with state officials show this is what happens when savvy (and mercenary) health care practitioners find lucrative loopholes in a loosely designed employee health plan.

As expected, the teachers' premiums have increased by 8 and 13 percent in the last two years. The most popular family premium plan cost in excess of $36,000 a year. This is nearly twice the cost in other parts of the country.

I dare say that if the teachers realized the exploitation of the plan, they will definitely think twice about how they use their health care benefits.

Back in in Singapore, there was an article in the Today Online paper regarding some physiotherapists in private practices paying doctors and surgeons kickbacks to get patients referred to them.

You can also read our other blog, where we have previously written about these kickbacks in our Singapore Healthcare system too. Needless to say, private medical clinics and MRI/ X-ray companies in Singapore are implicated as well.

It is bad practices like this that will lead to increases in our health care visits, insurance premiums and Medisave-approved Integrated shield plans.

You can read the article I referenced here.

Sunday, December 15, 2019

Teaching Kinesio Taping @Pilatique In Malaysia

Group picture
The last time I taught in Malaysia at the very same location was back in November 2013. Now that's a fairly long time ago.

So it was really nice coming back to a familiar venue to teach Day 1 and 2 of the Kinesio Taping Assessments, Fundamental Concepts and Techniques (formerly known as KT 1 and 2) here at Pilatique.
Day 1
I'm friends with Steven and Melissa (they are Pilatique's owners) and I couldn't turn them down when they asked to come and teach in KL, Malaysia. Most of the participants were from Malaysia although we had three students hailing from Mauritius.

Day 2 of the course went much quicker as usual as we went through more practical applications such the association of Gluteus Medius and contralateral pelvic drop (or CPD), how a rotated pelvis would affect the shoulder blade and implications of the hip flexors and foot drop.

Here are some pictures from the past two days.
Clarissa having a go
All the boys listening
Watching the ladies
A big thank you to Steven and Melissa for having me over to teach. You guys organize the best courses here in Malaysia. The pleasure is all mine.

Also grateful to Mary Leou as well for coming to get me and sending me back after each day's teaching.

Sunday, December 8, 2019

Consent And Unwanted Touching In Yoga

Picture of Pattabhi Jois on Karen Rain 
I treat many patients who practice Yoga regularly and diligently. A few of them have even gone for retreats in Mysore, (also known as Mysuru) India.

But lately, I've heard lots of horror stories from patients getting unwanted / not asked for adjustments from instructors. These improper touches happened in public right here in Singapore. One patient even stopped practicing after she felt so traumatized after one such adjustment.

Most of these patients practiced Astanga yoga. Ashtanga is physically demanding as there are many strenuous posture and dynamic moves. It was made popular by Krishna Pattabhi Jois.

Vinyasa, power or flow yoga are versions derived from Ashtanga yoga as well. Celebrities like Madonna, Gwyneth Paltrow and William Dafoe were early converts and helped popularize Ashtanga and Jois to the world. This made Jois famous and easily idolized. In Astanga, training under or with him was similar to a Catholic priest being trained by the Pope himself.

Jois also helped popularize touches or adjustments where yoga instructors physically touch, move or manipulate a student's body.

For a long time, much of the yoga community has been slow or perhaps unwilling to respond to such allegations. The fear may be that these instructors are fearful to discredit those seen as gurus.

Adding to this problem is that students are told that yoga is also part spiritual practice, anything that they did not understand, they have to trust what the instructors tell them.

Some teachers rely on just verbal cues to help students while others can either gently or forcefully move students into certain postures or alignments.
Karen Rain and Jois
Jois as you can see was definitely not about yoga postures or alignments as you can see from the pictures above. Due to his fame, power and perhaps devotion commanded by Jois, all these adjustments made in public somehow seemed to normalize them.

Nine women (including Karen Rain) went public about their experiences with Jois in 2018. The article written by Matthew Remski, a yoga teacher published in The Walrus, a Canadian publication. They described being groped, kissed, even fingered through yoga tights.

Prior to this in 2017, Rachel Brathen, a yoga studio owner asked her Instagram followers if they ever had inappropriate touches/ adjustments in yoga. Hundreds of women wrote back and shared how they were being propositioned after class, during retreats, forcibly kissed during private mediation sessions and even assaulted on post yoga massage tables.

In an article by Katherine Rosman published in the New York Times, she wrote about how she attended a class at a yoga festival when there would be many other yoga instructors and students with a producer, camera woman and sound engineer.

Her story "came to life" right before her eyes when the instructor demonstrated an adjustment with him placing a woman's bottom on his lap, spreading her legs apart and wrapping her legs around his waist. You can have a look at the article and watch the video here.

What is worse is being touched/ adjusted in improper ways during classes right in public. That somehow seemed to make the touches / adjustments legit. If forcefully done, adjustments have often caused physical injuries as well.

My patient tells me that now some local studios will have a "No adjustment" tag where students can place beside their mats to avoid unwanted adjustments.

Those of you who practice yoga beware and make sure you do not get hurt with unwanted adjustments.