Health at Work - Doctor Q&A

Posted by jass

Just recently I acquired lower pain following an onset of flu. We know of back pain associated with in-accurate postures; however are there any relevance between lower back pain and fever? What exercises would you recommend for lower back relief. On what grounds should person with back pains sort of a medical help? Thanks

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

A person with a flu or fever generally feels unwell with general malaise, lethargy and in particular if it a viral infection, there may be generalized body aches which may appear as backache.

However there are a variety of more specific conditions that are associated with lower backaches and fever. Some examples of these include musculoskeletal ailments or diseases affecting the muscles of the back or nerves and if trauma or inflammation is involved, a low grade fever may accompany this. Other conditions include rheumatologic conditions that may also present with backache, infections involving the muscles of the back or spine .etc.

In women, pelvic inflammatory disease may also present with low backache which may be associated with some discharge. Renal stones causing renal colic can radiate from the loin to the groin and symptoms of low backache may sometimes be due to referred pain from underlying pyelonephritis, which is an infection of the kidney itself. Occasionally, some forms of malignancy may originate or migrate to the spine and cause back pain and if there is associated inflammation, may be accompanied by a fever.

In general when we are ill with a fever, rest is essential and some analgesia may help. The aches and pains will wear off with recovery if the problem is just a viral fever.

Pain from more serious conditions may progress differently. For low backache that is associated with a slipped disc or arthritis involving the vertebral discs and spine, rest is also essential. Analgesics may provide some relief. When the pain has reduced, graduated exercises which may involve bending, stretching may help. Exercises should be phased in and we should not suddenly venture into heavy exercise, in particular if there is pain, as we might aggravate the pain and injury. In severe cases involving the spine, referral to an orthopedic specialist will help and physiotherapy assistance will be useful. In some instances, traction is needed and this is administered with the advice of a physiotherapist.

Posted by Janey

I work at the computer most of the day. My top right shoulder seems to be very stiff a lot of the time.

Is it my desk posture and alignment? I have one of those desks with a curve. Where should I put my computer screen and keyboard so I won't keep getting such aches. Most of the ergonomic advise seems to be for straight desk spaces only.

Also, if I keep getting cough and running nose in the office, does that mean the office conditioning is bad? How do I tell the boss so that action will be taken?

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

You should seek medical advice to ensure that that there are no other medical issues causing the pain in the shoulder. Some of these symptoms are similar to those experienced by people with repetitive strain injury of the upper limb. This is quite common among computer users and is particularly bad if you spend many hours in front of the computer and the equipment is not ergonomically arranged.

It is difficult to tell you the specific reasons for your problems without seeing what is happening at the desk if you suspect that ergonomic issues are involved. The normal approach is to evaluate the workstation first.

In general we should look at the placement of the computer which should be in front of the user.

The height of the screen should be at the appropriate height , with the upper border of the screen in line with the eyebrow.

The head should not be bent forward more than 30 degrees.

The table should be at the correct height; the shoulders should not be hunched forward or lifted up when you are typing. Identify and remove pressure points which may aggravate the pain.

The chair should be adequately supported and the handle should not obstruct the table. There should be adequate arm support.

The fingers should have adequate space on the keyboard.

The mouse/accessories and keyboard layout should be of the proper size and fit for the hands. Avoid stretching and keep good posture. There should be sufficient leg room below the desk and if the feet cannot touch the ground, a foot stool might help.

Take frequent breaks and stretches while at work. Ensure that lighting is adequate – not too dim and not too glaring. We provide patient care for people who require assistance and where needed we also go on site to evaluate the work station and give advice.

One of the common problems of working in an air conditioned office is air recirculation and spread of infectious diseases like the influenza and other upper respiratory tract infections within the office.

In generally, we should practice good etiquette and community congeniality by staying away when we are having a contagious disease and practise good personal hygiene when sick.

If we really must turn up when sick with a flu, wearing a surgical mask and covering the mouth with a piece of tissue when sneezing or coughing will help somewhat to reduce spread of the germs from aerosolization of droplets that contain these infectious particles.

Posted by vincenttan

Dear Doctor Would like to check with you what are the effects of computer radiation inside our body? How to effectively prevent the computer radiation?

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

Current scientific medical literature does not carry sufficient evidence to suggest that the radiation from a computer will cause serious illnesses in the body. The computers that we are using generally are relatively safe in terms of conventional radiation exposure in the form of ionizing radiation.

Posted by john

I travel a lot for my work and use the laptop and blackberry all the time. Even in the office I am at my desk half the time on the computer. Am I in danger of the wrist and hand problem that people are talking about? How do I avoid this? What about computer screen radiation and strain on the eye. Is this really serious or just hyped up by media?

If I get a problem related to the above, is my company supposed to take care of my doctor's fees and any reduction in work capability, or am I on my own here?

thanks for your time to answer me.

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

Whether a person has a higher risk of getting repetitive strain injuries (RSI) of the upper limbs depends on a variety of factors. Some of these include the type and force of movement, frequency and magnitude of repetitive use of the joint involved, posture, rest breaks and other issues specific to the activity and equipment. People generally get more neck and upper limb aches and pain when using the laptop. Some of the contributing factors include the way we use the laptop and our posture, the frequency of using the laptop in awkward positions and higher degree of lack of fit of user to the laptop design compared to the PC. Many people tend to have a head tilt when bending forward to use the laptop and when this is coupled with bad posture, substantial neck pain may develop. Also the fingers may be too big for the key board and the keyboard cannot be changed easily for the laptop, unlike the PC. Many of the problems also relate to pressure points when we are typing and unfortunately this is more problematic with the laptop.

I have noticed that blackberry users tend to get RSI involving the wrist and Tenosynovitis of the thumb. This is due to the repetitive movement and overuse of the joint of the thumb, pressure on the wrist and overuse of the joints involved when typing, leading to underlying strain and micro-tears of the tendons of the thumb and the wrist involved.

The computer screen issues relate more to eye strain due to glare. Again the radiation is not substantially related to ionizing radiation. Glare causing eye strain is real and we should take frequent breaks and take breaks to look away from the screen to reduce eye strain and ensure proper lighting is available.

If the repetitive strain injury of the upper limb is not due to work, the company is not liable.

Where work is demonstrated to be a significant or the main contributing factor to the RSI we call this work related musculoskeletal disorder (WRMSD). If this is so, then the company is liable. Some of the details are available at the Ministry of Manpower website. Work related musculoskeletal disease (WRMSD) is a notifiable condition under the Workplace Safety and Health Act. Workmen’s Compensation issues are dealt with in the Workmen’s Injury Compensation legislation.

Many companies proactively provide care for their staff by taking the effort to design their work stations ergonomically. However, there is no magic formula.

Posted by miki

Dear Doctor I would like find out from you, how often should we actually clean our office's water dispenser? And we appreciate if you can share with us some water dispenser cleaning tips? We do not want to be at risk of getting sick from harmful bacterial residue without proper cleaning. Thanks

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

For water dispensers, general hygiene issues and principles apply. A users’ guide is usually present with the dispenser on specific issues relating to the brand of dispenser and should provide useful information specific to the dispenser. A general rule of thumb is to clean the dispenser each time the bottle is changed and about 6 weeks in between if the change is infrequent. Cleaning solutions vary and some would recommend a diluted bleach solution. Ensure that the cleaning lotion is completely washed out before reuse. The details on how to do the cleaning are specific to each type of dispenser and detailed instructions should be obtained from the rental company if you lease the equipment. These instructions are also usually packaged with the dispenser when it is first given to you. Otherwise, ask the rental company for a copy of the instructions. If you purchased the dispenser, it should come with the package.

Most concerns on drinking water relate to fecal microbial or chemical contamination. There as specific standards and methods to test for these but for home use or small office purposes, it is too cumbersome. Use standard hygiene precautions instead.

The World Health Organization (WHO) website has a good posting on water and issues relating to monitoring and drinking water quality and standards which are general guidelines for safe drinking water. The critical issue is contamination by microbial organisms and to a lesser extent, the chemical content of water.

Posted by kiwi9982

My supervisor can lecture/talk to me (and my colleagues in the team) emotionally when he thinks I (either one of us) am not performing up to his expectation.

This happens at least since I joined the organisation (as I see it with my own eyes). Till now, this becomes very COMMON in my group (his subordinates).

As a subordinate reporting to him, I should respect him although he act emotionally. Maybe I am able to respect him if this emotional act happened once or twice. Unfortunately this is on going "activities".

What should I do? I have already spoken to him that I cannot accept his emotional act to me but still happen. Everytime, same response from him "Sorry". But I am normal human & have limit right? Due to his emotionally act, I have given up on him because the hurt I got from him already "planted" a deep wound on me.

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

It is a difficult situation as this involves a supervisor who has authority over you. If the problem lies with the supervisor and he is aware that he has a problem, it is then up to him to resolve this gap in his communication and management style. For you, it is important not to further provoke him as this might be misinterpreted. It would be helpful if a third party like a counselor or someone else in the office who does not report to him , can step in to provide feedback to your supervisor. Providing feedback to him to suggest that his style is causing a low morale might help but if he has no insight into the issue or is unwilling to change, it is very difficult for a subordinate to make him change.

A group response to provide feedback to him might point out the problem to him if he is open to accepting such feedback. On the brighter side, group dynamics sometimes can be shifted – if one person keeps getting emotional and gives negative feedback, the respondents could return this with positive strokes or responses to provoke a change in the dynamics. It is counter intuitive to do so but sometimes, it works.

A neutral way of making some change may be to suggest the need for team building to be developed. Some organizations, usually large ones, may have the facility to intervene by encouraging a team building culture which emphasizes the importance of positive feedback and teamwork.

Posted by rachel

My cousin works in an oil refinery in one of the islands off Singapore. Is he at higher risk of cancer from related smells from the oil fuels etc? What can he do to minimise his risk? What standard measures must the company take to ensure his safety, that we can submit to the company management, and insist that they take action?

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

Oil refineries general deal with crude oil and the byproducts of the processes involved in refining crude oil. There are also other chemicals involved in related processes in the industry.

There are a variety of hazards related to the exposure to hydrocarbons either in the form of aromatics like benzene and related chemicals or the aliphatic hydrocarbons Exposure and absorption can be through inhalation if these are volatile and through ingestion or absorption from the skin. Ingestion could occur when someone touches contaminated items and then contaminates the food ingested through contact.

Hydrocarbons whether aromatic or aliphatic are generally toxic substances. There is ample scientific literature to link hydrocarbons to a variety of medical problems including cancers. Several clinical and epidemiological studies have shown that long-term exposure to benzene can lead to leukaemia, and benzene has been classified as a human carcinogen (Group 1) by IARC. A good source of this information is from NIOSH or OSHA websites. I have extracted a short excerpt from one of the web pages of OSHA:

“Carcinogenic effects of hydrocarbons" One of the first epidemiological studies demonstrated an increased incidence of leukaemia, mainly acute myeloid leukaemia, in shoe workers in Istanbul (75). Also shoe workers in Florence, Italy, showed an increased risk of leukaemia before 1963 (76).

The most thorough and well investigated study, which has also been the main study used for quantitative risk assessment, is on workers that used to be employed in the manufacture of rubber film, the so-called Pliofilm cohort.”

On prevention - like many issues at work, the approach to managing these exposures is largely preventive. There are laws in most countries that protect the interests of the worker in such situations. In Singapore, the Workplace Safety and Health Act has clear guideline on the subject.

The principles of prevention are usually applied by the management of companies that work with these substances. A key step is risk management which includes hazard identification, risk stratification, development of measures to minimize the risk, strategies for emergency response, environmental and biological monitoring or surveillance, institution of personal protective measures and finally development of business continuity strategies.

These principles include controlling the hazard at source by substituting the use of the substance with a less harmful substances, isolating the source, implementing environmental monitoring and surveillance, biological monitoring, administrative controls to minimize exposure and advocating the use of personal protective equipment

Under the Workplace Safety and Health Act in Singapore, the requirements for compliance are clear. There are also provisions under the law that requires the employer to institute biological monitoring for staff exposed. This is in the form medical examinations and tests which are conducted regularly by suitably qualified medical practitioners. You might wish to check this out at the Ministry of Manpower (MOM) website.

Most employers would implement their own safety and health system that performs environmental sampling of the chemical and employees would be screened for the exposure to the chemical.

Posted by prettybaby

My position requires me to constantly travel all over the world. There are times whereby I am in country for only 2 days a month. I am recently diagnosed with hypertension, would constant flying worsen the hypertension?

What are the measurements that I can put in practice to ensure that I do not suffer any additional health conditions from my nature of job?

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

Frequent travel is becoming a common facet of work life in the 21st century with increasing globalization.

Hypertension is a significant medical condition which must be managed properly.. Frequent travel may be stressful to some people and this may aggravate the hypertension You need to be under the care of a doctor and if you take your medication regularly and have adequate rest, it is possible to keep the blood pressure within acceptable ranges. During a flight there are issues involving changes in pressure but in generally most airplanes are sufficiently pressurized to offset any changes that may occur arising from the changes in altitude of the plane.

Hypertension is often associated with other medical issues like ischemic heart disease, hyperlipidemia and kidney disease, to name a few. Many factors that aggravate hypertension are controllable and preventable. Stop smoking if you do, keep the weight down, decrease salt intake, keep fit and controlling the diet are things you could do to keep healthy. Regular exercise within the limits of your health conditions are good for you. Today, many people keep records of their own blood pressure and with the advent of tools like the electronic sphygmomanometer, home monitoring of the blood pressure is a breeze. Be compliant with your medications. Cardiac evaluation for ischemic heart disease and good control of diabetes are important.

Posted by pearlynwan

I am working in IT related position. I have to stare at the computer screen for 8-10 hours a day. Recently, I realized that I am having constant eye pain with a sense of nausea after 5 hour into work. Last week I have my first attack of migraine. I have been working in such manner for more than 8 years and this year it starts to create more health problem.

There is nothing much I could do as my nature of job require me to look at the computer screen for long hours. Thus, can you recommend any measurement that I can take to reduce the said condition? Does exercise help to reduce the problem?

Answered by Dr. Fong Yuke Tien, Singapore General Hospital

Eye strain is a common problem with staring at the computer screen. Main contributing factors are glare and fatigue.

1) Try not to stare at the monitor for too long periods and look away from the screen whenever possible.
2) Look far away every few minutes to reduce eye fatigue from focusing on close objects, so that the eye muscles can relax.
3) Keep frequent short breaks.
4) Reduce the glare from the screen by reducing the contrast to keep it at a comfortable contrast level but keep lighting at an adequate level. Work in ambient lighting environment for comfort.
5) There are eye exercises that help to relax the eye muscles. Check with your medical doctor to exclude other causes for the headache and other associated symptoms.