01-02-03 FLEx & A&E Marcus Ong V7 WF pathR2.indd 1 12/24/10 11:31 AM

reduced in ReLEx procedures.The benefits of the new procedure are

as clear as Ms Yap’s newly perfect vision. “I don’t have to fumble for glasses when I wake up in the middle of the night to attend to my kids. It’s such a relief! You have no idea,” she said.

“I love to be able to dress up and leave the house without worrying about glasses or contact lenses,” added Ms Manokaran.

What will then become of LASIK? As ReLEx becomes more widely used, it may eventually replace conventional LASIK.

“Over the years as we adopt new LASIK technology – just like Blackberry phone models – the results get better. And this is where ReLEx comes in – with it, patients now see even better,” said Prof Tan.

With wider use, the procedure will also become more affordable. Currently, ReLEx costs $2,500 per eye including post-operative care.

Reversible treatment?Cutting out an intact piece of corneal tissue has given researchers another idea – can this myopic lens be preserved and used later in a person’s life to correct pres-byopia or long-sightedness?

“Let’s say, you get presbyopia later on in life after ReLEx. In theory, we can retrieve your stored myopic lens, laser away the surplus negative value on the lenses and place them back into your cornea to correct your presbyopia in one eye, essentially providing you with mono-vision, so one can see near again,” said Prof Tan.

A team of researchers at Singapore Eye Research Institute (SERI), the research arm of SNEC, is now looking at freezing and storing discarded lenses in liquid nitrogen, a method known as cryopreser-vation, commonly used for storing cord blood and stem cells.

So when presbyopia eventually occurs years later, a patient could choose to have his cut lens re-implanted into one of his corneas, to counteract the presbyopia and eliminate the need for reading glasses, or to modify refraction if it changes with time.

SERI researchers hope to prove the reversibility of ReLEx in initial trials, which started in late 2010.

02 sINgAPOrE HEALTH JAN⁄ FEB 2011

News> Continued from page 1

Smile – no more glasses!

“ReLEx is a natural progression from LASIK. ReLEx performs a very precise cut inside the cornea to laser out a lens-shaped amount of tissue to match the degree. We then remove this lens and the myopia is gone,” said Prof Tan.

Excellent resultsSo far, the procedure has a 100 per cent success rate. It is also more accurate than LASIK, which is especially beneficial to those with higher degrees of myopia, between 500 and 1,000 degrees.

“This is currently the most advanced procedure available. And it only takes 30 seconds to perform the correction as this laser is extremely fast and uses very low energy, so there is less discomfort for patients,” said Prof Tan.

SNEC conducted a study of 24 patients who underwent LASIK and ReLEx (one procedure in each eye) and found that more than 75 per cent of them preferred ReLEx, as there’s less discomfort during and after surgery.

reLEx may be more accurate than LAsIK, especially for higher degrees of myopia.

reLEx is faster to perform than LAsIK as only one laser is used.

reLEx may be potentially reversible, while LAsIK is irreversible.

ReLEx vs LASIK

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Procedures such as ReLEx correct refractive errors (which cause myopia) by changing the shape of the cornea.

ReLEx uses a single laser to make a precise incision on the patient’s cornea.

The flap is lifted to laser out an intra-corneal lens matching the patient’s refractive error.

The lens is removed (and possibly stored cryogenically for later use) before the flap is replaced.

1Refractive Lenticule Extraction (ReLEx)

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The flap will take some time to heal, but the patient feels very little discomfort after the surgery.

Over the years as we adopt new LASIK technology – just like Blackberry phone models – the results get better. And this is where ReLEx comes in – with it, patients now see even better.PRofESSoR DonALD TAn, MEDIcAL DIREcToR, SIngAPoRE nATIonAL EyE cEnTRE

Another patient who has undergone ReLEx is Ms Gayathri Manokaran, a lab researcher who opted for this procedure to correct her mild myopia and astigma-tism, so she could continue to pursue her new hobby – diving.

“I got my diver’s license recently, but it’s really quite futile if I can’t see under-water,” said the 31-year-old. “The proce-dure was so painless, I didn’t even realise it was over.”

ReLEx also feels more comfortable for the patient because the suction on the eye during the treatment is gentler.

“Patients are also able to see the ‘aiming beam’ better because of the gentle suction, so there is almost no occurrence of what doctors call ‘light blackout’ during the treatment as compared to LASIK,” said Prof Tan.

Light blackout is a phenomenon in which the laser beam the patient is told to focus on during the procedure vanishes when the patient moves his eye.

This temporary disappearance of the focal point can cause panic. However, the incidence of light blackout is dramatically

JAN/FEB 2011 sINgAPOrE HEALTH 03

News> Continued from page 1

New tool better predicts cardiac arrest

Associate Professor Marcus Ong, Director of research and senior Con-sultant, Department of Emergency Medicine, singapore general Hospi-tal (sgH), has long been involved in research to improve the access to and the delivery of acute care.

Last year, he led a team to look for patterns in 995 calls. Analysing thou-sands of emergency calls, the team found that Mondays had the highest number of calls. This number gradu-ally dipped as the week progressed.

The researchers also found that the number of calls made during the

identify 40 out of 100 patients for urgent care correctly.

Now, there is a more accurate test developed by a team of clinician-scien-tists and researchers from Singapore General Hospital (SGH) and Nanyang Technological University (NTU). The team’s study found it to be able to identify 67 out of 100 patients who needed urgent, crucial care correctly.

“Our tool is 50 per cent more accurate in assessing a patient’s risk of cardiac arrest,” said Associate Professor Marcus Ong, Director of Research and Senior Con-sultant, Department of Emergency Medi-cine, SGH, and inventor of this tool.

The tool uses electrodes that are attached to the patient’s arms or chest, to track signals from the heart, including heart rate variability. The information is transmitted to a machine where it is recorded, and then analysed in combina-tion with other risk factors such as age and blood pressure.

Co-inventor and Associate Professor at NTU’s School of Electrical and Electronic Engineering, Lin Zhi Ping, said: “This device combines the art of medicine with

the science of computer engineering. We’re replacing the subjective assessment of the patient with an objective and stan-dardised risk score.”

Even so, said Assoc Prof Ong: “This new triage tool cannot replace a clini-cian’s judgment.

“Its value lies in its ability to accu-rately quantify the likelihood of patients suffering a cardiac arrest.”

With resources such as beds, doc-tors and nurses being limited, giving priority to the critically ill is key.

“If I have two very sick patients that need an intensive care bed, and I only have one such bed left in the whole hospi-tal, who should get it? If for one patient, the tool indicates a risk score of 70, and the other scores a 40, then it is clear which patient should have higher prior-ity to get the

day almost doubled that made at night. “This may be related to diurnal pat-terns of the body and hormone activity levels that trigger medical events,” said Assoc Prof Ong.

The highest number of emergency calls came from the densely populated eastern part of singapore, while the neighbourhoods in greatest need of an ambulance were in the north and north-east. This research was published in Annals Academy of Medicine in 2009.

since then, Assoc Prof Ong has led another study to test a simple, low-cost change in ambulance deployment. The

team gradually increased the number of ambulances on standby during the day and reduced the number working overnight, when a smaller number of emergencies are reported. They also spread the locations where ambu-lances were stationed to cover a wider area.

They discovered this significantly reduced the response time of ambu-lances to calls relating to patients suffering cardiac arrests. Cardiac arrests are usually fatal if patients are not promptly resuscitated and given appropriate medical care.

The team published its findings in Academic Emergency Medicine Jour-nal in september 2010.

resources,” said Assoc Prof Ong.To test the new tool, the team

used the data of 425 patients who were seen at SGH A&E

for heart-related complaints between November 2006 and December 2007.

The new tool correctly identified 70 per cent of patients who suffered a car-diac arrest.

Up to 500 patients are seen at the SGH A&E every day.

Often about half of them have acute cardiovascular symptoms,

such as chest pains, and stand to benefit from this tool, which will

help to identify those at risk of severe consequences, such as cardiac arrest.

The SGH-NTU team is working with a commercial partner to develop a proto-type and start a clinical trial to validate the initial findings.

“Currently, the tool is a software installed on a laptop. But carrying a laptop around is not very convenient. So we’re aiming to build it into a small box,” said Assoc Prof Lin.

Eventually the tool can be used not just in A&Es, but also in high-depen-dency wards, nursing homes and even disaster zones.

“This tool can be used to identify those disaster victims who need to be evacuated to more specialist facilities,” said Assoc Prof Ong.

The SGH-NTU team presented their data at the SingHealth Duke-NUS Sci-entific Congress and at the American Heart Association’s Scientific Sessions in Chicago, Illinois. The research was funded by grants from SingHealth Foundation and NTU.

If for one patient, the tool indicates a risk score of 70, and the other scores a 40, then it is clear which patient should have higher priority to get the resources.ASSocIATE PRofESSoR MARcuS ong, DIREcToR of RESEARch AnD SEnIoR conSuLTAnT, DEPARTMEnT of EMERgEncy MEDIcInE, SIngAPoRE gEnERAL hoSPITAL

Electrodes track signals from the heart, then combine the results with other risk factors to help medical staff assess a patient’s risk of cardiac arrest.

Spotting a pattern

Assoc Prof Ong found patterns in 995 calls that can improve ambulance deployment.

Heart rate variability is the change in time interval between heartbeats, from beat to beat. since ancient times, decreased heart rate variability – or when the heart beat pattern is unable to adapt to stress or illness – has been associated with an increased health risk.

Wang shu He, the military doctor to Cao Cao’s army in the Western Jin dynasty, published a book known as

The Pulse Classic or Mai Jing. In it, he described pulse positions and estab-lished 24 different types of pulse. He wrote: “If the pattern of the heart beat becomes as regular as the tap-ping of a woodpecker or the dripping of rain from the roof, the patient will be dead in four days.”

But because calculating heart rate variability involves a number of complex mathematical formulae, its clinical application in evidence-based medicine has been limited. It is only some 2,000 years later that research-ers at singapore general Hospital and Nanyang Technological University have been able to incorporate real-timse heart rate variability into an effective clinical-decision support tool.

The risk of a regular heart pattern

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A word of warningAlthough Dr John Chia, Consul-tant, Department of Medical Oncology, National Cancer Centre Singapore hopes to see more Singaporeans come forward to participate in this trial, which aims to recruit more than 2,600 patients from around the region, he strongly warns against taking aspirin to combat colorectal cancer without medi-cal supervision because:

Unmonitored consumption of aspirin can cause stomach ulcers or bleeding from the gas-tro-intestinal tract.

Those who have an allergy to aspirin will have negative or life-threatening reactions.

Patients who are already on anti-coagulants such as Heparin and Warfarin for the treatment of heart diseases, and indi-viduals who have a high risk of bleeding, cannot take additional anti-coagulants.

04 SiNgAPOre HeAlTH JAN⁄ FeB 2011

Two thousand years ago, Hip-pocrates, the father of medicine, called willow tree bark, a medicine capable of curing all maladies. While not quite living up to Hippocrates’ ambitious boast, the plant, or more accurately the salicylate-rich extract from which aspirin is made, has been proven to fight aches and pains as well as more serious condi-tions such as strokes and heart attacks. Now doctors are putting aspirin, a three-cent tablet, to the test to stop colorectal cancer from coming back.

Colorectal cancer, which affects around 1,500 people a year in Singapore, is caused when polyps in the intestines grow signifi-cantly and become cancerous. Even after surgery and chemotherapy, these polyps can regrow and may become cancerous again, which is why the cancer returns for 30 to 40 per cent of patients.

“Aspirin and its class of drugs have been shown by robust clinical trials to reduce the onset of polyps by quite a sig-nificant degree,” said Dr John Chia, Con-sultant, Department of Medical Oncology, National Cancer Centre Singapore. “That means aspirin can prevent the precursor lesions (polyps) of colorectal cancer.”

Other studies suggest an even more di-rect link – that aspirin can actually reduce the number of recurring colon cancer cases. “Researchers at Harvard have car-ried out studies looking at groups of pa-tients who either were or were not taking aspirin. Those colon cancer patients who took aspirin

A three-cent drug may save you more than a headacheCancer specialists hope to prove that aspirin reduces relapse rates for colorectal cancer

News

BY Jacqueline chiahalved their risk of the cancer recurring, as well as their risk of dying from it,” said Dr Chia.

But because these studies are not clini-cal trials, and the researchers did not ac-tively intervene and assign the patients under observation to take aspirin, there is insufficient grounds to introduce this use of aspirin into clinical practice.

“To change clinical practice, you need to do a trial like we are doing, and ours is the first in the world,” said Dr Chia, who with his team is driving the collaboration with hospitals around the region.

“We are quite excited. If we succeed, we would really have done something to help people who suffer from colorectal cancer. Not just in Singapore or in first-world countries, but also in developing nations since aspirin is relatively inex-pensive,” said Dr Chia.

Aspirin and its class of drugs have been shown by robust clinical trials to reduce the onset of polyps by quite a significant degree.Dr John Chia, Consultant, Department of meDiCal onCology, national CanCer Centre singapore

After surgery to remove the cancer and completing chemotherapy, suitable patients are asked if they would like to participate in the trial. Patients who con-sent will be randomly assigned to either receive aspirin or a placebo for three years. The team will closely monitor patients’ health and wellbeing.

Rather than being discouraged by the possibility of receiving a placebo, even pa-

tients on a placebo have been found to fare better than those not participating in clinical trials, said Dr Chia. This is at-tributed partially to the diligent health monitoring that clinical trials require. “If you miss a follow-up, you’ll get a call from us immediately,” said Dr Chia.

Aspirin may be key to preventing the recurrence of colorectal cancer.

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The most intimate parts of our bodies demand the most intimate care. That’s why there’s BETADINE®. The unique formulation of BETADINE® works by killing the 3 groups of organisms that may cause vaginal infections – bacteria, viruses AND fungi. So you’re protected. In more ways than one.

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06 News-BabyBluesV3 path.indd 6 21/12/2010 10:31:35 AM

Jan⁄ Feb 2011 singapore health 07

Instead of roaring F1 cars tear-ing around Singapore’s Grand Prix route, some 1,000 cyclists will be pedalling a 4km loop of the street circuit on March 6 to celebrate life after cancer.

The event, Cycle of Hope, aims to heighten awareness of cancer and how it affects not just patients, but also their families and friends. “A cancer patient’s journey is like a cycle ride,” said Profes-sor London Lucien Ooi, Chairman, Divi-sion of Surgery, Singapore General Hospi-tal, and Advisor, National Cancer Centre Singapore (NCCS).

“Their journey has ups and downs, easy and difficult parts, but there is always a goal to reach. The bicycle, in a way, represents the patient’s supporters – the healthcare providers, caregivers and family – who carry and accompany the cyclist through it all, however tough the journey may be.”

Besides awareness, participants are

Cycling for cancerCharity cycle ride aims to raise awareness and funds

By Nicole lim

by paying tuition fees for the patients’ children, for example.

Now in its second year, Cycle of Hope was the brainchild of Prof Ooi, and is part of OCBC Cycle Singapore, thanks to the generous support of OCBC and Spectrum Worldwide, the organisers of the event.

Cycle of Hope gathers cancer survi-vors and their supporters for an event which shows cancer survivors can live life to the full. Last year, some 500 participants showed their support. This

year, organisers are hoping to double that number.

“I was there last year with colleagues, supporters and friends from NCCS. The Pink Paddlers were also out in their best shocking-pink outfits, and we hope to see them and many more again this year,” said Prof Ooi.

Cycle of Hope is one of many activi-ties organised by NCCS to raise funds and awareness. In November 2010, some 7,000 people took part in the Run for Hope, rais-

ing more than $320,000 for the National Cancer

Centre Research Fund.

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encouraged to get sponsorship from friends and family, which will go towards the National Cancer Centre Research Fund. This fund is used to sup-port research projects as well as families of cancer patients,

Date: March 6, 2011 Flagoff: 9.45am

Register: www.ocbc.cyclesin-gapore.com.sg

Prizes: the 50th registrant wins a bicycle worth more than $300,

donated by lianhe Zaobao execu-tive photographer lee Keng siang.

Cycle of Hope

Instead of feeling bewildered by a complex hospital layout, visitors to Changi General Hospital (CGH) can now whip out their smart- phones, punch in their destination and a life-like 3-D version of the hospital pops up, guiding them to their destination.

Information at your fingertips

By Jessica JagaNathaN

From directions to a full listing of doctors, visitors at CGH can access it all on the go

chair users will include taking the lift, instead of escalators to get to their destination.

“We have two command screen menu options, one comfortable for standing and one reachable for wheelchairs, which is quite popular,” said Mr Yen Tun I, Assistant Director, Department of Facilities Plan-ning and Development, CGH.

“Other features you can find at the kiosk are advertisements. They allow for promotions to be featured, such as phar-macy promotions and announcements of

They can also access this informa-tion as well as a directory of specialists via self-service kiosks, located at the entrances to the wards and the Accident and Emergency Department at CGH.

The interactive touch screen uses a “way-finding system” to guide visitors to their destination, said Mr Liew Choon Leng, project manager of the 2m-tall 3-D kiosks.

Visually realistic, routes are scaled-down dimensions of the hospital, with colour coding cues and floor patterns rep-licated to make it easier for users to find their way through the hospital.

Since its introduction in September 2010, more than 100 patients and visitors have used the system to access directions or look up specialists.

Twenty-five-year-old Muhammed Ro-hani was impressed with the user-friend-liness of the kiosk. “It’s easy to under-stand and the colour characteristics are good, like a computer game,” said the civil servant.

At a touch of the screen, visitors can find the nearest doctor’s office, special-ist clinic, food court or toilet in four languages – English, Chinese, Malay and Tamil.

The kiosks come with two screens, with the lower half appearing at a height appropriate for wheelchair users. The routes mapped out for wheel-

The kiosks have been custom-made for wheelchair users.

At a touch of the screen, visitors can find the nearest doctor’s office, specialist clinic, food court or toilet in four languages – English, Chinese, Malay and Tamil.

public forums,” said Mr Liew, who is also Principal Systems Analyst, Information Services, CGH.

Two more kiosks will be added this year and will likely be located in the basement near the hospital’s carpark and at a high-traffic area.p

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Organization Accreditedby Joint Commision International

08 News-QI Project V4 pathR2.indd 8 22/12/2010 10:46:22 AM

We all experience sore throats from time to time. That’s why there’s BETADINE®. Its unique formulation kills the 3 groups of organisms that may cause sore throat - bacteria, viruses AND fungi. So your family’s protected. In more ways than one.

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CTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINEKILLINGÊEFFECTÊOFÊBETADINE¨̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈̈...............

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10.indd 4 22/12/2010 11:27:40 AM

Ms Cui Shu Li (right) and her team embarked on a study to explore the efficacy of acupuncture in treating male infertility.

Jan⁄ Feb 2011 singapore health 11

News

When it’s a problem with sperm – either what’s produced is insufficient or they are not active enough – acupuncture may be an alternative for couples trying for a family.

According to traditional Chinese medicine, commonly referred to as TCM, subfertility is caused by a deficiency of what it refers to as the kidney function. Using herbal remedies and/or acupunc-ture to strengthen this vital function can help improve the production and quality of sperm.

Although there have been studies, “we don’t really know how effective acu-puncture is in treating male subfertility”, said Dr Yong Tze Tein, Senior Consultant, Department of Obstetrics and Gynaecol-ogy, Singapore General Hospital (SGH).

This is because despite its growing popularity, TCM isn’t as well researched as western medicine, said Ms Cui Shu Li, Senior Principal Acupuncturist, SGH. For instance, studies elsewhere in the use of acupuncture to treat male subfertil-ity show positive results, but they can’t clearly isolate acupuncture as the sole cause of the improvement.

To explore acupuncture as an alternative for men with certain fertility problems, SGH has teamed up with Singapore Thong Chai Medical

Traditional treatment for a modern problem A new study aims to find out if acupuncture can help men with fertility problems

Couple therapyWhen a couple remains childless after years of trying, the woman is often thought to be the cause. however, blame should be apportioned equally, as about a third of cases is due to the man, with an equal portion attributed to female problems or to problems in both partners. another 10 to 15 per cent of cases have no known cause.

the modern lifestyle, food, environ-ment and late marriage may contribute to difficulty in conceiving in both men and women.

anecdoctal evidence suggests that male subfertility is increasing. “the impression is that sperm qual-ity is deteriorating,” said Dr Yong tze tein, senior Consultant, Department of obstetrics and gynaecology, sgh.

BY Vishwesh iYerInstitution to study whether using acu-puncture is as effective as earlier studies suggest. The institution already treats men with fertility issues using a combi-nation of acupuncture and herbal concoc-tions with some success, said Mr Chong Shaw Fong, Chief TCM Physician, Singa-pore Thong Chai Medical Institution.

In the joint trial, eligible participants will undergo 20 hour-long sessions of acu-puncture treatment, held twice a week for three months. The participants won’t be given other forms of fertility treat-ment during this period.

During treatment, a TCM physician or acupuncturist certified by the Ministry of Health will administer acupuncture

For that reason, it is not just the wife who will be tested when couples seek treatment at sgh’s Centre for assisted reproduction (Care), said Ms amy lee shaw ni, Care’s Chief embryologist. “it is extremely important in the evaluation of subfertility to consider the couple as a unit in evaluation and treatment.” however, in most cases, the men aren’t keen to step forward and most of the initial tests are done on the wives, she said. the good news is that this trend is slowly changing.

should the husband be found to have for instance, a low sperm count, reduced sperm movement, or too few sperm of normal form and shape, there are currently limited treatment options available. some men are amenable to hormonal treatment, while some require surgical retrieval of sperm for in vitro

Needling pointsa medical technique unique to tCM, acupuncture, with a history of more than 2,000 years, uses sterile silver needles inserted at various acupoints in the body to stimulate blood circulation, regulate the qi and blood, and restore the body’s balance.

fertilisation (iVF). but for a large major-ity of men, the cause is not known and that limits management. it could be genetic, but certain lifestyle factors like smoking can play a role.

iVF is an option in the treatment of subfertility for both men and women – but the procedure where the wom-an’s egg cells are fertilised by sperm outside the body and then implanted in the womb, costs about $10,000 and success is not assured.

the possibility of conception varies greatly, depending on the age of the female partner. pregnancy occurs in up to 40 per cent of women below 34 years old, and less than 15 per cent of women older than 40. so for young couples who are not ready for iVF, acupuncture might be an attractive alternative.

to several acupoints at the front and back of the body, with the points electrically stimulated to strengthen the kidney func-tion. In TCM, the kidney is considered vital for procreation, with the kidney function seen to be governing the body’s reproductive organs.

The trial, funded by a government grant, will continue till 2012. The research-ers hope to study at least 60 eligible par-ticipants. Semen samples will be taken before, during and after the acupunc-ture treatment to assess the participants’ response to the therapy. Participants can receive treatment at SGH, during work-ing hours, or in the evenings at Singapore Thong Chai Medical Institution.

Men between 21 and 55 years of age who meet a certain sperm count and activ-ity criteria, who have been unsuccessful in conceiving for at least a year, and have not undergone surgical procedures related to male fertility for at least a year before, can apply to participate in this trial.

To participate in the SGH-Thong Chai Medical Institute TCM trial or for more information, call 6326-5925.

Bai Hui

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tCM believes illness occurs when the body’s qi movements are blocked, disrupted or unbalanced, and that it can be cured by adjusting these imbalances back to normal through therapy that includes herbal remedies, acupuncture or exercise. Qi, loosely defined as the body’s energy flow, is supposed to circulate in the body’s channels known as meridians.

“the patient might experience sore-ness, heaviness, some tightness or numbness when the needle is inserted,” said Ms Cui shu li, senior principal acu-puncturist, singapore general hospital (sgh). During and after acupuncture, patients might also experience swell-ing, mild palpitations or bruising. some patients – less than five per cent – might have unusual symptoms like bleeding, pain or fainting that are temporary and go away quickly.

During treatment, you will receive acupuncture to these points to unblock the body’s energy flow.

12 singapore health Jan⁄ Feb 2011

News

BY Thava Rani

Many improvements made in SingHealth hospitals are the result of enterprising staff spot-ting and addressing a problem. These changes are often to the advantage of patients too, as these two projects show.

Sunday walkIt was Monday, just two days after surgery on his knee, and Mr Sreekumar Pillai was still in pain. Yet, he was sent to the gym for a second day of walking and other exercises with a physiotherapist.

Mr Sreekumar, who was injured in a soccer game in his 30s, was taught exer-cises to improve breathing, circulation and mobility. As the diseased or dam-aged portion of his knee joint had been replaced with metal and plastic implants, the 52-year-old aircraft technician was also taught techniques to strengthen the knee and increase the range of movement.

“The first two days after surgery are crucial (for recovery),” said Ms Ong Peck Hoon, Principal Physiothera-pist, Department of Physiotherapy, Singapore General Hospital (SGH).

Patients who receive knee replacements are mostly in their late 60s, suffering from severe osteoarthritis or a knee injury sus-tained when they were younger. It is important they start phys-iotherapy as soon as possible to reduce swelling and pain, and post-surgery complications such as deep vein thrombosis and bed-sores. They also need to learn to walk again.

Sometimes, the simplest ideas make huge differences to the lives of both patients and staff

Bug fixers“When the patient has been guided to

walk a couple of times, he will feel more confident, and will then be more keen to walk on his own, for example, to the toilet with assistance (instead of using a bedside commode or wheelchair). This will help him recover faster,” she said.

Certainly, Mr Sreekumar was glad to do the exercises. “If you don’t see the ther-apist, you most probably wouldn’t move as you don’t know what you should do,” he said.

While the principle to get patients up and about quickly is well understood, it is not possible for some patients to start physiotherapy the day after surgery or for them to have uninterrupted daily ses-sions, as there are no regular physiother-apy services on Sunday.

Patients who undergo surgery on Friday or Saturday, thus, face a gap in this service. Mr Sreekumar, for instance, had surgery on Saturday and would have started physiotherapy only on Monday.

A challenge by the late Dr Wong Yue Sie, who was SGH Chief Operating Offi-cer, to make services more accessible

to patients, prompted

The team compared the results of the programme with data from the same four months a year before, and from the four months before the pilot programme, and found that patients in the pilot pro-

gramme who had the benefit of Sunday physiotherapy generally recovered faster and were dis-charged earlier (after four instead of five days). Patients discharged a day earlier saved on charges for an additional day. Early discharge also increased bed availability.

The project received the best oral presentation award (Allied Health category) at this year’s SingHealth Duke-NUS Scientific Congress, which

gathered some 2,000 scientific and medical professionals from SingHealth and overseas to exchange ideas, and learn best practices.

More importantly, patients who undergo knee replacement surgery on Friday or Saturday benefit from having access to a physiotherapist on a Sunday. “We are seeing some spine surgery patients as well now. Plans are underway to eventually expand the service to include patients who are likely to benefit from early intervention, such as patients who have undergone hip surgery,” said Ms Ong.

Tasting rightPeople with swallowing difficulties often have to put up with unappetising, thick-ened fluids to maintain a healthy weight. Not surprisingly, Changi General Hospi-tal (CGH) found that more than 70 per cent of these patients disliked the oth-erwise nutritious concoctions so much, they wouldn’t eat enough. As a result, they became malnourished or ended up back in hospital.

To tackle this problem, a team of dietitians and speech therapists cooked up some 60 recipes, using natural foods to thicken the special liquid diets. The recipes, such as fruity soy curd shake or thick spinach soup, are easy to prepare at home. Families who buy commer-cial powders can save more than $100 a month if they use CGH recipes instead.

Since CGH introduced the recipes, more than 70 per cent of patients now eat enough. With patients eating better at home, repeat hospital visits are down

and caregivers also feel more confi-dent that they can look after them. To further improve the care these patients receive, the two depart-ments set up a joint clinic.

“We thought a combined approach of reviewing malnour-ished patients with swallowing dif-ficulties would make it easier for patients, who would have to spend less time waiting (for two separate appointments), and for dieticians and speech therapists (who can make a joint assessment of their needs right here),” said Mr Alvin Wong, Dietitian, Department of Dietetic and Food Services, CGH.

In the pipeline is a DVD to train caregivers after patients are discharged, as well as a specialist clinic to attend to such patients.

Their efforts have won several awards, including the Asian Hospital Man-agement Award for Departmental Service Improvement and a handful of awards from the CGH Quality Convention Forum. p

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If you don’t see the therapist, you most probably wouldn’t move as you don’t know what you should do.

Mr SreekuMar Pillai, 52, Patient

physiotherapists with the Depart-ment of Orthopaedic Surgery to look into this issue. In October 2009, the team started a four-month Sunday physiotherapy pilot programme for patients who underwent total or partial knee replacement sur-gery on Friday or Saturday. Ms Ong led the team, which included fellow physiothera-pists, Dr Pua Yong Hao and Ms Chong Hwei Chi, and Dr Lo Ngai Nung, Senior Consultant, Department of Orthopaedic Surgery, SGH.

Ms Ong helps patients overcome their fear of moving, especially on the first day after surgery, when there is a lot of pain and swelling.

The CGH team developed appetising recipes such as fruity soy shakes for patients with swallowing difficulties.

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Glucosamine acts more like a lubricant in the joints while collagen contributesto the global regeneration of the joint at all levels: tendons, ligaments, carti-lage, muscles, membranes and synovialliquid (lubrifi cation).

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14 singapore health Jan⁄ Feb 2011

What exactly does a patient relations officer do?As part of the Concierge team, I guard the premises, ensure the safety of the patients and staff, and escort VIPs when they visit. I also attend to warded patients who become violent, and help patients who come to the information counter, often assisting them to their destination. My job is to wait for patients too, helping them from their vehicle and into a wheel-chair or onto a trolley. How would you describe yourself?I’m careful. I love hygiene and good grooming. I like to smile. I’m courteous and polite. I also like to greet and help people. My uniform is my pride – I always keep it pristine, my shirt crisp and white, and my shoes freshly polished and shiny.

Is this something you’ve always wanted to do? I’ve always wanted to help people. I started working for the Thomson Road hospital on July 14, 1969 – 41 years ago! I then worked for the old Toa Payoh Hospi-

Age is no barrierHira Lal Parsad, Patient Relations Officer, Changi General Hospital, 62, spent the last 41 years (working) in a hospital

tal, and in 1996, I joined Changi General Hospital. During this time, I worked in security, as an ambulance driver, in medi-cal gas supply, and finally as a patient relations officer, a post I’ve held for the past 20 years. I love this job. If I could, I’d work another 41 years for this hospital!

We hear you speak many languages…I speak six languages: English, Malay, Chinese, Punjabi, Hindustani and Tamil. Patients are always very happy and sur-prised when I speak to them in their native language. Sometimes, I act as an interpreter for doctors and patients at the clinics.

What is the secret to success in your position?You must willingly do it. Never say no before you’ve tried something. Also, a lot of patience, acceptance and tolerance is needed. Accept the things you cannot change and work out how you can manage your responsibilities and patients’ needs. Never say no. Always try to find a way to do it.

Always establish and maintain eye contact and greet visitors sincerely, no matter how old or young they are.

What are some challenges of your job?Being assaulted by patients and visi-tors. I was once punched in the face by a drunk visitor. Off-duty police officers nearby arrested him straightaway. The other incidents involved patients on the wards who turned violent. One attacked me wielding a standing fan. But I stepped back, remained calm and let my col-leagues restrain them. I tell myself that they are patients and are unwell.

We hear you

from the heart

Fasting before a blood testWhy do I need to fast overnight before a blood test? Will patients taking tests that require fasting be given priority over others? Blood tests are done to check for preg-nancy, diabetes, cholesterol and vitamin and mineral problems. There are two main groups of tests that require fast-ing – blood sugar and lipids tests. Some examples include those measuring levels of blood glucose for patients suffering from diabetes, and triglyceride levels for heart patients.

During the day, the normal range of blood sugar and lipids undergoes changes, depending on the ingestion of food and drink. For instance, the concentration of triglycerides – a type of fat in the blood that is often tested as an indicator of heart health – increases after a meal. The effects of a meal on the levels of certain chemical substances in the blood can be felt even after 12 hours. So by fasting overnight, a blood test result will not be influenced by a recent meal.

Certain food compo-nents can also interfere with the analysis of some types

Do you have questions about hospital admissions, bills and procedures? E-mail us at editor@sgh.com.sg and we will address them in this section.

of tests. For example, a meal rich in fats can cause cloudiness in a blood sample, which might compromise the accuracy of the laboratory analysis.

Most of these food-related changes are temporary and can be controlled by a

simple overnight fast. About 80 per

cent of the tests done every day at SingHealth poly-

clinics require fasting. There-

fore, patients

to callers. This is not a general healthline that provides automated or pre-recorded information.

In order to bring this service to you, the hospital needs to maintain a whole range of facilities and provide staffing and resources, which incur operating expenses. The charge of 80 cents a minute is meant to cover only some of these costs, so we can continue to maintain this ser-vice for our patients and members of the public who need to consult us urgently.

The average duration of a call is about 3 to 5 minutes, and costs approximately $3 to $4.

- Associate Professor Ng Kee Chong, Deputy Chairman, Division of Medicine, KK Women’s and Children’s Hospital

i was admitted to sgh Ward 58 for a traffic-related injury and would like to thank the doc-tors and nurses for their kind-ness, help and care. the room i was in was also very clean and tidy, thanks to the hardwork-ing cleaner who mopped and cleaned the room in the morning and afternoon. i had a pleasant stay in this ward. - K Kuo

Dr lim see lim from national heart Centre singapore pro-vided advice on my condition, he was always ready to comfort and encourage me. he was a very helpful and friendly doctor who displayed professional and excellent skills. - Y T Tan

on the fourth day after my bypass, i was given sugar lac-tose and experienced trouble with my bowels. Ms pedrola rolyn almeria from national heart Centre singapore brought me to the toilet immediately and helped me undress. she gave me clean trousers and attended to me extremely well. she respected me and was very attentive. she was polite, caring and helpful. - N P Naidu

tributes

who are not required to fast are recommended to go for their tests in the afternoon when the polyclinics and SGH specialist out-patient clinic labora-tory are less crowded. They should also avoid the day before and after a public holiday when more patients are expected to turn up for tests.

- Department of Pathology, Singapore General Hospital

pay for advice?I needed to call KK Hospital for advice when my baby was running a high fever. A friend of mine suggested that I call KK-Ask-A-Nurse, but she also told me that I would be charged 80 cents a minute. Why are these calls charged at a premium rate?

KK-Ask-A-Nurse is a telephone advisory service for women and parents who seek reliable expert advice on issues related to pregnancy, gynaecological care and children’s health. The service is available from 8am to midnight every day of the week, including public holidays.

The service is manned by experienced and trained nurses, who provide advice

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A teaspoon or a tablet of one of these can kill a one-year-old child.

“Oral medications usually take about 30 minutes to an hour to work. Giving more will not result in the medication working faster,” he said.

Potential side effects vary according to the dosage given and the type of medica-tion. For example, while the effects of tak-ing an overdose of runny nose or cough mixture may be felt in four to six hours, liver failure caused by paracetamol poi-soning will not occur until two to three days later, said Assoc Prof Ng.

Deadly doses

Jan⁄ Feb 2011 singapore health 15

Do you really know what you’re using to medicate your kids? by Jessica Jaganathan

Health p16

Almost half the par-ents surveyed by Aus-tralian researchers said they might have given their children the wrong dose of common over-the-counter drugs, putting their chil-dren’s health, and even lives, at risk.

While parents here are more careful when giving such medi-cines to their children, a paracetamol overdose is still among the top three most common drug-related emer-gencies seen at KK Women’s and Chil-dren’s Hospital (KKH) Accident and Emergency (A&E) department.

Apart from paracetamol, other drugs commonly given in the wrong doses include ibuprofen to bring down a fever, as well as cough and runny nose medication, said Associate Professor Ng Kee Chong, Senior Consultant and Head, Department of Emergency Medicine, KKH.

“Over-the-counter medications will have been approved by regulatory author-ities such as Health Sciences Authority, and are by nature relatively safe, if taken as instructed,” said Assoc Prof Ng, who is also co-chair and member of the Ministry of Health’s Clinical Practice Guidelines on Toxicology.

But confusing instructions are still among the leading causes of medication error, according to overseas studies. Oth-ers include lack of dispensers and varying units of measurement.

“Also, children grow and what was effective for a younger child may not be enough when he is older and heavier,” said Assoc Prof Ng.

Beauty p18What labels tell us

a spoonful of what?a spoonful of cough syrup can mean different things depending on where in the world you are.

One way for parents to prevent chil-dren from taking an overdose of medica-tion is to have only one person responsible for administering medication.

“Otherwise, too many cooks may spoil the broth,” said Assoc Prof Ng.

Giving different medicines at the same time might lead to an accidental overdose and parents should check the active ingredients to make sure they aren’t the same before doing so.

More is not necessarily better either.

Keep out of children’s reachthere are specific medications, mainly prescription-only drugs that are poisonous for young children.

“We’ve seen very young infants at a&e who had intermittent breathing (known as apnoea) after being given ‘flu’ medications like chlorpheniramine (a type of antihistamine),” said associate professor ng Kee Chong, senior Consultant and head, Department of emergency Medicine, KK Women’s and Children’s hospital.

Camphor pure camphor cubes are sold packaged like sweets in indian shops for religious burning

Antidepressants

Antimalarials Drugs used for the treatment of malaria

Anti-arrhythmics Medicines used to treat heart rhythm disorders

Calcium channel blockers Used to treat conditions

like high blood pressure

Methyl salicylate Found in wintergreen oil and muscle-pain relief productsTheophylline a drug

used to treat respiratory diseases such as asthma

Oral hypoglycaemics anti-diabetic drugs

Narcotics addictive drugs used to reduce pain and usually to induce sleep

Antipsychotics tranquilising psychiatric medication

If an over-dose of medicine is taken accidentally, children should be rushed to the hospital where doctors will first make sure the child’s vital signs, breathing and circulation are stable, and his airway is clear.

They will then try to minimise the absorption of the medication into the body by pumping the stomach, induc-ing the child to vomit or giving oral activated charcoal. If the medicine is absorbed into the bloodstream, an antidote will be given.

When in doubt, parents should consult the pharmacist before buying medication for their children, said Assoc Prof Ng.

In Singapore, parents have to be aware that when doctors talk about dosages for children, they usually refer to the number of milligrammes the child needs – not millilitres – as concentrations of drugs vary between brands and the former provides a more accurate dosage, said Associate Professor Ng Kee Chong, Senior Consultant and Head, Department of Emergency Medicine, KK Women’s and Children’s Hospital. These dosages are normally calculated based on the milligrammes of medication required per kilogramme of the child’s weight.

Dose/Country United Kingdom United States

1 teaspoon 3.55 ml 4.9 ml

1 tablespoon 17.7 ml 15 ml

Watch that blood pressure

Fitnesspregnancy fitness

p17

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16 SIngAPoRE HEAlTH JAn⁄ FEB 2011

health

Managing high blood pressure requires more than medicine. By Rachel Chan

Don’t let the pressure build

When he was first diagnosed as suffering from high blood pressure, Mr Ho Teow Seng was a little scared. “I was already diagnosed with diabetes about two years before that,” he said. “I was worried that if I didn’t control these conditions, my health would worsen.”

But the medication his doctor pre-scribed didn’t agree with him. “I felt gid-dy and light-headed,” Mr Ho said.

Side effects with blood pressure medi-cations are common but mostly mild, said Dr Sng Wei Kwan, Clinic Director, SingHealth Polyclinics – Outram.

happy with the four anti-hypertensives which are keeping his blood pressure under control.

“It’s not just about taking medication. To manage a chronic condition like high blood pressure, you need to have a trust-ing relationship with your doctor,” said Mr Ho.

“You need to listen to his instructions on how to take the medicine and follow his advice on lifestyle changes.” Mr Ho takes his medications diligently and cuts down on snacks, oily and salty food.

He likes his doc-tor so much that he has continued to consult him even

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white coat syndromeTo avoid misdiagnosis of high blood

pressure, doctors recommend that you take deep breaths and relax. “Don’t smoke or drink caffeinated drinks just before seeing the doctor,” said Dr Sng, as both can affect the reading. “It is best to rest for approxi-mately half an hour before a blood pressure reading is taken.”

Studies have shown that up to 25 per cent of patients have higher blood pressure readings than normal when their blood pressure is measured at a clinic. “This is referred to as white coat syndrome,” said Dr Sng. “The elevated blood pressure is usually due to increased anxiety patients feel when visiting the doctor.”

after he moved, first to Bukit Merah Poly-clinic and then to Outram Polyclinic.

When is blood pressure high?There are usually no symptoms in pa-tients with high blood pressure, which is why it is known as a “silent killer.” But uncontrolled high blood pressure can lead to complications like stroke, heart attacks and kidney failure requiring dialysis.

“Some 95 per cent of patients suffer from essential or primary hypertension which has no specific identifiable cause. But there are risk factors relating to hy-pertension, like a family history of high blood pressure,” said Dr Sng.

He advised those who are 40 and above to go for annual health checkups. If they discover that they have high blood pres-sure, they should adopt a healthy lifestyle, cut down on smoking and alcohol, watch their weight and exercise regularly. They may also need to start taking medication to keep their blood pressure under control.

“Pregnant women who suffer from pre-existing high blood pressure or de-velop hypertension during pregnancy require closer monitoring and should be managed by their obstetricians as they are at higher risk of developing complica-tions,” added Dr Sng.

Managing high blood pressure “It is important that the medication pre-scribed is tailored to the patient, depend-ing on his pre-existing medical conditions and the allergies or adverse reactions he might have to certain drugs,” said Dr Sng.

He added that it is crucial for patients to take their medication regularly, to consult their doctors if they experience any side effects or have difficulty comply-ing to the medica-tion regime.

If your reading is still not within target, your doctor might take the read-ing again. He might also suggest that you monitor your blood pressure at home with an electronic blood pressure moni-toring device, to get a more accurate measure of your normal blood pressure. This can avoid unnecessary increase in the dosage of your medication or changes to your treatment.

Listen to your doctor’s instructions for medication and lifestyle changes as these are tailored for you.

Some 95 per cent of patients suffer from essential or primary hypertension which has no specific identifiable cause.

Dr sng wei kuan, clinic Director, singhealth polyclinics – outram

“Some patients might experience side effects such as lower limb swelling, light-headedness or a dry cough. While most of them are not dangerous, patients should inform their doctor who will adjust or change the medication to eliminate or minimise any side effects,” he said.

Mr Ho saw another doctor and tried again. But the new medications he was prescribed were no better.

It was not until he went to his local polyclinic in Marine Parade that he met a doctor who started him on the right medications. Now, the 73-year-old is

Handy Cure is reported to help relieve nagging pains.

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Jan⁄ Feb 2011 singapore health 17

Fitness

Unless a health condition or complication develops that demands complete bed-rest or hospitalisation, women can – and should – do some form of exercise during pregnancy.

“Staying fit during pregnancy helps women cope better with the physical demands of pregnancy, labour and moth-erhood,” said Dr Tan Wei Ching, Consul-tant, Department of Obstetrics and Gyn-aecology, Singapore General Hospital.

Regular exercise, she added, builds bones and muscles, and exercising at

least 30 minutes, five to seven days a week can benefit women in a va-

riety of ways. Exercise relieves backache, constipation, bloat-

ing and swelling. It can help prevent or treat ges-

tational diabetes – the diabetes that some

women develop dur-ing pregnancy, which often goes away after delivery. Exer-cise also increases energy, improves mood, posture and sleep, and promotes muscle tone, strength and endurance.

“Medical re-search has shown

that most women can safely continue to

An active pregnancyKeeping fit while you’re expecting has many advantages, and makes getting back to your pre-pregnancy weight easier. by Melissa De silva

exercise throughout pregnancy, as long as they make sensible adjustments to their routine. For women who were inactive before conceiving and who wish to get in better shape before the baby comes, it is even safe to begin exercise programmes during pregnancy,” said Dr Tan.

However, “a pregnant woman should not exercise to lose weight during pregnancy”.

Before you startBefore starting an exercise programme, a pregnant woman should ask her doctor for personal exercise guidelines based on her medical history. “Unless hospitalisa-tion or complete bedrest is advised, most patients will still be able to perform sim-ple exercises like brisk walking even if they have diabetes or hypertension,” said Dr Tan.

However, should the woman develop placenta previa, a complication where a low-lying placenta covers part or all of the cervix, then exercise is off limits. “Strenuous exercises can cause some uter-ine tightening and bleeding, which may mean an early delivery, especially if the bleeding is massive,” said Dr Tan.

Exercise is generally safe during pregnancy, although some involve posi-tions and movements that may be uncom-fortable or tiring for pregnant women. As the pregnancy progresses, the intensity should be reduced as “the actual level of difficulty is increased with the added weight,” she said.

“Walking is a great way to start an exercise programme,” said Dr

Tan, adding that brisk walking is a great low-impact total body workout. Swimming is an-other good form of exercise as it works many muscles while the water supports the body’s weight, minimising the risk of injury and mus-cle strain.

Aerobics keeps the heart and lungs strong, and aerobics classes for pregnant women, low-impact and water aerobics are good types of exercise. Cycling provides a good aerobic workout, but the growing belly can affect balance, making pregnant women more prone to falls. Sta-tionary or recumbent (where the rider is in a reclining position) biking may be better in the later stages of pregnancy.

Less suitable sportsRunners should be able to keep up with their running during pregnancy, with slight adjustments made to routines as the pregnancy progresses. Strength train-ing can make muscles stronger and help prevent some of the aches and pains com-mon in pregnancy.

Racquet sport players can continue to play but in moderation. Some racquet sports such as badminton, tennis and racquetball involve rapid movements and changes in direction. These rapid twists and turns may make pregnant women prone to falls.

Another sport where there is a risk of injury and falls is skiing. Skiing in very high mountains (above 3,000m) may also lead to altitude sickness which makes it harder for a pregnant woman to breathe and may cut down on the foetus’ supply of oxygen.

Contact sports like ice hockey, soccer and basketball can also result in harm to the pregnant woman and the foetus, while there is a risk of decompression sickness in scuba diving. Such activities

should be avoided during pregnancy.

Trimester-appropriate exercises

1st trimester

(weeks 1-12)almost any form of exercise

except contact sports and skiing can be undertaken safely.

2nd trimester

(weeks 13-27)in this trimester, you may feel

at your most energetic, but you should take the intensity of your

activities down a notch as the pregnancy progresses.

Avoid doing any exercises on your back, particularly after 16 weeks, as the belly presses on major blood vessels, and can

make you feel faint and decrease blood flow to the womb.

Sit down to lift weights because long periods of standing in one position can lead to a drop in blood pressure and cause diz-ziness. overheating can be a

problem, so wear cool clothing and drink plenty of water.

if you’re doing antenatal yoga, do not try new, advanced poses.

Focus instead on improving the technique. For standing

postures, use support such as a wall or chair, if needed.

3rd trimester

(weeks 28-42)running and cycling tend to become uncomfortable and

some women may switch from these sports to swimming,

walking and water aerobics. in the final three months, the

feeling of weightlessness in the water will be very comfortable, and it is safe to continue swim-

ming throughout the pregnancy. other exercises have an in-

creased risk of injury due to the loosening of ligaments and joints in pregnancy. it is also crucial to avoid ballistic movements, such

as jumping or running.

Dr Tan Wei Ching recommends

exercise for a smooth pregnancy.

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Above: As the pregnancy progresses, and the weight increases, backache is a common complaint among expectant mothers. This easy stretch eases that lower backache.

Right: Simple yoga poses and stretches on an exercise ball can help relieve backache, constipation and swelling.

18 singapore health Jan⁄ Feb 2011

Beauty

What do labels on a bottle really tell us and are we giving them due attention? Ms May Cheah, senior pharmacist, Department of pharmacy, singapore general hospital (sgh), tells us why and what those rows of words are there for. by thava rani

Label liability

Symbols and logos

Knownastheuniversalrecyclingsymbol.Tellsyouthatthepackagingcomponentsarerecyclable.

Indicates the period of time over whichtheproductshouldbeusedafteropening.

Impliesthatadditionalinformationabouttheproductisavailableelsewherelikeinaleaflet,cardortag.

Directions for use Tellsyouhowandwhentousetheproduct,howoftenitshouldbeused,howmuchtoapplyandwhichpartofthebodytouseiton.Inappropriateorexcessiveusecanleadtoskinirritationorallergy.Usinganightcreamintheday,forinstance,exposestheproducttothesunwhichcancauseskinreactions.Nightcreamsareusuallymoreoily,andifusedduringthedaywhenit’shotter,mightcauseskinbreakouts.

Name and address of local manufac-turer or importer Useful should therebe anyproductenquiries.

Batch reference Makes it easier for the rel-evant authorities to with-draw or recall particularbatches of the product ifrequired,egintheeventofadefectiveproductorinap-propriatecontent.

Precautions May include instructionssuch as: For external useonly, Keep out of reach ofsmall children, Avoid con-tactwith eyes andmucousmembranes or If irritationdevelops,discontinueuse.

Storage Most creams and lotionsshould be stored in cool,dry places. In hot, humidSingapore, you may thinkofputtingyourtoiletriesinthefridge,butthereisariskofthecreamorlotioncryst-allising.Serumscontainingchemicals such as vitaminC should be stored in thefridgebetween2ºCand8ºC.

List of ingredients Helps you avoid ingredientsyou’re allergic to, like lanolin orparaben,orthosethatyoumighthaveapersonalorreligiousconvic-tionagainst,suchasanimaloils. Ingredients may be listedby their chemical or botanicalnames. For instance, tocopherolacetate is thechemicalname forvitaminE,whilechamomilla recuitia matricaria is camomile and pyrus malusreferstoapple.Ingredients are listed in

descending order of amount intheproduct.Inlotions,forexam-ple, water or aqua is listed first,indicatingthereismorewater(bypercentage) than other ingredi-entsintheproduct.

Glycerin, jojoba oil, shea butter,propylene glycol and sorbitol aresome of the more common oils,waxesandemollientsusedinskin-care products, while zinc oxideor titanium dioxide are used aswhitenersorsunblock. Sodium citrate or citric acid iscommonly added to adjust the pH(acidityandalkalinity)of theprod-uct,andstabiliserssuchasxanthangumareusedtoensuretheproducthasthedesiredconsistency. Theamountoftheactiveingredi-entisusuallylow,likealphahydroxyacids(AHA)inanti-ageingproductsoraherbalextractinaherbalprepa-ration.Thismeans that the riskofdeveloping an allergic reaction tosuchsubstancesisusuallylow.

The right sequencesomething that is not often found on labels is the sequence in which skincare products should be used.

Ms May Cheah, senior pharmacist,

Department of pharmacy, sgh, advises starting your routine with a cleanser. once a week, this may be followed by a mask or scrub to exfo-liate dead skin. then, apply toner to restore the ph balance and remove residue from the cleanser.

prescription creams should be applied at this point, as the skin will be more receptive to absorbing the product. beauty serums and eye creams can be applied after this, followed by a moisturiser to lock in the active ingredients. Finally, protect your skin from damaging UV light with a sunscreen or sunblock.

Name of productServesastheproduct’sidentity.

Some chemicals, though necessary

additions, may cause irritation or allergy. These include:

sodium lauryl sulphate (SLS), a foaming agent that is found in cleansers, shampoos, bubble baths and

toothpaste. it has a drying effect and therefore should be avoided if you have eczema or psoriasis.

as an alternative, you can use products containing cocos nucifera (coconut extract).

fragrance and colourings (usually labelled as Ci followed by a five-digit number) are notorious allergens. avoid products containing these

ingredients if you have allergic contact dermatitis.acids may dry out the skin. a ph-balanced product is

more suitable for sensitive skin. preservatives, for example, paraben (methylparaben,

propylparaben) might cause irritation to those allergic to it.

Products containing natural ingredients are less irritating to the skin, but tend to be pricier. The choice is ultimately still yours,

as cheaper substitutes, for example, mild products (pH-balanced, fragrance-free, colour-free)

can work just as well.

19 Viewpoint-SMA WF V3 path.indd 19 21/12/2010 10:06 AM

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Dr Chan said that about 85 per cent of lung cancer patients in Singapore are smokers and those that have exposure to second-hand smoke.

Jan⁄ Feb 2011 singapore health 21

Lung cancer is usually diagnosed only in its advanced stages when the disease is more difficult to treat. But by immediately quitting smoking, a major cause of this cancer, a lung cancer patient can still experience significant benefits even at a late stage.

Treatment of lung cancer includes sur-gery to remove the cancerous growths and/or chemo- or radiotherapy to kill can-cerous cells that have spread around the body. A lung cancer patient who has quit smoking could face fewer complications

Never too late to stop smokingIf you are diagnosed with lung cancer, your best bet to prolong a quality life is to quit puffing immediately

By Jacqueline chia

with fewer complications. Some studies also suggest that these patients respond better to chemotherapy,” he said. In addi-tion, the risk of developing other smok-ing-related illnesses such as heart disease and stroke is reduced.

The damage that smoking does to the lungs cannot be reversed, but by quit-ting smoking, the deterioration of the lung function can be slowed to the rate associated with normal ageing, in-stead of continuing at an accelerated rate.

Lung cancer is the leading cause of cancer-related deaths

Spotlight

1 throw away anything that might remind you of the habit such as

lighters or ashtrays.

2 Make it known to your family

and friends that you’re quitting and seek their help and support.

3 list your quit buddies who are also

thinking of quitting, and non-smoking friends who will support you.

4 put up “no smoking” signs where you can see

them to remind yourself of your new resolution.

5 expect withdrawal symptoms and have a plan ready for what you will

do when this happens.

6 prepare a “rescue kit” with sugar-free sweets, handheld games etc

to distract you from cravings.

7 every time you feel the urge to light up, pop a sugar-free mint

into your mouth or drink water and let the craving pass.

8 Check out the “My Quit plan”, a six-session online quit plan for

an interactive and personalised guide to quitting at www.hpb.gov.sg.

9 take up a new sport or exercise to keep your mind off smoking.

10 Keep trying. even if you fail, start the quitting process

again. it takes more than one try to succeed.

For more information, go to Health Promotion Board at www.hpb.gov.sg/smokefree.

10 tips to quit smoking

think you can quit smoking any time? think again.

Willpower isn’t enough and some-one trying to quit will need the help and support of friends and family, as well as trained advisors and medication if he wants to overcome his addiction successfully, said Dr Kenneth Chan, senior Consultant, Department of respiratory and Critical Care Medicine, singapore general hospital (sgh).

“it is extremely difficult to quit on your own. studies have shown that if a smoker tries to quit on his own, his chance of success is less than five per cent,” said Dr Chan.

smoking is a real physical addic-tion, with studies showing that an addiction to nicotine is as strong as a heroin or cocaine addiction, Dr Chan said. temptation, peer pressure, psy-chological dependence and force of habit are some other reasons why it’s difficult to quit smoking.

Dr Chan describes smoking as “a chronic relapsing disorder”.

“it’s very easy to pick up a cigarette when you are under stress. physical withdrawal symptoms exacerbate stress, which can only be relieved by smoking,” he said. often, the habit is so deeply ingrained in the smoker’s daily

routine that he may feel something is seriously amiss if he doesn’t have a cigarette in his hand.

“it’s like waking up and forgetting to have your usual morning coffee at breakfast,” he said.

not surprisingly, many smokers take two to three attempts before they are able to give up smoking for good.

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People who experience symptoms such as a cough that doesn’t go away, chest pain, weight loss, breathlessness or blood-streaked sputum should seek medical attention.Dr kennetH cHan, senIor consultant, DePartment oF resPIratory anD crItIcal care meDIcIne, sIngaPore general HosPItal

in Singapore. On average, Singapore sees about 1,000 new cases of lung cancer every year.

About 85 per cent of lung cancer cases in Singapore are smoking-related, with a small percentage of patients developing the disease from long-term exposure to second-hand smoke and cancer-causing chemicals such as asbestos.

People who live or work with smokers and who breathe in second-hand smoke for a long period, are two to three times more likely to develop lung cancer than smokers, said Dr Chan. Indeed, second-hand smoke is more dangerous as the non-smoker directly breathes in the toxic chemicals. These chemicals can linger in the air or on furniture for a long time.

Lung cancer is often not detected until it is in an advanced stage because its “symptoms may not occur till very late in the course of the disease”, said Dr Chan.

People who experience symptoms such as a cough that doesn’t go away, chest pain, weight loss, breathlessness or blood-streaked sputum should seek medical attention, said Dr Chan.

A chronic relapsing disorder

during surgery and responds better to treatments, among other benefits, said Dr Kenneth Chan, Senior Consultant, Depart-ment of Respiratory and Critical Care Med-icine, Singapore General Hospital (SGH).

“Patients are able to function better in their daily lives and go through surgery

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Mr Anthony Ding (right) with his wife, Bridget, were about to accept their son’s offer, when the transplant coordinator called with good news.

jan⁄ feb 2011 singapore health 23

Two sides of the same journeyA patient and his wife tell Thava Rani how they helped each other prepare for his liver transplant

Spotlight

there was no news of a potential liver donor after 10 months, he decided to accept his son’s offer. As he was about to tell his son, the phone rang.

“That was like a call from an angel. Ms Lee, the transplant coordinator, said to be at the hospital in one hour as they had a liver for me,” said Mr Ding.

While waiting to enter the operat-ing theatre, “there was still a niggling feeling that my body might reject the liver, but in the end it was all good”, Mr Ding said.

Now, 11 months after surgery, Mr Ding wakes up every morning feeling thankful. Every day, he offers prayers and thanks to the deceased donor, and is clearly overwhelmed by his family’s love and support.

“I’m truly blessed. Bridget’s posi-tive attitude and bubbly nature really kept me going. Despite their busy lives, my sons visit with their families every weekend, and my wonderful daughters-in-law helped to take care of me when Bridget was not around. Throughout that dark period, I could feel my chil-dren solidly standing behind me,” said Mr Ding.

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His storyHaving liver cirrhosis meant he had a high chance of developing cancer, but when it was diagnosed, it still came as a shock to Mr Anthony Ding.

Doctors told him a transplant was his best option, but it would need to be performed within nine months to make sure his body was healthy enough to cope with the major surgery involved in such a procedure.

“I did my level best to stay healthy. I did light exercise daily with weights and a complete overhaul of my diet. Bridget, my wife, sacrificed her love for meat and fol-lowed suit. She spent a lot of time coming up with creative fish menus and prepar-ing fresh salads using cottage cheese and linseed oil,” said the 71-year-old.

Bridget’s positive attitude and bubbly nature kept me going. Despite their busy lives, my sons visit with their families every weekend, and my wonderful daughters-in-law helped to take care of me when Bridget was not around. AnThony Ding, TRAnsplAnT RecipienT

As he waited for a new liver, he underwent treatment to keep the cancer at bay. This left him in pain and physi-cally drained.

Previously an enthusiastic go-karter, he found himself sleeping more, unable to have his regular Friday nights out and too sapped to even play with his grand-sons. He became depressed.

To cope, he read up on his condi-tion and the treatments he was receiv-ing. Music and spiritual books gave him the strength to put up with the pain. He refused to let himself feel down for too long, and tried to make the most of each day.

“I think the fact that I’m contented with my life made the difference. If I really had to go, I had enjoyed my days with my wife and children,” he said.

While waiting for a donor, his second son Aaron offered to donate part of his liver.

Aaron had been meeting quietly with the transplant team and had undergone the necessary tests.

Initially, Mr Ding refused, but when

Her storyWorking for the family business in Cam-bodia, Mrs Bridget Ding felt the blood drain from her when her husband called with his diagnosis of cancer.

“My main concern was that I was not around, because I was always at his side when there was bad news before,” said the 63-year-old former HR consultant.

Over the next few months, she shut-tled between Singapore and Cambodia frequently to be with her husband, but intentionally did not cut down on her choir or church activities, believing a sense of normalcy would keep his spir-its up. Most importantly, she remained cheerful as she did not want him worry-ing about her.

Still, every now and then, things got to her. “Whenever he came back from treatment, he was cranky because he was in pain, and it was a challenge trying to maintain my sanity. So going back to Cambodia each time allowed me to get away from the situation just for a bit. That really helped me cope,” said Mrs Ding.

She knew that time was running out for her husband. There was a limit to the number of cancer treatments he could

have before a transplant would no longer be an option.

Yet when their son, Aaron, the only match in the family, came forward with his offer, Mrs Ding would not accept it. He was still young, had a wife, two kids and a third on the way.

“So many things could go wrong. They might not, but the risk was too great. Even our older son Allistair tried to con-vince us to accept his gift. He assured us he would stand by his brother’s family if anything were to happen,” she said.

The turning point came during a liver support group meeting when another patient shared his experience of receiving a liver from his sister, a young mother. That got them thinking.

“We were just going to tell Aaron that we’d accept his offer when the phone call came. We knew immediately what it was because Anthony’s voice was quivering. When the call ended, we all got up, and started hugging and crying,” she said.

Waiting outside the operating theatre, the family shared a spiritual moment. When the surgeon came out in his scrubs “grinning from side to side”, Mrs Ding knew her husband was going to be fine.

Whenever he came back from treatment, he was cranky because he was in pain, and it was a challenge trying to maintain my sanity. So going back to Cambodia each time allowed me to get away from the situation just for a bit. That really helped me cope.MRs BRiDgeT Ding

Now, their life is finding a new rhythm. Some lifestyle changes aren’t the most pleasant, such as the many medications Mr Ding requires for the rest of his life, or a diet that has switched from fresh food to only cooked meals. Mr Ding’s immune system would not be able to fight infec-tion if he were to contract hepatitis A. But these changes are a small price to pay and Mrs Ding is thrilled with the even closer bond that her family shares.

“Looking at the way the children reacted to the situation, we can be rest assured they will always be there for us,” she said.

21

BY LORNA TAN

24 singapore health Jan/feb 2011

Money

Pass on the burden of hefty medical bills

Imagine receiving a hospitalisa-tion bill of $200,000. If you man-aged to survive the shock, your next concern will be how to settle it. The good news is that with the right medical insurance plan, most, if not all of the bill is payable by your insurer.

Take Health Minister Khaw Boon Wan for instance, who paid just $8 out of his own pocket for bypass surgery in 2010. When contacted, the Ministry of Health said that out of Mr Khaw’s total hospitalisa-tion bill of about $25,000, $20,000 was paid for by insurance and $5,000 by Medisave.

Mr Khaw had subscribed to basic MediShield since it was launched in 1990 and topped it up with a private Medisave-approved Shield insurance plan which covers Class A and private hospitals. Based on his age of 56, his annual premium pay-able is in the $330 to $662 band.

A significant portion of his bill was absorbed by the Shield plan because it offers an as-charged feature. A traditional hospitalisation plan comes with specific sub-limits such as specified dollar benefits for room and board, doctor’s fees and pro-cedures. In a Shield plan, the as-charged feature removes these benefit limits, which means hospitalisation expenses are payable by insurance according to

what is billed, except for the deductible and co-insurance portions.

As-charged featureThe as-charged feature has become a stan-dard in all Medisave-approved integrated Shield plans, but there are many who have not upgraded to plans that offer this feature.

Shield plans come with deductible and co-insurance components. The former pertains to the first layer of charges that the policyholder has to bear, which ranges from $1,500 to $3,000. The co-insurance payment is the portion shared by the poli-cyholder, usually 10 per cent of the bill after taking into account the deductible. If you wish to avoid paying for these por-tions, Shield insurers offer optional riders for them, payable via cash.

“Private Shield plans provide an ideal solution to protect against the costs of seri-ous illness and help ensure the right treat-ment is received,” said Aviva Singapore’s Chief Executive Simon Newman.

Unlike MediShield, which offers cover till age 85, these plans offer lifetime coverage which is crucial because our medical needs increase with age, said Ms Tang Yin Fong, wealth management firm Providend’s Risk Management Senior Spe-cialist. Besides, you do not have to worry about the insurer refusing to renew your policy due to subsequent bad health or claims. Shield plans are also generally

more affordable than other non-private Shield

With the right Shield insurance plan, you may not have to foot a cent

plans in the market, and are payable with Medisave monies capped at $800 per policy per year.

For policyholders aged 81 and above, the Medisave withdrawal limit for insur-ance premiums is $1,150 per policy per year. Still, it is prudent to buy a hospitali-sation plan that is affordable and matches your healthcare expectations.

If you are insured under a plan with Class A coverage, you can choose an A class ward in a restructured hospital or any lower-class ward. But if you opt to be warded at a

Ministry of Health spokesman. The annual premium for basic

MediShield for a 35-year-old man is $54. If he upgrades to an integrated Shield plan, the premium may be about $100 to $250 depending on the plan type, said Ms Tang.

If you are considering a Shield plan, you should not be older than 75.

Other considerations include the time taken to settle a claim and finding out if the Shield insurer provides a Letter of Guarantee for your hospitalisation, so you can get in and out of the hospi-tal without making any payment, said Mr Newman.

Having an insurer with a big policy-holder base enables the customer to enjoy stable premiums, said Income’s Senior Vice-President and General Manager Lee How Teck. He added that it is a plus point if the insurer has a range of plans, so the cus-tomer can downgrade when premiums get costly with old age. Also, avoid getting a new health plan with a new insurer if you have pre-existing conditions, as the new insurer may not cover the pre-existing portion. It is far better to get an upgrade with your current insurer, said Mr Lee.

While Shield plans are effective prod-ucts, they do not provide overseas cover-age for non-emergency hospitalisation, said Ms Tang. “It does not provide cover for outpatient treatment, like specialist or general practitioner services, except for certain outpatient treatments such as kidney dialysis and cancer treatment,” she said. Nonetheless, outpatient treat-ment which leads to or results from hos-pitalisation may be covered by a Shield plan, subject to a specified period before or after hospitalisation.

Adapted from an article first published in The

Sunday Times on October 31, 2010.

HeALTHYsAviNgs

Mr Henry Tay (not his real name), in his 40s, was

admitted for spinal surgery owing to prolapsed disc in the middle of this year. He spent three months

in a Class A ward at Mount elizabeth Hospital. in 2008, he had bought a Medisave-approved integrated Aviva Myshield plan as well as a rider – Myshield Plus – which covers the co-insurance component. The annual premium for his shield plan is $480, payable by Medisave. He pays another $145 in cash for the rider.

His total hospitalisation bill of $203,000 comprised: room and board: $91,000 surgeon fee: $27,000 Doctor attendance fee: $51,000 other inpatient costs: $34,000

Total amount payable by insurance: $200,000 amount payable under Myshield: $180,000 amount payable under rider: $20,000 amount not payable by insurance: $3,000

(deductible)

as Mr tan’s rider does not cover the policy deductible of $3,000, he had to pay that amount out of his own pocket. the bal-ance worked out to $200,000, of which the co-insurance component was $20,000 or 10 per cent of the total bill, after taking into account the deduct-ible. had Mr tay opted for a rider that covers both the co-insurance and deductible, he need not have coughed up a cent.

Mr Daniel Loh (not his real name), 56, was admitted to a

restructured hospital for cancer treatment . He underwent three surgical procedures and stayed three

days in an iCU B1 ward, five days in a B1 normal ward and 51 days in a subsidised ward. He originally had an incomeshield standard plan

which he upgraded to an enhanced incomeshield Basic Plan – a B-ward plan with the as-charged feature. He added a Plus rider that covers the deductible

and co-insurance components. His annual premium for his shield plan is $340 and he pays another $224 in cash for the rider.

His total hospitalisation bill of $47,807 comprised: room and board and inpatient costs (iCU ward): $2,257 room and board and inpatient costs (non-subsidised b1 ward): $4,279 room and board and inpatient costs (subsidised

b2 ward): $24,652 surgical costs: $15,420 implants and medical consumables: $1,199

Total amount payable by insurance: $47,807 amount payable under inco-

meshield: $41,676.30 amount pay-able under rider: $1,500 (deductible) +

$4,630.70 (co-insurance) = $6,130.70

the policy paid the full bill as Mr loh stayed in the ward that

was covered by the health plan and his rider covers both the deductible and co-insurance.

CASE 2

CASE 1

Having an insurer with a big policyholder base enables the customer to enjoy stable premiums.

private hospital, the insurer will pay only a pro-rated portion of your bill.

MediShield coverCurrently, MediShield already covers 88 per cent of Singaporeans and of these, 58 per cent have topped up with a private Shield plan for hospitalisation in Class A/B1 wards and private hospitals.

“Depending on their preferences, they should choose a suitable Medis-ave-approved Shield policy. If they don’t plan to go to Class A/B1 or private hospitals, then basic MediShield should suffice. The premiums are highly affordable,” said a

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By Joshua Loh

When someone is rushed to Sin-gapore General Hospital’s (SGH) Accident and emergency depart-ment (A&E), one of the first people involved in his care is the pathol-ogist. The pathologist has to make a speedy assessment of his blood sample to help doctors determine how best to treat him.

“We provide test results in an accu-rate and timely manner, so doctors can diagnose and treat their patients appro-priately,” said Ms Chong Swee Chin, Senior Medical Technologist, Depart-ment of Pathology, SGH.

It doesn’t matter when a specimen is needed as the clinical biochemistry labo-ratory in SGH’s Department of Pathol-ogy is open 24 hours a day, one of the few backroom units that works through the night. “Specimens may arrive from A&E and inpatient wards anytime, so we have to work round the clock,” she said. For those on the night shift, requests from A&E, the high dependency and

intensive care units are common. Heart patients in ICU, for instance, need constant monitoring. This means blood samples are taken regularly to detect any change in the patient’s condition.

On any night shift, a small team of lab technologists tests close to 400 sam-ples with varying degrees of urgency. Urgent specimens from A&E have to be examined and ready within an hour. Work normally peters out after midnight before it gets busy again at dawn.

“The peak is from 5.30am to 8.30am when we can receive some 200 samples, mostly to prepare for the doctors’ ward rounds early in the morning,” said Ms Chong.

Just two people work a 12-hour night duty that starts at 8.30pm, and lab staff may also be asked to work from 12pm to 8.30pm. Because the department is large, staff need to work either shift only two to three times a month. Most of the time, they work from 8.30am to 5.30pm.

While many people may baulk at having to work shifts, Ms Chong said: “I don’t mind. I can make use of the day to do as I like – for example,

banking, shopping and attending to other personal matters (when these places are less crowded).”

What keeps this 13-year SGH veteran going is her passion for the job. “I was very interested in medical science when I was young, and I wanted to work in the healthcare industry after school,” she said.

The graduate from Taiwan’s National Yang Ming Medical College found a greater challenge in “a more spe-cialised lab” in SGH after four years of

jAn⁄ feb 2011 singAPOre HeAlTH 25

Lab supportTucked away from view, medical technologists do important work, quickly and accurately testing blood, urine and other samples to help doctors find the best treatment for patients

People

“working in various pathology depart-ments” in Malaysia.

She hopes more people will consider a career in the medical laboratory. “The healthcare industry in Singapore is growing because of the ageing popula-tion here.

“We are also seeing more patients from overseas coming to Singapore to seek quality treatment. There will be strong demand for medical technologists and it’s a good time for young people to join this profession,” she said.

Twist of fate

By RacheL chan

Endocrinology might have fallen in Dr Loh Lih Ming’s lap, but winning an award certainly didn’t

Fate, said Dr Loh Lih Ming, Consul-tant, Department of Endocrinology, Singapore General Hospital (SGH), had a role to play in her career as an endocrinologist.

“I have run into endocrinologists throughout my career. My current boss was my second-year medical school tutor. I have known her longer than I have known my husband,” said Dr Loh.

But her success as a practitioner probably has more to do with her own beliefs rather than fate. Dr Loh was conferred the SGH CEO Service Quality Award last year, a prestigious award that recognises an SGH doctor for outstand-ing service. Dr Loh believes that with the medical industry, “a lot of lifelong learn-ing” is involved. Besides medical knowl-edge, doctors should “have a love for people” and be passionate about their job, she said.

Her job goes beyond providing medi-cal consultation services to her patients. Being a “friend and confidante” to her patients, Dr Loh often lends a listening ear when they want to share their per-sonal problems with her.

is important because it establishes a rela-tionship with your patient.

“A patient learns to trust you and understands that you know enough about their condition. Building on that interaction, you can get to know patients very well,” said Dr Loh.

She specialises in conditions of the adrenal and pituitary glands, and works closely with neurosurgeons and urologists on surgery relating to these organs.

The adrenal glands are located at the top of each kidney and produce hor-mones that help the body control sugar, burn protein and fat.

The pituitary gland is a pea-sized organ at the base of the brain that secretes hormones responsible for many important functions throughout the body.

“The endocrine system is a very finely tuned and well-orchestrated system that involves a lot of interaction between hor-mones. What I find interesting is the fact that there is a lot of thinking and detec-tive work involved. That always intrigues me,” said Dr Loh.

“When the neurosurgeons pick up on a tumour case and need to operate on it, I will do the initial work, ensur-ing the patient doesn’t suffer from hor-monal imbalances, which can increase the risks for the patient during surgery,” she said.

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To communicate effectively with her patients, she often uses diagrams to illustrate their medical conditions and explains the rationale behind having to take their medication.

The most gratifying aspect of her job comes from her interaction with her patients and the ability to gain their trust. “As a doctor, you need to make a connection at the first visit. Interaction

As a doctor, you need to make a connection at the first visit. Interaction is important because it establishes a relationship with your patient.Dr Loh Lih Ming, ConsuLTanT, DEparTMEnT of EnDoCrinoLogy, singaporE gEnEraL hospiTaL

Dr Loh not only provides medical advice to patients, but also finds time to listen and relate to their personal concerns.

Having to assess up to 400 samples on night shifts doesn’t faze Ms Chong Swee Chin, who works quickly to assist patients who require intensive care.

OccupationalTherapists Day Time 11am-4pmVenue Educational Resource Room, SGH Block 1, Level 1, Rehabilitation Centre Price Free Contact sghOTday@gmail.com to register

SGH O&G/Neonatal Public Forum Time 10:15am-4pm Venue Deck on 9, SGH Block 6, Level 9 Price $12 (payment upon registration)Contact 6321-4668

SMA Lecturer 2011: Prof John Wong, Dean, NUS Yong Loo Lin School of Medicine(For doctors, medical students and allied healthcare professionals only)Time 1.30-5pmVenue NUHS Tower Block Auditorium,1E Kent Ridge Road Price Free Contact Register online at www.sma.org.sg/smalecture

Understanding Heart Valve Disease Time 1-3.30pm Venue Grassroots Club Auditorium (near Yio Chu Kang MRT Station), 190, Ang Mo Kio Ave 8 Price TBC Contact Hendrick Ou (6436-7928)

Pain Management ForumTime 1-5.30pmVenue Deck on 9, SGH Block 6, Level 9Price Free Contact 6321-3411/alice.peh.s.h@sgh.com.sg

1. What is the name of the latest alternative to LASIK?

2. Which story did you enjoy reading most in this issue of Singapore Health?

Closing date: Feb 9, 2011

Singapore Health issue 8 contest

eVenT Calendar

Jan 29 (Sat)

Include your name, age, gender, address and telephone number. All winners will be notified via phone or e-mail. Please note that incomplete entries will not be considered.

e-mail: editor@sgh.com.sg Post: The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608

Winners of Contest 61. John Chan Meng Kwong 2. Ho Aun Hui 3. Lim Wenfang 4. Agnes Tang 5. Yeong Ruwen

Prizes must be claimed by Jan 31, 2011.

All rights reserved. Copyright by SGH (registra-tion no: 198703907Z). Opinions expressed in Sin-gapore Health are solely those of the writers and are not necessarily endorsed by SGH, SingHealth Group and/or SPH Magazines Pte Ltd (registra-tion no: 196900476M) and their related compa-nies. They are not responsible or liable in any way for the contents of any of the advertisements, articles, photographs or illustrations contained in this publication. Editorial enquiries should be directed to the Editor, Singapore Health, 7 Hospital Drive, #02-09 Block B, Singapore 169611. Tel:+65 6222-3322, E-mail: editor@sgh.com.sg. Unsolicited material will not be returned unless accompanied by a self-addressed enve-lope and sufficient return postage. While every reasonable care will be taken by the Editor, no responsibility is assumed for the return of un-solicited material. ALL INFORMATION CORRECT AT TIME OF PRINTING. MICA (P) 060/06/2010. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).

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26 SINGAPORE HEALTH JAN⁄ FEB 2011

FYI

Congratulations! Issue 6 survey winners

Research from Mount Sinai School of Medicine in New York City found that children whose mothers had consumed peanuts during pregnancy were nearly three times more likely to develop a peanut allergy than those whose mothers avoided peanuts. Also, the more peanuts the woman consumed while pregnant, the greater her infant’s risk of testing positive for the allergy. However, consuming peanuts while breastfeeding didn’t significantly affect the result.

Feb 26 (Sat)

Pregnancy & peanuts

Jellyfish used to detect cancerScientists in the UK have developed a procedure using the luminous cells from jellyfish to detect cancers deep inside the body, which are currently difficult to spot. The green fluorescent protein, that enables jellyfish to glow in the dark, works much like regular imaging agents by distinguishing abnormal cells from healthy tissue. It is injected into the

body and absorbed in large quantities by cancer cells. These then light up brightly when viewed through a special camera. The research team leader, Professor Norman Maitland, believes this will revolutionise the way some cancers are detected. But clinical trials are still five years off.

Findings from the

Singapore Health readership Survey

In the past year, you read at least

3 issuesof Singapore Health

Favourite sections:

Medical conditions and treatments,

Ask the Pros and general health

and nutrition

90% of you pass on your copy

to family members, friends

and colleagues

You use Singapore Health as your

main source

of health information, in

addition to doctors and other

health publications

What you told us

Prizes must be claimed by Jan 31, 2011.

Feb 26 (Sat)

1. Lim Hock Seng2. Ng Chiao Ting3. Aileen Chua4. Bin Chin Yee5. Alex Cheng6. Daphne Lim7. Derrick Yeo 8. Balbir Kaur9. Gladys Lim10. Maryam Mohd Said11. Dr Lim Tock Keng12. G Samarasam13. Lim Hoon Cheng14. Siew Poh Chun 15. Rita Lopez

16. Ang Soon Hoon17. Seow Lay Lay 18. Mohameed Magnoon19. Eddie Cheong20. Karina Ong21. Ong Soo Bee22. Tham Choy Har 23. Tan Sok Ling24. Wong Lup Meng25. Kiong Choon Meng26. Dorothy Ng 27. Ivy Thia 28. Tan Lee Koon29. Chew Kim Seah30. Loke Wai Chun

page 30

大手术，小切口

page 27-28

您的心跳会停止吗?

page 31

账单疑问

新加坡中央医院

与新加坡保健服务

集团的双月刊

1月

20112月

page 29

心脏的健康之道

> 文转 page 28

眼镜找朋友, 更难了!随着技术不断改进，连不适合做Lasik激光视力矫正手术的人也能拥有完美视力

和叶贵芳女士（图右为女儿）一样，进行过屈光角膜透镜取出术的病人，在手术过程中和手术后，都不会感到有太大的不适。

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叶贵芳女士对严重近视所带来的种种不便，如配戴隐形眼镜、眼睛干涩和夜里盲目地摸索找眼镜，感到厌倦。于是，她决定做 Lasik 激光视力矫正手术。

不过，医生发现她有角膜破孔（角膜弧度不规则）的情况，如果做 Lasik 激光手术，会导致视力不均。因此，医生在最后一分钟取消了手术。

叶贵芳感到非常沮丧。她说：“他取消手术是正确的决定，但我非常失望。”

这件事发生在三年前。当时她打消了念头，认为自己会终身与眼镜和隐形眼镜为伍。

但去年年初，她丈夫获悉新加坡全国眼科中心院长陈长慧教授及其团队在视力矫正方面所取的进展，便鼓励她去见陈教授。

会诊后，32岁的叶贵芳发现，这项新手术可以让她告别戴眼镜的日子。

这项新手术不仅适合有角膜破孔现象的人，而且它快速、无痛，也能有效矫正高度数近视。

去年三月，叶贵芳成为第一批进行这项“屈光角膜透镜取出术”（简称ReLEx）的新加坡人。

Lasik 激光手术需靠两个激光仪将角膜组织消融，以矫正视力，但 ReLEx透镜 取 出 术 只 应 用 一 个 激 光 仪 。 此 外 ，ReLEx 透镜取出术使用的新一代激光仪将不需要的角膜组织切成镜片型状，通过Lasik 手术所开的角膜瓣口或针孔切口取出。

陈教授说：“ReLEx透镜取出术是Lasik 激光手术的自然进展。ReLEx 透镜取出术所做的是在角膜内，根据病人的近视度数精准地切割出适量的镜片型组织。把这镜片取出，近视就不见了。”

效果显著到 目 前 为 止 ， 这 项 手 术 的 成 功 率 是100%。它也比 Lasik 激光手术更精准，对近视度数介于500至1,000度的高度近视者特别有利。

陈教授说：“这是目前最先进的手术。整个过程只需要30秒。因为激光仪非常快速，而且使用的能量很低，所以病人不会感到太多不适。”

新加坡全国眼科中心研究了24个同时做了Lasik 激光手术和 ReLEx 透镜取出术

（每眼各做一项手术）的病人，发现超过75%的病人比较喜欢 ReLEx 透镜取出术，因为手术过程中和手术后感到较少不适。

接受 ReLEx 透镜取出术的病人会感到比较舒适的另一原因是因为手术过程所用的眼撑对眼球的吸力比较温和。

ReLEx 透 镜 取 出 术 快速 、 无 痛 , 也 能 有 效矫正高度数近视。

新加坡全国眼科中心院长陈长慧教授

陈教授说：“由于吸力比较温和，病人可以更好地看到‘目标光束’，不象 Lasik激光手术，会发生医生所谓的‘黑视’。”

在 手 术 过 程 中 ， 医 生 会 要 求 病 人凝望著一个目标光束。如病人移动眼睛，这光束便会短暂消失。这种称为

‘黑视’的现象会使病人惶恐不安。不过 ， R e L E x 透 镜 取 出 术 可 有 效 降 低

‘黑视’现象发生的几率。这项新手术的好处就像叶贵芳全新的

完美视力一样显而易见。她说：“当我半夜醒来照顾孩子时，我不须要盲目地

文 Jacqueline Chia

有许多患有重病的年长病人都须到医院的急诊部求诊。他们都是患有心脏疾病的病人。当中有些病人的情况会恶化，甚至在72小时内心搏停止。

这是随时有可能在任何一家医院的急诊部发生的情景。医护人员必须判断哪些病人的情况比较危急，哪些病人最有可能心搏停止，并根据判断立刻进行急救。

目前在医院的急诊部，医护人员一般靠的是一系列的测试来辨别需要优先救治的病人。这些测试包括：问诊、评估病人的症状，如疼痛程度、测量有关的风险因素，如年龄、血压及脉搏等。不过，这些测试的准确度只有 40%，也就是，在每100个病人中只能准确地辨别出40个需要优先救治的病人。

新加坡中央医院的临床科学家和南洋理工大学研究员现已研制出一套准确度更高的测试方式。在试验中，准确度高达67%。

新加坡中央医院紧急医疗部资深顾问医生及研究主任王英福副教授，也是新测试方式的发明人说：“我们的系统在测量病人心搏停止风险方面，准确度高出了50%。”

新系统利用医生在病人手臂或胸口贴上的电极片收集病人心电图读数，并结

新系统能更准确预测心搏停止世界首创的系统能更准确测出病人心搏停止风险

文 林雪

> 文转 page 28

王英福副教授与其他发明人研制出一套新系统为急诊病人更准确的测量出病人心搏停止的风险。

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28 新脉动 JaN⁄ FEB 2011

新闻

> 文接 page 27

眼镜找朋友, 更难了!

摸索找眼镜。你完全无法想象，这真的是一种解脱！”

Lasik激光手术随着 ReLEx 透镜取出术的应用越来越广泛，传统 Lasik 激光手术最终有可能会被淘汰。

陈教授说：“这些年来，我们采用新的激光科技，就像黑莓手机一样，随着 新 型 号 地 推 出 ， 效 果 是 越 来 越 好 。ReLEx 透镜取出术就是这样诞生的。如今有了它，病人可以看得更清晰。”

随着这项手术的应用越来越广泛，它也会变得越来越实惠。目前做这项手术，一只眼睛需$2,500，费用包括手术后的护理。

屈光角膜透镜取出术 （简称 ReLEx）

3

1

2

角膜还原,改善老花眼?把 完 好 无 损 的 角 膜 组 织 切 除 下来，给了研究人员另一个启发。这个取出的近视镜片是否可以保存起来，以便日后用来改善远视或老花眼呢？

新 加 坡 全 国 眼 科 中 心 院 长陈 长 慧 教 授 说 ： “ 假 设 你 通 过ReLEx 透镜取出术矫正视力，日后得了远视或老花眼，理论上，我们可以取出你保存起来其中的一 片 镜 片 ， 用 激 光 为 镜 片 调 整 度 数 后 ， 重 新 植 入 只 眼 里 的 角 膜 原 位 。 如 此 通 过 单 视 觉 矫 规法，改善你只眼的老花眼，矫正视力。”

这个方法能改善远视和消除配戴老花眼镜的需要，也能配合视力度数随着年纪的变更而修塑镜片。

目前，附属新加坡全国眼科中心的新加坡眼科研究所，正在使用低温贮藏法（一种常用于保存脐带血及干细胞的方法）来探讨用液氮冷却及保存镜片的可行性。

新加坡眼科研究所的研究人员希望，在2010年年底开始展开的初步试验可以证明ReLEx 透镜取出术是可还原的。

合病人其他资料如年龄和血压，来进行分析。

系统的共同发明人南大电机与电子工程学院林芝平副教授说：“这个仪器结合了医学的艺术和电脑工程科学，以更客观及标准化的风险评分来取代主观的评估。”

王副教授补充说：“即使新系统比目前的测试方式准确，它不能取代临床医

生的专业判断。它的真正价值是在于能准确地测量出病人心搏停止的风险。”

由于病床、医生、护士等资源有限，能准确地判断哪些病人需优先医治是一大关键。

王副教授说：“如果目前有两个需要加护病房床位的病人，而全医院仅有一张加护病房床位。该病床应给哪个病人呢？如果系统显示一个病人的风险指数是70，另一个则是40，我们就很清楚地知道该给哪个病人优先权及限有的资源。”

> 文接 page 27

新系统能更准确预测心搏停止

电极片收集心电图读数并结合其它风险因素，以帮助医护人员评估病人心博停止的风险。

研究小组以于2006年11月和2007年12月之间到中央医院急诊部求助并怀疑有心脏疾病的425个病人的资料来对新系统进行测试。结果显示该系统在 辨别有可能心搏停止病人的准确度高 达70%。

每天有高达500人到中央医院急诊部求诊。其中有半数患有如胸口疼痛等急性心血管症状。他们能从这个可以辨别有可能随时心搏停止高风险病人的新系统中获益。

中央医院和南洋理工大学的研究团队目前正和商家合作研制系统的原型以及展开临床试验来验证最初的研究结果。

林副教授说：“目前，系统是个安装在膝上电脑的电脑程序。但携带膝上电脑并不方便。我们希望把系统缩小成一个小盒子。”

这个系统将来不只可以在急诊部使用，也可以在加护病房、养老院甚至是灾区使用。王副教授补充：“它可以辨别需要疏散到有专业设施的灾民。”

研究小组日前在新加坡保健服务集团与杜克——国大医学研究院主办的科学研讨会及在芝加哥举行的美国心脏协会科学大会上，发表研究结果。

该研究是由新加坡保健服务集团基金及南洋理工大学拨款赞助的。

屈光角膜透镜取出术只利用单个激光仪在病人的眼角膜进行精准的切削。

角膜瓣需要一些时间才能愈合，但手术后病人不会感到太大的不适。

先将割除的角膜完整取出（并可把割除的角膜低温贮藏，在若干年后移植回眼球），然后再盖回角膜瓣。

手术利用激光将角膜瓣提起，并割除适当厚度的角膜以纠正病人的屈光不正。

ReLEx术比Lasik术更精准，尤其是用来改善高度数近视。

ReLEx术比Lasik术更快速，因为它只

使用一个激光仪。

ReLEx术有还原的可能性，但Lasik 术不能。

ReLEx透镜取出术与Lasik 激光手术的比较

心率变异分析指的是测量连续心跳速率变化程度的方法。心率变异指的就是心跳与心跳间隔时间的改变。自古以来，心率变异降低（也就是心脏跳动模式无法适应压力或疾病）一 直 与 常 人 的 健 康 状 况 出 现 问 题 挂钩。

中国西晋时期，曹操的随军医师王叔和撰写了脉学专著——《脉经》。在书中，他描述了脉冲位置，并阐述了24种脉象。他在文中写道：“如果心跳的规律变得像啄木鸟啄木或雨水从屋顶滴下来一样规律，就意味着病人将在四天内死去。”

但由于计算心率变异涉及到复杂的数学公式，因此在循证医学的临床应用一直相当有限。只有在约2000年后，新加坡中央医院与南洋理工大学的研究小组才成功将即时心率变异并入一个医疗工具，以帮助医疗人员作出有效的临床决策。

正常心律的风险

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越大未必越好

一年半前，43岁的符淑兰无法一口气爬上一排楼梯。

这名育有三个孩子的母亲体重81公斤，身体质量指数超过31，远远超过18.5至22.9的健康水平。这意味着肥胖增加了她出现各种健康问题的风险，例如心脏病和糖尿病。超重让她觉得自己“很丑”，她喜欢的衣服也没有合适的尺码。她怀疑自己睡觉时打鼾，是和体重有关。她非常担心自己的情况，于是向新加坡中央医院的康跃中心寻求协助。康跃中心提供一站式服务，帮助人们解决与生活方式有关的健康问题，例如肥胖和胆固醇（血脂）问题。

天生肥胖？有些健康问题如符淑兰所面对的甲状腺功能减退（甲状腺激素分泌不足而引发的症状），可导致体重增加或不易减肥。有些体重问题也可能是遗传所致。但是，不良的生活习惯往往才是真正的罪魁祸首。

新 加 坡 中 央 医 院 内 分 泌 科 顾 问 兼 康跃中心肥胖与代谢小组组长谭光慧医生说：“虽然遗传基因让你更容易变胖。但是，如果你生活在一个每天需

文 颜淑雯

注意您的体重，以免危害健康

要走五公里路才能找到食物的环境，不 管你是否有肥胖遗传基因，都不可能 变胖。”

2004年全国健康调查显示，肥胖 （身体质量指数为30或以上）的新加坡人占了6.9%，而在1998年，这个比例只有 5.2%。康跃中心去年就接待

了750个寻求肥胖及相关疾病治疗的新 病人。

符淑兰在怀第一胎前只有51公斤。她同意环境是一大因素，到处都能找到各种美食是一种持续不断的诱惑。她说：“就像其他新加坡人一样，我喜爱鸡饭和叻沙。每次我的孩子没有吃完他们的食物，我就会把剩下的吃完。”

改变生活方式与饮食习惯康跃中心为病人提供一套全面计划，以控制他们的体重。由多名医生、营养师、物理治疗师和职能治疗师组成的跨学科团队将设法解决病人现有的健康问题，然后为病人设计一套减肥计划。如果病人有任何心理问题，中心也会请心理学家来帮忙。

研究显示，一个胖子即使只是减掉原本体重的10%，也可大幅度地改善一些与肥胖有关的慢性疾病，例如高血压、高胆固醇和糖尿病。

通常第一阶段的治疗永远是最艰难的，因为病人必须改变他们的生活方式。他们应采用“缓慢和持续”的方法来达到减肥的目的，例如一个星期减掉大约半公斤至一公斤。这比遵循一些过度减肥计划更为安全，因为它不会带来破坏性的影响，包括矿物质流失导致心跳停止和心悸。

符 淑 兰 改 变 她 的 生 活 习 惯 和 保 持 甲状腺激素分泌正常后，成功甩掉了15公斤。她说：“刚开始做运动时，我还 以 为 自 己 快 要 晕 倒 。 但 现 在 ， 我 多么健康，最近还参加了10公里竞走 活动。”

康跃中心为符淑兰设计一套个人化减肥计划，让她重现苗条身材。

女性到了更年期，就拥有和男性同等的罹患心脏病风险。

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Jan⁄ FEb 2011 新脉动 29

王亚兰女士现年66岁，有两名孙子，但她依然充满活力，看起来比实际年龄年轻至少10岁。看到她体力充沛，你很难想象她曾经连走10步梯极也会气喘吁吁。

她说：“每次走上天桥，我都觉得很累。每走几步梯级，我就要休息一下，因为我喘不过气来。我看电视也会觉得上气不接下气，还会无缘无故感到焦虑。”

经过一连串检测，王亚兰被诊断患上高血压、高胆固醇和轻微糖尿病。这些因素都可能致使她罹患心脏病。

与心对话新加坡国家心脏中心心内科顾问医

生陈瑞耀说：“根据2004年发表的全球病例对照研究结果显示，引发心脏病的九大风险因素包括吸烟、血脂、高血压、肥胖、饮食、进行体力活动、喝酒及社会心理问题。”

致命的无声杀手根据新加坡心脏基金，新加坡每天有15人死于心血管疾病如心脏病或中风。2008年，心血管疾病占所有死亡原因的32.4%，亦即每三个新加坡人中就有一人死于心脏病或中风。它也是新加坡女性死亡的主要原因，但大多数女性都不知道这件事。陈医生说：“年轻女性通常都不易患上心脏病，但到了更年期，她们患上这个疾病的机率就会明显提高，与男性不相上下。”

女 性 普 遍 对 心 脏 健 康 都 存 有 误解 。 新 加 坡 心 脏 基 金 的

2006年“珍爱女人心”

提高意识是女性预防心脏病的第一步

新闻

文 黎淑芬

（Go red for Women heart）健康认识调查显示，27%的受访者认为他们无法预防心脏病。

陈医生强调，及早预防是抵抗心脏病最好的方法。他说：“如果病人发现胸部不适或用力时感到呼吸急促等症状，他的动脉很有可能已经有大约70%或完全阻塞。”

预防为首至于王亚兰的案例，由于她是高风险患者，所以她须要接受新加坡国家心脏中心的心血管疾病的康复和预防心脏病计划，进行治疗。这项计划相当全面，有助于心脏病患者康复，以及帮助有罹患心脏病风险的人培养新的健康生活习惯和个人化的体育锻炼。

陈医生说：“心脏康复是疗程中很重要的一部分，但往往为人所忽略。结果显示，只要遵循这项计划三个月，病人即使没有更换药物，血压也会明显下降。”

在参于该计划后，王亚兰就开始轻快步行和进行其他适当的体能活动。她发现自己的体力和整体健康都有明显改善，而且可以轻松地走上天桥。

她尽力改变自己的生活方式，在烹饪时坚持少油去脂的处理方式。她也不再是从前那个每天抽30根烟的“烟鬼”。王亚兰说：“关键是要节制和提高自我意识。我必须爱护自己，才能照顾我的家人。”

1注意饮食 少吃盐和脂肪，以便有效地降低血压。

2 常做运动 尽量每天运动至少半小时，但不要做任何剧烈运

动，尤其当你刚开始运动时。你可选择游泳、轻快步行、慢跑和有氧健身操。你还可以少乘电梯，多走楼梯，以及在回家时提前一两个站下车走回家。

3 控 制 压 力 和 保 持 充 足 的 休息 缺乏睡眠和压力太大会

增加罹患心脏病的风险。最理想是每晚睡六至八小时。

4 戒烟 抽烟会损坏血管壁和体内的自然化学平衡，使你易于

发生动脉阻塞。如果你戒烟时遇到困难，可请医生开适当的药给你。

5 不 要 滥 用 酒 精 每 隔 一 天喝一杯红酒对心脏有益，因

为它可增加良好胆固醇的水平，但 饮 酒 过 量 是 绝 对 不 允 许 的 。如 果 你 在 服 药 ， 应 咨 询 医 生 的 意见，确保药物不会和酒精产生 作用。

保持心脏健康的五大妙方

1 为了减肥，我一定要去健身房或购买昂贵的健身器材。

减肥不一定要去健身房。简单的轻快步行也是有效的减肥方法之一。常做体能活动，如运动和在家锻炼身体，也能达到一定的效果。

2 节食期间，我不应该 摄 取 碳 水 化

合物，因为这类食物会让我变胖。停 止 摄 取 碳 水 化合 物 及 提 高 蛋 白质 和 脂 肪 的 摄 取

常见的减肥误区可在短期内有效的减肥，但同时也会提高罹患肾病和胆结石的风险。长远的瘦身要诀，在于降低总卡路里的摄取，就是说，你应适量的减少碳水化合物的食物。

3 既然我在节食，我可以不吃正餐，以减少

卡路里的摄取。不吃正餐会让你感到饥饿，之后你可会吃得过饱。你应该改为全天小量、健康和低

卡路里的饮食习惯。

30 新脉动 Jan⁄ Feb 2011

少痛、少失血量和快速康复促使微创手术成为现今外科最重要的发展之一。但是，当微创手术或俗称的“锁孔手术”于20世纪80年代末开始出现时，人们对它是喜忧参半。

传统外科手术须切开一个五至十公分长的大切口，以便观察和去除体内的异常生长部位或肿瘤，但微创手术只须把仪器和设备放入一个大约一公分的小切口，就可通过远程控制台进行手术。

新加坡中央医院外科组处长黄平仁教授说：“微创手术是行得通的，但须要时间去解决一些安全问题和改良使用方式，医生也须要花点时间去适应。到了20世纪90年代，当这些问题得以解决时，各个医疗领域便开始广泛使用微创手术。”

以往，医生须要花费很大力气去解释微创手术的好处，以说服病人选择这种手术。竹脚妇幼医院妇产科微创手术主任兼资深顾问郑思敏副教授说：“如今，如果他们不适于进行微创手术，我们还须要花费一番唇舌才能说服他们选择传统手术！”

妇产科医生最先广泛使用这项新仪器，亦称腹腔镜手术，来检查子宫和输卵管。

建立在微创手术的基础上1989年，新加坡中央医院首创先河，进行胆囊微创手术。这是东南亚第一例微创手术，人们对它有更多的认识，并且开始接纳这项错综复杂的手术。

许多过往须要进行切开手术的病况，包括心脏、结直肠、胃肠道、耳、鼻、喉、妇产、神经、骨骼和胸椎，如今都

大手术，小切口新技术越来越进步，促使“锁孔手术”越来越不具创伤性

手术越来越精准，效果越来越进步，最终受 益 的 是 我 们 的 病人。机器人肯定是未来的手术平台 。新加坡中央医院外科组处长黄平仁教授

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改用微创手术。随着这种技术的不断改良和医生对它的适应，可用微创手术的病况也会越来越多。黄教授说：“微创手术有助于医生继续探索其他形式的手术，例如经自然腔道手术。这是一种可通过各种自然腔道如口、肛门和阴道切除患病器官和组织或肿瘤的手术，但它的发展仍未趋成熟。”

少痛手术微创手术须要三至四个切口，其中一个给带有摄像镜头的腹腔镜，以便医生观察内腔，其他切口则给一些特制微型手术工具。近期，新加坡正在测试一个特

行两个相关手术。黄教授说：“手术越来越精准，效果越来越进步，最终受益的是我们的病人。机器人肯定是未来的手术平台。”

竹脚妇幼医院的医生也希望把最新的手术技术和机器人技术结合，让病人获得更大的好处。郑副教授说：“越来越多手术可以或将可通过单一切口来完成。但愿我们能看到越来越多单切口手术和机器人结合，减少病人手术后的不适和加快康复的过程。”

正在进行模拟训练的郑思敏副教授说，越来越多病人要求做微创手术。

孕的组织很大，如果使用传统手术，可能会导致整个子宫受到创伤。为了保住该名妇女的生育能力，医生选择了这个方法，而且没有留下任何疤痕。他说：“病人都表示不太感到疼痛，也很惊讶她们的肚脐只留下一道近乎看不见的细微疤痕。但对于医生来说，这种手术有一定的挑战性。”

以往的微创手术有好几个切口，医生不会面对体内器官的方向问题。但现在只有一个切口，他们就必须适应动作受限制的手术。医生靠调整弧形仪器获得三维效果，能更形象化地掌握体内状况和整个手术过程。郑副教授说：“就像你早上开左边驾驶的汽车，稍后在同一天内却改用右边驾驶的汽车。单一端口手术不会完全取代传统的微创手术，但假以时日，谁知道它不会呢？”

机器人的出现用机器人辅助手术让微创手术更先进。新加坡中央医院在2003年首次把达文西机器人手术系统引进新加坡。这套系统结合机器人技术、特殊微型仪器和电脑辅助技术，能增强经验丰富的外科医生进行微创手术时的技能。

今年4月，新加坡中央医院引进了更先进的达文西机器人手术系统。它能让医生在进行手术时更灵巧、更精准，甚至能让两个不同领域的外科医生同时进

黄平仁教授说，外科医生未来动手术时，可能甚至不须要在病人身上切一个切口。

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文 Keith G Emuang

腹泻不可轻视腹泻一般属非紧急情况，但若饮水不足，它便会促成严重的后果

腹泻有可能发生在紧张的时分，例如上考场时、面试或上台前。这些情况也堪称为表演焦虑腹泻，一旦紧张的时刻过去，腹泻的问题也随之消失。

在 新 加 坡 保 健 服 务 集 团 属 下 的 红 山综合诊疗所看诊的陈友生医生说，除了同心身相关的因素（即因精神或情绪受影响而引起的身体状况）外，腹泻也是几种病况的症状，包括肠道感染。

陈 医 生 说 ： “ 它 也 可 能 是 对 抗 生素，或过度使用泻药来治疗便秘，乳糖不耐症，或肠胃过敏而出现的反应。”

如同发烧一样，许多人相信腹泻是身体抵抗机制在起作用，以帮助排掉体内的毒素或其他有害的物质。

陈医生说：“在新加坡，腹泻通常是因为吃了生冷、未熟透或不干净的食物，或是暴露在空气中数小时的熟食。至于婴孩，未经消毒的奶瓶是导致腹泻的原因。”

通常在腹泻时，每日会排便三次以上，所排泄的物状是稀薄或呈水的，此症状也会在数日内减缓。但是对婴儿或免疫力较弱的人来说，腹泻是有可能造成生命危险的。

在新加坡政府医院儿科病人当中，大约有5%须入院接受治疗是因患上了肠胃感冒。

腹泻也可能是一些较严重病症的症状，例如肠道癌、发炎性肠道疾病（肠

道受抗体攻击）、缺血性肠病（肠壁缺血）和糖尿病等，但这些颇为少见。

更大的隐患无论是什么原因，倘若腹泻时没有定时补充液体和盐分，病人有可能会同时患上由腹泻引发但无关其疾病的并发症。

陈医生说：“严重脱水可能导致患者出现肾衰竭等并发症。脱水也可引发其他病症，严重的话还可能导致死亡，因此必须及早医治。补充水份确实是治疗腹泻的关键。”

在一些卫生条件差的发展中国家，污水和垃圾未能妥善清理，也没有干净的饮用水，所以腹泻导致严重脱水的情况非常普遍。

病 人 因 严 重 腹 泻 而 送 到 医 院 治 疗时，医生通常会给他们打点滴来补充液体和盐分。一旦确认病症的主因后便会给病人服食抗腹泻药、药用炭片、含菌补充剂或抗生素等药物治疗。

医院也会收取病人的粪便，检查是否受感染。如果在粪便中发现血迹或病人体重下降，则可能用窥镜检查肠道和进行其他检测。

制端口，希望未来所有的仪器都能通过这个特制端口经由一个切口进入体内。

去年九月，一群以郑副教授为主的医生团队为一个出现子宫外孕（指受精卵在子宫外壁着床）的34岁妇女，进行全球首例单一端口手术。整个手术通过肚脐的一个切口（或端口）把一些特制仪器放进体内，去掉的组织也通过同一个切口取出。郑副教授指出，由于子宫外

事实:服用抗腹泻药物非治愈方法, 因为该药物无法治疗导致腹泻的潜在疾病。况且成人服用的抗腹泻药物不一定适用于孩童。

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