This Quarterly Magazine - Oct -Dec 2014

Dr Tan Soo Heong

the secret life of hands Toast to tourbillon heart of the watch Australia by

luxury train Eye on an

Overseas Property?

ISSN 2010-1597

OCT - DEC 2014 S$10.00

113

113

Editor’s Note

I

t’s been said that April is the cruellest month, but really, if I had to pick a cruel month, it would be October. Most of this once-new year has raced by, with barely two months to complete dreamed-of plans and projects and commitments made at the start of 2014. Either that, or end up dragging them along with you into the new year, feeling guilty and regretful!

Truth be told, though, this can also be the best time to reflect, think big picture, ask yourself the right questions, and appreciate the things that seem small but aren’t. Life is made up of so many of these... big and small moments, conversations, advice given and taken, meals, decisions, travelling, making things, ideas, healing, new things to learn. This issue of THIS QUARTERLY represents an attempt to capture some of those. Ride a luxury train through Australia’s vast lands, take a walk around the Maxwell Road neighbourhood to look for – and notice! – design details. Celebrate four Singapore chefs and their quick thinking in the face of reputation-ruining calamity. Raise a toast to tourbillon, the multilayered heart of the very best timepieces. Read about the trend of buying overseas properties – what’s driving it, and what are the most popular cities.

As the quest for good health intensifies everywhere, THIS QUARTERLY remains your source of the timely health and wellness information that you seek, presented simply, clearly and backed by current know-how. Specialist Opinions features more than 25 experts presenting a wide range of topics based on the latest research, while in Health Dossier, eight specialists provide insights on types of health challenges typically faced by children. Wellness & Health Update presents tips, facts and new findings presented in small bite-sized portions.

We hope you enjoy this issue!

Audrey Perera Editorial Director

Find us on facebook www.facebook.com/thisquarterly

6

Editor’s Note

Hand Surgeon Dr Tan Soo Heong is the subject of this issue’s Cover Story. Single-minded in his focus on his work of healing hands that have been hurt or disabled, he talks about Zen-like states and master craftsmen.

CONTENTS October - December 2014

33 Patek Philippe 175th Anniversary Special

24 Dr Tan Soo Heong

14

READERS’ LETTERS Feedback from THIS QUARTERLY readers, and a chance to win a special prize.

16

WELLNESS & HEALTH UPDATE The latest news, trends, updates and findings to keep you abreast.

COVER: DR TAN SOO HEONG Photography: CJ Sameer Wadhwa Styling: Phoebe Pong Bow tie by Fefe and jacket (top left)

by Bertoni, both from Robinsons

8

24

COVER STORY Zen & the art of hand surgery Dr Tan Soo Heong talks about his passion for hands and making possible the impossible.

44

HEALTH DOSSIER Kids’ health alert Spotlight on health challenges which children are more vulnerable to.

57

FEATURE Gastronomic gaffes Four chefs, four kitchen disasters, four quickthinking-quick-acting responses!

67

SPECIALIST OPINIONS From lupus, myopia and hearing loss to fertility, cardiac health and hernia, here’s your guide to uncomplicated health management.

57 Gastronomic gaffes

62 When tradition meets cutting edge

CONTENTS October - December 2014

140 Luxury unfolding

118 FEATURE Loving those overseas properties!

As prices in Singapore soar, more Singaporeans have been buying properties overseas. Which are the most popular cities and why?

146 TIME Toast to tourbillon Designed to counter the effects of gravity and beautiful in themselves, the tourbillion enjoys a unique position in the horological universe.

125 FEATURE Design trail Take a walk around one Singapore neighbhourhood to discover a cool old-new design sensibility.

154 IT’S MY PARTY! Properties to dine over

131 AFTER WORK 132 TREATS Lifestyle products, indulgences and toys for your after work enjoyment.

140 TRAVEL Luxury unfolding Take a cross-country train ride in one of Australia’s famous luxury trains for an uncommon experience.

156 LIFE’S BIG QUESTIONS Redefining success Grace Sai is Co-Founder of The Hub, the successful space for enterprise that goes beyond profit. From government leaders to corporate titans, the message is catching on.

125 Design trail

160 MOSAIC A thought, an image, a project that leaves you with a lingering thought.

132 Heritage made new

10

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: Ching, Ahmad Iskandar, Desiree Koh, Fiona Lim, Lye Kim Sheong, Sunuja Naidu, Callison Neo, Ong Weisheng, Phoebe Pong, Antoinette Tan, Sheralyn Tay, CJ Sameer Wadhwa Client Relationship Manager Jessie Kek Client Relationship Executive Leung Kit Ying

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.

12

Readers’ Letters

Winn Lettering

Your July issue is beautiful, well laid out and a joy to the eye. Congratulations to your team for having the gift of discussing intimidating medical topics [and turning them] into well-written articles containing sound, practical advice. It seems I can always identify experiences in my own family with those conditions your specialists describe.

Your articles help us realise that our problems are typical, and we can solve them in constructive ways. I look forward to the next issue. – Linda Wong

r Email you @ victoria letters to rly.sg thisquarte ld ou and you c e ll-inclusiv

Na win a 4D3 t Club Med stay a ting Chera

14

A one of a kind magazine that breathes journal of great literature writing on health, travel and food/ dining for professionals.

My first read was at MPH store. I bought an issue and subscribed to it on Facebook. It feeds me with current sagacious living with style, which makes it outstanding compared to other magazines in the local market.

– Joleen Ng

I read THIS Quarterly.

The coverage of the medical topics by the magazine is wellbalanced for men, women, the young and the elderly. For anyone who is seeking medical advice or information, the magazine is a complete read!

– Susan Leong

I love your magazine because it is very up to date and talks about articles I am extremely interested to know about.

– Cecilia Chng

9-131 Larry Jewelry.ai

1

Sep/10/2014

1:18 PM

WELLNESS & HEALTH Update

UNDERSTANDING SCHIZOPHRENIA Researchers from the Institute of Mental Health (IMH) and A*STAR’s Genome Institute of Singapore (GIS) have identified 108 genomic locations associated with risk of schizophrenia. With this new way to detect schizophrenia, the 1 in 100 worldwide sufferers could eventually receive earlier and more effective treatment.

Did You Know?

D Itchy and painful lesions m be a sign of skin cancer. may S Something to bear in mind if yyou have lesions which you cannot explain away.

EXER EXERCISE HELP HELPS Research findings fin presented at the European Europe League Against Rheumatism Annual Congress Research reveal r how exercise suppresses local and systemic inflammation ammatio on a molecular level.

This helps alleviate the persistent chronic swelling s and joint pain that characterises ch more than 200 rheumatic rh diseases.

16

D-DEFICIENCY DEMENTIA One of the first and largest studies by an international team at the University of Exeter Medical School found that participants who were severely vitamin D-deficient were twice as likely to develop dementia – a condition that afflicts 44 million people worldwide.

WELLNESS & HEALTH Update

GO LOW-CARB Both Type 1 and Type 2 diabetes patients should consume low-carbohydrate diets to suppress blood glucose levels, says a study conducted by the University of Alabama at Birmingham. This is especially so for those with Type 2 diabetes, where such diets could help eliminate symptoms and even the need for medication.

Did You Know?

For the first time, scientists have discovered a new mechanism by which the dengue virus impedes and evades the human defence system.

Just wait, mozzies!

SODIUM KILLS Over 1.6 million cardiovascular-related deaths globally are linked to the amount of sodium we consume. High sodium intake also increases blood pressure, one of the factors causing heart disease and stroke. All worrying signs as the average global sodium consumption level is double that recommended by the World Health Organization!

18

EAT FISH The American Journal of Preventive Medicine recently highlighted that regular fish consumption reduces the risk of age-related brain abnormality.

Consuming baked or broiled fish (without even factoring in omega-3 fatty acid content) every week can benefit brain health for decades ahead.

ANOTHER ONE FOR CAFFEINE After tracking the caffeine intake of 65,085 women over 18 years, a published research study found that increased caffeine consumption decreased the risk of tinnitus (ringing or buzzing in the ears).

Bespoke Jewellery H. Sena (Pte) Ltd.

|

#01-16 Paragon, 290 Orchard Road, Singapore

Sena_Yellow Diamond Earring_Full Page_275x205.indd 1

|

(65) 6732 5689

|

www.hsena.com.sg

5/06/2014 5:53 pm

WELLNESS & HEALTH Update

MOVE OUT OF STRESS

COVER THAT BRUSH Your toothbrush may be the reason you’re sick today. According to the School of Dentistry at the University off Alabama at Birmingham, the number of pathogens, including faecal germs, can hit up to 1 million colony-formingg units in a toothbrush, accumulated through toilet flushing, lack of handwashing hygiene and transference from the oral cavity and vice-versa.

Exercise reduces depression and anxiety, improves mental health and boosts self-esteem, says a consultant psychiatrist at Raffles Hospital’s counselling centre.

This was reaffirmed by a Singapore study published in the British journal Public Health, which showed that people who do moderate to vigorous physical activities regularly are 27% less likely to feel psychological distress.

Did You Know?

15% of SG’s population suffers from sleep apnoea, which occurs when a person’s breathing is interrupted during sleep. Regular, heavy snoring that increases in volume is an indicator.

SEEK HELP EARLY Approximately 5.6% of Singaporeans suffer from depression at some point in their lives, says the National Mental Health Survey. Unlike the feelings of sadness, depression is a medical condition that seeps into all aspects of life, affecting thoughts, behaviour and actions. Fortunately, depression is highly treatable, especially when addressed early.

20

SUNLIGHT FOR GOOD EYESIGHT Increased exposure to sunlight reduces the rates of myopia, says recent clinical research.

With more than 29% of young children in Singapore being myopic, and annual myopia costs in Singapore doubling to almost $1 billion over the past 20 years, it’s time to get away from the gadgets and enjoy the great outdoors!

CMS-046-07-14-Oct This Quarterly FPFC Finolhu VIlla Maldives-R7-FAp.pdf

C

M

Y

CM

MY

CY

CMY

K

1

22/8/14

11:34 AM

WELLNESS & HEALTH Update

RECHARGE IN NATURE

FROM MUM TO BABY Docosahexaenoic acid, or DHA, is an important omega-3 fatty acid and nutrient for growing children often found in baby formulas. Duke-NUS researchers have discovered ways to introduce DHA during a child’s foetal development and through food from the mother. This could improve brain function by ensuring pre-term babies receive sufficient DHA during their growth.

Walking helps our bodies and minds in more ways than one, so how about some stunning scenery to boot? NParks has organised guided walks around Singapore’s first Marine Park at Sisters’ Islands, where you can soak in the 40-hectare beauty of native marine biodiversity in a locale known for coral reefs, sandy shores and seagrass.

Did You Know?

95% of children worldwide will suffer from rotavirus gastroenteritis (RVGE) before they turn 5.

Rotavirus is highly contagious and accounts for the most common severe diarrhoea and dehydration in children in this region.

SING IT, KID! New research has shed light on why children who actively sing or play a musical instrument are able to strengthen their reading and language skills. This is mostly attributed to the enhancement of children’s nervous systems when processing sounds in a busy environment – leading to better memory and attention spans.

22

FOREVER YOUNG The World Health Statistics 2014 report reveals that people everywhere are living longer, with women in Japan having the longest life expectancy at 87 years, and Singaporean women coming in fourth at 85.1 years. Our men are also hanging on well in fifth place, at 80.2 years.

S SEAT PPOCKET A ALERT

BURN! Whatever your reason for running, Mayo Clinic experts advise that you should do it for longer than 20 minutes, as it takes at least that long for your body to switch from burning sugars to burning fat as its primary fuel.

W kind of infections should What you be concerned about when yo you’re on a flight? You might think yo you could catch SARS, MERS yo and Ebola, but an investigation an by the US Centers for Disease Control and Prevention (CDC) Co shows otherwise. It is diarrhoeash causing bacterial microbes that ca we should watch out for, with MRSA and E.coli lurking for M up to two days on the toilet handle and up to eight days on ha the seat pocket! th

Did You Know?

Seven in 10 mothers believe they can prevent their children from falling ill, despite overwhelming evidence to the contrary, according to a Lifebuoy Cost of Infections Study.

Love conquers all, not.

FLAT IS NOT FAB

Comfy flat footwear, ballet flats and flip-flops can actually be detrimental to your health, according to the Department of Podiatry at the Singapore General Hospital.

Thin soles are seldom shock-absorbent and they don’t provide adequate arch support. Other than painful feet, problems can also spread to the lower legs, knees, hips and even the lower back.

A BITTER TASTE? You may be suffering from an ENT-related (Ear Nose Throat) infection if you have a continuous metallic or bitter taste in your mouth, as taste buds could go out of whack from dehydration, sinus or dental infections, middle-ear inflammation, or specific medications like antibiotics. Another possibility is – mysteriously – because of all the pine nuts you’ve consumed in your low-carb diet.

23

COVER STORY Dr Tan Soo Heong

24

Zen and the Art of Hand Surgery He is calm, soft-spoken, economical in movement and considered in his responses. Dr Tan Soo Heong is a hand surgeon, one of a small number in Singapore, and here, he shares his passion for hands.

By Audrey Perera Photography CJ Sameer Wadhwa Stylist Phoebe Pong Shirt by Bertoni, bow tie by Fefe, both from Robinsons

25

COVER CO OVE VERR ST STORY TORRY Dr Tan Soo Soo Heong Heo eonng

What do you think about, when you think about hands?

They’re soft or calloused, elegant or chunky. Large or small. Smooth or wrinkled.

They cook and clean, they touch and soothe, they work machines, they slap and squeeze.

They carry scars, they leave scars.

They work hard, they’re pampered.

They’re to pray with, to lift, to shelter, to create. Hands.

What would we do without them?

But what does a hand surgeon think about when he thinks about hands?

If he is Dr Tan Soo Heong, certified hand surgeon since 2000, he thinks of harmony, perfect form, a masterpiece of engineering. And most important of all, he reflects on how we seldom really think about our hands and the fine balance between hands that work optimally and hands that are hurt.

“The harmony of tissues that make up the hand is very easily disrupted by diseases and injuries, and when this happens, the things that we do everyday with our hands – and often without conscious thought – become monumental obstacles or impossibilities,” he says. “Can you imagine not being able to comb your hair, button your shirt, feed yourself, type or use your handphone?”

That’s where hand surgery comes in. A relatively new speciality, Soo Heong is one of only 29 certified hand surgeons here.

These are surgeons specialising in anything to do with diseases and disorders of the hand, wrist and forearm. Many hand surgeons are also experts in problems of the elbow and shoulder. Hand surgery treats disorders that affect optimal functioning of the hand, which also means that hand surgeons are involved in treating patients with stroke, tetraplegia, cerebral palsy as well as brachial plexus injury as a result of birth trauma or accident and congenital malformations of the hands.

“Hand surgery also involves reconstructive microsurgery involving replantation of amputated digits, hands, and upper limbs as well as microsurgical free tissue transfer surgery that involves transfer of skin, muscles, nerves, bones or a combination of the tissues to repair and reconstruct the hand and upper limb lost through disease or injury,” explains Soo Heong.

This body part with its small, finely sculpted bones is held together with a system of even smaller and finer joints, flexor and extensor tendons, nerves, arteries, veins and the skin envelope. Many of these components are microscopic in size.

This explains his calm, unflappable demeanour.

Seated in his compact consulting room which is filled with reference books and art prints by Dutch artist M C Escher all focusing on… you got it… hands, Soo Heong explains. “Surgery of the hand requires a high level of refinement and careful handling of the tissues. Crushing tissues with forceps and surgical instruments will result in more scarring with resultant motion restriction. Careful tissue handling is especially important when doing microsurgery where structures are microscopic in size and stitched with sutures finer than a strand of hair.”

Everything is magnified by 30 to 40 times under the microscope. If the surgeon’s hand trembles, it’s like an earthquake, and it becomes impossible to safely perform microsurgery.

“As we perform more and more surgeries, we gain control of our actions, and during microsurgery, we eventually ascend into a Zen-like state of serenity and calmness and focus only on the surgery. This takes many years of practice

2 26

27

COVER STORY Dr Tan Soo Heong

The Golden Ratio “Many people do not know or think about this, that the human hand is perfectly designed, aesthetically and practically,” says Soo Heong, making reference to a concept that was born as far back as 400BC, when luminaries like Euclid and Plato explored the concept of perfect proportion and scale.

Sometime later, at around 1202, an Italian mathematician named Fibonacci studied numerical sequences, and captured the concept of perfect proportion in mathematical terms. This is reflected in the numerical series 1, 2, 3, 5, 8, 13, 21 and so on, with each number being equal to the sum of the two preceding numbers.

This “equiangular spiral” is reflected in nature, for instance, in the pattern of petals in flowers and in the whorls of seashells.

“The length of the metacarpal and the phalanges of each finger follow this series too. When the phalanges move, going from extension to full flexion, the motion path they traverse follows such as an equiangular spiral,” he explains, his eyes twinkling as he gets into his favourite topic.

It may have been figured out by mathematicians in a distant past, but the idea of perfect proportion continues to fascinate designers, biologists, artists, musicians, architects and more.

“The golden ratio has been described as embodying the most aesthetically pleasing and harmonious proportions. And the human hand is an example of it.”

28

and training,” he says. It means focusing on the moment, while planning the next step, and keeping Plan B and C in mind as well. It also means mundane considerations like not drinking coffee and tea, which can make your hands tremble no matter how calm you feel. And of course, he says, there is always music in the background.

The starting point How and at what stage in medical training does one choose a speciality, especially a lesser-known one?

“As a doctor in training, we experience different areas of practice, and at one stage, I was posted to the Hand Surgery department at the Singapore General Hospital where I met a group of specialists called the Hand Team, led by Professor Teoh Lam Chuan. They were very dedicated and very passionate about Hand Surgery, and their ability to meticulously plan, organise and reconstruct a severely injured hand so that the patient could regain its use was inspirational.”

This led to a Japanese government scholarship for Hand & Reconstructive Microsurgery with Professor Kazuteru Doi, for advanced hand surgery, peripheral nerve surgery and reconstructive microsurgery.

There, he encountered another team of committed professionals.

“Operating days, which occurred three times a week, meant a 12- to 14-hour work day that ended late at night. I remember operating through one Christmas Eve into the wee hours of Christmas. Working and training there built up a certain resilience and endurance for long complex surgeries. Complicated reconstructive procedures can last as long as 12 hours or more!”

That was followed by a year at the world-renowned Kleinert Kutz Hand Care Center in the US, a result of being awarded a Ministry of Health fellowship for Hand and Advanced Reconstructive Microsurgery.

The first hand transplant in the US was done there and Soo Heong was involved in the second. Similar to a kidney transplant, hand transplantation involves transferring a hand from a brain-dead donor to a living, unrelated recipient who has lost his or her hand through injury or disease.

“Being part of the team was certainly a high career point. The operation was incredibly complex and took more than 12 hours and a team of more than 40 working in a rotating shift. Imagine the magnitude of this for the patient, and all his hopes and dreams,” he enthuses in his quiet way.

Both institutions are world-renowned, leading state-of-the-art centres for Hand and Reconstructive Microsurgery. “Working in them allowed me to see and appreciate the differences in their approaches to difficult the similarities sim Most importantly, he adds, both centres have great teachers hand problems.” p who are a well-respected hand and microsurgeons with a wealth of experience.

“Surgery is learnt through an apprenticeship. We learn from masters of the craft.

“S There were many giants of Hand Surgery who taught me the necessary skills to take me further. They zealously and selflessly taught surgeons from all a over the world and I have benefitted greatly from their years of experience.

I imbibed their passion, their clinical acumen and clinical judgement experi in managing hand surgery cases. Every patient is different, with unique ma problems that require personalised management.” prob Hand surgeons, he points out, are intimately involved with the patient H at every step of their recovery. “Some patients become discouraged when e they can’t do the everyday things they usually do during the recovery period.

That’s Tha when we need to cajole, encourage and motivate them. This is really important because highly motivated patients will usually have excellent results.” impo

Unprecedented challenges Inspiration goes a long way, especially in the face of medical challenges.

Soo Heong describes two of the most challenging hand surgeries he has ever done.

A young man sustained life-threatening injuries in a road traffic accident in 2003 during the SARS outbreak. His right arm was pulled off from his body and detached just below his shoulder.

“During a seven-hour surgery, we replanted the arm but it had to be removed a week later because of the severe nature of the injury. On his left side, the network of nerves that control his arm had all been torn from the spinal cord.”

This network controls sensation and movements of the upper limb and hand. In severe cases, there is no movement and no sensation in the upper limb and it hangs limply. “These injuries usually affect young, economically active people in the prime of their lives. They wake up in the hospital with their lives changed forever.

“With complex reconstructive microsurgery, we can reanimate the hand and upper limb to restore functional use. The patient was very motivated to recover as much as he could, and after numerous discussions, underwent an unprecedented procedure.

All the nerves that previously controlled his amputated right upper limb were transferred to his left side so that he could move his left side again. Because of his youth, he could train his brain to reorganise itself to have some control so that instead of controlling his right upper limb, the nerves now controlled his left upper limb, a process achievable due to brain plasticity.”

It is tough not to wince as Soo Heong describes this ordeal and the next, faced by his patients in the face of unimaginable pain, trauma and loss.

“Then there was a woman who sustained very serious injuries to her right hand when she was trying to clear a jammed meat grinder. Her fingers were pulled in when the meat grinder suddenly started up. She retrieved the amputated parts and came to the hospital with parts of her four fingers and thumb in a plastic container usually used for take-away food. The fingers and thumb were all ground up into individual pieces of bones, skin and other soft tissue which were impossible to replant. After controlling her pain and infection, she had to be counselled about her altered right hand. She was very motivated to regain use of her right hand, and underwent toe transfer surgery whereby the missing fingers and thumb were reconstructed using her toes. Her recovery was quick and she could start using her reconstructed digits two months later.”

His smile at the end of this story is not the gleeful smile of the storyteller with an enthralled audience, but about the new chance at life that was given to the young woman. “It’s about being able to do something good. Patients come with pain and I can help them. It’s about doing things that are right, guided by faith and belief,” explains Soo Heong, who is a father of two teenaged children.

The harmony of tissues that make up the hand is very easily disrupted, and when this happens, the things that we do everyday with our hands – and often without conscious thought – become monumental obstacles or impossibilities.

Can you imagine not being able to comb your hair, button your shirt, feed yourself, type or use your handphone?

29

COVER STORY Dr Tan Soo Heong

Singapore as a teaching centre

Misconceptions about hand surgery “I consult a hand surgeon only when I need surgery” or “Consulting a hand surgeon will invariably result in surgery.”

Ironically, most hand surgery cases can be, and have been, managed non-operatively. The hand is intricate and has a propensity for stiffness after injury or surgery. If the results of nonoperative treatment are the same as/ superior to surgery, then surgery will not be recommended.

“My hand injury is minor so I do not need to see a hand surgeon.”

Hand injury is common because we use our hands for everything. An injury or affliction may look minor but it is never trivial. Neglecting an injury can lead to infection, stiffness, contracture with loss of movements, chronic pain and even amputation. This is because every important structure is contained very closely together in the hand. Extension of the injury in any direction by mere millimetres will result in injury to another vital structure of the hand.

30

With such major hand work – requiring such high levels of expertise and boldness – being performed in Singapore, it is not surprising that surgeons from the region come here to train in hand surgery. There are also many overseas patients who come here to seek treatment for their hand problems.

There are only a few countries in the world that have it as an actual speciality, as Singapore does. It was born during the 1960s and 70s when Singapore was rapidly industrialising. With a workforce not used to operating automated and heavy machinery and working long shifts, there were serious accidents involving hands. And this highlighted a need for better specialised care for injured hands.

The first Hand Surgery Department was started at the Singapore General Hospital in 1985, followed by a second department at the National University Hospital five years later. Today, there is a formal training programme that trains in all aspects of hand surgery.

“When I started, there were two centres for hand surgery training and only one trainee for each centre every two to three years. Presently, there are three training centres and they have two to three trainees at each place every year. It is a growing speciality!” says Soo Heong, who was President of the Singapore Society for Hand Surgery from 2003 to 2004, and is currently President of the Society for Reconstructive Microsurgery Singapore.

Two significant developments are changing the face of the speciality.

The first is 3-D printing. “It will allow personalised surgery. Right now, implants come in several standard sizes and lengths and in surgery, the body is altered to fit the implants. But in 3-D printing, by first scanning the body part to obtain the patient’s normal dimensions, implants can be produced that will fit each patient’s specific profile and dimensions.

It will also be able to produce custom guides so that the surgeon can make necessary alterations to restore normal anatomy after loss due to injury or previous surgery.

The second is robotics. “Robotics-assisted devices can help in rehabilitation to monitor and assist in hand therapy and upper limb retraining. They can be programmed to perform specific functions for the patient’s rehabilitation and to train patients in daily life activities. Robotics-assisted devices will also include prosthetic limbs for amputee patients. Using small myoelectric currents of working muscles in the arm or shoulder, these prostheses can function to hold and manipulate objects just like a normal hand.”

At the end of this interview, I have to ask: which is the most important digit of the human hand?

“Probably the thumb. We know this from the very large amount of brain area and nerves that the brain devotes to receiving sensation and controlling movements of the thumb.”

Our opposable thumb has the taken-for-granted ability to move further across our hand than any other primate’s digits can. It enables us to excel at tasks which other species can’t even begin to grasp – including the wondrous hand surgery.

As we perform more and more surgeries, we gain control of our actions, and... eventually ascend into a Zen-like state of serenity and calmness and focus only on the surgery. This takes years of practice.

31

LEGAL Special

Your Wishes Will Be Told By drawing up a will early, you can ease the stress faced by your loved ones when the inevitable happens.

By Rajan Chettiar

The thought of making a will while you are hale and hearty may not be the most pleasant one, but it is something that you might want to consider in all seriousness. If you pass on, a will ensures that your assets will be distributed according to your wishes, allowing your loved ones to have fewer difficult decisions to make in their time of mourning.

Here’s a snapshot of what a will is and how it is made valid. Having a basic understanding could make the process of drawing up one much easier.

Your wishes in writing A will is a document stating how you want your assets to be distributed amongst your family, friends, charities and others. In Singapore, as long as you are at least 21 years old and of sound mind, you can draw up your own will and change it at any time without consulting a lawyer.

However, your home-made will risks being rendered ineffective or invalid.

The Law Society of Singapore suggests that it would be in your interests to consult a lawyer to advise and help you draft your will, according to law.

When you contact your lawyer, you should have already prepared the following: • Particulars of two individuals above 21 who have consented to act as executors of your will. They will be the ones taking care of your personal matters, beginning from the date of your death to the date of distribution of your assets to your beneficiaries.

• The particulars of two individuals of any nationality who have consented to act as guardians of your children below 21 years old.

• The names of the beneficiaries and most importantly, the details of the gifts you want to leave them.

You should also note that: • •

•

32

Guardians and executors can be the same persons, and they can also be beneficiaries.

While you must get the prior consent of your appointed executors and guardians, neither they nor anyone else needs to know the contents of your will. They also do not need to know if you have actually drawn up one.

Administratively, it is more convenient if your executors are Singaporeans, but that’s not an imperative.

Signed and true Your will becomes valid when it is signed in the presence of two witnesses of your choice – these could be your executors, but not your beneficiaries or their spouses. Usually, the witnesses are your lawyer and a member of his or her staff.

You will retain the original copy of the will, while your lawyer keeps the filing copy and notifies the Wills Registry.

Because you can legally make as many wills as you wish, you should always bear in mind that only the last and most recent will is valid.

As you can see, the steps to making a will aren’t complicated at all, although the considerations behind your decisions could be perplexing.

For your peace of mind, it would be good to have this difficult matter sorted out early.

What if…

Your will is contested? A claimant can challenge the validity of the will if its formalities are not met. For example, a will is invalid if proven that the deceased was of unsound mind or under undue influence when making it. Contesting a will can be complicated, so do have a lawyer vet the will-making process early to ensure compliance.

You didn’t leave a will behind? Your assets would be distributed according to the Intestate Succession Act, which has strict rules on who the beneficiaries are, and what proportion of your assets they will receive. The same applies if your will is deemed invalid in court.

For additional reading, go to http://statutes.agc.gov.sg and search for either “Wills Act” or “Intestate Succession Act” within the “All Government Websites” option.

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

Art, invention and good business

From its earliest patents in the 1840s to its most lovingly-crafted timepieces to its major role in the history of horology, Patek Philippee has plenty to celebrate as it turns 175.

By Lye Kim Sheong

One of the earliest patents for mechanisms ech chhanisms annisms ani mss invented by Jean Adrien Philippe.

33

Patek Philippe 175th Anniversary Special

Patek Philippe: A legacy to respect

There’s something to be said about a company that has had a fantastic run of 175 years at the top of its game – and is showing no signs of letting up.

Patek Philippe is revered in the horological world not only as a maker of luxury timepieces, but also as an institution, and a pioneer of some of the most innovative and complex watch mechanisms in history. It has made numerous breakthroughs in watchmaking since 1839 and lays claim to more than 80 patents to date for its inventions in movements and timepiece designs.

It is no wonder Patek Philippe watches (affectionately referred to as “Pateks”) are loved by generations of watch aficionados as exquisite timepieces, and showcases of artistry and family heirlooms.

Behind this is Patek Philippe the business entity, clearly in a league of its own. The last of the great family-owned master watchmakers in Geneva, it has weathered wars, survived global economic crises, bucked digital marketing trends and resisted rapid ramp ups in production to maintain and deepen its enduring success and prestige.

The company holds dear its 1839 maxim of building the world’s best watches. Each of the 55,000 Pateks produced annually is still painstakingly handcrafted in a superb feat of micromechinal precision engineering.

An early image of the Patek Philippe workshop.

34

Antoine Norbert de Patek (above, left) and Jean Adrien Philippe (above, right) created a formidable marriage of luxurious artistry and technological wizardry.

These creations are so highly valued that some of Patek Philippe’s commissioned pieces are only revealed to the public when they appear at auction houses, to quickly change hands at astronomical prices.

Birth of a world best

Patek Philippe’s story began in 1831, when Antoine Norbert de Patek left his war-torn homeland in Poland to join the Great Emigration, arriving in Geneva two years later. As a refugee, he was acquainted with François Czapek, a watchmaker who had fled from Bohemia, with whom he would, together with his wife’s uncle Thomas Moreau, set up Patek, Czapek & Cie in 1839.

Right from the very beginning the watchmaker experienced success through Patek’s good network of relationships and the company’s striking creations, often reflecting the founder’s sense of style inspired by his penchant for quality and the fine arts. Not only was he fascinated with Geneva’s watchmaking heritage, he was also intrigued by the complementary artistry of the engravers, enamellers, and jewellers.

But discord between Patek and Czapek prompted Patek to look for a new partner. He found that person in 1844 at an industrial exhibition in Paris, and it was the gifted French watchmaker, Jean Adrien Philippe.

Between Patek’s a shrewd business acumen and Philippe’s ingenious watchmaking skills, the pair were unstoppable. In 1845, Patek terminated his partnership with Czapek and formed Patek & Cie – Fabricants à Gen, with Jean Adrien Philippe and a third partner, Vincent Gostkowski. This company would be renamed Patek, Philippe & Cie in 1851, significantly launching the earliest Patek Philippe brand incarnation.

The beautiful blue enamel p pe he pendant watch that caught the eyy of Queen Victoria in 1851.

51. eye

The road to the top

The first Swiss wristwatch was made by Patek Pihlippe in 1868 for a woman, Countess Koscowicz of Hungary.

When Philippe joined Patek in 1845 as the technical director, his focus was on the quality of the company’s timepieces, since he was responsible for manufacturing the most current models, improving the production processes and developing new models and mechanisms.

At the same time, he completed his invention of a new watch mechanism, a system for winding movements and setting the hands without requiring a separate key, for which he received a French patent that year. His ongoing work to develop additional enhancements led to two more patents in 1860 and 1861. The fact that even contemporary wristwatch winding mechanisms follow what were essentially his early concept shows how progressive his idea was.

In the company, Patek actively encouraged artisanal perfection, lavishly decorating his watches with engravings, enamelling techniques and precious stones, and transforming them into luxurious works of art. Philippe, on the other hand, was driven by his horological aspirations, and continuously refined the underlying technologies and the ongoing development of complications. Both their ambitions would characterise and accompany the brand throughout its history.

During the 1851 exposition at the London Crystal Palace, for example, Patek Philippe’s opulent creations caught the fancy of Queen Victoria, and she promptly acquired for herself the dainty pendant watch No. 4719, adorned with diamond roses on blue enamel, as well as the pocket watch No. 3218 which came with a chronometer escapement and a quarter-repeater, for her beloved husband Prince Albert.

That same year, Patek Philippe debuted in the US, when Tiffany New York began selling its first timepieces. The following decades would also see the company amass a steady stream of esteemed customers, who loved and appreciated the work that went into each creation. This list included Pope Pius IX in 1867, automobile tycoon James Ward Packard in 1912 and in 1926, New York banker Henry Graves, Jr.

35

Patek Philippe 175th Anniversary Special

Today’s Patek Philippe salon.

A new era of rejuvenation

After Antoine Norbert de Patek’s death in 1877, the company would remain under the directorship of one of the founding families until 1932, when the Great Depression took its financial toll on its business. Brothers Charles and Jean Stern, who were then supplying dials to Patek, bought the company – and there in the capable hands of the Sterns, Patek Philippe would remain.

Generations of Sterns at the Patek Philippe helm proved to be astute business people, each leaving a legacy of greatness to be continued into the next generation. The success of the modernised Patek Philippe, however, is credited to the ambitions of Philippe Stern and the stewardship of his son, Thierry.

Philippe Stern was appointed CEO from 1977-2009, during which he grew the company and doubled its staff from about 300 to more than 600. He knew that the classic mechanical watch stood a chance against the more precise quartz watches if it was a genuine high-end product, or even better, a work of art and a collector’s item. His conviction provided a new direction for the company, which led to its successful modernisation.

The legendary ultra-thin Patek Philippe calibre 240 self-winding movement is a prime example of this vision. With its patented automatic winder and a 22-karat gold mini-rotor totally recessed in the plate, it was ideal for extremely thin wristwatches, such as the elegant Perpetual Calendar-3940 introduced in 1985, still one of Philippe Stern’s favourite models.

Philippe Stern also wanted to ensure that components and quality

36

Philippe Stern (left), who modernised the brand, and his son, Thierry Stern (right), current President, and a trained watchmaker himself.

standards could be replicated, and to safeguard the service and repair of all Patek Philippe watches. He recruited the best engineers to transform Patek Philippe from a craftsmanship-driven entity to an industrial manufacturer, so to speak. The move preserved the company’s commitment to artisanship, while providing continuity with records of detailed blueprints and parts crafted with latest-generation machines.

In 1996, a manufacturing complex was built in Plan-les-Ouates, a suburb of Geneva. It was funded entirely by the company’s capital and became the base for all of Philippe’s ateliers, who up to that point, were working from various locations in Geneva.

In 2001, Philippe Stern inaugurated the Patek Philippe Museum, one of the world’s most eminent horological museums, in Geneva’s Plainpalais district. It contains more than 2,000 timepieces, automata and enamel miniatures, and a library with more than 8,000 works dedicated to the measurement of time.

A year later, the new Patek Philippe Advanced Research department was set up to focus on novel materials and avant-garde technologies, to become a key pillar of the manufacture’s philosophy of “Tradition & Innovation”.

Thierry Stern, who took over the reins in 2009, kept the momentum of modernisation going. Mentored from a young age by his grandfather Henri and his father Philippe, he underwent watchmaker training and pursued internships in all of Patek Philippe’s departments before assuming the role of Creative Director in 1998, a position which gave

Time to celebrate!

him the opportunity to leverage on his artistic talents to contribute to the development of the company’s strategies.

Shortly after his appointment as fourth-generation president in 2009, Thierry launched the Patek Philippe Seal. This is a written and published set of directives that comprehensively define the quality of Patek Philippe timepieces, and fortify the appeal of the Rare Handcrafts timepieces that were pioneered by his father and grandfather. Both Thierry and Philippe Stern were personally involved in drafting this constitution, and both were instrumental in transitioning the company’s Geneva Seal to the Patek Philippe Seal.

Patek Philippe today employs over 2,000 staff globally, and has become the most notable and the largest independent family-owned manufacture of top-end luxury timepieces.

This year, it celebrates 175 years of extraordinary accomplishments, a feat achievable only by an extraordinary company, which not only succeeds in business, but also in inspiring generations of customers and watchmakers past and future.

The historic festivities of Patek Philippe’s 175th anniversary began in May 2014, although the official anniversary celebrations kick-off in October, ending with the launch of a commemorative book on the company’s history sometime in 2015.

As with previous anniversaries, serious collectors are on the lookout for commemorative pieces produced in limited numbers, and featuring the best innovations and craftsmanship Patek Philippe has to offer, like the Calibre 89 pocket watch launched in 1989 to celebrate its 150th anniversary. The model took five years to develop and was four years in the making; and its estimated worth is US$6m.

The crossing of this milestone year will also be celebrated with two independent, high profile auctions: one at Christie’s and the other at Sotheby’s.

Christie’s International Watch Department will hold the Patek Philippe 175 thematic auction at Christie’s Geneva in November.

Featuring 100 symbolic timepieces from the early 19th century through to the 1980’s, it will showcase some of the most exclusive Patek Philippe models ever produced, including 58 watches which have never before been seen by the public.

Christie’s will also undertake an international tour ahead of the Geneva evening sale to a number of global cities like Dubai, Taipei, Hong Kong, Milan, New York, Seattle and San Francisco.

Over at Sotheby’s this November, the world’s most expensive watch will go under the hammer for the second time.

The Henry Graves Supercomplication is an 18-karat gold Patek Philippe masterpiece commissioned in 1925 by its namesake, New York banker Henry Graves. Considered to be the most complicated watch ever made, it was placed on auction in 1999, and promptly sold at a record-breaking US$11million.

Sotheby’s has high hopes for this The Calibre 89 (above, right) was created to mark pocket watch with its 24 horological the company’s 150th anniversary and is worth complications. It is expected to set a an estimated US$6m; the 1925 Henry Graves Supercomplication (above) once sold for US$11m. new record at US$16.5million.

37

Patek Philippe 175th Anniversary Special

Among the horological wonders to be discovered at the Patek Philippe Museum (left) are this 1867 pocket watch that was created for Pope Pius IX.

Uncommon depth of experience

The Patek Philippe Museum in Geneva displays a globally unique collection of timepieces spanning 500 years and also showcases a selection of horological masterpieces crafted in the manufacture’s workshop during the last 175 years. The Museums’s library, with over 8,000 books and documents related to time measurement, ranks among the notable institutions of the world.

This commitment to learning, documenting and developing new ideas has kept the company in the very top league of watchmaking artistry. The independence of Patek Philippe ensures creative freedom which allows it to take on endeavours such as the Museum and R&D investments while maintaining its continuous, in-house production which perpetuates a tradition and skills which are very hard to replicate.

For instance, in the making of a watch to preserve the “Traditional art of fine watchmaking’, more than 1,000 people representing more than 50 crafts are involved. Some 1,500 operations are required to manufacture all the components of an automatic watch, and 40 to 60 to produce every single wheel.

It is the legendary virtuosity of master craftsmen, handed down from generation to generation, that constitutes the heart and soul of Patek Philippe watches.

38

Ties that bind As timepiece appreciation continues to grow in Asia, two individuals closely tied with Patek Philippe in this part of the world share their views on the occasion of the brand’s 175th anniversary.

Deepa Chatrath GM of Patek Philippe/Geneva Master Time Marketing LLP, SEA

Deepa Chatrath GM of Patek Philippe/Geneva Master Time Marketing LLP, SEA The history of portable mechanical timepieces began 500 years ago.

Tracing the arc from there to Patek Philippe’s 175th year anniversary, this means that the Genevan Manufacture has co-written, co-designed and co-measured a third of the history in this category of time-keeping instruments.

Patek Philippe has pursued its core business without interruption since it was founded on May 1st, 1839 and has always been a privately owned company. To this very day, Patek Philippe is domiciled in Geneva and headquartered on Rue du Rhone in the heart of the city, in a building it has occupied since briefly after the company was first registered.

It is the only family-owned watch manufacturer in Geneva and at the helm of this family-owned company is our President Thierry Stern assuming the leadership of the manufacture, and successfully pursuing the Stern family tradition with surprising debuts. These demonstrate that despite its long history, the company remains a young and dynamic enterprise.

The entire team and I feel privileged to be part of this legacy brand that is celebrating its 175th anniversary this year. To me, this means a lot to the brand that has continued to stand by its promise, standing by strong values, upholding the vision, and delivering to the highest expectations of excellence.

The unparalleled renown and prestige that Patek Philippe has acquired amongst connoisseurs is not due solely to the perfection of the watches and the resources of knowledge and skill contained in the workshops.

This undisputed supremacy also stems from the consistency with which the company has applied its philosophy of excellence ever since it was founded in 1839.

That spirit is embodied in 10 brand values that have always represented

Jeremy Lim Chief Operating Officer, Cortina Watch

the very essence of Patek Philippe and will continue to do so for generations to come. These are Independence, Tradition, Innovation, Quality & fine worksmanship, Rarity, Value, Aesthetics, Service, Emotion, and Heritage.

This heritage and these values position Patek Philippe among the oldest and most distinguished watchmaking companies in Switzerland and the world.

Jeremy Lim Chief Operating Officer, Cortina Watch To see a brand reach its 175th anniversary milestone is of a great significance.

It demonstrates the experience of the company and shows how it has mapped its future. Cortina Watch is honoured to have been working with Patek Philippe over the years and to be able to witness and participate in this great anniversary.

Most of our customers have been purchasing Patek Philippe timepieces for themselves and for their children for a long time. They are watch afficionados who are based in Singapore and around Southeast Asia.

Most Patek owners love the quality, craftsmanship and brand values one is associated with when wearing a Patek Philippe timepiece.

I personally love the craftsmanship, and am currently wearing a Patek Philippe Aquanaut.

Cortina Watch has a long-standing relationship with Patek Philippe since the early days back in the 1970s. Founder and current CEO of Cortina Watch, Anthony Lim, worked very closely with then President, Philippe Stern. Anthony has passed the baton to his youngest son, Jeremy, and likewise, Philippe Stern has retired and passed the family business on to his son, Thierry. Both families have similar values when it comes to running a family business.

39

Patek Philippe 175th Anniversary Special

Patek Philippe Boutiques Here’s where you can gaze at, and choose the Patek Philippe ome m a family fam amililyy heirloom. amil hheeiirrlooom om. watch that will become

In July 2009, Cortina Watch partnered with Patek Philippe to open its first flagship sshhip boutique in Singapore. This was at the much coveted ION Orchard, in the heart heear artt of Singapore’s most famous and popular shopping district. The elegant boutique ique iq ue is an excellent testimony to the Group’s expertise and strength in watch retailing. liling. ng. ng One year later, the second Patek Philippe boutique in Singapore opened. Th TThis iss time it was at the highly-anticipated integrated resort, the Marina Bay Sands, ndds, nds s, providing a totally new luxury retail experience.

Patek Philippe at Marina Bay Sands.

Patek Philippe at ION Orchard.

40

The two “star” watches available at Patek Philippe boutiques in Singapore: the Patek Philippe Nautilus Travel Time Chronograph 5990/1A (above, left), and the Patek Philippe Diamond Ribbon Moon Phases 4968G-010 (below, left).

25 years old and well worth the wait Glengoyne Highland Single Malt Scotch Whisky 25YO. Carrying the delicate flavours of soft oak, cinnamon, stewed fruits and a Seville marmalade tang. Matured exclusively for 25 years in the finest hand-selected European oak sherry casks. Unchill-filtered and bottled at 48%ABV. At a still that runs slower than any other.

Packaged in a stunning bespoke bottle with a fine metal stopper, crafted cartouche and neck tag.

Glengoyne Highland Single Malt Scotch Whisky 25YO — an extremely special malt.

Glengoyne is owned by one of Scotland’s leading, independent, family-owned distillers, Ian Macleod Distillers Ltd. With this offering, Glengoyne is expanding its collection which includes the 10, 12, 15, 18, 21, 25, 35 Year Old and Cask Strength malts.

New Castle Trading (2005)

|

10 Admiralty Street #01-17 North Link Building Singapore 757695

|

(65) 6552 8435

|

www.newcastle.com.sg

CLUB MED Specia CLUB Special iall

Island Escapade Club Med sets a new benchmark for exclusive luxury with its soon-to-be-launched Finolhu Villas in the Maldives.

In a departure from the classic familyfriendly resort concept for which it is known the world over, Club Med will soon open an adults-only resort. Finolhu Villas in the Maldives targets adults and couples with the promise of privacy and exclusivity.

Club Med’s exclusive new property promises to surpass all expectations of those looking for luxurious accommodation in this island nation comprising some 200 inhabited islands and hundreds of uninhabited ones. Featuring 52 villas designed by French architect and interior designer Merriam Hall, the emphasis is on environmental sustainability done in lush eco-chic style, from the architecture to the amenities.

Tapping on energy-saving techniques and solar-powered energy, the villas blend in beautifully with their surroundings, while being perfect worlds in themselves. Each unit – 22 beach villas and 30 lagoon villas – comes with its own swimming pool, open terrace, comfortable furnishings and cosy touches. The lagoon villas offer the bonus of direct access to the ocean.

With a Villa Host to cater to your every whim, there is little need to venture out of your villa. In fact, you can opt to have breakfast and tea served in the villa, and step out of your secluded retreat only at mealtimes. Or you can make use of the extensive concierge facilities and choose from a menu of activities and services that includes private dinners and luxury spa treatments for a truly indulgent getaway. You can also choose your own vibe with options such as: • •

•

42

SIMPLE: Stroll on the unforgettable white-sand beach with your loved one EXHILARATING: Spend an active day snorkelling, scuba diving, water skiing, parasailing, kayaking and sailing* PAMPERING: Have a spa day in true luxury with deliciously rich products by British Organic brand ILA*

•

AT SEA: Take a private cruise* which includes a private tour and a lobster lunch

Club Med Finolhu Villas adjoins its sister resort, Club Med Kani Premium Resort, which means plenty of additional options for everything, since guests can avail themselves of these facilities too.

On top of Finolhu Villas’ fine dining restaurant, bar, main pool and spa, you can opt for the nightly entertainment, performances, theme parties, sporting options and massive international buffet that are so much a part of the Club Med experience.

At the end of each day, there are yet more options – you can catch a movie under the stars, dance on the beach or take a dip in your private pool.

All these services and options ensure unique experiences that cater to every taste, with no chance of boredom ever setting in.

A holiday of unparalleled romance and luxury awaits at Club Med’s Finolhu Villas, located in what is arguably one of the most beautiful beach destinations in the world.

Its opening in early 2015 coincides with the completion of renovations at Club Med Kani Premium Resort, which now offers an upgraded restaurant, boutique, beach bar and reception area following improvements already made to the 5 Tridents luxury space in 2013. All this means even better premium all-inclusive services and facilities for guests at Finolhu Villas.

Club Med does it again with this superlative luxury development. *These items at additional cost.

Call 1800-CLUBMED (258 2633) or visit www.clubmedski.sg to find out more.

Getting there Club Med Finolhu Villas is a 40-minute speedboat ride from Male International Airport and five minutes away from Club Med Kani Premium Resort.

Sunset Lagoon Villa

Beach Villa

Restaurant

Main Pool

End the day by watching a movie under the stars, dancing on the beach or taking a dip in your private pool. A holiday of unparalleled romance and luxury awaits at The Club Med Finolhu Villas in the Maldives, possibly one of the most popular beach destinations on the globe.

43

HEAL HE HEALTH ALTH AL TTH HD DOSSIER OSSSI SIER ER R Ki Kids Kids’ ids ds’ He H Health eal alth t th

4422

h t l a e H ’ s d i K Alert

It’s a primal human syndrome as old as time.

Fretting about the health of our children. And with so many serious conditions that we are now more than painfully aware of, and viruses mutating, we fret even more.

While we cannot prepare for every eventuality, it always helps to have an informed and up to date overview of the different kinds of health issues that children typically face – and that’s what you will find in this edition of Health Dossier.

In the following pages you will find insights from specialists covering a wide range of topics including common skin conditions, ear, nose & throat challenges, cardiac warning signs, hernia probability, orthodontic issues, increasingly common eye conditions and more – a kind of all-you-needto-know guide. Read on and come away well updated!

43 43

HEALTH DOSSIER Kids’ Health

Kids and their ears, noses and throats Here are some areas of ENT practice that particularly trouble children.

Dr Lau Chee Chong, Ear, Nose & Throat Specialist

CHRONIC COUGH is often caused by one or more of the following: Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-flow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm).

Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-reflux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths.

The nose filters, humidifies and warms air before it reaches the lungs. Mouth-breathers lack these benefits.

Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Look out for mouth-breathing, dry and wrinkly lips, a nasal voice, noisy nasal breathing and snoring. Gently hold the lips together when the child is sleeping and observe if he can breathe well.

SNORING & OBSTRUCTIVE SLEEP APNOEA Snoring occurs when something (such as enlarged tonsils or adenoids) obstructs airflow through the airways during sleep. Many obese children snore,

46

as neck fat “strangulates” the airway.

Up to 5% of Singaporean children have Obstructive Sleep Apnoea (OSA), where the obstruction is so severe that air to the lungs is greatly reduced. The heart and lung muscles work much harder for oxygen, and the lung muscles become so tired that they stop inhaling and breathing. A non-breathing period of more than 10 seconds is an “apnoea”.

OSA may cause heart/lung strain, poor brainoxygenation and troubled sleep (night sweats, bed-wetting, waking frequently, tossing and turning, gasping and sleeping in odd positions (eg sitting up or lying on his face, bottom in the air). In the daytime, the child may be tired, irritable, less attentive, hyperactive (ADHD) and performing poorly academically. Growth may be affected, because special growth hormones are produced during good sleep.

Chronic snoring or OSA in children may stretch upper airway tissues, leading to adult OSA and sometimes to abnormal development of jaw, teeth and cheekbones (‘long (adenoidal) face’ syndrome).

Approximately 60% of a child’s face is “built” by the time he is four. Left unchecked, abnormal facial development may be irreversible.

If concerned, consult an ENT surgeon, preferably with an audio-visual recording of the child’s sleep.

MIDDLE EAR INFECTIONS The middle ear (behind the eardrum) can become infected. This area is drained and regulated by the Eustachian Tube (ET) connected to the back of the nose. Children’s ETs are very short, so infection can easily spread from nose to middle ear. Children’s ETs are immature and more horizontal (becoming more vertical as the child grows and the face lengthens) and might not drain the middle-ear fluid properly. Acute middle ear infection occurs when the middle-ear fluid becomes infected and develops mucopus, which (unless drained) builds up, stretching and bulging the middle ear and sometimes, even rupturing the eardrum.

When middle ear fluid is not properly drained, the eardrum cannot vibrate properly. This is called glue ear and can cause hearing loss.

See if the child seems inattentive, can’t hear, speaks loudly, turns up the volume on the TV or has ear pain. Infants and toddlers may cry for no apparent reason, holding or pulling their ear, especially at night.

Dr Lau’s clinic provides comprehensive medical and surgical services in all areas of ENT, head and neck practice. He loves children and has two teenaged daughters.

Dr Lau is also a keen chef and sportsman who has represented Singapore in sabre fencing.

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

Common skin problems in children

As children play and explore their environment, they are not only more prone to bumps and scrapes but skin infections too. Learn to identify these common problems.

By Dr Wong Su-Ni, Dermatologist

Birthmarks

W

hether it is rough-housing with their siblings and friends or experiencing their environment through touch and smell, children tend to be more physically connected with the world than adults. While these experiences are an inherent and important part of learning and development, they can also put kids at higher risk of skin infections as their immune systems are not yet developed enough to counter a wide range of pathogens in the environment. Here are some common skin problems that can occur in childhood.

Eczema (dermatitis) Eczema is the most prevalent group of skin conditions in Singapore and is very common in children.

It refers to skin inflammation that usually results in itchy red rashes which may or may not look dry and scaly.

Skin infections The warmth and humidity in the tropics is conducive to the growth of bacteria and fungi which can cause skin infections. These can spread from child to child, and the high population density in Singapore makes spread more likely.

•

•

Impetigo appears as sores with weepy and golden yellow crusts, usually near the nostrils or mouth. Nose-diggers and those who harbour staphylococcus aureus bacteria in the nostrils are more prone to this infection. Treatment is with topical or oral antibiotics and careful cleansing and removal of crusts.

Ringworm is a fungal infection seen as red ringshaped rashes with scaly margins that typically

occur in the groin and buttocks, and sometimes on the face. Children who perspire a lot and live in close proximity to dogs and cats are more prone. It is important not to use steroid creams for this. Topical or oral anti-fungal treatment is used instead.

•

Viral warts thrive in humid and wet conditions, and often start on the soles as circular thickened skin with black dots within. They can spread to other parts of the body and to other children.

Apart from topical wart paints, dermatologists can freeze them with liquid nitrogen, or remove them using laser or cautery.

•

Molluscum is an infection seen as smooth, shiny, well-defined bumps on the skin, with a whitish central plug or indentation. Children with eczema are more prone to it, and it can emerge when a pox virus enters scratched and broken eczema-affected skin. It is self-limiting and can be left alone, or treated with liquid nitrogen, pricking or blister beetle juice.

Viral rashes Viral rashes such as pityriasis rosea, hand-footmouth disease (HFMD) and chickenpox are often preceded by fever or a flu-like illness. Chicken pox, previously a common childhood infection, has declined after widespread vaccination. More common today is HFMD, a usually harmless and self-limiting condition characterised by painful mouth ulcers and blisters on the hands, feet and/or mouth. It spreads through coughing, sneezing and used diapers.

Though not infectious and rarely harmful, some birthmarks can be of concern. Children born with medium to large congenital moles have an increased risk of developing melanoma (a deadly skin cancer) and should be examined periodically or have the moles fully removed if possible.

Birthmarks may present at birth or develop in the teens, in brown, greyblue or red. Some red birthmarks can become lumpy in adulthood and are best treated with laser in early childhood.

A dermatologist can help differentiate between those that require treatment and those that can be left alone.

Dr Wong is an experienced practising dermatologist whose practice is founded on her belief in holistic and balanced dermatological care. She is inaugural president of the League of ASEAN Dermatological Societies.

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

47

HEALTH DOSSIER Kids’ Health

8 signs that your child could have heart disease This possibility is always on a parent’s mind when their child tires easily or re regularly feels under the weather. Here are some clear signs.

By D Dr Ruth Kam, Cardiologist

1. Lips turn blue on crying, feeding, or moving around Babies born with heart disease, especially those suffering from “hole in the heart”, have oxygenpoor and oxygen-rich blood mixing as it circulates.

Put simply, this means that blood going to the lungs gets mixed with blood going to other parts of the body.

The result is that oxygen concentration of the blood going to the tissues is lower than normal, causing the blood to be darker in colour, hence giving rise to the term “blue baby”.

When the need for oxygen is increased, as it is during feeding, crying or running around, for example, the blueness becomes more pronounced, as more oxygen is extracted from the blood by the tissues.

2. Frequent chest infections Children with heart problems may have “wet lungs” due to decreased heart function. Fluid is held back in the lungs, causing difficulties in breathing and increased susceptibility to infections. Symptoms of infection include cough, phlegm, fever, increased breathing rate, panting and “blueness”.

3. Failure to thrive (growth retardation) Good circulation is required to deliver nutrients and oxygen to growing bodies. Children with heart disease may have poor appetite or breathing difficulties during feeding, leading to malnutrition. Hormone production may be low, further retarding growth. Thus, children with heart disease may be small for their age and show delayed developmental milestones.

4. Swelling of the legs or abdomen This is a sign of poor heart function as the heart cannot pump efficiently and blood is “held back” in the extremities and abdomen, causing a bloated abdomen and swollen legs.

5. Club-shaped fingertips and toes This is a sign called “clubbing”, where the tips of the fingers and toes look like drumsticks. It is a sign of congenital heart disease with mixing of oxygen-poor and oxygen-rich blood (see point 1 above). The cause is not clear.

6. Persistently rapid heart rate This could be a sign of heart failure or arrhythmia.

Although children have higher resting heart rates than adults, it is normal for the heart rate to fluctuate and to decrease during the night. It is, however, not

48

normal if the heart rate remains persistently high through the night and during sleep. A persistently high heart rate wears the heart out, leading to heart failure. Paradoxically, heart failure itself causes the heart to compensate by increasing the heart rate in order to increase its output.

7. Easily fatigued While fatigue is a common and non-specific complaint with many different causes, heart disease is one of them. A low cardiac output (decreased heart function) causes the child to tire easily, with less than maximum exertion. This may affect the child’s performance in school and in physical activities. The child may feel the need to take frequent naps or breaks during the day to recharge himself.

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.

8. Fainting spells or loss of consciousness This is always a symptom of something serious.

Loss of consciousness occurs when blood flow to the brain is insufficient and can be due to serious arrhythmia or low blood pressure.

If your child exhibits any of the above symptoms, you should bring him to a doctor to check if the heart is the cause of the problem.

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

Watch those eyes!

Myopia affects more than a quarter of Singapore children as young as seven years. Here’s what you need to know.

By Dr Leo Seo-Wei, Ophthalmologist

S

ingapore has one of the highest rates for myopia (or short-sightedness) in the world. Children, especially, are susceptible to this condition, as it affects 28% of children as young as seven years, with the number rising to 83% when they reach 18.

Myopia is suspected in a child when they cannot see things well in the distance. Often, younger children may not be aware of the condition, but some of the signs which suggest myopia include children going up close to the TV to watch.

The earlier the onset of myopia, the higher the degree of myopia becomes. This in turn increases the risk of complications which can lead to reduced vision and blindness.

The following are some myopia-related complications that can occur: 1. Retinal detachment: a condition where the inner layer of the eye detaches from the eyeball

2. Cataracts (opaqueness of the lens): there is a higher chance of this at an earlier age 3. Glaucoma: increased fluid pressure in the eyeballs 4. Macular degeneration: when the retina degenerates, reduced vision follows 5. Amblyopia or “lazy eye: decrease in vision when one/both eyes send a blurry image to the brain during the critical period of development.

This happens if there is a lot of difference in the eye power between the two eyes or the myopia in both eyes is very severe. This interferes with the normal development of the part of the brain responsible for vision, and the brain “learns” to only see blurred images with that eye. If it is not treated, it can cause permanent loss of vision. Since about 3-5% of children are affected by amblyopia, routine vision screenings in school are important.

A study of six-year-old Chinese children shows that myopia rates are 29% in Singapore but only 3% in Sydney. The key difference? Children in Sydney spent 14 hours per week outdoors while Singapore children spent only three hours per week outdoors.

The risk factors are excessive reading, writing, computer use and lack of time outdoors. Exposure to high sun light levels may cause the release of dopamine in the retina and prevent excessive eye growth and myopia development.

Treatment of myopia Evidence suggests that the most effective method to slow the progression of myopia is an eyedrop called atropine. Atropine 1% has been used in ophthalmology for a long time. It relaxes the pupil and focuses eye muscles causing blurred vision for near sight but results in a dilated pupil which is sensitive to light.

To counter this sensitivity, lower concentrations are used with great success. Currently atropine 0.01% has almost no side effects compared with higher concentrations of atropine, and is still effective in controlling myopia progression.

Intermittent exotropia This common eye condition is experienced by 50% of paediatric eye patients in the clinic. The child may experience an outward drift of an eye only occasionally – such as when they are very tired or feeling sick – despite their efforts to refocus. Children may squint one eye in bright sunlight, or may rub one of their eyes. Some describe the sensation of blurry or double vision, and this happens when their eyes are misaligned. Some can sense that one eye is misaligned, while others are unaware unless someone tells them.

Non-surgical treatment may include glasses or eye exercises. In some instances, patching therapy may be recommended, but if the eyes are misaligned more than they are straight, surgery is usually recommended for realignment. If the eyes are constantly misaligned, the child will lose the ability to see objects with both eyes simultaneously, an important part of normal depth perception.

Dr Leo has a special interest in paediatric ophthalmology and learning disabilities in children. She is one of the few eye specialists performing bladeless, laserassisted assisted cataract surgery in Singapore.

Dr Leo Seo Wei Dr Leo Adult & Paediatric Eye Specialist Pte Ltd 3 Mount Elizabeth #11-12 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6737 8366 www.drleoeyespecialist.com

49

HEALTH DOSSIER Kids’ Health

Children under the knife

Far from being for cosmetic reasons, plastic surgery for children is usually a medical treatment option to correct deformities or remove lesions that may arise during childhood.

By Dr Hong Soo Wan, Plastic Surgeon

T

he most common childhood problems that require surgery are pigmented or red birthmarks, accessory ear or skin tags, sinus, cysts, soft tissue lumps and prominent ears. The more severe birth deformities are the cleft lip and palate, partial ear deformities or underdeveloped ears.

Pigmented birthmarks These are congenital naevus which are dark, thick and sometimes hairy. They are present at birth and continue to grow proportionally in size with the child.

When the lesion is on the face or on exposed areas, it attracts attention and unfavourable comments. Parents are concerned on two fronts. Firstly, that it may grow larger or develop malignant changes, and secondly, that it’s appearance may affect the child psychologically as they grow.

Red birthmarks are blood vessel deformities and can be treated with laser, sclerotherapy or surgical excision. Another kind of birthmark which appears like a yellowish plaque is the sebaceous naevus, for which surgical excision is recommended because there is a likelihood of malignant change in the long run.

Dermoid cysts These commonly appear and become obvious as lumps located at the corner of the eyebrow. There are other kinds of lumps which develop from the entrapped sebaceous secretion of skin or enlargement of the

hair follicle cells, but these are benign and can be excised completely with good outcomes. The wound heals well in children and the scar becomes faint over time.

Ear deformities The most common of these in children are accessory ear or skin tags which look like extra lumps in front of the ear, or pre-auricular sinus, which is present at birth. The accessory ear usually includes extra ear cartilage and the pre-auricular sinus appears as a dimple on the root of the ear. Both the skin and excess cartilage need to be excised, and the tragus reconstructed if necessary. The pre-auricular sinus needs to be excised with the tract in order to prevent infection.

Prominent ears tend to bother parents and child during the pre-school years because of teasing.

They can be set back by scoring and shaping the ear cartilage at the age of five to seven years when the cartilage is more firm and developed.

Other congenital problems Other less common ones include duplication of the thumb, fingers or toes. These can be corrected when the child is four to seven years old. Small and accessory digits can be excised, while the duplications can be reconstructed to form a more normal-sized digit by combining two smaller portions to achieve better form and function.

Dr Hong has a special interest in reconstructive surgery, microtia reconstruction and scar treatment. A visiting consultant, he also teaches in various public hospitals and has travelled overseas on volunteer medical missions.

Hong Plastic Surgery 38 Irrawaddy Road #10-38 Mt Elizabeth Novena Specialist Centre Singapore 329563 Tel: 6339 6210 www.hongplasticsurgery.com.sg

50

M marks the start of womanhood Young girls are either anxious or eager to experience menarche or their first menses as it marks the definitive start of the change from child to adolescent to woman.

By Dr Ann Tan, Obstetrician & Gynaecologist

B

efore the onset of menstruation, young girls are likely to experience breast development and the growth of pubic and axillary hair. As such, they are usually aware that their bodies are changing and will be anticipating that their menses will start soon after.

As pubic hair and breast buds will usually appear from age 10 onwards – the upper primary years – most young girls are particularly aware of breast development for a very practical reason: they first feel the need to wear singlets, before moving on to junior or sports bras and then actual adult-sized bras.

Whilst most mothers may not remember their own experience of menarche, or their first period, they can certainly be sensitive to their daughter’s physical or emotional changes and empathise with them.

Stick to the facts Factual matters about all these changes are dealt with in the schools’ sex education programmes, and most young girls will certainly be checking with their peers.

Demystifying puberty and menarche for your daughter will help make these life events and processes less forbidding. Not to mention countering the sometimes dire impressions and endless do’s and don’ts from well-meaning friends and family.

Menses tend to be irregular for most young girls during the first two years following the first menses.

The amount of time between a girl’s periods is called a menstrual cycle, which is counted from the first day of the menses to the first day of the next menses.

Menstrual cycles can vary from 21-45 days or even longer in the first two years, and then shorten to more regular 21-34 day cycles.

Cycles and mood swings The menses is considered abnormal when the period lasts longer than a week, or when one needs to change pads every one to two hours, or when one experiences bleeding between periods, or an unusual amount of pain that affects the daily routine. At this point, it would be helpful to seek a gynaecological review to determine if there is any pathological problem. Cycles that develop changes in their patterns are also a sign that you should take your daughter for a gynaecological review.

Perhaps for most mums, the bane of menarche is the moods that their daughters go through and the less than desirable acne problems which break out during this time. Some girls tend to be particularly sensitive and more apt to cry or get angry as part of the premenstrual syndrome (PMS). Th ey may

also feel bloated because of water retention or experience breast tenderness. PMS usually goes away once the menses starts. Eating right, getting enough sleep and exercising regularly can help to minimise PMS symptoms.

Young girls will invariably get used to the whole routine of using pads, tampons and panty liners, depending on their needs. The sooner they get comfortable and embrace their hormonal, physical and emotional changes, the more well-adjusted they are likely to be. And this will definitely help them make a smooth and effortless transition through adolescence and into adulthood.

This may also be the best time to consider protecting your daughter’s health with the HPV vaccination. For this to be meaningful, you need to be comfortable discussing issues such as personal values, self-respect, peer pressure, desirable behaviour as well as contraceptive advice with her.

It is always tough to accept that one’s child is growing into adulthood, and tougher still to have these conversations, but they must take place – because you love them and want to prepare them for life even as you protect them.

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

51

HEALTH DOSSIER Kids’ Health

Orthodontics for kids

There are many reasons to straighten a set of crooked teeth, including easier brushing, a more effective bite, clearer speech, improved lip position and even a better facial profile.

By Dr VicPearly Wong, Orthodontist

O

rthodontics is a branch of dentistry that deals not only with teeth alignment but also facial growth and dental development.

As children’s teeth progress through different stages, it is helpful to understand what to look out for and what might need help.

Birth to 6 years The first tooth can emerge between four months and a year from birth, and by three, most children have their full set of milk teeth. Orthodontic intervention is usually not required at this stage, though those born with a cleft lip or palate may require some form of treatment.

6-7 years Here’s when the permanent teeth begin to appear.

Orthodontic treatment is seldom prescribed at this age, but there are situations where some early intervention is needed. For instance, habits such as thumb-sucking or using pacifiers must be discouraged before the first adult front teeth emerge in order to avoid permanent misalignment. Lower lip trap, the habit of trapping the lower lip behind the upper front teeth, can cause protrusion of the upper front teeth if the habit persists. Early treatment with preventive devices may be recommended to help change the habits and prevent more serious problems from developing.

7-9 years This is the stage of mixed dentition, when the child is losing primary teeth and gaining permanent ones. For those who clearly require orthodontic intervention, early treatment gives the orthodontist the chance to guide jaw growth, ensure that both sides grow evenly and retain their shape, lower the risk of trauma to protruding front teeth, and correct harmful oral habits.

9 to 12 years Some children attain their full permanent teeth by age 12. Early detection of orthodontic problems makes correction easier.

Orthodontics can also help in modifying the upper arch expansion to help increase the size of the upper airway, modify speech problems arising from habitual tongue thrust, and modify the growth pattern of a child’s upper and lower jaws to correct

52

such issues as a short or long lower jaw, and asymmetry of the face.

How to tell if you child needs orthodontic help Here are some signs or persistent habits that may indicate it: • Retention of baby teeth (baby teeth taking longer than expected to drop out) • Difficulty in chewing or biting • Breathing through the mouth • Thumb/finger sucking • Crowding, misplaced or blocked out teeth • Jaws that shift or make sounds • Biting the cheek or roof of the mouth • Teeth that meet abnormally • Jaws and teeth that are out of proportion to the rest of the face

Finding satisfaction in making a difference to a patient’s life, Dr Wong focuses on modern treatment options and participates in missions to treat cleft palate children in developing countries.

Orange Orthodontics 304 Orchard Road #05-42/44 Lucky Plaza Suite Orchard Medical Specialists Singapore 238863 Tel: 6737 0544 www.orangeorthodontics.com.sg

Hernias and children

They can occur at any age, but most apppear in infancy, early childhood, and in the elderly, with 80% of those affected being male. Here’s what you need to know.

By Dr Charles Tan, General Surgeon

A

hernia is the protrusion of an organ – such as the small intestine, the colon or the bladder – through a weakness in the abdominal wall.

It occurs when the inner layers of the abdomen tear or weaken. This area may be congenitally weak or acquired as a result of excessive strain on the abdominal wall from heavy lifting, excessive weight gain, persistent cough or chronic constipation.

This weakened area allows the inner lining of the abdominal wall to bulge through and form a balloon-like sac. Consequently, abdominal organs may slip into this sac causing pain and other health problems.

Hernias can arise in men and women of all ages.

Most hernias are located near the groin, though they may also arise around the navel and through old surgical incisions.

Children A groin hernia in children can occur at any age, but the peak incidence is during infancy and early childhood with 80-90% occurring in boys.

About 3-5% of healthy, full-term babies may be born with an inguinal hernia and one-third of infancy and childhood hernias appear in the first six months of life. In premature infants the incidence of inguinal hernia is substantially increased, by up to 30%.

A hernia in an infant or a child will be seen as a bulge or a swelling in the groin. In boys the swelling might be seen in the scrotum. In many cases the swelling may only be seen during crying or straining. This may lead parents to assume that the crying is because of the hernia, whereas it is more often the case that the hernia appears because the child is crying for some other reason.

Groin hernias in children are prone to get stuck, which means that the lump does not go away when the child relaxes. Because this is quite common, most experts advise that groin hernias should be repaired as soon as possible after they are diagnosed. A hernia that does not reduce or go back in should be seen by a doctor urgently. This is because it may contain intestine that is in danger of strangulating. This is extremely serious and must be avoided at all costs. Even if the hernia goes back without any emergency operation, it should still be operated on at an early stage.

5 signs Your child may have a hernia if he/she has: • a lump in the groin • a lump that moves in and out • a lump that gets bigger • a lump that does not remain there permanently • a swollen abdomen with a lump in the groin Treatment Most hernias require surgery. Carried out under general anaesthetic, it may be day surgery or might involve an overnight stay. A small incision is made in the groin and the hernia sac is found. In children and babies it is sufficient to remove the hernia sac, as the hole in the abdominal muscle does not usually need to be repaired. It will close itself as the child grows. The incision made in the skin is usually closed using stitches that dissolve.

President of the Singapore Hernia Society, Dr Tan has performed more than a thousand operations, authored a bestselling book for medical students and is an Adjunct Professor at NUH where he has been voted best tutor.

Charles Tan Surgery 38 Irrawaddy Road #09-37 Mount Elizabeth Novena Specialist Centre Singapore 329563 Tel: 6684 3433 www.charlestansurgery.com

53

QV Special

Beautiful skin begins at childhood QV Kids is the specially formulated range of skincare products for children, developed by Australian skincare experts QV.

There is a story behind the name QV. In 1975 the Queen Victoria Hospital asked Gerald Oppenheim, a chemist and founder of Ego Pharmaceuticals, if he would create a specialist skincare product for their patients. Gerald agreed and QV skincare as we know it today was born.

Today, the QV brand has over 50 products and is trusted around the world. As pure and gentle as it was back then, the much-loved QV range consistently delivers high-quality products that have helped many families improve their skin health, and is Australia’s top Dermatological Skincare Brand.*

QV Philosophy The QV philosophy is to use only gentle ingredients that have a reduced chance of irritating delicate and sensitive skin.

That’s why QV products do not contain soap, which has an alkaline pH that can strip away the skin’s natural layer of protective oils. They’re free from fragrances, which are the major cause of skin irritation, especially for those with sensitive or dry skin conditions. QV products are also free of lanolin and colourants.

But while it is critical to avoid using unnecessary ingredients, it is equally important to include ingredients that are proven effective. QV uses “working” ingredients such as: • Glycerin, which works with the skin’s natural processes to improve hydration levels.

• Squalane, a natural component of the skin’s sebum, which boosts skin moisture and hydration while being non-irritating and good for suppleness.

• Light liquid paraffin, an emollient which promotes rehydration and suppleness.

• Soft white paraffin, an occlusive agent with excellent emollience.

The QV Kids Range This range was developed for the special needs of children. Suitable for dry and sensitive scalps, and eczema, the products are soap-free, fragrance-free, pH balanced, non-comedogenic, hypoallergenic and dermatologically tested.

54

QV Kids Hair Shampoo and Hair Conditioner Suitable for everyday use, this gentle foaming shampoo has added moisturiser to help rehydrate the scalp, and is suitable for dry, sensitive skin conditions. QV Kids Hair Conditioner is a rich and creamy solution that leaves hair clean, soft and smooth. Suitable for eczema and dry, sensitive or itchy skin conditions.

QV Kids Wash Gentle and non-drying, this wash leaves skin feeling soft and clean.

The absence of soap means that the skin’s hydration is maintained during cleansing. QV Kids Wash is pH balanced and free from lanolin, fragrance and propylene glycol, and suitable for children with all skin types including those suffering from skin conditions.

QV Kids Moisturising Cream Highly concentrated, non-greasy and easy to apply, this product is suitable for dry, sensitive and itchy skin. It contains vitamins A and E in colourful micro-beads that dissolve following application to the skin, making it fun to learn good skincare. It’s easy for children to apply, is absorbed quickly, hydrates dry skin and is suitable for those with eczema. Its pH-balanced, low-irritant formulation is free from fragrance, lanolin and propylene glycol.

QV Kids Balm This is gentle relief and effective moisturisation for extremely dry skin.

Because it is water-free, stinging and inflammation are reduced, as it seals in natural moisture by acting as a protective barrier.

The QV Kids product range is available at all leading pharmacies.

For more information, visit our website, www.egopharm.com, or contact us at +65 6562 7755. *Australian Pharmaceutical Index D02A - Emollients & Protectives Market MAT December 2013

LEGAL Spec Special ecia iall

When marriages end To ensure fairness and succcess, the right lawyer makes all the difference.

Divorce is never easy or painless. It marks the official ending of a relationship entered into based on the ideal of ‘forever’. Because it revolves around humans with all their complexities, it is often fraught with tension, accusations and counter-accusations.

Sadly, divorce rates continue to rise, with Singapore seeing more than 7,000 divorces per year.

Engelin Teh Practice LLC specialises in family law, although it also provides other legal services such as commercial litigation and conveyancing.

According to Ms Engelin Teh, the firm’s managing director and founder, not many lawyers are keen to take on divorce cases, partly because a high proportion of people seeking divorce cannot afford legal fees, especially if the process ends up being very long drawn-out with multiple court appearances, and partly because of the emotions that need to be handled.

“We are possibly one of the only firms doing this much of matrimonial work. You could say that we are a divorce specialist,” explains Ms Teh. As a Senior Counsel who is also a certified mediator and arbitrator, Ms Teh always hopes that mediation will triumph over acrimony in divorce proceedings. Some clients are amenable to mediation, others are not.

“Although we encourage reconciliation, by the time clients come to see us, it is usually too far gone.” Even then, mediation often provides a solution that saves months of heartache, sleepless nights and money.

When divorce is certain, the firm’s approach is based on fairness.

“You often hear about huge divorce settlements being won and lost.

But it is important to realise that most often, hurt and a sense of betrayal are behind the acrimony between a couple, and those emotions often drive the settlement demands. Some get caught up in the money, and use it to extract revenge on a spouse who has hurt them, or use the children as pawns in their battle against each other,” she explains.

Sadly, children are often used as weapons between couples at war.

“Kids are so often caught in the cross-fire. Often, the parent who gets care and control influences the child or children against the other parent,” she says, citing a few examples of petty or extreme behaviour unbecoming of rational adults. But then, divorce is one of life’s most stressful situations, and few of us can stay rational throughout the duration of such a situation.

And there are new dimensions today. “In the past, the biggest fight was over the children. Now it is over assets, and children are often used as bargaining chips. Divorces among high net worth individuals can involve

56

hundreds of millions of dollars in assets. Lawyers end up doing forensic work when one party denies the existence of assets, in order to deny a share of them to a divorcing spouse.” And there is another dynamic at play.

In the past few years, it is not only wives seeking the assets of their husbands, but the other way around. This is not just because women are more financially independent, but also applies to men who are married to women who inherited family wealth.

According to the law, if a wife has assets of her own or from her family, and her husband does not enhance the value of these assets, he is not entitled to a share in the event of a divorce. “Some men uphold their dignity and take a share only of what was jointly accumulated, but some want a share of the total assets. Under the Women’s Charter, wives are entitled to maintenance from husbands but not the other way around. There are, of course, husbands who advocate a change to this law.”

People expend a lot of money fighting over issues like this, says Ms Teh, who stresses that it is not about extracting the maximum from your spouse in order to feel vindicated, but about fairness. She cites an example of a client whose husband tried to hide millions of dollars’ worth of assets in a bid to deny his wife her share.

“In cases like this, we had to ensure our client obtained justice.

She fought for what belonged to her and was awarded a substantial share of matrimonial assets. After a certain point however, she ended the proceedings for peace of mind,” explains Teh. This case marked the firm’s biggest success in court so far.

Founded in 1994 under a different name, the firm prides itself on providing results-oriented high quality service. With an impressive track record of wins and satisfied clients, Ms Teh and her team are driven by the principle of ensuring clients receive fair treatment. “If, as is sometimes the case, we feel that their chances of winning are low, we advise them to save their money and keep their peace of mind instead of engaging in lengthy proceedings which will be expensive and most likely futile.”

Ultimately, the law can only do so much for you; much would, however, also depend on the lawyer who is fighting on your side.

Engelin Teh Practice LLC

20 Cecil Street #13-02 Equity Plaza Singapore 049705 Telephone +65 6224 9933 Email: legal@etplaw.com

FEATURE

c i m o n o r t s a G Gaffes

Behind every restaurant meal from Michelin-starred to mamak stall, there’s a story about misfiring stoves, power-shorted freezers and severed body parts.

Four of our favourite Singapore chefs reveal their worst moments in the kitchen.

By Desiree Koh

As a cook, your station, and its condition, its state of readiness, is an extension of your nervous system.

- Anthony Bourdain

In Kitchen Confidential, the first book to give unfettered access into the boiler room setting of the world’s top cookeries, Anthony Bourdain unfurled steamy and saucy scenes ranging from gory accidents to broiling tempers – a far cry from the placid, elegant dining rooms on the other side of the wall. Like recipes, professional kitchens are meant to function like clockwork based on a myriad of carefully measured parts that comprises prepping, cooking and plating, where one kink can undo an entire dish. At peak service playing to a full house, the proverbial hearth of the house transforms into a high-octane, high-heat pressure cooker where what can go wrong will go wrong, and the unexpected must be expected.

So it’s no surprise that in addition to a collection of their favourite knives, secret recipes and signature dishes, all chefs come with an arsenal of war stories and battle scars reflecting culinary disasters, crises and emergencies that take place daily behind the scenes.

The real pros ensure that what happens in the kitchen, stays in the kitchen – guests rarely have any inkling of how off-course their meals might have gone before arriving at the table.

To titillate the imaginations of those with a taste for Gordon Ramsay’s reality TV show Hell’s Kitchen, four of Singapore’s most beloved chefs reach into their aprons and pull out their worst kitchen moments to share.

57

FEATURE A

Starting out in his career at an exclusive French restaurant, modern Mediterranean chef Bjorn Shen was slicing pears on a mandolin during a lunch rush when the tip of his right ring finger “flew to the other side.”

Don’t leave a tip Bjorn Shen, Artichoke

“I was new on the job and didn’t want anyone to know, so I wrapped it up in layers of gauze and masking tape.

I slipped a finger cot over everything and carried on working, emptying it each time it ballooned with blood, and hiding it whenever someone passed my station. I was feeling nauseous from the loss of blood but pushed through the whole service.

After a chef noticed my big, swelling finger and sent me home, I refused to go to the hospital and crossed my other fingers that everything would be OK. I kept the masking tape on for two weeks out of fear that my fingertip would come back off if I removed it.

I could have gotten gangrene and had my entire arm amputated.

58

When I showered, I tried to protect it and every night I took off the gauze to let the wound breathe. Eventually, I unwrapped the masking tape and my fingertip had somehow reattached itself, good as new.

The best part is, the fingerprint lined up almost perfectly.”

Shen calls it “a real Frankenstein kind of story” but would not let such a serious accident pass without immediate medical treatment in his kitchen.

“When you’re 21 years old and trying to prove yourself, you’re a bit stupid as well, and do stupid things,” he recollects, insisting that even on hindsight, any physical pain was better than getting laughed at by colleagues.

Petrina Loh confidently mans the open kitchen of her contemporary small plates restaurant.

But at this year’s prestigious Copenhagen Cooking Festival, she and co-chef Bryan Chia arrived on site with one day to prepare for a collaboration dinner, their ingredients missing and Petrina running a 40-degree fever.

Race against time Petrina Loh, Morsels

“The missing ingredients were eventually tracked down to the festival’s main kitchen. We had to rush there and set up all over again, only to find that the 40kg of pork ribs and 40kg of bones for our bak kut teh were missing. We needed to get the stock going as soon as possible and were already four hours behind schedule. We had to re-order the items and finally started prepping at 3pm. Next, the mackerel for our otah noodle salad arrived not deboned and not yet skinned, so I had to do it for 7kg of small fish, while getting the bak kut teh stock going. Then our spring rolls went missing from the freezer, which threw everything into the next level of panic. They had been sent to another festival location because someone forgot to label the crate, and were eventually tracked down.

“This was a huge industrial-sized kitchen, compared to our small Morsels one which is basically one long counter. It was a feat to go from one point to another to get equipment and utensils – we worked through the night and only got done at 8.30am the next day. We slept for an hour at the hotel, then went right back to the kitchen to continue cooking.”

This series of epic emergencies had a happy ending: the 150-guest dinner, which featured innovative interpretations of classic Singaporean heritage dishes, went exceedingly well.

Up until now, Loh had never faced a kitchen crisis of such magnitude.

“You can only plan this much, but a lot of times, things can go awry,” Loh says. “Just embrace it and move forward!”

59

FEATURE A

Because experimental dessert chef Janice Wong is constantly tinkering and innovating with ingredients and techniques, any thought process she executes has apocalyptic potential, such as an oven-destroying attempt to fry chocolate. Wong is also known for her larger-than-life “edible art” installations, room-sized creations that redefine Willy Wonka fantasies.

Eventful edible art

Janice Wong, 2am: dessertbar “Once, we hung a rotating Christmas tree from the ceiling, applying 40kg of chocolate onto the wood then decorating it with 200 bonbons – the final creation weighed more than 80kg. We started working on it the night before the event it was commissioned for, and installed it on site by 10am the next day. Everything was going well when suddenly at three o’clock, the chain suspending the tree broke and everything fell apart. I was very calm, and stood looking at the crash for five minutes, plotting what had to be done next. Then, we dived into a very stressful rush,

60

re-doing in three hours what we had originally taken 24 hours to accomplish, including running out to gather all the ingredients and implements again. By the time the event started at 6.30pm, it had turned out as just well as its predecessor, and no one knew any different.”

Wong sees every snag and mistake in the kitchen as an evolution and necessary maturing, and learns more about the feasibility and architecture of her edible art with each project. Her trump card: “I don’t freak out – I never do.”

As the chef-owner of Singapore’s newest molecular interpreter of local heritage dishes, Han Li Guang’s practice is to provide diners with unexpectedly exceptional experiences.

This can sometimes backfire.

Disastrous degustation Han Li Guang, Labyrinth

“When we first opened, we were doing water balloons made of mozzarella cheese inflated with tomato consommé that we let drip for 12 hours. During dinner service, we were serving this as a starter to a group of three guests, and as with every fine dining setting, all dishes must be served at the same time. However, only two of the balloons were plated and the cooks sent them out to the group without notifying me. My sous chef then told me that we had completely run out of tomato consommé for the last balloon – something that takes 12 hours to make! Since we only serve prie fixe menus, it was even more difficult to substitute an alternative appetiser for

the third guest stranded without a dish.”

Fortunately, those three guests were the last reservation for the evening, and Han only had to pull his emergency move once.

Molecular gastronomy is typically a chef performing magical tricks and techniques on ingredients but often, he has to pull a miracle out of his toque, too.

“I somehow managed to produce a consommé within the next 15 minutes to fix the situation – I still don’t know how I pulled it off in pure panic with disaster looming over the full house, worrying about how crucial good first impressions are for a very new restaurant!”

61

MONTBLANC Special

When tradition meets

cutting edge In Montblanc’s new Extreme Collection, craftsmanship comes together beautifully with technical innovation, to enhance and withstand fast-paced urban lifestyles.

62

Active, dynamic and with an impeccable sense of style – the urban adventurer’s fast-paced lifestyle demands being dressed and accessorised with highly functional, elegantly designed pieces, made for durability as much as looks.

The latest Montblanc Extreme Collection is a perfect match for the exacting standards of this modern day achiever.

Pushing the boundaries of its leather products, Montblanc’s new generation of sleek, dark leather accessories balances style with functionality through technical innovation and distinctive contemporary designs.

The highlight of Extreme is a new composite calfskin leather material, created with enhanced resistance and repellence to abrasion, heat and water. This key material is crafted by Montblanc’s artisans into elegant pieces in an aesthetic study in black on black.

The leather’s dark textured matt is skilfully contrasted with the sleek deep black of the metal fittings – with the lightweight anodised aluminium juxtaposed against the warmth of the natural material.

The classic Montblanc emblem is the crowning touch on the final product. From the smallest gadget cover to the largest shoulder bag, it is the unmistakable seal of quality and excellent workmanship.

Masters of leather artistry Montblanc’s quest for leather crafting excellence began in 1935 with the opening of its own leather workshop in Offenbach, Germany; and was reaffirmed in 2006, when it established the Montblanc Pelletteria, a Centre of Excellence for leather craftsmanship, at the outskirts of Florence, in Scandicci.

This idyllic town, known for its cluster of historical churches, has a rich history as the centre of the Italian leather trade, being home to many Florentine tanneries along the nearby Arno River. This is also where the team of artisans from Montblanc Pelletteria sources for the most exquisite materials, and draws upon the well-honed skills of Italian craftsmen of the area.

63

MONTBLANC Special

64

The Montblanc Pelletteria brings together these traditions where they can be preserved and advanced with the help of present-day knowledge, via an extraordinary array of cutting-edge equipment and quality control processes.

Over the years, there have been many leading and advanced technologies and techniques pioneered by the luxury maison. Take for example the hot and humid conditions of Asia. Such an environment can be simulated in climate chambers to test a product’s durability. A one-armed robot bears a shoulder bag, quietly testing the endurance of the sling strap to ensure that all quality standards are stringently met.

This is what creates the Montblanc’s hallmark; flawless workmanship and unrivalled quality in every minute detail, from the stitches to the finishes.

Facing the elements Through advances in materials science, Montblanc developed a technique to create highly durable, black calfskin leather that is textured with a subtle weave pattern.

Unlike normal leather treatment, the Extreme Leather is conjoined – and not merely coated – with a protective element, making the quality hide intensely resistant to abrasion, water and fire.

To ensure high performance, this composite material is meticulously tested at every stage of its development, for light fastness, tear strength, heat, wear and abrasion; all in keeping with Montblanc’s promise of delivering a leather accessory that serves as a fine lifetime companion.

By developing this unique “made in Germany” method of dressing and finishing, every accessory in the new collection is endowed with additional protection against extreme wear and tear.

A timely taste of the Extreme The world first got a glimpse of the Extreme Leather early this year, with the release of Montblanc TimeWalker Extreme Chronograph DLC, launched to mark the second decade of this iconographic watch line.

This particular timepiece is also called Extreme for its durability-enhanced stainless steel parts and Extreme Leather strap.

The metal casing and other external steel components are specially tempered with a highly protective Black 4 DLC coating for greater resistance to hard wearing.

Protective “diamond-like carbon” (DLC) microbeads are blasted onto the metal surface to form an almost inseparable coat, which also gives a smooth, matt finish in Black 4 – the code for “very black”.

Then there is the clean-lined, checked-textured and exquisitely crafted watch strap, featuring the state-of-the-art high-performance Extreme Leather in a matching black hue. Adding strength and flexibility is an inlay made of the tough yet highly elastic “Vulcarboné” cautchouc (vulcanised rubber). Threading all the layers firmly together to form the final wristband is breakage-resistant black twine.

The completed Montblanc TimeWalker Extreme Chronograph DLC is a showcase of Montblanc’s depth of experience in design excellence, traditional craftsmanship and modern science – imbuing comfort and functionality for the wearer, without compromising on its signature of timeless elegance.

Elegance in luxurious functionality Fast-forward two calendar quarters and the prowess of the TimeWalker Extreme Chronograph DLC is now etched into an entire collection of lifestyle accessories, giving every modern adventurer the style and confidence to face the elements of the urban outdoors.

The new Montblanc Extreme Collection pays strict attention to detail. Smaller leather pieces like the passport holder, business card holder and wallet, are well constructed using Extreme Leather as an outer shell, and lined with a luxuriously soft, natural Italian cowhide on the inside.

The larger leather goods are also similarly lined, except for the larger bag compartments where Neoprene – a highfunctioning synthetic material – is used to give briefcases, bags and rucksacks extra protection and cushioning.

Thanks to both its softness and thickness, modern devices like laptops, smartphones and other mobile gadgets can be kept safe from the rigours of everyday transport and handling.

65

SCOTTS MEDICAL CENTER Special

Healing in the heart of town A dedicated medical facility joins the ranks of the well-located in Singapore’s famous Orchard Road.

Orchard Road is Singapore’s retail and lifestyle mecca.

With shopping malls, major department stores carrying a multitude of high-end brands to one-of-a-kind products, abundant hotels, restaurants, cinemas and entertainment centres sitting glamorously on a mere 2.2km-long street, it’s hard to challenge this claim.

The greater Orchard Road area, however, is also reputed for a different reason, that of being home to the country’s de facto private medical facilities cluster.

Besides distinguished medical institutions like Mount Elizabeth Hospital, Gleneagles Hospital, Paragon Medical and the nearby Camden Medical Centre, there are also numerous private and specialist clinics across the entire stretch, catering to a mix of well-heeled local patients, executives working in the area, expatriates and medical tourists.

As demand for discreet, private and easily accessible healthcare in the city centre increases, so does the need for more dedicated spaces for medical practices, treatment and recuperation. Scotts Medical Center (SMC) is one of the most recent to meet this need.

The Healing Space Opened in 2013 on the 6th to 12th floors of Pacific Plaza along Scotts Road just off Orchard Road, SMC occupies the extensively refurbished upper-half of the building, with 44 exclusive and meticulously planned medical suites. These range from 496 sq ft to 6,671 sq ft (amalgamated size).

The medical centre is designed to provide a stylish yet comfortable environment to positively impact patients’ well-being. It is noteworthy for thoughtful touches, such as dedicated lifts which serve only the seven medical floors, bypassing the retail zone at the lower levels.

This offers much-appreciated privacy.

Location, location, location Being centrally located enables easy cross-referrals for medical practitioners to the various hospitals, medical labs and specialist clinics in the immediate vicinity, as well as the nearby Novena medical cluster – where Tan Tock Seng Hospital, Mount Elizabeth Novena Hospital, Novena Specialist Center and Novena Medical Center are situated.

66

first stop Xiamen

The location is also a plus for patients and visitors.

It is well-served by buses and taxis, and only a short walk from Orchard MRT station. With a wide choice of serviced residences and hotels in the area, suitable accommodation for international patients and their families is easily found.

The Tenants SMC currently has reputable names such as the Thomson Group’s Thomson Well Women Clinic and Thomson Women Imaging and Virtus Fertility Centre*. Other medical services include: - Aesthetics - Clinical TCM Services - Dentistry - Dermatology - Orthodontics - Pain Management - Periodontology - Prosthodontics - Psychiatry * Virtus Health is Australia’s largest IVF provider.

Occupying the 9th floor of SMC as Virtus Fertility Centre, this is their first Virtus-branded fertility centre in Asia. They will open in December 2014.

Scotts Medical Center 9 Scotts Road, Levels 6-12 Pacific Plaza, Singapore 228210 www.scottsmedicalcenter.com.sg

WELLNESS W WE L NEESS LL SS & H HEALTH EALLTTH U EA Up Update pda d te te

SPECIALIST Dr Colin Tham Dr Lau Chee Chong Dr Cheong Lai Leng Dr Leo Seo Wei Dr Francis Seow-Choen A/ Prof Luke Tan A/ Prof Leong Keng Hong Dr Lim Hwee Yong Dr Leslie Kuek Dr Wendy Teo

1

P68 P70 P72 P73 P74 P76 P78 P80 P81 P82

Dr Kelly Loi Dr Tay Khoon Hean Dr Wong Su-Ni Dr Tan Kok Liang Dr Ruth Kam Dr Ho Kok Sun Dr Chen Chern Yi Dr Karen Sng Dr Goh Hak-Su Dr Ann Tan

PINIONS P84 P85 P86 P88 P90 P92 P93 P94 P96 P98

Dr Colin Song Dr Bernard Lim Dr Christopher Ng Dr Leo Kah Woon Dr Lim Yi Jia Dr A B John Dr Ho Chee Khun Dr Elaine Chee Dr Michele Lee

P100 P101 P102 P103 P104 P106 P107 P108 P109

SPECIALIST

OPINION

Fat removal made easier Vaser LipoSelection is a targeted minimally invasive method of removing body fat that promises more reďŹ ned shaping with a shorter downtime.

By Dr Colin Tham, Plastic Surgeon

68

Vaser LipoSelection is ultrasound-assisted Liposuction, an advanced technique of removing unwanted fat from the body. Instead of using traditional suction and physical force to remove fat, Vaser uses patented internal ultrasound probes combined with advanced surgical techniques to achieve better contouring with less recovery time.

This minimally invasive procedure begins with an injection to the targeted area with a specially formulated solution via a technique known as tumescent anaesthesia. This solution shrinks the local blood vessels to reduce the likelihood of bruising, while numbing the area for the patient’s comfort. The fluid also expands the volume of the treated area, making the fat cells in the region easier to remove.

This done, fine probes are inserted into the skin to deliver ultrasound energy into the fatty layer.

High-frequency ultrasound waves from these probes selectively “melt” the fat, sparing the nerves, blood vessels and other important structures from damage or inflammation. The fat that is broken down, or emulsified, is removed from the body through small tubes using a combination of gentle massage and suction. Although patients can choose to watch the procedure, most prefer to be lightly sedated.

Owing to the precision of the technique, only fat is targeted, leaving nerves and blood vessels intact.

Consequently, patients experience less pain, bruising and swelling, and can usually return to work within one to three days. Since the procedure destroys only the fatty tissue, the results are smooth, shapely and predictable.

In contrast, traditional liposuction uses the physically demanding process – for the patient and the surgeon – of avulsion, in which forceful thrusting movements of the suction cannula are employed to break up the fatty deposits. This often results in trauma to the surrounding tissue. This accounts for the pain, bruising and extended recovery time that typically follows traditional liposuction. This method is also known to sometimes result in uneven skin texture.

Next gen sculpting technology The next evolution of Vaser LipoSelection is Vaser Hi-Definition Liposculpture (VAHDL), pioneered by Colombian plastic surgeon Alfredo Hoyos.

As this technique involves creating athletic-looking toned bodies through the sculpting of existing fat,

it requires additional expertise and finesse on the part of the surgeon, as well as additional time and special equipment. This procedure involves removing the bulk of the fat, followed by superficial and deep liposculpture that reveals itself in contours such as an abdominal six-pack or more defined biceps.

It requires the surgeon’s knowledge and ability to decide which fat can be retained and sculpted to maximum effect, and which should be removed. Vaser technology makes this possible.

The procedure is conducted under local or general anaesthesia, depending on the size of the area being treated.

Patients have responded enthusiastically to these approaches, mainly because of the results and the fact that their downtime is less severe and shorter compared to conventional methods.

These procedures are considered suitable for destroying stubborn fatty deposits and removing inches from certain areas, and attract a very wide range of patients, from young adults to adults over 70. Women comprise about 70% of patients, with the most common sites being the tummy, thighs, buttocks, arms, double chin and jowls.

Men typically seek fat removal from the tummy and double chin, as well as to reduce the appearance of male breasts. In fact, most VAHDL patients are men seeking six-packs and greater chest definition.

In both procedures, early results are immediately visible after the procedure. Once the swelling subsides within a week or so of the procedure, the results become increasingly dramatic. There are some temporary side effects, namely, mild pain, bruising and swelling, which may be treated with medication. Pressure garments are sometimes prescribed, depending on the area treated. Needless to say, a proper diet, exercise and lifestyle regime will maintain the surgical results. Risks are minimal in the hands of trained plastic surgeons.

In VAHDL cases, athletic definition created by the technique continues to be enhanced until the second month. Vaser technology has made it possible for surgeons to: • • • • •

offer enhanced techniques for body contouring provide excellent predictable outcomes permit faster recovery minimise trauma to surrounding tissue ensure ease of use and surgical control

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

69

SPECIALIST

OPINION

Sinus surgery explained Today’s methods are described as minimally invasive, but that doesn’t mean complex surgeries are excluded. Here’s a quick guide to the procedures and the reasons for them.

By Dr Lau Chee Chong, Ear, Nose & Throat Specialist Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils.

Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally invasive, maximally effective The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

Endoscopy has been described as “minimally invasive”. This may be a bit misleading, as the words suggest that the endoscope is limited to simple procedures. In fact, very complex surgery may be performed endoscopically and without external scarring, swelling, superficial trauma, pain and with reduced blood loss. The hospital stay is also greatly reduced.

ESS is most commonly performed for sinus infections.

Sinuses are bony cavities surrounding the nasal passages and are connected to them by small openings called ostia. Infection to these sinuses occurs usually with any common cold and usually clear spontaneously within a few weeks, with or without medication. Surgery in such cases is not recommended.

What is sinusitis?

During a common cold, the lining of the sinuses is often swollen and filled with fluid as the sinuses respond to infection by producing more mucus to “flush” and “cleanse” the nose. X-rays, CT scans or MRI will show these areas as shadowed, and the diagnosis will often be “sinusitis”. Such imaging is neither necessary nor recommended for common colds or even shortly after colds. This also reduces unnecessary exposure to radiation, or worse, unnecessary surgery. Such imaging is only needed if the doctor suspects complications, if the infection fails to resolve, or if the patient has a history of recurrent or chronic sinus infection and the doctor wants to identify any abnormality that may require surgery.

70

Sinusitis tends to occur more commonly in individuals with/in the following conditions: nasal blockage from enlarged nasal turbinates; deviated nasal septum or structurally narrow sinus openings; nasal polyps or allergic rhinitis; living in polluted environments; smokers.

The first line of treatment involves treating any allergies medically and making lifestyle changes, such as smoking cessation and minimising exposure to allergens and pollution. Surgery may be considered for structural abnormality or nasal polyps which are compromising drainage and ventilation of the sinus, causing recurrent or chronic sinusitis. This is like an inadequate drainage system that leads to stagnation and floods in a city.

ESS is commonly used for: • • • •

• •

Removing nasal polyps Removing blockages in the nose Treatment of nasal neuralgia or sinus headache caused by pressure on sensory nerve Treatment of sinus barotrauma (such as the sinus pain that sometimes occurs in flights or while scuba diving) Removal of benign or cancerous tumours of the nasal cavity or sinus As an approach to the base of the skull, brain and eyes (performed with brain or eye surgeons)

Image-guided surgery (IGS) involves feeding data from CT or MRI scans into a computer system which creates a 3-D “map” of the head. The surgeon operates with the computer system, which helps to guide the instruments in real time, very much like GPS. The system warns of possible dangers ahead when the surgeon’s view may be masked or obstructed by disease, tumours or deformities. IGS is more useful in complex surgeries.

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

Skin on fire Red, scaly, itchy and often painful eczema is a common skin condition that can cause troublesome discomfort to sufferers.

By Dr Cheong Lai Leng, Dermatologist

Often appearing as red, bumpy and peeling patches of skin, eczema is a common skin disorder also known as dermatitis – “derma” for “skin” and “-itis” for “inflammation”. It is not infectious, but causes severe itching and can be caused by internal or external factors.

Genetic eczema Eczema due to genetic factors is known as endogenous eczema. This form of eczema is chronic and recurrent.

Often, endogenous eczema sufferers may also have other hypersensitive conditions such as allergic rhinitis, allergic conjunctivitis or asthma.

Three of the most common sub-types of endogenous eczema are: •

•

•

72

Atopic eczema: This condition often starts in childhood and affects about 20% of school children in Singapore. The rashes are severely itchy, red, dry and scaly and can appear on the limbs, knees and elbows, as well as on the scalp, eyelids, ears, trunk, fingers and toes. In some cases, the affected skin becomes wet and weepy, or painful.

Asteatotic eczema: This form of eczema causes cracking and mild peeling of the skin and typically affects older people. It is due to dryness of the skin which is a natural part of ageing.

Discoid eczema: Discoid eczema causes circular red patches of little blisters or red spots that develop into pink-red, dry and scaly itchy patches. It tends to occur in young people and may be precipitated by insect bites.

The condition can be triggered by exposure to extremes of weather, excessive exposure to sunlight, dust, friction, harsh soaps and cleansers, and viral infections such as the flu and stress. Treatment involves a multi-pronged approach. Apart from avoiding aggravating factors and triggers, eczema sufferers should also take gentle and appropriate care of their skin. This includes avoiding long hot showers and opting for lukewarm quick showers instead, using gentle, soap-free shower cleansers and not scrubbing the skin. Regular application of moisturiser is essential. Mild eczema that is not extensive can be treated with steroid creams or antihistamine pills. In more severe cases, the use of light therapy (phototherapy) or oral medication that impacts the immune system, such as steroids, may be needed.

Environmental eczema Allergens or irritants in the environment can also cause eczema. Allergic contact dermatitis is due to skin contact with a substance that the sufferer is allergic to, such as perfume or nickel. In this case, a diagnosis can be made through a careful and detailed history and a patch test. Here, individual suspected allergens are applied to the skin in tiny concentrations and the point of contact is then observed for a reaction. Irritant contact dermatitis is due to repeated exposure of the skin to irritants. The most common irritant in our environment is water. Frequent exposure of the hands to water – as is the case with chefs and housewives – results in chapping of the skin. If the exposure continues, the skin of the hands becomes dry, inflamed and itchy and full-blown dermatitis develops. Apar t from treating the inflammation of the skin, it is vital that the hands be protected from the excessive exposure to water by the judicious use of gloves for wet work.

These skin reactions can be managed with steroid creams, moisturisers, oral antihistamines and the avoidance of skin contact with the identified allergens or irritants.

Living well with eczema Lifestyle changes are important in managing and preventing eczema. These good habits are helpful in preventing eczema from flaring up, or preventing the condition from worsening: • Avoid excessive exposure to sunlight, particularly between 10am and 4pm.

Use sunscreen and protect skin with hats, sunglasses and clothing • Moisturise skin liberally at least twice a day after showering • Maintain general health with adequate rest, exercise and a healthy, balanced diet • Do not smoke as smoking is detrimental to skin health • Manage stress well as eczema is often aggravated during stressful periods

Dr Cheong Lai Leng LL Cheong Skin & Laser Clinic 3 Mount Elizabeth #09-09 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6836 1480 www.llcheongskin.com

SPECIALIST

OPINION

Misaligned eyes This condition, known as strabismus, can be treated surgically, resulting in many beneďŹ ts for the patients.

By Dr Leo Seo Wei, Ophthalmologist

There are many different types of strabismus, described by the direction of the misalignment.

It is sometimes called wandering or wall eye when the eye turns outward, or crossed eye when the eye turns inward, or deviating eye, where one eye is looking at the target and the other eye may be horizontally, vertically and rotationally misaligned. Sometimes it is a combination of misalignments.

Often, it is constant, which means the same eye is always deviating. Occasionally, it is intermittent and noticeable only at times. It can also alternate, sometimes the right eye is the culprit, sometimes the left.

Strabismus is more common in people with a family history of the condition, and children who were born prematurely. Most of the time, it is the result of an abnormality of the neuromuscular (including brain) control of eye movement. Uncorrected farsightedness and focusing problems are other possible causes of strabismus in children. Some children are born with a defective visual processing centre in the brain.

An adult may have strabismus that persisted from the time he or she was a child, and it was either unsuccessfully treated in childhood or has recurred after a period of time. Adults can also face it as a result of other conditions, including loss of vision in one eye as a result of diseases in the eyes such as glaucoma, or retina abnormalities; trauma to the eye or eye socket, causing damage to the eye muscles or the nerves that send messages to move the eye muscles; neurologic disorders, such as strokes and head trauma that affect the signals from the brain to the eye muscles; or other medical conditions such as diabetes or thyroid disease, in which the muscles or nerves that move the eyes do not function properly.

Signs and symptoms Family members are usually the first to notice that a child’s eyes are misaligned. Some signs of strabismus are unusual head tilting or face turning, squinting, closing one eye when gazing carefully at something or going into the sun, clumsiness, or the appearance of not looking directly at the object of regard.

Older children and adults will frequently complain about double vision and loss of depth perception.

Treatment Strabismus cannot be outgrown, and treatment to straighten the eyes is required. It is never too late to restore normal alignment to the eyes, and treatment will depend on the type of strabismus and its cause.

Some cases respond very well to glasses.

There are many positive and life-changing reasons to treat this condition. Straightening crossed eyes improves vision, aligns the eyes and head, enlarges the visual field and restores depth perception.

This means that double vision is eliminated and a sense of well-being restored. Since eye contact is so essential in human interaction, having straight eyes is important psychologically and socially as well. Treatment improves self-image, ability and confidence to interact, and enhances employment opportunities.

Surgery for strabismus is typically an outpatient procedure and involves loosening or tightening the muscles that move the eye from side to side.

This will change the pull of the eye, and correct the condition.

Dr Leo Seo Wei Dr Leo Adult & Paediatric Eye Specialist Pte Ltd 3 Mount Elizabeth #11-12 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6737 8366 www.drleoeyespecialist.com

73

SPECIALIST

OPINION

Colon cancer in young people A family history of colon cancer doesn’t just put one at risk of the disease – but at risk of getting it earlier, too. Awareness of risk and regular early screening is essential to spot the cancerous enemy before it invades.

By Dr Francis Seow-Choen, Colorectal Surgeon

74

SPECIALIST

OPINION

Cancer, particularly colon cancer, is a condition typically associated with older people. However, it is not unusual to see patients who are below 40 diagnosed with it.

As many as 10 to 15% of all colorectal cancer cases may be these patients. Hereditary cancers such as some colorectal cancers, breast cancer and ovarian cancer, by definition, tend to occur before the age of 40 years.

Around the world, the incidence of colorectal cancers occurring in younger people seems to be rising. This is partly the result of improved diagnosis due to earlier screening that picks up the cancers earlier. Other factors which may cause this rise in young cancers include increased exposure to harmful environmental and other cancer-causing agents. Better treatments for patients with genetic cancers also mean better prognosis, with the ability to conceive and perhaps pass on the genes.

A family history There are two main groups of patients who develop colorectal cancer at a younger age. The first and most important group are those who have a family history of colorectal or associated cancers. People who are born to parents who carry gene mutations that can cause colorectal cancers have a higher risk of getting the disease than someone without a family history.

There are two main groups of familial colorectal cancers.

The first group, which makes up about 1-2% of all colorectal cancers, are those carrying an autosomal dominant gene called the familial adenomatous polyposis (FAP) gene. This gene causes hundreds, if not thousands, of colorectal polyps to start developing in the colon of affected individuals in their early teens.

Some of these polyps will become cancerous before these people reach their 20s. The other sorts of genes are those seen in patients harbouring the hereditary non-polyposis colorectal cancer (HNPCC) gene. There are two sub-groups of such genes. The first only causes colorectal cancer. The second may be associated with other sorts of cancers like breast cancers, female genital tract cancers, urinary tract cancers and endocrine gland cancers. People with these genes often develop colon cancer in their 30s or 40s.

Genetic mutation The other group of patients who develop colorectal cancer at a younger age are those who do not have a family history of colorectal cancers, but through genetic mutation, genetic interaction between the parents’ genes, or interaction with cancer-causing substances in the environment, develop the disease. Some colorectal cancer-causing substances include azoxymethane and dimethylhydrazine, substances found in petrochemicals.

Treatment options Surgery is the primary treatment of choice for colon cancer. Early-stage cancers can be treated with surgery alone, but late-stage cancers may require chemotherapy and/or radiotherapy, depending on the location and stage of the cancer.

The best “treatment� however, is screening and prevention. If one has a known family history of colorectal cancer, definitive genetic testing should be performed. Alternatively, early routine colonoscopic examination should be carried out before the onset of symptoms or the appearance of cancer about 10 years earlier than the youngest affected member of the family. This will enable preventive steps to be taken to remove pre-cancerous benign polyps or detect early cancerous changes before invasive cancer sets in.

Patients with a known family history and showing colorectal symptoms should be seen by a doctor immediately without delay .

It is important for patients with FAP to screen for colorectal polyps in their teens. If colonic polyps are present, surgery to remove the entire colon may needed before cancer develops. For patients in families with HNPCC, colonoscopic screening should start early, ideally 10 years before the age of the youngest affected member of the family. For instance, if an uncle developed colon cancer at age 35 and is the youngest in the family to have cancer, screening for any younger members in the family should start at 25.

This screening and early detection is essential as younger patients with colorectal cancer have a worse prognosis than older patients. The five-year survival rate for patients aged 30 or younger is about 25 to 30%. This may be because young patients with colorectal cancers are more likely to present with late-stage disease as they are often misdiagnosed as having benign problems like irritable bowel disease and piles. Younger patients also tend to have higher grade tumours which are poorly differentiated (fast-growing and highly abnormal tissue), or mucus-filled tumours which carry a very poor prognosis. Patients under 40 with colorectal cancer often have aggressive tumours that spread quickly.

However, familial cancers are the most preventable as they are in a group that should be screened at an early stage. Furthermore, people in such families should have a wider awareness of their genetic background.

Timely investigation and early treatment will ensure appropriate treatment resulting in an extremely good prognosis for such people.

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

75

SPECIALIST

OPINION

Taming the thyroid Growths in the thyroid gland – a butterfly-shaped organ in the throat – though often benign, can be of concern and easily remedied with surgery.

By A/Prof Luke Tan, Ear Nose & Throat – Head and Neck Surgeon Situated in the lower part of the neck with two “winged” lobes on each side of the windpipe, the thyroid is responsible for producing key hormones that regulate the body’s metabolic rate, heart function, digestion, muscle control, brain development and bone. The amount of these hormones needs to be “just right” and a malfunction in the thyroid can cause several health problems. In the case of hypo- or hyperthyroidism, the balance of hormones is thrown off, causing abnormalities in body functions. In cases of hypothyroidism, the metabolism often slows, resulting in chronic fatigue and sluggishness, among other symptoms. In the case of over-production, or hyperthyroidism, an abnormally high metabolic state results, causing signs such as sudden unexplained weight loss, a swelling at the base of the neck (goitre), insomnia and a rapid heartbeat.

Detecting thyroid nodules Apart from these hormone abnormalities, the thyroid gland can enlarge or grow thyroid nodules. The majority of these nodules don’t cause any problems and are noncancerous. These nodules can be solid or filled with fluid.

While harmless, nodules that grow larger can cause some problems. Because they are located at the throat, large nodules can compress the critical structures of the windpipe or food pipe. This may in turn cause difficulty in breathing or swallowing. If the voice box is compressed, there may be a change in voice.

There are some nodules that are cancerous and present as a symptomless neck mass. However, since thyroid cancer can invade the surrounding structures, it is always best to have early detection and removal.

In thyroid cancer, the same symptoms of difficulty in breathing or swallowing and voice change may also occur if the growth compresses the structures of the throat. Moreover, the cancerous (malignant) growth can spread to the lymph nodes or to surrounding tissue and to other parts of the body.

A thyroid nodule or cancerous growth can be detected during a routine medical check. Your doctor

76

may advise you to monitor the nodule if there are no suspicious features and a needle biopsy suggests it to be a non-malignant nodule.

Surgery for thyroid nodules and cancer Surgery is the cornerstone treatment of thyroid cancers. This is followed by nuclear radioactive iodine therapy and then long-term medication.

The procedure to remove a thyroid mass is typically done under general anaesthesia. An incision is usually made in the neck following the creases around the neck.

More novel ways in recent years have been to access the gland thyroid via the armpit or from behind the hairline with the use of special equipment and/or robotic arms to result in a more cosmetically appealing outcome.

Thyroid surgery incurs some risk because the organ is close to several other glands and nerves. One possible complication is a change in the voice as the voice box and its nerves are in close proximity to the thyroid gland. Another is blood calcium abnormalities if the close-lying parathyroid glands (organs that produce calcium-regulating hormones) are affected during surgery.

Surgery, nevertheless, is safe and effective in solving issues such as uncontrolled hormone dysfunction, large compressive thyroid masses and for cancer. In fact, the cure rates are extremely favourable in the latter case and have a 90% success rate for up to 25 years after surgery – a result that is as good as a cure!

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

EN031_QPFC FAP.pdf

C

M

Y

CM

MY

CY

CMY

K

1

22/09/2014

18:59

SPECIALIST

OPINION

Lupus: the “disease of many faces�

Named for the wolf because the disease is said to cause scarring rashes that look like wolf bites or because it devours affected parts, the many meanings of lupus are surpassed by its many disguises.

By A/Prof Leong Keng Hong, Rheumatologist

78

SPECIALIST

OPINION

There’s no single way to diagnose systemic lupus erythematosus (SLE) or lupus. The disease of many faces affects the skin, joints, kidneys, haematological system, lungs, blood vessels, brain, gastrointestinal tract, heart and more. Diagnosis is based on a range of criteria such as blood tests for auto-antibodies, cell counts and kidney function, as well as tissue biopsies of the affected organ.

The enemy from within At its core, SLE is an autoimmune disease, meaning that the body’s immune cells attack its own healthy tissues, leading to inflammation and tissue damage.

If not suppressed, this causes a range of complications over time, including: Kidney damage: Up to three out of four people with lupus can develop kidney problems.

Heart problems: Lupus can cause inflammation of the sac around the heart and increase the risk of arterynarrowing plaque.

Lung inflammation: Some people with lupus may suffer from this, leading to painful breathing, chest pain, cough and breathlessness.

Digestive problems: Though uncommon, lupus can cause belly pain, nausea, vomiting, difficulty swallowing, or inflammation of the liver or pancreas.

Anaemia and blood cell problems: Lupus can affect the red blood cells, white blood cells and platelets, and the medications used to treat it can contribute to anaemia and abnormal blood cell counts in some patients.

Nervous system disorders: Lupus can trigger a wide range of nervous system issues such as headache or mild memory problems. Some people with lupus have a greater risk of stroke, and in rare cases, seizures.

Mental health concerns: Depression and anxiety are a risk and may be the result of the condition’s effect on the nervous system or due to the emotional strain of coping with a chronic illness.

Pregnancy complications: The condition increases the risk of complications during pregnancy.

Speak with your rheumatologist to discuss the best time to conceive and to modify the medications prior to conceiving.

Risk factors and symptoms SLE is estimated to affect 0.5% of the population and tends to be more severe with people of Oriental and

Afro-Caribbean origin. It affects women 10 times more often than men. Aside from being female, your odds of getting the disease are higher if you are: • • •

of African-American, Latino or Asian descent aged between 20 and 40 from a family with a history of lupus There are many manifestations of SLE:

Joint pain: Joint and muscle pain, particularly in the joints of the wrists, hands, fingers, and knees, are often the first signs of lupus. The joints may look inflamed and feel warm to the touch. Unlike rheumatoid arthritis, lupus usually does not cause permanent joint damage.

Butterfly rash: A distinct sign of lupus is a butterflyshaped rash across the cheeks and bridge of the nose.

Other skin problems include sensitivity to the sun with flaky, red spots or a scaly, purple rash on the body, face, neck and arms. Some people develop mouth sores.

Fever and fatigue: Lupus causes some degree of fatigue severe enough to interfere with daily activities. Most patients also run a low-grade fever from time to time, which may be the only warning sign in some people.

Light sensitivity: Lupus causes unusual sensitivity to the sun and other forms of ultraviolet light causing skin rash.

Hair loss: Hair may fall out in patches or become thinner. Post-flare up, new hair tends to grow back.

Raynaud’s phenomenon: Painful, numb, and tingly fingers and toes triggered by cold temperatures or emotional stress. This happens when small blood vessels spasm and restrict blood flow, causing the affected parts to turn red, blue and white at the same time.

Living with lupus While there is no cure, the condition can be managed. People with severe lupus may benefit from immune-suppressant drugs that restrain the mutinous immune system. Doctors are now able to better balance disease control with the side effects of treatment.

Lifestyle changes are also important. These include adequate sun protection, avoidance of smoking, regular exercise, a healthy diet, stress management and plenty of rest. Some people with lupus need up to 12 hours of sleep a night. This multi-modal approach has helped people with lupus live significantly longer and healthier lives.

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

79

SPECIALIST

OPINION

Molecular and genetic frontiers of cancer treatment As more is understood about the make-up of genes, and technology allows oncologists to see the ďŹ ner details of the micro-molecular and genetic structure of cancer cells, treatments now attack rogue cells at the very core.

By Dr Lim Hwee Yong, Oncologist

One of the hallmarks of cancer is the way the cells behave. Normally, cells grow and divide, forming new ones only to maintain the state of health. Old cells die and new cells take their place. However, sometimes a single cell may mutate in a way that results in uncontrolled and unorganised growth of one mass of cells with the destruction of other healthy functional cells. These disordered masses of cells are named cancer cells. They occur as a result of factors such as exposure to environmental toxins, dietary cancer-causing chemicals, excessive radiation or genetic predisposition.

Genes & molecules Firstly, the network of chemical and molecular signals that maintain the cells in a constant state of healthy balance must be kept in fine balance. Once this is disrupted, the cells no longer divide normally or die when they should, resulting in cancer.

Cancer can also happen because of disruption in two types of genes. Proto-oncogenes are normal genes involved in cell growth and division. Abnormal changes in these lead to the creation of super cancer genes called oncogenes. These promote excessive and continuous cell growth and division. Tumour suppressor genes are normal genes that slow down cell growth and division.

When a tumour suppressor gene malfunctions, autogrowth kicks in and cells may be unable to stop growing and dividing. Cells replicate themselves endlessly leading to the formation of a useless mass of tissue, known as a tumour.

80

The original cancerous cells can also induce other cells to behave abnormally by producing abnormal proteins. These proteins may be normal proteins produced in excessive amounts or abnormal proteins that stimulate cells into deregulated growth or function.

Cancer occurs when abnormal proteins inside cells cause it to go into uninhibited growth, reproducing excessively and allowing those cells to live much longer than normal cells.

Because the cells in cancerous tumours are abnormal, they can also invade nearby organs and tissue, and spread to other parts of the body.

Since this is all happening at a molecular and cellular level, the aim of today’s treatment regimens is to target, as accurately as possible, the specific molecules involved in the evolution of cancer.

Molecular treatment has changed the landscape of treatment. This is because in the quest to destroy cancer cells, the toxicities of cancer treatment can now be minimised while achieving greater benefits.

Molecular treatment is so targeted that it can now be directed at tiny molecules present on every single cancer cell. There are several major benefits to having more specific and molecule-targeted treatment. Namely, better prognosis, quality of life, tolerance to treatment, less side effects and longer survival.

Some of these treatments target specific cells which are abnormal, and attack them in different ways. They can, for instance, damage these cells directly, deliver anti-growth signals to them or halt the supply of nutrients to them by altering their blood supply lines.

Such targeted cancer therapies basically disrupt cancer cell growth and division at various points during the development, growth, and spread of cancer. Many of these therapies involve proteins which are part of the signalling process. By blocking the signals that tell cancer cells to grow and divide uncontrollably, targeted therapies can stop the growth and division of cancer cells.

Other molecular treatments cause specific cancer cell apoptosis, which means cell death, by stimulating the signalling system that initiates natural cell ageing.

Targeted cancer therapies at the molecule level allow doctors to increasingly tailor-make cancer treatments to individual patients. With more personalised strategies, fewer side effects, better quality of life and higher treatment effects can be attained. It is fortuitous that these treatments are already being used widely, and will be used even more widely over time.

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

SPECIALIST

OPINION

Shaping your body Contrary to popular belief, body contouring is not just about removing fat from the body.

By Dr Leslie Kuek, Plastic Surgeon When people think of body contouring, what commonly comes to mind is the removal of excess fat in order to achieve a desired shape. But body contouring is actually much more than that.

In its true sense, it can also include adding to the body, depending on the patient’s needs and desires.

So treatments such as breast enhancement can be considered a form of body contouring. When it comes to contouring the breasts, you can not only enhance or enlarge them, you can also reduce them, or tighten and lift them. This last procedure, known as mastopexy, is typically for women with sagging breasts. This is common after weight loss or prolonged breast feeding.

Mastopexy allows the plastic surgeon to remove excess skin, tuck the breasts in and lift them.

Similarly, for women who have heavy breasts that cause chronic neck and back pain, soreness, difficulty in finding bras that fit, hygiene issues and social embarassment, the solution lies in a procedure known as reduction mammoplasty. This involves removing excess breast tissue and skin, repositioning the nipple and areola, and finally reshaping and lifting the remaining breast tissue. This helps correct the challenges being faced while simultaneously enhancing the overall appearance by making the breast size more proportionate to the rest of the body.

Breast enlargement options However, the most popular breast contouring treatment in Singapore is breast enlargement, either by using silicone implants or by fat transfer technique. Our “Body to Breast” contouring programme removes fat from the waist, thighs or abdomen, providing a simultaneous body-shaping of the donor area with a breast enlargement. The removed fat is purified, concentrated and immediately re-injected into whichever part of the breast is deficient in volume. This technique is especially appealing to women who do not like the idea of inserting foreign materials into their bodies. It also allows the plastic surgeon to customise and inject the exact amount required for each breast and in the exact area.

The drawback is that enlargement is limited to one cup size per time whereas implants can achieve a larger volume in one go.

A lesser-known problem is gynaecomastia or “man boobs”. This socially embarrassing issue can easily be taken care of with new techniques that allow plastic surgeons to remove the abnormal breast tissue via a minimally invasive treatment that does not leave scars.

Remodelling the Body If you are bothered by saggy arms that no amount of weight lifting or exercise can correct, an arm lift procedure that removes excess skin can help put that

matter to rest. The same goes for sagging buttocks, which can be also lifted surgically.

Women who have had large or multiple pregnancies and suffer from a floppy tummy or herniation of the muscle wall may never regain their original body shape and may require a tummy tuck. This is the most common body shaping surgery and results in more dramatic results than what you would get from non-invasive procedures.

Non-invasive procedures using machines to remove the fat are slower and need to be done a number of times for visible results. The advantage is they do not require surgery and there is no downtime.

One such procedure is Ultherapy, an ultrasound treatment which tightens the collagen under the skin and enables it to redrape better. Another procedure using ultrasound technology is UltraShape, which uses ultrasound energy to break down fat cells. A newer technique called Cryolipolysis uses extreme cold energy to achieve the same outcome.

The most common surgical body-contouring treatment is liposculpture. Apart from bulk removal, strategic removal of fat in key areas using this method allows the plastic surgeon to “sculpt” the body.

Synthetic fillers can also be added to contour the body.

They can be injected into the buttocks if a patient has flat buttocks or even to the hip areas to create or enhance feminine contours.

Apart from aesthetics, patients opt for body contouring to enhance the quality of their lives or regain normality. Women who have suffered from breast cancer, for example, can have their breasts reconstructed using the “Body to Breast” contouring programme.

In the hands of a skilful plastic surgeon, body contouring can take on a whole new meaning.

Dr Leslie Kuek Leslie Kuek Plastic Surgery 38 Irrawaddy Road #05-41 Mount Elizabeth Novena Singapore 329563 Tel: 6772 2972 www.lesliekuek.com.sg

81

SPECIALIST

OPINION

Womb invader No one knows why tough growths called fibroids occur in the womb. Though often harmless, regular screening is nonetheless essential.

By Wendy Teo, Obstetrician & Gynaecologist Fibroids are non-cancerous tumours that result from excessive muscle growth in the womb. Found in about a third of women in their childbearing years, fibroids are the result of an overgrowth of the smooth muscular tissue of the uterus that causes a firm, rubbery mass to develop. These growths can range in number and size, from “seedlings” undetectable by visual examination to large masses that enlarge the uterus. Some grow rapidly, while others shrink over time and disappear. Many fibroids do not cause symptoms. However, if they are large, numerous or located in certain areas, these growths can cause heavy and/or painful periods, infertility, abdominal pain, frequent urination, urinary infection and constipation. The good news is that there is a very low chance (around 0.5%) of a fibroid turning cancerous.

In any case, it is still advisable for women to undergo regular scans every six to 12 months to detect any abnormities.

What causes fibroids?

It is not clear what causes fibroids to grow, though female hormones have been found to play an important role in promoting their growth. Typically, uterine fibroids only develop after puberty and after the age of 30. They also usually shrink or disappear after menopause, when oestrogen levels fall. Other factors that may affect the growth of uterine fibroid include:

•

Early menstruation: Women whose first period was before the age of 10 are more likely to get fibroids

•

Pregnancy: Women who have had children are less likely to get fibroids

•

Birth control: Women on the pill are less likely to develop fibroids

•

Family history: Women whose mothers and sisters have fibroids are more likely to have them too

Treating fibroids Most uterine fibroids do not require treatment, especially if they do not cause symptoms or problems.

It is helpful to monitor the growth of fibroids and ensure they do not grow overly large and form an obstacle in the womb. In some cases, the fibroids will naturally shrink over time, though most uterine fibroids will remain the same size or grow larger.

There are several options to treat fibroids that cause conditions such as painful periods, infertility or chronic pain: Taking oral contraceptives or birth control pills: These contain hormones (oestrogen or progesterone in isolation or in combination) that may reduce heavy periods caused by uterine fibroids.

Pain medication: Painkillers may be dispensed to manage cramps caused by uterine fibroids.

Iron supplements: Heavy periods caused by uterine fibroids can lead to an irondeficiency, so iron tablets may be prescribed.

Myomectomy: A surgical procedure to remove uterine fibroids. The uterus is left in place and only the fibroids are removed. This procedure is often done for women who wish to have children.

But although the fibroids are removed, new ones may grow in their place after some time.

Hysterectomy: Surgery to remove the entire uterus and all the fibroids. A hysterectomy may be considered for women with numerous uterine fibroids and who have passed their childbearing years.

82

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

SPECIALIST

OPINION

Growing into a woman Whether she is your daughter, granddaughter, niece or just a young girl that you care about, it’s important to realise that the path to womanhood can be intense, inconvenient and full of surprises. But help is always at hand.

By Dr Kelly Loi, Obstetrician & Gynaecologist

For many young girls, puberty can be a challenging, exciting and even confusing time. But as the significant women in their lives become more aware of this important part of growing up, many more are seeking help, advice and consultation for their young female family members, and earlier than before. The idea is to encourage open conversation with a gynaecologist about these previously too-embarrassing or taboo topics, from irregular periods and vaginal discharge to contraception and HPV vaccination.

Here are some of the more common teen gynaecological issues: Puberty and precocious puberty Puberty typically occurs at around 10 years old, though this varies. You know puberty is happening when you notice breasts developing, pubic or underarm hair appearing, rapid growth in height, the onset of periods and acne on previously perfect skin. Precocious puberty – puberty that occurs before age eight – can indicate an underlying health problem and it’s important to get a medical evaluation to exclude serious conditions such as hormone disorders, tumours or brain abnormalities.

Menstruation While breast development is typically the first indication of puberty, menarche – the first menstrual period that usually occurs around two years after – is often the defining feature of “becoming a woman”. Most girls experience regular cycles, but in the first two or three years, these can be irregular. An average menstrual cycle happens monthly with a period that lasts five to seven days. If periods are irregular or stop, visit a doctor as this might be caused by any number of factors, among them hormone imbalances, an unhealthy diet, excessive exercise or very low body weight.

Menstrual cramps, caused by contractions of the uterus, are a rude shock for a young girl, and can range from mild to extremely painful. Unfortunately, cramps run in families, and while they are not often serious, they can disrupt normal activities. A consultation could rule out ovarian cysts or yield advice on pain management approaches.

Pre-menstrual Syndrome The hormones that trigger puberty have well-publicised emotional and mental effects, leading to mood changes called premenstrual syndrome (PMS). Often the subject of jokes, PMS can cause severe mood swings which, in exceptional cases, can spiral into depression. If you sense this might be happening, a visit to the doctor is in order.

84

Vaginal discharge This is another phenomenon which can be distressing to a young girl. Normal vaginal discharge has a faint smell, is either clear or white and helps keep the vagina healthy. Itching, a strong odour, a burning sensation or a change in discharge colour indicates an infection.

Encourage your young charge to tell you if this happens as a medical consultation is needed to identify candida or thrush, which require treatment.

Contraception, STIs and HPV vaccination It can be a challenge to decide when a young girl should be told about unplanned pregnancies, vaginal and pelvic infections and sexually transmitted infections (STIs).

But the conversation cannot be avoided, for her own safety and for her future as a mother.

STIs such as chlamydia or gonorrhoea, for instance, can cause lasting damage to the reproductive organs resulting in subfertility. And since cervical cancer is predominantly caused by the Human Papilloma Virus (HPV), it is best for a young woman to be immunised against it before her first sexual encounter. To make this a reality, women under 26 can use up to $400 per Medisave account per year to pay for a HPV vaccination.

Gynaecological screening Invasive approaches such as pelvic examinations and PAP smears are usually not suitable for young girls and teens, so ultrasound scans and imaging methods are useful to assess the health of the uterus and ovaries.

Blood tests are also useful to assess hormone profiles and determine hormone-related disorders.

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

Hernia repair works This age-old, highly inconvenient condition can happen to anyone, at any time and at any age.

Thankfully, it is easy to resolve with a short procedure.

By Dr Tay Khoon Hean, Hepatobiliary Surgeon

blood supply gets cut off from the constriction around the abdominal tear, causing tissue to die from oxygen starvation. Some hernias are also irreducible, where the protruding content cannot be pushed back into place, and these need careful evaluation from a doctor.

The good news is that not all irreducible hernias are strangulated.

Most common hernias • Groin hernia One of the most common hernias is direct or indirect inguinal (groin) hernia. These make up 75% of all abdominal wall hernias, with men being up to 25 times more likely to suffer from them than women.

An indirect hernia follows the pathway created for the testicles to drop during foetal development.

Even though the opening closes before birth, a weak spot remains for a potential hernia later in life. Direct inguinal hernia, on the other hand, is caused by a tear at the abdominal wall and usually occurs in the middle-aged and elderly, as the wall becomes thinner and muscles weaken with age.

A hernia occurs when an organ or fatty tissue contained by a muscle or membrane squeezes through a weak spot to produce a lump, most often at or near the abdominal wall. Unusual pressure at the stomach area, for instance, can cause portions of abdominal contents like intestine or abdominal fatty tissue to pop out from their natural encasement.

There are many kinds of hernias that occur in different ways and from various causes, although not all are painful. Some people experience slight to severe pain, while others present a combination of signs and symptoms, including fever, nausea, swelling, bleeding and even difficulty in breathing, eating and drinking.

Ironically, those who fall ill rapidly and severely are more likely to seek immediate treatment, and have their condition rectified without delay.

The danger of untreated hernia is the potential risk of it becoming strangulated, which happens because

Causes of hernia Anything that causes an increase in pressure in the abdomen can cause a hernia, including: • carelessly lifting or jerking up heavy objects • diarrhoea or constipation • violent and continuous coughing or sneezing While some hernias are present at birth, most occur later in life, and all of them will not go away in time or without clinical intervention.

• Femoral hernia Femoral hernia is more common in women. It occurs at the canal where the femoral artery, vein and nerve leave the abdominal cavity to enter the thigh. This tiny space can become enlarged, allowing abdominal contents (usually intestine) to protrude into a bulge just below the groin crease. Femoral hernias are particularly at risk of becoming irreducible and strangulated.

Hernia repair This is usually conducted under general anaesthetic, and includes options for open or laparoscopic surgery, depending on your doctor’s assessment. Laparoscopic surgery is preferred if access to the problem site is uncomplicated, and patients experience little downtime and faster recovery.

The procedure involves a small incision at the navel area to inflate the abdomen with air. A laparoscope is then inserted for the surgeon to see the problem spot, followed by other small incisions to enter and repair the tear. The surgery ends with a mesh placed over the weakened area to reinforce the abdominal wall. The patient can go home the following day.

Hernia affects millions worldwide, but its repair is relatively straightforward. If you suspect you have hernia, consult a doctor and get the condition resolved early.

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

85

SPECIALIST

OPINION

Deep impact The acne of adolescence often leaves a deep and lasting impression – so preventing scars is important before they stay for life.

By Dr Wong Su-Ni, Dermatologist

86

Adolescent acne is an unavoidable part of growing up for many. In fact, many adults still bear the scars of uncontrolled acne from their youth with scarring that ranges from shallow dents to deep craters and visible bumps. Although much can be done nowadays to treat acne scars, these marks can only be reduced but can’t be made to disappear. So it is much better to control acne to prevent scars, than to rely on scar treatment after the damage is done.

Acne scars may lead to loss of confidence, low selfesteem, and even depression. Some may find it more difficult to secure employment, especially for women and men in front-line jobs, or where a premium is placed on looks, such as cabin crew, models and sales staff.

Acne attacks Acne most often affects adolescents, and over 90% of adolescents have acne at some stage. It starts in the pre-teens as comedones and can last into the early 20s. Good face hygiene and a consistent skin-cleansing routine are important. Twice-daily face washing and over-the-counter acne creams such as benzoyl peroxide are helpful in mild cases. For cases that involve many red or pus-filled pimples and numerous comedones or scarring, professional help should be sought. Large red nodules or large pus-filled cysts have a higher chance of causing scarring, and an early consultation with a dermatologist is recommended.

About a quarter of adult women will continue to have adult acne after adolescent acne subsides. Adult acne may also start anew in adulthood without previous adolescent acne, particularly in the 30s and 40s, when hormone levels change. Adult acne occurs around the mouth and jawline, compared to adolescent acne which often affects the forehead, cheeks and T-zone area. Adult female acne often worsens just before and during menstruation due to hormones.

Other causes may include using comedogenic or acne-genic skincare products, taking oral medications, excessive use of steroids, excessive levels of hormones from underlying hormone-secreting tumours or occupational exposure to fluorinated hydrocarbons.

The development of acne Acne often starts as a clogged pore (a blackhead or whitehead) which becomes a red, swollen or pus-filled pimple after bacteria acts on it.

Most people recognise pimples by the characteristic plugging, progression, tenderness on pressing and sometimes, a mild itch. Eczema is usually itchy and the red bumps are finer, not plugged, and often join up

3 tips for acne sufferers 1 Treat early to prevent scarring

2 Treat adequately – do not hesitate to seek medical help or inform your doctor if you think the treatment is not working after a reasonable length of time

3 Treat scars only after the acne is brought under control

to form larger red areas. Acne-like conditions such as rosacea and folliculitis are not associated with blackhead or whitehead formation (comedone) but begin as red or pus-filled bumps.

Rosacea is linked to symptoms such as easy flushing, or the use of strong steroid creams on the face. The latter is the reason steroid creams, particularly the higherpotency ones, should not be used indiscriminately on the face without medical supervision.

Treating acne A multi-pronged approach is important to reduce the physical impact and psychological burden of acne. It is important to treat acne early to prevent scarring; treat it adequately and seek medical help; and treat scars after the acne is brought under control.

To improve depressed scars, treatments such as laser resurfacing, fractional ablative radiofrequency, scar excision, subcision or filler injections may be used alone or in combination. To improve the appearance and itch or pain of raised keloid scars, steroid injections with or without laser treatment are usually effective.

Psychological support and advice on makeup is important, while more serious cases which have led to depression can necessitate a psychiatrist referral.

There is no need to suffer in silence, as effective treatment is available.

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

87

SPECIALIST

OPINION

Get it straight: the facts about crooked teeth Crooked teeth are more common than you think. While a little gap or kink can give your smile a little unique character, severely crooked teeth can have a more significant impact.

By Dr Tan Kok Liang, Orthodontist

From Madonna’s distinct gap-toothed smile to Tom Cruise’s pearly whites, a smile is a distinct and striking personal feature. While we all covet the perfect smile, very few people – less than 10% – have naturally occurring perfect tooth alignment.

Some level of tooth misalignment – crooked, overlapping or twisted teeth – is normal and at the lower end of the spectrum, cause no real issues at all.

But when teeth misalignment is severe, three different types of problems can result. For one, there may be emotional stress due to teasing during childhood that leads to low self-esteem and other psycho-social problems. Misalignment of the teeth can also cause issues with oral function including difficulties in jaw movement that result in poor jaw muscle coordination or pain, problems with chewing, swallowing or speech.

Crooked or overcrowded teeth can also lead to a greater susceptibility to trauma, gum disease and tooth decay.

Tooth misalignment happens for several reasons: • A cleft lip or cleft palate • Mouths that are too small for their teeth, causing overcrowding of the teeth • Malformation or differently-sized upper and/or lower jaw • Early loss of baby or adult teeth • Improperly fitted dental restoration • Gingivitis (gum disease) • Undue pressure on the teeth and gums • Tumours in the mouth or jaw • Prolonged thumb sucking, pacifier or bottle use • Extensive mouth breathing that alters the posture of the head, jaw and tongue (especially during sleep) • Jaw misalignment after an injury Concerning the last factor, childhood falls should be carefully monitored as jaw fractures or chipped teeth may result in problems in later years. Damage to the jaw and teeth may manifest as asymmetrical growth of the jaw with the affected side growing less well compared to the unaffected side. In such circumstances, an orthodontist can start treatment to normalise growth as much as possible when the condition is noted.

Restoring a beautiful smile The best solution for misaligned teeth is orthodontic treatment which is typically done with fixed braces.

Braces work by applying pressure to the teeth and jaws to move them into a more desired position.

Braces can be made out of stainless steel, ceramic, plastic or a combination of materials.

88

These days, minor to moderate problems can be treated with clear plastic aligners that move teeth into beautiful alignment. Corrective treatment can start as early as six years old, but as most orthodontic procedures require good patient cooperation and acceptance, treatment is usually started at about nine years old.

Caring for braces and teeth Dental braces with their wires and brackets trap food and plaque that can stain teeth and increase the risk of cavities. Regular brushing and careful flossing is important to remove any residue. To prevent braces from moving out of alignment or breaking, avoid chewing ice or hard foods such as whole apples or corn on the cob and sticky candy such as gum or caramel.

Dr Tan Kok Liang Embrace Dental Surgery 360 Orchard Road #01-14 International Building Singapore 238869 Tel: 6235 6325 www.embrace.com.sg

Wh e r e Go u r me t s Ga t h e r

SPECIALIST

OPINION

The hearts of men and women A lot is said about the differences between men and women – the way they think, the way they feel, the way they are able to multi-task or otherwise. But is there a difference between a male heart and a female one?

By Dr Ruth Kam, Cardiologist

90

SPECIALIST

OPINION

It will surprise many to know that there is actually no difference between male and female hearts.

All the structures present in male hearts are present in female ones. Relative to body size – the weight of the heart relative to total body weight – they are the same.

A heart may grow larger in size because of high blood pressure, heart disease or hormonal disease, but this phenomenon is not gender-specific.

That said, there are certain heart conditions that are more prevalent among one gender or the other.

Men, for instance, are more prone to coronary heart disease and Brugada Syndrome.

Coronary heart disease is caused by narrowing of the arteries supplying blood to the heart. It is related to diseases such as hypertension, high cholesterol, diabetes and smoking. It presents as chest pain, breathlessness, palpitations or sudden death. Brugada Syndrome, on the other hand, is a disease of the ion channels and affects the electrical system, and therefore the heart rhythm. The symptoms include palpitations, fainting spells or sudden death.

Women are more prone to Long QT syndrome, which is, like Brugada Syndrome, a disease of the ion channels, which affects the heart rhythm and has similar symptoms.

Different symptoms for women?

There is an urban legend that women’s heart attack symptoms are different from men’s. The truth is that the most common symptom in both men and women is chest pain. Let’s not forget that while trying to point out the differences between women and men.

If there is no chest pain, other symptoms such as giddiness, palpitations or indigestion are called atypical or unusual symptoms. They occur more commonly in women, especially those over 65.

It is unusual for women to suffer heart attacks before menopause. If a woman does have a heart attack before menopause, the prognosis is worse because it means that even with the protective effect of female hormones, other more potent risk factors may be present, such as diabetes, or inflammation of the blood vessels.

When angiograms are performed for chest pain, the proportion of patients with normal-looking arteries is higher in women, and this is called Syndrome X. The cause of the chest pain is thought to be vessel spasm. This happens because women generally have smaller blood vessels than men, and these may be more reactive to agents which cause constriction.

Under-diagnosed and under-treated Heart disease is under-diagnosed and under-treated in women, and there are several reasons for this, involving patient, cultural and physician factors. Patients and doctors need to be made more aware of these so that they do not dismiss symptoms or fail to recognise them as heart disease symptoms. The same treatment procedures, and life-saving and life-changing therapies used to address coronary heart disease in men – such as bypass or stenting – should not be denied to women as a result of lack of awareness or ignorance.

For certain conditions, women may be at higher risk of complications. For example, in atrial fibrillation (a type of arrhythmia), women have a higher risk of stroke. Hence one’s gender is taken into consideration when deciding on clot prevention treatment.

For both men and women, the available treatment options for the most common conditions are the same, as follows: CONDITION

AVAILABLE TREATMENT(S)

Coronary heart disease

Stenting, Bypass surgery

Heart arrhythmia, including atrial fibrillation

Catheter ablation

Sudden Cardiac Death

Defibrillator implantation

Excessively slow heart rate

Pacemaker implantation

Valve problems

Valve surgery

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

91

SPECIALIST

OPINION

Pain in the gut Sudden severe pain in the lower right side of your abdomen could signal appendicitis – a serious infection that requires immediate medical attention.

By Dr Ho Kok Sun, Colorectal Surgeon

and inflamed appendix results in pain in the lower right side of the tummy, nausea, vomiting, and fever.

Emergency medical care is essential in the case of appendicitis as the infected organ needs to be removed before it bursts. In this severe scenario, pus is released into the body and the infection may spread and progress to a critical condition called sepsis. Organ failure and even death can result.

A finger-shaped pouch that extends from the lower right side of your colon like a vestigial tail, the appendix is something of a mystery. In herbivores, the appendix – much larger than ours – is used to store and digest dietary fibre. In humans, however, the appendix – located in the right lower abdomen – serves no purpose as we are not able to digest fibre. In theory, our tiny appendix could be a remnant of an ancient digestive tract when our ancestors were able to digest leaves and bark. Though it serves no known purpose, the appendix can cause severe trouble if it gets infected, a condition called appendicitis. While the risk is very low, appendicitis requires immediate medical attention when it does occur.

Causes and signs of appendicitis Appendicitis refers to a condition where the appendix becomes swollen and filled with pus. This may happen if bits of faeces drop into the appendix and block it.

The bacteria in the trapped stool may cause infection and swelling. Very infrequently, a small tumour within the appendix can also cause appendicitis. The swollen

92

Diagnosis and treatment In the past, appendicitis was diagnosed based on physical examination – pressing the abdomen to check for pain, fever and a blood test. Today, a more accurate diagnosis can be made using a computed tomography (CT) scan. Surgery for appendicitis has also benefitted from technological advancements.

Laparoscopic or keyhole surgery means the appendix can be removed via three small incisions instead of a single long one. The earlier the treatment, the more likely it can be removed through minimally invasive keyhole surgery. When the appendix has ruptured and caused infection around the area, poor visualisation of the organs may necessitate traditional open surgery.

In keyhole surgery, a 1cm cut is made around the navel into which a tube-like camera is inserted.

Two smaller 5mm cuts are then made in the abdomen to insert the cutting instruments. These “arms” tie off the connection between the appendix and the colon, cut away the infected appendix, and remove the tissues through the cut at the navel.

Some signs of appendicitis • • • • •

Initial pain near the navel that moves to the lower right abdomen and increases in intensity Loss of appetite, nausea and/or vomiting Abdominal swelling Fever Less typical symptoms such as diarrhoea, constipation, back pain, painful urination and severe cramps

These are just some of the signs of appendicitis.

If you experience these symptoms, seek medical attention immediately. Avoid eating, drinking, or using any pain remedies, antacids, laxatives, or heating pads, which can aggravate the inflamed appendix.

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

The final period Menopause marks the “official” end of a women’s fertile years and brings with it some challenging changes. Here’s what to expect.

By Dr Chen Chern Yi, Obstetrician & Gynaecologist

Menopause refers to the complete cessation of menstrual cycles, and it is said to occur 12 months after the last menstruation, typically between the ages of 45 and 55. In the years preceding menopause (the perimenopausal period), oestrogen levels start to decline, bringing with it a range of symptoms that vary greatly between women. Menopausal symptoms occur over four categories: • • • •

Menstrual irregularities Genital and bladder changes Vasomotor problems, and Mental and emotional problems

Menstrual irregularities include delayed menstruation, prolonged periods and heavy or scant menstrual flow. Genital and bladder changes result in vaginal dryness, painful intercourse, frequent urination and urinary incontinence, while vasomotor problems include hot flashes, sweating, insomnia, dizziness and palpitations. Lastly, mood changes, depression, fatigue, lack of concentration and poor memory are also commonly experienced. Women who have had a hysterectomy to remove their uterus but not their ovaries will cease to have menstruation but will not experience menopausal symptoms until their ovaries stop functioning.

Interestingly, the incidence of symptoms varies among ethnic groups. Hot flashes and mood changes occur in about 75% of American Caucasians, but only in 10% of Chinese. This has sometimes been attributed to the regular intake of soy products by Chinese. Soy products contain phytoestrogens which are similar in structure to female oestrogen which helps prevent or alleviate some of the symptoms.

Eastern vs Western management There are several ways women in Singapore can manage the changes in the peri-menopausal period and alleviate the symptoms. Traditional Chinese Medicine (TCM) therapy is one. This approach uses syndrome differentiation to diagnose the underlying problem and treat the problem accordingly. According to TCM, common vasomotor problems such as hot flashes, sweating, insomnia, dizziness and palpitations are due to a deficiency of kidney yin. Some other symptoms may be due to ageing resulting from liver dysfunction, and the decline in essence and blood storage. TCM physicians typically prescribe appropriate herbal concoctions or acupuncture treatment to treat

the identified deficiency and to restore the yin and yang balance. In Western medicine, a doctor takes a detailed history and does a medical examination to evaluate the condition and to exclude gynaecological problems. Appropriate treatment is then based on the predominant complaint. Medications using herbal extracts have been proven by research to help alleviate menopausal symptoms and can be used to treat hot flashes, mood changes, sweating and insomnia.

To treat genital and bladder problems, topical oestrogen application is usually recommended.

Other important changes that occur during this period include decrease in bone density and increase in bad cholesterol (LDL) due to decline in oestrogen levels. Bone mineral densitometry (BMD) and fasting blood test to screen for high cholesterolemia should be done and treatment instituted if necessary.

In addition, women should be counselled regarding measures to improve general health like a balanced diet, moderate exercise, decrease in smoking and excessive caffeine intake, and appropriate supplements. These will help improve well-being, maintain good bone density and cholesterol levels, and enhance sleep quality.

Dr Chen Chern Yi Healthcare for Women 8 Sinaran Drive #06-02 Novena Specialist Center Singapore 307470 Tel: 6681 6699 www.healthcareforwomen.com.sg

93

SPECIALIST

OPINION

A nose for beauty The nose has long been considered a symbol of beauty. And for those born with a nasal deformity, getting a “nose job� is more than a matter of appearance but is also a boost to self-esteem.

By Dr Karen Sng, Plastic Surgeon

94

From Scarlett Johansson’s daintily upturned point, to Elizabeth Taylor’s small “snub” nose and Tom Cruise’s aquiline Roman one, a nose is a distinctive feature that contributes not only to the aesthetics of the face, but its character. It is no wonder that many seek surgery to enhance their noses in the quest for a more pleasing appearance.

Cosmetic nasal surgery, called rhinoplasty, is frequently requested because people are conscious of the appearance of their nose. Nasal enhancement procedures which can be done include raising the bridge of the nose, making the tip less round or boxy, making the nostrils smaller, or lengthening the nose.

The number of patients seeking cosmetic rhinoplasty is on the increase, due largely to the greater acceptance of cosmetic surgery in general.

In addition to the increasing popularity of rhinoplasty, the kinds of requests are also changing.

While patients used to focus more on raising the nasal bridge, they are now asking for ways to refine the nasal tip or nostrils as well.

The goals of rhinoplasty In rhinoplasty, the surgery of the nose, the angle, shape and size of a nose can be enhanced. This can be for two reasons: functional or cosmetic. In the former, the primary goal is to treat breathing problems, which could be caused by a variety of factors. Cosmetic rhinoplasty refers to nose surgery that is primarily done to enhance the external appearance of the nose.

Rhinoplasty can also serve both cosmetic and functional purposes, such as for those who have experienced trauma from a blow to the face that can lead to a crooked nose and breathing difficulties. Congenital deformities such as cleft lip and nose can also result in functional and cosmetic problems.

A more aesthetically pleasing nose can be a great boost to one’s self-esteem, but the patients who achieve the greatest improvement in their self-confidence after a rhinoplasty are those who have a crooked or asymmetric nose due to congenital deformity or trauma. Imagine someone who was born with a cleft lip/nose, who has been teased all their lives about having a crooked nose.

For this individual, rhinoplasty can be life-changing.

Enhancements for the nose Rhinoplasty can take several forms, from a simple procedure using just an implant to a more complex procedure that involves use of the patient’s cartilage, or a combination of both methods.

In implant rhinoplasty, solid silicone nasal implants are used to augment the nasal bridge to make it higher.

A silicone nasal implant is typically shaped like an

“L” or “I” and sits between the nasal framework and the skin to add definition.

In cartilage rhinoplasty, the patient’s own cartilage is taken from the nose, ear, or rib. This cartilage is used to strengthen the structural framework of the nose.

It helps to straighten the nose, and give projection, definition and refinement of the tip. This mode of rhinoplasty tends to have a lower risk of infection, although it requires more time and expertise.

The duration of surgery increases with the complexity of the procedure. In rhinoplasty involving a nasal implant only, the surgery takes about an hour.

For rhinoplasty using the patient’s own cartilage, the procedure can take about three hours or more as the cartilage needs to be harvested and shaped.

Downtime ranges from one to two weeks, again depending on the complexity.

Important questions to ask Before embarking on surgery, a patient needs to discuss various issues with their surgeon and take in advice based on the surgeon’s expertise. Rather than decide what method of rhinoplasty they want based on hearsay, patients should discuss with their surgeon to understand what is more suited for them. As with any cosmetic surgery, it is important that the patient has realistic expectations of what surgery can achieve and understand that the enhanced nose needs to fit the rest of their face and their ethnicity. The following are good questions to ask: • • •

•

What can I expect from this procedure? What will my new nose look like?

What are the risks of this procedure?

What should I expect after surgery and what preparations should I make? What kind of aftercare can I expect?

How long will my recovery take?

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

95

SPECIALIST

OPINION

Colorectal polyps While most polyps show no symptoms, finding and removing them can reduce cancer risk.

By Dr Goh Hak-Su, Colorectal Surgeon

A polyp is a fleshy growth which can be found in many parts of the body. Unlike other polyps, a colorectal polyp is clinically important because it has the potential of becoming cancerous. Because colorectal cancer develops by progression from a benign polyp which is readily detectable and removable, it is one of the two human cancers which are easily preventable.

The other is cervical cancer. The aphorism is, “if you don’t have a polyp you don’t get cancer, and if you have polyp and have it removed, you prevent cancer.”

Polyps possessing malignant potential are called adenomas and are present in 15% of the adult population.

Fortunately not all of them turn malignant. What causes them to turn cancerous are the same factors causing cancer, namely, progessive genetic changes, ageing and an unhealthy lifestyle.

Most polyps have no symptoms at all and are not detected by the stool faecal occult blood test used in cancer screening. The best way to detect polyps is by colonoscopy which allows direct magnified vision and importantly, enables removal and retrieval of the polyp.

It is recommended that an individual of either sex should have a colonoscopy by the age of 50, and repeat it every 10 years if normal. For an individual

96

with first degree relatives (parents or siblings) with colorectal cancer or adenomas, the advice is to undergo a colonoscopy 10 years before the age of diagnosis of the relative and every five years thereafter.

In a small unique group of individuals with very bad familial cancer genes, colonoscopy is performed much earlier and more frequently.

It is now very clear that colonoscopy is effective in preventing cancer by removing polyps, but it must be performed safely and carefully.

Safely because of the danger of causing perforation of the colon which is a serious complication, and carefully because it is possible to miss polyps, especially in the right colon.

Recent data from the US shows that colonoscopy prevents 80% of left-sided cancer but only 40% from the right side. This is because the right colon is more difficult to reach. It also has more flat polyps known as sessile serrated adenomas which are more difficult to detect and remove.

It is also recommended that each individual adopts a healthy lifestyle to reduce the risk of adenomas and cancer, and if possible and on your doctor’s advice, one should consider taking 100mg of Aspirin a day as it could reduce the incidence of polyps by 30%.

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

SPECIALIST

OPINION

Making sense of pregnancy scans After the good news of being “positive” for pregnancy, the driving question is typically: is my baby normal and healthy?

Here’s a primer on understanding what the tests and scans are all about.

By Dr Ann Tan, Obstetrician & Gynaecologist

98

During your pregnancy, there are various ultrasound scans and blood tests to determine the health and progress of your baby. There are also investigations to ensure that the mother is nutritionally well and not suffering from hormonal or pregnancy-induced illnesses.

First trimester From as early as six weeks of conception, tests can confirm the viability of the pregnancy. This includes a transvaginal scan to determine the size of the foetus, check for heart pulsations and a healthy yolk sac. In this internal scan, the probe is inserted into the vagina to be as close to the foetus as possible for early detection and greater clarity. The uterus, cervix and ovaries are usually assessed at the same time.

Serial hormonal blood investigations for BHCG and/or Progesterone are often done to determine the status of the pregnancy should there be questions as to the dating of the pregnancy. These could be especially useful to exclude ectopic pregnancies or miscarriages.

Once the pregnancy is viable, the most important screening tests are performed between 10 and 14 weeks gestation to determine the risks of common chromosomal abnormalities. These include either the First Trimester Pregnancy Screen (FTPS) and Nuchal Scan or the Non-Invasive Prenatal Test (NIPT).

The First Trimester Pregnancy Screen (FTPS) and Nuchal Scan This is recommended for low-risk pregnant women.

It combines a maternal blood test and a Nuchal scan. The goal is to identify the risk of the common trisomies, namely Trisomy 21, 13 and 18. The Nuchal Transclucency Scan should be performed between 11 and 14 weeks for the computation of the risks.

Non Invasive Prenatal Test (NIPT) More women are considering this as a first-line screening test. NIPT has a sensitivity of 99% of detecting fetuses affected with Down Syndrome, determine gender and detect abnormal numbers of sex chromosomes. This test is recommended for those expectant women who are at higher risk, and those who had an abnormal FTPS result with moderate risks and wish to have more certainty without an invasive diagnostic procedure.

This test is also for those who have a previous history of abnormality but wish to avoid an invasive test.

The Early Fetal Anomaly Scan Regardless of whether FTPS or NIPT has been done, an ultrasound at between 12 and 14 weeks is important in order to exclude other chromosomal anomalies and detect major structural anomalies such as spina bifida or anencephaly.

Chorionic Villus Sampling (CVS) This is the procedure of choice in the first trimester should there be a positive screen on the FTPS or NIPT. CVS is a placental biopsy to extract a small piece of the placenta to obtain cells to

determine the fetal karyotype. Amniocentesis can be done at 16 weeks to determine the cause of the abnormal FTPS or NIPT. Both CVS and amniocentesis carry similar miscarriage risks.

Second trimester A detailed Fetal Anomaly Scan can be performed between 18 and 22 weeks. At this stage, major organs and physical structures are as they should be at term except that they still need to develop more complexity and maturity, for example, in the brain.

This prenatal diagnosis of structural problems will help guide management and determine the prognosis of the baby post-delivery. Some 6% of pregnancies have a structural anomaly and 2% are (major) anomalies.

Doppler studies can be done at 12-20 weeks to determine if a pregnancy is at risk, and possibly offer timely medications to reduce risk of growth issues and high blood pressure.

Cervical length screening should be done at the time of the fetal anomaly scan to help determine risk of preterm labour.

Routine blood investigations should be performed early in the second trimester as well, and should include the full blood count, Hepatitis B serum screen, VDRL and HIV, and possibly screening for Thyroid Function and Gestational Diabetes. Other investigations commonly carried out include Ferritin and Liver Function to assess maternal nutrition and well-being.

Third trimester Fetal Growth Scans are typically carried out between 28 and 36 weeks. They ascertain how well the fetus is being “fed� by its mother, and where the placenta is located to help determine the mode of delivery.

Amniotic fluid assessments are particularly important at the end of the pregnancy to determine the risk of placental insufficiency of the pregnancy.

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

99

SPECIALIST

OPINION

Paradigm shift in aesthetic surgery and treatment Innovation, technology and a move toward less invasive surgeries have made the field of plastic surgery ever more dynamic. This is so due to a multitude of advancements.

By Dr Colin Song, Plastic Reconstructive & Aesthetic Surgeon

Plastic surgery is no longer just about enhancing or reshaping the body or face to achieve an ideal form or balance – but a field in which plastic surgeons seek new ways to achieve the same goal with less invasive surgeries and downtime. Collaborating with a range of specialists from engineers to scientists to relook old surgical procedures and develop newer technology and techniques has this goal in mind. The main catalyst for this change are the patients we treat, to achieve what they desire at minimal disruption to their exacting lifestyles.

One recent example is from reconstructive surgery, which utilises flaps containing fat tissue with its own blood supply so that it can allow tendons to glide in badly injured hands. This has been used in facial reconstruction and is aimed at correcting contour defects.

The patient’s own fat is used to increase volume in the face and achieve a plumper look to the skin. Another is in the use of laser energy beams introduced through the skin using fibre optics to reduce tissue excess. These advancements not only result in similar outcomes, but also meet the demand for lower downtime and more natural and lasting solutions. The added advantage is rejuvenation surgery without major scars.

The most popular aesthetic procedures today include energy-producing devices that stimulate or improve skin quality, fat transfer to eyebags and face, nose reduction and refinement, breast enhancement, eyelid surgery and abdominoplasty or “tummy tucks”.

patients a more proactive role in their desire to restore youthfulness.

Rhinoplasty (nose surgery) There is now less reliance on foreign materials such as silicone for creating a higher nose ‘bridge’. Instead, rhinoplasty using a patient’s own tissue such as cartilage and fat is becoming more popular. This reduces the risk of tissue reaction to the implanted foreign material.

Anti-wrinkle treatments Methods to reduce wrinkles are in demand, but surgery is less preferred. Techniques and technologies such as fillers, neurotoxins, light source energy (visible light), lasers (invisible light), radio frequency and ultrasonic waves, all of which offer minimal downtime, are more popular.

Eyelid surgery Surgeons are reappraising methods for eyelid surgery and using higher magnification to see the intricate anatomy of the eyelids during surgery. This increased precision has lowered swelling and decreased downtime.

Plastic surgeons who developed skills through their microscopic blood vessel work in flap transfers have adopted this in aesthetic surgery to great benefit for the patient. Fat transfer for early eye bag correction is becoming a more acceptable solution as well.

Facelift surgery Age causes the face to sag for several reasons: loss of muscle fat and bone density, loosening of suspensory ligaments and degeneration of the skin. The standard facelift of tightening the skin is considered inadequate as it only addresses the superficial layers. Today, skin tightening is accompanied by filling the deep layers of the face with fat, tightening lax facial ligaments which “suspend” the skin and addressing bone resorption with grafts. This holistic approach offers a more sustainable outcome. Adjunctive procedures such as skin rejuvenation by laser resurfacing and periodic radiofrequency are employed after surgery to maintain the surgical result for longer. This comprehensive approach accords the

Breast enhancement Likewise in breast enhancement, the use of silicone implants is under extensive review. Since the FDA ban in the US on use of silicone gel implants was imposed in the early 90’s, the science of fat or adipose cell characterisitics and behaviour has been elucidated upon, and the manipulation and transplantation of fat is being employed increasingly for breast augmentation.

The major advanatage is that the patient’s own fat is harvested to achieve the enhancement.

These paradigm shifts are exciting advances in the science of aesthetics, and plastic surgeons will increasingly adopt and adapt their reconstructive skills to achieve the best patient outcomes.

Advances in plastic surgery:

100

Dr Colin Song CAPE Plastic Surgery Pte Ltd 38 Irrawaddy Road #10-31 Mount Elizabeth Novena Singapore 329563 Tel: 6339 9242 www.capeclinic.com

SPECIALIST

OPINION

Big surgery, small incision While traditional “open” surgery is commonplace for colorectal operations, minimally invasive laparoscopic surgery adds a new dimension to almost all types of colorectal surgery, with benefits for patients.

By Dr Bernard Lim, Colorectal Surgeon

Surgery is often the most common form of treatment for serious conditions such as colorectal cancer or for benign but debilitating conditions of the colon such as infections or recurrent and massive diverticular disease bleeding.

Typically performed via a long incision in the abdomen, surgery can now be much less invasive but just as effective. Minimally invasive techniques, namely laparoscopic or “keyhole” surgery, bring several potential benefits: • The smaller incisions mean less pain and less need for strong painkillers, enabling potentially faster recovery and less scarring • Less bowel handling and minimal exposure to the external environment mean less post-operative disruption of the gastrointestinal tract so bowel function recovers faster and patients can resume an oral diet in a shorter time • The cameras used in surgery give better views of the organs, so that surgery can be more precise • In the hands of a trained and experienced colorectal surgeon, this surgical option is as fast as traditional open surgery.

Types of laparoscopic surgery There are several sub-types of laparoscopic procedures: conventional multi-port laparoscopic, single-port laparoscopic, and robotic-assisted laparoscopic surgeries.

In conventional laparoscopic surgery, a small incision is made for the laparoscopic camera, and two or

three additional small incisions are required for the instruments to do the dissection. A final and thereafter slightly larger incision is then used to remove the diseased part of the colon or rectum.

In single-port surgery, only one “keyhole” is used to insert the instruments. The latest form of keyhole surgery is robotic-assisted laparoscopic surger y where surgeons manipulate laparoscopic robotic arms that mimic the human hand. This allows the surgeon to perform very fine surgery under a magnified and three-dimensional view. This has the benefit of providing better depth perception compared with the conventional laparoscopic view.

The precision allowed by the high-definition cameras and robotic arms minimises bleeding and protects the fine nerves in the pelvis.

The main advantage of this technique is most evident in dissecting low rectal tumours, which lie in a deep and confined space of the pelvis, and the most common surgery using this robotic technique is called an ultra-low anterior resection, where the anus is preserved and the remaining bowel can be joined to the anus after removing the part of the rectum with the cancer.

These advancements in laparoscopic surgery not only advance the state of colorectal surgery, but potentially bring enormous benefits to patients.

It is my greatest joy when patients are able to return quickly to their usual diet and activities after a major colorectal surgery.

Why early detection is important Colorectal cancer is now the leading cancer in Singapore.

Regular screening is important as the tumours in their early stage can be surgically removed for a higher chance of cure. Not only does early treatment increase the rate of success, a less invasive operation is also possible with potentially less pain, faster return of bowel function, movement and recovery.

Dr Bernard Lim Bernard Lim Specialist Surgery 38 Irrawaddy Road #08-52 Mount Elizabeth Novena Singapore 329563 Tel: 6334 7988 www.blimspecialist.com

101

SPECIALIST

OPINION

Tailor-made contraception There is no one method that suits every woman. But the good news is that, unlike in the past, there are many methods to choose from, depending on your lifestyle and personal preferences.

By Dr Christopher Ng, Obstetrician & Gynaecologist

prevents ovulation and causes the cervical mucus to thicken and inhibit sperm movement.

It also thins the uterine lining, resulting in lighter and shorter periods. Once it is removed, pregnancy becomes possible even within the first month.

On one end of the spectrum is sterilisation for men and ligation for women, considered the most effective because they are permanent. Unless you are absolutely sure that you will never want to try for a child again, these are not your options. Many have undergone these procedures only to seek reversal later on because they had a change of heart or circumstances. Reversal is not always possible, it is expensive and the tubes can get blocked again over time. Eventually some have had to resort to IVF (in-vitro fertilisation).

At the other end of the spectrum, there are many reversible contraceptive methods and these are either short-term or long-term reversible.

Long-term reversible options Known as “fit and forget” options, the following are considered very effective: Implanon NXT involves implanting a small, plastic rod under the skin of the upper arm via a small incision under local anaesthesia. The rod contains progestine, and the contraceptive effect lasts for three years. It works by preventing ovulation and also thickening of the cervical mucus, which then acts as a barrier to prevent sperm from reaching egg. Implanon NXT is considered one of the most effective birth control methods with a 99% success rate. Once removed, normal menstrual cycles resume rapidly.

Mirena IUS (intrauterine system) is an option that offers a longer five-year window of effectiveness. It is a small, flexible plastic T-shaped frame that is inserted into the womb. Everyday, it releases a tiny dose of the hormone levonorgestrel into the uterus, and this

102

Short-term reversible options One common method is the condom. While it is popular, condoms can leak or burst, must be used every time there is intercourse, and can cause allergic reactions. Another option is the pill, with many dosages and types available. In use for more than 50 years, it has evolved vastly to cater to different needs and minimise side effects. Among the best new generation options are Yaz and Yasmin.

Yaz is taken every day, while Yasmin is taken for 21 days, followed by a 7-day break before resuming again. These hormone-based products are also used to reduce heavy periods, manage menstrual cramps, treat premenstrual syndrome and even acne. These newergeneration pills are not associated with weight gain.

While the pill protects against certain cancers, such as ovarian and womb cancer, some women have a small increased risk of developing breast cancer while taking it, depending on their own and their family’s health history. This risk will reduce back to their background levels once they cease taking the pill, but the protection against ovarian cancer can last up to 30 years after the patient stops taking the pill.

Women can also opt for Depo-Provera injections administered every three months. This delays fertility, which means the three-month window must pass before fertility returns.

Nuvaring is one of the latest contraceptives. It is a once-monthly vaginally administered contraceptive ring. Once inserted, it releases a low dose of hormones that prevent pregnancy. When used as directed, it is just as effective as the pill, except that you don’t need to remember to take it everyday, and it does not interfere with intercourse. After you insert it, it stays in place for three weeks, and is then removed for one week before a new one is inserted.

These are some of the many options available.

A detailed discussion with your gynaecologist will result in the option most suited to your needs.

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

SPECIALIST

OPINION

It’s all in the lids Why changing the shape or structure of the upper eyelid or even creating a whole new one can make a significant difference to one’s appearance.

By Dr Leo Kah Woon, Plastic Surgeon

William Shakespeare wrote that the eyes are the windows to the soul. He was right – alluring eyes can have a positive effect on an individual as well as on those who look upon him or her, so it is no surprise that upper eyelid surgery is one of the most sought-after cosmetic surgery procedures in Singapore.

Younger patients desire “double-eyelids” to make their eyes look larger, less droopy or less puffy.

With puffy eyelids, they may have difficulties applying eyeliner due to the excess fat on their eyelids.

There are various “home-fix” techniques such as doubleeyelid tape, thick eyeliner or even rubbing of the eyes to create double eyelids. Such methods are, however, time-consuming and temporary. With surgery, patients are looking for a permanent solution to their desire for larger and “more attractive” eyes.

Mature patients often want correction of ageing eyelids with excess skin, fat and lax eyelid muscles.

This may be complicated by drooping (ptosis) of the upper eyelids. This causes the eyes to appear smaller and misshapen, and in severe cases, vision may also be obstructed by the excess tissue.

For “double-eyelid” creation, the techniques include either suture blepharoplasty or incision upper blepharoplasty. Suture blepharoplasty (scarless double eyelid creation) is suitable for younger patients with minimal skin or fat excess. Usually three well-aimed sutures are placed in each eyelid, with technique and surgical precision being of utmost importance.

The downtime is around three to five days as no cutting is involved.

Incision upper blepharoplasty is indicated for patients who have a moderate amount of excess fat.

This technique involves judicious removal of upper eyelid skin and excess fat. Thereafter, the upper eyelid crease is created by stitching the skin down to the deeper tarsal tissue. This technique minimises the chance of losing the fold. As skin excision is involved, the downtime is typically one to two weeks. This is also performed to correct ageing upper eyelids where the excess skin, muscle and fat are excised.

For patients with concomitant brow descent needing correction, a new technique of browlift using the Endotine Transbleph device can be performed. This allows rejuvenation of both the sagging eyebrow and the upper eyelid with one surgery performed under local anaesthesia.

Sometimes, droopy eyelids are caused by overstretching of the thin tendon-like structure that helps the levator muscle elevate the upper eyelids.

Here, a slightly more complex procedure known as levator advancement must be performed. As the dissection is more extensive, patients should expect a two-week downtime.

For patients who desire “longer eyes”, medial or lateral epicanthoplasty procedures can be performed.

It is important to know that eyelid surgery should be customised to suit the patient’s facial aesthetics as well as his or her ethnicity. The Caucasian “double-eyelid” usually is higher, deeply set and has a crease parallel to the lash line. The ideal Asian “double-eyelids” are more subtle with slight flaring at the lateral edge. Previously, “westernisation” of Asian eyes was very common but resulted in unnaturally high folds with excessive fat and skin excision leading to a hollowed-out and aged look post-surgery.

It is therefore vital that patients consult with qualified plastic surgeons with intimate knowledge of eyelid anatomy. Only an experienced plastic surgeon can make an accurate diagnosis of the problem and recommend the appropriate surgical treatment.

Dr Leo Kah Woon Dr Leo Aesthetic Plastic & Reconstructive Surgery Pte Ltd 3 Mount Elizabeth #06-10 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6733 3895 www.drleoplasticsurgery.com

103

SPECIALIST

OPINION

Shouldering on We use our shoulders all the time without thinking about it. Here’s a brief overview of this important body part, the injuries it can suffer and some tips on shoulder care.

By Dr Lim Yi Jia, Orthopaedic Surgeon

The shoulder is made up of three main bones – the collar bone, or clavicle, the shoulder blade, or scapula, and the proximal arm bone, or proximal humerus. The collar bone is the only bone which connects the entire upper limb to the chest, while the rest of the connections between the shoulder blade, proximal arm and collar bone to the chest wall are made by muscular attachments.

The shoulder is so important because it allows positioning of the hand in front of the body, which allows us to reach out to get an object in front or above us. It can do this because of four joints.

The most well-known of these is the glenohumeral joint, or shoulder joint. This unique ball and socket joint (like the hip) allows a 360-degree range of motion, and makes possible the greatest freedom of motion of all the joints in the body. Not surprisingly, it is probably the most frequently dislocated joint as well.

Got a shoulder problem?

Shoulder problems are far more common than you would expect, because the shoulder joint is used everyday and all the time, when we put on our clothes, hang out the laundry, lift weights in the gym, swing a tennis racquet, or simply transfer groceries out of the trolley.

As we grow older, the tendons and joint surfaces that help our shoulder function well can undergo degenerative wear and tear. And no matter what the age, any accident that involves a fall onto the shoulder or an outstretched hand can lead to shoulder problems and injury.

Although these can affect anyone at any age, there are certain types of problems more prevalent in certain age groups and lifestyles. This is related to changes in our body with increasing age, and differences in activity types at different times of our lives.

Younger people: fractures and dislocation which occur mainly from falls onto the shoulder or onto an outstretched hand, collisions in mid-air challenges for the basketball, and sports that involve the throwing action, such as baseball and some racquet sports.

Cyclists and motorcyclists: dislocations and fractures around the collar bone because of falls onto the point of the shoulders.

104

Middle-age onward: inflammation and tears of the shoulder tendons around the shoulder joint.

This is related to poor posture (hunching, bony spurs in the acromion, which is a bony extension of the shoulder blade above the joint), ongoing degeneration of the tendons, and acute or repetitive trauma from over-use. Patients with this may also be suffering from inflammation of the long head of the biceps tendon (biceps tendinitis), and arthritis of the acromio-clavicular joint.

Diabetic and heart disease patients: frozen shoulder, which sometimes occurs by itself, and sometimes after shoulder injuries, or as complications for those already suffering from inflammation of the tendons around the shoulder.

5 tips for shoulder care 1. Warm up adequately before racquet sports and weight-training 2. Work your way to higher levels of play only with concurrent physical conditioning 3. Use proper techniques and safety precautions when playing games and working out, especially during weight-training 4. Position yourself correctly when lifting heavy objects 5. Seek medical advice if you experience shoulder pain that does not go away after three weeks

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

CD-1710-09-14 WINE Chiller-FAp.ai

C

M

Y

CM

MY

CY

CMY

K

1

8/9/14

2:54 PM

SPECIALIST

OPINION

How acid reflux affects the throat This condition affects many people and causes damage to the structures in and near the throat. Preventing it requires an understanding of what causes it and what helps.

By Dr A B John, Ear Nose & Throat Surgeon

What is reflux?

When we eat, chew and swallow, food reaches our stomach by going down a muscular gullet or eosophagus that connects the back of our throat to the stomach.

Food in the stomach is mixed with acid and digestive enzymes, produced by the lining of our stomach.

The gullet or eosophagus has two sphincters, or bands of muscle fibres that close off the muscular tube.

These keep the stomach contents within the stomach where they belong. One sphincter is at the top of the eosophagus (at the junction with the back of your throat) and one is at the bottom of the esophagus (at the junction with the stomach).

The term “reflux” means the backward or return flow of contents, through the sphincters and into the lower esophagus from the stomach or into the throat via the esophagus.

What are GERD and LPRD? When abnormal amounts of reflux of stomach contents come up through the lower sphincter and into the eosophagus, it is called GERD or Gastroeosophageal Reflux Disease.

If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD or Laryngopharyngeal Reflux Disease.

The structures in/near the throat (pharynx, larynx, trachea and lungs) are more sensitive to stomach acid and digestive enzymes, so even very small amounts of reflux here can result in damage.

Why don’t I have heartburn or stomach problems?

Very few patients with LPRD experience significant heartburn, which occurs when the tissue in the eosophagus becomes irritated from acid reflux. Most of the reflux events that damage the throat happen without the patient even knowing that it is occurring.

Common symptoms of LPRD The common symptoms are hoarseness, chronic cough, frequent throat clearing, pain or discomfort in the throat, feeling of a lump in the throat, problems swallowing, a bad or bitter taste on waking up, shortness of breath, referred ear pain and phlegm in the throat.

A doctor finding the following symptoms while doing a voice box examination will diagnose LPRD: 1. Red irritated arytenoid (structure at the back of the vocal fold) or larynx (voice box) 3. Small laryngeal ulcers 4. Swelling of the vocal folds 5. Granuloma in the larynx 6. Thick mucus from the voice box How to reduce LPRD? • Stress Make time for stress-reducing activities.

•

Food Notice how your body reacts to various foods and know which ones cause reflux. These include spicy/acidic/tomato-based foods; acidic fruits/ juices; fast food/fatty foods; caffeinated beverages and chocolate.

• Mealtimes Eat in moderation, have your last meal three hours before bedtime, avoid bedtime snacks and don’t exercise right after eating.

•

Weight Excess weight can increase reflux.

•

Night reflux Elevate the head of your bed by four to six inches to achieve a 10-degree slant.

•

Clothing Avoid tight belts and restrictive clothing.

•

Smoking Stop because it causes reflux.

What are the medications for LPRD? Over-the-counter antacids such as Gaviscon or Mylanta are helpful if taken correctly, while H2 blockers like Zantac or Tagamet, and Proton Pump Inhibitors such as Nexium, Controloc or Pariet, may be prescribed.

106

Dr A. B. John A. B. John ENT Clinic & Surgery 3 Mount Elizabeth #15-10 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6735 9654 www.sinonasal.com

SPECIALIST

OPINION

Common renal issues explained How the renal systems works and what are some common problems.

Dr Ho Chee Khun, Nephrologist

The renal (urinary) system consists of two kidneys, ureters, the bladder and the urethra. The kidneys consist of about a million of nephron each, which is the functional unit of the kidney. Their main functions are removal of waste material and excess water from the body, blood pressure regulation and normalising electrolyte concentrations and blood pH. Urine formation and excretion involves filtration of excess water and waste material from blood in the kidneys. This travels through the ureters to the bladder, and is then expelled through the urethra. A healthy person generally produces about 1.5 litres of urine per day, although this varies. Because the kidneys have a large functional capacity, it is possible for a person to lose as much as 70% of kidney function without any symptoms. Here are four common renal problems.

Blood in the urine Possible causes: inflammation of kidney filters; stones, infections, cancers in the kidney or urinary tract; enlarged prostate in men or physical injury to kidney Symptoms: pink or red urine, or no symptoms (blood is only visible when the urine is examined under a microscope)

may need other medications to control the underlying disease and sometimes may need steroid and/or immuno-suppressants. If more than 90% of kidney function is impaired, dialysis/kidney transplantation is needed

Evaluation: requires blood and urine test. May need ultrasound, CT or MRI scans of the urinary system; kidney biopsy or bladder scope may be necessary

Urinary tract infection Causes: bacteria

Treatment: may require no treatment, medical treatment only or surgery

Symptoms: frequent urge to pass urine, pain or burning sensation while urinating, pain over the bladder area, fever or loin pain

Impaired kidney function and/or proteinuria (protein leakage in the urine) Possible causes: diabetes mellitus, hypertension, inflammation of the kidneys, urinary stone disease Symptoms: none in mild cases, but in severe cases may have frothy urine, swelling, breathlessness, poor appetite, nausea, vomiting Evaluation: requires blood and urine test to determine severity of the protein leakage and the stage of kidney impairment; may need imaging of kidney or kidney biopsy Treatment: for patients with diabetes mellitus or hypertension, good control of blood sugar or blood pressure will help decrease proteinuria and delay the progression of kidney impairment; dietary change to help preserve kidney function as well;

Evaluation: may require urine and/or blood test; imaging of the urinary tract Treatment: advisable to drink more water; may need antibiotic and other medications to help relieve symptoms Urinary stone Causes: usually occurs in those who excrete high concentration of calcium and/or uric acid in urine Symptoms: back pain that may radiate to the front, blood in the urine, stones/gravel in the urine, symptoms of kidney impairment Treatment: may need surgical removal or fragmentation by shockwave so that they can be passed out in the urine; specific diet or medication may help to prevent stone formation

Dr Ho Chee Khun The Kidney Clinic 3 Mount Elizabeth #12-09 Mount Elizabeth Medical Centre Singapore 228510 Tel: 6737 9022 www. thekidneyclinic.sg

107

SPECIALIST

OPINION

Teary or dry eyed?

Most of us have experienced these relatively common conditions that become an issue once they persist and affect our daily activities.

By Dr Elaine Chee, Ophthalmologist

Decreased tear elimination, on the other hand, is a result of narrowing of the opening and tear drainage passages. This can be caused by ageing, foreign bodies or tumours, and could also be linked to sinus or nasal problems. A previous history of radiation treatment around the head and neck area and chemotherapy have also been associated with tear drainage issues.

Symptoms: Patients with significantly teary eyes often have increased discharge from the eyes and may have constant red and inflamed eyes.

Treatment: Whether it is due to lax eyelids, incomplete closure of the eyelids, or obstruction of the tear duct system, surgery is usually required. This condition can lead to serious infections and permanent scarring if left untreated.

Tears are produced by the tear gland, which is underneath the upper outer part of the eyelid. It forms a film over the eye, as well as a tear lake in the lower part of the eyelid. When you blink, the eyelid spreads the tears and pushes the tears towards the inner corner of the eyelids towards the nose via the tear ducts. This is the reason why we get a runny nose when we cry. The tear drainage system drains the tears away passively and via the blinking action of the eyelids.

Tears consist of three layers, namely an outer oily layer, a middle layer of water, electrolytes and proteins, and an inner mucin layer. The tear layers have a variety of important different functions: they maintain a smooth surface for clear vision, lubricate to help in blinking, and protect the eye against infection.

Teary eyes This is caused by excessive production or decreased elimination of tears through the tear drainage system.

Excessive production of tears is usually caused by foreign bodies, inflammation or infections of the eyes, or malposition and laxity of the eyelid resulting in the eyelid margin either turning inward or outward.

108

Dry eyes This condition is caused by either insufficient tear production or excess evaporation of the tears. It is increasingly common and tends to worsen with age.

Insufficient tear production may be caused by age-related changes in the tear gland, certain medications such as anti-histamines, high blood pressure medication and painkillers. Dry eyes have also been found to be linked with menopause. Reduced tear production can also be caused by certain viral infections, LASIK surgery and radiation treatment.

Dry eyes due to excessive evaporation can result from conditions such as abnormal oil production at the eyelid margin, excessive exposure of the eye surface due to reduced blinking, incomplete closure of the eye due to stroke or thyroid eye disease, and diseases or surgeries that damage the conjunctiva (white part of the eye). High altitudes, dryness (especially in air-conditioned places) or extreme heat can also accelerate tear loss and worsen symptoms.

Symptoms: General discomfort in the eyes, a sandy or gritty sensation, tiredness, intermittent blurring of vision and occasional tearing.

Treatment: Mild cases are treated with artificial tears and gels, while serious conditions require daily lid scrubs to reduce bacteria. In severe cases, occlusion is performed to reduce tear drainage and increase the amount of tears in the eye. Nutritional supplements such as Omega-3 have also been used to improve the situation. If left untreated in severe cases, it can lead to recurrent inflammation and eventual scarring of the eyes.

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

SPECIALIST

OPINION

Fertility issues & what you need to know It can be frustrating and demoralising when you cannot conceive, so it helps to have a clear understanding of the various factors that come into play.

By Dr Michele Lee, Obstetrician & Gynaecologist, and Fertility Specialist

While it is often assumed that infertility is a female issue, the fact is that infertility is just as common among men. About one-third of infertility issues are female, one-third are male, and the remaining one-third are described as non-specific, arising from combined male-female issues or of unknown causes.

How long, on average, does it take a couple to conceive once they start trying?

It varies from couple to couple, and can depend on age as well, but conception should normally take place between six months and one year with unprotected intercourse.

About 85% of all couples will get pregnant within a year, although women aged 35 and older should not wait that long before seeking help.

How does one know if there might be a problem?

If conception does not occur naturally despite one year of regular unprotected sexual intercourse (at least two to three times per week), the couple should seek a gynaecologist’s help. Older women face the reality of overall reduced fertility, and should see a doctor if they are not pregnant within six months of trying to conceive.

How will the doctor find out the cause of the infertility?

For both parties, there will be a review of your medical and family history, and a physical examination with a cervical smear for the female. The male will need to undergo a semen analysis and blood tests. The blood test will reveal hormone-related and medical issues, and possibly genetic ones as well. For the female, investigations include a pelvic ultrasound scan to look for gynaecological conditions such as fibroid and endometriotic ovarian cysts which can affect fertility, and follicular tracking to exclude ovulatory problems.

Blood tests include a female hormone profile, thyroid function tests and a check of ovarian reserve, the Antimullerian Hormone. Hysterosalpingogram (HSG) may be considered, to check for tubal patency.

The most common causes of infertility?

Men: Varicocele, which happens when the veins on a man’s testicle/s are congested, which can be associated with reduced sperm numbers and quality. Other causes include factors that result in reduced production of sperm, and injuries or any other kind of damage to the reproductive system.

Women: Ovulation issues, often because a hormone imbalance can interfere with normal ovulation. Without it, there will be no release of eggs for fertilisation. Other

possible causes include blocked fallopian tubes arising from severe endometriosis, previous pelvic surgery, and problems with the uterus that affect successful implantation of the embryo.

How is infertility treated?

By various means, ranging from ovulation tracking with timed intercourse, medication and surgery to correct pelvic anatomy, to assisted reproductive techniques such as intra-uterine insemination and in-vitro fertilisation. The treatments are individualised according to the cause of infertility, the female’s age, the health of the couple and the duration of infertility. It is also important that the couple makes an informed decision on their preferred treatment based on their personal beliefs, religion and understanding of the benefits and risks of the various treatment modalities.

What are the success rates for the most commonly used fertility treatments?

Success rates vary depending on many factors, such as the age of the couple and the cause of the infertility.

For women under 35, the success rate can be as high as 40%, but it drops to 30% in women aged 35-37, and drops further to about 20% for those aged 37 to 40. It suffers a further drop to about 10% for women past their 40s.

While fertility treatments can be time-consuming and stressful, they do make it possible for a couple to conceive where they might otherwise not be able to.

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

109

Nobel Biocare Special

Just like your own teeth Millions of despondent denture wearers yearn for renewed quality of life.

And the answer lies in dental implants.

At one point in time, a patient facing tooth loss had two options: dentures or living without teeth. Both options came with their own challenges, but all things being equal, dentures were the better option. This is no longer the case.

They are not easy to wear, but people get used to them. Wearers get used to not enjoying their food and drink as much; used to painful spots and blisters, and occasional embarrassing situations involving dentures falling out; and used to speaking less and trying not to laugh because of the potential for embarrassment.

Not to mention bone resorption, where the dentures accelerate the shrinkage of the jaw bones, which leads to facial changes, the appearance of ageing and challenges in chewing. Adhesives, denture relining, ill-fitting dentures – these are all inconveniences, at the very least, associated with removable dentures.

There are so many reasons to consider migrating away from traditional dentures. Most importantly, leading a full life – rather than just surviving – requires teeth that work.

And that means today’s best alternative – implants which look and feel like your own teeth.

It all began with Per-Ingvar Brånemark, a Swedish orthopaedic surgeon and researcher often described as the father of modern dental implantology. In 1983 he presented his research on the unprecedented biological fusion of bone to a foreign material. Since his pioneering of fullarch bone-anchored restorations, no other form of oral implant treatment has had longer or more favourable outcomes. Nobel Biocare is proud to continue to develop new solutions based on this experience.

When implants were invented, they became, for the first time, a well-proven, scientifically validated, bone-anchored alternative to the countless social, emotional and even nutritional disappointments patients had always faced after losing their teeth.

110

Fast forward to today. New technologies and materials have enabled great strides in implant design and function, making it possible to restore 60-80% of chewing function, prevent the jaw bone from shrinking, and help retain the natural structure of the face. A dental implant, in fact, mimics the root of a tooth.

So, for instance, if you are looking for an efficient full-arch treatment for immediate loading – that’s affordable and well-proven – the Allon-4 treatment is supported by almost 15 years of clinical success, and was pioneered by Nobel Biocare. All-on-4 is a graftless solution, which means that patients do not have to wait for six to nine months for the bone graft, and it is possible to have the denture installed on the same day of surgery.

The humble overdenture – still a good alternative to the removable denture according to long-term data collected by Nobel Biocare over the years – has gone high-tech with the advent of the NobelProcera Implant Bar Overdenture.

Beyond just providing the implants, Nobel Biocare works closely with healthcare professionals and patients to provide the right know-how and guidance in using these implants, and presents seminars that showcase the differences between removable dentures and implant-based alternatives.

The idea is to raise awareness about these options which come with so many positive outcomes and benefits to patients. Patients, on their part, only need to adapt and get used to different maintenance and cleaning practices.

Nobel Biocare’s implant-based solutions are acknowledged around the world for their design and efficacy which make the implants feel like the patient’s own teeth.

No one should have to die with their teeth in a glass of water beside their bed.

– Per-Ingvar Brånemark

HSBC Private Bank Special

NO quick cure

As traditional family businesses mature and evolve, and new ones take flight, the challenges are shared. Both need reservoirs of stamina, passion and successful engagement with Gen-Y employees.THIS QUARTERLY speaks with Marielle Reussink, guest speaker of HSBC Private Bank Next Generation Seminar, on the behavioural trends of the Millennials.

112

Experts project that around the world in the creative work environment.” Universum conducts coming decade, family businesses worth trillions the annual Ideal Employer Survey, the world’s largest of dollars will change hands as baby boomers and global research project on Millenials, with more Gen-Xers hand the reins over to the next generation, than 700,000 taking part. the Millenials. The concern among many, especially Millenials also, the data reveals, want to get for businesses in Asia, is that succession planning ahead quickly and believe they have the skills to is not taking place as much as it should. lead right from the get-go, although they expect There are many reasons for this. Primarily, and need a lot of support, training, coaching because in Singapore and most parts and mentorship to do so. of Asia, most family businesses are How they feel about taking relatively young compared to their over the family business depends parallels in the US and Europe, largely on how entrepreneurial many of whom have been around they are, and whether this means Marielle Reussink for more than a century. For building their own dream or these older (and some say, wiser) taking the baton from their elder companies, succession planning predecessors and running with it. has long been in the works as a Other factors do come into play, key part of the strategy to grow the such as family relations, personal company’s value. ambitions and aptitude. Concern Here in Asia, the idea, let alone for work-life balance also plays a part. the practice, of succession planning, is not “If, for instance, family members had great well-entrenched. In this age of flexibility over their schedules deferred retirement and longer and were more easily able to life expectancy, Asian founders “…family businesses integrate family life with work are also remaining longer at than someone slaving away will be faced with the life, the helm. at a large corporation, they may So w h e n s u c c e s s i o n challenge to ‘innovate feel favourably about taking planning and execution do take the family business. If, or die’. Innovation may over place, businesses are faced with however, they perceive that many challenges, not least the lie in reconsidering the their family members sacrificed differences between traditional their lives and families to build family model or and contemporary approaches to the company, and they don’t see addressing the needs value in this, they will feel less career, life and personal choices.

Says Marielle Reussink, to take over. This does and career expectations inclined not necessarily mean they will Head of Activation Solutions, Universum Asia-Pacific: of Millennials to ensure reject taking over. If they have deep feeling of responsibility “Millennials, regardless of sociothey are more inclined atowards their families – which economic status, generally aren’t is still often the case in Asia – driven by money or traditional they may well still take it on,” status symbols. When it comes explains Reussink. to career, the majority of Different values, lifestyles, Millennials want to join large Marielle Reussink, Head of Activation Solutions, world views, dreams – these international organisations and Universum Asia-Pacific are just some of the differences only 15% show an inclination between the baby boomers and towards being entrepreneurial. the Millennials. But they’re possible to bridge What is interesting is that this does not necessarily with awareness, openness and willingness to really mean that they want to start their own business, join engage and understand different perspectives. And, a start-up or take over the family business. Rather, “as with all businesses, family businesses will also a big proportion expect that they will be able to be faced with the challenge to ‘innovate or die’. be entrepreneurial within an organisation, being Innovation may lie in reconsidering the family model responsible for their own projects, solving problems or addressing the needs and career expectations of independently, and so on. This also explains why Millennials to ensure they are more inclined to Google, for example, is seen as a dream employer by follow in their families’ footsteps,” says Reussink. many Millennials, with its flexible, innovative and

to follow in their families’ footsteps.”

3 Millenial traits • They want to be themselves in everything they do, and not have to adopt one persona at work and another out of work.

• They don’t choose employers purely based on the brand or industry.

The working environment is very important; they want to know who works in this company, can they be themselves, and so on.

• They know what it means to have working parents; they know what the lack of work-life balance means.

This is why work-life balance is so important to them.

HSBC Private Bank is a division of The Hongkong and Shanghai Banking Corporation Limited which is incorporated in the Hong Kong SAR with limited liability.

113

EU HOLIDAYS HOLIDAY Special Special

Winter wonders in Europe Indulge in winter-time activities like sledging when you visit Europe with EU Holidays.

Few things can beat the adrenalin rush of whooshing down a mountain slope, icy winds blowing in your face. You can do just that when you visit Switzerland with EU Holidays. And don’t worry if skiing or snowboarding are not your thing. Sledging affords the same thrills and is something almost everyone – young and old – can do.

EU Holidays’ 13day Italy-SwitzerlandParis and 10-day Winter White Switzerland-Paris itineraries both include sledging as one of the highlight activities. A specially designed snow bus takes you up to Mount Bussalp which boasts the longest sledge run in Europe, at 7.6km.

With a difference in altitude of 1,600m, the descent through various obstacle courses offers unforgettable thrills. A range of snow runs is available, so you can choose a faster or slower route depending on your fitness level and preference. Either way, you’ll enjoy breathtaking views of Jungfrau’s snow-covered peaks. In fact, the activity has received a five-star TripAdvisor rating.

114

While sledging will undoubtedly be the highlight of your European winter holiday with your tour group, the itineraries provide many other attractions too.

Geneva goodness Both travel itineraries include a tour of Lucerne, a picturesque lakeside city. Bring enough memory cards for the photo-taking opportunities here – the covered Chapel Bridge with its 17th-century interior paintings; Aion, the world’s largest rolling ball clock; and the stunning six-metre-tall Lion Monument made of limestone for soldiers killed in battle. Visit Evian Les Bains, home of the renowned Evian Mineral Water; bring a bottle to fill with mineral water at its source. Travel to Montreux for photographs of the 1,000-year-old Chillon Castle and to experience Montreux’s colourful Christmas market. Soak in the festive atmosphere, sip mulled wine and pick up an unusual trinket or two to decorate your Christmas tree back home.

While in Switzerland, you’ll also get to enjoy picturesque views of Lake Geneva and Lavaux, the only UNESCO World Heritage site vineyard. In Geneva, come up close and personal to the headquarters of international organisations like World Health Organization, International Labour Organization, the International Committee of the Red Cross and the United Nations headquarters. Don’t miss Jet d’Eau, the highest fountain in the world. On the 10-day Winter White tour, you’ll get to wander through Bern, with a stop at the Bear Pit, the Astronomical

The mighty Matterhorn, the symbol of the Alps

Tummy-warming Swiss fondue

Clock Tower and Einstein’s house. As you go through the Grand St Bernard tunnel to Italy, you’ll catch beautiful views of the surrounding mountains.

In the Black Forest region of Germany, visit Lake Titisee where you can watch a demonstration of cuckoo clock-making and taste some ice wine. While you’re there, savour a piece of blackforest cake from its place of origin.

To Paris and Italy for romance and retail Besides Switzerland, travel to Paris, the city of love, on the Winter White tour and savour attractions such as the Avenue Champs Elysees, Place de la Concorde, the Louvre and its glass pyramid designed by I. M. Pei, as well as the Opera House. Climb the Eiffel Tower for a panoramic view of the city, set off on a romantic cruise along the Seine or watch a Moulin Rouge show.

On the 13-day tour, you’ll get to visit several Italian cities like Venice, Milan and Rome, as well as Siena, Pisa and Tuscany. In Rome, wander around St Peter’s Basilica in Vatican City and admire the Pieta, Michelangelo’s masterpiece. Go on a guided tour of the Colosseum, see the Roman Forum and meander through the Piazza Venezia. Be bowled over by Siena, a walled city in Tuscany where the Il Palio, a bareback horse race, is held twice a year. Take a selfie next to the Leaning Tower of Pisa; travel in a private water taxi in Venice and cross the romantically named Bridge of Sighs. In Milan, see the Castello Sforza, take Instagram-worthy photos of the gothic

Panorama of Siena, Italy

Duomo cathedral and the La Scala opera house. You’ll spend the night in the Lorraine region in France, famous the world over for its quiche lorraine, macarons and madeleines.

If shopping is a must-do, you won’t be disappointed. Both itineraries include the Barberino Designer outlet. Shop for Puma, Furla and Prada, among other brands.

Foodies will be pleased to know that they’ll get to try traditional fare like German pork knuckle and Swiss fondue. Both itineraries include a three- or four-course French meal.

The Sledging Story The sport of sledging started in the Alps in 1883. It is a worldwide winter activity, done in a prone or seated position.

There are many types of sleds commonly used today: runner sleds, toboggans, disks, tubes and backcountry sleds. Each type has advantages and disadvantages if one is trying to get the most out of a given slope.

Look out for EU Holidays promotions and winter itineraries.

Call EU Holidays at 6535 8535, check out www.euholidays.com.sg, or visit the EU Holidays Facebook page – then book your best winter break!

EU Holidays celebrates its 4th anniversary in October 2014, so do ask about specials.

115

ZOE NISSI Special

A Natural Glow Treating skin at the cellular level is the best way to achieve a porcelain-perfect complexion.

“As skin builds up tolerance and cells become more resilient, its ability to repair itself strengthens.”

Healthy skin is smooth, firm and tight, even-toned, hydrated and strong.

Unfortunately, many women are plagued by skin problems that include uneven skin tone. This is the result of over-production of melanin due to hormonal imbalances, exposure to the sun and ageing.

Pigmentation problems are often treated with hydroquinone-based creams but it has been found that 80% of those treated with hydroquinone can develop a resistance to it if used for more than a few months.

The ZO non-hydroquinone pigmentation system created by Dr Zein Obagi aims to treat pigmentation problems at their source by addressing them at the cellular level. Rather than only treating the symptoms, Obagi’s skin solutions treat the skin as well as the problem. Doing that allows skin to repair itself on the inside and the outside.

The ultimate goal is to stabilise skin through correction, stimulation, pigment control, hydration and sun protection. A skincare regimen using ZO’s range of products is meant to reduce the negative effects of sun,

116

hormones and ageing. Most over-the-counter products tend not to address skin problems at the cellular level but focus on moisturising the skin instead.

This is only a panacea and, in fact, can be harmful as it tends to increase dryness and sensitivity. Stimulating hydration from within helps to reduce inflammation and redness.

ZO products are developed to stabilise melanocytes, the pigmentproducing cells responsible for brown spots or sun spots. The goal in treating pigmentation issues is to reduce melanocyte hypersensitivity and activity by increasing skin’s resistance to external and internal stimulation.

The products in the range are Retamax, Brightenex, Ossential Growth Factor Serum Plus and Advanced Radical Night Repair.

Retamax is a Vitamin A derivative which contains the highest concentration of retinol to repair ageing skin and sun damage. It aids in skin rejuvenation by stimulating the natural formation of collagen and encouraging the regulation of skin barrier function by up-regulating the production of hyaluronic acid, the skin’s most vital hydrating factor. It also helps block free radical damage, protects vulnerable DNA and addresses the root causes of future ageing.

Brightenex is a non-hydroquinone skin brightener. It is uniquely formulated to control hyperpigmentation to achieve an even tone and colour. Ossential Growth Factor Serum is a lightweight gel that strengthens and repairs skin and protects against future ageing while Advanced Radical Night Repair targets multiple signs of ageing and also protects against it in the future.

Stabilising the skin with these products also prepares skin for further treatment if necessary as it reduces skin sensitivity. Often the result of weakened and intolerant skin which is unable to tolerate the products being used, dry, sensitive skin can also be caused by disease or genetic factors.

Healthy skin tolerates treatment without reacting. As skin builds up tolerance and cells become more resilient, its ability to repair itself strengthens.

Treating skin at the cellular level is the best way to restore strong, hydrated skin and achieve a more youthful and glowing complexion.

Singapore Medical

d

Your Health Our Concern Singapore Medical is a compilation of the medical and dental specialists in Singapore who have impeccable qualifications and are accredited by the Ministry of Health. The specialists featured in Singapore Medical are highly qualified, well respected and experienced medical and dental specialists who are recognized leaders in their fields. This is one portal that every patient can use as a reference to seek quality medical healthcare services in Singapore.

www.Singapore-Medical.com

Feature

Loving those

overseas properties!

The number of Singaporeans investing in overseas properties is on the rise, and they are casting their nets far and wide. By Lye Kim Sheong A Singapore passport is the sixth most accepted around the world for non-restricted international access. As such, almost all Singaporeans own a passport and many have travelled overseas for leisure. And when Singaporeans vacation, they shop – a lot.

Take Japan for example. Visitors from the little island state accounted for nearly 2% of foreign tourists last year, contributing significantly to the total foreign tourists spent of 463 billion yen. At the same time, London too observed that Asian visitors from China, Singapore, Hong Kong, Malaysia and Thailand have been quick to pick up the tax-free shopping benefits in the UK. Small wonder then, that in recent years, this overseas spending habit has increasingly encompassed shopping for properties overseas.

International buying spree Today, or more precisely, since 2011, midto-high income earning Singaporeans with annual incomes of S$500,000 – $1million are joining high net worth individuals in investing in properties overseas, says a recent report in The Business Times.

Encouraged by the strong Singapore dollar against major foreign currencies, low interest rates and affordable prices of overseas properties, well-heeled Singaporeans have been pouring investments into countries around the world. These include old favourites like

Australia, Malaysia and the UK, as well as major cities that were previously less prominent on the property radar, like New York and Tokyo – which offer lower property prices as well as strong and sustainable rental markets.

In Knight Frank’s European Cities Review 2014, which maps luxury residential market performance in Europe’s key cities, it was revealed that of all the luxury properties snapped up by foreigners in Dublin, Ireland, Singapore-based buyers were the most prolific. To get a perspective, luxury residences in Shrewsbury Road, one of the most expensive streets in the world, were priced at around €6,500 – €8,500 per sq m, as at March 2014.

In Paris, Singaporeans made up the second largest group of foreign buyers (prices at the posh Avenue George V range from €12,000 – €17,000), while in London (from €26,000 – €32,000 at Kensington Palace Gardens), it placed third.

London calling Despite staggering prices, London has always been and will remain a choice destination for Singapore buyers, reports Jones Lang LaSalle. This is because Singaporeans have a strong affinity to the UK, and it also helps that the kingdom poses no language barrier, has good tax efficiency and its legal system is highly transparent.

Dublin, Ireland

118

Kensington Palace Garden,London

Industry watchers also noted that lowerpriced residences, especially those in the £500,000 – £1million range, have spiked in popularity.

Real estate service provider CBRE reported that 62% of London property sales from Singapore in the first five months of the year were for units priced £500 – £750 per sq ft; this compared to the 21% in all of last year that belonged in that price range. It also credits higher quality projects, and developments near revitalised areas as key factors.

First time investors would notice that a lot of the process is taken on by law firms. This is because there is a web of rules and regulations, guidelines and policies that could confound even the most seasoned non-professional.

Likewise for loans – it’s almost always through mortgage brokers who not only have experience, but also come with strong repute for handing foreign buyers.

In the UK, the practice is for the buyer and seller to only act through their solicitors, who also handle contracts, funds, and all manner of documentation, submissions and approvals. Therefore, the law firm you choose must be experienced in dealing with property transactions on behalf of foreign investors.

You can check that it is regulated by the UK Law Society at its website www.lawsociety.org.uk).

The solicitor will also be responsible for handling the money for all transactional matters, including the purchase money and the initial deposit. The buyer’s funds should also be available in a single bank account that is under the buyer’s name.

To play it safe, it is best if you do some online reading before you commit to anything.

And if you remain confused, you can find help in legalising title documents at the UK’s Foreign Office.

Australia Beckons

Malaysia Mari-lah

The world’s largest island is widely recognised as a safe haven for investment, especially in the cities of Brisbane, Melbourne, Perth and Sydney. With a world-class and resilient economy, political stability and a wellestablished legal and property buying system, demand is growing, especially among parents buying properties for their children who are studying there and those who are migrating or choosing a retirement retreat.

“We expect to see the buying trend grow and continue especially with the all-time low cash rate of 2.5% by the Reserve Bank of Australia, and correspondingly, a lower cost of mortgage from the bank” explains Karen Chia, Country Director, Singapore Office of Australia’s Crown Group property developers.

Overseas investors can only purchase brand new dwellings like off-the-plan apartments in Australia, and the trend is toward apartments located closer to the city and amenities.

When it comes to foreign ownership of properties, the processes are strictly regulated

by Australia’s Foreign Investment Review Board (FIRB). This is, therefore, not something you want to attempt DIY. It’s best to seek legal assistance from an Australian solicitor due to the complexity of the buying process. Since solicitors are licensed by state, you will first need to identify which state you want to invest in, and then select the law firm.

Australia frowns on speculative buying, and only welcomes foreigners buying properties for residential and/or long-term investment purposes.

A property in our closest neighbouring country has always been a big draw.

For many, there is a natural affinity because of our shared culture and history. It is close to home, offers a slower pace of life, plentiful land and natural attractions, from beaches and forests to hill stations and islands.

Kuala Lumpur urban View Malaysia has some of the most liberal regulations in the region when it comes to foreigners buying residential property, particularly landed Avoiding pitfalls homes. But the rules have changed a number of With the increasing number of foreign times over the past few years and there is still properties being marketed in Singapore, The some confusion over the current policies Council for Estate Agencies (CEA) in March governing the minimum price at which this year published an online consumer guide, foreigners can buy.

Consumer Tips for Buying Foreign Properties, Many are not aware that property is on its website. This is to help potential buyers actually a State matter, which means that make informed decisions when investing in individual states have the power to overrule foreign properties. Some of the tips include: Federal policies. For clarity, your best bet is to visit the State Land Offices.

• High and guaranteed returns – ask for By way of example, as of 1st September evidence from credible/authoritative 2014, the Selangor Land Office changed sources; ensure that the return and time the minimum purchase price regulations frame of the guarantee is indicated in the for foreigners to RM2 million, effectively Sale & Purchase Agreement. doubling the price which foreigners have to pay to purchase property in certain • Irresistible promotions, discounts, financing districts. Penang too has raised the price options – examples include zero legal limit for foreigners buying different kinds of fees, state levy, capital tax or discounted residential properties. maintenance fee. Check if you are subject But despite these new regulations, to other terms and conditions.

Malaysian properties continue to lure Singapore buyers. Cosmopolitan • Excellent location – very often the claims Johor, Melacca, Kuala Lumpur, Sydney Harbour Bridge of proximity to world-class academic Selangor and Penang, for example, facilities, central market, state library and are in close proximity to Singapore so on may not match the reality. and the luxury residences offered there are of relatively high quality, Potential buyers note! with the developments situated All property transactions handled by estate in familiar surroundings. The strong agents in Singapore, including those involving Singapore dollar to Malaysian ringgit foreign properties, are regulated by CEA under also contributes to the country’s the Estate Agents Act. ongoing popularity.

Foreign property developers must either But even as the demand appoint a local licensed estate agent, or have for overseas property grows, a their foreign estate agents licensed with CEA cautionary note is in order. before they can market foreign properties It is easy to be swept away by here. The CEA advises the public to contact savvy marketing, glossy brochures them at 1800-6432555 or feedback@cea. and promises of high returns. gov.sg if they encounter any person, not But the fact is that investors have listed on the Public Register, carrying out had their fingers burnt, and for estate agency work. Consumer Tips for Buying many unexpected reasons, from Foreign Properties is downloadable at www. changes in government and hidden cea.gov.sg/cea/content/binary/pdf3Files/ costs to natural disasters and sheer ForeignProperties.pdf lack of awareness. Remember, due diligence is your responsibility.

119

MIX-MEDIA RECOMMENDS WINDOWS

SPECIFICATION Windows 8.1 Pro Office Home and Business 2013 Intel i7-4820 3.7GHz Asus P9x79 MainBoard 8GB 1600MHz DDR3 Ram 1TB Sata 6GB 64MB HDD Nvidia GeForce GTX650 1GB Graphic 24x DVD+RW Dual Layer Drive 3xUSD 3.0 + 8xUSB 2.0 + HDMI + G.Lan 8 Channel Audio Sound Microsoft Keyboard & Mouse 24� LED Monitor (VGA/DVI/HDMI) Norton Internet Security

S$2,188 with GST 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

The Entertainment Evo360

Home & Business 2013

OEM hardware solutions

Follow Me Japan Special

Natural attractions, sumptuous food and unniq ique u activities promise to make your holiday in Hokka kaid i o id nothing short of magical.

122

Imagine waking up in the morning to a landscape of powdery white snow and nights spent huddled around a fireplace, sipping warm sake and slurping bowls of steaming hot ramen.

You can do this in Hokkaido, the second largest island in Japan and the least developed, with harsh winters, below-zero temperatures and frozen seas. Located in Northern Japan, it has a varied landscape with mountain ranges and lakes with jewelled tones. The island draws lovers of the outdoors with its unspoiled natural attractions.

On Follow Me Japan’s Hokkaido tours, you’ll visit Chitose where you’ll be blown away by the beauty of Lake Shikotsu. The lake does not freeze most winters – on calm days, the placid waters reflect the surrounding snow-capped mountains, a sight which will take your breath away.

Towards the east lies the hot spring town of Lake Akan. The lake is inhabited by marimo, a species of algae that grows into large green balls, and it is one of the most renowned sightseeing venues in Hokkaido. The town along its lakeshore is also home to the Ainu, who are indigenous to North Japan and have a different cultural and racial background from ethnic Japanese.

Explore Ainu Kotan, a small village with souvenir shops retailing Ainu handicraft. There is also a small museum displaying traditional Ainu craft, clothes and utensils. Also visit Lake Mashu, a caldera lake considered by many to be Japan’s most beautiful. It is usually appreciated for its clear blue waters on the days when it is not blanketed in heavy fog. See Mount Iou, an active 500m-tall volcano, where acid smoke and solid sulphur p can be observed,, and Lake Kussharo,, where large g numbers of whooper swans gather each winter.

At the city of Kushiro, stop at Akan International Crane Centre and learn about Hokkaido’s red-crested cranes. At the adjacent Tancho no Sato Observatory, 200 of these cranes live, court and mate. Here, you can watch and photograph their spectacular dance up close. Coming face to face with the cranes, you’ll be surprised by how large they actually are.

Hakodate is Hokkaido’s third largest city. Among its attractions are Goryokaku Tower, a 107m tower with an observation deck overlooking Goryokaku Fort, a massive star-shaped Western-style citadel. The Motomachi area of Hakodate is lined with historical buildings like the Old Public Hall, the Hakodate Roman Catholic Church and the Russian Orthodox Church.

For a spectacular view of the city, take the ropeway up to 334m high Mt Hakodate and see the city from the observation deck. This view, incidentally, is ranked among the top three in the world. A popular activity is visiting the Hakodate Morning Market, with its array of delectable fresh Hakodate produce sold in more than 300 shops. Besides the lively buzz, try squid fishing and have your fresh catch prepared sashimi-style on the spot. On the way to Lake Toya, stop at Konbukan, a kelp product shop with every possible kind of kelp product you can think of; and Onuma Quasi-National Park where islands which dot the lake are connected by a series of picturesque bridges, allowing you to explore the lakes’ peninsulas and take in the scenic beauty of the area.

Next stop Otaru This is a city not only famous for its nostalgic canals but also renowned for its glasswork, music boxes and sweet shops lining bustling Sakaimachi Street. Stroll, shop for souvenirs and treat yourself to some of the freshest and tastiest seafood in all of Japan. For delicious sweets, drop in at LeTAO where you’ll find an impressive range of over 50 kinds of cakes and sweets. Wander over to Otaru’s Music Box Museum, home to almost 15,0 15,000 music boxes ranging from matchbox-sized souvenirs to precisely tuned masterpieces.

No trip to Hokkaido would be complete without a visit to Sapporo. Japan’s fifth largest city, this is one of the nation’s youngest major cities. Incredibly, back in 185 1857, the city’s population stood at just seven people. Sapporo becam became famous in 1972 when the Olympic Winter Games were held th there. Every December, the city hosts the annual Sapporo White Illumi Illumination festival, which features a romantic, artistic collaboration of natu nature and light with over 400,000 light bulbs used to herald the advent of the snow season.

At the festival’s main site, the 1.5km-long Odori Park, you’ll find the TV T Tower, trees and artistic structures, all adorne adorned with colourful light bulbs powered with renewable renewab energy, including recycled cooking oil and solar panels specially designed to produce power even in the heaviest snow season.

Head up to the TV T Tower for a view of the park or or see it from the JR Station Tower Observatory.

Shop till you drop at Sapporo’s Stellar Place,

123

Follow Me Japan Special

Daimaru, Paseo and the Apia Shopping centre which connects to ESTA that houses Uniqlo, Muji and five floors of BIC Camera.

In Asahikawa, visit the uniquelynamed Wooden Toy World Museum’s Chacha World. The young and young at heart will have a field day checking out elaborate wooden block displays and building their own wooden sculptures. The museum includes a child’s play area, traditional Japanese toys and a collection of other random toys.

If you are a ramen lover, head for Ramen Republic in Sapporo, a mini ramen village consisting of eight different ramen shops each with its own distinct flavours and toppings. Sake drinkers can look forward to sampling sake at Takasago in Asahikawa; be sure to try the prefermentation “sweet sake” (non-alcoholic) that uses only the sweetness of the rice for its core flavour and is bottled prior to fermentation.

One-of-a-kind experiences

Eat, drink and be merry Foodies have much to look forward to in Hokkaido, which is known for its fresh produce and mouth-watering specialities. Try the Katte-don at Washo market in Kushiro – basically, a bowl of rice topped with a selection of fresh ingredients. Browse the rows of stalls to select the ingredients you like. Each stall has a unique selection of fish; get advice from stall owners to pick the ones in season.

At Sakaimachi Street, treat yourself to a delicious seafood lunch or dinner. Interested in bringing some of it back home? The best place to buy Hokkaido seafood such as crab, sea urchin, salmon roe, squid and scallops and local produce such as corn and melons would be Curb Market in Sapporo. One of the city’s largest public markets, it has nearly 80 stalls and restaurants that specialise in Hokkaido specialities.

124

Delectable fresh Hakodate produce is available from over 300 shops.

Besides the lively buzz of the market, try squid fishing and have your fresh catch prepared sashimi-style on the spot.

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

A vast array of indoor and outdoor activities are there for the taking, to enhance your holiday and arm you with new skills. Learn how to make ice cream, potato cakes, caramel or cheese.

Take part in leather- and glass-making classes, and bring home your own handmade souvenir.

Over at the Rusutsu Resort, children can take part in snow activities like tubing and sledding in a snow park. For a more energetic experience, go for a snowmobiletouring course, snowmobile powered snow rafting or dog sledding. Or take a course in horseback riding or try a snow shoe nature tour. Why not try skiing on West Mountain with its terrain that is suitable for every level.

Packed with natural beauty, unusual flora and fauna, exciting activities and delectable cuisine, a winter holiday in Hokkaido will be just what you imagined and more. So much to do, so little time – that’s what the best holidays are about!

FEATURE

nts to restaura g in in d e fin plenty ecture to , there is s it k h c n r li a ff e u appear fc ting-edg this may ned set o e ig il s e h From cut w -d t y u layed beautifull e, design-wise. B always p s a h n the most r o ig ap es es. g in Sing menon, d olonial tim some c o happenin tively new pheno t k c a h the way b away wit like a rela t here, all n side, and come r discover a e p r r ig o b a ver o desig c e is h d t o n T o s. g trail alk n starter ed walkin io Take a w n t a ig s s r e e v -d g con ecially fascinatin sures, try this sp ar and a jong Pag e n r a T h old, e h t some t filled wit e r through a h ic s wh erings. soh area w new off e -n Bukit Pa e d a old-m Naidu new and

By Sunuja

125

FEATURE

2

Red Dot Museum

ll Maxwe road

1

URA City Gallery

4

Jinrikisha Station

oad

Neil r

South bridge road

New

brid

3

ge r

oad

Buddha Tooth Relic Temple

Maxwell to Neil Road,

From

N

design, Savvy city s. d n u o b a ries design ducts, centu ro p g in n in award-w er solutions anship, clev sm ft a cr ld o ew… of old and n and fusions ail! along this tr it’s all here

126

Keong Saik Road

5

Kr

et

tECK lIM R

aA

ye

oad

rR

oa

d

Tea Chapter

oa

d

6

bU

KIT

Ro ad

pA

SO

HR

Hotel 1929

ik

Sa

ONG

h tEO

New

8

Neil road

g Keo n

Pinnacle@Duxton

7

OAD

r

t

Can

New Majestic Hotel

to

nt nme

Can

ad

t ro

en onm

d

roa

9

Baba House

br

idg

er

oa

d 127

FEATURE

Start at the URA City Gallery (45 Maxwell Road, www.ura.gov.sg/gallery), a little-known public gallery that offers an excellent overview on how the entire city of Singapore was – and continues to be – planned. Check out one of the world’s largest architectural models, which offers a bird’s-eye view of Singapore’s central areas. If you’ve wanted to have a go at planning a city, an eight-player game allows you to figure out how to meet the needs of a city-state in the face of land shortage and other constraints. This place will leave you with a greater appreciation of what it takes to design and build a city, and a new respect for the city planners and architects who get the job done.

Step out and cross the road to 2 Red Dot Design Museum (28 Maxwell Road, www.museum.red-dot.sg/) which has done wonders in highlighting the importance of good design. The colonial brick red building, which used to be the traffic police barracks and headquarters around 1928, displays local and international products with award-winning designs. Its shop stocks many of these products so you can take home a piece of great design, whether it’s a handmade, hand-dyed leather wallet, a piece of costume jewellery inspired by Singapore’s ferns, quirky standing lamps, or notebooks with attitude.

Turn left and walk down Maxwell Road towards South Bridge Road where you can’t miss the imposing red-lacquered

Buddha Tooth Relic Temple (288 South Bridge Road, www.btrts. org.sg). With architecture and craftsmanship featuring techniques thousands of years old, this Tang Dynasty-style building houses armies of Buddha statues and a massive cloisonné prayer wheel. It manages to achieve the twin objectives of blending in with its surroundings while standing out from the low-rise shophouses. Great architecture and ingenious artistry are combined with a sense of peace and well-being created by the gentle fragrance of the constantly burning incense and the air coolers. Collectively – an exceptionally well-designed experience.

Turn right and head for the junction of South Bridge Road and Neil Road to the

Jinrikisha Station (1 Neil Road).

URA City Gallery is distinctly cool.

This elegant structure was built in 1903 in a neo-revivalist baroque style on a triangular plan with a brickwork exterior. It features long pilasters, a square tower with an octagonal cupola and a sunny central courtyard. Set up as the main depot for jinrikshas, a small, two-wheeled cart-like passenger vehicle with a fold-down top, rickshaws were registered and road-tested here. It now functions as a seafood restaurant owned by Hong Kong actor Jackie Chan.

Continue walking up Neil Road in the direction of the traffic and you’ll come to

Red Dot Design Museum, lovely by day or night.

Tea Chapter (9 Neil Road, www. teachapter.com), one of the first 32 shophouses conserved in the area from 1987 to 1988. Part of a URA shophouse conservation project at a time when large parts of the city had already been cleared of pre-war shophouses, this house was chosen as a demonstration unit. Now called Tea Chapter, it was built at the end of the 19th century. The unit is part of 200 acquired by the government – the houses in this area were previously owned by wealthy Chinese and Arabs.

From here, turn right to Kreta Ayer and then into Keong Saik Road to

Hotel 1929 (50 Keong Saik Road, www.hotel1929.com). Named after the year in which it was built, the hotel is made up of five shophouses and has a saucy history as a one-time brothel. An avid collector of designer chairs, its owner Loh Lik Peng

128

(who also owns the New Majestic Hotel) has put his hobby to good use by placing some of his chairs in the guest rooms and in the Art Deco lobby for guests to enjoy.

Take pleasure in trying out vintage Eames LCW and OCW chairs dating from 1946 and Arne Jacobsen’s ‘Swan’ and ‘Egg’ chairs.

Adding to the hotel’s quirkiness is the installation of outdoor baths in two of the rooms that overlook Chinatown.

Head south toward Teck Lim Rd, turn right on Neil Road and make another right on Bukit Pasoh Road until you reach

New Majestic Hotel (31 Bukit Pasoh Road; www.newmajestichotel.com), striking for its juxtaposition of a retro-chic exterior with modern interiors. The hotel is a paean to design, from the quirkily combined vintage and designer furniture in the dramatic all-white lobby, to the hotel’s concept rooms designed by creative agencies like fFurious and design studios like Asylum.

Guests can also see local art with unique art installations by Singaporean artists, such as as Miguel Chew’s steel and aluminium female silhouettes dangling from the ceiling.

Turn right onto Teo Hong Road, left on New Bridge Road and left onto Cantonment Road where you can’t miss the towering Pinnacle@Duxton (www.pinnacleduxton.com.sg). The first 50-storey public housing project in Singapore, the architecture was born out of the first international design competition for public housing. Husband and wife duo Khoo Peng Beng and Belinda Huang of Arc Studio Architecture + Urbanism beat 201 international submissions to win the contract to design the Pinnacle.

The most distinctive aspects of the building are the two skybridges linking the seven blocks on the 26th and 50th storeys.

The skybridges create what are possibly the longest continuous sky gardens in the world, offering a panoramic view of the city skyline. The 50th storey observation deck is open to the public from 9am to 10pm daily for an entry fee of $5 per person. A limited number of people is allowed at any one time, so check the website before you go.

Finally, turn right onto Neil Road and keep walking until you reach Baba

House (157 Neil Road, www.nus.edu. sg/cfa/museum/about.php) Owned and

Hotel 1929 is a sliver of a building.

Baba House, a vision in blue.

New Majestic Hotel is awash with design details.

managed by the NUS Centre for the Arts, Baba House is a lovely ultramarine Peranakan prewar terrace house. The money to acquire and restore it was gifted to the NUS by Agnes Tan, the youngest daughter of philanthropist and founder of the Malayan-Chinese Association, Tan Cheng Lock. It was officially opened to the public in 2008 – by appointment only – with two storeys showcasing artefacts from the previous owners (the Wee family and others). The third storey is an art gallery with a regular programme of exhibitions. A stunning showcase of Straits Chinese architecture and home décor, there is plenty here for the design-hungry: surname lanterns, elaborate carvings and cornices, porcelain pillows that kept the women’s heads in such a position that their hair would not get mussed, and discreet peep-holes so that those on the upper floors could see who had entered the house before deciding whether or not to make an appearance!

129

GEOMANCY Special

The

Feng Shui of Well-being Attune your home for positive energy flow and create better heath for the family.

Health and wellness are two words more often associated with Traditional Chinese Medicine than living spaces. But in the study of feng shui, a healthy body and mind is just as affected by the chi (energy) pattern of your home as, say, wealth and romance.

By harnessing chi into the best cardinal directions specific only to you, you can bring many benefits to your daily well-being, like speedy recovery from illnesses, avoidance of accidents, and even getting restful sleep. You should never have to live with bad feng shui when you can choose otherwise.

But before you grab a compass, know that everyone has his or her specific feng shui map, and a detailed reading requires know-how and experience. However, the Art of Placement contains basic principles that anyone can learn to adopt – or at least, to avoid.

Also, basic feng shui recommendations seldom require drastic changes, and don’t involve awkward positions, symbolic items or outlandish claims. Get started on healthy living with these simple feng shui tips.

Locale • Your house should not be sandwiched between two tall buildings as occupants will feel oppressed, petty and short-tempered.

Home • Trees blocking and preventing sunlight from entering the house also create sha chi, making occupants sickly or suffering from mental disturbances.

• Rooms should be ventilated with open doors and windows to dispel yin energy, as strong yin makes you fall ill easily.

• The home entrance should be bright. If necessary, leave an energy-saving light switched on all day.

Kitchen • Do not place a stove close to/behind/above a toilet as that can cause stomach problems.

• If the stove is directly in front of the toilet, keep the toilet door closed or place a live plant inside.

• A stove under a beam causes financial worries, and when placed against the window, signifies a lack of financial backing.

• Water pipes running under the sink cause health issues.

Bedroom • A bedroom over a garage, or a bed or chair facing a fan or air conditioner can cause respiratory problems.

• A bed or work desk in the direct path of the door induces poor health and concentration.

• It should also not face a narrow gap between buildings, as that creates(sha chi) or “ominous energy”, making you prone to sickness and accidents.

• A beam over the bed will create pains and stress.

• Don’t live next to a power station or a telecoms tower as chi can be disrupted and cause illnesses.

• A night light may help a nervous child sleep better, but remove objects that cast shadows.

Family Health With good feng shui, you and your family can prosper in health, peace and harmony, as well as cultivate: - a more positive mental attitude - clearer decision-making

• TVs and other entertainment appliances are unhealthy for the sleeping person.

-

better wellness improved concentration and performance increased earning capacity happier personal relationships harmony within the family

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

130

The work day is done and it’s time to relax, kick back and please yourself. Read on for some ideas, from lifestyle indulgences and beautiful craftsmanship, to luxury watches, hot new properties, thought-provoking ideas and cool travel experiences.

1

AFTER WORK Treats

When

Heritage Meets Contemporary An ancient art form revived. Not since the Han Dynasty has Chinese lost-wax casting been practised, until some 27 years ago, when LIULIGONGFANG revived it. It is a 12-step process, with each step as important as the one before. The result is a collectible and complex masterpiece that is far more than mere ornament.

Yet into this very traditional Chinese form, LIULIGONGFANG has infused a contemporary Asian design aesthetic that leans toward the minimalist. Far from being the abandonment of intricate sculpting, it features deep details with a 3-D effect.

A Resplendent Union is one such treasure. In exquisite gold foil to symbolise and wish for an opulent existence, two small hulu are encapsulated within a large natural world, which uses to beautiful effect the transparency of LIULI. The design captures the idea of the wonder of harmony with nature.

Now available, the collection is the manifestation of one’s best wishes and sentiments. www.liuli.com.sg

132

Bezel beauty on a bangle It began as a device to keep perfect time for divers, but has evolved into an iconic detail favoured by many as a “must-have”, worn for every occasion. And today, Speedometer Official and its designer Marco Gatti Torino are pushing the boundaries. Using the beautifully calibrated details of the bezel, Marco reproduced the signature motifs from the most popular bezels on stainless steel bangles. And this concept will carry through into garments, writing instruments and accessories.

Designed and produced in Italy, the Speedometer Official bangle is available in nickel free 316L Marine Steel and Black Steel in six colours. The Black Steel bangles are Diamond Like Carbon (DLC) coated with diamond and carbon, to increase the durability and scratchproof quality of the bangle while remaining malleable enough to fit wrists of every size. www.speedometerofficial.com

Journey of 100 steps As Montblanc celebrates its 90th anniversary, here is some fascinating trivia which tells a story of dedication to its craft.

It takes 100 separate steps to create a Meisterstuck fountain pen, and the process remains largely unchanged since the 1920s when it was created. Before any fountain pen is released, trained testers write hundreds of figure eight’s to ensure the nib moves smoothly and effortlessly across the paper. Nib grinding and analysis take at least six months to master. And in a bid to revive the art of writing, Montblanc Singapore is organising master classes in the art of writing every quarter starting from October 2014. Contact Montblanc Singapore at +65 6590 6102 for more details.

Now that’s a cool idea. www.montblanc.com

133

AFTER WORK Treats

New concept Larry Jewelry store opens

Inspired by the mansion of a worldly man with exquisitee taste, the re-opened Larry Jewelry flagship store at Paragonn features a tasteful selection of fine furniture, luxuriouss fabric and lighting design. The result is an ambiencee of refinement with thoughtful details. Its most strikingg feature is the grand entrance, highlighted by mirroredd surfaces and walls detailed with intricate print designs, s, in a play of reflections and glimpses. A lounge wheree guests can enjoy privacy and consult resident nt experts on bespoke jewelry adds to the sense of exclusivity. y. www.larryjewelry.com

134

www.zwiesel-1872.com

Wine Classics.

Impressive design for the great wines of the world.

WINE CLASSICS of the manufactory of ZWIESEL 1872 is setting a unique character in terms of design and enjoyment. The straight and distinctive design of the goblets allows a perfect development of aromas in the glass.

WINE CLASSICS was developed in cooperation with the International Wine Institute and aims at an intensive and authentic sensoric perception of the aromas of great wines.

ZWIESEL ASIA PACIFIC PTE LTD 40 Club Street, Singapore 069419 Tel: +65 63242931, Fax: +65 63242932 info@zwiesel-kristallglas.sg

ZWIESEL 1872 | GOURMET COLLECTION. TOUCHING THE SOUL OF FINE WINES.

XVAL14037_AZ_ZW_WineClassics_206x276+3_engl_ThisQuarterlyMagazine.indd 1

06.03.14 18:07

AFTER WORK Treats

Hotel Clover 33 Jalan Sultan

A clever juxtaposition of east and west, the old and the new, this refreshing boutique hotel in the Bugis area is a luxuriously rustic, Southeast Asia-infused getaway for travellers and locals alike.

Tipped to be a serene urban sanctuary with strong regional influences, Hotel Clover 33 Jalan Sultan will open in the historic Bugis enclave in late 2014. Outfitted from 17 two-storey conserved shophouses, this boutique hotel takes inspiration from the rich culture of its neighbourhood with a design that contrasts sophistication, fun and quirkiness in a rustic, pampering setting.

Hotel Clover 33 Jalan Sultan has 88 wellappointed rooms and suites that are decked out in rich furnishings and hand-picked fittings, with plush beds, warm lighting and thoughtful nature-inspired design elements to make your stay even more memorable. Featuring design accents from the countries of Southeast Asia and plenty of warm wood, here’s a preview of some of the hotel’s charming accommodation options.

All the rooms are fully equipped with mini bar, coffee- and tea-making facilities, unlimited Internet access and local calls. Guests also have access to the cosy lounge on the ground floor and the in-house gym. Clover Garden, the hotel’s all-day dining restaurant, offers a menu of delectable East-meets-West selections.

LOCALE

SUITES Loft Suite 17 units, featuring a ground level private living area and an indulgent bedroom featuring a pair of Siamese daybeds on the mezzanine level.

appointed bedroom, a lush private garden and a built-in hydro bath in one of the suites.

Garden Suite

ROOMS Garden Room

Three units, each individually designed with touches of Southeast Asia and featuring an elegantly-

19 units featuring airy wooden patios and vertical gardens to relax outdoors within comfort and privacy.

136

Bugis is a historical multicultural melting pot which has been conserved into an energetic retail and lifestyle district with a distinct village vibe. In its immediate vicinity are countless heritage and modern attractions and amenities, among them Chinese and Hindu temples, mosques, arts and culture venues, street markets, modern shopping malls hipster cafes and hundreds of dining options. www.hotelclover33jalansultan.com

Make it a festive meal at Lawry’s Spinning salad bowls and prime rib that’s been aged for 21 days and roasted in a bed of rock salt – these are par for the course at this well-reputed American restaurant. With the festive season coming up, Lawry’s The Prime Rib has plenty of special offerings for Thanksgiving, Christmas and New Year’s Eve, as well as special festive menu items from November until the end of 2014.

Executive Chef Nick Lee and his team have come up with delicious creations such as Lobster Pumpkin Bisque and Spiced and Roasted Honey Turkey Breast, Traditional Bread Pudding and Rich Chocolate Raspberry Tree.

Sweetening the deal are goodie bags* and special deals for UOB Card members. www.lawrys.com.sg *Conditions apply.

Keeping wines at their best Vintec, the leading specialist in climate-controlled wine cabinets, unveils its Noir series. Striking for its sleek design – no visible handles, borderless black glass doors, Crystal White LED lighting – the series was designed in collaboration with architects and interior designers. It also features clever single and multi-temperature settings and a smart shelving system that makes the best use of storage space. Adding to the cool factor is the use of R600a, a cooling gas which is more energy-efficient than the current R134a, with zero ozone-depleting properties. www.apslifestyle.com

137

AFTER WORK Treats

Da Vinci made notes The master of so many fields kept copious notes in journals. Dating from the late 1400s to1519, the tomes were packed with notes and sketches on everything from flying machines (left), war devices and musical instruments, to astronomy, anatomy, random musings and even lists of groceries and people who owed him money. Now, for the first time, you can see a selection of these pages, taken from his largest notebook, the Codex Atlanticus, at ArtScience Museum’s Da Vinci: Shaping the Future exhibition, which runs from 15 November 2014 to May 2015. It also features original paintings from the School of Leonardo, and combines Da Vinci’s original works with reproductions of other notebook pages, models of his inventions, and interactive exhibits which marry technology, film and art. This rare exhibition is appearing only in Singapore, direct from one of the world’s greatest Renaissance museums, Biblioteca Ambrosiana in Milan. www.marinabaysands.com/ArtScienceMuseum

Food stars to watch for Three stars of the culinary universe are making ng their way to the iconic Marina Bay Sands. Opening ng in late 2014, David Thompson (left) will open en Long Chim, serving authentic Thai street food. d.

Known for his expertise in Thai cuisine, Australian an Thompson created the only Thai restaurant to be awarded a Michelin star. Award-winning LA chef ef David Myers, best known for soulful, imaginative ve creations inspired by his travels, will open a small all plates restaurant featuring a “cocktail mashup up from both sides of the Pacific”. Also opening in 2015 is Gordon Ramsay’s Bread Street Kitchen, an industrial warehouse-inspired restaurant and bar ar which will serve a British European menu. Ramsay ay (right) boasts a combined total of seven Michelin in stars in his global restaurant empire. www.marinabaysands.com

Chefs’ Photo: Marina Bay Sands

138

MIX-MEDIA RECOMMENDS WINDOWS Office Workstation Evo360

SPECIFICATION Windows 8.1 Pro Office Home and Business 2013 Intel i5-4670 3.4GHz Asus B85-PLUS MainBoard 4GB 1600MHz DDR3 Ram 500GB Sata 6GB 64MB HDD Nvidia GeForce GTX650 1GB Graphic 24x DVD+RW Dual Layer Drive 6xUSB 2.0 + HDMI + Gigabit Lan Microsoft Keyboard & Mouse 21.5� LED Monitor (VGA/DVI/HDMI) Norton Internet Security

Home & Business 2013

OEM hardware solutions

S$1,588 with GST 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

AFTER WORK Travel

Luxury Unfolding To really get a sense of the vastness and changing landscapes of Australia, there is no better way than to travel in its luxurious heritage trains. And when it comes with ever-changing views and unexpected friendships, what’s there to think about?

By Audrey Perera

It’s as if there’s a giant roll of carpet unrolling just ahead of the train.

It’s a fabric of many weaves, colours and patterns which you take in, as you notice, over thousands of kilometres, the land changing: scrub morphing into red earth which evolves into salt lake to desert and more. It often feels like there is no evidence of life, except for those of us in this metaland-wood container – until you begin to notice, here and there – camel paw prints in the ochre sand, an eagle sitting in the shade of a gum tree, bleached animal bones, a small flock of wild horses, picturesque in the breeze, whirlies or swirls of dust. It’s mesmerising.

Australia’s luxury trains – The Ghan and Indian Pacific – are steeped in history, a tribute to times when steam trains pulled carriages across

140

the country, and cameleers trekked from the east to west coast of Australia. But unlike those purely functional and uncomfortable early models, today’s versions recreate those routes with luxury and style.

There’s definitely something special about travelling by train across a vast land like Australia, apart from the five-star service, fine dining and premium wines. With the rhythm of the train as the background music to every second of the journey, the endless landscapes and big skies, and the star-studded night skies, it’s about a sense of timelessness, and being together with a group of people inside a container travelling across vast spaces, and it’s about realising that everyone is the same, yet different.

The Ghan

In the 1800s, the race to discover Australia’s interior and its natural resources, and to stake claim to them was intense, but traditional horses, mules and oxen could not survive the long journeys through harsh landscapes. Camels, considered “ships of the desert”, could, and were imported, along with their riders, from Afghanistan, North India, the Middle East and parts of Central Asia. For about 50 years, they were the backbone of the Australian economy: they accompanied exploration parties, carrying supplies, heavy materials, mail and even water to remote settlements.

They also transported the tools and equipment needed for the surveying and construction of some of Australia’s earliest and greatest infrastructure projects such as the Overland Telegraph and Trans-Australian Railway. No surprise that they were so important – they could carry more than 300kg in weight, they cost half as much as a mule and adapted comfortably to the local weather.

The Ghan is named after these Afghan cameleers, who once used this route from the southernmost point of the continent to the northernmost point, right through the centre of the country. But today’s journey, covering 2,979km, is all about quiet luxury.

The journey: Running from Adelaide to Darwin or vice versa, the journey lasts either two or three nights, depending on the season. Expect spectacular and diverse landscapes, sunsets and sunrises, with highlights like off-train excursions into Alice Springs, dinner under the stars at a mountain range, a day spent exploring an underground town which is the opal mining capital of Australia.

Darwin Katherine

Alice Springs

Adelaide

141

AFTER WORK Travel

Indian Pacific

The history of the Indian Pacific can be traced back to the early 1900s. As the colonies of Australia headed toward federation at the end of the 19th century, Western Australia was persuaded to be part of the new nation on the promise of a transcontinental railway that would link this isolated western region with the colonies in the east.

True enough, by 1917, the longest railway ever built as a single project in Australia was ready. It had taken five years to complete using picks and shovels, carthorses and camels. Because different segments of the route used different gauges, passengers had to change trains at different stops, but by 1970, the first unbroken journey of the new Indian Pacific commenced, running for 4,352km from the Pacific Ocean in the east to the Indian Ocean in the west.

The journey: Running from Sydney to Adelaide to Perth and vice versa, the journey takes either two or three nights, depending on the season. Expect diversity in the landscapes, including the stunning Blue Mountains, the Flinders Ranges, the Nullarbor Plain which is the longest straight stretch of rail track in the world, the gold-mining town of Kalgoorlie and the beautiful Avon Valley. Off-train trips include one to the protected Kangaroo Island, swimming with dolphins off the Adelaide coast, or touring South Australia’s famous wine regions and produce markets.

Kalgoorlie

Cook

Perth

Sydney Adelaide

142

Broken Hill

The Overland

Its name is inspired by the term “overlander� which describes an adventurer who has travelled across the country. The idea of an interstate train between Victoria and South Australia was born more than a century ago in 1887.

Costly and taking more than 18 hours at first, the route was rehabilitated and the train refurbished at different times, and today the 828km distance between Melbourne and Adelaide is covered within a swift 10 and a half hours.

The journey: Enjoy many different terrains, from scrublands to fields of crops and wide open plains. The big bonus is that the train includes Motorail Service, which means you can travel comfortably from one city to the other with your car.

Adelaide Melbourne

143

AFTER WORK Travel

Sleeping quarters

There are three classes of travel on The Ghan and the Indian Pacific, namely, Platinum, Gold and Red. Platinum service cabins are about twice as large as Gold, feature double beds, spacious en-suite and 24hr room service. Everything folds away when you’re not in bed, so that you have a comfortable sofa and table-top with which to relax and enjoy the view.

There is often a charming “kampong style” ambience that sets in as guests get to know each other. When a cabin door is open, it means you can safely pop your head in to say hello, and may be invited in to shoot the breeze over a drink.

On The Overland, there are two classes of travel, Red and Red Premium, depending on how much privacy, space and personal attention you want.

If you have some reservations from memories of famous murder mysteries that unfolded on long-distance trains, rest easy. The train’s gentle rocking can actually lull you to sleep, along with the knowledge that the very experienced Duty Manager is patrolling the train through the night, between tidying up, switching on the ovens at 3.30am for the morning bake, chatting with the occasional insomniac passenger, and generally playing protector to everyone on the train.

144

Dine in style

The experience begins at the crack of dawn with a gentle knock on the door and someone bringing in a cup of steaming coffee made just the way you like it.

Platinum and Gold Service guests dine in the elegantly themed Queen Adelaide Restaurant Car, which looks like an Old World European restaurant. Nothing gives away the fact that this is a train cabin made good. It’s all white linen tablecloths and napkins, silver cutlery and china plates, with Chef-prepared menus that showcase seasonal produce from the region. Expect menu items such as pasture-fed pork cutlet accompanied by broken potatoes and pork crackle, Regattas Point Atlantic Salmon, and Coorong Angus Beef Medallion.

It will amaze you to see the tiny space in which the chefs work on a constantly rocking train, and the speed with which they prepare and plate the meals, since there are generally two sittings per meal. Orders taken, the diners get started on their selection of premium Australian wines and beverages. The decibel level slowly begins to rise as people get to know each other.

Train crew syndromes Aside from dealing with weather changes, derailment, animals on the tracks, flooding and time-table disruptions, crew on long-distance trains are known to get so used to the motion of the train that they feel nauseous when they’re on land. And they’re so used to being rocked to sleep that it’s hard to sleep in their own homes.

Making conversation

Opportunities to meet and get to know your fellow guests are many, if you are not too shy. Travellers of many nationalities are on board, most of whom are keen to make friends and sweeten the experience with conversation, which, depending on how they go, end up being lively, entertaining, enlightening, profound and even silly.

On my travels on these trains, I have met so many people I would never have met otherwise, such as: a 96-year-old world champion veteran woman swimmer about to take part in an international meet; a retired couple who had run a dance academy for decades, whom everyone had noticed for their stand-tall posture and grace; a fun-loving and open-hearted couple from Sarawak; a former British Transport Council member who has travelled on every luxury train between Europe and Australia. I met families travelling to fulfil a parent’s or grandparent’s late-in-life wish to take a historic train journey, a family honouring a late grandfather’s lifelong desire,

and a cancer patient working her way through her bucket list.

All those conversations reminded me that we are all alike, no matter where we are from. We find joy and experience sorrow at the same life events, we laugh at the same things, we are touched by kindness, cry at weddings and partings, and we all feel the years passing. I could never have experienced these insights on any other kind of land excursion, and that’s the magic of train journeys.

As one Duty Manager, Larry Ierace, put it: “Every train journey is different. At the beginning, no one knows each other. By the end of the journey, they’re friends.

I love to see the lounge packed with guests having a good time on a trip they’ve saved and planned for.

My biggest satisfaction comes when people are happy with the experience we give them. There’s a magic because people are very relaxed, and connect on a train in a way that doesn’t often happen.”

Kit to the rescue!

Crew members in charge of customer service often travel with their own personal “train survival kit”. It comprises a few good holiday reading novels, a sewing kit, a stapler, scissors, nail varnish and remover, a skipping rope, a hairdryer, colouring pens, writing pads, drawing paper. Little things can make a big difference to a guest in need of emergency supplies or distraction.

Like father, like son Here’s something you don’t often encounter. Many of the people who work on these trains come from families where this is tradition, and it’s now in its second or third generation.

Often, a father or grandfather worked all their lives on trains, and their love for the unique nature of the work has become a long-standing family tradition.

145

AFTER WORK Time

A Toast to Tourbillon Meaning “whirlwind� in French, the tourbillon was designed in the 18th century to negate the effects of gravity. It was an obscure feature until its beauty was noticed. Given recognition, the tourbillon became sought after, and today it is, some say, a coveted grand complication.

Photography Ching Styling Ong Weisheng

Patek Philippe Grand Complication 5217P Minute repeater with tourbillon escapement in platinum case and fully visible from the back.

These are among the most complex mechanisms in the horological world.

146

Audemars Piguet Extra-thin Royal Oak Tourbillon in steel.

Elegant blue dial with “petite tapisserie” pattern is the perfect foil for the tourbillon which is clearly visible at 6 o’clock.

147

AFTER WORK Time

Chopard L.U.C Tourbillon Tech Twist All Black A symphony of finely calibrated, perfectly fitted parts moving in accord, and centred by a tourbillon elegantly positioned at 7 o’clock.

148

PATEK PHILIPPE Ladies Moon Phase 7121/1J Relaunched this year with a hand-polished 18K yellow gold case and bracelet, this piece features 66 Top Wesselton brilliant-cut diamonds that light up the silvery-white dial. The Moon phase indicator doubles as a small seconds counter, and the celestial satellite and stars are gold-dusted. The manual-winding movement tracks the moon’s phases with such precision that a correction is needed only once every 122 years.

Corum Admiral’s Cup Legend 42 Tourbillon Micro-rotor Housed in the iconic 12-sided case and bezel, the open-worked tourbillon bridge offers a plunging view of the 12mm tourbillon carriage. The micro-rotor is revealed through the caseback while not obstructing the view of the tourbillon at 6 o’clock.

149

AFTER WORK Time

Breguet Classique Grande Complication 5357BA in 18-carat yellow gold with a silvered gold dial. Note the B-shaped running seconds on the tourbillon shaft, in recognition of the brand’s famous forefather, Abraham-Louis Breguet, who invented the mechanism.

150

Rotonde de Cartier Flying Tourbillon in white gold, striking for its openwork Roman numerals sculpted from a solid gold block. Its flying tourbillon is only secured to the movement by one bridge on the bottom, allowing the observer a full view of its unceasing workings.

151

AFTER WORK Time

Jaquet Droz Tourbillon Côtes de Genève Enclosed in a white-gold case with a Côtes de Genève dial, the tourbillon carriage is crafted from sapphire crystal, and sited at the very heart of the seconds subdial, off-centered at 12 o’clock.

152

Montblanc Collection Villeret 1858 ExoTourbillon Chronographe in red gold with a distinctly 3-D effect. In a limited edition of eight pieces, it is the first watch in this collection to combine a chronography function and a tourbillon.

153

IT’S MY PARTY

Properties to dine over There’s nothing like mulling over a special property in an exclusive setting with good company and a delicious meal. Two such events took place recently.

In August, guests gathered to preview and hear all the details about two exciting new properties, Mon Jervois and Pollen & Bleu, the latest developments

by UIC Limited and Singland Limited. September saw the launch of Princess Cove luxury apartments, a new development by R&F Properties.

Both events were co-organised by THIS QUARTERLY, in collaboration with UIC Limited, Singland Limited and R&F Properties.

AUGUST 2014 PREVIEW Mon Jervois and Pollen & Bleu A development by UIC Limited and Singland

SEPTEMBER 2014 LAUNCH Princess Cove A development by R&F Properties

154

LIFE’S BIG QUESTIONS

REDEFINING

SUCCESS Grace Sai, 30, co-founder of The HUB Singapore, looks forward to a sea change in the business landscape.

And the tide, it seems, is slowly turning. By Fiona Lim

Who are you?

In Singapore, I’m probably most known for being the “social-entrepreneurship girl”, having founded The HUB Singapore in 2012. It’s now the largest community of entrepreneurs with a special focus on social entrepreneurs, people who are really purpose-driven and want to make the world a better place.

We want to redefine culture in Singapore, to include a broader definition of success. So it’s not just in being a banker, lawyer or oil trader that you’re successful – that’s the traditional, economically-driven Singapore definition of success. In the last six years, Singapore has really opened up to allow more tracks of success, and I fundamentally believe that individual success is related to success on a national, macro level.

That involves people self-actualising, according to their maximum potential; it is about self-fulfilment, but also what an individual can do best to serve the community, the society, the country – that is, a larger purpose.

In our case, it’s much more about using entrepreneurship for society, using business for good.

What is your life’s purpose?

It’s in creating environments where people can have the courage to become entrepreneurs – social entrepreneurs – and to encourage people

156

to think about the meaning of what they’re doing. This includes people who are not entrepreneurs, the leaders of big companies, government agencies. There is more to what they do than it just being a job.

I also want to provide the environment for people to collaborate, for the right people to meet the people they are supposed to meet, because we believe in innovation through collaboration.

Recently, I’ve been given opportunities on a national level – in a few cities, actually – to grow entrepreneurship and social entrepreneurship.

So that can potentially affect policy, and shift more leaders, talent and capital from the private sector to social ventures.

The HUB is great – it is necessary for Singapore – but I want to look at bigger platforms to create larger-scale change.

How do you know that you are making a difference?

I look at both the financial and the social bottom lines. On the former, we’re still alive, still cashflow positive and relatively profitable. The market feedback mechanism shows that something is right: we are providing a solution for the market that is valued and paid for.

On the social level, we are still signing up one or two hubbers a day, even after two years and with zero marketing budget. The growth has just been organically driven, with hubbers referring hubbers.

I continue to get invited to speak to a lot of young people, company leaders, as well as ministers. So there must be a message that I’m carrying which is resonating with how people think the future of business and the future of society might be. And, recently, there has been more awards recognition.

We define success in a broader way. To see hubbers connecting and collaborating is one of the matrices of success for us, and we see that happening every day. The people you see sitting next to each other at The HUB are not from the same start-up. It’s almost like belonging to an alumni group: when you’re a Harvard alumni and you meet another Harvard alumni, you know immediately there’s a common ground. It’s the same effect here.

Successful start-ups that sprang out of The HUB Singapore include Milaap – a micro-lending platform led by our investor-in-residence, Jayesh Parekh. So far, they have disbursed more than $2 million. We also had Play Moolah and Tech in Asia, the more “rockstar” start-ups in Singapore.

They moved out because they’ve grown too big for a co-working model; now they want to create their own culture and their own privacy, which is great! It is a measure of success to us. We don’t want the place to be stagnant, because that would mean that people are not progressing and growing.

Ahmad Iskandar Photography

What is happiness?

zoom o t have ur spirit u o y ... at yo want h w in to ur being kill s yo is a and s i h .T for to do acquire . you iscovery d self-

At the end of the day, I would say happiness is very much rooted in relationships – with yourself, with your close ones and with the world. So if you can get all three right, you will be a very happy person. I don’t think someone who is only fulfilling happiness for him/ herself and not thinking about his/her relationship with the world is 100% fulfilled. Someone who is super-altruistic, like Mother Teresa, can’t gain 100% fulfilment either if it is not self-sustaining. I think people with all three aligned are truly fulfilled, and we see a lot of them here. We also see a lot of younger Singaporeans who are totally getting this.

What do you want to be known for?

A lot of people say that when they are in The HUB or when we talk, they really think harder about their lives or their purpose. Some of them changed their direction in life because of one conversation, or because they felt the courage and the dynamism here.

I want to be known as someone who really forces people to come to their truth – their own personal purpose. And that requires a lot of cutting through bullshit; you have to zoom in to what your spirit and your being want to do. This is a skill you acquire for self-discovery.

157

Subscribe to THIS QUARTERLY and receive a Pure carafe and a pair of Dancing Tumblers

Confirm a two-year subscription to THIS QUARTERLY and receive • 8 issues of THIS QUARTERLY delivered to you • A Pure carafe & a pair of Dancing Tumblers by Schott Zwiesel Known internationally for their beautifully crafted crystal ware and their patented Tritan crystal glass which is break-, chip- and scratch-resistant, the Pure carafe is for wine or water, while the Dancing Tumblers are crafted with a unique rounded base so that they rock gently in place, making them a great conversation piece.

Retail Price S$88

YES! I would like to subscribe to eight issues of THIS QUARTERLY for $65 and receive a Pure carafe & a pair of Dancing Tumblers by Schott Zwiesel

I hereby enclose my crossed cheque made payable to EDEN PUBLISHING PTE LTD Bank:

Name: Dr/Mr/Ms/Mrs

Cheque No.:

Mailing Address: Fax this form to +65 6253 8658, or mail it to

EDEN PUBLISHING PTE LTD NRIC/Passport No:

Date of birth:

Email:

51 Goldhill Plaza #20-05 Singapore 308900 Please send your cheque to Eden Publishing Pte Ltd, 51 Goldhill Plaza #20-05 Singapore 308900. For enquiries and other oversease subscription rates, please call +65 6253 8660 or email subscription@thisquarterly.sg

Occupation: Tel (Home):

(Office):

Fax:

HP:

Terms & Conditions Eden Publishing reserves the right not to accede to subscription requests due to controlled circulation. All forms must be completed to be accepted.

Please allow 2-4 weeks for processing. Promotion ends 31 December 2014. Gift is valid for Singapore subscribers only, and while stocks last.

NGEE ANN CITY TAKASHIMAYA S.C. SINGAPORE SERENITY SPANISH RESTAURANT 391 Orchard Road, #05-32 Ngee Ann City Takashimaya S.C., Singapore 238872 Reservation Tel: +65 6235 9989 Open Daily 11.30am to 10pm

Suckling Pig2_206x276mm.indd 1

VIVOCITY HARBOURFRONT - SINGAPORE SERENITY SPANISH BAR & RESTAURANT No 1 Harbourfront Walk, #01-98/99 VivoCity Singapore 098585 Reservation Tel: +65 6376 8185 Open: Sunday to Tuesday 11.00 am to 11.00 pm Wednesday to Saturday & Eve of Public Holiday 11 am to 12 midnight

SANUR - INDONESIA SERENITY SPANISH BAR & RESTAURANT Jln By Pass Ngurah Rai 27A Sanur 80228, Bali, Indonesia Reservation Tel: +62 361 284 381 Open Daily 11.00am to 11pm

28/11/13 10:13 AM

MOSAIC

© J Baylor Roberts/National Geographic Creative

Unseen moments, unrecorded histories Arresting and surreal, this 1941 photo captures aquatic performers applying lipstick underwater. There are more than 300 more where this came from, among them Martha Stewart as a fashion model, the real Von Trapp family, Bill and Hillary Clinton as Yale college students, Ronald Reagan modelling, dour Queen Elizabeth smiling, Kim Jong-il in a bumper car. These aren’t just old images. They’re unexpected peeks into moments that lay behind the big events of history, and they’re published in RETRONAUT: The Photographic Time Machine, released by National Geographic Books in September 2014. Described by The Guardian as “an emporium of retro treasure...from shocking sculptures of the 1700s...to biblical scenes captured by Google Earth”, the images were sourced from Retronaut.com, one of the world’s most popular online destinations for vintage photography and visited by millions every month. Weirdness, wit and wonder are the order of the day here. www.retronaut.com/buy-the-book/

160

the Residences at Killiney

the

HEE-0788-ThisQuarterly-275x205-S3path.indd 1

29/9/14 1:03 PM

TO BREAK THE RULES, YOU MUST FIRST MASTER THEM. IN 1993, AUDEMARS PIGUET CHANGED THE WORLD OF THE SPORTS WATCH FOREVER. THE POWERFUL ARCHITECTURE OF THE ROYAL OAK OFFSHORE BECAME THE ULTIMATE STATEMENT IN PERFORMANCE HAUTE HOROLOGY. THE 2014 ROYAL OAK OFFSHORE COLLECTION MOVES THE GAME ON ONCE MORE; THE 22 CARAT GOLD OSCILLATING MASS NOW VISIBLE THROUGH THE SAPPHIRE CASEBACK, A WINDOW ONTO 139 YEARS OF HOROLOGICAL MASTERY.

NEW BOUTIQUE NOW OPEN AT MARINA BAY SANDS

ROYAL OAK OFFSHORE IN PINK GOLD. CHRONOGRAPH.

SINGAPORE AUDEMARS PIGUET BOUTIQUE 541 ORCHARD ROAD LIAT TOWERS #01-03 TEL (65) 6836 4918 THE SHOPPES AT MARINA BAY SANDS CANAL LEVEL B2-207 TEL (65) 6688 7595 AUDEMARSPIGUET.COM

ROO_26470OR_206x276_m.indd 1

12.08.14 09:39