THIS QUARTERLY Magazine - Jan-Mar 2015 by Johnny Tan

Bonded by kinship & medicine Kah Woon, Eric & Seo Wei

What will you do with 2015? | Silence therapy for body and soul | Health news vetted, accurate, timely

ISSN 2010-1597

JAN - MAR 2015 S$10.00

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CITY AWAITS.

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Editor’s Note

Plenty to read about, learn, enjoy. Make 2015 your year! Audrey Perera Editorial Director

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Editor’s Note

elcome to a THIS QUARTERLY new year! With all good wishes as we get into 2015, we want to take this opportunity to give a shout-out to new initiatives and directions, and to Appreciation. Let’s start with the strongest sections of THIS QUARTERLY, its two dedicated health sections called Specialist Opinions and Health Dossier. At a time when we are inundated with so much unverified – and unsolicited – medical information and advice, we’re proud of these sections, which are filled with well-researched articles written by more than 30 respected practising specialist medical practitioners. These articles are written simply and clearly, are based on current knowhow and medical advances, and meet our readers’ increasing interest in good health and lifestyle practices. Every article is researched, vetted and accurate – not just because that is a given for any self-respecting publication, but because it is serious and well-considered advice that involves your health and wellbeing. In this first-of-the-year issue of THIS QUARTERLY, we introduce these esteemed medical practitioners at the front of the magazine, where some of them share some deceptively simple advice. And of course, there is the fact of a new year – what better time to consider the idea of Appreciation and how it makes life better? Without preaching, we invite you to be reminded, within the pages of this issue of THIS QUARTERLY, of things to appreciate: the opportunity to embark on new endeavours, sound medical advice which helps us manage our health better, brilliant creative ideas which start out as scribbles, the health benefits of silence, dawn views of Singapore, bold vision that impacts millions. Three specialists are the subject of this issue’s Cover Story. Ophthalmologist Dr Leo Seo Wei, her husband, cardiologist Dr Eric Hong, and her brother, plastic surgeon Dr Leo Kah Woon. They speak with appreciation about their most memorable influencers and mentors, and the passion that drives them to excellence.

TQ Medical Consultants

THIS QUARTERLY’S MEDICAL CONSULTANTS These are the specialist medical practitioners who make THIS QUARTERLY a strong and authentic healthcare and lifestyle publication read and appreciated by our readers. Before getting into the specialist topics inside the magazine, some of them offer up nuggets of wisdom on how to make this a year of better health for yourself.

Don’t make resolutions to exercise more; just do it

Early detection and treatment of cancer improves cure rates tremendously. Know your early signs of nose, head and neck cancers.

1. Dr Lau Chee Chong Ear, Nose, Throat Specialist Ear, Nose & Throat Centre CC Lau 2. Dr Kelly Loi Obstetrician & Gynaecologist Health & Fertility Centre for Women 3. Dr Francis Seow Choen Colorectal Surgeon Seow-Choen Colorectal Centre Pte Ltd

4. A/Prof Luke Tan Ear, Nose & Throat – Head and Neck Surgeon Luke Tan ENT-Head & Neck Center & Thyroid Surgery Centre 5. Dr Ruth Kam Cardiologist Ruth Kam Heart & Arrhythmia Clinic

Knowledge is only the first step. Putting it to practice makes it work!

Don’t leave colorectal health to the last.

6. Dr Tan Soo Heong Hand Surgeon Hand, Wrist & Upper Limb Surgery 7. Dr Eric Hong Cardiologist EH Heart Specialist Pte Ltd 8. Dr Goh Hak Su Colorectal Surgeon Goh Hak-Su Colon & Rectal Centre 9. Dr Karen Sng Plastic Surgeon The Plastic Surgery Practice @ Orchard 10. Dr Christopher Ng Obstetrician & Gynaecologist GynaeMD Women’s & Rejuvenation Clinic

TQ Medical Consultants

1. Dr Colin Tham Plastic Surgeon Asia HealthPartners (Aesthetics)

Stop and smell the roses. Unwind. Health>Wealth.

2. Dr Tay Khoon Hean Hepatobiliary Surgeon Tay Khoon Hean Surgery 3. Dr Michele Lee Obstetrician & Gynaecologist, and Fertility Specialist Michele Lee Women & Fertility Clinic Pte Ltd

4. Dr Lim Hwee Yong Oncologist Novena Cancer Centre 5. Dr Ann Tan Obstetrician & Gynaecologist Women & Fetal Centre

Bones‘r’us! 09

Treasure ourselves because we are worth it.

6. Prof Christopher Goh Ear, Nose, Throat Specialist Novena ENT – Head & Neck Surgery Specialist Centre 7. Dr Wong Su-Ni Dermatologist Dr SN Wong Skin, Hair, Nails & Laser Specialist Clinic 8. Dr Lim Yi Jia Orthopaedic Surgeon Ortholimb Bone and Joint Surgery

Skin – your largest organ and first line of defence. Care for it, celebrate it.

9. Dr Wendy Teo Shun Hui Obstetrician & Gynaecologist Wendy Women’s Clinic 10. Dr Tan Yeh Hong Urologist Centre for Urology, Robotic & Minimally Invasive Surgery

TQ Medical Consultants

THIS QUARTERLYâ&#x20AC;&#x2122;S MEDICAL CONSULTANTS These are the specialist medical practitioners who make THIS QUARTERLY a strong and authentic healthcare and lifestyle publication read and appreciated by our readers. Before getting into the specialist topics inside the magazine, some of them offer up nuggets of wisdom on how to make this a year of better health for yourself.

Live life to the max and you will leave life with no regrets.

Breast issues? Get your worries off your chest.

1. Dr Leslie Kuek Plastic Surgeon Leslie Kuek Plastic Surgery 2. Dr Bertha Woon General & Breast Surgeon Bertha Woon General and Breast Surgery 3. Dr Noor Halif Said Dermatologist Renaissance Dermatology Laser & Aesthetics Clinic

4. Dr Elaine Chee Opthalmologist Eye & Retina Surgeons 5. Dr Yap Lip Kee Gynaecologist Gynae Consultancy Pte Ltd

6. Dr Richard Sim Colorectal Surgeon RSim General & Colorectal Surgery 7. A/Prof Leong Keng Hong Rheumatologist Leong Keng Hong Arthritis & Medical Centre

You might think that your eyes are healthy but visiting the eye doctor for a comprehensive dilated eye check is the only way to be sure!

8. Dr Ho Kok Sun Colorectal Surgeon Ho Kok Sun Colorectal Pte Ltd

Keep your weight healthy to keep your knees and back healthy.

9. Dr See Tho Kai Yin Obstetrician & Gynaecologist The See Tho Clinic for Women 10. Dr Leo Seo Wei Ophthalmologist Dr Leo Adult & Paediatric Eye Specialist Pte Ltd

TQ Magazine Jan15

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CONTENTS January-March 2015

34 COVER STORYDrs Leo Kah Woon, Leo Seo Wei and Eric Hong

THIS QUARTERLY’S MEDICAL CONSULTANTS More than 30 specialists who provide accessible, up to date and well-researched health information and advice.

What will you do and how will you evolve in this new year? 34

READERS’ LETTERS Feedback from THIS QUARTERLY readers, and a chance to win a special prize. WELLNESS & HEALTH UPDATE The latest news, trends, updates and findings to keep you abreast.

COVER: KINSHIP & HEALING Photography: cj sameer wadhwa Styling: Phoebe Pong Hair & make up: Lolent Lee Clothes Robinsons, various designers Location Goodrich Gallery

FEATURE MAKE 2015 YOUR YEAR

COVER STORY Kinship & Healing Drs Leo Seo Wei, Leo Kah Woon and Eric Hong talk about influencers, mentors and personal passion.

HEALTH DOSSIER Women’s Health Spotlight on health challenges unique to women.

FEATURE THE SILENT TREATMENT Take a healthy break of silence in these wonderful locatons.

28 Make 2015 your year

56 The silent treatment

CONTENTS January-March 2015 65

SPECIALIST OPINIONS From diabetes and loss of vision to blood pressure and endocrine cancer, here’s your guide to uncomplicated health management.

118 FEATURE Scribbles on a Paper Napkin Great ideas are born in the most unlikely places. Here’s a toast to some of them. 117 AFTER WORK 118 TREATS Lifestyle products, indulgences and toys for your after work enjoyment. 124 FEATURE Dawn in the City A photo essay celebrating aspects of the city only seen by early risers. 124 FEATURE Money to make Money How does private banking work and what is a HNWI? 136 TIME Classic Pieces Here’ s a toast to some classic watches which are standing the test of time.

124 Dawn in the City

145 IT’S MY PARTY! Stunning precious stones to lift your heart. 146 LIFE’S BIG QUESTIONS Maker of Gardens CEO of Gardens by the Bay, Dr Tan Wee Kiat, talks about turning personal passion and vision into reality. 150 MOSAIC A thought, an image, a project that leaves you with a lingering thought.

118 Bali Beckons

136 Classic Pieces

EDEN PUBLISHING PTE LTD 51 Goldhill Plaza #20-05 Singapore 308900 Tel: 65 6253 8660 Fax: 65 6253 8658 www.EdenPublishing.sg Publisher Vincent Teo vincent@thisquarterly.sg Senior Publication Manager Serene Leong serene@thisquarterly.sg Manager, Sales & Marketing Yvonne Tay yvonne@thisquarterly.sg Manager, Business Development Victoria Tio victoria@thisquarterly.sg Editorial Enquiries editorial@thisquarterly.sg Sales Enquiries enquiry@thisquarterly.sg

THINKFARM PTE LTD 3 Changi South Lane Kingsmen Creative Centre Singapore 486118 Tel: 65 6831 1299 www.thinkfarm.sg Managing Director Christopher Tay Editorial Director Audrey Perera Art Director Johnny Tan Contributors Ahmad Iskandar, Antoinette Tan, Chin B Ho, Ching, CJ Sameer Wadhwa, Lolent Lee, Lye Kim Sheong, Ong Weisheng, Phoebe Pong, Sheralyn Tay, Sunuja Naidu, Suresh Nair, Tania Jayatilaka Client Relationship Manager Jessie Kek Client Relationship Executive Kit Leung

THIS QUARTERLY is wholly owned by Eden Publishing Pte Ltd and contracted to be published quarterly by ThinkFarm Pte Ltd. No material may be reproduced in part or in whole without prior written consent from the Publisher. Views and opinions expressed in THIS QUARTERLY are not necessarily those of the Publisher or the Editors. Although reasonable care has been taken to ensure the accuracy and objectivity of the information provided in this publication, neither the Publisher, Editors or their employees or agents can be held liable for any errors or omissions, not any action taken based on the views expressed or information provided within this publication. Printed in Singapore by Times Printers Private Limited. MCI (P) 133/06/2014.

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Readers’ Letters

1N stay at Hotel Clover Plush worth $470, complete with breakfast for two!

Winn Lettering

I am an avid reader of THIS Quarterly Magazine, for you have good reading materials containing well-written articles that are either amusing, thought-provoking, awe-inspiring or tantalising! I can always identify similar experiences in my social circle with the medical issues your magazine highlights. The health articles help us realise that our problems are typical, and we can solve them in constructive ways. Thank you and keep these good articles coming. Elyn Chan

I always look forward to the articles on current affairs and health while my wife likes the travel, lifestyle and food. There are always multiple articles that spark our interests, especially those pertaining to health. This is one of the few health magazines these days that contains credible medical knowledge and tips which empower one to become a smarter and healthier person. Jonathon Yeo

I recently read your October issue where its quirky cover caught my attention. What I found within its contents was valuable, pertinent, real-life information regarding health. Where medical and health information seem excessive on the World Wide Web, it is important readers have access to credible sources in order to make informed choices on important health matters. I believe THIS Quarterly is one source most, if not all, of us can refer. Clement Ong STAY IN TOUCH

Your magazine…has everything that everyone is concerned with from healthcare, nutrition, beauty, travel, dining, latest fashion, and other accoutrements for elegant living. There is a vast overview of many subjects and very informative. I have always purchased this when I was shopping and decided…to subscribe so I will not miss an issue. I applaud its success! Cin Bee Tan 20

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WELLNESS & HEALTH Update

Did You Know?

ZEBRAFISH TO SAVE OUR DAY A common aquarium fish may yield answers about human respiratory diseases. Scientists at A*STARâ&#x20AC;&#x2122;s Institute of Molecular and Cell Biology (IMCB) have identified genes in the zebrafish which could be functionally similar to the human genes needed to form motile cilia, those hair-like structures on the suface of airway cells which are responsible for removing dust and pathogens from the human airway. This means that the fish is set to play an important role in finding the causes and cures to human respiratory diseases, even more so for those suffering from Primary Ciliary Dyskinesia (PCD), a rare genetic disorder, for which there currently is no cure.

Sex reduces pain, improves immunity, boosts overall health and mental well-being, and can also block chronic back and leg pain.

SUNLIGHT STIFLES CANCER When you put Vitamin D on prostate cancer cells, it inhibits their growth. A study by the University of Colorado Cancer Center revealed this and has found that Vitamin D curbs inflammation, which is thought to drive many cancers including prostate, gastric and colon. But while it hasnâ&#x20AC;&#x2122;t been proven as an anti-cancer agent, it can help in keeping prostate tissue healthy by suppressing inflammation.

BANISH THE BED BUGS! You might think that your home is super-clean, but most bed bug infestations happen at home. According to the Bugs Without Borders Survey, most infestations occur in residential settings, including apartments, condominiums and family homes, with higher percentages than at hotels or hostels!

Did You Know? Six-month old babies demonstrate better memory and learning when exposed to two languages from infancy. Good to know for us in Singapore, with its compulsory Mother Tongue policy.

GROW STRONG, GROW PROUD Sprouts have proven to be small but super for the body, especially with its high mineral and vitamin content, along with good fibre and acid-regulating properties. But add to that the gardening or greenthumb benefits of growing your own sprouts and you are set to prevent mental disease too!

GET SOME SMARTS

TOP FITNESS TRENDS FOR 2015 According to the Worldwide Survey of Fitness Trends for 2015: What’s Driving the Market by the American College of Sports Medicine (ACSM), the top picks include Body Weight Training, High-Intensity Interval Training (HIIT), Strength Training, Yoga and Functional Fitness. If you’ve been religiously doing those squats and planks, congrats, you’re closer to achieving your fitness goals even faster this year.

Eating more Tyrosine will boost your mental capacity, reports Men’s Health magazine. Experts say that consuming just 2gms of this allows people to score better on mental reflex tests than those who don’t. The increased levels of dopamine also hone mental sharpness. The best news? This brain-boosting amino acid is found in eggs and cheese.

WELLNESS & HEALTH Update

EAT YOUR WAY OUT OF DEPRESSION Consume at least five servings of fruits and vegetables a day to ward off depression and increase levels of happiness, optimism, self-esteem and resilience, says a new study led by University of Warwick Medical School and reported in Prevention magazine. Data collected from more than 14,000 adults revealed consistently higher mental well-being among those who practiced this. How much is one serving? One small apple or orange, half a grapefruit, a cup of leafy greens, half a cup of raw fruits and veggies like berries or squash.

ANOTHER REASON COA! TO EAT COCOA! In addition to all the happyy and yummy benefits of chocolate, new research h shows that cocoa can prevent memory loss too, o, according to a study by Columbia University. rsity. It reveals that flavanols (naturally found und in cocoa, plus a main ingredient in n chocolate) can help reverse at least one part of memory loss as a person on ages, thanks to its anti-inflammatory properties.

BASIL BOOSTING BENEFITS Multiple studies and reports have shown that sweet and holy basil offer plenty of health benefits. These include anti-anxiety properties to calm nerves, iiron to combat PMS, liver detox properties, and oils that fight pimple-causing bacteria, bacteria to name a few. Take a leaf from fro Thai cuisine, and use it liberally li Coconut water is healthier than fruit in your cooking.

OLIVE OIL FOR BETTER FRIED Did You Know? GOODIES

juice. With all the hype around the benefits of coconut water for sports and hydration, one thing’s for sure: unflavoured coconut water contains half the calories of fruit juice, and more potassium than its counterparts.

If you can’t live without your fried foods, at least pick the right oil. A scientists’ report in the American Chemistry Society’s Journal of Agricultural and Food Chemistry states that olive oil is the most stable of four different refined oils (olive, corn, soybean and sunflower) and remains the most stable at deep-frying temperatures, without losing its nutritional properties, while sunflower oil degraded the fastest. The researchers deep- and pan-fried raw potato pieces in the different oils and reused the oils 10 times as part of the test.

WHAT’S NOT TO SMILE ABOUT? Tooth loss is a smile-killer, and dentures can be too, what with concerns about them moving around or worse, falling out. Enter Straumann® Roxolid® dental implants that promise to restore your smile with minimum fuss and maximum efficiency. These implants are 50% stronger than conventional titanium implants, and clinically proven to bond faster with bone and heal more quickly.

Did You Know?

STRETCH THAT MIGRAINE AWAY Before you pop that painkiller, try stretching out and reaching for your toes. A study by the International Journal of Yoga states that chronic migraine sufferers who practised yoga for 30 minutes five times a week over a period of six weeks reported that they had fewer migraine attacks and less intense symptoms.

Singapore has the highest prevalence of myopia in the world, with a staggering 34% of 7 to 9yr olds and up to 85% of tertiary educated men wearing glasses! To prevent myopia occurring or getting worse, doctors advise spending more time outdoors, and taking regular breaks from work or study. Besides ensuring a high calcium intake for strong We know that emotional pain and bones, a study by the heartache are made better or worse depending on National University of the music we choose, but what about physical pain? To Singapore (NUS) and find out, British pharmaceutical group Lloydspharmacy Duke-NUS has found commissioned a survey of more than 1500 respondents that a diet rich in fruits, who live with persistent pain. Findings revealed that vegetables and soy products 40% of them listen to music to help alleviate their helps to lower the risk of pain. Pop music came out as the most popular genre at hip fracture and is good for 21%, followed by classical at 17%, and overall health as well. rock/indie at 16%. The top five pain-alleviating songs in order to preference: Bridge over Troubled Water by Simon & Garfunkel, Angels by Robbie Williams, Albatross by Fleetwood Mac, Candle in the Wind by Elton John and Easy by the Commodores. Another good reason to make music a part of your life’s soundtrack.

MUSIC FOR PAIN

SAVE YOUR BONES

WELLNESS & HEALTH Update

DON’T EVEN THINK OF THAT FIRST STICK On top of the standard markers of nicotine addiction – the number of cigarettes smoked, the duration of smoking, and the number of pack years (or cumulative exposure) – researchers have found that the time to first cigarette (TTFC) is also tied to lungg cancer risk. According to the studyy in the Journal of the National Cancerr Institute (JNCI), regardless of light or heavy smoking, the shorter the TTFC, the higher the lung cancer risk.

HEART ALERT! A shocking 15 people die of cardiovascular diseases every day in Singapore. These diseases accounted for 29.5% of all deaths in 2013, meaning that nearly one in three deaths here were due to heart disease or stroke. It’s time to stop taking our hearts for granted, and time to start taking our heart health more seriously.

Did You Know? 76% of Singaporeans declare that they are happy. The survey by Ipsos and Toluna also revealed the source of the respondents’ happiness: their spouses, their health and their relationships with parents. Shout-out for the value of love and bonds.

GRIM & BEAR IT One in three Singaporeans are reluctant to treat headaches and muscle and joint pains with over-thecounter medication, according to a new GlaxoSmithKline survey. Instead, they opt to either endure the pain, use medicated oil, or head straight to the doctor. It may seem commendable to endure pain, until you realise that untreated pain can affect your state of mind, relationships, productivity and health.

YOU’RE HURTING YOUR TEETH Long cardio workouts could be causing you some dental grief without you realising it. A German study has found that the longer athletes trained, the more likely they were to have tooth troubles because of the lack of mineral-rich saliva. To counter this, dentists advise brushing before exercise and rinsing after consuming sweet sports drinks or energy gels after.

GEOMANCY Special

The best is

within your reach Natural forces can play a role in one’s success in life, if you know how.

To some, dissatisfaction is a persistent feeling; life goes by but is not unhappy enough to inspire a life-transforming change. For some others, dissatisfaction is a persistent, nagging force that drives them to continually look for what is better in life, fuelled by the belief that no one should settle for what they have when the ‘better’ is always within reach. Looking at Adelina Pang, a leading feng shui consultant at Adelina Pang FengShui Consultancy, it is clear which category she fits into. Pang is an expert who has been researching the ancient Chinese history of classical feng shui for about 20 years. Her aim has been to draw out the secrets of its greatest benefits for today’s modern man and woman. In addition to giving consultation and readings to clients, Pang travels and teaches on the principles of authentic feng shui, promoting the ways in which the life forces of nature and man can be harnessed to dramatically improve life, help one reach one’s fullest potential, and attain the best. The words ‘feng shui’ come from the word ‘Kan Yu’ meaning ‘the way of Heaven and Earth.’ It’s essentially the study of the flow of qi or life energy between the elements and humans and how positive qi can be utilised for a person’s well-being. The practice of feng shui begins with predicting the qi structure of a person or place based on an ancient set of numerical codes associated with times, seasons, and attributes that differ between people and places. Different people experience different levels of positive and negative qi. Professional feng shui masters give highly personalised readings using personal attributes and an ancient numerical code which evolved from the meticulous observations of Chinese philosophers over 6,000 years ago. For these ancient thinkers living in southern China, superstition and rumour mattered little in their study of their environment.

Their conclusions were based on observations that communities of people who lived in areas south of mountains, surrounded by rolling hills, lived extremely prosperous lives. These observations became the basis of the San He system, which, combined with the San Yuan system, makes up the fundamental application of feng shui practices. The San He system is the study of the individual’s environment and the qi structures present within environmental forms such as buildings, mountains, and other big or small structures. The San Yuan system analyses the relationship between qi, time and their effect on individuals. A person’s birth year and gender can be used to determine a person’s position – west or east – in the eight cardinal directions of a compass in what is called the Eight Mansions system. Eight Mansions helps feng shui consultants assess the flow of qi within a person’s home or workspace, identifying the most auspicious areas that have positive qi. Another system, the Flying Stars, uses a mathematical diagram to assess the qi structure of a home, office, or other building, based on the year it was built and its physical and magnetic orientation. Consultants and practitioners such as Pang who adhere to classical feng shui believe that the proper application of these principles will enable people to harness the positive energy that is already within themselves and their environments. Most people may live out their whole lives without realising the potential for a higher quality of life, whether it is through improved physical and mental health, prosperity, workplace productivity or healthy relationships. But as was evident in ancient China, feng shui may prove to be another way of reaching for what is best instead of settling for what is good.

Adelina Pang FengShui Consultancy 7 Temasek Boulevard #44-01 The Penthouse Suntec Tower One Singapore 038987 Tel: 6430 6766 www.adelinapang.com

FEATURE

MAKE

2015

Here’s some good news to celebrate the dawn of a new year with. If you follow the Chinese horoscope – and most of us do, either seriously, or just for fun – great things are in store for 2015. This is the year of the wood goat. Being an earth element, this conflicts with this year’s wood element, portending a general collapse of the status quo. Taken from a wider and wiser perspective, this means that the global economy of the past few years shall finally make way for a cycle of greater calm, peace and prosperity. These positive changes will filter down, giving us all the opportunity to ride new and better lifestyle waves. With these good prospects forthcoming, what changes will you make in 2015? Will this be a year of personal firsts, or a year of completing the unfinished? How about making it a year of acquiring new skills, pursuing causes close to your heart, or focusing on personal health and wellness? Here are some points to ponder and be inspired by.

YOUR Year

What will you do, and how will you evolve in this new year? Lye Kim Sheong offers some suggestions.

AIM TO ACHIEVE SOMETHING We all have many things that we’ve always wanted to do, but have never quite got round to doing. Resolve to stop procrastinating and do at least one of those things this year. And remember that the pleasure lies in the process rather than the result, so at least for this, set pre-conceived mental roadblocks aside and just enjoy doing.

TRY Digital photography With smartphones giving us plenty of snap shooting practice, why not graduate to digital cameras that support interchangeable lenses? They are widely available, and cost much less than they used to, providing amateur photographers with enough bandwidth and versatility to take pictures (almost) like a pro.

Create your own cook book Don’t let your kitchen experiments go to waste. Whip up your very own recipe journal with dishes that you’ve successfully put your spin on – by documenting your culinary journey via words, photos and/or videos. At the end of the year, compile them with pride into a DIY cookbook. To celebrate the event, you can even organise a tasting session to launch it to family, friends and maybe even future fans. Just think what a great gift it would be for your loved ones.

Care skills Pick up a skill that will allow you to help others in different ways, through courses like: •

Basic First Aid: a course offered by Singapore First Aid Training Centre (FirstAidTraining.com.sg)

•

Sign Language (General): four levels of learning are available at The Singapore Association for the Deaf (www.sadeaf.org.sg)

•

Docent Training: for those with a deep interest in Singapore’s museums, tour guiding programmes are offered by Friends of the Museums (www.fom.sg)

Overcoming a fear, pursuing a passion We’ve all got fears and shyness which hold us back from enjoying certain activities. If these mental constructs are the only barrier, why not make a decision to overcome them? Or maybe you’ve had a passion for something, but have never made time to learn or master it yourself. Take the plunge and learn to: swim, cycle, drive, rock climb, speak in public, dance, appreciate poetry, write songs, start your first novel, learn pottery or sewing…the list is endless. Ask friends for recommendations or simply Google for coaches, instructors, classes, workshops and associations which you can join. For starters, check out these sites for ideas: • People’s Association, one.pa.gov.sg, • Toastmasters Club of Singapore, http://www.toastmasters.org.sg/ • Academy of Literary Arts and Publishing Singapore, http://alap.bookcouncil.sg/ • The Arts House, www.theartshouse.sg • Goodman Arts Centre, www.goodmanartscentre.sg • Singapore Sports Hub, www.sportshub.com.sg

FEATURE

THINK HAPPY THOUGHTS How do you want to feel in 2015? Would more happiness be a welcome change in your life? Embark on a personal pursuit of happiness and learn to look forward to having a great day, every day.

TRY Be kind to yourself Believe it or not, this is the first true rule to happiness. By being kind, we mean consciously cultivating good habits towards yourself, like listening to yourself and being less self-critical; forgiving yourself more readily; and pampering yourself with fresh air, sunshine, breathing space and the right nourishment.

Ready, set, laugh! Be open to being amused by the challenges in life and in the process, reap physical and psychological benefits, including better blood flow, reduced stress, improved immune response and better quality sleep. If you want to have a good laugh regularly, check out: â&#x20AC;˘ Laughter Yoga: the programme that has chortled its way to more than 70 countries, and is offered here by Singapore Laughter Yoga (www.singaporelaughteryoga. com) â&#x20AC;˘ The Comedy Club Singapore: organiser of key comedy events in Singapore with a year-round line up of shows at various venues (www.thecomedyclub.asia/home)

Keep a happy diary Reconnect with the joy of scribbling on paper, with the 2015 What to Focus On (Happy) weekly planner. This 16-month engagement calendar and diary is peppered with simple yet uplifting illustrations by American artist Marc Johns. Take the cue from its weekly inspirations and map out your happiness schedule throughout the year. This pen-and-paper diary is available at Amazon.com. Alternatively, you can also create your own, taking inspiration from the many free options online.

Reserve will show you why it’s an ASEAN heritage park. Alternatively, you can lose yourself in the world’s largest collection of orchids which is in the Singapore Botanical Gardens, our revered horticultural institute which has applied for World Heritage Site status.

DISCOVER HOME Sadly, so many of us know very little about Singapore, considering how small it is. As we celebrate 50 years of independence, why not resolve to discover its many lovely and unexpected experiences and locations. Put on your walking shoes and play local tourist as you explore the island with fresh eyes.

•

TRY Park visits Singapore is not called the Garden City for nothing – and you’ll be spoilt for choice if you decide to make your new year’s resolution a green one: •

Fascinating sights can be found at the Gardens by the Bay, where a myriad garden adventures and exhibits await, while a nature trek up Bukit Timah Nature

Singapore also has many green spaces in unexpected corners of the map, like Kranji, which houses the atmospheric War Memorial Park and a collective of local farms which are open to visitors. You can also revive childhood memories at the Jurong Lake area, where the beautifully manicured Chinese and Japanese Gardens still charm. And if you’re up for distance, trek round to all of the island’s green spots via the Park Connector Network. Fully ready in 2015, this green belt is designed to allow cyclists and walkers to experience an entire unbroken round-island trip on safe and well-paved paths. How cool is that? Find out more at www.nparks.gov.sg.

You can do what, where? Not one to suffer standard offerings? Set your sights on the kooky side of Singapore with these unusual places which are definitely worth a visit: •

Countryside Farmer’s Market: this farmer’s market in Kranji is where you can find fresh local produce from farms in the area. Opening dates can be found at http:// www.kranjicountryside.com

•

Singapore Really Really Free Market: a community art project by independent cultural and social enterprise, Post-Museum, this occasional Sunday event pops up at various locations, just so that people can give things away for free – really. Relish the thrill of picking up interesting finds at no cost, or have a blast by setting up a stall of your own. Updates at: http://postmuseum. wordpress.com

•

Explore waterways: Nature Society (Singapore) has all manner of activities for the public. Register to kayak through Singapore’s mangrove swamps for a small sum, or sign up as a volunteer to help the Horseshoe Crab Rescue and Research team conduct an island-wide population and distribution survey. The 2015 event listing is available on its website: http://www.nss.org.sg

•

Balek kampong: if you don’t mind a little dirt on your feet, travel back in time to our last surviving kampong at Lorong Buangkok. This area has been designated for redevelopment but for now, a scattering of well-kept wooden homes still stand, offering a delightful glimpse of an era long gone. Just be sure to ask permission before snapping photos of the villagers; a kampong is a housing estate too.

Sincere Healthcare Group Special

Growing

with

health

It takes a trusted brand name to serve the growing healthcare demands and rising patient expectations for quality healthcare in Asia. Meeting those needs is parallel to Sincere Healthcare Groupâ&#x20AC;&#x2122;s philosophy to deliver exceptional medical care with integrity, expertise and a personal touch (with sincerity). Launched in 2011, Sincere Healthcare is a premium healthcare provider that believes in offering a high level of personalised and specialist care for all. Started by Ms Jenny Bi Xiao Qiong in Singapore, the Group has a comprehensive and multidisciplinary suite of health services that cater to patients at every stage of their lives and for a wide range of conditions and needs. The Group draws on their integrated network of specialist clinics and collaborative ties with some of the regionâ&#x20AC;&#x2122;s best and internationally renowned healthcare institutions and academia to provide their patients with a new healthcare experience, with access to expert care from around the world.

Clockwise from bottom left: Prof Ng and Ms Bi; Sincere IVF Center; Sincere Specialist Center for Women.

Innovating and growing for you Starting with its flagship Specialist Center for Women at the Novena Specialist Centre within Singapore’s central medical hub, Sincere Healthcare Group has since grown from strength to strength with the opening of IVF Center in 2012, followed by Andrology Laboratory and Specialist Center for Men in 2013. Today it offers healthcare services that include anti-ageing, aesthetics/ plastic surgery, andrology services, assisted reproduction technique, breast surgery, colorectal, cardiology, gastroscopy, health screening, IVF services, obstetrics & gynaecology, oncology, prostate care, urology and wellness programmes. The Group is well poised at the forefront of medical advances in providing the latest treatment modalities and investing in the latest medical equipment and technologies. Its excellent track record has led to the internationalisation of the Sincere Healthcare brand. In March 2014, Sincere Healthcare Group marked another milestone in its growth with its first footprint in Xiamen, China, with the inauguration of (దɠ) ķ‫މ‬౫ॲ‫ؘ‬ɠႊˌ. The Sincere Women’s Clinic in Xiamen offers ‘Singapore-style’ customer-oriented care that caters to an affluent and increasingly sophisticated demographic of Chinese patients. At the Clinic, patients can rest assured that their concerns and questions will be addressed by experts in their field in a private and relaxed environment. Leading the group’s medical professionals is Sincere’s Professor Ng Soon Chye, Medical Director. Prof Ng often flies to Xiamen to offer expert advice and personal consultations. Patients can also seek medical advice via teleconferencing for greater convenience and savings. This level of service is what sets Sincere Healthcare apart and is a distinct and well-received feature of the clinic.

With the aim of offering a similarly comprehensive level of care as that in Singapore, the Xiamen clinic’s services include general health, preventive care, adolescent health, anti-ageing, infertility treatments and women’s health. A new innovation – a membership model – was also introduced to make treatment more proactive and thus, more effective, shares Ms Bi. “We hope that by introducing a membership system, we can encourage Chinese members to go for regular health checks, which can provide a higher chance of early detection, earlier treatment and better outcomes.” This is an improvement on a typical scenario where Chinese patients tend only to seek medical help when they are seriously ill. “With regular health checks and more visits to the same doctor, our specialists will get to know members better and give the most appropriate health advice,” she explains.

A network of excellence Apart from its venture into Xiamen, and more future locations in China, Sincere Healthcare has pipeline projects in the ASEAN countries. These joint ventures, alliances and partnerships with like-minded organisations and specialists are highly-prized and the Group is always on the lookout for more opportunities for growth in the region. In fact, partners and organisations that share the goals of quality medical care and excellent service are in great demand. This is reflected in private and government healthcare sectors to benefit the community. Part of the corporate growth strategy is to establish specialist centres in key markets associated with the “Sincere Healthcare” brand to ensure patients have continual access and the same quality of medical care and excellent service from the heart, wherever they are. Sincere Healthcare Group 8 Sinaran Drive #06-13/14 Novena Specialist Center Singapore 307470 Tel: 6222 9969 Email: enquiries@shg.com.sg www.sincerehealthcaregroup.com

COVER STORY Kinship & Healing

Kinship & Healing They’re young, they’re driven and they’ve all been inspired by mentors, from their parents to their teachers. And through it all runs medicine, in this family of brother, sister and husband. By Audrey Perera Photography CJ Sameer Wadhwa Stylist Phoebe Pong Hair & make up Lolent Lee Clothes Robinsons, various designers Location Goodrich Gallery

If the dream of saving human lives is the first spark of inspiration that makes someone want to become a doctor, it is perhaps mentors who help keep one focused and driven to larger goals. This was the case for each of these three medical specialists – Dr Leo Seo Wei, Dr Leo Kah Woon and Dr Eric Hong, an ophthalmologist, a plastic surgeon and a cardiologist, respectively. For all three, it was their parents who were first mentors. Dr Eric Hong’s father is a physician and his sister is a psychiatrist. Among his cousins are endocrinologists and anaesthetists. “It’s what you’re exposed to. We knew it was going to be a life of hard work and long hours by seeing our father go through it and experiencing his sacrifice of family time. In my time, the hours are even longer and we went to different parts of the world for post-graduate training. That meant being apart from the family, but I don’t regret it – as long as you learn the trade, come back to your own society and use the skills well, the sacrifices are well worth it.” In the case of Drs Leo Seo Wei and Leo Kah Woon, the driving force was watching their parents and being involved in helping the family business. Said Dr Leo Seo Wei, an ophthalmologist: “Our grandfather and father were tailors who ran shops. My father’s shop is still at Peninsula Shopping Centre. They call him Dr. Tailor

because two of his children are doctors. My grandmother sewed at home, and we had a Singer sewing machine that we learnt how to use. When we were young, she sewed all the clothes for us and our cousins, so we all had the same clothes but in different sizes and patterns. Our schoolbags were sewn by her too. It was natural for us to learn how to sew at that young age, and my brother and I are still sewing now, as surgeons.” Adds her brother Dr Leo Kah Woon: “Our mother was a great influence in our childhood. She was not highly educated, and was a jack of all trades. When we were in primary school, she ran a tailor shop in Katong Shopping Centre on her own. At the same time, we used to go to the shop to help out, and she had to teach us. She was really juggling, taking care of the shop, taking care of us, doing the household chores, cooking the meals. That has really had a huge impact on me, and she taught me what you can achieve, if you balance your time well. “We were also strongly influenced by our father. He was a tailor with a very strong work ethic. He worked throughout the year except for one week during Chinese New Year. On Sundays we’d go either to his shop or to the one in Katong, and we’d watch our parents working. They were a living example. Their work ethic and culture of hard work has really

COVER STORY Kinship & Healing

Iâ&#x20AC;&#x2122;m a medical doctor who specialises in diagnosing and treating eye diseases. Treatment involves a whole range of options and therapies, from simple medicated eyedrops to laser treatment to the most delicate and complex surgery.

â&#x20AC;&#x201C; Dr Leo Seo Wei 36

“He ran a very high-end practice, he taught foreign students like me and he also ran a free clinic for street kids and migrant kids who didn’t speak English. He taught me to remember to give back to society. And that your practice needs to be successful so that you can afford to support charities in your own country and overseas.” influenced me; we grew up knowing that we had to work hard to achieve what we wanted in life.” Then came professional mentors, who were no doubt, in their earlier years, mentored by their own elders; an unbroken line of individuals, passing on and inspiring members of the next generation. For Dr Leo Kah Woon, a plastic surgeon, it was a passionate Irishman. “This was during the later years of my plastic surgery training. While on a Fellowship in Seattle, Dr Peter Neligan was a huge inspiration and a strong influence on me. He was passionate about his work, and was always looking at pushing the frontiers of plastic surgery.” For his sister, Dr Leo Seo Wei, it was a somewhat different kind of mentor. She counts herself fortunate to have been inspired by many different doctors at different times. “Many senior doctors have inspired me in different ways with their attitude to medicine, their devotion, and always remembering what medicine is about and putting the patients first,” adding that in the course of her training, her exposure to different fields included general surgery and neurosurgery. One mentor in the US was Professor Kenneth Wright. “He looks like a typical Californian boy – he surfed, was blond and good-looking, even at age 60. He ran a very high-end practice in Beverley Hills, he taught foreign students like me and he also ran a free clinic for street kids and migrant kids who didn’t speak English. He taught me to remember to give back to society. And that your practice needs to be successful so that you can afford to support charities in your own country and overseas. And to never mix the two. Recently, he reminded me that if you don’t build up your own practice, you don’t have the bargaining power to get help for patients who need support.” A good case in point was a situation Dr Leo was involved with here. “We have a lot of poor patients who fall between the cracks. I’ve operated on some of them and one was a case highlighted by the media. She was a blind grandmother who sold newspapers with her grandson in Ang Mo Kio. Like many other Singaporeans, I offered to help. When she agreed to have the cataract surgery, it was a team effort: my husband, Dr Eric Hong, controlled her blood pressure, I did the cataract surgery, a friend, Dr Roy Lim, was the anaesthetist, and we used the hospital facilities. We got in

touch with the social workers, and the neighbours helped ensure she used her eye drops. Her vision was restored and she got to watch the National Day Parade, so it had a nice ending.” For Dr Eric Hong, mentors emerged in unexpected contexts, and brought lessons in humanity and belief. “During Christmas in some societies, some people leave their parents with their suitcases at the emergency room. Sometimes, homeless people come in. If a patient is there and you cannot contact the relatives, you have to admit the patient. Some do it because they can’t afford the heating at home. In one hospital I trained at, the staff were trying to get us to chase these patients out, but there was no place for them to go. One of the physicians I trained under would examine every one of these patients from head to toe. Sometimes we had about 40 patients. One day, I asked him why he went through these lengthy examinations when we knew that this was the same repetitive situation. He told me that this was how you respect the patients and give them dignity, in a situation where other staff kept asking them when they would be getting out. That was doctoring, and others were condemning him because these patients were taking up the beds. The lesson was that our role is to comfort and be doctors, and not just think about bed situations and so on. It was about one doctor upholding the morale of these patients who were old and/or homeless in winter versus the others who were complaining that they had no beds. Eventually, he had to leave, and there was a road march to try and reinstate him. As a young doctor, I realised that he was a good doctor, but good doesn’t always win.” Then came a mentor who was actively rooting for him to succeed. “When I was training in the US, it was highly competitive. We worked as hard as possible, and were competing against Americans from the Ivy League. One senior doctor kept giving me opportunities. I was surprised and asked him why he was so good to me. His reply was that he wanted me to be as good as I could be. That really motivated me. In Singapore, there was one cardiologist in particular, Professsor Y T Lim, who was exemplary. He was unassuming because he was consistently good at what he did.

COVER STORY Kinship & Healing

Iâ&#x20AC;&#x2122;m a cardiologist, a doctor who specialises in diagnosing diseases of the heart and blood vessels. With advances in medical science and technology, if you treat patients appropriately and in a timely fashion, the outcomes can be very good.

â&#x20AC;&#x201C; Dr Eric Hong 38

“He told me that this was how you respect the patients and give them dignity, in a situation where staff kept asking them when they would be getting out. The lesson was that our role is to comfort and be doctors and not just think about beds...it was about one doctor upholding the morale of patients who were old/homeless in winter versus those who were complaining that there were no beds.” I remember one night he noticed that there was no porter around, the junior doctor was running around doing everything and a patient in a wheelchair needed help. He wheeled the patient back to his bed. Another lesson in not forgetting why we studied medicine. “It is difficult for any of us to actually pinpoint one mentor. Along the way, we evolve, we have our superheroes that we endeavour to be and when we actually reach that goal, we realise that we need new heroes. These days I still find new heroes.” All three doctors have already made a mark for individual credibility and achievement.

Individualising heart treatment For quietly passionate Dr Eric Hong, it began with an interest in geriatrics before evolving into cardiology and then into cutting-edge cardiology sub-specialties. One of the few cardiologists who is trained in two of these areas – interventional cardiology and non-invasive cardiac imaging – he was also the first Singaporean to be accepted into two clinical fellowship programmes at Harvard Medical School’s Brigham & Women’s Hospital. One of those sub-specialities is multimodal imaging (MMI). “In the past, when we considered condition like coronary artery disease, we did things like ultrasound of the heart – an echo cardiogram (ECG) – and if we wanted to diagnose coronary artery disease we had to do an invasive procedure called a coronary angiogram. “With MMI, a technology that has matured over the last decade, we can assess the severity of the blockages of the arteries non-invasively. Various imaging techniques combined and used together mean that we can combine anatomical data with physiological data, link them and begin to understand. Someone can say that there is a significant blockage, but what is a significant blockage? A blockage of 70% is considered significant, but can you differentiate a 71% blockage from a 69% blockage? Imaging compares the individual against himself. “In some cases, the patient has more issues, maybe is wheelchair bound or his functional status is not very good. So the question is, do you really want to do the conventional

steps – angiogram, diagnosis of multi-vessel disease and prescribe heart bypass surgery – when it is clear that the patient cannot take that route? MMI allows us to individualise medicine for the individual.” Naturally, older patients come with a lot of medical issues. “For instance, diabetic patients are fearful of any invasive procedure, and these imaging techniques help us understand the pros and cons of medical therapy versus invasive procedures and we can discuss this with the whole family before anything is done. Or there are patients who had a bypass several years ago and they start developing symptoms. They get chest pains and start wondering whether there’s been a recurrence of the disease. The MMI techniques are really helpful, to better advise and treat patients,” he said. When Dr Hong returned from overseas, he helped to set up and deliver a 24/7 acute cardiology service for heart attack patients and anchored the MMI service at Tan Tock Seng Hospital.

Preventing irreversible blindness It is no surprise that Dr Leo Seo Wei chose to focus on eyes, given her energetic people-oriented personality and her early fascination with our windows to the soul. “I was intrigued by the eye because it is a very small and delicate organ but it is also very complex and joined to the brain. With so many different layers, even the simple act of moving your eye is finely coordinated from the brain. I didn’t want to do surgery without the medical aspects. Ophthalmology has a good range where you use medicine and surgery, and also lasers and new technologies. “I feel that sight is the most important sense, and we are faced with a unique challenge when we deal with patients who are at risk of losing their sight. It is highly stressful, even though it is not life-threatening. It’s about what you can see and what you can’t see, and the value of things. “After I finished my training in ophthalmology, I decided to sub-specialise in paediatric ophthalmology, a very challenging and rewarding area of work. Something

COVER STORY Kinship & Healing

I’m a plastic surgeon and my work revolves around restoring form and function to the patient. Restoring form is about enhancing a person’s beauty, and restoration of function happens after a patient has had cancer, or been a victim of a serious road traffic or industrial accident. I work to restore the patient to where he was before.

– Dr Leo Kah Woon 40

“Our mother...was a jack of all trades...taking care of the shop, taking care of us, doing the household chores, cooking the meals. She taught me what you can achieve if you manage your time well. My father...was a tailor with a very strong work ethic. He worked throughout the year...they were living examples...and we grew up knowing that we had to work hard to achieve what we wanted in life.” that can be very elective in an adult cannot be neglected in a child because if you don’t treat it early, the child may end up with irreversible blindness. There’s the time component because their eyesight is still developing. Also, kids can’t complain because they may not realise that anything is wrong. So clinical skills are all the more important. They have their whole life before them so you are potentially curing a lot more years of problems. For instance, if it is a newborn baby, you can actually reverse 80 years of blindness versus an adult who might lose their eyesight momentarily but can gain it back with a procedure. It’s challenging and rewarding; once you know you fixed it, you can change a child’s life. In order to sub-specialise, Dr Leo completed two fellowships at the worldrenowned University of Michigan Kellogg Eye Center and the Wright Center for Pediatric Ophthalmology in Los Angeles. At Kellogg, she was the first non-American clinical fellow from Southeast Asia to be admitted. “A lot of Asians go there to do research and observe, but I wanted the full hands on experience. There were two of us as clinical fellows and then my partner decided to resign. They used to joke that I killed off the other fellow. So I had double the work and had to continue. You can’t just cut out of the system, you have to complete it. So it was quite a full year. I got used to managing with the kids in daycare, and I would get help from the other mothers, and that’s how I got by. A lot of people called me crazy for bringing the kids to the US with me, but we managed.” And it certainly proved that Dr Leo, like her mother, is one of those master jugglers.

Restoring harmony and beauty Having always had a love for beauty, beautiful objects and art, plastic surgery was a natural extension for the warm and chatty Dr Leo Kah Woon. “To me, beauty is harmony, proportion, and congruous with the social context. Plastic surgery appealed to me because it is very meticulous work, which cannot be rushed. I do a lot of micro surgery for breast reconstruction, reconstruction of lower limbs and so on, in relation to

causes relating to cancer, and traffic and industrial accidents. You need to feel calm, feel inner peace and go about delivering what you seek to do. I like challenging cases but don’t have to do them that often,” he explains, citing the very recent case of the Vietnamese timber factory owner whose leg skin was yanked off when a huge log rolled over his leg. “We needed to use muscles from his back on his leg, and the surgery took 24 hours.” It could be said that plastic surgeons are faced with the most demanding patients. “Our patients are essentially normal and healthy and just want to look better. Apart from wanting physical enhancements to look good, a lot of people have some underlying psycho-social reason behind this desire. It might be that they are going through a divorce or recovering from a cheating spouse, for instance. I need to first decipher if there are any underlying issues which need to be addressed, before seeing if my surgery can match their expectations. I take the role of listener and facilitator to help them fulfil and live out their dream. Most patients have realistic expectations which are achievable. The best thing about plastic surgery, says Dr Leo, is that it is the only specialty that allows the surgeon to operate from head to toe, because it involves the skin, the body’s largest organ. And there is a lot of freedom and self-expression possible. “For instance, in general surgery, there is basically one way to do an appendectomy. But in plastic surgery, there is no one way, it is up to the surgeon to improvise and achieve the best solution.” True to his meticulous nature, Dr Leo is actively involved in the academic training and development of young surgeons. Besides being an adjunct A/Prof at Duke-NUS Graduate Medical School, he is also an examiner for plastic surgery exit examinations. His expertise has also taken him on overseas humanitarian missions to China, Indonesia and Vietnam. Bonded by these ties of kinship and healing, Drs Leo and Hong are driven in their respective specialties, sharing one common belief – that the patient’s needs must always be best served.

The Canary Diamond Special

Fabulous Jewel Colours As the mines of precious stones run dry and the export of fine gemstones becomes ever rarer, it is no wonder that jewellery connoisseurs are on the lookout for quality stones from the vaults of knowledgeable collectors.

with about 15% each. Colombian emeralds differ from other deposits, in that they exhibit an especially fine, shining emerald green unimpaired by any kind of bluish tint. One of the most precious gemstones in the world, a quality Colombian emerald is coveted for its textured yet intense and radiant green. Most of the finest emeralds come from the eastern range of the Andes Mountain in Colombia, which has what is considered the purest emerald deposits in the world. Their deep green is the most beautiful, scarce and valuable, says Colombia.travel, a government-backed tourism website; and the colour is also the most exclusive, found only in the deepest depths of Colombia. But despite the volume of Colombia’s emerald export, it is estimated that less than 1% of them are fine gemstones; and these are so soughtafter that they can rarely be found on retail shelves.

The Canary Diamond Company is launching its RGB jewellery collection 2015 that features rare gemstones from extinct mines around the word. This exquisite colour collection is the brainchild of Johnny Lam, who took over the company from award-winning jewellery designer, William Lam, in 2013. A gemologist trained at Geological Institute of America (GIA), Johnny stands by the company’s tagline: “Always Something Beautiful at the Canary Diamond”. And this year, beauty begins with the rich, red hue of Burmese Pigeon Blood rubies, the clear green of Colombian emeralds and the silky blue of Kashmir sapphires. Johnny explains the rationale behind the choice of these precious stones, and why they make fine additions to anyone’s jewellery collection.

Burmese Pigeon Blood Rubies Ruby is the most famed and fabled of all red gemstones, distinguished by its brilliant bright red, and desired for its hardness, durability, lustre, and rarity. Rubies and sapphires are the second hardest stones next to diamonds, and eye-clean rubies of larger sizes can be even rarer than diamonds. Burmese rubies have the most preferred hue of all, and are renowned for their exceptionally deep blood red with just a tinge of blue. Such rubies are known as “Burmese Ruby” or “Pigeon’s Blood Ruby”, so called because the finest come from the Mogok mines of Burma, or Myanmar, as the country is known today. The area, also called the Valley of Rubies, has traditionally produced the most important rubies in history, particularly those that adorn European crown jewels. According to GIA, top-quality Burmese rubies are the standard by which the world’s production is judged. The record selling price for such a ruby was set at Christie’s in St. Moritz on February 15, 2009, when an 8.62 carat cushion-cut ruby fetched a price of US$425,000 per carat.

Kashmir Sapphires Sapphires come in all colours, but blue has always been the most valued. Amongst the many shades of blue, there are only two standout hues – Ceylon and Kashmir. While Ceylon sapphires are famed for their crisp electric blue, Kashmir sapphires are highly regarded by specialists and connoisseurs as having the most premium of blue – described as being “velvety” – and always leaving a lasting impression of what first-class sapphires should look like. Typical of the Kashmir colour is a pure, intense blue with a very subtle violet undertone, enriched by a fine, silky sheen. There has been no more mining of Kashmir sapphires and all the material that The Canary Diamond Company has were mined over 200 years ago between India and Pakistan, in the Kashmir Valley. Some of these rare gems have been recut to bring out even greater lustre for the RGB collection. Certified by GIA, the lineage of these fine stones is guaranteed, making them even more precious for collectors.

Colombian Emeralds Colombia produces 55% of the planet’s emeralds, followed by Brazil and Zambia

The Canary Diamond Company 402 Orchard Road 01-12 Delfi Orchard Singapore 238876 Telephone: +6567363383 www.thecanarydiamond.com

HEALTH DOSSIER Womens’ Women’s Health

A Woman’s

Health

Designed with the ability and capacity to nourish, grow and deliver children, a woman’s body comes with its own specific spectrum of features. Like any other well-designed marvel of engineering, we need to ensure we keep our bodies in their best condition. And when problems arise, as they sometimes will, early intervention can make a huge difference to the outcome. In this edition of Health Dossier, you will find insights on health topics and challenges unique to women, from osteoporosis, gastrointestinal issues, breast cancer and reconstruction, to eye health, reproductive surgery, plastic surgery and skin disorders. Read on for some timely and current expert advice.

HEALTH DOSSIER Women’s Health

Different ages, different conditions S Some illnesses are age-specific, such as autoimmune diseases which usually affect yyounger women, and osteoporosis, which typically hits post-menopausal women. By A/Prof Leong Keng Hong, Rheumatologist B

Autoimmune diseases One of the immune system’s jobs is to protect the body from viruses, bacteria and other “foreign” organisms. Sometimes, however, the immune system responds to a trigger and produces antibodies that attack the body’s own tissues instead of fighting infections. It attacks the cells it is supposed to protect. This is called autoimmunity. It is a widely-held that certain bacteria, viruses, toxins, and drugs trigger this autoimmune response in people who are genetically susceptible to autoimmune disorder. The onset of these diseases is usually between 20 and 50 years of age. Autoimmune diseases include rheumatoid arthritis, lupus, vasculitis, psoriasis, scleroderma, Sjogren’s syndrome and spondyloarthropathy. The symptoms of autoimmune disease are many: joint pain with swelling and morning stiffness, leg swelling, easy bruising, prolonged fever, hair loss, and photosensitive rashes. Multi-organ autoimmune diseases such as Lupus can have almost any symptom. These diseases can be serious and can affect major organs such as the kidneys, brain and lungs, and can, in a worse-case scenario, lead to organ failure or death. They can be managed to prevent severe consequences, but they are life-long conditions. Fortunately, most of them get better as the patient grows older. Treatment involves medication to control the immune system, and these range from corticosteroids to newer drugs such as targetted therapies like anti-TNF and anti-CD20, which have been proven to be more effective and with fewer side effects. Osteoporosis This is a progressive bone condition characterised by decrease in bone mass and density. The result is weak and brittle bones, which increases the likelihood of fractures and breakages. It occurs because the rate of bone loss exceeds the rate of bone replacement. Post-menopausal women are the most prone to this condition because of the decrease in production

of oestrogen, a female sex hormone responsible for protecting bones in women. Low body weight, a family history of osteoporotic fractures, use of corticosteroid medication and Vitamin D deficiency are also risk factors. Research has shown that Asians and Europeans have a higher tendency to develop osteoporosis compared to Africans. There are no symptoms of osteoporosis until fractures occur. At that stage, one of the best methods for diagnosing it is with a dual-energy X-ray absorptiometry (DXA). Taking less than 15 minutes, this scan can accurately analyse and diagnose osteoporosis. There are generally two ways to treat osteoporosis, namely, with medication that slows down the rate of bone loss, such as HRT, SERMs, bisphosphonates and calcitonin; and with medication that increases the rate of bone formation and lowers the risk of fractures, such as parathyroid hormone injections. Many people think that boosting one’s calcium intake will help prevent osteoporosis, but the fact is that calcium, vitamin D and exercise are lifestyle measures that enhance bone health but which cannot arrest the illness once it is there. You can prevent it from developing in the first place by taking the right amounts of Vitamin D and calcium, which are essential for bone formation; exercising regularly to build stronger, healthier bones; avoiding smoking and excessive alcohol consumption, which lead to increased bone loss rate; and reducing caffeine consumption, as it reduces the rate of calcium absorption. Another condition that can happen to women as they get older is osteoarthritis, which is caused by wear and tear in the joints. It affects an estimated 40% of adults and generally starts from the age of 50 onward. It affects the fingers, knees, lower back and neck. Treatment depends on the severity of the disease and the patient’s expectations, and ranges from rest, weight loss and cessation of smoking to exercise, physiotherapy and medication and surgery.

Founder and long-running President of the Osteoporosis Society (Singapore), A/Prof Leong is a well-published Consultant Rheumatologist who also teaches at NUH. He has a special interest in autoimmune and degenerative diseases.

Leong Keng Hong Arthritis & Medical Clinic 6 Napier Road #04-18 Gleneagles Medical Centre Singapore 258499 Tel: 6472 4337 www.leongkenghong.com

Simpler, more targeted, less invasive Women today can expect better outcomes when they undergo surgical procedures for common reproductive system issues, thanks to smaller instruments, robotics with 3D vision and other innovations. By Dr Ann Tan, Obstetrician & Gynaecologist

ynaecological surgery is commonly done when there are abnormal growths in the female reproductive organs, namely the cervix, uterus and ovaries. Among the most common operations performed are Hysteroscopy for the removal of polyps and Laparoscopy or Laparotomy for the removal of fibroids and ovarian cysts. Other common procedures include evacuation of the uterus for miscarriages or unwanted pregnancies and Colposcopy cervical biopsy for pre-cancerous lesions.

Conventional surgery This term refers to ‘open’ surgery as opposed to Laparoscopy or keyhole surgery. An abdominal incision is made, usually on the bikini line, to remove large growths which are not as easily removed with keyhole surgery. For cancer surgery, the approach may be through a midline incision so that the liver and other organs are more easily visualised and accessible if and when required.

Less invasive approaches Minimally-invasive surgery using smaller instruments is being used to perform more and more complex procedures as lenses are better and instruments more versatile. The additional use of robotic surgery allows greater degrees of freedom for the keyhole surgery while 3D HD vision allows for more precise cutting and suturing. Today there are many innovative instruments which assist in keyhole surgeries to optimise the outcome and shorten the time taken to complete the surgery. How to choose? When there is a choice of open or laparoscopic surgery, you need to discuss the pros and cons of each with your surgeon. Open surgery The most obvious downside is a larger scar on the abdomen. It will also be more painful and the road to recovery may be a bit longer. The sight of the scar, especially if it does not heal well and becomes a keloid, could also cause emotional pain and the sense of feeling less desirable or attractive. Even if the surgery was absolutely essential for one’s health and well-being, these effects on the patient can be powerful and must be taken into consideration. The open surgery option is perhaps better when there have been multiple previous surgeries and there are likely to be severe adhesions within the abdomen and pelvis. These could make access via the laparoscope more difficult and dangerous. Laparoscopic surgery The obvious advantage of this is that abdominal muscles are not cut and hence post-operative pain is reduced and the road to recovery usually faster. This means overall less downtime for the patient. While this option is better for simple cysts and superficial fibroids, this must be qualified. The “shredding and suction” process of removing the fibroid in this way can pose the risk of spreading unknown cancerous cells – if present – within the patient’s abdominal cavity. This applies if the suspected fibroid harbours pre-cancer cells. This risk has led to a reduction in the number of patients opting for keyhole surgery. So the decision on which is the best option is not so straightforward, with more factors needing careful consideration in consultation with your surgeon.

Having won numerous awards in her area of specialisation, Dr Tan’s greatest pleasure lies in helping her patients achieve their dream of having healthy babies.

Women & Fetal Centre 290 Orchard Road #20-01 Paragon Medical Singapore 238859 Tel: 6887 1106 www.anntan.com.sg

HEALTH DOSSIER Women’s Health

Looking your best – at all ages Through the ages, the quest for beauty and youth has been a constant. Learn about the most popular aesthetic procedures for mature women. By Dr Leslie Kuek, Plastic Surgeon

very woman wants to look as beautiful and young as possible. In this day and age of pervasive digital technologies and social media, the pressure to look good is even more pronounced. You never know when you might appear on a friend’s social media feed. The good news for those who desire to look their best and as young as they feel is that there are many options to achieve this through non-surgical and surgical alternatives. The most telling signs of age are often in the eyes, jowls and neck. Fat and collagen loss in the face can also cause gauntness and a haggard look. It is no wonder that the most common youth-enhancing procedures aim to include those treatments for the eyes, face lifts and filler treatments. Hey, bright eyes With age, tear troughs (depressions that run from the nose and all around under the eye) become more pronounced. This gives the appearance of eye-bags and dark circles. There are several ways to reduce the appearance of eye-bags. Surgery involves removing excess eye-bag fat or redistributing it. The cut can be made in the external part of the lid (an ‘open’ technique) or in the inner part of the lid (a ‘closed’ technique). Other non-surgical techniques may also be used to lift the eyes, reduce wrinkles and plump up the eye area. These include hyaluronic acid filler injections, eye brightening serums and ultrasonic or radiofrequency collagen stimulation. The look of youth Age can cause cheeks and jowls to sag and wrinkles to form. Face and neck lifts, known as rhytidectomy, can help the face regain its youthful tautness. In a facelift, incisions are placed in the hairline and in front of and behind the ears. The skin is then ‘pulled’ back to reposition and tighten over the face. Deeper tissues are also lifted upwards. This lifts the cheeks, adds definition to the jawline and firms the neck. Excess skin and fat may also be removed during this procedure. In another type of facelift called a threadlift, special threads are inserted into the face using a thin needle. These threads attach to the underside of the skin tissue and can be pulled back to reposition skin and facial tissues. Compared with a traditional facelift, threadlifts usually give a less dramatic and long-lasting result, but are minimally invasive, quicker and can be done under local anaesthesia. Another non-surgical option

is to use a specialised ultrasound device called Ulthera. This device emits heat via highly focused ultrasonic waves into the deep layers of the skin to stimulate new collagen growth and over time, tighten the skin. Wrinkles away! Other options to banish wrinkles and gauntness include fillers, Botox and fat injections that smooth out lines and creases. These rejuvenative treatments can be used in combination with other procedures previously described. Many of these treatments are non-invasive and have little or no downtime, although they require regular maintenance. Doctor knows best Always speak with your plastic surgeon about what to expect from the various procedures because he is in the best position to give advice about the options available. The pre-treatment consultation is very important in order to discuss the best and most feasible options for your own particular circumstances. The best plastic surgery is often the kind that looks natural so you do not look ‘done’. The goal of aesthetic surgery is to optimise and bring out the best that is in you. Try not to shop around for the cheapest price because often, you “get what you pay for!” Instead, find a doctor who has the best experience and the necessary skills to help you achieve your desired goals. Patients who understand this are usually the happiest post-procedure and go on to feel more confident and beautiful inside and out.

A pioneer in the development of plastic surgery in Singapore, Dr Kuek is much sought after by the media on matters pertaining to plastic and cosmetic surgery.

Leslie Kuek Plastic Surgery 38 Irrawaddy Road #05-41 Mount Elizabeth Novena Singapore 329563 Tel: 6472 2972 www.lesliekuek.com.sg

Heart health for women Thoug often thought of as a ‘man’s problem’, women face unique risks for Though heart disease because of low awareness and the higher impact of risk factors. By Dr Ruth Kam, Cardiologist

hile it is true that men have more heart attacks than women, this is only true for women who have not yet reached menopause. After menopause, the protective effects of oestrogen wear off, making the risk of heart attack equal to that of men. In addition, if a woman has risk factors for coronary artery disease — such as high cholesterol, high blood pressure, diabetes and obesity — these factors may also play a bigger role in the development of heart disease. Common heart conditions in women Because heart disease can affect women as much as men, it is important to be aware of the types of cardiac conditions that can strike: Arrhythmias are a disorder of the heart rhythm, and can present at any age, from early childhood to late adulthood. The cause may be congenital, or due to hypertension, heart disease or ageing. Hypertension is also known as high blood pressure and usually presents in early to late adulthood. It is linked to stress, obesity, smoking, and unhealthy eating habits. If left untreated, the condition can lead to complications such as heart attack, stroke, heart failure and kidney failure. Coronary artery disease is the narrowing of arteries supplying blood to the heart muscle and leads to heart attack, heart failure and arrhythmias. The risk factors include hypertension, diabetes, high cholesterol, stress, smoking and a family history. Pregnancy places extra demands on a woman and some may suffer from pre-eclampsia (hypertension in pregnancy). This may lead to maternal and foetal death, small babies, maternal fits and kidney complications. Peripartum cardiomyopathy is a condition in which there is heart failure during pregnancy. This could be fatal or the mother may need heart transplantation at a later stage if the heart muscle cannot recover. Menopause, apart from causing the dip in heartprotective oestrogen, can also cause hypertension, weight gain, palpitations, elevations in cholesterol, insomnia and depression. These may have adverse effects on heart health. Relative to age Under 20: Risk of heart disease is low, but does not preclude congenital heart problems and arrhythmias.

20-40: May be susceptible to arrhythmias, hypertension, stress-related and pregnancy-related issues. 40s and beyond: Prone to hypertension, arrhythmias, coronary artery disease, menopause and stress-related issues. Keeping the heart healthy Good cardiac health results from good habits which must be inculcated from childhood because narrowing of the arteries occurs over many years and bad dietary habits are difficult to change once they are ingrained in adults. It is important to: • • •

•

eat a healthy diet, exercise regularly, and avoid overeating and too much alcohol consumption do not smoke as smoking has a greater adverse impact on women focus on emotional and social well-being as stress and depression affect a woman’s heart more than a man’s aim for seven to eight hours of sleep every night

Passionate about the heart and its workings, Dr Kam is deeply involved in consultation work, teaching and writing on this topic in Singapore and overseas.

Ruth Kam Heart and Arrhythmia Clinic 290 Orchard Road #14-10 Paragon Medical Singapore 238859 Tel: 6333 6866 www.arrhythmia.com.sg

HEALTH DOSSIER Women’s Health

New hope for breast cancer Even though the rate of breast cancer is rising, more effective and targeted treatments give new hope for the afflicted. By Dr Lim Hwee Yong, Oncologist

risk of breast cancer and much higher risk of ovarian cancer. Actress Angelina Jolie decided to undergo a double mastectomy after she tested positive for one of the genes. Besides the obvious inheritance of breast cancer genes, having first degree relatives with a history of the disease will also increase the risk of getting breast cancer. Other factors that increase the risk include: • • • • • •

Age, as overall cancer risk increases with age Early onset of menses or menopause Previous use of hormone therapy Late pregnancy Not having children Obesity

Besides these risk factors, research has indicated that exercise and a low fat diet can decrease the risk of breast cancer, while a diet high in beta-carotene is also linked with a lower incidence.

ancer remains an important and significant health problem globally and in Singapore it is responsible for the largest proportion of deaths. The most common cancer in women is breast cancer. Like other cancers, it occurs when normal cells undergo genetic changes and keep on growing without control, spreading to colonise other tissues. In breast cancer, cancerous cells can affect various parts of the breast, and often cause changes in the skin, bleeding from the nipple and unusual lumps. Vigilance in observing these signs is important as the later the cancer is detected, the more likely it can spread and affect the whole body. Risk factors and prevention The highest prevalence of breast cancer is found in women aged 35 to 65. Research has also indicated that those of Chinese descent tend to have a higher incidence compared to the Malay and Indian populations. DNA and genetics plays a big role in the occurrence of breast cancer. Those with the breast cancer genes BRCA1 and BRCA2 gene have up to 85% lifetime

New treatment modalities The good news is that breast cancer, if detected early, has one of the highest rates of cure, reaching more than 90% rate of cure if detected at early Stage 1. More encouragingly, the side effects of chemotherapy are now much less severe because the drugs are given in conjunction with anti-emetics to reduce feelings of nausea. There are also new targeted ways to deliver cancer drugs so these medicines ‘seek out’ and destroy only the cancer cells. Some of these drugs disrupt the cancer’s ability to bind and grow or attack the supply line of blood vessels that feed the cells. Interestingly, some drugs can be disguised so that the cancer cell is fooled into absorbing them. The drug then attacks the cancer cell from within. Better understanding of molecular and cancer genetic signatures have enabled doctors to better personalise treatment of individual molecular subtypes of cancer for individual patients. Very long term control of the disease can now be achieved with patients continuing fully functional and quality lives. Hope for the future As we understand cancer better and learn to target it in more focused ways, survival rates will continue to rise. But it is imperative that all women are conscientious about their screening, breast selfexamination and mammograms. If cancer is spotted, see a doctor and start treatment early. Cancer evolves over time, so there is time for a cure if it is addressed in a timely manner.

Dr Lim is a medical oncologist with a deep commitment to cutting-edge cancer treatments, clinical trials and research. He also teaches medical students and palliative care nurses.

Novena Cancer Centre 38 Irrawaddy Road #09-41 Mount Elizabeth Novena Singapore 329563 Tel: 6339 0233 www.novenacancercentre.com

Saving the breast The advancement of surgical techniques means that a diagnosis of breast cancer does not necessarily mean a mastectomy. By Dr Bertha Woon, General & Breast Surgeon

one are the days when a mastectomy – removal of the entire breast – is the only option in the event of breast cancer. In the last 15 years, studies have proven that early breast cancer patients who undergo breast conservation surgery coupled with radiotherapy have an equivalent rate of survival as those who undergo a mastectomy. Whether the breast can be conserved is dependent on the size of the tumour relative to the volume of the entire breast, as well as on which quadrant of the breast the tumour is in. Even when the tumour is not very small, it is possible to use chemotherapy to shrink it before breast conservation surgery. To determine which type of treatment is most suitable, we usually first perform biopsies to ascertain the cancer type and receptor status. Our team ensures the best possible care for our patients.

Advancements in surgical techniques Some of the newer techniques that are improving the outcome of breast conservation involve using tissue flaps to cover defects by moving or rotating tissue from another part of the affected breast. If a mastectomy is required, we can do skin-sparing mastectomy or even nipple-sparing mastectomy with immediate reconstruction, using a patient’s own tissue flap, breast implant or a combination of both. The type of surgical method and the resultant cosmetic outcome depends on the variables cited above. For conservation surgery, the more challenging areas to reconstruct include the cleavage and the area behind the nipple. No matter which method is used, the main objective is to ensure removal of ALL the cancer. For early breast cancer, we do sentinel nodes and/or axillary sampling (taking a few lymph nodes out of the armpit area). This decreases the morbidity associated with full axillary clearance such as lymphoedema and numbness of the inner part of the upper arm. For advanced breast cancer, axillary clearance is still required. Implant surgery Various types of breast implants are available today. The most common is a saline-filled silicone implant, followed by silicone gel-filled implants. Implant surgery can be done at the same time as removal of the breast tumour or later. Usually, delays are due to the uncertainty about whether any tumour has been left behind and whether the patient might need radiotherapy. In such cases, the plastic surgeon will usually leave a temporary implant known as a spacer and put in the definitive implant after all the radiotherapy and chemotherapy

have been completed. It is important to discuss options with your doctor before deciding which is best for you. Advanges of implants There are fewer scars and a shorter recovery time. Post-implant, the plastic surgeon can sculpt the final cosmetic outcome over a few procedures using fat harvested from the patient’s own adipose. Drawbacks There is a risk the implant may rupture. A tough layer of scar tissue may form around the implant and affect the cosmetic outcome. Breast implants also have a lifespan and may need to be replaced every decade or so. Tissue flap surgery This involves using a section of your own skin, fat and in some cases, muscle from the shoulder blade region, abdominal wall, thighs or buttocks to reconstruct the breast. The advantages of using your own tissue for reconstruction is that the tissue is more likely to look and feel natural and will “grow” with you, changing in size as you gain or lose weight. But there will still be some scarring and the tissue may feel a little tough or fibrous, especially if you have undergone radiotherapy. We usually consider patients’ general health before deciding on the best surgical plan. Different procedures take different amounts of time, and different patients tolerate different durations of anaesthetic and surgery.

Dr Woon is a general surgeon with a sub-specialty interest in breast surgery, particularly breast conservation surgery for cancer.

Bertha Woon General and Breast Surgery 6 Napier Road #09-02/03 Gleneagles Medical Centre Singapore 258499 Tel: 6479 7307 www.berthawoonsurgery.com.sg

HEALTH DOSSIER Women’s Health

Patches and dots Although they are often harmless, pigmentary skin disorders affect skin colour and can cause distress and anxiety. Here are the most common ones that affect women. By Dr Noor Hanif Said, Dermatologist Treatment: In most cases, pigmentation penetrates deep into the skin, making treatment challenging. Pigment lasers are used to break down the melanin in the affected areas. Solar lentigines Also known as liver spots, they commonly affect fair-skinned people over 40 with brown, black or grey spots appearing on sun-exposed areas of the skin. These are caused by sun exposure when UV rays speed up melanin production. Solar lentigines can be left alone as they do not turn cancerous, but they may look similar to other more serious skin conditions, so it is important to see a dermatologist, especially if the spots: • are very dark or in different colours • increase in size over a short period of time • have irregular borders • bleed, itch or turn red Treatment: Ranges from topical creams with skin lightening properties, IPL and pigment laser treatments to chemical peels and light cryotherapy, which uses liquid nitrogen to destroy the melanin.

Melasma This disorder mainly occurs in women, resulting in grey-brown patches appearing on sun-exposed areas such as the face, neck and forearms. Usually related to hormone excess, it is so common in pregnancy that it’s called the “mask of pregnancy”. Some melasmas fade, but most are stubborn and take a long time to improve. Treatment: As chances of recurrence are high, and sun exposure and tanning worsen it, daily and adequate sun protection is crucial. Topical creams containing hydroquinone or a combination of hydroquinone, tretinoin and steroid (Kligman’s formula) may also be used. For stubborn cases, intense pulse light (IPL), chemical peels and lasers are options. Laser treatments should be considered very carefully and performed by an experienced doctor as they can sometimes worsen melasma. Hori’s Nevus Hori’s nevus is commonly seen in middle-aged Asian women in the form of bluish-grey patches typically on the cheeks. Largely caused by genetics and hormonal activity, melasma and Hori’s Nevus can occur simultaneously.

Freckles Freckles are small flat brown marks on sun-exposed areas of the skin. They are more common in fair-skinned people. Caused by sun exposure, freckles may fade, but will reappear when skin is exposed to the sun. As a person ages, freckles generally become less noticeable. Treatment: Reduce and lighten them by avoiding sun exposure and ensuring regular use of sunscreens and skin lightening creams. IPL and pigment laser treatment also work. Post-inflammatory hyperpigmentation (PIH) PIH is a general term for excess pigment formation after an underlying skin condition has healed. It occurs because the body’s immune response is activated due to inflammation or injury and causes pigment-producing skin cells to produce more melanin. Discolouration is temporary but may become darker when exposed to sunlight. PIH is more common in darker-skinned people. In most cases, PIH improves over time and normal skin colour will return. Treatment: Hydroquinone and retinoids may be used to lighten PIH. Procedures such as chemical peels, lasers and IPL may be helpful, though they can aggravate pigmentation. For maintenance, regular application of sunblock is a must.

Dr Noor Hanif Said is an accredited dermatologist who believes in providing high quality dermatological care as well as evidence-based treatment for all medical and aesthetic skin conditions.

Renaissance Dermatology, Laser & Aesthetics Clinic 38 Irrawaddy Road #10-36 Mount Elizabeth Novena Specialist Centre Singapore 329563 Tel: 6570 2883 www.renaissancederm.com

Sparkle with healthy eyes Certain eye conditions are more common in women because of genetic make-up and hormonal influences, while some are exacerbated by eating habits, smoking and environmental effects. By Dr Elaine Chee, Ophthalmologist

wo-thirds of blindness and visual impairment occurs in women, and most of it is either preventable or correctable. On top of that, women in Singapore live until 87 on average, as opposed to men at 81. So it is very important to be aware of common eye conditions which women face and how to treat them. The following are the most common sight-threatening eye conditions that women face as they age. Cataract A cataract develops when the lens of the eye becomes cloudy, due to the build up of protein in the lens. This usually results in blurred vision, difficulty in reading, double vision, increase in glare or colours that appear faded. The only treatment for cataract is surgery to remove the cataract and replace it with an artificial lens. Stronger lighting or spectacles may resolve the problem in its early stages while protection against sunlight and a diet high in antioxidants may help to delay the development of cataract. Glaucoma Glaucoma is a potentially blinding condition that is often termed the “silent thief of sight”. There is gradual damage to the nerve fibres of the optic nerve, which is essential for sight. There are two main types of glaucoma – open angle and closed angle. Open angle glaucoma usually presents late with painless progressive loss of peripheral vision first, and patients often don’t realise it until much of their vision is lost. Closed angle glaucoma is more common among Chinese females and presents with sudden acute episodes of raised eye pressure with pain, blurring of vision, headache and inflamed eyes. Severe vision loss from glaucoma can be prevented if detected early enough. Hence patients with a family history of glaucoma should have their eyes examined at age 40, with regular follow-up thereafter.

Age-related macular degeneration (ARMD) ARMD is a common and serious eye disease that affects the centre of the retina. It causes the cells around the retina’s centre to degenerate, leading to loss of the sharp central vision that is needed for most daily activities. As women live longer, they are twice as likely as men to develop ARMD, which presents in two forms. Most people have the dry form, which presents more gradually. There is no effective treatment to date for dry ARMD, though wet ARMD can be treated with laser, drug and photodynamic therapies.

It is recommended that everyone over the age of 60 be examined at least every 1-2 years to detect any early signs of ARMD. Dry Eyes Dry eyes are a common complaint which occurs as a result of insufficient tear production or excess evaporation of the tears. It is two to three times more common among women. Dry eyes due to excessive evaporation are secondary to conditions like meibomian gland dysfunction (abnormal oil production at the eyelid margin), excessive exposure of the surface of the eye due to reduced blinking, or incomplete closure of the eye due to strokes or thyroid eye disease, and diseases or surgeries that damage the conjunctiva (white part of the eye). Artificial tears or gel are usually prescribed for mild cases while occlusion of the opening of the tear duct with plugs is reserved for severe cases. Teary Eyes Tearing (a watery eye) is due to excessive production or decreased elimination of tears caused by reduced passage of tears into or through the tear drainage system. Excessive production of tears is usually a result of an irritative focus such as foreign bodies in the eyes, inflammation or infections of the eyes, malposition and laxity of the eyelid. Blockage of the tear drainage passages affect women twice as frequently as men. The treatment of watery eyes depends on the cause. If the cause is due to lax eyelids and incomplete closure of the eyelids, surgery is often needed to correct the lid laxity and malpositions, while a bypass surgery is usually required to channel the tears through the new drainage system when there is blockage of the tear system. Keep your eyes healthy Rest your eyes adequately during work or watching TV and read in adequate light. A balanced diet protects your eyes from age-related diseases, while shielding your eyes from direct sunlight helps prevent certain types of cataract and age-related macular degeneration.

Dr Chee is a Consultant Ophthalmologist with a special interest in oculoplastic conditions and surgeries as well as aesthetic rejuvenation of the eyes and face.

Eye & Retina Surgeons 1 Orchard Boulevard #13-03 Camden Medical Centre Singapore 248649 Tel: 6738 2000 www.eyeretinasurgeons.com

HEALTH DOSSIER Womenâ&#x20AC;&#x2122;s Health

Stages of a woman There is a clear-cut optimal age at which to bear children, beyond which options narrow and cancer risks loom. By Dr Yap Lip Kee, Gynaecologist

omen are at their most fertile in their 20s, with fertility starting to decline sharply after age 30. Studies show that the possibility of conceiving without fertility drugs or IVF after one year of trying is 75% at age 30, compared to 44% at 40. The risk of a miscarriage is also much lower for younger women. For women in their 20s, the risk is 10%, compared to 18% for those in the mid-30s and 53% for those aged 45. The risk for Down Syndrome also increases with age, while IVF success rates decline significantly, dipping from 58% before age 35 to 15% between 41 and 42. All the evidence points to this: the best time for having a family is in the 20s and early 30s. Waiting until later can result in higher risks and higher costs, if medical intervention is needed for conception. Female cancers These are also tied to age. Cervical cancer mostly occurs in women between age 25 and 55, peaking at 39, while breast cancer, the most common cancer in women, is most prevalent in women aged 35 to 65. Ovarian cancer mostly occurs after menopause, while uterine cancer is most common in those aged 50 and above. Cervical cancer develops when abnormal cells develop and spread in the cervix. In the early stages, there are

rarely any symptoms. If the cancer has not progressed past the upper part of the vagina, surgery involves a total hysterectomy and removal of some of the surrounding tissue. The fallopian tubes, ovaries and lymph nodes near the tumour may also be removed. (This is traditionally done by laparotomy but with the advent of laparoscopic surgery and robotics, the keyhole surgery approach has been gaining acceptance.) A combination of radiation therapy and chemotherapy is used as well. Breast cancer can affect different parts of the breast, and occurs when cancerous cells begin to grow and spread. This causes physical changes in the breasts, ranging from unusual lumps and depressions to discharge and bleeding from the nipples. Depending on the stage of the cancer, treatment includes a combination of surgery (partial or full removal of the breast), radiation therapy and chemotherapy. For breast cancer and cervical cancer, there is the option of cryopreservation, which involves preserving oocytes and ovarian tissue for future use. This is because radiation therapy and chemotherapy can damage the ovaries so severely that normal egg production may not resume. While cryopreservation does not hold a guarantee of pregnancy in the future, it does offer hope. For ovarian and endometrial cancers which occur at a later age fertility tends not to be an issue. Ovarian cancer is believed to begin in the fallopian tubes before moving to the ovaries. Initially, it has no or mild symptoms such as bloating, constipation and early satiety. Surgery is the standard treatment, and most patients undergo chemotherapy and sometimes, radiation. Cancer of the uterus is usually found in the endometrial lining. Symptoms include abnormal vaginal bleeding or discharge, difficult or painful urination, an enlarged uterus, pain during intercourse and unexpected weight loss. The standard treatment is total hysterectomy, along with removal of suspicious lymph nodes, tissue and organs, and a combination of radiation therapy and chemotherapy.

Dr Yap is a known fertility specialist who is considered a leader in minimally invasive surgery. In treating cancers, he works closely with a gynaecological oncologist.

Gynae Consultancy Pte Ltd 3 Mount Elizabeth #09-07 Mount Elizabeth Medical Centre Singapore 228510 Tel: (65) 6734 3328 www.gynae.com.sg

Women and their gut Anatomical and other differences make women more susceptible to digestive disorders. By Dr Richard Sim, Colorectal Surgeon

olorectal cancer is the second most common cancer among women in Singapore after breast cancer, although the incidence level has been on a downward trend since 2009 or so. The main gut problems plaguing women today are functional bowel disorders where the primary issue is an alteration in the way the bowel works, rather than an identifiable structural or biochemical cause. The most common is irritable bowel syndrome (IBS), where patients experience abdominal pain, distension or bloating and altered bowel habits with either constipation, diarrhoea or both. Studies suggest that gastrointestinal (GI) activity is slower in women than men, and even more so when IBS is present. Gender-related differences in the efficacy of IBS-specific medications, too, imply there are actual differences in the way the digestive system functions in men and women. Biopsychosocial factors may explain this difference. The ‘gut brain’ and hormonal changes appear to be responsible for many of the gastrointestinal issues faced by women. The gut has a complex nervous tissue network within its walls, often referred to as the enteric nervous system or ‘the gut brain’. There is growing belief that abnormality in functional bowel disorders and IBS lies in the interaction between a person’s gut and his/ her brain – an abnormality of gut-brain interaction. Gender-related differences do exist in the perception and responsiveness to painful stimuli. Women demonstrate a greater sensitivity to pain compared to men. GI activity changes during the different stages of a woman’s life. Before puberty, both girls and boys tend to have similar functional gastrointestinal disorders. However, young women, especially in their childbearing years, are most likely to be affected by chronic constipation and piles. Older perimenopausal and elderly women are troubled by rectal prolapse, rectocele and pelvic floor weakness. At this stage of life, diverticular disease and colorectal neoplasms (polyps and cancer) predominate. During the reproductive years, hormonal changes during menstruation and pregnancy can alter the normal movements of the digestive tract and increase sensitivity within the gut. Many women experience diarrhoea or constipation during their menstrual cycle. Excessive straining during natural childbirth may lead to the enlargement of internal haemorrhoids which in turn cause pain when moving the bowels, and leads to incomplete emptying and consequently, constipation.

Other contributory causes include stress and withholding of stools. Social pressures arising from juggling work and family, hygiene concerns and the inconvenience of using public toilets may lead women to withhold their stools, leading to irritable bowel syndrome and constipation. Dietary factors also predispose women to constipation and colorectal disorders. On the upside, women are generally more health-conscious and make a greater effort to follow a diet which includes more vegetables and fruit. Unfortunately, excessive fibre can backfire, giving rise to constipation. 5 things every woman should know about colon health: • What you consume affects your gut function – probiotic-rich foods can help you stay regular • How you think and feel affects your gut – learn to manage your stress • Know what is a normal bowel habit for you – so that you can recognise any departure from the norm • Go when you have to – holding your stool leads to digestive disorders • Learn the correct way to move your bowels -knees higher than hips, lean forward with elbows on knees, bulge out your abdomen, straighten your spine

Dr Sim is Past President of the Society of Colorectal Surgeons (Singapore) and currently Honorary Secretary of the Asean Society of Colorectal Surgeons. He champions patient empowerment and is actively involved in public education.

RSim General & Colorectal Surgery 1 Farrer Park Station Road #13-10 Farrer Park Medical Centre Singapore 217562 Tel: 6636 3493 www.icut2cure.com

Feature

The

silent

treatment

Whether we realise it or not, our lives are filled with unceasing noise. So every now and then, we should reach for some health-enhancing, true silence. By Lye Kim Sheong

566 556

Tiger Mountain Pokhara Lodge: a majestic view best savoured in silence.

The sound of silence is loud â&#x20AC;&#x201C; and inviting. Silent retreats and treatments are steadily gaining popularity as more and more frazzled individuals, overwhelmed by the noisy demands of a strung out corporate world, seek comfort in the various ascetic and luxury sanctuaries around Asia. There are many health benefits associated with silence, such as stress reduction, lowered blood pressure and regulated hormone levels. A daily dose of about 30 minutes of true silent therapy is enough to soothe your nerves, regain your calm and sharpen your focus. The trick, however, is to find an environment quiet enough. Therapeutic silence

should be free of loud and sudden noises, so it's not the same as zipping into a facial spa to relax with soft piped-in music, or strolling down a quiet neighbourhood where dogs may bark and doors may slam. True benefits can only be reaped if you put in effort to seek the right environment, set aside the time, and be engaged in the correct contemplative state. If you think youâ&#x20AC;&#x2122;ve been burning the candle at both ends for too long, take an overdue break. Sign up for a silent retreat and get immersed in an environment conducive to reconnecting with yourself. Here are some quiet spots to consider.

Feature

Bali Silent Retreat

Dharana Phuket Meditation Center

Bali, Indonesia www.balisilentretreat.com

Phuket, Thailand www.phuket-meditation.com

Destination A nonprofit and semi-volunteer eco-green sanctuary amidst swathes of Balinese padi fields and lush tropical jungle. This restorative and inspirational refuge bears the philosophy, “Meditation, Yoga, Prayer and Restful Contemplation – in Silence”.

Destination A boutique meditation and retreat centre for holidaymakers seeking a serene vacation. The centre has various accommodation choices, multi-disciplinary classes, excursions and programmes for different budgets and needs. These range from yoga and meditation retreats, seminars and workshops on Mindfulness Meditation and Qigong Healing, and life coaching.

Activities Various styles of yoga in the mornings and afternoons, and scheduled meditation classes for all levels. For beginners, try the Labyrinth Walking Meditation; a simple and ancient practice you can easily attempt in silence. There is a labyrinth route drawn on the compound lawn, and you walk along it slowly back and forth – all the while being aware of your breathing and your positive thoughts. Different people receive different benefits, and each walk can produce a different result. Benefits Walking meditation conducted in contemplative silence can help you clear your mind and centre yourself. You also get to ponder difficult questions or reflect on past actions or life’s challenges, which are helpful to your body and soul. Difficulty Low - Medium (a semiserious retreat that also doubles as an eco-vacation)

Activities Meditation classes are beginner-friendly and offered free at the centre. Each class usually begins with a teaching, before progressing to silent meditation and ending with a Q&A session. Alternatively, you can book a spot for the meditation excursion, which brings you to different scenic spots in Phuket for early morning meditation. Benefits An integrated soul-cleansing and holidaying experience that showcases the laid-back side of Phuket. Difficulty Low (a perfect vacation with a difference)

Shreyas Yoga Retreat Nelamangala, Bangalore India www.shreyasretreat.com Destination The luxurious garden sanctuary is located in rural Bangalore and pampers up to 20 guests at a time. Thereâ&#x20AC;&#x2122;s no alcohol or smoking allowed and meals are strictly vegetarian. The retreat is also ranked as one of the top Ayurvedic rejuvenation spas in India. Activities Besides the different yoga and meditation activities and spa treatments, there is also a sevennight Mouna Retreat, designed to let you calm the mind, introspect and think about your goals. You will first go through a detailed consultation to customise your diet and set your agenda.

A reading list is also provided for self-study at the extensive library. You will also wear a â&#x20AC;&#x153;Shhhhhreyasâ&#x20AC;? badge to indicate your preference for silence as you practise yoga, meditation and jotting down your thoughts and emotions. Benefits Silence and solitary contemplation bring to surface deep-seated emotional, intellectual or spiritual issues, and help guide you towards selfdiscovery and self-analysis. This retreat is said to have helped guests suffering from insomnia, high blood pressure, stress, burnout and other modernday maladies. Difficulty Medium - High (a luxurious but serious retreat with diverse offerings for different needs and levels)

Feature

Suan Mokkh International Dharma Hermitage

Images courtesy of the properties featured.

Chaiya, Thailand www.suanmokkh-idh.org

the retreat and keeping the Eight Precepts, which are basically abstinence from things and activities considered entertainment, luxury or vice.

Destination This ascetic Buddhism-centric retreat is held within the compound of Wat Suan Mokkh forest monastery in south Thailand. Thereâ&#x20AC;&#x2122;s only one programme, the English-instructed 10-day silent meditation course that begins on the first of each month. This silent retreat follows an exacting regimen and its demands are not for everyone. An interview prior to registration will determine if you are suitable to participate.

Benefits The teachings and the retreat structure are designed for 10 days of almost complete silence, allowing you to withdraw from the everyday world, and devote time and thought to study, contemplation and meditation in the quiet seclusion of a functioning monastery.

Activities You will be taught Mindfulness with Breathing through meditation and yoga, and introduced to basic aspects of the Buddhaâ&#x20AC;&#x2122;s teachings, including the Four Noble Truths and the Noble Eightfold Path. Your stay on monastery grounds means keeping to strict rules, like observing complete silence throughout

IMPORTANT The registration process for this retreat is rudimentary. You show up in person on the last day of the previous month, before 3pm, to make your booking. Advance, email or phone bookings are not entertained. There are no shorter durations, and no, you cannot join the retreat and bail out halfway through.

Difficulty High (suitable only for those seeking deeper answers through Buddhist teachings and philosophies)

Tiger Mountain Pokhara Lodge Kathmandu, Nepal www.tigermountainpokhara.com Destination Set on a ridge 1,000 feet above the Pokhara Valley, this is no grotty trekker’s lodge, but a luxurious hillside spa resort surrounded by astounding Himalayan views. What these ancient Nepalese slopes have to offer is silent therapy of a different kind. Free of big city sights and sounds, time slows in the crisp cool air, and the magical stillness that settles over you is unlike anything a city dweller would know. Here, it is less about silence than it is about quietness.

has elated many past visitors to spontaneous applause and even tears. Benefits The setting here could not be more perfect for practising yoga, meditation or contemplation. But with such expansive folds of ancient hills and valleys all around, the simple act of just keeping still and breathing in silence is in itself soul-cleansing. Difficulty Low - High (depending on your levels of fitness and meditative practice, and choice of activities).

Activities Various yoga and meditation sessions, and the full range of spa treatments will keep guests well-occupied within the estate. The real highlight, however, is in the array of nature excursions offered. Stretch your legs on organised walks, treks, camps and drives accompanied by trained local guides, and bask in the quiet of bird-watching or day hikes through the forest. One of the must-dos is to brave the night chill to watch Nepal’s amazing sunrise. If you are blessed with good weather, you will be greeted with a most spectacular sight – the dawning of a new day across the Himalayas' mountainous silhouette. This magnificent display can be viewed at several trekking pit stops, and the experience

Follow Me Japan Special

The in Nara & Mie This 10D/8N jaunt is a dream-come-true holiday, with natural beauty, unusual flora and fauna, exciting activities and delectable cuisine, to savour Japanese heritage in Nara and Mie.

Spring brings the best of breathtaking beauty as you explore the historical, touristic and gourmet delights of Japan’s historical and cultural heart in Nara, Japan’s first permanent capital established in the year 710, way before Kyoto became the seat of the emperor. On Follow Me Japan’s Nara & Mei tours, it’s a dream-come-true as rural nature combines with urban architecture for a feast of a holiday that captures the imagination of the young and not-so-young. Stretch your legs and enjoy the grounds at Nara Park, where about 1,200 adorable deer graze the spacious lawns. Within the park stands Todaiji (ʀęᅅ, Tōdaiji, “Great Eastern Temple”), a UNESCO World Cultural Heritage Site where the world’s largest Buddha statue, weighing about 300 tons and standing at 15m tall, is enshrined in the great hall of the temple. Small streams and ponds add charm to the scenery and the image of lofty temple roofs and the tips of tall pagodas peeking through the trees will be an unforgettable memory of your journey to Nara. Considered in Shinto to be messengers of the Gods, Nara’s nearly 1,200 deer have become a symbol of the city and have been designated a natural treasure. Nara’s deer are surprisingly tame, although they can be rather aggressive if they think you will feed them. Deer crackers are for sale around the park, and some deer have even learned to bow to visitors, asking to be fed.

Follow Me Japan Special maze of lanes and alleys lined with old warehouses and machiya (traditional wooden townhouses), that have been converted into art galleries, craft shops, restaurants and cafés. Two have been transformed into a museum, giving an insight into their interior architecture and the way of life of their occupants.

Classy Mikimoto pearls

Delight in tuna carving Explore tuna carving at its elite artistry in Wakayama Marina City, where Kuroshio Market is a wellknown fish market where you can eat and buy fresh Japanese fish. Tuna-cutting shows are held three times a day and it’s a rare sight in Japan, as awesome as the fish delicacy. Watch in awe as a giant tuna is skillfully cut right before your very eyes. You may have tried ice cream-making and even sushi-making in Japan, but have you ever tried somen-making? Somen are very thin noodles made from flour, just like udon, but with a smooth yet strong texture. While most of us are familiar with udon, soba and ramen, which are probably the most well-known Japanese noodles in the world, the locals would certainly add somen to this list. The birthplace of Miwa Somen noodles is Miwa territory, presently known as Sakurai city in Nara prefecture. The noodles have been made for more than 1,200 years using high quality wheat flour and traditional production methods: hand-kneading the flour, salt and water, then adding vegetable oil and more flour, before the dough is stretched and dried. Learn all the intricate steps behind the making of these fine white noodles, and best of all, tuck into the hot, just-cooked results of your labour afterwards. Explore Naramachi in Nara’s historical district where former merchants made a living and settled down during the 18th and 19th centuries. The town has been wonderfully preserved into a

The breathtaking Mikimoto Pearl Island is a definite stopover to learn about the history of the cultured pearl and Kokichi Mikimoto, the first person who succeeded in cultivating pearls in 1893, and the genius behind the world-class Mikimoto brand. The world-renowned island lies just off the coast in the blue waters of Toba Bay on the northern half of the Shima Peninsula in Mie Prefecture. It features four main pavilions: the Pearl Museum, the Women Diver or Ama San Pearl Diver Stand, the Pearl Plaza, and the Kokichi Mikimoto Memorial Hall, all set in lush greenery against the backdrop of beautiful Toba Bay. You can’t miss the Pearl Plaza, where visitors can purchase Mikimoto pearl products. It’s a valuefor-money place to shop for souvenirs and you are bound to find something suitable for a special friend or your significant other. More importantly, reasonably priced pearl jewellery is sold here, with some items exclusive to this store. Next stop: A pampering, luxury rail travel experience on board the Kintetsu Shimakaze Premium Express. This journey has been hailed as the experience of a lifetime, taking guests to Ise Shima in a deliciously appointed train complete with leather reclining seats with a massage function, luggage lockers, a cafe and rooms for parties. The in-seat service includes coffee, snacks and craft beer. And finally, there is the unique experience of paying respects at Meoto-Iwa. Near the small town of Futami, along the coast of Ise City in Mie Prefecture, are two sacred rocks in the sea called Meoto-Iwa, which means “rocks of husband and wife”. This pair of “wedded rocks” are joined by a shimenawa rope (a heavy rope of rice straw). According to Shinto fables, the rocks represent the union of the creator of Kami, Izanagi and Izanami. The rocks, therefore, celebrate the union in marriage of man and woman. The Japanese believe that these rocks symbolise matrimonial happiness and safety of the family. The ropes of Meoto-Iwa are changed in May, September and December, and these are among the most important festivals at the shrine. Five thick ropes, 35m long, 10cm wide and 40kg in weight, are used. This 10D/8N jaunt is a dream-come-true spring holiday, packed with natural beauty, unusual flora and fauna, authentic activities and delectable cuisine. A rare chance to savour the Japanese heritages in Nara and Mie.

Follow Me Japan 16 Raffles Quay #B1-14D Hong Leong Building Singapore 048581 For enquiries and bookings, please call 6221 4250 or visit www.followmejapan.com.sg

WELLNESS WELL WE LNE NESS SS & H HEALTH EALTH Update

SPECIALIST A/Prof Leong Keng Hong Dr Ho Kok Sun Dr See Tho Kai Yin Dr Leo Seo Wei Dr Lau Chee Chong Dr Kelly Loi Dr Francis Seow Choen A/Prof Luke Tan

P66 P68 P69 P70 P72 P73 P74 P76

Dr Ruth Kam Dr Tan Soo Heong Dr Eric Hong Dr Goh Hak Su Dr Karen Sng Dr Christopher Ng Dr Colin Tham Dr Tay Khoon Hean

PINIONS P78 P80 P81 P82 P84 P86 P87 P88

Dr Michele Lee Dr Lim Hwee Yong Dr Ann Tan A/Prof Christopher Goh Dr Wong Su-Ni Dr Lim Yi Jia Dr Wendy Teo Shun Hui Dr Tan Yeh Hong

P90 P91 P92 P94 P96 P98 P99 P100

SPECIALIST

OPINION

When itâ&#x20AC;&#x2122;s more than back pain Chronic pain in the lower back can be more significant than you realise. Learn about spondyloarthropathy and how to spot the signs. By A/Prof Leong Keng Hong, Rheumatologist

Spondyloarthropathy causes back pain, joint pain and inflammation, and can be mistaken for other types of pain. This is because awareness of this autoimmune disease tends to be low. And because the condition affects younger people, many downplay and manage the symptoms until the condition worsens. In spondyloarthropathy, the immune system gets confused and attacks the body. The term refers to a family of long-term diseases of the joints that include ankylosing spondylitis, Reiter’s syndrome (reactive arthritis), psoriatic arthritis, and joint problems linked to inflammatory bowel disease (enteropathic arthritis). While each of these specific conditions present different symptoms and outcomes, they are similar in that all of them: • usually involve the sacroiliac joint in the lower back, causing pain in the buttocks area • affect areas where your ligaments and tendons attach to bone, most commonly causing pain in the heel • involve stiffness in the back or neck that is worse in the morning and after periods of rest but gets better during the day and after exercise • cause fatigue Types of spondyloarthropathies Ankylosing spondylitis causes stiffness and lower back pain. In severe cases, the affected joints in the spine fuse together. In children, the signs start in the hips, knees, heels or big toes, and progress to the spine. Other areas such as the chest wall and heels may also be affected. Reiter’s syndrome causes pain, swelling and inflammation of the joints after infections, especially sexually transmitted diseases. The fingers and toes may swell, and fever, weight loss, skin rash, mouth ulcers and inflammation of the eyes can also occur. Psoriatic arthritis is a type of arthritis associated with psoriasis (scaly red patches on the skin). This rash precedes the arthritis symptoms, sometimes by years. Fingernails and toenails may also become thickened and yellow. Psoriatic arthritis involves both small and large joints, such as the fingers, toes, knees, hips and sacroiliac joints (tailbone). Enteropathic arthritis is spinal arthritis that also involves inflammation of the intestinal wall. The arthritis affects large joints such as the knees, hips, ankles, and elbows.

Treatment Short-term medicine includes painkillers to reduce swelling and pain. It is more important to consider disease-modifying medication which controls the immune system, such as sulfasalazine and methotrexate. In recent times, research has shown a role for the newer biologic disease-modifying drugs such as anti-tumour necrosis factor agents that are now approved for use in several countries. They have been shown to be highly effective in treating not only arthritis of the joints but spinal arthritis associated with ankylosing spondylitis and related diseases. This class of drug attempts to block a protein that causes inflammation.

Spondyloarthropathy or rheumatoid arthritis? While both cause joint pain and swelling, the pattern of joints affected is different. Spondyloarthropathy also has a different diagnostic marker. It is associated with the presence of the HLA-B27 gene, while rheumatoid arthritis is linked to a different marker. Spondyloarthropathy tends to affect more men, while rheumatoid arthritis affects more women.

A/Prof Leong Keng Hong Leong Keng Hong Arthritis & Medical Centre 6 Napier Road #04-18 Gleneagles Medical Centre Singapore 258499 Tei: 6472 4337 www.leongkenghong.com

SPECIALIST

OPINION

Close off the pain Anal ﬁstula is the second of a double whammy, the ﬁrst being a painful anal abscess. It should be promptly treated to prevent infection recurring on the same site. By Dr Ho Kok Sun, Colorectal Surgeon

An anal fistula is a small tunnel that persists after recovery from an anal abscess or an anal gland infection. It has one end opening on the inside of the anal canal, and the other on the outside, at the skin surface near the anus. Some fistula first manifest as a small pimple around the anus – which bursts and heals, then recurs. They can also occur after an abscess has been treated by a small surgery. The wound may start to heal but never closes completely, creating a tunnel. It is very important for the internal opening to close, or the fistula will not heal. It can cause bleeding and discharge when passing stools, and can be painful. In some cases, an anal fistula causes persistent drainage, or, in cases where it is on the outside of the channel that is blocked, the result may be recurrent anal abscesses. Among the typical symptoms are: • • • • •

A recurring cycle of pain, swelling, discharge and healing Constant, throbbing pain Skin irritation around the anus, including swelling, redness and tenderness Discharge of pus or blood Pain associated with bowel movements

Most of the time, diagnosis is straightforward, although for some complex fistula, further tests like endoanal ultrasound imaging or magnetic resonance imaging (MRI) may be necessary to ascertain the entire length of the fistula tract. This is also the case for surgical treatment, which is usually a straightforward procedure to open up the tunnel and allow the wound to heal from the inside. It gets more complicated for deeper tracts, as a deep incision can cause damage to the muscles and result in incontinence later on. For these, more innovative options are explored, including: •

• • •

Ligation of Intersphincteric Fistula Tract (LIFT) – the tying off of the tunnel between the two layers of anal muscle. Fistula plug – filling up the tract with prosthetic material to let new tissues grow over. Fibrin glue – using surgical “glue” to seal up the tunnel. Seton – a stitch placed around the tract to drain the pus, allowing the muscle above it to heal; a second operation may be necessary later on.

•

Video-assisted Anal Fistula Treatment (VAAFT) – one of the latest techniques, it lets the surgeon insert a video scope through the external opening to look at the entire tract all the way to the inner end. The internal opening is then closed, and the tract is cleaned out using a brush and a heater probe through the video scope. The added benefit of this approach is that there is no long cut over the skin.

The only cure for an anal fistula is surgery. Complications from this or any kind of surgery are a reality, so this procedure is best performed by a colorectal specialist to reduce the risk of losing bowel movement control. Most of the time, fistula surgery can be performed on an outpatient basis or with a short hospital stay. If properly healed, the problem will usually not return. However, it is important to follow the directions of your doctor to prevent recurrence.

Dr Ho Kok Sun Ho Kok Sun Colorectal Pte Ltd 3 Mount Elizabeth #12-09 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6737 2778 www.hkscolorectal.com.sg

SPECIALIST

OPINION

An embarrassing condition Urinary incontinence is the involuntary release of urine that can happen for many reasons, and at any age. Women in their childbearing years and older are affected by three common forms of it. By Dr See Tho Kai Yin, Obstetrician & Gynaecologist

This socially embarrassing condition is actually a symptom and not a disease, as the causes are many and often multifactorial. There are three common types of incontinence affecting women, namely, stress urinary incontinence (SUI), urge incontinence (UI) and a combination of both. Stress Urinary Incontinence (SUI) This is characterised by the leakage of urine that is associated with increased intra-abdominal pressure from coughing, sneezing, laughing and exercise. In extreme cases, even walking can bring it on. The cause of SUI in women is hypermobility of the urethra (the urine outlet) and poor pelvic support. Pregnancy is, arguably, the most common cause of SUI, which can occur as a result of pressure from the enlarging uterus on the bladder, coupled with the softening of the bladder supports and uterus due to the increased hormone production. Vaginal delivery, whether normal or instrumental, leads to stretching and often tearing of the bladder and uterus supports. Prolonged and difficult instrumental deliveries are especially harmful, and care must be taken to ensure that precise repair of vaginal and perineal tears and lacerations is done, and a proper bladder regimen in the pueperium and diligent pelvic floor exercises are practised regularly. Most women will recover within two to three months after delivery. Other important causes of SUI are menopause, surgery (such as hysterectomy), pelvic trauma, obesity, chronic constipation, chronic coughing from smoking or other respiratory diseases.

Dr See Tho Kai Yin The See Tho Clinic for Women 6 Napier Road #07-11 Gleneagles Medical Centre Singapore 258499 Tel: 6472 2283 www.seethoclinic.com

Urge Incontinence (UI) Urge incontinence is commonly due to urinary tract infection, in which instance it is accompanied by frequent and painful urination. An overactive bladder (OAB) as a cause of UI is now seen more frequently, and in this condition, the muscle of the bladder wall is hypersensitive. This may be attributed to excessive coffee consumption, smoking and excessive water intake. Atrophic vaginitis in postmenopausal women and chronic medical conditions such as diabetes are also common causes. The management of urinary incontinence in

this age group of patients is complex. It’s important to keep track of its progress, in order to determine the extent of the problem. Clinical and pelvic ultrasound examinations, counselling and medical treatment are usually the first approach to treatment and management of it. Even if surgery is required, there are supporting treatments that can help in the short-term. For instance, SUI can be managed by a combination of surgery, pelvic floor exercise, and medication, while UI requires changes in diet and behaviour, pelvic floor exercise, and medication. When the incontinence is a combination of both, medication and surgery may be required. Although the first choice of treatment should ideally be the least invasive one, sometimes minimallyinvasive surgery may be the most effective option. Of all the surgical procedures available, none has been researched more than Tension-Free Vaginal Tape (TVT) for the surgical management of SUI in women. The tape is non-absorbable, and the cure rate, depending on the patient’s profile, varies between 80-90% after 10 years. Some specific causes of urinary incontinence have been mentioned in this article, but the fact remains that not enough is understood about this condition. This makes it imperative that patients’ expectations of a cure must be managed.

SPECIALIST

OPINION

The link between diabetes and eyesight What exactly happens, to go from being diabetic to losing oneâ&#x20AC;&#x2122;s sight? By Dr Leo Seo Wei, Ophthalmologist

High blood sugar (glucose) increases the risk of eye problems which can threaten vision. In fact, diabetes is one of the leading causes of blindness in adults. Diabetes causes changes to the blood vessels. In some people, blood vessels may swell and leak fluid, while in others, abnormal new blood vessels grow on the surface of the retina, which is the light-sensitive tissue at the back of the eye. Good vision, however, requires a healthy retina. The three major eye problems that people with diabetes may develop and should be aware of are cataracts, glaucoma, and diabetic retinopathy. Cataracts A cataract is a clouding or opacity of the normally clear lens of the eye. The lens allows us to see and focus, just like a camera does. Although cataracts are caused by ageing, diabetics develop cataracts at an earlier age than most because of a biochemical reaction between a particular enzyme and glucose. In diabetics, the cataract also progresses more rapidly, resulting in vision impairment. The symptoms include blurred vision, cloudy vision or glare. Cataracts are treated surgically by removing the cloudy lens and replacing it with a clear artificial intraocular lens. However, diabetic patients with visually significant cataracts pose unique challenges during surgery, and may face a more difficult recovery. Surgery may cause rapid acceleration of retinopathy, induce the formation of abnormal bloods vessels or lead to macular changes. There is also a higher risk of post-operative infection. Glaucoma and diabetes Glaucoma is the name for a group of eye conditions that result in optic nerve damage, which in turn may cause loss of vision. This damage is usually caused by abnormally high pressure inside your eye. People with diabetes are three times more likely to develop glaucoma than people without, especially if they are over 40. In diabetics, there is a higher risk of open-angle glaucoma where the increase in pressure can damage the eyeâ&#x20AC;&#x2122;s nerves and blood vessels, causing changes in vision. Treatment requires lowering the pressure, either by increasing the drainage of aqueous humor or decreasing the production of fluid. Medication can accomplish both. With open-angle glaucoma, there may be no symptoms until the disease is very advanced with significant vision loss. Symptoms can include headaches, eye aches or pain, blurred vision, watering eyes, halos around lights, and loss of vision.

Diabetics are also more likely to get the rare neovascular glaucoma, which causes blood vessels to grow on the iris. These vessels block the normal flow of fluid out of the eye, raising eye pressure. Treatment can include special eye drops, laser procedures, medicine, or surgery. Diabetic retinopathy This occurs when diabetes weakens/damages the blood vessels in the eye. Risk factors include long diabetes duration, poor diabetes control, high blood pressure, previous stroke and heart disease. Diabetic retinopathy is the leading cause of irreversible blindness in industrialised nations. Preventing eye problems for diabetics A detailed eye examination can help identify a problem early when it is more easily treated and prevent further vision loss, especially for diabetics. Women with diabetes who become pregnant require a comprehensive eye examination during the first trimester and close followup with an ophthalmologist throughout pregnancy.

Dr Leo Seo Wei Dr Leo Adult & Paediatric Eye Specialist Pte Ltd 3 Mount Elizabeth #10-04 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6737 8366 www.drleoeyespecialist.com

SPECIALIST

OPINION

Nose Cancer Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong – and often hereditary in South Chinese communities around the world. By Dr Lau Chee Chong, Ear, Nose & Throat Specialist

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age. Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms. Symptoms of NPC NPC often originates in the back of the nose and above the soft palate, so it is often not visible or noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as: •

•

Blood-stained sputum, usually first thing in the morning. Any bleeding from a tumour usually flows into the throat overnight. In rare cases, there may be bleeding from the nose. A “blocked” sensation in the ear, hearing loss or tinnitus (a ringing sound) for no apparent reason. The tumour often occurs where the Eustachian tube of the ear opens into the nose and may affect the normal functions of the Eustachian tube. The blocked sensation would be similar to the sensation one might experience when landing in a plane. Abnormal, persistent lumps in the upper neck. NPC often spreads to the lymph nodes in the neck.

radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required. Detection and diagnosis: • EBV Serology: EBV-serology (cancer-marker) screening, through a simple blood test, helps early detection. •

Endoscopic examination: Over the last 20-30 years, ENT (ear, nose and throat) specialists have routinely used endoscopes (inserted into the nose or pharynx) to detect NPC and other head and neck cancers. This examination is done as an inclinic procedure.

•

NBI – Narrow Band Illumination: Some clinics are equipped with video endoscopy with a special NBI function, which uses a specific wavelength of light to enhance blood vessels of extremely early cancers, which are not yet bulky enough to be seen under normal light. With NBI, head and neck cancers can be detected earlier and more accurately.

Later-stage NPC symptoms include blocked nose, headache and problems with cranial nerves, eyemovement and vision. Eventually, the cancer may spread to the bones, lungs and liver. Treatment – the good news The good news is that early-stage NPC, if treated promptly and properly, enjoys an extremely high cure rate. Accordingly, early detection is incredibly important. If detected early, the NPC may require only radiotherapy. Later stages may require both

•

If you have a family history of NPC: You may want to do an EBV-serology screening. Depending on the results, regular NPC check-ups may also be advisable.

Dr Lau Chee Chong Ear, Nose & Throat Centre CC Lau 3 Mount Elizabeth #14-11 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6235 9535 www.entcentrecclau.com.sg

SPECIALIST

OPINION

Fertility protection for cancer patients Cancer can impair fertility, depending on the type of cancer in question and the treatment regime. Thankfully, there are ways to protect oneâ&#x20AC;&#x2122;s fertility for the future. By Dr Kelly Loi, Obstetrician & Gynaecologist

Studies indicate that about 10% of cancers occur in those below 45 years old. Invasive breast cancer (BC) is the most frequent cancer among young women, and women under 40 years comprise about 5% of the overall BC population. Treatment is increasingly effective, but will render many affected women infertile; and they may not have completed child-bearing at the time of diagnosis. If the cancer involves the reproductive area, fertility would most likely be affected. Preserving fertility is, therefore, a major concern, especially for women without children. Some patients require surgery to remove their reproductive organs, while others may need chemotherapy or radiotherapy which can reduce their reproductive function. And even though chemotherapy, radiotherapy and bone marrow transplantation can cure up to more than 90% of girls and young women with certain cancers and diseases, these treatments can result in premature ovarian failure or early menopause. Certain cancer drugs are also required for a prolonged period to prevent recurrence, and these include certain hormonal medications prescribed for breast cancer patients. Over time, fertility will be affected, particularly because the number and quality of eggs in the ovaries decreases with age. The unfortunate news is that even if the cancer involves other areas of the body and requires certain types of chemotherapy or radiotherapy, these very treatments may harm the reproductive system. Preserving fertility for the future For men, the options are extraction and storage of sperm and/or testicular tissue before the cancer treatment. Freezing of semen is an established technique for adult males, but it is difficult in adolescents. For adolescents as well as pre-pubertal boys, testicular tissue may be harvested before cancer therapy and frozen for future use. For women, a wide range of options is now available, depending on the patientâ&#x20AC;&#x2122;s age, diagnosis, and treatment modality: Conservative surgery Fertility-preserving cancer treatment may be possible in the early stages of some cancers. These include conservative surgery for early stage cancer of the cervix or ovary. For early stage endometrial cancer, hormonal therapy may be considered to induce regression of cancer. Freezing of embryos Freezing of embryos may be performed if the patient is married. These embryos are obtained through ART

or IVF. Hormonal injections are required, followed by egg/oocyte retrieval. The eggs are then fertilised with sperm to form embryos which are frozen for future use. Freezing of eggs or ovarian tissue Freezing of eggs or ovarian tissue is considered more experimental as a method to preserve fertility, although successes have been recorded. Today, eggs can be frozen with minimal damage using a technique of rapid freezing called vitrification. Vitrified eggs have been thawed for fertilisation to form embryos resulting in healthy pregnancies. Ovarian tissue, which may be obtained by laparoscopic or minimally-invasive surgery, can be frozen, then thawed and transplanted back into the patient at a future time. It is important to discuss options with your doctor to decide on the safest and most suitable option. A multi-disciplinary approach is required, with close collaboration between cancer doctors, anaesthetists, haematologists and, if the patient is a child, paediatricians. It has been estimated that one in 250 young adults will be childhood cancer survivors. The fiveyear survival rate at all cancer sites has improved from 56 to 75%. With the recent advances in fertility preservation for cancer patients, international guidelines now recommend that these options be discussed with the patient. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during the treatment planning process.

Dr Kelly Loi Health & Fertility Centre for Women 290 Orchard Road #18-06 Paragon Medical Singapore 238859 Tel: 6235 5066 www.healthfertility.com.sg

SPECIALIST

OPINION

Laparoscopic innovations With the advent of laparoscopic surgery, it is possible to perform major surgeries with the help of several small stab wounds rather than one long incision. By Dr Francis Seow-Choen, Colorectal Surgeon

Surgery is the invasive removal or correction of diseased parts within the body. Traditionally, major surgery was performed via long incisions to facilitate the act of surgery. Long incisions, however, come at a cost. They result in more pain, require a longer recovery period, and are also associated with increased risk of complications including wound infections and adhesions. Laparoscopic surgery, on the other hand, involves the use of laparoscopes and thin, sleek instruments to perform surgery with the surgeonâ&#x20AC;&#x2122;s hands outside the abdomen rather than inside it. Surgeons only need to make a small incision to deal with the problem. Besides decreasing the pain and complications of traditional long-incision surgery, laparoscopic surgery also has the happy advantage of a better cosmetic outcome as the scar that remains is small. Having said that, most abdominal surgeons using laparoscopic surgery use about five to six such incisions; each ranging from 5 mm to 12 mm in length. As I continue to perform and teach laparoscopic surgery around the world, I am increasingly of the view that most laparoscopic surgeries can be performed with fewer and smaller incisions. There are specific ways to do this, as follows: Three-port laparoscopic surgery To use this technique, I require only a camera assistant. There is no need for the usual assistant to help retract the surrounding tissues and organs. Three-port surgery is just as efficient and safe, and patients have an improved cosmetic outcome since only three incisions are needed. Through the umbilicus There are two procedures which can be carried out by this method. Firstly, many surgeons remove a resectioned colon or rectum through a separate incision. I feel there is no need to make a separate incision on the abdominal wall just for this, as there is already an incision over the umbilicus. Using the umbilicus to remove the resectioned intestine enables me to keep the number of incisions to three or four, at the most, in rare cases. Most patients who underwent three-port surgery saw a fast and good recovery with much less pain and many were able to return to normal activities sooner. Secondly, where the entire rectum needs to be removed, saving only the anus and the colon joined

to the anus, most surgeons perform a defunctioning stoma to safeguard the low ano-rectal joint. The site of this stoma would often be the ugliest scar. I use the umbilicus as the site of the defunctioning stoma. Patients are relieved that they do not need a separate incision, and when the stoma has closed about a month after the surgery, all that remains are the scars of two small wounds and a small umbilical scar. These methods help patients to recover more quickly, with better cosmetic results that do not compromise safety. In fact, minimally-invasive techniques are considered safer than conventional surgery. Currently, any sort of abdominal or intestinal surgery can be performed via the laparoscope, from the most complex to the most straightforward. What used to require long incisions and hours-long surgery now takes take much less time and leaves only three or four small scars. Many patients comment that loved ones who meet them a week or two after surgery do not even realise that they have had any surgery done, let major surgery!

Dr Francis Seow-Choen Seow-Choen Colorectal Centre Pte Ltd 290 Orchard Road #06-06 Paragon Medical Singapore 238859 Tel: 6738 6887 www.colorectalcentre.com

SPECIALIST

OPINION

Early detection: 5 common head & neck cancers There are many different types of head and neck cancers, so it is helpful to begin with an understanding of the most common ones and how to detect them. By A/Prof Luke Tan, Ear Nose & Throat – Head and Neck Surgeon not exempt. Unfortunately, it presents late because it shows no symptoms until it is large enough to obstruct breathing, invade the ear or appear as a neck lymph node due to spread. The Epstein and Barr (EB) virus has been found to be present in patients with nose cancer, so the EB viral marker is used for early detection and as part of post-treatment followup. The mainstay of treatment for nose cancer is radiation therapy, with chemotherapy recommended at the later stages and surgery employed in some severe cases. Overall, the prognosis is directly related to the stage at diagnosis, with early diagnosis affecting the outcome significantly.

Head and neck cancers involve the neck lymph nodes, thyroid gland, the back of the nose and throat, and the salivary glands. Lymphoma The head and neck have a significant amount of lymphatic tissues. Lymphoma is cancer of the lymph tissue and usually presents with no specific symptoms except for one or a few lumps, usually at least 2cm or larger in diameter, usually on the side of the neck. Malignant lumps are generally painless, which explains the delayed presentation. Lymphoma lumps also present themselves are in the axilla or groin. The diagnosis is via a biopsy after all the other areas have been carefully examined to exclude a primary tumour. Thyroid cancer Usually close to or at the midline, thyroid gland lumps are distinctive in that they move up with swallowing. Some thyroid cancers, such as papillary and medullary thyroid cancer, are genetically determined. Today’s advanced screening methods mean that thyroid cancers are detected earlier, with a generally good prognosis. The cornerstone of treatment is surgery with radioiodine therapy. Nose cancer There is a genetic predilection for nose cancer in the Cantonese, although other Chinese communities are

Squamous cell carcinoma The mouth, tongue, throat, voice box and the entry to the food pipe (the pyriform sinus) have a squamous cell lining. This lining can change because of smoking, alcohol consumption, betel nut chewing and frequent trauma from tooth edges. The change can result in squamous cell carcinoma, which tends to present with ulcers that don’t heal, bleeding or pain. Swallowing issues and a change in voice indicate late presentation and evaluation must be sought. Such cancers are treated with a combination of surgery, radiation and chemotherapy, depending on the site and stage of the disease. Salivary gland cancers The three salivary gland sites are the Parotid, located at the angle of the jaw, the Submandibular, under the side of the jaw, and the minor salivary glands, which are located in the mouth. These slower growing cancers present no early signs but as long-standing swellings. There are hardly any symptoms until they affect the nerves, resulting in pain or weakness of facial muscles. Treatment involves surgery followed by radiation therapy, and the prognosis is satisfactory. The head and neck region affects all our major functions of expression, breathing, senses of smell, taste, hearing and sight, and our eating, speaking and other functions. Since there is no simple answer to early screening and detection, neck masses, mouth ulcers, bleeding, swallowing discomfort and voice change should not be ignored.

A/Prof Luke Tan Luke Tan ENT-Head & Neck Center & Thyroid Surgery Centre 3 Mount Elizabeth #14-17 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6474 6116 www.thyroidsurgery.com.sg

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LLCheongSki n&LaserCl i ni c 3MountEl i z abet h, #0909MountEl i z abet hMedi cal Cent r e Enqui r yHot l i ne:68361480 Webs i t e:www. l l cheongs ki n. com

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Understanding the highs and lows of BP Those numbers that indicate your blood pressure tell an important story about your state of health. Hereâ&#x20AC;&#x2122;s what you need to know about blood pressure. By Dr Ruth Kam, Cardiologist

The body’s circulatory system is made up of a ‘pump’ – your heart – and a complex network of ‘pipes’ – your blood vessels. The pumping action of the heart generates the force with which blood is moved along these pipes. This force is called blood pressure. Without this force, nutrients and oxygen cannot be delivered to living cells in the body and neither can waste materials be removed from them. Blood pressure in numbers Blood pressure is measured in millimetres of mercury (mm Hg) and expressed through two numbers, one above the other. The top number is called the systolic blood pressure and the bottom number is the diastolic blood pressure. Systolic pressure refers to the pressure generated when the heart contracts. It is the driving force to push the blood forward. Diastolic pressure is the pressure generated when the heart relaxes in order for blood to fill up its chambers again. Both figures are important. High numbers and low numbers In general, the normal range of blood pressure is 90-139/50-89 mm Hg and this number fluctuates throughout the day. For instance, blood pressure tends to be higher during the day and lower at night. Therefore no two blood pressure readings in the same person taken at different times will be exactly the same. Blood pressure is also affected by stress, anxiety, food, exercise and by what we have consumed in the past few hours. Lack of sleep may cause elevated blood pressure as well. Some medications, such as painkillers, nasal decongestants containing ephedrine or pseudoephedrine, weight loss medications, antidepressants and migraine medication can also increase blood pressure. When numbers are chronically high or low, there is a risk of long-term complications that require medical attention. High blood pressure (> 140/90): When blood pressure is chronically high, the risk of many diseases increases. Hypertension is closely related to obesity, diabetes and high cholesterol levels. High salt intake, age, and cigarette or cigar smoking are some of the risk factors for hypertension. Hypertension may also be caused by autoimmune and kidney diseases. Uncontrolled hypertension can, in the long term, lead to kidney failure, heart attack, heart failure and stroke. It is also a leading cause of dementia and atrial fibrillation. In most cases there are no symptoms, but some people may experience headaches, palpitations, breathlessness or dizziness. It is important to regularly screen for high blood pressure.

Low blood pressure (< 90/60): In hypotension, extreme fatigue, dizziness and fainting spells can occur. When there is a sudden dip in blood pressure, there is usually an underlying reason such as blood loss, dehydration, infection or heart attack. It may be a medical emergency because if blood pressure is very low, one can go into a coma and experience multi-organ failure. The underlying cause must be corrected before the blood pressure can be normal again. Some people with persistently low blood pressure feel well and have no evidence of heart disease. If that is the case, then this is not a cause for concern. Living with high BP Lifestyle modification by diet, exercise, weight reduction, smoking cessation and stress reduction can help to reduce high blood pressure. These should always be employed, with or without the use of drugs. Drug treatment is necessary when the initial blood pressure is very high, when there are already complications associated with hypertension, or when lifestyle measures fail to bring the blood pressure back to normal.

Measuring BP at home Most automatic digital blood pressure monitors using an arm cuff are quite reliable, although those that use wrist cuffs tend to be less accurate. When measuring your own blood pressure at home, make sure you are seated in a comfortable position. Have the arm cuff placed correctly, and relax. Do not talk while the blood pressure is being measured. You may measure it from either arm, but do not expect two readings to be exactly the same, even if they are taken within a few minutes of each other. A difference of 10-15 mm between the left and right arm is acceptable. There is no “best time” to measure the BP, so you can measure it at any time of the day or night. If the monitor gives an error message or indicates arrhythmia, be sure to get the doctor to measure your blood pressure manually to check why your pulse is irregular.

Dr Ruth Kam Ruth Kam Heart and Arrhythmia Clinic 290 Orchard Road #14-10 Paragon Medical Singapore 238859 Tel: 6333 6866 www.arrhythmia.com.sg

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Foreign stuff in my hand Never take for granted a recurrent swelling or prolonged pain, which could be caused by foreign bodies in your hand. By Dr Tan Soo Heong, Hand Surgeon

Hand injuries are the most common injuries seen by Accident and Emergency (A&E) Departments and by General Practitioners (GP). Commonly, the injury may leave foreign bodies (FB) embedded in the hand. Not removing these early can lead to potentially serious complications. So when treating hand injuries, the doctor must have a high index of suspicion to exclude the presence of a FB. All wounds that penetrate the skin need to be evaluated for embedded material. Missed FB is a frequent cause of medico-legal litigation. In a study on court cases against emergency physicians in Massachusetts, 32% of the 109 cases were due to undiagnosed FBs. Patients with retained foreign bodies may present after the wound heals, when they experience sharp pain with movement or pressure over the healed wound site. Foreign bodies can be made up of different materials such as metal, glass, wood, plastic, stones and gravel etc. Metallic FBs These can be from broken sewing machine needles, metallic chips in heavy industries, air gun pellets or charm needles. Glass FBs These are usually due to fragments from broken glasses, dishes, or bottles either during washing or as weapons during assault. They can also be caused by car windows broken during traffic accidents or when the hand passes through glass doors, or by broken fluorescent lights. Among the more unusual causes are cactus or sea urchin spines. These days, a common cause is wooden splinters from disposable chopsticks. This usually occurs when the chopsticks are being removed from their plastic packaging. Very rarely, it can be the result of

self-embedding behaviour; often involving adolescent patients who present frequently with more than one embedded FB. If metallic or glass FB is suspected, X-rays should be obtained in multiple views. Metallic FB will appear radio-opaque but aluminium FB can be missed. Fragments of glass FB larger than 2mm can usually be detected in X-rays, although smaller fragments can be missed. Ultrasound is excellent for detecting the presence of radiolucent FB such as wood and plastic. High frequency high resolution ultrasound can quickly diagnose the presence of a FB and identify its exact position. CT scan and MRI may be useful if the suspected FB cannot be detected by other studies. Generally, FB in the hand should be removed as retained FB can have adverse outcomes. It can cause infection, delayed healing, persistent pain and swelling. Nerve injuries can develop later and FB eroding into major blood vessels with bleeding, pseudoaneurysm formation, ischaemia and skin necrosis have been reported. Some FB can also migrate to other parts of the body. If the FB is visible, superficial and palpable, it can be removed with tweezers and good magnification. Be careful not to break it and leave fragments behind and be aware of the possibility of other, deeper FB. If the FB is deep, removal can be difficult and time-consuming and can potentially damage tissues. Removal should be done in an operating theatre with good lighting, magnification and a tourniquet to provide a bloodless field. Ultrasound localisation of the FB before surgery may be extremely useful to the hand surgeon and may minimise surgical dissection and operating time.

Dr Tan Soo Heong Hand, Wrist & Upper Limb Surgery 3 Mount Elizabeth #10-11/12 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6737 0177 www.hand.com.sg

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Molecular imaging of the heart Better diagnostic tools have made it possible for heart condition therapies to be tailor-made for patients. By Dr Eric Hong, Cardiologist

Cardiovascular disease is the single largest cause of global mortality, causing more than 17 million deaths each year and exacting an annual financial cost of a staggering $863 billion globally. In the US alone, 729,000 people die from cardiovascular disease annually. Annual US health costs are estimated to be $280 billion, rising to $800 billion by 2030. This has spurred a great interest within the medical community in identifying patients who can benefit most from preventive and therapeutic strategies. Today, physicians typically use a stepwise approach to test for heart disease: first through non-invasive testing, followed by coronary angiography only in appropriate patients, using coloured dye and special X-rays to show the insides of the coronary arteries. This has proven to be one of the most cost-effective modes of treatment and is useful in identifying high-risk patients. In some cases, another type of diagnostic imaging tool may be used, called a Positron Emission Tomography (PET). It helps a physician tell: • • •

•

If an invasive heart catheterisation is required; Whether chest discomfort, shortness of breath, or unusual fatigue are due to heart disease; If a patient has silent heart disease with multiple coronary risk factors such as diabetes and kidney disease; or If angioplasty, stents, and/or bypass surgery will be helpful to improve clinical outcomes.

For patient who may be allergic to iodinated contrast which is used in CT and conventional invasive coronary angiograms, this scan would be safer and also more appropriate. How does cardiac PET work? Cardiac PET uses radioactive tracers (called radionuclides) to produce a three-dimensional (3D) image of the functional processes in the heart. These are injected into the patient and as the tracers move through the heart, the energy given off by the tracers is detected by a scanner which transmits the information and translates it into an image. The resulting 3D image allows a physician to look at cross-sectional images of the body organ from any angle and detect any problems comparing the heart in resting phase and in a stress state. Giving the best diagnostic picture A key advantage of the PET scan is that it gives a wealth of data and a comprehensive picture of the heart. Compared with other diagnostic tools such as computed tomography (CT), which reveal the structure of the blood vessels, a PET scan gives more information about how

organs and tissues are working and reveals metabolic changes that occur on a cellular level. Because heart diseases often begin with functional changes at the cellular level, a Cardiac PET scan can often detect these early changes. The PET scan also reveals information about whether the heart muscle is receiving sufficient blood, detects if there was previous heart damage like scar tissue, and assesses the significance of calcified plaques documented in the coronary blood vessels. With the growing number of patients with chronic coronary artery or with multi-vessel coronary artery involvement, molecular cardiac imaging with Cardiac PET will increasingly play an important role in clinical decision making. The key is to get it right the first time, especially when considering the danger of cumulative radiation exposure to the individual patient. The best diagnostic test done early may actually eliminate the need for subsequent invasive, expensive or unnecessary tests.

Dr Eric Hong EH Heart Specialist Pte Ltd 3 Mount Elizabeth #03-09 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6736 1068 www.eheartspecialist.com

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The link between diet and colorectal cancer If the claims of special diets, health foods and expensive supplements being able to prevent colorectal cancer were true, there wouldn’t be any cases today. By Dr Goh Hak-Su, Colorectal Surgeon

3. Diet is defined not only by what we eat and the amount we eat, but also as part of a healthy lifestyle that includes physical activity and the prevention of obesity, diabetes and over-exposure to radiation. 4. Dietary supplements are not recommended in healthy individuals, but are meant for those with deficiencies, such as patients who have not been eating before or after abdominal surgery, those with osteoporosis and/or expectant mothers.

Just about everyone holds an opinion about diet and colorectal cancer – from relatives to friends to coffeeshop buddies. This is, after all, a cancer that commonly plagues modern societies and developed countries; where certain foods – especially those that are rich and processed – are over-consumed. Unfortunately, this over-consumption includes vitamins and other antioxidants. These are often thought to help in preventing this cancer but may actually cause and perpetuate it. The truth, however, is often buried amidst prevailing folklore, hearsay, advertisements and media claims, making it difficult to talk about the subject sensibly and scientifically. Whatever your understanding is of the correlation between colorectal cancer and diet, it should hopefully not deviate too greatly from the facts below.

Dr Goh Hak-Su Goh Hak-Su Colon & Rectal Centre 6 Napier Road #04-08 Gleneagles Medical Centre Singapore 258499 Tel: 6473 0408 www.gohhaksu.sg

4 Simple Truths 1. Analysis of worldwide cancer trends over the last 20 years shows that the greatest colorectal cancer occurrences are in economically transitioning populations such as the Czech Republic, Slovakia, Shanghai, Miyagi Prefecture (Japan) and Singapore. 2. With the exception of the hereditary variety, colorectal cancer is a disease that takes decades to form, and much of its risks can be mitigated by cultivating a healthy lifestyle, including dietary habits from a young age.

For the record, it is also inconceivable that a single, particular food – such as dragon fruit, bird’s nest or duck meat – is capable of preventing or causing colorectal cancer. What will actually help protect us against colorectal cancer is the well-accepted fact of regularly consuming unprocessed dietary fibre (especially from whole grain), fruits and vegetables, while cutting back on red meat, processed meat, cigarettes and alcohol. Findings reveal that consuming 50g of red and processed meat per day is safe, but 100g or more increases the risk by 20%. Smoking adds another 8% and drinking over three glasses of alcohol each day adds a further 11% of risk. Food for thought If there is a magic pill that has been known to reduce the chances of developing colorectal cancer, it has to be aspirin, the common over-the-counter painkiller. Taking 100mg of aspirin a day has been known to reduce the risk of developing colorectal cancer by 30%. It’s also interesting to note that while the US is the epitome of over-consumption with its obsession with fast food, unhealthy diets and obesity, it is the only developed country in the world with a decreasing incidence of colorectal cancer. This is thanks to the sheer number of Americans who undergo regular screening by colonoscopy. It can be concluded that even if a person adopts a perfectly healthy lifestyle, eats a healthy diet and takes aspirin regularly, he or she can probably only reduce 45% of the risk. Hence, screening for colorectal cancer, as with most chronic diseases, is equally if not more vital for early detection and improved chances of successful intervention.

Smiles all around Dental implants promise to restore your smile and confidence.

A sparkling set of pearly whites are essential for a dazzling smile. Missing teeth can mar your appearance, leading to self-consciousness and low self-esteem. Nobel Biocareâ&#x20AC;&#x2122;s dental implants can help rectify the problem and restore your smile. The implants are man-made titanium screws that replace the root portion of a missing tooth. The implant is placed in the bone of the upper or lower jaw, allowed to integrate with the bone and anchor the replacement tooth. Implants are the gold standard in replacing missing teeth, says Dr Juliet Tay, Director of The Implant and Oral Surgery Centre and a specialist in full mouth reconstruction using dental implants. They look, feel and function like natural teeth. They preserve the integrity of the facial structure, prevent bone loss, and reduce the inconvenience associated with tooth loss. Dental implants can be used to replace a single lost tooth, several missing teeth or all missing teeth.

Benefits of dental implants When a tooth is lost, the jaw bone begins to resorb, making the face look older. Dental implants can stop the process of bone loss, preserving your appearance. With ill-fitting dentures, the teeth slip and slide around the mouth. The facial muscles become tense in an attempt to hold the denture in place. This often results in mumbling, slurred speech or clicking noises. The implant supported replacement teeth allows you to speak with confidence in a relaxed and natural tone. Dental implants can eliminate the embarrassing inconveniences of removable partial and full dentures. There is no need for gooey denture adhesives that must be applied throughout the day. You no longer need to cover your mouth when you laugh or smile for fear that the dentures may fall out. They will improve your self-esteem as you can regain nearly all the capabilities you had with your natural teeth, including the ability to chew properly. This is a far cry from those with dentures who can eat at only 15-20% efficiency when compared to a person with natural teeth. This is made more acute as the ability to chew well with dentures diminishes as the jawbone shrinks. Although dental implant treatment may initially be more expensive than other treatment methods, Nobel Biocareâ&#x20AC;&#x2122;s dental implants have been documented to be a worthwhile investment from a long-term perspective since most patients can expect them to last a lifetime.

Dr Juliet Tay is the Director of The Implant and Oral Surgery Centre with over 14 years of clinical experience. Her expertise includes full mouth reconstruction with dental implants.

Caring for your implant Dental implants are designed to mimic natural teeth and do not require special care beyond the daily routine of brushing and flossing, says Dr Tay. While implants will never decay, the bone supporting the implants may be subject to gum disease if proper oral hygiene is not carried out. If your implants are well looked after, you can expect them to last a long time.

The Implant and Oral Surgery Centre 10 Sinaran Drive #11-25/26 Novena Medical Center Singapore 307506 Tel: 6397 6540 www.iosc.com.sg

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A better breast Advances in breast augmentation have created the ability to improve the look and feel of surgically-enhanced breasts and paved the way for the increased popularity of the procedure. By Dr Karen Sng, Plastic Surgeon

Breast enhancement surgery has always been a popular procedure. Many women are born with breasts that are disproportionate in size to the rest of their body; in the local context, many women have breasts that are smaller and less developed relative to their frame. The increased awareness and acceptance of cosmetic enhancements now means more women seek to augment their breasts. Trends in breast implants The trend today is to have breasts that are not just bigger, but also have a natural shape. Instead of the perky and round breasts popular in the past, anatomically correct, or tear-drop shaped implants that give a full and more natural appearance are the ones of choice. The “mummy makeover” is increasingly popular as modern mothers seek ways to regain their pre-pregnancy body contours. This is usually because breast-feeding – which imparts wonderful benefits for babies – can cause breasts to lose volume. For women who were happy with their breasts before pregnancy, the change in size and ‘deflation’ of the breasts can be distressing. New directions in augmentation For years, breast augmentation has been achieved by surgically inserting silicone or saline implants behind the breasts. Silicone implants are the preferred choice as they impart a more natural feel compared to saline implants which tend to feel firmer. Cohesive gel implants These are a result of research and development of medical grade silicone implants. These are sometimes called “gummy bear” implants. The gel ‘sticks’ to itself and maintains the shape of the implant, and hence the breast, better. Cohesive gel anatomic implants impart a more natural teardrop shape and are gaining popularity. This is in keeping with the desire for a larger but still natural-looking bust. These anatomic implants come in a range of projections and volumes, and can impart a full-breasted appearance just as the round implants can. Fat grafting This is an exciting new option for breast augmentation. In this procedure, liposuction is used to remove fat – usually from the abdomen, thighs or buttocks – which is then processed and re-injected around the breasts, resulting in a fuller look. Because the procedure yields only a small volume of augmentation with each session, it is best suited for women who seek only a modest increase in breast size. However, fat grafting can be repeated to achieve a greater total volume of enhancement. Fat grafting is suitable for women with a moderate amount of fat that can be removed and transferred and is an excellent two-in-one procedure to reduce fat and boost breast size.

Fat grafting is also ideal for women who have had breast implants and wish or need to remove them. Injecting fat to replace some of the volume prevents breasts from looking ‘deflated’ after implant removal. Some women actually prefer the feel of their breasts after implant removal and fat grafting, and may return for additional fat grafting to further increase their breast size. Composite breast augmentation Another technique that is gaining popularity, this marries the traditional surgical breast implant augmentation with fat grafting. The implant is placed behind the breast, and the fat is injected above the breast. For patients with thinner tissue over the breast, this option enables the surgeon to ‘pad’ the tissue covering the implant, giving the breast a more natural feel. Another use of this technique is to inject the fat between the breasts to enhance the cleavage andprevent the breasts looking too separated. Considerations before augmentation If you are thinking about breast augmentation, remember that it is not just the size but also the shape of the breasts that you need to think about. It is also important to be realistic about what can be achieved through surgery, whether using implants or fat. For a significant volume increase in a single surgery, breast implant augmentation is still the ideal option, especially for women who are of a slim build. Fat grafting is an option only if you have sufficient fat, and if you only want a very modest increase in size. Do discuss your options with your plastic surgeon; he or she will advise on what is best based on your breasts and body, and your desired outcome.

Dr Karen Sng The Plastic Surgery Practice @ Orchard 3 Mount Elizabeth #12-02 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6235 7565 www.karensng.com.sg

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Visiting your gynaecologist Many women delay visiting a gynaecologist out of embarrassment, fear or ignorance. While this is understandable, it is important to realise that, for the sake of good health, it is a must. And the process is not as daunting as it is thought to be. By Dr Christopher Ng, Obstetrician & Gynaecologist When should a young woman go for her first gynaecologist visit? Women should start seeing a gynaecologist if they have been sexually active for at least three years, or are sexually active for less than that and are aged 21. After a woman has had sex, she needs a full gynaecological examination at least once every three years to track her reproductive health and review her contraceptive methods. Young, sexually-inactive girls with menstrual problems or puberty issues should also see a gynaecologist. Why a gynaecologist and not a GP? While pregnant women need to be under a gynaecologist’s care, any woman suffering from gynaecological problems or who would like a health screening on female issues should see a gynaecologist, a specialist who is better able to diagnose female problems properly. How should one prepare for a visit to the gynaecologist? Be clear and concise when describing your main concern, as your gynaecologist can only advise, investigate and treat based on specific information. Bring relevant medical reports, and come prepared with questions. When scheduling your appointment, bear in mind that if you want a pap smear, it cannot be done when you are menstruating. What can one expect on the first visit? Your gynaecologist will need details about your menstrual cycle, contraceptive use, allergies, previous operations and medical conditions, if you are on medication, and family health history. Your height, weight and blood pressure will be recorded, and there may be a heart, lung and abdomen examination. A breast examination is usually performed. The pelvic examination involves an examination of the external genitalia, and a speculum is then gently inserted into the vagina to visualise the cervix in women who have already had intercourse. A pap smear is performed as part of the routine cervical cancer screening procedure. It is relatively painless if you are relaxed. Finally, a pelvic ultrasound scan will reveal pelvic abnormalities such as fibroids and cysts. What should a good gynaecologist do, ask or say? A good gynaecologist will quickly make you feel comfortably relaxed, and will take the time to answer all your questions and address your concerns directly and sensitively without rushing you through. If he or she fulfils these criteria, then that’s the one for

you. If not, find another gynaecologist more suited to your needs. What are the most common gynaecological problems among Singaporean women? Depending on their age, women experience a range of issues about pregnancy, menstruation, contraception, ovarian cysts, endometriosis, fibroids, infertility, female cancers and menopause. There are so many gynaecological tests we hear about. What are the must-do ones? All sexually active women need a pap smear test performed within three years of commencing intercourse, and this must be repeated once every three years until age 65, provided there are no abnormalities. Mammogram, as the most effective and proven method to detect breast cancer, is the other must-do. Women aged 40-49 should go for a screening mammogram once a year until they are 50 or reach menopause, whichever is later, after which they should go every two years.

Dr Christopher Ng GynaeMD Women’s & Rejuvenation Clinic 1 Orchard Boulevard #04-03A Camden Medical Centre Singapore 248649 Tel: 6733 8810 www.gynaemd.com.sg

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Thread(Face)-lifts: A brief review The use of threads is a non- or minimally-invasive approach to facial tightening, contouring and lifting which originated more than a decade ago. There are many versions of this technique, which can be confusing for the patient. Here’s a simple guide. By Dr Colin Tham, Plastic Surgeon Threads can be divided into those which are smooth and those which have cogs, barbs or cones. In general, threads which are smooth work by stimulating contraction and subsequent tightening of the skin. Examples of smooth threads are the Gold Threads and the Polydioxanone (PDO) threads used in the popular Korean Ultra V-lift. Threads with barbs or cones are usually deployed deeper and are designed to grab the facial tissues, lift them into more youthful positions and hold them there. These threads, which require laser technology to create the precisely-cut cones and barbs, have a stronger effect than smooth threads. To highlight the differences, let’s examine Ultra V-lifts and Silhouette Threadlifts. Ultra V-lifts These are smooth threads made of PDO. They are of extremely fine calibre and are left free-floating. An effective mid-lower face procedure usually requires at least 50 threads of varying lengths. The procedure takes about half an hour and is very comfortable, and usually performed under topical anaesthetic cream. There is no downtime, with patients generally able to return to work the next day.

The effects typically last for 12 to 18 months. The popular Ultra V-lift describes the desired youthful sharp and narrow V-shaped lower face. It is best achieved non-invasively with PDO threads used on the jawline, Botox to the jaw muscles (masseters) for narrowing, and chin fillers to lengthen or sharpen the lower face. Silhouette threads These “catch” the tissue with three-dimensional cones. But unlike barbs, they will not buckle under stress. The threads are anchored to a fixed point in the temple requiring a small (<2cm) incision which is easily covered by the hair. Just four to six threads per side, when placed just beneath the skin, give a very presentable mid-lower facelift that improves laugh lines and jowls. The procedure takes about an hour and is performed under local anaesthesia. The downtime is short, at between two to five days, and the effect generally lasts between three to five years. Silhouette threadlifts work synergistically with lower face liposuction to reduce heavier jowls and double chins, and together, the procedures can effectively recontour the face into more youthful proportions. The 4th dimension When considering the different lifting techniques, it is important not to neglect the fourth dimension, which is about volume. With ageing, we lose volume in our faces. This deflation adds to the laxity and sagging which are already a concern for many mature patients. Good fourdimensional (4D) lifts address this issue through the adjunctive use of fillers or fat transfer. Sometimes all that is required are tiny volumes added to the cheeks in order to achieve the lifting result. While Threadlifts, Botox and fillers offer a less invasive option for patients who may not want or need the full surgical experience, they are not designed to replace facelifts. *Disclosure: Dr Colin Tham is a certified SilhouetteLift trainer with no financial interest in the company.

Dr Colin Tham Asia HealthPartners (Aesthetics) 304 Orchard Road #05-06 Lucky Plaza Singapore 238863 Tel: 6235 8411 www.colintham.com.sg

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OPINION

Benign liver conditions: understanding unseen abnormalities They range from harmless to mildly harmful, and are generally little known. But it is useful to know about them, as a preventive measure and to promote awareness of how to manage them. By Dr Tay Khoon Hean, Hepatobiliary Surgeon

A healthy liver carries out indispensable functions in our bodies: it clears toxins and waste from our bloodstream and helps digest the food we eat. While we have all heard of complications like acute liver inflammation and liver cancer, we know less about benign, or non-cancerous, liver conditions. Here are some of the more common ones. Benign Liver Diseases Unconjugated Hyperbilirubinemia, or Gilbert’s Syndrome, isn’t a disease but a hereditary condition caused by a mutated gene inherited at birth. It is caused by the liver’s inability to break down a yellow substance called bilirubin, which passes into the bloodstream. The symptoms of this harmless condition don’t usually appear until puberty or later. People with Gilbert’s Syndrome may experience yellowness on their skin and in the whites of their eyes, dark urine, fatigue, nausea, abdominal pain, or irritable bowel syndrome following strenuous exercise, high levels of stress, dehydration or an illness. The most common symptom is jaundice or the yellowing effect, although some people present no symptoms at all. Although there isn’t any treatment for Gilbert’s Syndrome, symptoms can be minimised by adopting a healthy diet without skipping meals, carefully managing stress, and keeping doctors informed about the condition to avoid complications later on. Another condition – Acute Fatty Liver of Pregnancy (AFLP) – sometimes occurs in women in the last trimester of pregnancy. Its symptoms closely resemble those of Gilbert’s Syndrome or other liver conditions, which makes early diagnosis a challenge. It happens when a baby inherits an enzyme deficiency gene which inhibits its ability to break down fatty acids. The resulting fatty acid build-up in the womb passes into the mother’s bloodstream via the placenta. If not treated, this condition can lead to liver and kidney failure, threatening both the mother’s and child’s lives. Women with this condition have to be hospitalised and be closely monitored during and after childbirth. A different type of fatty liver disease occurs in some people who frequently consume heavy amounts of alcohol. Liver cells become lumbered with extra alcohol-induced fat. This condition usually goes away when the alcohol intake decreases or stops.

Alcoholic hepatitis occurs when the liver swells because of an overload of the toxic chemical byproducts of alcohol breakdown. The resulting symptoms include nausea, abdominal pain and swelling, fever, jaundice, and loss of appetite. Liver damage may be reversible for mild alcoholic hepatitis, though liver failure and death may follow severe cases. Benign Liver Tumours Benign liver tumours generally do not present any symptoms and can go undetected for a long time, unless revealed through an ultrasound, a CT scan or an MRI. For instance, a hemangioma is a mass of abnormal blood vessels. Depending on its size and proximity to other organs, it is relatively harmless and does not require treatment. A focal nodular hyperplasia (FNH) is a liver tumour that occurs mostly in women, much like a hemangioma. Like hemangiomas, an FNH can be removed surgically if it causes pain or other problems. Hepatocellular adenomas, often found in women of childbearing age, have been linked to the consumption of birth control or hormone pills. Occasionally, an adenoma grows and ruptures, causing abdominal pain. It is advisable that large adenomas be removed surgically to prevent any such risk.

Dr Tay Khoon Hean Tay Khoon Hean Surgery 6 Napier Road #08-02 Gleneagles Medical Centre Singapore 258499 Tel: 6471 1221 www.tkhsurgery.com

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OPINION

Ovarian cysts Although common, some forms of ovarian cysts can cause problems such as bleeding and pain. By Dr Michele Lee, Obstetrician & Gynaecologist, and Fertility Specialist

Ovarian cysts are small fluid-filled sacs that form in the ovaries – the small organs located on either side of the uterus that make hormones and produce eggs. Ovarian cysts can occur in all ages and are common in women of child-bearing age. Ovarian cysts that form in post-menopausal women are of more concern as the risk of cancer increases due to the formation of non-functional cysts. Types of ovarian cysts There are several different types of ovarian cysts. Functional cysts form during the menstrual cycle and are the most common. Functional cysts include follicular cysts and corpus luteum cysts. These cysts are typically harmless, do not cause symptoms, and do not need treatment as they dissolve in time. Follicular cysts form when, during ovulation, the egg is not released or the follicle – sac in which the egg forms – does not dissolve after the egg is released. Corpus luteum cysts are harmless cysts that appear after ovulation. The corpus luteum is what is left of the follicle after the ovum has moved to the fallopian tubes. The risk of a functional cyst increases if you have had a previous functional ovarian cyst, use fertility drugs containing clomiphene, or take low-dose progestin-only contraceptives. Another type of ovarian cysts are non-functional, and are the result of problems in ovulation. They are not considered normal. They include polycystic ovaries, cystadenomas, endometriosis and dermoid cysts. Polycystic ovaries are a mass of multiple cysts that form in the ovaries. Called polycystic ovary syndrome (PCOS), the follicles in which the eggs normally mature do not open and form cysts.

pelvic examinations and the diagnosis is confirmed using ultrasound. Most ovarian cysts are harmless unless they bleed, rupture, become twisted or infected. Because the symptoms of a problematic ovarian cyst are very similar to those of ovarian cancer, it is important to be aware and seek help if: • •

Cystadenomas are fluid-filled cysts that form from the cells on the surface of the ovary. Endometriosis is where the tissue from the lining of the uterus grows in other areas of the body such as the ovaries. This condition can cause pain and affect fertility.

• • •

Dermoid cysts form from cells that produce human eggs and may form tissue similar to that of hair, skin or teeth. These cysts are rarely cancerous.

• •

These types of cysts do not go away on their own and may continue to grow. Complications can arise if these cysts grow too large or bleed.

When to see a doctor In many cases, ovarian cysts go undetected as they do not cause problems. They can be detected during routine

• • •

your periods have changed from being relatively pain-free to painful; your periods have changed from being regular to becoming infrequent during the past 3 to 6 months and you are not nearing menopause; you have pain during sexual intercourse; there is abdominal pain or bloating; you experience difficulty urinating, or a frequent need to urinate; there is a dull ache in the lower back; your periods are unusually painful and there is abnormal bleeding; you gain weight unexpectedly; you experience nausea; or there are changes in your appetite.

If you are worried or unsure, please consult a gynaecologist.

Dr Michele Lee Sook Ling Michele Lee Women & Fertility Clinic Pte Ltd 820 Thomson Road #08-54 Mount Alvernia Medical Centre D Singapore 574623 Tel: 6354 3003 www.gynaefertility.com.sg Lee Women’s Clinic and Surgery 304, Orchard Road #06-33 Lucky Plaza Singapore 238863 Tel : 6235 6545

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OPINION

The masked invader Although less common, neuroendocrine cancer is unusually aggressive in Asians and is often overlooked because the symptoms are common to many other diseases. By Dr Lim Hwee Yong, Oncologist

Neuroendocrine cancer occurs in the cells of the neuroendocrine system. It is an insidious invader which causes a wide range of symptoms that could be attributed to other diseases, making diagnosis difficult. The neuroendocrine system is a diffuse one that runs throughout the body, and its cells are present in organs such as the pituitary, pineal, thyroid, parathyroid and adrenal glands, the lungs, the pancreatic islets, the stomach, small and large intestines and the ovaries. These cells receive messages from the nervous system and respond by making hormones. Certain changes in the neuroendocrine cells cause tumours to form, and some may become cancerous. When this happens, the symptoms depend on where the cancerous cells are. These cancers disrupt important hormonal functions or produce hormones in excessive amounts resulting in severe symptoms and complications. For instance, intestinal neuroendocrine tumours may cause severe episodes of diarrhoea, abdominal distension and discomfort. The cancer can also trigger the excessive release of hormones such as serotonin and cause heart valve damage. A complex diagnosis Since the cancer can originate in more than 40 places and cause a wide range of non-specific symptoms, it is often misdiagnosed as irritable bowel syndrome, ulcers, anxiety, asthma or even menopause. On average, it can take five to seven years to accurately pinpoint the disease, by which time the tumours can be very large and could have spread to other tissues and organs in the body. It is, therefore, crucial to spot persistent symptoms and seek advice. Because of the need to rule out other health problems, diagnosis of neuroendocrine cancer can be a long process. It typically includes a comprehensive medical history and physical examination, blood tests to spot any abnormal levels of glucose, stomach acid or hormones, and to identify cancer markers. Diagnostic imaging such as X-rays and scans may also be performed to detect tumours. One new scan, Gallium-68 DOTA-PEPTIDE scan, is especially useful in detecting neuroendocrine cancers. A radioactive isotope that targets only the cancer cells is injected into the body and can accurately reveal the mass. The scan has been found to more accurately evaluate patients before treatment and guide decisions on the best treatment option.

Targeted cures Surgery may be done if the tumour is discovered early. However, this is often not the case in neuroendocrine tumours. Other technical treatment modalities may be considered when the tumour has spread to the liver, whereby a long catheter is passed through the blood vessels to the mass to deliver medications. This may involve small nanomolecular carrier molecules that deliver medications or cut off the blood supply ‘feeding’ it. Fortunately, the advancement of new scientific discoveries and technologies has given us many new treatments. Neuroendocrine cancer commonly carries a visible molecular receptor that can be targeted by available medicines. This involves the use of targeted hormone receptors bringing medications for symptom control. Some novel cancer drugs behave like Trojan horses and can ‘unlock’ and enter the cancer cells to attack them from within. Others are targeted mini nuclear bombs that attach to specific molecular targets on cancer cells and detonate, delivering a small blast to destroy the cancer cells but leaving normal cells largely unharmed. The key to successful neuroendocrine cancer survival is early detection. It underscores the need for increased awareness of the disease and earlier interventions for better outcomes.

Dr Lim Hwee Yong Novena Cancer Centre 38 Irrawaddy Road #09-41 Mount Elizabeth Novena Singapore 329563 Tel: 6339 0233 www.novenacancercentre.com

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OPINION

Saving your fertility When the time is not right to start a family, there are ways to preserve your fertility for when circumstances are more ideal. By Dr Ann Tan, Obstetrician & Gynaecologist

In Singapore, many men and women are conscious of the risk of infertility and the increase in abnormal babies and pregnancy complications after the maternal age of 35. However, many women are pushed into trying for conception at a later age due to work pressures, financial pressures or the lack of a suitable partner. Marrying earlier is difficult for many young couples and trying for a family becomes more challenging and difficult as time plods on. With later marriages and the corresponding dip in a woman’s fertility, many couples are concerned that their dreams of a family may not be realised. For women with a family history of premature menopause, saving one’s fertility potential may be critical for her to have her own genetically similar children.

Egg freezing is also a useful adjunct for those undergoing IVF, as it allows couples – who for personal or religious reasons – choose not to place extra embryos in cold storage and feel more comfortable storing the extra eggs instead. In other unhappy instances, when cancer strikes for either men or women, saving fertility for a later time when one is in a stable state is often seen as having a positive impact for prognosis. For the women, there is usually a small window of opportunity prior to chemotherapy to save her eggs and/or embryos for a chance at having a child in the future. (Similarly for the men, sperm freezing can easily be performed prior to chemotherapy.) Social egg freezing is a promising option to preserve eggs before they are damaged or depleted.

From 2012, the American Society of Reproductive Medicine declared that egg freezing is no longer an experimental procedure. Improvements in freezing methods and culture media have given many labs an almost 100% freeze and post-thawing survival rate. Apart from the cost of storage, the current cost for egg freezing is identical to that of routine IVF. In Singapore, egg freezing is only available in the context of those suffering from cancer and desiring to store their eggs before undergoing chemotherapy. Egg freezing is also an option for them post-chemotherapy if they are not able to consider a pregnancy at the time. (Sperm freezing has been in place for many years.) The egg freezing process Called oocyte cryopreservation, egg freezing allows women to freeze and store their eggs until the time that they wish to start or expand their families. The benefit of freezing your eggs while you are still young and at your reproductive peak is one of the best ways to ensure a chance for a future pregnancy. While the uterus can carry a pregnancy well into the 40s and 50s, your ovaries and oocytes (eggs) do not age as well. Freezing your eggs by vitrification means they can be stored and ‘suspended in time’, preserving their quality. It is recommend that 10 eggs be stored for each pregnancy attempt. Most women 35 years or younger can expect to harvest from 10 to as many as 20 eggs per cycle. This is being recognised globally as a particularly good option for women who have not had the opportunity to be a mother for various reasons. Preparing for egg retrieval Before the eggs are retrieved for freezing, you will need to undergo the same hormone-injection process as for IVF. Just as with the initial stages of the IVF process, it takes approximately 12 to 14 days for eggs to reach retrieval stage. • The process begins with a baseline test done a day or two after the onset of menses. This typically includes an ultrasound and a blood test. • For those with irregular menses, a cycle of oral contraceptive pills may be used to regulate the menses before starting ovarian stimulation. For those with regular cycles, this may not be necessary. • After your hormones are successfully suppressed, a series of carefully measured fertility medications is given to start ovarian stimulation. These hormone

injections are given daily over 10 to 12 days to stimulate the ovaries and ripen multiple eggs. To monitor the eggs, regular timed clinic visits involving ultrasounds and blood tests are done to look for mature eggs. • If the case is urgent, as in the case of cancer therapy, stimulation can begin using special protocols at different phases of the cycle. These cycles have been shown to potentially produce adequate good quality eggs or embryos for storage. • When tests indicate that the eggs are approaching maturity, a trigger to simulate the LH surge is given and the eggs are then removed via a needle placed through the posterior vaginal vault. • The removed eggs are immediately frozen. When you are ready to become pregnant, the cryopreserved eggs are thawed and each one is then injected with a single sperm to achieve fertilisation before they are transferred to the uterus as embryos. Success rates Younger is better when it comes to storing eggs and sperms. It must be remembered that frozen eggs from a 40 year old have only a 10% chance of success. An IVF cycle at age 42 with frozen eggs retrieved at 38 years is more likely to succeed than a fresh cycle at 42 years. To be effective, therefore, egg freezing is best carried out from age 35 or younger.

Corporates for egg-freezing As part of its package of employee medical benefits that includes free meals, four months of maternity leave and financial assistance for newborn expenses, Facebook recently began to offer female employees financial assistance of up to US$20,000 for egg-freezing. Apple will begin offering this benefit as well from 2015. Though well-intended, these announcements have generated varied responses, from appreciation to outrage that corporates are getting into such a personal aspect of an employee’s life.

The risks of egg freezing With ovarian stimulation, the risks of hyperstimulation are always possible, but with newer methods, such as an agonist trigger, these are greatly reduced. The risks of storing abnormal eggs is always possible as it is impossible to test the egg prior to freezing. (Sperm freezing, on the other hand, is easily done and each ejaculate can be stored in multiple straws and are capable of being used in more than a single cycle of IVF. ) Conclusions Egg or sperm freezing is a process that can be of benefit as an insurance for a chance at parenthood. While it is not for everyone, it definitely gives women and men more options where there were none before. It is not meant to encourage delayed parenthood but as a protection against childlessness, because there is always hope as long as there are eggs or sperm in the bank.

Dr Ann Tan Women & Fetal Centre 290 Orchard Road #20-01 Paragon Medical Singapore 238859 Tel: 6887 1103 www.anntan.com.sg

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OPINION

Spotting salivary gland cancer Have a painless bump in the jaw? It could be serious. Learn how to spot the signs of salivary gland tumours. By Dr Christopher Goh, ENT Head & Neck Surgeon

The first sign of salivary gland cancer can easily be mistaken. It often appears as an innocuous, typically painless lump that grows in the salivary gland area, which runs along the jawline. These lumps can be either benign (harmless) or malignant (able to spread and possibly fatal). Either way, I strongly recommend surgical removal of these salivary gland growths. Even if a lump in the salivary gland is not cancerous when it is diagnosed, the benign tumour will keep growing, and there is a chance it may turn malignant in the future.

Prof Christopher Goh Novena ENT-Head & Neck Surgery Specialist Centre 38 Irrawaddy Road #04-21/22/34 Mount Elizabeth Novena Singapore 329563 Tel: 6933 0451 www.profchristophergoh. com.sg

Salivary gland cancers Salivary gland growths most often occur in the parotid glands, the largest salivary glands that are located just in front of and below the ears. The second most common area in which salivary gland tumours can occur is the submandibular glands, located just below the jawline. Tumours can also grow in the salivary glands under the floor of the mouth, below the sides of the tongue, as well as beneath the lining of the lips, tongue, in the roof of the mouth, inside the cheeks, nose, sinuses, and voice box â&#x20AC;&#x201C; but these are rare. While there is no specific cause of salivary gland tumours, smoking is associated with a benign parotid gland tumour commonly called Warthinâ&#x20AC;&#x2122;s tumour. This growth is a result of the proliferation of lymphoid tissue within the gland as a response to smoking. The causes of salivary gland cancers are unknown but risk factors include a family history of the same cancer,

age and previous exposure to radiation. To diagnose if a growth in the salivary gland is serious and warrants timely medical intervention, we do a procedure called a needle biopsy, where we use a needle to obtain a tissue sample of the lump. This procedure is commonly done in conjunction with ultrasound scan guidance. The cells are then tested in a laboratory to determine if they are cancerous. Treatments and outcome Many patients ask me if their salivary gland growths can be treated with medication, but surgery is the only option to remove the growth. If the tests show that the growth is malignant, radiation therapy may have to be given as part of the follow-up treatment. This will help kill off any remaining cancerous cells. In most cases, recovery from the procedure will take a couple of weeks, and most patients are able to go back to work about two weeks after the surgery. For those requiring radiotherapy, their treatment will usually start about four to six weeks after surgery and may take about six weeks to complete. As with many cancers, early detection is important as it is associated with a much better outcome and less risk of the cancer spreading. A fair number of patients come in for consultation only during the later stages of the cancer because they were unaware of the growth. Thus, it is important that you have a good awareness of your body, so that you can detect any unusual growths early and get them evaluated.

ZOE NISSI Special

The balance between health and beauty Good health practices can comfortably include those that enhance beauty.

The older we get, the more conscious we become of environmental impurities and unhealthy lifestyle habits that need to be tackled. We’re looking for a balance between good health practices and beauty care. Fortunately, maintaining good health brings benefits such as diseaseprevention, mental well-being, better work performance, as well as beauty benefits. In response to these needs, new beauty products and treatments are emerging with the goal of safe-guarding and restoring natural beauty rather than just ‘fixing’ problematic skin with products that work but are, over time, too harsh on our skin. Peptide chemists and dermatologists are working to bridge health and beauty with natural and powerful ingredients, creating products that work with the skin’s natural processes to slow degeneration and revitalise the skin through DNA repair.

Skin Brightening & Anti-pigmentation BrightAlive™ Non-Retinol Skin Brightener uses a multi-faceted approach to skin brightening. It inhibits overpigmentation of skin and enhances it with the brightening properties of Ascorbyl Glucoside, a stable form of Vitamin C. BrightAlive™ uses Alpha-Arbutin, a milder derivative of hydroquinone, which is extracted from cranberries, blueberries, bearberries, pears and other plants. This ingredient presents a better alternative for patients with skin that is sensitive to the stronger effects of hydroquinone and retinol skin-whitening agents. Extracts of rosemary leaf, purple betony leaf and sunflower seed oil help reduce skin irritation and inflammation, curbing the browning effects of such problems on the skin. On its part, glycerine helps hydrate the skin barrier and restores its moisture balance by providing a layer that traps moisture, just as the skin’s sebum or natural oil does. Dealing with skin damage caused by UV rays, BrightAlive™ Non-Retinol Skin Brightener contains timerelease antioxidants that slowly carry out the healing

effects of Vitamins A, C and E over a period of 12 hours. The result is a visible reduction of inflammation of the skin and a targeted suppression of the free radicals that cause damage to the epidermal layer. BrightAlive™ is suitable for all skin types and mild enough for everyday use. The consistent, daily removal of dead skin cells through an enzyme exfoliator called Papain will quicken the renewal processes of the skin, limiting discolouration and giving it a more balanced and even tone.

Skin Strengtheningn Wrinkles. Lines. Dark spots. The worst way to deal with them is to let them be. Though they are the natural outcome of the skin’s ageing processes made worse with stress, unhealthy eating habits and over-exposure to harmful UV rays, they can become less visible as skin is nursed to an optimum level with the application of Vitamin C and other powerful antioxidants. C-Bright™ 10% Vitamin C Serum uses a waterfree formula that delivers the benefits of pure Vitamin C to the skin. When applied straight after facial cleansing, the serum reacts with facial moisture, quickening the exfoliation process to bring about a lighter, more even complexion. The ascorbic acid in the serum works beneath the surface of the skin to limit the formation of melanin pigment by up to 80%. At this level, it also strengthens the skin’s surface layer and stimulates collagen production, helping to reduce wrinkles, boost the skin’s texture and protect the skin from environmentally-triggered pigment formation later on.

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OPINION

5 common skin issues Heat, haze, stress and humidity may wreak havoc on your skin. Here are ďŹ ve top skin problems and how to resolve them By Dr Wong Su-Ni, Dermatologist

Our tropical heat and humidity can cause a range of skin conditions. Cumulative sun exposure accelerates skin ageing, while heat, humidity and high stress levels contribute to increased acne and acne scarring. Here are some common skin issues and the treatment options. Pigmentation and sun spots Freckles and other pigmentations are common on skin that is sun-exposed. Freckles, small spots that tend to cluster on the face, arms or shoulders, are common in fair-skinned people, particularly those of Caucasian descent. Melasma – blotchy, map-like areas of pigmentation usually on the cheeks, nose, forehead, and sometimes the upper lip – are more common among Asians with darker skin, especially those with previous pregnancies or who have used contraceptive pills. Treatment: Topical therapy, chemical peels, Intense Pulsed Light or pigment laser. Pigment laser yields excellent results for solar lentigenes and freckles. For melasma, long-term maintenance treatment is required although excessive treatment should be avoided. Acne & acne scars Acne is characterised by blackheads, whiteheads and pimples of varying appearance called papules, nodules, pustules and cysts. Acne can cause significant scarring, and is common among adolescents and adult women. It is caused by a combination of hormonal activity, genetic predisposition, cosmetics, humidity, stress, increased sebum production and diet. Treatment: Medication, chemical peels and various laser treatments. If oral or topical medication has not been effective, chemical peels, PPX pore-cleansing treatment (IPL with vacuum suction) or pulsed dye/ vascular laser may help with acne and post-acne marks. Scar treatment includes the use of fractional laser, sublative rejuvenation, laser resurfacing, surgical excision, localised steroid injections and vascular lasers.

glands, reducing sweat volume. There is an average 82% reduction in sweating after two treatments. Wrinkles and folds Wrinkles are caused when the skin loses collagen. Dynamic ones appear with facial expressions while static wrinkles are seen even when at rest. Wrinkles typically start to appear at age 30 to 40 and are more common in those with expressive faces, long-term sun exposure and smokers. Treatment: Botulinum injections can be used to weaken the muscles responsible for forming wrinkles. Deep wrinkle folds or grooves can be treated with filler injections.

Excessive sweating The tropical heat can cause excessive sweating that stains clothes and/or causes body odour. While not harmful, the condition can be embarrassing and affect social relationships. Where the whole body is affected, the cause could be hormonal, metabolic, or due to certain drugs, nerve conditions or even tumours. In most cases, the cause is not known.

Excessive or unwanted hair In many societies, body hair is not desirable, especially on women. Dressing for the tropical climate further exposes embarrassing body hair. Hair removal is typically desired for underarms, arms, legs, bikini line and upper lip. Hirsutism – excessive hairiness on parts of the body where hair does not normally occur or is minimal – can occur in women with hormonal problems such as polycystic ovary syndrome, or in women with a genetic predisposition. Some medications can also lead to excessive hair growth.

Treatment: Botulinum injections are effective but painful, and require repeated injections every six to nine months. A new non-invasive option is miraDry®, a microwave gun that permanently destroys sweat

Treatment: Creams, manual removal or light-assisted hair removal. A prescription cream is available to reduce facial hair and in some cases, a more permanent way is to use laser or light-assisted hair removal.

Dr Wong Su-Ni Dr SN Wong Skin, Hair, Nails & Laser Specialist Clinic 3 Mount Elizabeth #07-09 Mount Elizabeth Medical Centre Singapore 228510 Tei: 6733 3629 www.drwongsuni.com.sg

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OPINION

The rising case of ‘athlete’s shoulder’ Shoulder pain is a common complaint – especially among active people. Here are some common injuries to look out for. By Dr Lim Yi Jia, Orthopaedic Surgeon

muscles around the shoulder can become torn or weak, causing dislocations to occur again. In young active patients, surgical stabilisation is often the best way to give long-term stability and the best outcome to patients. It can also lower the risk of developing arthritis in the joint in later years. Fractures, inflammation and sprains These kinds of shoulder injuries are related to the increasing number of road cycling and workout enthusiasts. Riding accidents are not uncommon for cyclists and one of the common outcomes of a spill is a fractured or dislocated collarbone. While this injury can be managed conservatively, surgery needs to be done in more severe cases. For new gym goers, especially those who start a new routine without supervision, the often accelerated and intensive introduction to a more active lifestyle can sometimes cause tendon inflammation, sprains and other related aches. Typically, most of these injuries are minor and can be managed with rest, painkillers and physiotherapy. Unlike knee or back pain, shoulder problems – although just as common – tend to be neglected. That is, until they affect one’s work, sleep or daily activities. But shoulder pain should not be neglected as it can get worse over time, affecting mobility and quality of life. Shoulder injuries fall into two broad types: those leading to reduced movement and stiffness; or excessive joint movement leading to joint instability. With more weekend warriors and the increase in contact and extreme sports, shoulder injuries are becoming more common.

Dr Lim Yi Jia Ortholimb Bone and Joint Surgery 6 Napier Road #07-19 Gleneagles Medical Centre Singapore 258499 Tel: 6479 7372/ 8513 2324 www.ortholimb.com

Shoulder dislocations One commonly seen injury is shoulder dislocation, which tends to occur in young men, particularly those doing NS or who play contact sport. In a shoulder dislocation, the top of the upper arm bone is forced partially or wholly out of the socket in which it sits, causing a painful deformity. A shoulder dislocation can be caused by sudden trauma or from overuse. In cases of dislocation, the arm should be stabilised and timely emergency treatment is important. While surgery is not always necessary, it can be helpful. Once dislocated, the ligaments, tendons, and

Degenerative shoulder conditions Degenerative conditions in the shoulder, namely, shoulder subacromial impingement (also called swimmer’s shoulder because it affects the rotator cuff) and shoulder osteoarthritis are also common, especially in athletes who train their upper limbs. These conditions also plague adults, particularly women who do housework. Part of the reason could be the exertion of hanging heavy loads of laundry out to dry. The act of manoeuvring heavy laundry poles can be particularly strenuous, causing severe strain in the tendons and joints in the shoulder region. Treatment and therapy Depending on the type of problem or problems (there can be multiple concurrent problems that need to be addressed individually), treatment should ideally be tailored to address the different symptoms or underlying causes. Commonly, treatment involves painkillers, physiotherapy to improve mobility and strengthen muscles, or surgery. In addition, activities may need to be modified temporarily or permanently, depending on injury type, treatment performed and response to treatment.

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OPINION

Winning the battle against cervical cancer Thanks to greater awareness and available vaccines, cervical cancer numbers have dropped in the last few decades. By Wendy Teo, Obstetrician & Gynaecologist

Cervical cancer was once the leading cause of cancer death for women in the US. These days, however, the number of cases of cervical cancer and the number of deaths from it have decreased significantly, by about 50%. This is attributed to the widespread availability of pap smear for the screening of pre-cancerous changes in the cervix. Vaccine for the human papilloma virus (HPV) – a main risk factor for cervical cancer – has also reduced the incidence of the disease. Who is at risk? Cervical cancer, which occurs when cancerous cells multiply in the neck of the uterus, occurs in about 12 per 100,000 women aged 40 to 44. This incidence tapers down between the ages of 45 and 64 and peaks again at around the 65 to 69-year mark. Women who smoke, are overweight or whose diet is low in vegetables and fruit are at greater risk of getting cervical cancer. The risk is also increased in women who have been exposed to high-risk strains of HPV, who have a family history of cervical cancer, are immunosuppressed or have taken a drug called diethylstilbestrol (hormone medication given in the old days to prevent miscarriage). The importance of screening The lack of clear symptoms underscores the importance of regular screening. A pap smear is a screening test to check for changes in the cells of the cervix. It is a simple and painless procedure where cells are collected

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from your cervix and sent to a laboratory for analysis. All woman aged between 25 and 69 years old who have ever had sex should do a pap smear once every three years. In many cases, cervical cancer is only detected during routine pap smears. In late-stage cancers when the growth is larger, there may be irregular vagina bleeding, foul smelling discharge, pain or bleeding after intercourse, as well as abdominal pain. Other complications can arise if the tumour invades the bowel, bladder or spine and signs can include constipation, pain or blood in urine and or stools, severe back pain and increased need to urinate. Get protected One way to prevent cervical cancer is to get vaccinated against HPV. Two strains of this, Type 16 and 18, are responsible for causing 70% of all cervical cancers. The HPV vaccine can be administered from age nine to 26. The vaccine is given one and six months apart. Thus far, it has proven to be 100% effective in those who have not been previously infected with HPV 16 and 18. While long-term studies are still ongoing, the vaccine has been shown to provide protection against persistent cervical HPV 16 and 18 infections for up to eight years. Having said this, there are other HPV types that can cause cervical cancer, so even if you are HPVvaccinated, a routine pap smear is still a very important part of maintaining good cervical health.

Dr Wendy Teo Wendy Women’s Clinic 38 Irrawaddy Road #08-36/37/38/39 Mount Elizabeth Novena Singapore 329563 Tel: 6100 9636 HP: 9118 9636 (Ofﬁce Hours) www.wendywomensclinic.com.sg

Children’s Eye & ENT Special

Eyes, ears, noses and throats The recently-opened Children’s Eye & ENT provides specialised services that cover the spectrum of children’s eye and ENT challenges.

This is the first eye and ENT private medical practice for children in Singapore. Its founders, both mothers of young children, want to create an inviting environment for children who need treatment. “We know the anxieties that kids experience, and we also understand a parent’s concerns,” explains Dr Dawn Teo (left), one of the founding partners. Adds Dr Zena Lim, the practice’s other founding partner: “It takes a lot more patience, commitment and time to treat children. They need to feel safe and comfortable.” Hence the clinic’s open area where kids can play, watch TV and just feel at home. “Sometimes we even examine kids in this area, where they are most relaxed.” The Children’s Eye and ENT Centre is essentially a three-in-one practice, providing eye and ENT specialty care for babies and children, and adult eye and ENT services as well. “It’s a one-stop clinic for families, and we want to build relationships over time. As medical information becomes more accessible, there is a strong trend of parents wanting to have their children checked by a paediatric sub-specialist rather than a general eye or ENT doctor, and once the trust is established, the relationship builds over time,” explains Dr Lim, who, like Dr Teo, has been in practice for about 15 years. Dr Teo is a Paediatric ENT specialist and Dr Lim is a Paediatric Ophthalmologist. Both sub-specialties are relatively uncommon in Singapore. “Due to the proximity of the nose and the eye, several eye and ENT conditions can occur together, and it is important for the eye and ENT doctor to work closely together.” said Dr Teo, adding that even before they set up the practice in November 2014, they would often see patients who required both ENT and eye care. Together at their new practice, they treat patients, from newborns to teenagers, for a host of issues including allergy-related eye and ENT issues, sinus problems that lead to eye inflammation, tear duct issues, and developmental problems that require both eye and ENT checks and screenings.

The most common conditions they see include, for paediatric ENT, snoring, tonsil problems, allergic rhinitis, sinus conditions, speech and voice issues, blocked ears, ear infections, and hearing loss. The common eye issues are related to myopia, astigmatism, lazy eyes, squint or misaligned eyes, itchy eyes, frequent blinking, styes and infections, paediatric cataract and retina problems. Many of today’s paediatric eye conditions are a result of genetics and what is referred to as “near work”, meaning reading and using devices at very close range. The popularity of electronic devices, gaming, and of course, homework and studying, all take their toll over time. The rising incidence of myopia in Singapore children is a case in point. On their part, parents too want the best for the children, and are acutely conscious of how certain conditions affect their children’s performance in school. One such condition encountered in the ENT practice is sleep apnoea, which often presents with snoring or noisy breathing during sleep. This is a potentially serious condition in which breathing is disrupted during sleep resulting in decreased oxygen levels to the brain. Untreated, it can affect school performance, concentration and may lead to health issues in adulthood. Childhood is a precious time that is meant to be cherished and enjoyed. In the words of John Betjeman, “Childhood is measured out by sounds, smells and sights, before the dark hour of reason grows.” Dedicated to offering the best treatment approaches to their young patients, The Children’s Eye and ENT Centre seeks to ensure your child remains in the pink of health to enjoy and grow in this special period of their lives.

The Children’s Eye & ENT Centre 38 Irrawaddy Road #10-21/39/40 Mount Elizabeth Novena Specialist Centre Singapore 329563 Tel: 6339 8938 www.ceec.com.sg • eyeinfo@ceec.com.sg • entinfo@ceec.com.sg

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SPECIALIST

OPINION

Problems with the prostate Common issues affecting the prostate gland. By Dr Tan Yeh Hong, Urologist

urinary tract infections, urinary leakage/incontinence, bladder stones, blood in the urine and kidney function impairment (chronic retention of urine). Those with enlarged prostate usually have LUTS such as weak urinary stream, difficulty in starting the urine flow, interrupted urine flow, incomplete voiding, passing urine frequently (in intervals of less than two hours), nocturia (waking up more than once to pass urine at night), difficulty in postponing urination and uncontrolled urine leakage. These symptoms may also occur in other conditions like prostate cancer, diabetes and urinary stones.

Many men above 50 tend to experience swelling in their prostate glands and an urge to urinate frequently. The size of a walnut, the prostate gland is located just below the bladder and is vital for two main reasons. It wraps around the tube that carries urine out of the bladder and serves an important function in reproduction by producing a secretion which nourishes the sperm in the semen. The common prostate conditions faced by men in Singapore are benign prostate enlargement (BPE), prostate cancer and prostatitis.

Dr Tan Yeh Hong Centre For Urology, Robotic & Minimally Invasive Surgery 3 Mount Elizabeth #16-15 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6733 9233 www.drtanyehhong.com

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Benign Prostate Enlargement (BPE) This condition is usually due to an imbalance in male hormones. It may present with lower urinary tract problems (LUTS) and does not lead to prostate cancer, although both are common in older men. To detect BPE, an abdominal examination and digital rectal examination are usually carried out to assess the size of the prostate, whether the prostate has lumps or an abnormal texture. A urine test is done to exclude infection and a blood test to rule out prostate cancer. If necessary, an uroflow test is carried out to measure the speed of urine flow and an ultrasound examination of the kidney and bladder/prostate. A cystoscopy (endoscopy of the bladder) may also be done. Prolonged obstruction or blockage of the urinary tract can lead to the sudden inability to pass urine,

Treatment Only about half of men having BPE symptoms need treatment. Non-surgical treatments are used in patients with bothersome symptoms but without significant blockage of urine or complications. If the symptoms are mild, the patient will be asked to adjust his fluid intake and make lifestyle changes. Alpha blockers may be given to relax the bladder neck muscle, which relieves part of the blockage. If the prostate is very large, 5 alpha reductase inhibitors may be used to help relieve the symptoms and size of the prostate. Surgery is only necessary if the symptoms or conditions do not improve or when complications arise. Prostate cancer This is the third most common cancer among males in Singapore. Its cause is not known but risk factors include race and family history. Early prostate cancer usually does not show symptoms although elevated serum PSA (prostate specific antigen) may be detected during a health screening. Treatment options depend on the age and health status of the patient and the stage of the cancer. Early cancer is treatable and potentially curable. Prostatitis This condition arises from inflammation or an infection of the prostate. It is sometimes caused by bacterial infection. Unlike other prostate conditions, prostatitis usually occurs in young and middle-aged men. BPE and prostate cancer are a natural part of ageing and there are no specific methods of prevention for them. However, reduced caffeine intake and adjustment of fluid intake may improve the urinary symptoms. A diet low in saturated fat and high in fruit and vegetables may lower the risk of developing BPE or prostate cancer.

Sozoluz Clinique Special

Chronic wounds closed The Wireless Micro Current Stimulation (WMCS) delivers a revolutionary solution to acute and chronic wounds.

Chronic wounds and ulcers often result from diabetes and cardiovascular diseases, and are also linked with burns, accidents and post-operative wounds. These wounds include diabetic foot wounds, pressure sores, and lower extremity venous and arterial ulcers. Chronic ulcers are defined as wounds that fail to heal within six weeks. They are considered a serious public health issue, since they are persistent and often recurrent. High-voltage electrical stimulation has been long proposed as a method of accelerating the wound healing process. Traditionally involving the transfer of current through electrodes and direct contact with the wound, the less-thandesirable side effects are skin irritation and infection to the wound, which can set in motion a whole new chain of painful and costly health events. WMCS is a new and innovative solution that provides the transfer of current wirelessly to the wound. Simple, non-invasive and pain-free, its main advantage is the lack of contact with the wound, which means that irritation and infection in the wound are no longer risks. The technology works by restarting or accelerating the process of healing through the application of current. Blood flow and oxygen concentration levels are increased around the wound, and this accelerates cell migration, growth of granulation tissue, bactericidal effects and the synthesis of collagen and other components of the extracellular matrix. Clinical studies indicate the WMCS Technology heals wounds in 30% of the time taken by modern wound management methods of treatment, and is especially beneficial for hard to heal wounds. WMCS technology can close a chronic wound and in some cases, prevent an amputation. Where an amputation does occur, any residual or resultant wound can be treated with the WMCS with positive indications. This noninvasive, contactless treatment means that it is pain-free and with no known side effects. With visible results after one week of treatment, treatment can be applied concurrently with other treatment methods, and multiple sites can be treated simultaneously, saving time and money for the patient. With 15% of the worldâ&#x20AC;&#x2122;s estimated 347 million diabetics suffering from chronic wounds, pressure sores and venous ulcers which are prevalent among the elderly, and burns a common occurrence through accidents, there is a pressing need for a treatment method such as WMCS, that reduces the pain and discomfort of chronic wounds and heals faster than modern wound treatment methods, with the resultant improvement in the patientsâ&#x20AC;&#x2122; quality of life.

Advanced wound management To assist patients with challenges surrounding successful closure of wounds, Sozoluz Clinique provides consultation and wound assessment on optimal solutions. WMCS is one of the most advanced technologies that Sozoluz Clinique offers to patients. It works by re-establishing, stimulating and accelerating the bodyâ&#x20AC;&#x2122;s own healing process in situations where the natural process has been interrupted or halted altogether.

10 Sinaran Drive #08-17/30 Novena Medical Center Singapore 307506 Tel: 6397 2234 www.sozoluzclinique.com

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LEGAL Special

Mental capacity act There is a lot of attention lately in relation to Lasting Power of Attorney (LPA) and the Mental Capacity Act.

The Act was introduced to help people plan for a future loss of capacity, and to protect vulnerable people over the age of 21, who currently are unable to make decisions due to a lack of capacity. A lack of capacity may be due to a learning disability, mental health problem, brain injury, dementia, alcohol or drug misuse, side effects of medical treatment or any other illness or disability caused by accidents or misfortunes of life which prevent them from making daily important decisions relating to their life and welfare. It also allows parents of children with intellectual disabilities who are below the age of 21 years to apply to the Court to appoint a deputy to ensure that their child’s future care is planned if the parents pass away or lose their mental capacity. An LPA is a legal document which allows a person of 21 years and above and who is mentally fit to voluntarily appoint one or more persons to take charge of his affairs. The appointed persons, known as a Deputy, may act and make decisions on the person’s behalf when and if he loses his mental capacity. An LPA can be done by way of completing the Office of the Public Guardian (OPG) Form 1 to appoint one or more persons to manage a person’s personal welfare, property and other affairs. The OPG Form 2 is a detailed form which can be drafted with the assistance of a lawyer to cater to one’s specific needs and requirements. The Forms must be witnessed and certified by an accredited medical practitioner or a lawyer in Singapore.

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There is a significant difference between the LPA and a Will. A Will allows a person to state his wishes in relation to his assets after his death. The LPA allows the management of a person’s affairs during his lifetime when he lacks mental capacity. If a person does not have a LPA and loses his mental capacity, then his family has to appy for a Court order under the Mental Capacity Act. The process of obtaining a Court order under the Mental Capacity Act in the Family Justice Courts in Singapore is a complex procedure which is time-consuming and costly. The OPG has a wide range of supervisory and investigatory powers including imposing criminal sanctions on caregivers and decision makers who ill-treat persons who lack capacity and prohibits decisions from being made on behalf of such persons, for example, consenting to marriage, divorce or adoption or renouncing of religion.

Rajan Chettiar LLC Advocates & Solicitors 112 Robinson Road #05-04 Robinson 112 Singapore 068902 Tel: 6533 6451 www.rajanchettiar.com

LEGAL Special

Understanding the legalities of divorce In these unhappy circumstances, it helps to understand the legal landscape first. Some couples present documents that run into hundreds of pages just to vent their pain, even though at this stage the court is no longer looking for the cause of the divorce. Others make difficult demands that test both memory and patience. Lawyers have had clients whose wives asked for 60 or more documents - such as bank statements and credit card reports - to be produced that date back four years.

Template for affidavits

Family Justice Act The Family Justice Act, passed by Parliament in August 2014, is more family-friendly and aims to help resolve family conflicts in a less adversarial manner, with judges focusing on relevant issues concerning the children, maintenance and division of assets. Lawyers believe it could help lower the chances of divorce being a “grievance-led process in court” and pave the way for both parties to find an amicable compromise, without too much of the proverbial dirty linen being washed in public. The new Act also minimises prolonged husband-wife duels of the domestic kind, especially in exchanging unnecessary embarrassing details in court documents. Ridiculous demands by warring spouses can mire divorce proceedings in angst and anger and cause some cases to drag on for years, says Mrs Aye Cheng Shone, a family lawyer and sole proprietor of law firm A C Shone & Co. She welcomes the new judge-led process of handling divorce cases.

New judge-led approach The new judge-led approach will hopefully cut this unnecessary acrimony in court, she says. For many who have been bruised by divorce, the bitterness can take years to dissipate. Among the trickiest and most time-consuming parts of any divorce hearing is the discussion over what is known in legal parlance as “ancillary matters”, which determine costs, custody, division of assets and maintenance issues.

The new Act will introduce a template for affidavits to be used in divorce cases, to zero in on relevant information only. These templates will ensure irrelevant information is not included. “Sometimes, it is difficult for lawyers to tell clients to cut to the chase as they feel they are denied justice,” says Mrs Shone. “They are far more likely to take the same advice from a judge, especially a judge who has the skills and training to show support and sympathy.”

Singapore divorce laws Under Singapore laws, a couple can divorce if they have been separated for at least three years and both parties agree to end the marriage. For more information in divorce proceedings, this link provides a summary of the procedures for filing for a divorce at the Family Justice Courts: https://app.statecourts.gov.sg/family/page.aspx?pageid=161945

Family Justice Courts For the record, the Family Justice Courts were established pursuant to the Family Justice Act which was passed by Parliament on 4 August 2014. The Family Justice Act was enacted based on the recommendations of the Committee for Family Justice which was formed in 2013 to review how Singapore’s family justice system may be reformed to address the needs of youth and families in distress.

A C SHONE & CO 10 Anson Road, #12-11 International Plaza Singapore 079903 Tel : (65) 6225 4456 Fax : (65) 6225 4457 Email: info@acshone.com

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Hairdreams Special

The mane event Luscious shampoo-ad locks are now possible for everyone, with Hairdreams. While daily hair loss is normal for the most part, many people suffer from thinning hair, alopecia, or excessive hair loss. This can be temporary or permanent. The great news is that even if your hair is fine, sparse or slow-growing, you can actually have a full, beautiful mane. This is no longer an impossible dream. Hairdreams Couture Salon’s unique, patented system from Germany, is available for the first time in Singapore. Featuring a range of unique, patented technologies, new techniques and systems to address thinning hair, balding, and hair loss, and based on more than 30 years of research, Hairdreams’ new generation solutions allow you to lengthen or increase the volume of your hair in just two hours – and that’s a promise. From lost hair to full hair Using high quality real hair which has been carefully selected and treated by Hairdreams, the hair is fused so perfectly with your own hair that it becomes “one” with yours, creating a natural head of shiny, healthy locks that feel and behave just like your own hair on a perfect hair day. The technique ensures beautiful, shiny and healthy hair in any length, volume or preferred colour. Hairdreams has solutions for any hair situation, and its “hair creation” system can help create a fuller head of hair, even in cases of severe hair loss. Skin-safe, you can go swimming or play sports without worrying about your hair going out of shape. Choice of celebrities It is no surprise that Hairdreams is one of the best-kept hair secrets among fashion and beauty insiders around the world, with a client list of models and entertainment celebrities. It has been used in Hollywood blockbusters like Snow White and The Huntsman and Hunger Games, and has been seen on the catwalks of Paris, Milan, New York and Berlin, in hairstyles created to reflect current trends and creations by the world’s most famous designers.

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Hairdreams Couture Salon 51 Cuppage Rd, #01-09, Singapore 229469 Tel 6589 8798 www.hairgrowth.com.sg

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FEATURE

S E L B B I SCR PAPER NA N I K P A N

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FEATURE

Diamonds ar e a girl’s

best friend

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FEATURE

Between bites of a burger

The late Paul Lauterbur is the man widely considere d to be the father of MRI, resonance imaging. Althoug or magnetic h the idea itself was not new , it was Lauterbur who made to create accurate 3-D ima it possible ges of organs and other sof t tissue that could not be see His initial discovery, which n by X-rays. was about how to get spatial information about atoms in field, was, in fact, sketched a magnetic out on a paper napkin wh ile he was having dinner restaurant in Pittsburgh. Alth at a Big Boy ough it didn’t immediately tak e off, his vision that magnetic imaging would someday ma resonance ke it possible to watch the body at work, was wisely with technological breakthro held. Today, ughs, the MRI machine can see a stroke unfolding, infl that indicates multiple scle ammation rosis, narrowing and constri ction of blood vessels that disease…and so much mo presages heart re.

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MIX-MEDIA RECOMMENDS WINDOWS

SPECIFICATION S PECIFICATION Windows Wind Wi nddoow ws 8. 88.1 .1 PPr Pro ro Offi Of ffificce ce Home Hoom me and and Business an Bussiine Bu ness ss 2013 200113 Intel 3.7GHz Inte In t l i7 te ii7-4820 7-4 -482 820 20 33. .77G GHz Hz Asus MainBoard As suuss PP9x79 9x79 9x 79 M aaiinB nBooaard r 8GB 1600MHz DDR3 Ram 8G GB 160 16 600 00MH MHz D DD DR R33 R am am Sata 1TB Sat 1T 1TB Sa attaa 66GB GB G B 664MB 44M M MB B HD HDD HDD Nvidia GeForce N Nv iddia i G eFoorrccee GTX650 eF GTTXX65 650 1GB 1GB Graphic 1G Grrap Gra aphi hc DVD+RW Dual Drive 24xx DV 24 VD D+ +R RW WD uuaal La LLayer y r Dr ye D riv ive HDMI G.Lan 33xUSD 3x US SD 33.0 .0 + 8xU 88xUSB 8x xUS USB 2. 22.0 .00 + HD H DMI MI + G .LLan an Channel Sound 8 Ch C hannne nel Audio AAuudi dio SSo oun u d Microsoft Keyboard Mouse Micr Mi cros cros cr osoof oft KKe eyybbooaarrdd & M ouse ou se 24” (VGA/DVI/HDMI) 24 4” LED LLEED Monitor Monniito Mo tor ((V VGA GA/D DVI VI/H HDMI) DM MI)) Norton Security Nort No ortton IInternet nntteerrne net Se ecuri curirity cu ty ty

S$2,188 S $2,188 w with ith G GST ST Mix-Media Equipment Address: No. 1 Rochor Canal Road #06-72 Sim Lim Square Singapore 188504 Tel: (65) 6337 9205 / (65) 6337 3923 Fax: (65) 6337 5715 www.mixmedia.com.sg

Small Office Home Office

Home & Business 2013

OEM hardware solutions

Made in Norway

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17/12/14 6:30 PM

Make time for winding down. For appreciation â&#x20AC;&#x201C; of beauty, the city at dawn, fine craftsmanship. For the joy of passionate opinions, good health, wealth & personal pursuits. Read on.

AFTER WORK Treats

Bali Beckons

There is yet another reason to visit Bali: to experience Club Med’s Nusa Dua property. Newly-renovated, it’s most enticing offering is its adults-only Zen Pool designed by renowned French architect Marc Hertrich. Built on theatre-style architecture that opens with a grand staircase, guests enjoy spectacular ocean views while they relax on daybeds set in water, four-poster beds and suspended beds under sunshades, all designed by Studio MHNA. Everything here turns on the concept of

A designer cooker to support your creations Whipping up culinary creations for family and friends to rave about is great, but why not take it up a notch with a state-of-the-art cooker designed by a company that dates back to 1882? Bertazzoni from Italy is known for its attention to detail, imaginative details and good looks, and offers a range of three cooker options, namely, Professional, Design and Heritage. Depending on which you choose, there are features that no passionate cook can ignore: super-wide cooktop, six brass burners that include a 5kW burner with a heavy duty cast iron pan support, an electric teppanyaki, multifunction oven with a user-friendly interface that stores up to 33 cooking programmes, and in vivid colours like fiery red, crimson, yellow or minimalist stainless steel.

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harmony. Club Med Bali has been listed as one of the top 10 all-inclusive hotels in Asia and has won the TripAdvisor’s® Travellers Choice Award for consistently great reviews. In 2014, the resort was listed amongst the Top 6 Hotels for Families in Indonesia based on reviews by travellers from around the world. Club Med’s signature GO service, wide selection of activities and Children’s Club were cited.

Not just dry skin We tend to think of dry skin as just that, and use generic products to treat it. But, in fact, there are different types of dry skin, forming a spectrum from dry to very dry to sensitive to atopic, with each type responding differently to environmental factors. Thirty-five year old French company Laboratoire Bioderma has added new products – named Atoderm and Hydrabio – to its range, to specifically address the needs of different kinds of dry skin. With 50 international patents to its name and three research laboratories in France, these skin specialists know what they’re talking about.

Strengthen those bones and joints As we age, we lose bone mass, flexibility and mobility. The statistics reveal that increasing numbers of over50s are suffering from fractures that immobilise them, or make them vulnerable to more fractures. More than ever, we need to ensure we’re consuming the required amounts of calcium, magnesium and Vitamin D, and the other substances we need to tackle these age-related challenges. Envie’s range of bone and joint health supplements in tablet or liquid form are a good option. Backed by research, these products get to the root of the problem.

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AFTER WORK Treats

Airbus A330-200

Garuda Indonesia named as a 5-star airline by Skytrax Airbus A330-200 Business Class

Indonesia’s national carrier Garuda has made it to the list of only seven airlines in the world with this prestigious ranking. A 5-star airline rating represents the highest level of recognition and approval and is only awarded to airlines that deliver exceptional service consistently. Skytrax, the world’s leading airline and airport review specialist, uses a ratings system with more than 800 assessment categories. Among the airline’s recent and coming service offerings are the option of 10 flights between Singapore and Jakarta daily – making it the airline with the most flights on this busy route – and the inclusion of Singapore favourites such as chicken biryani, rojak and ayam panggang (spicy grilled chicken) in Business Class menus.

Chill that wine If you want to enjoy your fine wines at their best in warm and humid Singapore, you need a wine chiller to keep them at optimal temperatures. Kadeka offers a range of chillers to hold between 24 and 168 bottles. They come with three-layered anti-UV glass doors, storage options of up to three independent temperature zones, and sleek design. If you buy a Kadeka wine chiller between now and 31 January 2015, you will receive a three-tier Japanese Bento Basket and an Epachi dining voucher worth up to $120, depending on the model purchased. Helmed by Chef Kishio Watanabe, Epachi is best known for its signature Omakase courses, Izakaya and wide selection of wines, Sake and Shochu.

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Culti The right scents are integral to the feeling of wellbeing. And high-end Italian perfumier Culti, which invented reed diffusers, has designed a range of different ways to surround yourself and awaken your senses with scent. Their newest offerings include three beautifully designed cube-shaped bottles with Art Deco-inspired patterns. Each comes with a choice of three new scents, inspired by sunshine and open spaces, using oils and essences like bergamot, tangerine and sandalwood.

Montblanc’s new China ambassador The world’s “King of Badminton”, Lin Dan, has been named as Montblanc’s China Brand Ambassador. Lin Dan’s pursuit of excellence and drive to push push boundaries are shared by luxury maison, Montblanc, which also strives to exceed expectations and achieve value that transcends time. More than an undefeated badminton champion, Lin Dan has also won several Olympic and World Badminton Championships and completed the “Super Grand Slam” twice, becoming the first and only player to achieve this feat.

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i-Bridge design Special

Your

Dream

Home

i-Bridge Design helps transform your vision of a perfect home or office into a reality.

THERESA VILLE An Art that Inspires The interior composition of a home serves as a canvas for one’s individuality and personal take on space to be showcased.

Dreaming of a home designed in an English cottage-style or like a Balinese resort? Or maybe an eco-theme that captures your commitment to doing your part for the environment, or a retro-chic theme to showcase your collection of vinyls and early Singapore memorabilia? You have your vision clear but don’t know where to begin. An interior design professional like i-Bridge Design could be the answer. Besides working with you to select the most appropriate fittings and furnishings, their trained eyes can also handle practical problems like awkward corners and unsightly pillars. i-Bridge, after all, specialises in transforming empty rooms into vibrant spaces to live and work. The process begins by getting to understand the client’s needs and desires, and their personal aesthetic preferences. i-Bridge Design believes that the first meeting with the client is the most important. But before that takes place, the client needs to communicate their design preferences, specific requirements and budget – all this goes

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into a form provided by i-Bridge. Then comes a discussion, before the client gets to see examples of i-Bridge’s work, as presented in the company’s showflat. Here’s also where the client gets to see examples of i-Bridge’s workmanship and design ideas, and this goes a long way toward helping them visualise their own final result. By the time the i-Bridge team meets the client for the second time, the client is presented with a layout proposal and a draft quotation. Clients also have the option of getting 3D artist impressions created before making up their minds on whether to engage the company for the project. i-Bridge Design has worked on HDB, condominium, landed and commercial projects of all sizes and budgets. Among its residential projects is a home at Jalan Mutiara Latitude Condominium, where its designers created a music-themed room for the musician son of

5 questions to ask your ID 1) Warranty – what is the warranty period given for the design and renovation of the property? 2) Overall renovation cost – how much would the total renovation of the house or commercial space cost? 3) Renovation timeline – how long will it take to complete the renovation and a breakdown of the different phases of the renovation. 4) Materials and cost – what kind of materials will be used, are they available locally or will they have to be shipped in, and how much will they cost? 5) Best offer/discount – what is the company’s best price, the different packages available and how much of a discount can they offer.

MIMOSA DRIVE Grand Ambitions - Luxury and Glamour The home begins outside, with a water feature to draw in more prosperity for the head of the house.

LATITUDE CONDO Sense of Style - Imbued with Character Clearly a fan of guitars, the occupant of this room has his collection displayed on a fixture with custom-built carpentry and special hooks.

a Taiwanese client. At Theresa Ville condominium, they converted a bedroom into a gallery to house the family’s collection of figurines and ornaments. Another project was a landed property at Mimosa Drive which was decorated in an elegant style suitable for entertaining the owner’s clients. Some of the commercial projects it has worked on include a candy shop, a shop selling skincare products, a restaurant and a fashion boutique. i-Bridge Design’s exquisite eye for detail combined with its ability to understand its clients’ vision and needs sets it apart from other interior design firms. In tune with with the latest trends and working with well-reputed renovation contractors, i-Bridge can make your dream home a reality. Your house is your castle, your private sanctuary. A professional can help turn it into a home you will be proud of and want to spend time in. And when it comes to retail spaces, a welcoming interior goes a long way towards attracting customers, and the right interior designer will ensure that it is inviting and stands out from its competitors.

i-Bridge Design Pte Ltd 144 Rangoon Road, Singapore 218421 Tel: 6255 5909 | Fax: 6255 5101 www.i-bridgedesign.com

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FEATURE

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Dawn in the

City

Most of us are still oblivious when dawn arrives in Singapore, still in slumber or clinging on to just a few minutes more of restful bliss. But those who venture out before – and just as – the sun’s coming up get to experience a different view of the city. At that time of the day, it’s a quieter, gentler place. A place of soft light, changing skies, cool air, birdsong and unexpected sights. Geri Kan, a dedicated runner, shares her best iPhone images of dawn captured in the east and centre of the city.

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FEATURE

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Familiar landmarks seen in a different light. An almost moody palette in many shades of rich grey and blue, mirror-like surfaces moved by current and motion, a pathway less-trodden, clouds illuminated and clouds darkened by the early sun and imminent rain. The little details lost or not noticed in the bright sunshine of a typical Singapore day.

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FEATURE

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Early morning is when the earthâ&#x20AC;&#x2122;s energies are at their most positive, and the air is clear, crisp and cool. Here along the East coast, these hours draw solitude seekers, walkers, companions. Itâ&#x20AC;&#x2122;s for quiet contemplation, focus and appreciation, and to experience the changing hues of the sky as the sun rises and a new day begins.

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M+S Development Special

Luxury residences in the heart of Singapore’s Marina Bay financial district. Artist Impression

Welcome to the Marina Bay district, which has quickly emerged as Singapore’s most prestigious residential and business address with a unique 24/7 buzz. And no wonder. It is set in a neighbourhood that boasts the country’s most iconic and game-changing developments, from the striking Marina Bay Sands and the lush and futuristic Gardens by the Bay, to the pulsing Esplanade Theaters on the Bay and the wondrous ArtScience Museum. Also calling this district home are the annual Formula 1 Singapore Grand Prix, the International Cruise Centre, the Singapore Flyer and the Marina Bay Golf Course. At the centre of it all is Marina One, one of two landmark projects under a historic collaboration between Malaysia’s strategic investment fund, Khazanah, and Singapore’s investment company, Temasek. This impeccable pedigree is combined with an impressive design concept that was unveiled in 2013 by the Prime Ministers of both countries. Marina One is a 3.67 million sq. ft., award-winning, premier integrated development located at the heart of the prestigious Marina Bay financial district. It will be the newest and largest integrated development to be completed in the coming years in the vibrant Marina Bay financial district which is home to many MNCs, including DBS, Google, Allianz, Swiss Re, Citi and Standard Chartered Bank. Consisting of luxury residences, prime Grade-A office space and unique retail offerings, it is the most connected development in the city, with four out of Singapore’s six MRT lines accessible via a series of underground pedestrian networks. It offers truly integrated living and working options in the vibrant Marina Bay district. Surrounded by two lush green parks – the Marina Station Square

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and Central Linear Park – together with Marina One’s own 65,000 sq. ft. Green Heart, Marina One offers the rare opportunity for park-like luxury living, working and unique retail offerings reminiscent of prized real estate developments around London’s Hyde Park and New York’s Central Park. Marina One is at the cusp of the Urban Redevelopment Authority’s (URA) 2014 Masterplan for the Central area which includes the planned transformation of the city towards Marina South and the Greater Southern Waterfront. This will further accentutate Marina One’s intrinsic values, ensuring long-term capital appreciation and significant growth as the city further expands to create a new Waterfront City. The development offers a potential upside in the context of the way prices of The Sail have more than trebled in value since it was launched in the Marina Bay area. Apart from Marina One, there is no known new supply in the Marina Bay area.

Sustainable and Supergreen Marina One Residences is spread across two 34-storey towers, with configurations ranging from 1- to 4-bedroom units and luxurious penthouses. Offering different panoramic views, of the city skyline, the expansive sea or the magical Gardens by the Bay. All units are fitted with the best names in home furnishing – such as Miele, Poggenpohl and Villeroy & Boch – and complemented by full facilities, including a 50m lap pool, a 200sqm gym, concierge and clubhouse lounges. But what sets the Marina One project apart, besides its choice locale, is its architecture, created by world leader in sustainable Supergreen architecture, Christoph Ingenhoven.

Your space in the city awaits • A 3.67 million sq.ft integrated development with luxurious residences, unique retail offerings and prime Grade A offices. • Connected to 4 MRT lines (North-South, Circle, Downtown and upcoming Thomson) • 34-storey Residential Tower comprising 1, 2,3,4-Bedroom & Penthouses • 65,000 sq ft of lush greenery within the development With striking features such as louvres which help create a comfortable environment for users, and multiple stepped gardens, which create the largest green urban sanctuary within the CBD. Within the project’s park-like landscape, designed by Gustafson Porter and ICN Design International, is a spectacular biodiversity garden inspired by the diversity of flora found at different altitudes in the tropics, together with a stunning 13-meter high waterfall as its main feature. A retail podium called The Heart will offer a variety of unique lifestyle and dining outlets including a fitness club, a supermarket, a food court and F&B outlets. The Pulse is a double-storey event space with public terraces, water features and gardens to provide entertainment to residents and visitors; and The Oasis features two signature restaurants with mist pools nestled in a garden terrace on the fourth level.

Bay, ArtScience Museum and the Singapore Flyer, as well as green urban parks, the magical Gardens by the Bay and a breezy waterfront.

Rave reviews As of 3 November 2014, more than 83% of Marina One Residences’ released units of Park Tower (Tower 21) have been sold, with prices ranging from S$1,965 to S$2,760 psf. Not surprisingly, buyers are impressed with the vibrant location, the quality and scale of Marina One’s integrated concept, and its seamless connectivity. The lifestyle offerings add special appeal for potential investors and buyers purchasing for owner-occupation. Marina One, benchmarked against the best integrated development projects in the world, promises enduring value and long-term investment potential.

• Panoramic views of city skyline, sea and Gardens by the Bay • Brought to you by the developer of the overwhelmingly successful DUO Residences, M+S – a historic collaboration between Khazanah and Temasek

Visit the Marina One Show Gallery off Central Boulevard Call 6327 1011 for enquiries Visit www.marinaone.com.sg

Luxurious Residences Premier Marina One Residences offers premier luxury living at the heart of the city’s new financial district and is mere minutes away from the existing CBD at Raffles Place. When completed in Q3 of 2018, Marina One Residences will be an appealing choice for local and foreign investors looking to rent or stay in this glamorous neighbourhood. The all-important connectivity is unsurpassed with access to four MRT lines (North-South, Circle, Downtown and the upcoming Thomson) and links to MRT stations at Marina Bay Interchange Station, Downtown and the upcoming Shenton Way Station, opening in 2021. In addition, Marina One is located just off major expressways providing access to the rest of the island, Changi Airport and beyond. Surrounding the development are spectacular coastal and bay views peppered with established icons such as Marina Bay Sands, Esplanade Theatres on the

Artist Impression

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FEATURE

Money to make Money

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As the number of high net worth individuals (HNWI) shoots skyward, private banking has seen a parallel rise. Who is this animal called the HNWI, how does private banking work and what are the investment options most favoured? Chin B Ho answers these questions and more.

Once upon a time they were a difficult breed to detect. Not anymore. These days, if you were to randomly approach any adult passerby in Singapore’s financial district, the odds are very good – 1 in 40 – that you could be hitting someone in the category of Singapore’s Super Rich. If you were to include everyone else below the age of 21, the odds drop to 1 in 50. With odds far better than those for striking a prize in the thrice-weekly 4D lottery, it comes as no big surprise that Singapore’s Super Rich now number at least 105,000. But who are they? “There are no hard figures on the composition of the [105,000] millionaires. It is probably not illogical to surmise that many of your millionaires next door could be investment bankers, doctors or lawyers. The remaining ones are probably entrepreneurs and investors,” wrote PwC tax experts Abhijit Ghosh and Leng Harn Szuan in an article published in TODAY in 2014. According to the Asia-Pacific Wealth Report 2014, these stay-inSingapore HNWIs are worth a combined US$523 billion (about S$668 billion). That’s 1.8 times the size of the country’s yearly GDP. Viewed from yet another eye-popping vantage point, the Average Mr or Ms Super Rich in Singapore is easily worth a cool US$4,981,000 (approx. S$6,360,200). Consequently, many of these “millionaires-next-door” (each worth US$1 million to US$5 million, strictly defined in terms of investible assets excluding principal residence, collectibles, consumables and consumer durables) are set to join Singapore’s “Mid-Tier Millionaires” Club (each worth US$5 million to US$30 million) soon.

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FEATURE

And finally, there are the UHNWIs, known in full as Ultra High Net Worth Individuals. These are the financially accomplished individuals in our midst with at least US$30 million in investible loose change. So how do Singapore’s Super Rich constantly and ceaselessly create money, keep track of it, re-invest it and make yet more? With plenty of tailor-made help from a coterie of sidekicks, better known as private bankers, or bankers who provide customer service of a more personalised form than is done in mass market retail banking. Private bankers are dedicated to managing the personal finances of wealthy individuals and their families. What they do is called private banking, which is how banking – and the first banks in Venice – actually originated centuries ago. Private banking in Singapore comprises banking, investment and more. Until recently, it provided a convenient run-of-the-mill one-stop hub for banking services (deposit taking and payments), discretionary asset management, brokerage, limited tax advisory services and even some basic concierge-type services. All are offered by a single designated relationship manager. Typically, a Singapore-based private banker would help a wealthy individual set up a family office to address issues such as adequate governance, reporting and education. However, unlike their counterparts in the US and Europe, private bankers here usually do not need to advise taxable investors in terms of long-range estate planning decisions.

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This is because “under Singapore’s current income tax regime, investment income, be it dividend or interest, is largely tax exempt. Income from overseas is also tax free when received in Singapore by individuals,” noted PwC’s Ghosh and Leng. “Further, Singapore has no capital gains tax regime. A savvy investor or an enterprising entrepreneur could, in Buffett’s words, make money with money, without paying any income tax.” Naturally, inter-bank competition is keen, and lead generation is a vital part of Singapore’s private banking environment. Banks go about acquiring new clients in different ways. Some rely heavily on referrals from within the group’s wholesale, retail and corporate banking divisions, while others believe that the primary source of leads must be from client referrals. By and large, however, most of our Super Rich place a premium on privacy, understandably so, in a nowhere-to-hide city such as Singapore.

How they make it Having made their first pile of money the hard way – that is, having selfcreated their original wealth as sleep-deprived entrepreneurs – many now wish to re-invest this wealth, either to preserve it for posterity, or to give it back to society by way of philanthropy. In reality, though, 39.3% of Singapore HNWIs demonstrate a stronger focus on wealth growth than wealth preservation (18.7%).

According to the Asia-Pacific Wealth Report 2014, real estate investments are still their first choice. On average, Singapore’s HNWIs allocated the balance of their portfolio to real estate (22.8%), equities (14.4%), fixed income (12.5%), and alternative investments (14.4%), with most (19.9%) of the alternative investments being in structured products. They also favoured cash and cash equivalents over all other investments (27.1%). A 2013 survey by Barclays Bank conducted with 2,000 respondents worldwide – among them 100 based in Singapore – revealed that nearly a quarter of those interviewed in Singapore seriously contemplated moving to a different country over the next five years. That said, Singapore – with its status as a safe haven to park wealth – remains the abode of choice for the vast majority. In fact, in recent years, Singapore has quietly attracted a steady inflow of assets once held by foreigners in Swiss banks, who have become wary of new taxes imposed on Swiss accounts and a perceived weakening of Swiss bank secrecy. On the flip side, while it is true that tax evasion is illegal in Singapore, an Organisation for Economic Co-operation and Development (OECD) official pointed out that Singaporean authorities tend to cooperate with other countries’ tax authorities only when evasion of Singaporean taxes is involved. Today, thanks to Singapore’s decidedly pro-wealth policies, it takes a successful Singaporean at most 10 years to become a self-made millionaire – the fastest rate anywhere in the world. And here’s how the money is made: 72% of the wealth of Singapore’s HNWI was made from personal investments, followed by 58% from property and 55% from savings through employment income. Significantly, a quarter of the Singaporeans polled by Barclays said their personal wealth had jumped five-fold or more over their lifetime. Against this backdrop, the many private bankers in the financial district are certainly being kept busy, thinking up endless new and innovative ways to woo and win clients who will, in turn, make them a lot of money.

Who are the ultra rich? Seated at the very top of this wealth pyramid are the UHNWIs who hail from Singapore’s very own Top 50 richest people or families. Now at No. 50 on this list is Primus Cheng, head of food conglomerate Prima Group, with an estimated wealth of US$450 million. At the very top of the list are dynamic duo Robert and Philip Ng, sons of the late Ng Teng Fong, a legendary property tycoon, who are worth a combined US$12.8 billion. Other Singapore notables include Kwek Leng Beng and his family (worth US$7.8 billion), the family of the late hotelier Khoo Teck Puat (now fronted by his filmmaker son Eric Khoo; worth US$7 billion), and top banker Wee Cho Yaw (worth US$6.2 billion). There are, of course, highly-visible targets who are much sought after by private bankers. These include: – Facebook co-founder Eduardo Saverin (a transplant from the US, at No. 6 with US$4.2 billion); – Celebrity fishmonger’s-son-turned-football-club-owner Peter Lim (at No. 9 with US$2.5 billion); and – Fujian-born food tycoon “popiah king” Sam Goi (at No. 13 with US$2.05 billion)

How they spend it Forget about hitching a ride in a Rolls-Royce. While UHNWIs elsewhere may have, on average, “eight cars and three or four homes”, and while three-quarters worldwide also own a private jet and a yacht, Singapore’s are, in comparison, a rather frugal lot. They prefer to put away as much as 61% of their hard-earned cash for saving and investing, second in parsimony only to their Chinese counterparts in Hong Kong at 66%. Travel and social activities come in at second place (16%). Only 7% said they would contemplate splurging on cars, jewellery or collectibles, while 13% here still prefer to pass their assets on to the next generation. Deep down, what more than half of them really want is to find meaningful ways to give their wealth away to charity, and in their lifetime.

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AFTER WORK Time

The Jaquet Droz Grande Seconde in 18-carat gold with Ivory Grand Feu enamel dial has been a bestseller and is one of the brandâ&#x20AC;&#x2122;s flagship models. Legend has it that an 18th century Chinese emperor who loved the brand inspired the trademark off-centre hours and minutes dial and the large seconds sub-dial, which together form the auspicious shape of a number eight.

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Hereâ&#x20AC;&#x2122;s a toast to some classics, as we bring in the new year.

Photography Ching | Styling Ong Weisheng

Like the best music, these timepieces have stood the test of time, and are sought after for various reasons, such as clean, uncluttered faces that can be read at a glance, perpetual calendar and moon phase indicators, which conjure up the romance of the moon and her intriguing effects on the tides and on our moods. Whatever the reasons, they tell a story of an appreciation for value and beauty that remains forever; not a slave to the vagaries of fashion and fads.

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AFTER WORK Time

Like all the officerâ&#x20AC;&#x2122;s watches crafted in Geneva, the Patek Philippe Calatrava 5153 features a silvery opaline, hand-guilloched sunburst pattern in the centre. Small gilt minute pearls encircle the periphery of the dial and the hour markers are faceted and arrow-shaped while the slender seconds hand extends to the fringe of the dial.

Quartz or mechanical? Quartz This is battery operated, and is the most accurate in terms of telling the time. The user has to wind the watch manually with the crown. The watch can stay wound from anywhere between 42 hours and 50 days. Automatic This has a rotor attached to the mainspring that winds it whenever there is movement. To keep running even when itâ&#x20AC;&#x2122;s not in use, it must be placed in a watch winder.

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The Hublot Classic Fusion King Gold features the brandâ&#x20AC;&#x2122;s exclusive 18-carat gold alloy that is redder than traditional red gold, with a composition that is classified as top secret. Bare bones simplicity at its best; Bearing the iconic off-centred non-overlapping dial, the LANGE 1 in yellow gold features the characteristic outsized-date display. Simplicity at its best.

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AFTER WORK Time

The Montblanc MeisterstĂźck Heritage Moonphase manifests the timeless values of the company. Pure elegance, with its bombĂŠ dial with sunburst finish, faceted hands in the classical dauphine shape, a mix of polished and satin surface finishes and a timeless interpretation of the moon phase and date; From Ulysse Nardin, a company founded in 1846, comes the Classico Automatic in 18-carat rose gold. With traditional hour, minute and second hands and a date set at 3 oâ&#x20AC;&#x2122;clock, this is chronometer certified. This means it has been stringently lab-tested for its COSC certification which is printed on its dial.

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Movements, in-house, ebauche and calibre A movement The completed, finished individual mechanism that is contained inside the case of the watch. It is responsible for keeping time, and does not include the case or dial.

Encircled in 66 diamonds, the IWC Portofino Midsize comes in 18-carat red gold and a dial in the lovely ardoise colour, which resembles rich slate. Simplicity uplifted with diamonds.

In-house This terms means that the entire movement of the watch is made by the watch brand itself, with no outsourcing of parts. Ebauche This means that some parts of the movements could have been done inhouse while the remaining parts are from component suppliers. An ebauche is typically understood to mean a â&#x20AC;&#x153;rawâ&#x20AC;? or unassembled, unfinished movement, including the major structural components and sometimes parts of the wheel train and other moving parts. Calibre This is the collective name given to a series of movements of the same design.

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AFTER WORK Time

Audemars Piguetâ&#x20AC;&#x2122;s Millenary collection comes in a unique oval shape, which instantly makes it a classic. This one, in pink gold with anthracite and silvertoned dial, with its intricate hand-finished inner workings, is reminiscent of early timepieces with a modern design aesthetic.

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With its off-centre hour, minute and second hands, the GlashĂźtte Original Panograph in rose gold has many elements on its dial yet retains a clean simplicity that spells classic. It includes a 30-minute chronograph counter and its big date display which is synonymous with the brand.

Timepiece Trivia Power reserve indicator Appreciated in a manual wound watch as it lets the user know when they need to wind the watch. Chronograph One of the most complicated and expensive features, yet not used by most watch owners. Perpetual calendar A highly complicated and expensive but useful function which takes into account the days per month and leap years. Moonphase A classic but also not very useful complication, itâ&#x20AC;&#x2122;s the only complication of a watch that incorporates graphics to let the user know the phases of the moon. Date indicator A useful but not always necessary complication.

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Blue Duna Black Caviar Special

A taste of

black pearls From the pristine waters of Hungary comes Singapore’s own brand of black caviar, the gourmet delicacy once reserved for royalty. You can now savour the exquisite taste of top quality sturgeon caviar to your heart’s content. Blue Duna, an importer of fine European delicacies and premium products, has launched its Singapore Edition caviar that is directly sourced from Hungary. This black caviar is glistening pearls of gastronomical luxury, harvested from sturgeon bred in mineral-rich geothermal waters. The well-sized orbs are characterised by a delicate texture on the tongue and a smooth, natural taste – discernible from the more common freshwater farm variety. If you need even more reasons to start indulging, we’ve got a few winsome ones.

Delish and nutritious Top quality black caviar is a delicacy of bright, shiny fish eggs harvested from sturgeon roe, and renowned for its buttery texture and lusciously briny taste – always reminiscent of the sea, but never stale or fishy. Rich both in flavour and nutrients, caviar is very good for you as it contains copious amounts of vitamins and minerals: • • • • •

Vitamin A – a strong antioxidant Potassium – which lowers blood pressure and improves mental capacity Omega-3 Fatty Acids – one of the best oils for reducing risks of stroke and heart attack Vitamin D – essential for the body to absorb minerals like calcium Haemoglobin – the component of red blood cells responsible for transporting oxygen

Caviar is also considered a powerful aphrodisiac, and used to be served at Emperors’ dining tables in ancient Asia. Used in cosmetics, it is also good for skin and hair and post-surgery recovery.

Caviar care

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Caviar is a gourmet food like wine and truffles, and comes with specific handling instructions. Adhering to these basic rules will help bring out the best of the caviar’s flavour and freshness. Here are some useful points to note: • Serving spoon – fish eggs are delicate and should not be handled with metal spoons, so experts suggest using alternative materials like mother-of-pearl, tortoise shell, silver or gold. • Serving technique – when spooning caviar, it should be lifted vertically rather than horizontally, as this will avoid damaging the individual eggs. • Settling the flavour - caviar should be removed from the fridge 10 to 15 minutes before serving, and opened just prior to consumption. For those who have acquired a taste for sturgeon roe, there are few delights greater than the taste of gently chilled caviar as a canapé, traditionally prepared by mixing a dollop of the delicacy with sour cream, minced onion, capers and chopped hard-boiled egg. A squeeze of lemon juice completes the magic, and the mixture is served spooned onto bitesized pancakes for easy partaking. But of course, the most popular and easy way to enjoy caviar is to take a small amount of it in a mother-of-pearl spoon, put it in your mouth along with some good champagne. You will taste and feel all the colourful notes of caviar, the Queen of the table!

IT’S MY PARTY

Stunning precious stones to lift your heart When it comes to rich colour and depth of clarity, nothing beats precious stones. So it was no surprise that the exclusive Larry Jewelry Appreciation Workshop was well-attended. It was a wonderful opportunity for guests to view Larry Jewelry’s latest 60’s inspired Neo Collection up close, with its beautiful combinations of diamonds, sapphires, rubies and other precious stones. Guests also got to discover more about the stunning Lazare Diamonds, pick up tips from an expert on choosing jewellery best suited to one’s style and personality, and enjoy exclusive discounts. It was held at the elegant Larry Jewelry boutique at Paragon Singapore, the perfect setting in which to savour beauty. The event, held on 12 December 2014, was co-organised by THIS QUARTERLY, in collaboration with Larry Jewelry.

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LIFE’S BIG QUESTIONS

Maker of Dr Tan Wee Kiat, CEO of Gardens by the Bay and Advisor to National Parks Board, has always been a nature lover, and turned his personal passion into a career devoted to protecting Singapore’s parklands and bringing to Singaporeans the stunning Gardens by the Bay. By Audrey Perera

Who are you? My childhood experiences have played a big role in who I am today. I was blessed in being able to enjoy the environment that I grew up in. It was a Singapore that was more rural, with more pockets of nature, without the distractions of electronic entertainment. We got our fun from the plants, animals, insects, birds and fish that were around us, and it kept us in touch with the natural environment. That, to me, was comfort. Seeing Singapore become more and more urbanised and losing some of its connection with the natural environment is what led me to this field. I was able to study overseas to become a botanist and then an orchidologist. My parents were passionate collectors and creators of orchid hybrids. My mum even had her own lab in the kitchen using her pressure cooker. I watched and learnt and grew to love orchids. My first job when I returned from studies was to rejuvenate the Singapore Botanic Gardens, one of the world’s top tropical botanical institutions. Then came the job of ensuring the protection of Bukit Timah Nature Reserve and then the upgrading of Marina South to the new Gardens by the Bay. I remember using a pencil to draw out the outline of where this new garden should be and what size; not being too ambitious, and proposing to make it the same size as the then Singapore Botanic Gardens, about 54 hectares. In Cantonese, 54 sounds like ‘emm sei’, never die! At the time, the plan was that the waterfront should remain as a public space rather than being privatised. What a shame it would be if Singaporeans don’t feel that they’re living on an island. So now we have these gardens where people can come to the water’s edge and feel the soft breezes. We wanted two glass houses that would have full daylight, without shadows cast on them. With a broad waterfront, the glass houses would have maximum exposure and daylight. The glass houses were created as envelopes of cool Mediterranean and Tropical Montane climate, between 23 to 25 degrees. That’s enough to give year-round flowering because the plants think it’s spring time and keep blooming. Singaporeans told us that they want flowers and colour, so that was the underlying motivation, to develop a garden full of flowers and colour – and it’s delighting a lot of people.

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We wanted vertical gardens, and had to convince the world’s top landscapers and architects to develop the best masterplan they could. The winning one was tweaked to work for Singapore. I had to fight like crazy to keep the Supertrees. We are on reclaimed land, and we will never in a thousand years have forest giants the size of regular forest trees. We needed instant height and scale, but we had them clad with living vegetation and simulating the role of a tree. Each gathers water at the top and transports nutrients and water up and down, and it supports life. They capture sunlight and convert that into living energy. If you work within the confines of convention, you are restricted in what you are allowed to do. To develop the kind of garden that I envisioned, you need the freedom of an artist. Gardens by the Bay is a theme park where horticulture is the theme, and the key players are the plants, used in such a way that the animals also like it. That’s why we have birds breeding and wildlife coming. The gardens took four years, but need to stabilise, grow and mature. Now it’s about seeing whether we’ve planted them in the right places, how well they’re growing, and how we can tweak what we’ve done. This requires an alchemy of art, science, and obsession with the natural environment.

What is your life’s purpose? I love plants, I love beauty, I love to be able to create beauty using plants, so my life’s purpose is to share my joy in the living environments, plants, animals, flowers. If I do my job well, people will enjoy parks and gardens in this rapidly urbanising environment.These are places where you interact with your family, friends and members of your community, where people gather because social barriers don’t matter. Here is where the social fabric is best woven and mended. I hope that the Gardens inspire people to make the time to understand and respect plants. To understand that to grow a plant properly, you need to know its needs; you don’t just add water and stop there. You’re dealing with a living entity. A plant is a result of millions of years of evolution – just as humans are – and we have to respect that.

How do you know that you’re making a difference? When I see people coming to the gardens and enjoying them, particularly kids going around looking at the flowers, taking photos with their phones and being able to touch. The grown-ups don’t see these things, but their kids see something they want to capture. And witnessing the thrill of those who see the otters running around, they’re actually seeing wildlife. I remember all the critics saying that we were creating such a man-made artificial environment, but the animals disagree. Birds are breeding here, and the number of species of kingfishers, for example, in any one spot, is amazing. We’ve had so many batches of kingfisher babies being raised in plants that they have never been exposed to before. For example, the bottle tree has a belly button in which there is a hole where the kingfisher made a nest. Things like that are just amazing.

Do you think the gardens are influencing Singaporeans?

to do r nature nd fo e c a ya g sp creatin can enjo ind We are people m t e a r th o t o ,s ay its thing m it. It’s a w eatures of o r fr c benefit we are nnect es that st reco ourselv , that we mu ds to have ee th the ear e. Everybody n es. People r liv tu a ir n e h h wit trees y in t jo d n s and a n y e t d u r a a e g b s, ant to er park e s ” b u t I w consid v their e to ha ’s something it as “nic t a hem th show t d. ee n souls

It makes me happy that there are people making room for the blue and green programme. For example, at Jurong Lake district, there are developments based on the realisation that this precious pocket of water and greenery is surrounded by industrial areas and must be treasured. Singapore is gaining a reputation for creating and managing urban nature. Urbanising natural environments, so to speak, by creating urban forests, gardens and parks, which are the most difficult environment possible. We are creating space for nature to do its thing, so that people can enjoy and benefit from it. It’s a way to remind ourselves that we are creatures of the earth, that we must reconnect with nature. Everybody needs to have beauty and joy in their lives. People consider parks, gardens and trees as “nice to haves” but I want to show them that it’s something their souls need.

What do you want to be known for? I want my creations to be known. The key thing is to create something and to have it sustained. I can’t do all these things by myself, and I work with wonderful people who have those skills. I will not live to see the Gardens in their full glory – how long does it take for a tree to grow? A garden can be forever, and that’s the beauty of it, it keeps getting better – just look at the Singapore Botanic Gardens today.

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MOSAIC

Crown shyness Ponder this wonder of nature. The kapur tree is one of the tallest trees in the Malaysian rainforest, frequently growing to heights of more than 60m. Natural breaks between the canopy of each tree allow essential sunlight, water and warmth to come through, to nourish them and other shorter plants and shrubs. Botanists have deduced that the trees have an inbuilt survival mechanism that prevents them from merging into a single large canopy, as that would shut out what they need to survive. The breaks also serve as a barrier to animal movement and as a vent for the exchange of heat and gas. The result is a dramatic mosaic-like formation that looks almost unreal. Deep in the forest, this natural phenomenon â&#x20AC;&#x201C; called crown shyness because it brings to mind tree crowns which are too shy to connect with others â&#x20AC;&#x201C; makes a poignant statement for all life and survival.

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