01

3 105

NUH – First Certified Baby- Friendly Hospital In Singapore

A Trip Less Travelled

Precise Facial Reconstruction With 3D Technology

Issue 3 / 2013A publication of the National University Hospital

MICA(P) No. 041/09/2013

Patients with severe facial injuries and deformities now have an improved chance of looking like themselves pre-trauma with the innovative use of 3-Dimensional (3D) technology.

Aided by a 3D prototyping printer, surgeons at NUH can now reproduce a physical model of the patient's skull from corresponding 3D virtual models. These serve as operative guides before and during surgery, enabling surgeons to build and place implants with a high degree of accuracy.

President's Award For Nurse Veteran

Cont’d on page 2

A member of the NUHS

02

cove

r sto

ry

Precise Facial Reconstruction With 3D Technology

Cont’d from cover page

“T his gives us the avenue to fit the implants onto the printed 3D model to bend and shape as accurately as possible, following the contours of the ‘bone’,” says Associate Professor Lim Thiam Chye, Head and Senior Consultant with the Division of Plastic, Reconstructive and Aesthetic Surgery at NUH.

Without the aid of such technology, reconstructing a severely injured or deformed face depends mainly on the surgeon’s judgment, using x-rays, scans and sometimes, photographs of the patients, as guides to make the implants.

With the 3D technology platform, surgeons can now reconstruct the cranio-maxillofacial skeleton optimally with 99 per cent accuracy even with only half the facial skeleton intact, minimising the need for re-operations.

In February, 21-year-old Hannah Maria Mohamed Sakban arrived at NUH’s Emergency Medicine Department with the bones on the left side of her face severely damaged due to a traffic accident.

As a professional dancer, Hannah’s facial expressions are part of her craft. After the accident, she worried about never being able to perform on stage again.

But much to her relief, three months after her reconstructive cranio-maxillofacial surgery using the complete 3D technology platform, there are hardly any signs of a bad trauma on her.

“Before the surgery and when I first awoke from the surgery, I was worried that I would not look like myself. When my face started to heal, I was happy when I started to see the face I was used to in the mirror,” she says.

At NUH, the full suite of the 3D services is used mainly for patients with severe and complex facial deformities or damage, such as that resulting from trauma injuries like road traffic accidents or cancer treatment.

how A fAciAl reconstruction is done

1

5

Surgeons use the 3D model to fit and mould implants, bending and shaping them as accurately as possible, following the contours of the ‘bone’.

3

The computer modeling 3D software allows surgeons to reflect the undamaged bone (yellow) over to the damaged portion of the skull (blue). This creates a 3D image of what the intact facial skeleton should be.

Model is now ready.

2

The 3D image is then sent to the prototype printer.

The 3D medical model – an exact replica of how the patient’s face should be.

4

03

NUH

news

bite

s

Clean Rooms For Patients

W ith a machine which emits a cleaning agent, 90 minutes is all it takes to thoroughly disinfect and eradicate harmful organisms that may linger in an isolation room after a patient is discharged.

Known as hydrogen peroxide vapourisation (HPV) technology, it is one of the latest measures introduced by NUH in its continuous effort to reduce healthcare associated infections.

Says Associate Professor Dale Fisher, Head, Division of Infectious Diseases, “Manual cleaning, despite the best efforts, has limitations and it is impossible to achieve the same level of disinfection that the machine is capable of. There is often pressure on staff to quickly turnover a bed so that admitting patients can be brought to the ward faster. This is why we decided to invest in technology, to help us overcome the challenges of manual cleaning and supplement the current efforts.”

Surveys conducted by the hospital’s infection control team last year found that when rooms are manually wiped with bleach, some spots are missed. These include hard-to-reach corners and innocuous items like television remote controls and switches.

While the new system takes time to work, patients are assured of an almost 100 per cent germ-free environment. It is used primarily for the 129 isolations rooms in the hospital, where most multi-drug resistant organisms are commonly found.

To bring down infections, the hospital has also started using disposable bedpans, vomiting bowls and urinals.

Made of pulp, the disposable items are thrown into a macerator which are then shredded and flushed completely. This frees nurses from having to wash and disinfect the items.

“We have been receiving good feedback from the patients who say they find this more

hygienic. More importantly, we can now spend more time caring for our patients.”

Senior Staff Nurse Sapphire TeoAn isolation room being cleaned using HPV technology.

NUH has become the first hospital in Singapore to be accreditated by the Baby-Friendly Hospital Initiative (BFHI).

“Breastfeeding may be a natural part of motherhood, but may not be easy for some mothers. Mothers who deliver at NUH will be in an environment where breastfeeding is regarded as normal practice while receiving consistent support from trained staff, which is especially helpful for mothers facing challenges while breastfeeding”, says Dr Yvonne Ng, Consultant at the Department of Neonatology and Chair of the NUH BFHI Steering Committee.

The BFHI was launched in 1991 by UNICEF and the World Health Organisation (WHO) to promote breastfeeding.

NUH – First Certified Baby-Friendly Hospital In Singapore

04

NUH

news

bite

s

National Day Award For NUH Director Of Nursing

Congratulations to Adjunct A/Prof Lee Siu Yin, Director of Nursing at NUH, for receiving the National Day Award – Public Administration Medal (Bronze) this year!

The Award is in recognition of her contributions to the nursing profession, including initiatives such as the Trendcare Patient Acuity System, which optimises nursing manpower while providing patients customised care based on their conditions. The system was first implemented in NUH in 2006 and has since been adopted by all public hospitals in Singapore. With her years of experience in nursing, Adjunct A/Prof Lee has held key positions in various committees both at the hospital and nationally. For instance, she is a member of the National Nursing Taskforce (NNT) set up by the Ministry of Health to chart new directions for the profession, and chairs the NNT sub-group on nursing education to look at developing the educational framework for nurses.

“Nursing is a profession that can bring out the best in a person – especially the humility to help when the patients need you most. If you have the heart to do it, Nursing can be a lifelong profession with many

opportunities to grow and shine.” Adjunct Associate Professor Lee Siu Yin

Nurses are patients’ angels! As a way of recognising their good and hard work caring for our patients, we celebrated Nurses’ Day 2013 with a slew of activities over four days!

T ough on the issue, tender to the heart – this is the philosophy that has guided Deputy Director of Nursing Chia Lay Hoon through her 38-year-old nursing career. Ms Chia is a recipient of the President’s Award for Nurses 2013, the highest accolade in the nursing profession in Singapore. She received her award from President Tony Tan on

31 July 2013.

Ms Chia has spent her past 31 years working in the intensive care unit, with special interest in cardiothoracic intensive care. A firm believer in the training and mentorship for nurses, she is known for her commitment and efforts in developing nurses through various training programmes. Advanced Practice Nurse (APN) Lim Mei Siew is one who has benefitted from Ms Chia's support.

“I was considering giving up my studies to become an APN as I was pregnant with my second child. Ms Chia went all out to support me. I completed my course and have become a better, more skilled ICU nurse, all thanks to Ms Chia’s encouragement,“ she says.

On receiving the award, Ms Chia says, “I am humbled and honoured. Nursing is a team effort and I would never have been able to achieve this without my colleagues who have helped and supported me throughout my career. It is with a thankful and grateful heart that I would like to dedicate and share this award with them.”

05

NUH

news

bite

s

05

President’s Award For Nurse Veteran

Deputy Director of Nursing Ms Chia Lay Hoon (second from left) receiving the President's Award for Nurses from President Tony Tan at the Istana.

“We are very proud of Lay Hoon. Throughout her 38 years in nursing,

she has always been passionate about uplifting her profession and improving patient care. Above all, her heart as a

nurse allows her to show sincere care to her patients and be there for them in their

time of need. ” Adjunct Associate Professor Joe Sim,

Chief Executive Officer, NUH

National Outstanding Clinician Mentor | ASSOCIATE PROFESSOR QUAH THUAN CHONG Head & Senior Consultant, Division of Paediatric Haematology-Oncology, NUH

From his mentor, the late Professor Wong Hock Boon, A/Prof Quah learnt about having a life-long hunger for learning not only in paediatrics or medicine, but in all areas of life. This went on to shape his belief that one must be self-directed in acquiring new skills and knowledge.

As a teacher, A/Prof Quah is known to be both patient and encouraging, constantly reminding his charges the practice of medicine should centre on the patient and his family.

A/Prof Quah is credited with setting up a clinical fellowship programme in paediatric oncology in Singapore in 2004. In 2010, he went on to develop a complementary two-year training programme. This programme eventually became the second paediatric sub-specialty Diploma endorsed by the College in Paediatrics and Child Health, Academy of Medicine Singapore.

NUH tops National Medical Excellence Award

“For his outstanding contributions, mentorship and leadership in raising the next generation of paediatricians in Singapore and the region

”

National Outstanding Clinical Quality Activist | ASSOCIATE PROFESSOR QUEK SWEE CHYE Deputy Chairman, Medical Board; Head & Senior Consultant, Division of Paediatric Cardiology, NUH

A/Prof Quek Swee Chye champions quality improvement and patient safety at the NUH, spearheading various innovative clinical improvement programmes that have improved patient safety. Some of these programmes are subsequently adopted by other healthcare institutions.

Under A/Prof Quek’s leadership, NUH became the first hospital in Singapore to receive the Joint Commission International (JCI) accreditation in 2004. This year, he once again led the hospital to become the first hospital in Singapore and the region to achieve the new Academic Medical Centre standards, the “Gold Seal” accreditation newly introduced by the JCI.

“For his distinguished and outstanding achievements as a leader, teacher and clinician in the development of quality improvement and Paediatrics (Cardiology)

”

T he National Medical Excellence Award is presented annually by the Ministry of Health to healthcare professionals to acknowledge their contributions in advancing healthcare, improving the standards of patient safety and quality of care which ultimately improve people’s lives.

This year, NUH is proud to win five out of the eight award categories.

National Outstanding Clinician Scientist Award| ASSOCIATE PROFESSOR YEOH KHAY GUAN Senior Consultant, Division of Gastroenterology and Hepatology, NUH; Dean, NUS Yong Loo Lin School of Medicine

A/Prof Yeoh leads the Singapore Gastric Cancer Consortium which is carrying out research to improve the early detection and treatment of gastric cancer, the second leading cause of cancer death worldwide. The group brings together clinicians from various hospitals and scientists from local universities and research institutes.

Under his leadership, the team has shown that endoscopic screening is able to successfully detect early gastric cancer. By detecting stomach cancer at Stage 0 to 1, lives are saved and cure is made possible by minimal surgery, avoiding the complications of major surgery, chemotherapy and radiation. Collaborating with scientists, A/Prof Yeoh has pioneered new imaging methods and biomarkers for better detection of early gastric cancer.

“For his outstanding contributions and achievements in research in the field of gastric cancer, in improving patient outcomes and achieving better

understanding of the disease

”

06

NUH

awar

dsan

dacc

olad

es

07

NUH

awar

dsan

dacc

olad

esNational Outstanding Clinician Educator| ASSOCIATE PROFESSOR SHIRLEY OOI Senior Consultant, Emergency Medicine Department, NUH; Designated Institution official, NUHS Residency Program

Second-time NMEA winner A/Prof Ooi is a passionate educator and highly respected emergency medicine physician.

A/Prof Ooi took on the role of Designated Institution Official of the NUHS Residency Program in 2009, having spent 10 years as the Director of Postgraduate Education with the Emergency Medicine Department at NUH. She has been instrumental in the implementation of various specialty programs under the residency

program, notably the ACGME-International accreditation of all its 14 programs. Under her leadership, 10 more programs were rolled out in July 2013, making the NUHS Residency Program one of the most comprehensive in Singapore.

She also co-edited the 'Guide to The Essentials In Emergency Medicine', with Associate Professor Peter Manning, Senior Consultant with the Department of Emergency Medicine at NUH.

National Clinical Excellence Team Award | Represented by ASSOCIATE PROFESSOR DALE FISHER Head and Senior Consultant, Division of Infectious Diseases; ASSOCIATE PROFESSOR RAYMOND LIN Head and Senior Consultant, Division of Microbiology Division; NURSE CLINICIAN CATHRINE TEO Department of Nursing, Infection Control and MS LISA ANG Assistant Director, Corporate Communications Department, NUH

“For their outstanding contributions in reducing Methicillin Resistant Staphylococcus Aureus (MRSA) infection rates, leading to improved patient safety, outcomes and clinical standards

”

“For her outstanding and immense contribution in nurturing and shaping future medical leaders, and the development of the field of emergency medicine education in Singapore

”

• Joanna Mah (Senior Nurse Manager, Blood Donation Centre)

• Lang Siew Ping (Nurse Clinician, Ward 8A)

• Lam So Shan Susan (Nurse Manager, Ward 28)

• Alison Anne Tan (Nurse Clinician, Clinical Nursing Unit)

MOH Nurses’ Merit AwardCongratulations to our nurses for winning the award:

Under the leadership of A/Prof Fisher, the team has been instrumental in spearheading several initiatives and MRSA control measures at the NUH. These include active surveillance to identify ward-based acquisition, audits and novel hand hygiene publicity campaigns to reduce MRSA infection rates. With the “MRSA bundle of interventions” rolled out in a sustainable manner, MRSA acquisitions began falling. Also significant were the drop in bacteremias and other clinical infections, and the rise in hand hygiene compliance rate.

The team successfully oversaw change across the hospital, while continuing all the usual and necessary hospital infection control efforts. Awareness on the importance of hand hygiene in saving lives was notably raised among staff, patients, visitors and the general public.

• Nazirah Binte Ismail Maideen (Nurse Manager, Ward 42)

• Siti Meriam Binte Rais (Nurse Manager, Day Surgery Ward)

• Yeo Hui Ling (Nurse Clinician, Ward 54)

• Chong Jun Wei Kelvin (Senior Staff Nurse, Emergency Medicine Department)

Called the ‘silent thief of sight’, glaucoma occurs when pressure in the eye increases.

The increased pressure, called intraocular pressure, can damage the optic nerve which transmits images to the brain. If the damage to the optic nerve from high eye pressure continues, it will lead to permanent loss of vision within a few years. The incidence of glaucoma in Singapore is around four per cent, of which 60 per cent occurs after the age of 60.

Doctors believe eye pressure should be higher when one is awake and lower when one is resting or sleeping. Yet, for some patients, their eye pressure appears normal during consultation despite the fact that their optic nerves are deteriorating.

During a surgery, Associate Professor Paul Chew, Senior Consultant with the Department of Ophthalmology at NUH, observed that a slight pressure on the surgical drape had caused the patient's

eye pressure to go up. This led to the study to determine if indeed there is a difference in the eye pressure depending on whether patients are lying sideway or on their back.

“Based on the results from participants for the study, we have seen that the eye pressure does increase when patients are lying on their sides. This finding may potentially benefit glaucoma patients whose condition could be getting worse despite therapy”, says A/Prof Chew.

“The next step will be to conduct a simple eye pressure test during consultation to see if the eye pressure increases when one is lying sideway. If so, doctors can then adjust their treatment and introduce eye drop therapy at night to see if the patients’ conditions stabilise over time. This could prevent the glaucoma from worsening in some.”

New Insights Into Glaucoma

NUH Medical Centre Now Open!

T he new NUH Medical Centre welcomed its first patients in late July with the opening of Diagnostic Imaging and Outpatient Procedure Centre/OPAT (Outpatient Parenteral Antibiotic Therapy) Centre.

In August, several other facilities including the Eye Surgery Centre, Medicine Clinic, Ambulatory Surgical Centre and clinical support services such as medical social work, rehabiltation, pharmacy and dietetics opened. Likewise for the National University Cancer Institute, Singapore which occupies three floors at the new centre. Patients who travel by the MRT can now access the medical centre directly from the Kent Ridge MRT station which is located on the first floor.

For updates on the relocation of facilities to the NUH Medical Centre, visit www.nuh.com.sg

08

NUH

news

bite

s

Conveniently linked to the Kent Ridge MRT station, getting to the NUH Medical Centre is now a breeze.

Bigger and more comfortable waiting area at the clinics.

09

NUH

news

bite

sWhen a child successfully battles and wins the big “C”, the victory is often attributed to dedicated care and the medical treatment he or she received. This victory,

however, might not be the end of the fight for the child. Ironically, the same treatment that cured the cancer might have side effects that manifest years later, affecting the child’s health and growth.

With current advances of cancer treatment, more children – up to 80 per cent – are surviving cancer. However, treatment such as radiation therapy and chemotherapy can potentially cause late yet long-term side effects including poor bone health, metabolic syndrome, growth hormone deficiency and fertility issues.

Since March this year, with a newly set up late effects clinic at NUH, young cancer survivors and their parents are receiving support for these side effects. Helmed by a team comprising a paediatric oncologist, endocrinologist and a nurse, the clinic allows the young patients to be monitored closely. Other specialists may be involved based on the needs of the child. “Even though late effects can go undetected initially, and take time to surface, particularly in the case of endocrine deficiencies, regular monitoring through the years helps identify the onset of these effects early. This is crucial for more effective management and treatment,” says Dr Cindy Ho, Associate Consultant with the Division of Paediatric Endocrinology at NUH.

One of the more common late effects caused by cancer treatment is hormone disturbance, affecting up to four in 10 patients. Depending on the type of cancer treatment received, hormone disturbance can cause either early or late puberty, resulting in the child developing much earlier or much later than their peers. Early detection of this condition can allow treatment through medication, to help the young patient develop as optimally as possible at the right age and improve their quality of life.

“The focus of the clinic is on preventive healthcare to enhance the health and well-being of these young people,” says Dr Tan Poh Lin, Senior Consultant, Division of Paediatric Haematology and Oncology, NUH.

“We hope to create awareness among the patients and their parents on the importance of being proactive in managing their health in the years after cancer. Early detection is key in ensuring that the children grow up the best they can, making the most out of their victory.”

More Children Surviving Cancer

Beyond Dispensing MedicationOften, people identify pharmacists as the people behind counters dispensing

medication. Not many know that the field of pharmacy is much deeper and broader, and that it is a profession that allows for higher learning that can

translate to safer, more efficient and more focused patient care.

At NUH, pharmacists can now enrol in a programme that equips them with the skills and knowledge to better care for patients, including managing patients’ medications in terms of monitoring and adjusting the doses, and ensuring the right drug is prescribed for the right conditions. They will also be able to train and guide fellow pharmacists.

“Even as Singapore’s pharmacy profession is fast-growing, many post-graduate study opportunities for pharmacists can only be found overseas. We hope to increase and sustain the number of appropriately-trained clinical pharmacists to meet the demand for higher quality of patient care,” says Ms Lim Siew Woon, Director of the Pharmacy Residency Programme and Senior Principal Clinical Pharmacist at NUH.

The NUH programme is the first of its kind in Singapore and saw its first batch of pharmacy residents graduate in April this year.

Paediatric Late Effects Clinic (within the Viva-University Children's Cancer Center)

Location NUH Medical Centre, Level 9

Operating Hours

Every second and fourth Wednesday of the month, 2.00pm to 4.00pm

Appointments 6772 5030

Pharmacy residency graduate Ms Tan Su Ching (left) is now able to train fellow NUH pharmacists on patient consultation.

10

NUH

news

bite

s

A Trip Less TravelledContributed by Dr Stephanie Young | Department of Ophthalmology

“A little boy and his mother cried as they looked into the mirror – the unilateral “droopy eyelid” was gone.

A man who had a large haemorrhagic cyst that lined the inside of the eyelids and covered the white part of his eye kept smiling in appreciation as he realised the black mass in between his eye and eyelid was a thing of the past.

They were but two of the 42 patients we saw during a recent trip to Yangon, Myanmar.

The Department of Ophthalmology at NUH has had a long standing relationship with major providers of ophthalmology services in the country, training local doctors in various ophthalmology specialities. The most recent trip was their eighth trip to Myanmar. It was led by Dr Gangadhara Sundar, Head of Orbit & Oculofacial Surgical Services, accompanied by Dr Thet Naing, Resident Physician, Opthamology and myself.

Despite having gone on several medical trips, nothing prepared me for the whirlwind of events that were to unfold during our three days in Yangon.

day 1 Early Monday morning in the capital city started out ordinarily enough. A quick breakfast before we were whisked off to Yangon Eye Hospital. That was where all normality ended. For hours on stretch, we saw patients with a wide range of eye conditions - various forms of eye-related tumour condition, orbital disorders, lid disorders and so on. We were to learn that some had travelled long distances for the consult. Racing against time to attend to as many patients as possible, we took time to discuss each case with the local team of doctors.

day 2 Teaching continued in the operating theatre as we performed various complex orbital, eyelid and lacrimal procedures. Some were being performed for the first time at the Yangon Eye Hospital, we were told.

day 3 Post-operative review was the order of the day. The outcomes ranged from good to excellent. We emphasised on pre-operative evaluation, treatment planning, principles of surgery, risk management and postoperative care, including multi-disciplinary care when indicated.

I was amazed by how much one could do in 72 hours, and also struck by how much our surgeries had impacted the lives of each individual. The patients, as well as their relatives, were extremely grateful.

It was not just the patients who benefited. The local doctors who had assisted or watched the surgeries were equally excited to see how the procedures they had learnt could help their patients.

The trip was extremely challenging yet rewarding both to us and the local team. We shared our knowledge and expertise, in the process built good rapport with our Myanmese colleagues.

To help those in need, to know that someone trusts you with his body, to feel gratitude from someone you know you have helped - these are the reasons for many of us to become doctors. From time to time, we grow wary or jaded. But sometimes, if we reach out, take a trip less travelled (even if it was just for three days), we can once again touch and be touched by the human spirit – this feeling can never grow old.”

“We are here to add what we can to

life, not to get what we can from life”

William Osler

11

healt

h m

atte

rs

Giving Baby A Headstart By Breastfeeding

Tips on breastfeeding:

1 Place baby on the mother’s chest immediately after birth. This helps baby familiarise himself with the mother’s breast so he can feed whenever he is ready.

2 Room-in with baby day and night to allow breastfeeding on demand and to promote bonding. Frequent feeding helps in establishing milk supply.

3 Breastfeed “on cue” according to the baby’s demand and as soon as the baby shows signs of being ready to feed.

4 Recognise baby’s latch. This enables proper expression and good supply of milk, which in turn helps reduce painful nipples or engorgement.

5 Practise various breastfeeding positions such as cradle, cross cradle, football hold and side lying to find the preferred position that best suits mother and baby.

T hough it is a natural part of motherhood, breastfeeding is not instinctive. Lactation Consultant Wong Lai Ying from the NUH

Women’s Centre shares the facts, myths and benefits of breastfeeding.

• Breast milk is best for babiesBreast milk contains natural nutrients that are essential for the baby’s growth. It protects babies against infections and decreases the risk of obesity, Type II diabetes, allergies and childhood illnesses. Research has shown it enhances brain, cognitive and motor development. A UK Millennium Cohort Study (2006) reported that children who were breastfed exclusively for at least two to four months appeared to have more developed motor-coordination skills and dexterity, compared to those who have never been breastfed.

In addition, the anti-bacterial, anti-viral and anti-parasitic agents that act as an immunity booster in breast milk help with faster recovery from illnesses.

• Mothers benefit tooBreastfeeding reduces a breastfeeding mother’s risk for health conditions such as postpartum haemorrhage, breast, ovarian and uterine cancers, osteoporosis and cardiac diseases.

• Knowledge is keyNot all mothers have an easy let down of milk when breastfeeding for the first time. Mothers are encouraged to read up on breastfeeding and where they can seek support from before delivery. Typically, most mothers and babies will settle into a routine within two to three weeks after childbirth.

Myth Fact

Supply of breast milk is limited. Breast milk has a natural “auto-refill” production. Demand generates supply.

It is not safe to breastfeed when one is unwell.

It is fine to continue breastfeeding. Breast milk is a “life fluid” and contains a substance that increases the ability of the immune system to fight infection and disease.

Ask your doctor for medications that are safe for breastfeeding.

Baby prefers the bottle. Some babies may find it more difficult to latch. It may be because the flow is not established or the latching position is incorrect. Consult a lactation consultant. Try alternative feeding methods like a cup, spoon or syringe instead of a bottle teat.

More About breAst Milk

12

ask

the

expe

rt

co. Reg. No. 198500843RDesign by Red Ink communications

Ask The Expert By Johncy Concepcion | Senior Speech Therapist

Information in this newsletter should not be used as a substitute for medical diagnosis or treatment. Contents in this newsletter may be reproduced with the permission of National University Hospital.

Please contact:The Editor, LifelineCorporate CommunicationsNational University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 13, Singapore 119228Tel: 6772 4695 Email: nuh_enquiries@nuhs.edu.sgFax: 6774 0936 Website: www.nuh.com.sg

Is food always too chunky for you to chew and swallow? Do you frequently choke, or even vomit when you eat or drink? If your answer is yes to any of the questions, you may be suffering from

dysphagia, or difficulty in swallowing.

whAt is dysphAgiA?

Dysphagia is the medical term for swallowing difficulties. A person with dysphagia may encounter difficulties in moving the food within the mouth, swallowing, and moving the food from the mouth through the stomach. Some may even have difficulties sipping water.

who is At risk of swAllowing difficulties?

Dysphagia is usually caused by medical conditions that weaken or damage the muscles and nerves used for swallowing.

It affects up to some 67 per cent of patients who have had a stroke. Other common conditions that may cause dysphagia include head injuries, dementia, Parkinson’s disease and other neurological disorders. Patients with cancers in the head and neck may also experience dysphagia.

Individuals with respiratory disorders may be affected as these conditions disrupt the coordination of breathing and swallowing.

whAt Are the syMptoMs of dysphAgiA?

Common signs of swallowing disorder include:• Frequent coughing and choking during meals • Uncontrolled drooling• Uncontrollable spillage of food and drinks out of the mouth • Sensation of food stuck in the throat or chest area

why is it iMportAnt to correct swAllowing difficulties?

The most common complication of dysphagia involves food and drink entering the airways or lungs (a condition known as aspiration) instead of being directed to the stomach. This may result in chest infection and in some cases, be fatal.

Managing Difficulty In Swallowing

Poorly managed dysphagia can contribute to malnutrition and dehydration. These increase the risks of complications, prolonged hospitalisation and lower quality of life. Dehydration can increase the risk of another stroke in patients who have had stroke.

if i hAve dysphAgiA, does it MeAn thAt i cAn only tAke liquid diet?

The answer is no. The speech therapist will recommend changes you can make to your diet in terms of texture and fluid consistency after an assessment of your condition. You may need to avoid certain food types (e.g. hard, crunchy, dry foods), to cut the meat and vegetables in smaller pieces or to blend the food.

Fluids may be thickened to aid safe swallowing.

how cAn dysphAgiA be treAted?

Risks of dysphagia may be reduced by the use of specific swallowing strategies. Some patients may be taught exercises aimed at strengthening the swallowing muscle and improving the coordination of their movement of these muscle groups. Some patients may need to take medicine or undergo surgery.

It is important to maintain good oral hygiene, as it significantly helps to reduce the growth of bacteria in the mouth that may potentially enter the airway or lungs together with saliva or food/drinks.