Singapore Health Jan/Feb 2012 by Singapore General Hospital

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JAn⁄ Feb 2012

News

Risk-free training for surgeons BY Sheralyn Tay

During vascular surgery, a thin wire snakes through a blood vessel, works its way towards the dark mass – a clot of hardened plaque that narrows the vessel and limits blood flow – and, very precisely, begins to clear the obstruction. This exacting procedure, and many like it, requires a confident hand. But thanks to a new simulation training programme at Singapore General Hospital (SGH), surgeons can now train in a risk-free environment to hone their skills and gain experience. The simulation training programme for vascular surgeons – named the Alexandre Chao Endovascular Simulation-Training Platform, in memory of the late vascular surgeon who succumbed

to severe acute respiratory syndrome (SARS) in 2003 – is one of six surgical training platforms at the SGH Surgical Skills Centre. The others train doctors in the surgical areas of critical care, endoscopy, general surgical skills, laparoscopy and musculoskeletal surgery. “In the past we trained for surgery using the classic approach of ‘see one, do one, teach one’. You see someone do a case, then you do the next case that comes along and can start teaching by the third case,” said Dr Benjamin Chua, Consultant, and Director, Endovascular Surgery, Department of General Surgery, SGH. “With the advancements in medical complexity, rising expectations and a greater awareness of patient outcomes and accountability, this is not an ideal approach. Training with simulators gets doctors familiar with the systems and the processes, so they can practise until the routine becomes second nature.” The

PHOTO: Alvinn Lim

A simulation programme allows vascular surgeons to hone their skills and gain experience

Dr Benjamin Chua (right) believes that training with simulators will allow surgeons to familiarise themselves with the process, and practise their skills till the procedure becomes second nature.

simulators closely replicate real medical scenarios such as blocked or weakened veins, and can be customised to simulate a range of complexities and challenges. During the training programme, participants also attend lectures and sit in on real surgical cases. Thirty-five doctors from Singapore and the region participated in the first endovascular simulation-training programme last November. One of the participants was Dr Tay Hsien Ts’ung,

Dealing with hospital phobia A colourful, illustrated book helps children who are staying in hospital deal with fear and anxiety It is natural for a child to be fearful and anxious when faced with the prospect of being warded in hospital. It is a new environment where there are bright lights, needles, bandages and strangers examining and treating them. And all this is happening when they are already feeling unwell or in pain. Parents often feel helpless as their child goes through the fear and panic of being admitted to hospital. Recognising the problem, KK Women’s and Children’s Hospital (KKH) recently launched a fun and colourful children’s book to help children deal with such fear and anxiety. The book What Happens To Me At The Hospital? was written by Associate Professor Anette Sundfor Jacobsen, Chairman, Division of Surgery, KKH, with drawings by award-winning illustrator Patrick Yee. “A hospital stay can be a bewildering experience for children. Understand-

ably, parents are often concerned about how best to prepare their kids for such a stay. With that in mind, this book has been produced to provide an overview of the hospital experience for parents and their children,” Assoc Prof Jacobsen explained in the preface of the book. Merely asking a child not to be afraid might not be enough. One way to lessen his anxiety is to prepare him for what he will experience. The book covers many situations commonly encountered by children who need surgery and have to stay in hospital for more than a day. The chapters include “Meeting the people who work at the hospital”, “Getting scanned and tested” and “Going in for an operation”. It also explains things such as a stetho-

Does your child have a phobia of hospitals? Some physical symptoms associated with such phobia include:

Heart palpitations Feeling sick Chest pains Difficulty breathing Source: www.anxietycare.org.uk

Dizziness “Jelly legs” Feeling “unreal” Intense sweating

Feeling faint Dry throat Restricted or “fuzzy” vision or hearing

scope, an x-ray and ultrasound scan. Best read before a visit to the hospital, it can also be used as an activity book. “A stay at the hospital is usually not something to look forward to, but it should not be something to be feared either,” said Assoc Prof Jacobsen. “With the publication of this book, it is hoped that parents and their children have at their disposal a tool and resource to make the hospital stay a less forbidding experience.” What Happens To Me At The Hospital? is available at KKH’s Outpatient Pharmacy at a discounted price of $10.70. All proceeds from the sale of these books will go to the KKH Health Endowment Fund to help needy patients. The book is also available at SingHealth Academy (#06-07 Tower 3, 168 Jalan Bukit Merah) at the retail price of $14.90. Enquiries or orders for the book can be directed to academy_publishing@singhealth.com.sg, or call the SingHealth Academy Publications team at 6377-8649.

Registrar, Department of General Surgery, SGH, who noted the value of learning through experience. “You get handson practice on how to manipulate the wires and instruments, but you are training outside the patient’s body, so there is no risk of complications,” Dr Tay said. The SGH Surgical Skills Centre aims to be a regionally recognised training centre for surgical skills, offering a multidisciplinary, structured and comprehensive curriculum in a dedicated, state-of-the-art training facility.

A tribute to Dr Alexandre Chao More than just a skills-building programme, the Alexandre Chao Endovascular Simulation-Training Platform is also a poignant reminder for the family of the late Dr Alexandre Chao, who succumbed to SARS in 2003. “Alex always had a passion for medical education. Today, the Alexandre Chao Endovascular Simulation-Training Programme encapsulates his vision and passion,” said Associate Professor Koh Woon Puay, Saw Swee Hock School of Public Health, National University of Singapore, who was married to the late Dr Chao. “My family and I are deeply grateful and we are confident this programme will continue to play a pivotal role in reducing morbidity and mortality related to vascular diseases, and training doctors to preserve and improve health of people in Singapore and beyond,” said Assoc Prof Koh. For their daughters, Beatrice and Berenice, Dr Chao “passed away when we were very young and our fondest memories of him were those of a devoted father reading to us while we sat on his lap. Today, this programme helps us see his vision towards excellent patient care as a vascular surgeon”.

JAN⁄ FEB 2012

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Bringing balance to the force Study helps determine why older people are more susceptible to falls BY Jacqueline Chia

Humpty Dumpty couldn’t have prevented his fall even if he were to work a little harder on his balance when seated on the wall. He was, after all, an egg. For older adults who face mobility problems from osteoporosis or symptomatic knee osteoarthritis, the ability to maintain their balance when walking, standing or sitting is vital to preventing or lowering their chances of falling. But just how important is the relation between the ability to balance and the prevention of various symptoms found in the elderly with osteoporosis or knee osteoarthritis? That is what a team from Singapore General Hospital’s (SGH) Physiotherapy Department, led by Principal Physiotherapist Pua Yong Hao, sought to investigate. “Our population is ageing and when old people fall, they can become disabled or even die as a result. For this reason, our studies have two overarching aims – to identify older adults with an increased risk of falls, and potential intervention targets to improve their balance,” said Mr Pua. Started in 2009, the project comprises five concurrent studies and aims to establish a standard and accurate measurement of standing balance, and identify the causes of instability and how to prevent falls or instability in the elderly. One study looks at the relationship between body posture and leg strength in older women suffering from osteoporosis, while another study compares the effectiveness of a new prevention programme with that of a traditional, supervised exercise programme for older patients who are prone to falls. A third study examines and measures physical function, standing balance and knee strength in healthy older adults. The last two studies looked at therapy for patients with mild-to-moderate knee osteoarthritis and those who have had a total knee replacement. A key component of the studies is the accurate measurement of balance. Although laboratory force plates are the “gold standard” equipment, they are expensive, bulky and heavy. “Thankfully, we found a solution in the (Nintendo) Wii gaming board,” said Mr Pua. “The Wii board has several advantages – it is affordable, portable

PHOTOS: Vernon WONG

It is a well-known outcome of Humpty Dumpty’s tale: neither the king’s horses nor men can put Humpty Dumpty back together again after his fall. Truth be told,

The Nintendo Wii board (left) is a crucial part of the study, undertaken by Principal Physiotherapist Pua Yong Hao (below) and his team, to examine the role of balance and the risk of falling.

The portability of the 3.5kg Wii board offers several advantages. Because a laboratory force plate (typically weighing 30 to 50kg) cannot be lifted or transported easily, it is difficult or near impossible to use it to measure seated balance,” said Mr Pua. Before the team’s project, seated balance could not be measured objectively. Hip extension strength could only be reliably measured with a device known as an isokinetic dynamometer, which is expensive, tedious to set up and cannot be carried around. The team is hoping to utilise the Wii board to measure a variety of physical variables to help guide medical professionals in their management of patients. SGH uses seven Wii boards to measure physical balance. The team is also looking at expanding their research to young adults who sustain knee injuries. “Sports people with knee injuries (which have not fully healed) are at risk of becoming young people with old knees,” said Mr Pua. “Hopefully, the low cost and portable nature of the Wii board as a screening tool can facilitate its widespread use across various clinical settings,” he added. Despite its many advantages, Mr Pua said the Wii board cannot replace laboratory force plates as the “gold standard” research equipment. Although the board is able to provide standing or sitting data that is as good as what the force plate provides, it is not built to withstand the high forces produced during more dynamic activities such as jumping or walking.

In focus

and connectable via the Bluetooth protocol. Importantly, the board’s measures of standing balance are reliable and they agree with the measurements of laboratory force plates.” In its study examining rehabilitation for patients after knee replacement surgery, the team was able to use the Wii board to measure patients’ standing balance accurately, and is planning to use the results to develop a guide to help determine the most appropriate walking aid for patients. “From these measurements, we know precisely what type of walking aid, whether it should be a walking stick or frame, is best for each patient during the recovery period. Obviously, if your standing balance is poor, you require a walking aid with a larger base of support,” he said.

Can you guess what this is? See page 24 for the answer.

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Jan⁄ Feb 2012

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The biological clock ticks for men too

smoking, drinking and working in highheat environments have been shown to lower sperm count and quality in men, said Dr Tan. Already, he noted that male fertility is falling worldwide, and Singaporean men are not spared. “Normally, in a semen sample of a millilitre, there should be more than 15 million sperm. But in some samples that we see, there may only be one sperm.”

A local study has found that older fathers increase the risk of miscarriage in women

Race against the clock With the current trend of men and women marrying and having children later in life, is it all doom and gloom for older fathers-to-be?

The clock is ticking fast for those over 40 who want to be fathers.

“Normally, in a semen sample of a millilitre, there should be more than 15 million sperm. But in some samples that we see, there may only be one sperm.”

By Jamie Ee

When it comes to fathering a child, time is not always on a man’s side. More studies are showing that men, too, have biological clocks, and they may start ticking at around 40 years old, said Dr Tan Thiam Chye, Consultant, Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital (KKH), who recently spearheaded a Singapore study which showed that advanced paternal age increased the risk of miscarriage. The study monitored 139 women with threatened miscarriage (those with vaginal bleeding during early pregnancy) over a period of 16 weeks. It found that fathers over 40 years old added an eight-fold risk of miscarriage, compared to fathers between 30 and 40 years old. For fathers between 30 and 40, the risk of miscarriage was about four times higher than fathers between 20 and 30 years old. The reason for the higher risk of miscarriage is linked to the decline in quality of sperm in older men, said Dr Tan, who is also an Assistant Professor at Duke-NUS Graduate Medical School (Duke-NUS). “Having noted an increased risk of foetal loss with a paternal age greater than 40, we can infer that the biological clock ticks not only in the woman, but also in the father-to-be,” said Dr Tan. The study, conducted jointly by KKH and Duke-NUS,

contributes to the growing amount of evidence, which points to the fact that the age of the father affects not just fertility, but the health of the pregnancy and baby too. While research on the impact of women’s age on childbearing is well known, fewer studies have been done to determine the role that paternal age plays, said Dr Tan. For women, their biological cut-off point is well defined at age 35. But for men, this could be at around 40 years old, said Dr Tan. “For a man above 40, we’ll be more worried that there could be a possibility of paternal DNA changes, and this can predispose his offspring to congenital problems or even lead to miscarriage,” he said. How a man’s clock ticks Like women, men experience changes to their bodies and reproductive systems as they age, and this impacts their fertility and the health of their offspring. While sperm production is unending in men, their production and transportation structures weaken over time, said Dr Matthew Lau, Associate Consultant, Department of Reproductive Medicine, Division of Obstetrics and Gynaecology, KKH. “For instance, the sperm production slows down and the

reproductive tubes narrow. Beyond this, the prostate and urinary functions also change,” said Dr Lau. The male sex function declines too. Over time, men’s testosterone levels dip, they experience lower sex drives and are more susceptible to sexual problems like erectile dysfunction, said Dr Lau. “Erectile dysfunction is closely linked to blood supply problems. When people get older, and if they have diabetes or high cholesterol levels, they are likely to have blood vessel problems. If such problems affect the penis, it leads to erectile dysfunction,” he added. In older men, sperm quality also becomes poorer. As sperm is produced at a slower rate, the risk of exposure to toxins through factors such as infection and smoking is higher. This can damage the DNA of the sperm, said Dr Lau. If the sperm’s DNA is more than 40 per cent damaged, there is a higher chance of miscarriage, he said. Studies have also shown that older fathers increase the risk of genetic problems such as autism and dwarfism in their children.

Dr Lau does not think so. He said that as long as a man continues to produce sperm and is able to have normal sexual intercourse, there is still a possibility of him fathering a child. A fertile female can also compensate for a lower male childbearing potential. Reproductive technologies like intrauterine insemination (IUI) and in-vitro fertilisation (IVF) are also available to help couples who have problems conceiving. But with the risk of birth issues increasing with advanced paternal age, doctors have advised those who want to become fathers to start planning earlier. Dr Tan said: “Men aged 40 and above who are thinking of having children should not delay any longer.”

Help turn the clock back

Environment and lifestyle matters Besides the ageing process, a man’s lifestyle can also upset his sperm count and quality. Factors like stress,

Dr Tan Thiam Chye (right) and Dr Matthew Lau (left) advise men aged 40 and above who intend to have children not to delay any longer.

Exercise regularly to help keep testosterone levels up, improve sperm quality and reduce the risk of erectile dysfunction.

Maintain a healthy weight and diet by eating foods high in antioxidants like vitamins A, C and E. PHOTOs: Vee Chin

The quality of a man’s sperm will deteriorate with time, causing damage to its DNA and leading to a higher chance of miscarriage in the woman.

Dr Tan Thiam Chye, Consultant, Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital

Reduce toxin exposure by not smoking, and avoiding the contraction of sexually transmitted diseases.

singapore he alth

JAN⁄ FEB 2012

News > Continued from page 1

Diabetics regain control

Genetics vs lifestyle

Defining diabetes Type 1

Type 2 When the insulin that is produced by the pancreas is ineffective in controlling glucose levels in the blood.

the Dose Adjustment for Normal Eating (DAFNE) programme to him. Since joining the programme in April 2011, Mr Su has been able to manage his condition much better than before. He said his hypo episodes – when his blood glucose level falls below normal – occur two to three times a month, much less frequently than the 10 or more occasions previously. “DAFNE helps a lot. I can enjoy life now compared to the past. I can have anything I want and, with a bit of care, just need to adjust the (insulin) dosage according to the food I eat,” he said. Pioneered in Germany in the 1980s, the DAFNE programme has since been rolled out in other European countries, including the UK. In the mid-2000s, the programme was launched in Australia and New Zealand.

The underlying principle of DAFNE is that we want to hand control back to the diabetic patient. This is his life. Dr Goh Su-Yen, Consultant and Head, Department of Endocrinology, Singapore general hospital

Patients take control What makes DAFNE different from older methods of controlling Type 1 diabetes is that it empowers the patient to manage his condition. The DAFNE programme underscores the trend of a more patientcentric (as opposed to physician- or disease-directed) management style, which is particularly necessary when it comes to coping with long-term chronic diseases. “When they have a chronic disease like Type 1 diabetes, often patients – especially those who have been diagnosed in childhood or their teens – feel like the control is taken away from them. Some-

Type 2 diabetes

Age of onset

Mainly under 40 years

Mainly over 40 years

Body weight

Usually not associated with being overweight

Commonly associated with being overweight

Causes

Genetic predisposition

Genetic predisposition, insulin resistance, insulin depletion, lifestyle factors

Triggers

Possibly viruses and infections

Obesity, insufficient exercise, drugs (like steroids), surgery

Treatment

Insulin

Lifestyle changes, tablets, insulin

PHOTOS: ALECIA NEO

When there is too much glucose in the blood due to the inability of the pancreas to produce enough insulin.

Type 1 diabetes

During the DAFNE course, dietitians like Ms Kala Adaikan (right) teach patients to calculate the amount of carbohydrates in their food, so they can adjust the insulin dosage on their own, said Dr Goh Su-Yen (left). The course is tailored to take into consideration local preferences and foods.

body else is telling them what to do, how much insulin to give, and (telling them) a lot of ‘nos’ and ‘cannots’,” said Dr Goh SuYen, Consultant and Head, Department of Endocrinology, SGH. “Every single second of the day, they are living with diabetes. Everything can affect their blood sugar. The underlying principle of DAFNE is that we want to hand control back to the diabetic patient. This is his life,” she said. Dr Goh led a small team to Melbourne in November 2010 to be trained on the DAFNE programme. When the team returned to Singapore, they worked on modifying it to the Singapore context. For example, the team found that diabetic patients in Singapore may be more insulin-sensitive than previously thought and, thus, do not need as much insulin as their peers globally. “Eat what you like. Like what you eat.” That’s the mantra of the DAFNE programme at SGH, the first of its kind in Asia. Before, patients took nutritional dictates from their doctors who might prescribe meal plans aimed at maintaining glucose levels and matching regimented insulin dosage, but which left little gastronomic flexibility. The DAFNE programme imparts skills that Type 1 diabetics need to match their

insulin dosage to whatever they eat, whenever they want to eat. It also teaches patients how to deal with sick days and low-sugar situations, how to exercise safely and effectively, and how to handle drinking and dancing in social settings. Counting carbs Two classes have been held at SGH since the DAFNE programme started in April 2011. Each class, which teaches a set curriculum over five full days (spread out over weekends and public holidays), allows for up to eight participants. The group setting is aimed at encouraging participants to share and compare experiences. Even after the intensive course is over, the group stays in touch with regular reviews. For now, the DAFNE class, which has support from pharmaceutical giant Sanofi-Aventis Singapore as well as Abbott Diagnostics for glucometers (for home glucose monitoring), is free for SGH patients. As with programmes launched in other countries, the SGH programme is tailored to the local population and foods found in Singapore. A big part of the programme is teaching patients how to count the amount of carbohydrates they will consume. Teach-

ing materials include pictures of full plate servings of hawker centre favourites such as char kway teow and laksa, as well as models of common fruits and vegetables. Dietitians teach patients how to calculate the amount of carbohydrates their food has, so they can figure out how much insulin they need to inject themselves with. Participants are encouraged to keep weighing scales handy with them until they get used to accurately eyeballing the carbs in their meals.

Are you experiencing these symptoms? If so, you may have diabetes Passing large amounts of urine Yes/No

Feeling very thirsty with a dry mouth

Yes/No

Feeling tired

Yes/No

Losing your appetite

Yes/No

Losing weight

Yes/No

Vomiting or abdominal pain Yes/No Infections, like thrush

Yes/No

Personal Hygiene Where It Counts Last night, Mary* a 29 year old marketing executive, started noticing foul odour and white discharge from her vagina. After a quick stop at the doctor’s earlier this morning her suspicion was confirmed, she had a yeast infection! Having a yeast infection can be very irritating, not to mention frustrating because of all the itching and burning. Add to that the embarrassing task of discussing this with her fiancée and Mary was really feeling the annoyance of this infection.

BEYOND YEAST INFECTIONS Mary is not alone, vaginitis (medical term for vaginal inflammation) is quite common with as many as 3 out of 4 women experiencing a yeast infection at some point in their lifetimes.1 Vaginal infections occur when bacteria, viruses or fungi grow in and around the vagina. Although most of us have experienced or at least heard about yeast infections, it is important to know other kinds of infections and pathogens that can cause vaginitis:

GETTING TO KNOW THE ENEMIES Yeast infection

Cottage cheese like discharge and/or itching or burning.2

Candida albicans

Bacterial vaginosis (BV) Off-white watery or foamy Haemophilus vaginalis

Trichomoniasis Trichomonas vaginalis

discharge accompanied by a fishy smell.3 Frothy yellow or greenish discharge accompanied by vulval itching and soreness.4

can cause the Candida fungus to flourish due to the increase in moisture in and around the vagina. Povidone-iodine washes and douches have proven effective at rapidly killing broad spectrum of pathogens (bacteria, protozoa and fungi) commonly involved in vaginitis. Here is a checklist of things you can do to help fight vaginitis: • Avoid tight nylon underwear which does not provide good ventilation therefore blocking air circulation and perspiration. • Use vaginal douche/wash such as BETADINE® (10% povidone-iodine)**: 4 For effective cleansing and deodorizing for optimum vaginal hygiene 4 For washing out vaginal medication such as

creams and jellies if instructed by a physician 4 For deodorizing and washing out accumulations

of normal secretion 4 For cleansing the vagina after sexual relations 4 As an itch reliever for common external

irritation due to infections

* If you experience any of these symptoms please consult your doctor or pharmacist.

4 For vaginitis due to bacterial, candidal,

IF YOU DON’T TAKE CARE OF IT, NO ONE ELSE WILL

* Mary is a fictional character.

Personal hygiene is not only a confidence booster but it is also the first step to good health. Heat and humidity

trichomonal, or non-specific infections

** If symptoms persist, please consult your doctor or pharmacist.

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19/12/11 2:09 PM

singapore he alth

JAN⁄ FEB 2012

News > Continued from page 1

Flu shot saves lives

Quit smoking to reduce risks

no COPD patients had been vaccinated. Three months later in May, 30 per cent had received it. The polyclinic intends to increase this to 70 per cent by February this year.

Local benefits In Singapore, there are about 60,000 patients with moderate to severe COPD and about 2,000 of them are warded every year for the condition. Bukit Merah Polyclinic has about 300 COPD patients. “The aim of the project was to protect as many of them as possible from flu complications,” said Dr Tan.

What is COPD? Chronic Obstructive Pulmonary Disease (COPD) refers to respiratory diseases where the lungs are damaged and airways become irreversibly narrowed. COPD is most commonly brought about by exposure to toxic chemicals, such as cigarette smoke, severe pollution or frequent excessive smoke inhalation. The chemicals in cigarette smoke, for example, damage the cells in the lungs, causing repeated swelling and inflammation. The smoke also causes these swollen cells to secrete an enzyme that breaks down the stretchy fibres in lung tissue. Over time, there is permanent damage to

The flu jab, when given to COPD patients, has been shown to reduce the hospitalisation rate by 52 per cent and the death rate by 70 per cent, said Dr Tan Yew Sang (right).

Smoking excuses busted

“We found a lack of awareness among healthcare providers and patients of the benefits of the flu vaccine, which was an obstacle to vaccination,” said Dr Tan. To address this, the team held a talk to educate healthcare providers, as well as highlight and manage patients’ concerns about the possible side effects.

The aim of the project was to protect as many COPD patients as possible from flu complications. Dr Tan Yew Sang, Senior Family Physician, Bukit Merah Polyclinic

lung tissue because it becomes less and less elastic. The swelling in the airways and the increased production of mucus caused by cigarette smoke also limit the amount of air that can be absorbed by the lungs. This causes breathlessness and wheezing. There are two main forms of COPD: Chronic bronchitis, which causes persistent cough and mucus due to inflammation of the airways in the lungs. Emphysema, which causes shortness of breath due to the destruction of air sacs of cells in the lungs and airways. The majority of COPD sufferers have both of these conditions.

PHOTOS: JUSTIN LOH

What the vaccine can do Dr Tan Yew Sang, Senior Family Physician at Bukit Merah Polyclinic, said COPD patients can benefit from the flu vaccine. It can reduce the severity of flu and COPD symptoms, as well as the risk of pneumonia. “Studies show influenza vaccination reduces the hospitalisation rate by 52 per cent and the death rate by 70 per cent. “Our COPD patients – many of them above 65 years old – have poor lung function. If they get influenza, it could worsen their COPD symptoms and cause other complications like pneumonia. This can then result in hospitalisation and, in severe cases, death,” said Dr Tan. Studies in Europe indicate estimated savings of £50 (S$100) per elderly person vaccinated. Hospitalisation means a loss of earnings for the patients and family members who care for them. Another upside is that the more people vaccinated against flu, the lower the chances of the virus spreading. “This can impart community immunity,” said Dr Tan.

Smoking is one of the main causes of COPD and about 90 per cent of such cases are directly caused or triggered by smoking. According to studies, the risk of developing COPD increases with age and the length of time spent smoking. In fact, almost all long-term smokers will develop COPD, provided that other smoking-related diseases such as heart disease, cancer or diabetes do not result in death first. The toxic chemicals in cigarettes damage the cells in the lungs. In the long run, this causes permanent damage resulting in poor lung function. By the time symptoms appear, the damage is extensive.

“Some side effects include mild fever and muscle ache or tenderness at the injection site. But these are resolved in a few days,” said Dr Tan. The polyclinic created awareness by putting up posters in public areas, while counter staff handed out pamphlets, printed in three languages, to inform COPD patients and others about the vaccine. The vaccination can also benefit young children, the elderly and anyone with a chronic disease like diabetes, kidney disease or a heart condition. The team found that many patients, once informed of the benefits, were keen to get the vaccination.

The first signs of COPD are hard to detect and often mistaken for harmless cough or normal breathlessness due to exertion. Usually, by the time symptoms such as shortness of breath, coughing spells and wheezing become more frequent, the damage is extensive and the disease is in its moderate to severe stage. Other symptoms include fatigue, difficulty in breathing and a higher rate of respiratory infection. Patients with COPD can also develop other complications due to the condition. These include irregular heartbeat, heart failure, pneumonia, collapsed lungs, weight loss or malnutrition and osteoporosis (brittle bones).

I’ve smoked for so long, the damage is already done, so there’s no point in quitting. It’s never too late to quit. The longer a person smokes, the greater the risk of developing smoking-related illnesses. By the time symptoms appear, the damage is extensive. If I stop smoking, I’ll gain weight and get stressed – these are just as bad for my health. The net gains from quitting outweigh concerns about weight gain. In fact, quitting can help you breathe more easily and enable you to exercise with more ease and enjoyment. I quit but caved in and had one cigarette the other day. I might as well continue smoking. Having one or even a few cigarettes does not mean utter failure. The fact that you got through a few days, weeks or months without a cigarette means you don’t need to smoke. Just strengthen your resolve to quit and try again. I’ve cut down my smoking to a safe level. There is no such thing as a “safe level” of smoking. In fact, light smokers tend to inhale more often and deeply, cancelling the benefits of cutting back. My grandfather/uncle/neighbour smoked and lived to a ripe old age. Some people may be exceptions to the rule, but the numbers are not in your favour, as 90 per cent of smokers succumb to COPD or lung cancer.

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News

Please say “Ah” SGH launches DVD to help patients with swallowing or speaking difficulties BY Jacqueline Chia

Grandfather used to tell stories about his youth to his grandchildren before they went to bed. But after suffering a stroke, he couldn’t continue with the nightly routine as the disease had impaired his ability to speak. Thankfully, Grandpa made a fast recovery, after practising speech and swallowing exercises prescribed by his speech therapist. More importantly, he was able to do these activities correctly in the comfort of his home, following detailed instructions from a DVD produced by Singapore General Hospital’s (SGH) Department of Speech Therapy. “This exercise video came about because we found that our patients, especially the older ones, often could not remember the exercises that were taught or were doing them

incorrectly. We had to review the exercises with the patients again and again during therapy sessions and this delayed rehabilitation,” said Ms Melissa Chua, Head and Senior Principal Speech Therapist, SGH. Patients are given instruction sheets to take home or rely on caregivers and family members to help them with the exercises. But exercises that are done wrongly can slow down their recovery, and it may be

another two to four weeks to the next review when the mistakes are corrected, Ms Chua added. To address this problem, and after two years of hard work, the Department of Speech Therapy produced a step-by-step DVD guide Say Ah that helps patients do their prescribed exercises easily – and correctly – at home. “Exercises can range from those working on lip and tongue movements to specific swallowing exercises, such as those that teach the patient how to stimulate the back of the throat to facilitate faster swallowing,” said Ms Chua. Launched on Nov 1, Say Ah consists of two DVDs with 20 exercises. The video is offered to the department’s patients as an additional resource to help them do their exercises correctly at home. Sold at $19.58 each and available in English, Malay and Mandarin, the DVD has drawn an enthusiastic response from patients, especially the elderly. Only the department’s patients can buy the DVD as it must be used in conjunction with the instructions and exercises prescribed by theraThe DVD lets patients practise their exercises correctly at home, helping to speed up their recovery.

pists. “We don’t want patients to rely only on the video because professional advice is required for this tool to be used effectively,” Ms Chua said. The video was produced by the department and SingHealth Academy – the education arm of SingHealth. “The talents you see in the video are members of the department,” said Ms Chua. “We were involved in the whole process, coming up with the script and doing research to ensure that all the material was evidence based.” SGH has produced 1,000 copies of the video. With the use of the speech therapy aid, Ms Chua has noticed more consistent progress in patients – encouraging results for the department which may develop more resources for patients in the future. SGH sees more than 19,000 patients seeking treatment for speech and swallowing problems each year. The numbers are increasing, but this is also due to a greater awareness among Singaporeans of the value of speech therapy services in treating communication disorders. “Sixty per cent of our total patient load are inpatients with swallowing and communication disorders. Ten per cent of our outpatient cases are patients with communication disorders,” said Ms Chua. Patients who require speech therapy include those who have suffered a stroke, have Parkinson’s disease or brain injury from road accidents or bad falls, as well as those who suffer from head and neck cancers.

Perfect vision with new eye operation The procedure offers patients the chance of perfect eyesight with a rejection rate of one per cent or less BY Thava Rani

Having already undergone two corneal transplant operations in his left eye over the last 10 years, Mr Chok Teck Chow was more than a little apprehensive about going through another one in his right eye. “Previously, I needed 20 stitches and took six months to recover,” said the 59year-old who is semi-retired. But he needn’t have worried. With an improved corneal transplant procedure offered at the Singapore National Eye Centre (SNEC), he suffered only a few days of blurry vision. “By the fourth day, I could see well enough to go out by myself,” he said. The new procedure, which is known as Descemets Membrane Endothelial Keratoplasty (DMEK), is the latest innovation in minimally invasive corneal transplantation. It involves transplanting a delicate sheet of corneal cells 1/100 mm thick, which is 10 times thinner than what was

required in a previous commonly used procedure at SNEC. The cornea is the transparent, protective outer layer of the eye, and a transplant is the standard means of treatment in patients whose corneas are cloudy from ageing or diseases. With DMEK, the patient’s original cornea is left mostly intact, so it’s not immediately apparent that he’s had a transplant. It may also be possible for the patient to attain 100 per cent vision within a few weeks of surgery. Professor Donald Tan, Medical Director, SNEC, said: “The future will be DMEK. We have a chance for a transplant that provides for 20/20 vision and a rejection risk that is one per cent or less.” This new, sutureless technique was invented in Europe and first performed in Asia by Prof Tan in September 2010. Since then, he has performed three such corneal transplant procedures, which cost between $1,500 and $1,700 each, after subsidies at SNEC. Private patients pay up to $5,900.

The new procedure offers patients the chance of perfect vision with a rejection rate of one per cent or less.

The current downside of the new procedure is that it is an extremely difficult form of surgery. As the membrane transplanted is ultra thin and delicate, it tends to wrinkle into a tight roll when touched, potentially damaging the corneal cells when surgeons try to uncoil it. To get around the problem, Prof Tan and his team at the Singapore Eye Research

Institute have developed a method that is safer and easier to perform, using a new DMEK surgical insertion device currently awaiting a patent. Each year, about 350 corneal transplants are performed locally, of which about four in 10 involve patients with ageing corneas. With the ageing population, this number is expected to grow.

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JAN⁄ FEB 2012

Tell us

No refund for unused medicines I have a chronic heart problem and need medication regularly. The doctor prescribed a three-month supply of medication to last till my next visit. But as I began to feel more breathless, I called the centre for an earlier appointment. The doctor who saw me said I had to change medication, as the old one was no longer effective. Again, I was given a three-month supply. As I still had one month’s supply of the original medicines, which were stored according to instructions, I took them to the pharmacy, but was told they could not take them back. Why is this so? Someone else may benefit from it. - Mdm Ida Soh

The reason medication cannot be returned or refunded is because once it has left the pharmacy, we are not able to ensure it has been properly handled and stored. Therefore, we cannot guarantee other patients that the quality of the medication has not been compromised. At NHCS Pharmacy, we issue medication to many patients with different heart conditions every day. Each time we dispense medication, patients can be assured that it is safe and will help manage their condition. We cannot hand out “returned” or “recycled” medication as this may compromise patient safety.

All returned medication is destroyed. This is a standard practice across most public healthcare institutions. For patients who are prescribed new drugs or require dose changes, our doctors will monitor them closely and limit their collection to two weeks’ or one month’s supply. Our pharmacy, at the point of dispensing, will also routinely check with patients and advise them to collect their medication in instalments to reduce waste. In the event of an adverse drug reaction or allergy, our doctor will review the patient’s condition and we will make the necessary refund.

Tributes I went to the Geylang East Polyclinic for the first time as it is near where I work. Dr Siska Ferdina Taslim who attended to me was very careful and thorough with her examination, and had ordered more blood tests for me. Her style of consultation is much better than what I’ve experienced with private doctors. I am very pleased with the quality of service at the polyclinic and believe Singaporeans should be proud of having such excellent service. Also, the fees charged are very reasonable. - Ms Lee Eng Hee

AND WIN A PRIZE FOR BEST LETTER Letters must include your full name, address and phone number. Singapore Health reserves the right to edit letters and not all letters will be published. Write to editor@sgh.com.sg or The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608, or talk to us on Facebook.

The winner will receive an iCare 200 Blood Glucose Monitoring System worth $58 and Sun Chlorella A tablets (150 tablets) worth $33.

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Singapore General Hospital Erik Prasetia How do I make an appointment for my mother? I want to consult a physician who can deal with breast cancer. Please help. Like · Comment · Sep 25 at 12.43am 5 people like this Singapore General Hospital Hi Erik, you may find out more about making an appointment at www.sgh.com.sg/patientservices/specialist-outpatient-services/pages/make-changeappointments.aspx. You can also find out more about breast cancer at www.youtube.com/watch?v=quhFSMQtMZE. Like · Comment · Oct 5 at 6.30pm

Maran Rko Hey! Is it possible to send greeting cards and flowers to patients in the wards? If so, what address can I use? Thanks :) Like · Comment · Oct 4 at 10.56pm 3 people like this Singapore General Hospital You may just indicate Patient’s Name, Block, Ward and Bed, and send them to Singapore General Hospital, S169608. Like · Comment · Oct 6 at 10.24am

Maran Rko Okies :) Thank you so so much! Like · Comment · Oct 6 at 11.23am

Unable to get through the hotline My wife called SGH’s Call Centre many times last Monday morning to reschedule her appointment for a medical followup, but was unable to get through. We are very sorry that your wife was not able to get her call through to SGH Central Appointments Call Centre at 6321-4377. Mondays and Tuesdays are the Centre’s peak days. On average, the Centre receives 4,600 to 5,000 calls on Mondays and Tuesdays, and some calls are unintentionally missed. We are training our call agents from the General Enquiries team to help out with the Central Appointments’ calls, but that could affect our ability to take calls for General Enquiries. We are monitoring the situation, and are trying very hard to reduce the number of missed calls for both hotlines. Patients can also change their appointments online at www.sgh.com.sg/ Patient-Services/Specialist-OutpatientSer vices/Pages/make-change-appointments.aspx, but a Singpass ID is needed. They can also email appointments@sgh. com.sg for an appointment change. They will receive a response within 24 hours.

I would like to say a big thank you to the doctors, nurses and other staff who took care of me when I stayed in SGH Ward 73 in October. In particular, I want to thank the nurses who gave me a scarf to cover my baldness, so I wouldn’t feel uncomfortable leaving the ward for a CT scan. They took care of me so well that I didn’t feel like I was a patient, but was a part of their family. The doctors constantly updated my parents and me about the status of my health. - Ms R Pang

I would like to commend Ms Edna Woo who took my call recently to find out if a family friend had been admitted to SGH. She was very professional and cheerful from the moment she picked up the call. I am impressed by her service and would like to compliment SGH for having such a great frontline service staff member. Please relay my compliments. Keep up the good work! - Ms T John

Annoyed by the repeated questions On the way to the operating room for surgery, hospital staff repeatedly asked for my name, NRIC and the type of procedure that I was scheduled for. My personal and medical data is already in the hospital file, but the same questions were asked in the ward and at the operating theatre. We have your medical records, but to guard against the possibility of oversight or error such as sending the wrong case file or incomplete medical records with the patient to the operating room, our staff will verify information, such as name, NRIC number, the kind

of surgery to be performed and confirmed consent for the correct surgery, at various points in the ward and operating theatre. They check the patient’s replies against the medical records and, as another precaution, mark the surgical site to avoid operating on the wrong part of the body. Active involvement and effective communication are important to avoid mistakes, with the patient playing an important role in ensuring his own safety. Members of the surgical team do a final verification just before the operation to ensure they are carrying out the right procedure, on the right part of the body, on the right person.

Jan/Feb 2012

Science What happens to a tissue sample after surgery?

p16-17 Wellness Don’t let your periods get you down

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Sweet suffering Sink your teeth into this article before you take your next festive bite

patients walk in on unscheduled visits for different reasons: fractured or dislodged fillings, toothache, tooth sensitivity and cracked or fractured teeth. Many of these complaints are linked to festive snacking on lots of sticky, sugary foods, quaffing litres of carbonated soft drinks, chomping on hard candies and nuts, and cracking heaps of melon seeds with the teeth. But, can a few days of eating with abandon do much harm? “You will be surprised what a few days of feasting can do to your teeth,” said Dr Christina Sim, Senior Consultant, Prosthodontic Unit, Department of Restorative Dentistry, NDC.

Diet and decay Dr Sim explained that traditional snacks, such as bak kwa, niangao (sticky rice cake), pineapple tarts, love letters, sweets, chocolates and cakes, contain fermentable carbohydrates which bacteria in plaque metabolise into acids. These acids “leach” minerals from the teeth, causing caries, disease or tooth decay. With frequent snacking between meals – a common practice during Chinese New Year – acid levels in the mouth remain high and the “leaching” continues. In fact, frequent snacking can possibly cause more damage to the teeth than eating a greater amount but less often.

Chinese New Year snacks like bak kwa, pineapple tarts and cakes adhere to the teeth and are hard for saliva to wash away.

Photo: getty images

Before Chinese New Year, the National Dental Centre (NDC) of Singapore sees an influx of people wanting to clean and whiten their teeth. After the celebrations,

“Sticky foods such as niangao, pineapple tarts, chocolates and toffee adhere well to tooth surfaces, and are more difficult for saliva to wash away. Saliva rebalances the pH level in the mouth, slows down mineral loss from the teeth and allows repair to take place. Sufficient time must be given for the pH level in your mouth to return to normal,” said Dr Sim. Orange juice (with a colour that represents wealth) and soft drinks are typically served in many homes. Sugar-laden and acidic, they are far from tooth-friendly. “Drinking such beverages frequently lowers the pH level in the mouth and also causes minerals to ‘leach’ from the teeth. They can also erode the outer enamel of teeth, exposing the softer inner dentine layer which is more sensitive. In fact, sipping a soft drink for a long time puts you at a higher risk of caries than finishing it within 10 minutes,” said Dr Sim. The other concern is the cracking of the teeth’s enamel. “When we chew on sugary, sticky and hard foods like candy, nuts and melon seeds, there is a chewing force exerted by our teeth. This force can be so great that it causes micro cracks to develop in the enamel structure,” said Dr Sim. Tooth decay and gum disease can be prevented through good oral hygiene, Nuts, melon seeds and sweets pose a danger to the teeth’s enamel.

Snack smart

Limit your intake of sugary and acidic foods. Go easy on sugar-laden juices, coffees, teas and fizzy drinks. Avoid sipping acidic or sugary drinks over a long period of time. Drink through a straw to minimise contact time with your teeth. Maintain a strict oral hygiene regime. Drink enough water to avoid

reducing the frequency of snacking as well as cutting down on sugar-rich foods and drinks. Saliva is the body’s natural protective and defensive mechanism regulating the pH level in the mouth. Increasing saliva flow in the mouth and drinking sufficient water help optimise saliva’s protective mechanism. “Saliva is essential for oral and pharyngeal health. It lubricates the mouth, and helps swallowing, digestion, speech and taste. It also protects against plaque acids, and its antibacterial properties and enzymes aid in digestion. It contains minerals and other compounds, which promote remineralisation of the teeth. Good saliva flow helps clear food particles from the mouth too. But smoking, alcohol and recreational drugs may affect the quantity and quality of saliva,” said Dr Sim. Keeping hydrated is also important. Dr Sim said that the lack of water decreases saliva flow and pH and, if prolonged, this can accelerate tooth erosion and decay.

dehydration, which will reduce saliva flow and depress the pH level in your mouth. Allow time for the pH level in your mouth to return to normal. Check the pH level of your saliva using a piece of pH paper, which is easily obtained from the dentist. A healthy saliva pH is mildly alkaline at 7.4.

Heavy drinkers of alcohol and caffeine should increase their water intake to restore their fluid balance. Sugar-free chewing gum and artificial sweeteners are also tooth-friendly. Normal oral pH can be achieved by just chewing gum for 20 minutes. Sweeteners, too, cannot be turned into acids by bacteria in the mouth. So, for a great start to the year, it would be vital to spring-clean not only your home, but also your mouth. “We highly recommend that people visit a dentist prior to Chinese New Year to make sure their teeth are in good condition and prevent an emergency toothache during the festive period, when dentists are not easily available. The dentist can also check for existing chipped teeth or fillings that are leaking, to minimise the risk of chipping a tooth while eating. You can also ask your dentist to do simple saliva function tests to assess saliva flow, its acidity and ability to neutralise acids,” said Dr Sim.

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Dissection These small sections are placed into cassettes (in pink) and put in a machine to be processed overnight. This process dehydrates the tissue samples in preparation for them to be embedded in paraffin wax. “The dehydration process is important, because any moisture that remains in the tissue sample will cause the paraffin not to bond properly with it,” said Ms Chin.

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Embedding The sample is now ready to be sliced and placed onto a glass slide.

Tissue processing When the dehydration process is complete, the samples are ready for embedding. The cassette is carefully filled with molten wax and left to solidify into paraffin blocks.

Sectioning Slicing off a paper-thin sliver of the paraffin block is an art in itself. A well-trained technician shaves off the excess wax before using this machine, known as a microtome, to cut a ribbon of wax-embedded tissue that is only a few microns (one-millionth of a metre) thick.

The Academia Pathology and laboratory services will be housed in new, larger premises at Diagnostics, one of two 13-storey towers being built on SGH Campus and scheduled to be completed in 2013. Diagnostics and the other tower, Discovery, are part of The Academia complex that will hold SingHealth’s research, education and pathology activities. The Department of Pathology, which celebrates its 110th anniversary in 2013, is a well-known centre of pathology services in Asia, and is the reference centre for specialised laboratory tests in Singapore. The building will have built-in sample delivery systems that speed up transportation of specimens to the lab, translating to faster test results for patients.

Microscopic analysis The stained slides are now ready to be read under a microscope by a pathologist.

Slide sorting The glass slides are then collected and placed into another machine that is filled with different chemicals and alcohol mixtures. “These chemicals preserve the tissue samples and stain them with various colours depending on the type of cellular structure,” said Ms Chin.

Fishing With great care, the thin slice of wax containing the sample is lifted off the microtome and placed into a water bath.

Auto-staining The water helps to smooth the strip and a glass slide is used to fish it out from the bath. The almost-invisible sample remains fixed to the glass slide after being left to dry.

singapore he alth

Jan⁄ FeB 2012

Wellness

That time of the month

The menstrual cycle is designed for reproduction, but it also brings pain and problems for many women and their partners. By Rachel Chan

More extreme is the belief that menstruating women are unclean and should be banished from the home during that time. While few cultures now consider menstruation as something impure, the monthly bleeding – a result of the lining of the womb breaking down after pregnancy fails to occur – remains a curse for many modern women. Heavy menstrual flow is a typical complaint, although some women can suffer from prolonged, irregular, infrequent or erratic periods. For many women, having the period can also be accompanied by

Teens May experience irregular cycles or pain

Fertility rites

Designed purely for the purpose of getting her pregnant, a woman’s reproductive system goes through a 28-day menstrual cycle every month, although it can also vary from 21 to 45 days.

mood swings, vomiting, diarrhoea, stomach cramps or pain, lethargy, bloating, weight gain or even food cravings. “Period problems typically occur in the very young or old,” said Dr Yong Tze Tein, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH). “For girls who have begun menstruating, it’s almost like a new factory starting to get into production. They may initially have irregular cycles that usually improve when the ‘factory’ gets more efficient. Sometimes, they may get period pain which lessens as they grow older.” Women in their late 40s or early 50s often experience irregular, heavy or prolonged periods, or spotting in between

30s May be prone to growths in the womb or ovaries, which can result in heavy bleeding or pain

40s May develop fibroids or cysts which can result in heavy bleeding

At the end of the cycle, the bleeding stops when the lining of her womb is shed and becomes very thin. The cycle starts when signals from the brain to the ovaries prompt the eggs in the ovary to grow in a bid to achieve ovulation. Many will start in this race, but only one will emerge dominant. During this time, the ovaries produce estrogen, a hormone that causes the lining of the womb to thicken. When the amount of estrogen reaches a certain level, a signal is sent to the brain to release another hormone – LH or luteinising hormone – that causes final maturation of the egg and ovulation occurs. The corpus luteum which is left behind produces a second hormone, progesterone, which changes the lining of the womb to become very “nutritious”, setting the stage for an embryo to be implanted. If

periods, as a result of hormonal changes brought about by impending menopause. When they reach their late 30s, women become more prone to growths in the womb and/or the ovaries. They may develop fibroids, which are solid benign tumours that grow from the muscle of the womb; or adenomyosis which occurs when the lining of the womb infiltrates its muscular wall. Endometriotic cysts, or blood cysts, are thought to result from the reversed flow of the menstrual blood through the fallopian tube into the pelvic cavity and ovaries. Fibroids are more common, with one in five women likely late

40s early

50s May experience irregular, heavy or prolonged periods, or spotting in between periods

PHOTO: Tan Weite

It was once believed that the presence of menstruating women can spoil milk and meat, and should not be allowed in the kitchen.

Period problems typically occur in the very young or old, said Dr Yong Tze Tein.

pregnancy doesn’t occur, the corpus luteum degenerates and the estrogen and progesterone levels will fall. Without support from the hormones, the lining breaks down and is expelled from the body as “menses”. Menstruation lasts for three to 10 days.

to have it at some point, said Dr Yong. Some women may lose so much blood that they become anaemic. “They are usually in their 40s, but don’t think about seeing a doctor. Instead, they may wear two or more (sanitary) pads or even disposable baby diapers, and use a plastic sheet on their bed to avoid staining. But they may lose so much blood that they end up needing a blood transfusion,” said Dr Yong. Doctors usually prescribe drugs to reduce the blood flow, or painkillers for pain if sufferers are found to have little or no problem. But if they are found to have fibroids or cysts, an operation to remove them is likely to be an option. The average uterus has a diameter of about 60mm – about the size of an egg – but it can become enlarged by fibroids or cysts. One patient, said Dr Yong, had a womb that was as large as that of a fivemonth-pregnant woman. The condition, unusual for someone so young, caused the woman who was in her early 20s to have very heavy periods. On an overseas trip, she was so desperate to stop the blood flow that she combined two types of medicine, including one that promoted clotting. But she developed a blood clot in the leg, a potentially fatal condition known as deep vein thrombosis. To dissolve the clot, doctors gave her blood-thinning medication, but the treatment took her back to square one – heavy menstrual bleeding. Eventually, doctors had to resort to blocking the blood vessels that supply her womb, a procedure known as embolisation. This caused the bleeding to stop and her womb to shrink, but she eventually had to have her womb removed. Removal of the womb or hysterectomy is now much less common than before, both in Singapore and worldwide. This is because there are more options to manage heavy periods. Mirena – an intrauterine contraceptive device that releases progestogen, a hormone that makes the lining of the womb thinner and bleeding lighter – is an alternative. Mirena has FDA approval and is the first line of treatment for heavy periods, said Dr Yong. “Adenomyosis and fibroids are benign conditions. If you have an enlarged uterus but a normal period, there is no need to have any treatment,” Dr Yong said. “But we don’t believe women should suffer from their periods. If they have heavy or painful periods, they should seek treatment,” she added.

JAN⁄ FEB 2012

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Spotlight

At the heart of the matter

Patients who cannot risk open heart surgery can now be treated with a new, minimally invasive procedure BY Thava Rani

Madam Margaret Lim, a 68-yearold retired hawker, does not smoke or drink. Yet, for more than two years, she had difficulty walking the length of a room. She would become breathless and tired. In fact, she was so exhausted all the time that she stopped going out to meet her friends. What she had was a severe form of a heart condition known as mitral regurgitation, which can only be treated with surgery. To complicate matters, she also had chronic lung disease and a severely weakened heart, which made surgery too risky for her. In the past, patients such as Mdm Lim had few therapeutic options. “They could only take medication to control the symptoms and hope for the best,” said Dr Yeo Khung Keong, Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS). But now, a new minimally invasive procedure called the MitraClip has given new hope to patients like Mdm Lim. In April 2011, she became the first patient in Asia to receive the MitraClip in a procedure led by Dr Yeo at NHCS. “I didn’t feel any pain after the procedure. Before, I was always tired and breathless. Now, I feel more energetic, can do household chores and go out with my friends,” said Mdm Lim.

Since April 2011, NHCS has successfully performed the procedure on 11 patients. As Singapore’s population ages, NHCS expects to perform the procedure on an estimated 50 patients a year. Moderate to severe mitral regurgitation is estimated to affect about 12 per cent of patients over the age of 75. Left untreated, about a third of those with the severe form of the condition are not likely to survive for more than six years. What is mitral regurgitation? Mitral regurgitation occurs when the mitral valve (the valve that separates the upper and lower chambers on the left side of the heart) does not close as tightly as it should. This causes blood, which normally flows in one direction from the left ventricle (the lower chamber of the heart) to the rest of the body, to leak and flow backwards into the left atrium (the upper chamber). As a result, the heart has to work harder to pump blood around the body, making patients breathless, tired and unable to do the things they used to be able to, such as playing sports or carrying heavy things. In mild cases, patients usually do not experience any symptoms, as the heart has the capacity to cope. However, symptoms appear if the heart is unable to compensate or deal with the regurgitation adequately. “You can look at it as a boat. We accept that there is no boat that does not leak. It is only when the leakage becomes severe that the boat will have trouble coping, and that’s when we need to take action,” explained Dr Yeo.

NHCS’ multidisciplinary team behind Asia’s first MitraClip procedure, from left: Dr Yeo Khung Keong (holding the MitraClip device), Assoc Prof Chua Yeow Leng, Assoc Prof Koh Tian Hai, Medical Director, NHCS, and Assoc Prof Ding Zee Pin, with the first MitraClip patient Mdm Margaret Lim (centre).

In younger patients, mitral regurgitation may be due to some form of valve degeneration. But in older patients like Mdm Lim, the most common cause is functional, which means the valve itself is not at fault. Rather, it may be due to a heart that is weakened by heart attacks or damaged by viruses. Dr Yeo likened it to a door that is in good working condition, but with cracks on the frame or the walls surrounding it. “With time, the leaky valve can cause heart failure, an irregular heartbeat or increased pressure in the lungs.” Treatment options The first line of treatment is medication, which does not treat the underlying problem, but helps the heart pump more efficiently and reduces the risk of complications such as an irregular heartbeat. Patients are also advised to continue with a healthy lifestyle, as regular moderate exercises like brisk walking or light jogging can help alert them if their condition worsens. Once symptoms appear, surgery to repair the valve is the treatment of choice. But it is not suitable for all patients, as conventional surgery is too A dangerous or risky for patients with other underlying problems.

IllustrationS: heymans tho

(A) The MitraClip and catheter enter the body through a small incision in the groin, go through the femoral vein, cross the atrial septum (the wall of tissue separating the right and left atrium) and enter the left atrium. (B) The device is aligned over the site of the leakage and the open clip is sent into the heart’s left ventricle. (C) The mitral leaflets, which are causing the leakage, are grasped and the clip is closed to seal them. This reduces the leakage significantly.

More on the MitraClip The minimally invasive procedure was first performed in Venezuela in 2003. The procedure involves implanting a 4mm-wide cobalt chromium clip covered with Dacron fibre in the heart using a minimally invasive route. The clip is attached to a catheter and inserted into the body through a 1cm incision in the leg vein. The catheter is then directed to the heart, where the clip is used to bring the two valve leaflets together to reduce the leakage. It is performed under ultrasound guidance to ensure accurate placing of the clip. The whole procedure takes an average of three hours and involves a multidisciplinary team.

Advantages Both conventional open-heart surgery and the MitraClip procedure help to improve symptoms of mitral regurgitation by fixing the underlying problem. But the MitraClip procedure offers some extra advantages: The heart beats normally and, hence, does not require a heart-lung bypass machine. There is a reduced need for blood transfusion. Patients recover faster with a shorter hospital stay. Patients avoid the risk of wound infection and other complications.

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Jan⁄ Feb 2012

Viewpoint

Rejections and decisions A rejection letter leads to a contemplation of the different paths leading to a medical degree

My son recently received a rejection letter for his application to the local undergraduate medical school – the Yong Loo Lin School of Medicine (YLLSoM). It was a tough pill for him and his parents to swallow as he had done very well in his International Baccalaureate exam and had completed several clinical attachments. I had to deal with the fallout from the situation and help my son get through this setback. As for my wife, the thought of him going away for five to six years abroad to study Medicine gave her separation anxiety. I guess we had to endure the disappointment along with the 500-odd families every year who have the same experience. At least, we have the means to send him abroad; quite a number of these families do not have this luxury. This situation I was experiencing was

I find the idea of Medicine, as a great way for the lower socioeconomic classes to be upwardly mobile, to be very attractive.

juxtaposed with the graduation ceremony that I was invited to attend at the DukeNUS Graduate Medical School recently. The pioneer batch of 24 students was graduating, and there were huge smiles all round, with proud parents, spouses and even children beaming away. I had also been fortunate to be invited to be an examiner in their final exam. From their performance, I could see that there were great differences in going to medical school as an undergraduate and as a postgraduate student. That made me wonder if Medicine is better appreciated as a postgraduate degree as opposed to our current system. The Americans have long stuck to this view and the Austra-

lians are slowly coming round as well. In the midst of all these events, I started thinking about our motivations for studying Medicine. I recall that when I made my decision, I was following the herd instinct of those who had done well for their A Levels. I was also attracted by the idea that I could defer my National Service obligations and go straight to varsity. Now, looking back on my career, I have no doubts that I chose the right path. I still remember the late Dean Prof Wong Poi Kong’s parting words to me during my medical school interview. There had been some robust to and fro, and he told me that if I got into medical school, I would have to change some of my views! I took that to mean I had failed the interview, and went home to look at brochures for my second choice of study – Chemical Engineering. I also remember at that time that there was a deliberate policy to shunt good students away from Medicine to other fields such as Law. I believe one of the recently elected Members of Parliament for Aljunied Group Representative Constituency was a casualty of that policy. Again, fate or karma would have it that his rejection by medical school might not have been a bad thing! Not grades alone I guess, in an emotional sense, rejection does put down a bright student who has achieved what he was told and tasked to do. In the end, the prize he was aiming for was not awarded to him and, while he did his best, that apparently was not good enough. In a meritocracy, that does create quite a few problems as it seems to undermine the very foundations of the system. In our academic system where marks and scores are everything, admission to medical school is not based on grades alone. Perhaps, that is why the YLLSoM administration has some tough decisions and situations on its hands. On top of external audits, it faces pressure from parents for all manner of justification, clarity as well as transparency of its

Illustration: heymans tho

BY Dr Chong Yeh Woei

decision-making process. As for the motivation for studying Medicine, I think that, as a teen, one may not have too many ideas about doing Medicine as a career. Some may think it glamorous or find it intellectually challenging. Some may also have been influenced by their family doctors or relatives, while others may have developed a rose-tinted vision from watching medical soap operas. Medicine is fundamentally egalitarian. Even doctors who are President’s Scholars are treated no differently by their colleagues in housemanship or the early years of practice. I find the idea of Medicine, as a great way for the lower socioeconomic classes to be upwardly mobile, to be very attractive. The students who come from the bottom 20 per cent of our socioeconomic strata, and have benefited from the SMA Medical Students’ Assistance Fund, have certainly impressed me.

Deciding if studies or National Service comes first is a hard decision for many local male students in their late teens.

Defining the options Coming back to my son, he will have to serve his National Service and decide at the end of the day where he wishes to go for his medical studies. He will have to choose between an undergraduate programme or a postgraduate one. Of course, both options have their own merits. These days, quite a few of the postgraduate schools also bundle a basic degree with a postgraduate medical degree. He may yet have the option of staying in Singapore by applying to the upcoming Lee Kong Chian School of Medicine at the Nanyang Technological University. He will have to decide and, as his parents, we must give him our fullest support. Whatever the outcome, I believe his heart is still with Singapore and, despite their global exposure, Singaporean students doing Medicine in America, Europe and Australia will certainly look forward to coming home to serve the public and our patients in our finest healthcare institutions.

Dr Chong is the President of the 52nd SMA Council. He has been in private practice since 1993 and has seen his fair share of the human condition. He pines for a good pinot noir, loves the FT Weekend and, of course, wishes for world peace.

Jan⁄ FEB 2012

singapore h e alth

Money Matters

Where there’s a will, there’s a way Leaving a note for your loved ones may be an enriching experience for all BY Celene Ting

“Finally, I think it is time I say some things to you I may not have said before. Better late than never, right? So here goes…” Writing an “emotional” will to loved ones will give them answers to personal questions we may have wanted to answer, but did not, during our lifetime. “An ‘emotional’ will can enhance the peace of mind of the dying by helping to connect the dots with their filial bonds,” said Mr Lee Poh Wah, Chief Executive Officer, Lien Foundation. “Those who are left behind tend to grieve better as they would have felt enriched by their profound ‘inheritance’, attained a sense of closure, and grown in ways that are important to themselves and their loved ones who have passed on.” So, in October 2011, the concept of the “emotional” will was introduced to the public as part of a larger initiative by the Lien Foundation. Called Life Before Death, it seeks to advocate better care of the dying, and destigmatise death and dying. The “emotional” will is one of the foundation’s series of life-affirming tools introduced to encourage people to start thinking about and dealing with end-oflife issues.

wake-up call to live fully and consider what we are living for. An “emotional” will is similar to a love letter in its intent and purpose, said Mr Lee. In its simplest form, it contains and offers intimate insights into an individual’s feelings, memories, life lessons, values and wishes for others, especially those whom he cares deeply for. Designed and written in everyday speech, not the legal language of a will, the “emotional” will completes unfinished statements such as “My wish for your future is…” and “I don’t know if I have told you before, but I’m sorry for…”. This helps the person crystallise and convey unexpressed feelings in a conversational manner within a casual context. According to Mr Simon Tan, Managing Director, Attorneys Inc. LLC, and a member of The Law Society of Singapore, an “emotional” will need not be separate from a traditional will, which sets out how assets should be distributed after death. A will can take on an “emotional” aspect if it contains feelings and intentions that enables one to “speak from the grave” on matters of the heart. But, he said, a document which only contains a person’s expression of feelings towards

another, without instructions about the distribution of his assets after death, is not to be mistaken for a legal document, nor is it intended to serve as one. “The difference between the two types of wills is their purpose. One is a reflection of emotional wishes, while the other could be non-emotive and matter of fact,” said Mr Tan. However, he would rather not differentiate between the two but classify both as wills. This is because an “emotional” will can offer the deceased’s family and even the courts valuable insights into a lifetime of innermost thoughts, unspoken desires and pent-up remorse. For instance, remarks by the deceased that a certain property meant so much to him, that he did not want it sold or disposed of until some contingency happens, will provide a court of law with vital insights. Mr Tan said it is important that a will contains our “emotional wishes”, state of mind, attitudes and feelings about any matter or person in our lifetime. “Such expressions of feelings, when carefully thought out and articulated, show that the testator (the person who wrote the will) has thought carefully about how to distribute his assets.

It would be difficult for any disgruntled next-of-kin or relative to argue that he was not mentally capable of making the right decisions. This would reduce the risk of the court making a finding which may run contrary to the intentions of the testator. If a person’s instructions to his lawyer were specific and clear, the court might find little or no justification to rule that he did not know what he was “willing” away to another. The court’s decision would apply, in the absence of strong medical evidence to suggest otherwise. Emotional wishes, vividly expressed in a will, can, and often do, indicate to the court that the writer of the will knew exactly what he was doing, rather than leave the court to interpret his intentions. So, not only is writing a comprehensive “emotional” will a way to confront end-oflife issues, it can potentially save family members the hassle of going to court. After all, the last thing they need after losing a loved one is to face the stress of a lawsuit initiated by a disgruntled relative.

To avoid a dispute, consider the following: (i) The testator must be of sound mind. A person may be physically sick or infirmed, but he should be of sound mind when writing the will. It is advisable to have a doctor certify, at the time of the signing of the will, that the person was not mentally impaired and his judgment was not diminished to the extent that he did not know what he was giving away. (ii) The testator must be identified with certainty. His name and identity

number should be stated. (iii) An executor and/or trustee should be appointed. The executor will handle funeral matters, pay expenses, determine the assets for distribution and appoint a lawyer to take out a grant of letters of probate to empower him to distribute the assets under the will. If there are children or minors involved, a trustee should be appointed, as his duties start after the executor consolidates the assets and readies them for future distribution if it cannot be done immediately.

(iv) Beneficiaries must be appointed. Otherwise, it is not a will. However, if a person only wants to express his feelings without any distribution of assets upon death, it can be done through a letter, which need not comply with the formalities of a valid and enforceable will. (v) The will must be signed in the presence of two witnesses.

Download a copy of the emotional will booklet from www.lienfoundation.org/news.

The value of emotional wills Mr Lee said writing an “emotional” will can help us confront our mortality consciously, learn about ourselves and reflect on the important things we really want to share with our loved ones. It reminds us not to postpone expressing our gratitude, apologies, forgiveness and love to the people who matter to us. For some, this stocktaking exercise may be a timely

Avoiding a dispute For a will to be valid and enforceable under the law, it must capture all the concerns and wishes of the testator (the person who wrote the will) accurately. An ambiguous will can be challenged and runs the risk of being declared invalid.

*Information above courtesy of Mr Simon Tan, a member of The Law Society of Singapore.

singapore he alth

JAN⁄ FEB 2012

People

From one theatre to another

Dr June Goh, Consultant and Director, Neuro Anaesthesia, Department of Anaesthesiology, SGH, shares her insights on life behind the surgical mask and her love for movies and plays I don’t talk about work because nobody understands what I’m saying. I saw Real Steel last night, but that’s what happens when you have kids – the choices are limited to Johnny English and Real Steel. My husband and I are movie buffs. I think in order to de-stress, we don’t like to watch things that are too intellectual. We like X-Men and Iron Man.

By J.R. Wu

When the scrubs come off… I’m a mother. I’ve got two kids – seven and 13. I have a very diverse social circle. My husband is in business, a totally different occupation. That’s why when I go home,

In another life… When I was in medical school, I did The Land of Smiles, an operetta by Franz Lehar. I don’t sing at all, but when I went to audition for a non-speaking part, they put me in the chorus as well as the non-speaking part. It was an amazing experience. I was also with this theatre group run by a chap called Roger Jenkins, who is still doing children’s productions. Medical school was so demanding, so (acting) was more like a holiday diversion. Nowadays, I support a lot of the local shows by the Singapore Repertory Theatre and Wild Rice, which is led by this very flamboyant theatre personality Ivan Heng. We were in the same hostel when we were studying at the National University of Singapore and he directed a lot of our hostel productions.

PHOTO: VERNON WONG

On the job… Neuroanaesthesia is providing anaesthesia for operations involving the brain or spine, like brain tumours, cerebral aneurysms (burst blood vessels) and deep brain stimulation (to implant a medical device in the brain). So as the surgeons concentrate on the tumour or the blood vessel, we keep everything else on an even keel. The surgeries here can last more than 12 hours for one neurosurgical patient. We have to keep track of blood loss, transfuse blood where appropriate, and make sure the other organs are well perfused. Because the patient is on a ventilator, we have to make sure there is enough oxygen going in and enough carbon dioxide coming out of the lungs. As for the heart, the blood pressure has to be kept stable throughout the operation.

Dr June Goh enjoys working at a hospital because it gives her the opportunity to interact with younger doctors and be a mentor to them.

On not going into private practice… If I left for private practice, I would lose the aspects of institution practice that I enjoy. We teach students from the Yong Loo Lin School of Medicine and Duke-NUS. I am in the core faculty for the anaesthesia residency so, apart from helping to develop the curriculum, I teach residents in theatre too. As anaesthetists, we run courses and workshops for the hospital. However, that’s mostly on weekends. I love the diversity of the job. I like interacting with the younger doctors and being a mentor to them. An interesting conversation would be… With my grandmother. She was a Straitsborn Chinese who was a national swimmer and career woman. She broke from tradition. I wish I had the chance to have long conversations with her to find out more about her life and what motivated her. On TV hospital dramas… I like watching medical dramas on TV with my husband because he’s not in the medical field but loves them. I’ll go: “No! No! No! You know how in Grey’s Anatomy and ER, the interns do everything. It doesn’t happen that way.” I actually took a clip from one of the episodes in Grey’s Anatomy as an introduction for a (weekly departmental) talk. There was this whole episode on a neurosurgical operation with an air embolism and it was completely rubbish! At least, there was Patrick Dempsey. I edited the bit from TV and put it in front of the talk and discussed it.

A good, clear picture By Nazir Keshvani

On the walls of the ophthalmology clinic at Singapore National Eye Centre (SNEC) are photos that could be mistaken for shots or landscapes of the sun, moon or distant planets. They are, however, clinical images of diseased eyes, all shot by Principal Ophthalmic Imaging Specialist Mr Joseph Ho and his team. Resembling works of art, these images (called fundus auto fluorescence photos) are used by eye doctors to diagnose problems and prescribe the right treatment. They are not x-rays, but shot using a digital fundus camera which produces magnified images. Sometimes a dye is used to highlight affected areas of the eye for the camera to capture subtle signs. “We have to use the right amount of dye and direct light into the patient’s eye to give the doctor the best view, so that he can make the best diagnosis. Based on these images, the doctor can analyse the patient’s condition and prescribe the right treatment,” said Mr Ho. A former commercial photographer, he has taken numerous shots and seen all kinds

of eye problems in his 16 years with SNEC. He joined the unit as a photographer with no experience in ophthalmic imaging. But his passion was sparked after SNEC sent him to London for training. “My teacher there fanned my interest in this kind of photography.” Back home, he was instrumental in improving the department’s ability to produce accurate, high-quality images. He constantly encourages his staff to train and improve. The other two ophthalmic imaging specialists in his team have been with him for 14 years and, together with a medical illustrator, they handle about 30,000 patients a year. The unit is also equipped with nine digitalbased imaging systems, and occasionally has new machines that companies keep there for test runs. “This keeps us abreast of new technology in the field,” he said. His fascination with the job makes him often stay late at work, studying photos. Otherwise, he can be found deep in research at home. A bachelor, he said: “I’m married to the job. Yes, I like tinkering with bikes and going mountain biking when I can. But I’m completely compulsive about my job.” The quality of his work has not gone unnoticed. He has won major awards at

PHOTO: ELLEN LIM

Ophthalmic imaging specialist, Mr Joseph Ho, explains why he finds his work to be both science and art

Mr Joseph Ho is passionate about taking photos of diseased eyes, many of which line the walls of his workspace, as seen in this picture.

prestigious international medical meetings such as the American Society of Cataracts and Refractive Surgeons. But to him, this is secondary to his primary task of producing good photographs for diagnosis. “An ophthalmic imaging specialist is an extension of the doctor’s eye – his right-hand man. So, my first priority is to record the pathology and produce an image the doctor needs.” One photo he is very proud of is an image of a retina with an eye condition known as retinal schisis, recorded at 20 degrees mag-

nification. In 2010, it appeared in The Retinal Atlas by Dr Lawrence A Yannuzzi, an important international reference for ophthalmologists, with more than 5,000 images of retinal disorders. But Mr Ho is modest about taking credit. He said: “Once in a blue moon, you photograph an eye where you can get a clear view from front to back. It’s not always the skill of the photographer but the eye of the patient as well. When it all comes together, the result is a good clinical image.”

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singapore health

Jan⁄ Feb 2012

FYI

Spread the sweet, festive cheer The time for giving and feasting is back. Buy a box of biscuits from Polar Cafe this festive season and bring seasonal cheer to the less fortunate. Polar has ”adopted” the SGH Needy Patients Fund during this holiday season, and will donate $1 for every box of Polar goodies bought at any of its 35 outlets from Jan 2 to 22.

Send in your answers and stand to win eight sample packs of Viartril-S worth more than $80.

Occupational Therapists’ Day

6.1% of cancer cases linked to a lack of fruits and vegetables 4.9% to occupation 4.6%

to alcohol 4.1%

to obesity 3.5%

Include your name, age, gender, address and telephone number. Winners will be notified via phone or email. Incomplete or multiple entries will not be considered.

Jan 11 (Wed)

Learn how to prevent falls in the elderly, and get other information about occupational therapy at the open house. Time 11am-3pm (open house) Falls Prevention Talk – 12pm in Mandarin, 1pm in English and Malay Venue SGH-Postgraduate Medical Institute, Block 4, Level 1 Registration Free, email sghotday@ gmail.com for more information.

LASIK Myths and Facts (in Mandarin)

Men

Jan 12 (Thu)

The Singapore National Eye Centre will hold a public forum on the topic LASIK Myths and Facts. There will also be a section on ReLEx, a new laser vision correction procedure to provide the next-generation treatment for myopia. Time 6.30pm-8.15pm Venue Singapore National Eye Centre, Auditorium, Level 4 Fee $5 for registration Registration Sms your full name, NRIC and mobile number to 9725-2366 or register online at www.singlasik.com.sg.

Email: editor@sgh.com.sg Post: The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608 Winners of Contest 13 These winners will each receive a bottle of Ultra IQ Plus worth $62.05. 1. Asmidah Mohd Jailani 2. Gladys Chen Lih Ching 3. Rhoda Kua 4. Kuok Wei Liang 5. Soe Wei Ming Prizes must be claimed by Mar 6, 2012.

Eating Disorders Awareness Public Forum

Mar 3 (Sat)

Time 9.30am-12.30pm Venue NUSS The Guild @ Suntec Fee $5 per person for early registration, $8 for same-day registration Registration Email name and contact details to ed.publicforum@sgh.com.sg. For more information and other listings, please visit www.singhealth. com.sg/events or the respective institution websites.

to excessive sun exposure

Women 6.9%

of cancer cases linked to obesity 3.7%

to infections such as HPV (which causes most cases of cervical cancer) 3.6%

to excessive sun exposure 3.4%

to lack of fruits and vegetables 3.3%

to alcohol

Source: BBC

Publisher

1. What is the main cause of COPD in Singapore?

Closing date: Feb 14, 2012

of cancers are due to lifestyle

In a study done in Europe, researchers have pinpointed the ABCC9 gene as the reason why some people require more sleep than others. Sleep experts say about half a dozen genes are linked to sleep patterns, but the data collected showed that people who possess the gene seemed to require more sleep than the eight-hour average. “A tendency to sleep for longer or shorter periods often runs in families,” said Dr Jim Wilson of the University of Edinburgh, where the study was done.

Singapore Health issue 14 contest

2. What is your favourite story in this issue of Singapore Health?

40%

Sleepy genes

event Calendar

Co-funded

Content Advisor Tan-Huang Shuo Mei Group Director, Communications & Service Quality, SingHealth & SGH Editorial Team Angela Ng (SGH), Lim Mui Khi (SGH), Tina Nambiar (SingHealth), Ann Peters (SingHealth), Deborah Moh (SGH), Wendy Seah (SGH) Singapore Health is partially funded by SGH Integrated Fund and SingHealth Foundation to advance the health literacy of Singaporeans.

Answer to In focus (Page 3): These are glass slides containing processed tissue samples which are sent to the pathologist’s office to be analysed under a microscope. The tissue samples are stained a variety of colours, in this case bright purple, to make them easier to see and analyse under the microscope. More details about the intricate process needed for these tissue samples to be readied for analysis by a pathologist can be found on page 16.

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For advertising enquiries, please call 6319-3022 or email jrani@sph.com.sg

All rights reserved. Copyright by SGH (registration no: 198703907Z). Opinions expressed in Singapore Health are solely those of the writers and are not necessarily endorsed by SGH, SingHealth Group and/or SPH Magazines Pte Ltd (registration no: 196900476M) and their related companies. They are not responsible or liable in any way for the contents of any of the advertisements, articles, photographs or illustrations contained in this publication. Editorial enquiries should be directed to the Editor, Singapore Health, 7 Hospital Drive, #02-09 Block B, Singapore 169611. Tel:+65 6222 3322, Email: editor@sgh. com.sg. Unsolicited material will not be returned unless accompanied by a self-addressed envelope and sufficient return postage. While every reasonable care will be taken by the Editor, no responsibility is assumed for the return of unsolicited material. ALL INFORMATION CORRECT AT TIME OF PRINTING. MICA (P) 076/06/2011. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).

新加坡中央医院

1月

与新加坡保健服务

2月 2012

集团的双月刊

page 28

运动伤害的疗法

page 29

page 30

脱发问题

糖尿病患孕事

让糖尿病患者重新掌控生活一型糖尿病患者也能尽享美食、轻松地应对生活

患者掌握控制权

图：SIMON ONG

与传统的一型糖尿病控制方法不同的是， DAFNE 是赋予患者管理病情的控制权。 DAFNE 课程更强调以病人为中心 ( 相对于与医生或疾病为主导 )的病情管理方式，这对于应付长期慢性疾病来说是有必要的。 “当患上一型糖尿病这样的慢性疾病时，很多时候患者，尤其是儿童或青少年，会感到自己的生活控制权像是被剥夺了一样。别人会告诉他们做什么、注射多少胰岛素，（告诉他们）很多‘禁忌’。”新加坡中央医院内分泌科顾问医生兼部门主任吴淑雅说。

苏泉铭先生之前的饮食选择受到限制。DAFNE课程使他能根据食物调整所需的胰岛素剂量。

( DAFNE ) 课程遵循的基

本原则就是让患者重获病情控制权，还给他们属于自己的生活。

间用餐，并坚持食用同类型的食物，以原文 J R Wu 防止血糖或葡萄糖水平突然变得过高或过低。例如，如果一型糖尿病患者在注射胰岛素后没有按计划进食或吃得较少九年前当他15岁时，律师助理苏泉铭先时，就会因过量胰岛素而出现低血糖的新加坡中央医院内分泌科顾问医生兼部门主任吴淑雅生被确诊患上了一型糖尿病。他曾经多危险。次出现严重低血糖症，在睡梦中会陷入新加坡中央医院内分泌科助理顾问昏迷状态。例如，某天下课后，他感到医生陈淑玲，也是苏泉铭的糖尿病医生，非常疲累，就在家里小睡。向他推荐“正常饮食剂量调整” ( Dose “我当时真的像个瘾君子一样，口吐 Adjustment for Normal Eating ，简称 “他们每分每秒的生活都与糖尿病有白沫。妈妈试图叫醒我，却叫不醒。她 DAFNE ) 的课程。自2011年4月加入该课关。一切都可以影响他们的血糖水平。很害怕。我含糊地记得，她喂我吃了一程以来，苏泉铭能够比之前更好地控制 ( DAFNE ) 课程遵循的基本原则就是让患些甜食。尽管失去了意识，我似乎还能自己的病情。者重获病情控制权，还给他们属于自己够下咽。但醒过来后我便没事了。”现他说，现在自己的血糖水平如低于正的生活。” 吴医生说。年23岁的苏泉铭回忆说。常值而出现低血糖症状，一个月才发生吴医生于2010年11月带领了一组糖尿病患者体内的血糖水平如果突了两、三次，大大降低之前发作多达十医疗人员前往澳大利亚墨尔本接受然下降就会出现低血糖症，这种症状可余次的频率。能导致患者昏倒或昏迷。胰岛素是将糖、苏泉铭补充道，“ DAFNE 对我淀粉和其他食物转化成能量然后释放到有莫大帮助。与以前相比，现血液的激素。要是有过多的胰岛素或当在的我更加享受生活。我二型一型体内的葡萄糖因运动而被迅速地耗尽时，只需要根据食物调整 ( 胰岛就会导致低血糖症。素)用量, 就可以吃想吃的东胰腺产生的胰腺不能产生一型糖尿病，有时也被称为青少年糖西了。” 胰岛素不能足够的胰岛素尿病，因为它通常发生于体内缺乏胰岛素 DAFNE 课程于 80 年代最有效的控制而导致血液分泌的儿童和青少年身上，所以他们每天先在德国实施，至今已推广血液中的血中葡萄糖浓度都需要注射好几次胰岛素来控制病情。到其他的欧洲国家，包括英糖水平。过高。定期注射胰岛素的糖尿病患者必须遵国在内。在2000年中期，该课守固定的用餐时间表，每天得在同一时程也在澳大利亚和新西兰推出。 > 文转 page 26

糖尿病的定义

page 31

结单后仍收到催款信

流感疫苗能够挽救生命越来越多的老年慢性阻塞性肺病患者，接种了流感疫苗以保命原文 Sheralyn Tay

59岁的陈亚钳先生每呼吸一次都是得经

过一番挣扎。哪怕是一点点的缓解对他来说都有很大的帮助。而流感疫苗就是这样的缓解。他说：“医生建议我接种流感疫苗，我觉得花25元来避免经常生病是物有所值的。” 陈亚钳患上慢性阻塞性肺疾病 ( chronic obstructive pulmonary disease，简称 COPD ) 后，经常感到呼吸困难及喘息。虽然这种肺疾无法治愈，但却可以通过药物来缓解症状，情况严重时，还可能采用氧气疗法。大约95%的 COPD患者是烟民，由于吸入了有毒化学物质，所以造成肺部不可逆转的损伤。红山综合诊疗所发起了一项鼓励患有这种肺疾的老年患者接种流感疫苗的计划，陈亚钳是 100 名受益患者之一。该计划于 201 1 年 2 月推出，当时没有 COPD 患者接种过流感疫苗。三个月后， 30% 的患者获得接种。该综合诊疗所希望在一年内将接种比例提升至70%。

疫苗的作用红山综合诊疗所高级家庭医生陈友山认为， COPD 患者可以从接种流感疫苗中受益。该疫苗能够缓解严重的流感及肺疾的症状，以及降低患肺炎的风险。研究显示，流感疫苗接种使住院率下降了 52%，死亡率也下降了70%。 “我们的COPD患者大多数都超过65岁，而且肺功能也很弱。一旦感染流感病毒，他们的肺疾症状可能会恶化，并引起其他并发症，例如肺炎。这可能导致患者入院治疗，严重的话还会导致死亡，” 陈医生说。欧洲的研究显示，每位接种流感疫苗的老年人估计可节省50英镑 ( 约100元 )。因为住院治疗可让患者和照顾他们的看护者收入受损。另一个益处是，接种疫 > 文转 page 26

新脉动

JAN⁄ FEB 2012

新闻杜绝吸烟的借口

> 文接 page 25

流感疫苗能够挽救生命苗预防流感的人越多，病毒传播的可能性就越小。陈医生说：“这样可达到群体免疫的效果。” 在新加坡，大约有6万名患者患有中度到重度的 COPD，其中，每年约 2,000人会为此入院治疗。红山综合诊疗所有大约 300 名这种肺疾的患者。陈医生认为：“该计划旨在使更多患者免于遭受流感并发症的痛苦。” 陈医生说：“我们发现，医疗人员和患者对接种流感疫苗的益处缺乏意识，也因此成为接种疫苗的主要障碍。”为了解决这个问题，医疗小组举行了一场座谈会来教育医疗人员，并强调如何管

理患者对副作用的担忧。 “一些可能出现的副作用包括轻微发烧，以及注射的部位肌肉感到酸痛或按压痛。但是这些症状会在几天内自行消退，” 陈医生说。诊疗所通过张贴海报来提升接种疫苗意识，前台人员也分发印有三种语言的宣传手册，向COPD患者和其他公众普及接种知识。接种疫苗同样可使幼儿、老年人和其他慢性病患者受益，如糖尿病、肾病或心脏病患者。医疗小组发现，很多患者一旦了解到接种疫苗的益处，都渴望尽快接种。

陈友山医生指出，对于慢性阻塞性肺疾病的患者，流感疫苗接种使住院率下降了 52%，死亡率也下降了高达 70%。

什么是慢性阻塞性肺疾病？随着时间的推移，由于逐渐失去弹性，肺部组织将出现永久性损伤。香烟烟雾造成的气道肿胀以及不断产生的大量黏液还会限制肺部呼吸时的容量，从而导致呼吸困难和喘息。这种肺疾的初起症状难以察觉，通常会被误认为是无害的咳嗽或由于劳累而造成的正常喘息。等到呼吸急促、反复咳嗽和喘息等症状频繁出现时，肺部往往已损伤严重，病情也已发展到中后期。

图：JUSTIN LOH

慢性阻塞性肺疾病是指由于肺部受到损伤、气道不可逆地变窄而形成的呼吸道疾病。这种肺疾最常见的病因是接触有毒的化学物质，例如，香烟的烟雾，严重污染或频繁吸入过量烟尘。以香烟烟雾中的化学物质为例，这些物质能够损伤肺部细胞，造成重复肿胀和发炎。香烟烟雾还能导致这些肿胀的细胞分泌一种酶，对肺部组织的弹性纤维造成损害。

我已经抽烟那么久，损伤已经形成，因此戒烟也无济于事。什么时间戒烟都不晚。一个人吸烟的时间越长，患上与吸烟相关疾病的风险就越大。只要戒烟就对健康有益处。事实上，当肺疾患者停止吸烟后，肺部的损伤速度降至与非吸烟者的相同水平。如果戒烟，我就会发胖，就会有压力。这样也有害健康。戒烟的益处胜过对体重增加的担忧。事实上，戒烟能够使您的呼吸更通畅，使您能够更轻松和更享受地进行锻炼。我戒烟了，但是忍受不了，于是几天前我又抽了一根，我还不如继续吸烟。吸一根或是几根并不意味着戒烟的彻底失败。事实上，几天、几周或几个月没有香烟的生活就已经意味着您再也不需要香烟了。只要下定决心戒烟，再试一次又何妨。我已经将吸烟的次数降低到了一个安全的水平。没有所谓安全的吸烟水平这一说辞。事实上，轻度吸烟者往往更频繁、更深入地吸入的烟雾，抵消了降低吸烟次数的好处。

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DAFNE 课程培训，该团队返回新加坡后则根据本地的状况而对课程项目进行了修改。例如，该团队发现新加坡糖尿病患者对胰岛素的反应比之前预想的更为敏感，因此对胰岛素的需求不需要和世界其他国家一样多。 “食你所爱，爱你所食”。这就是新加坡中央医院DAFNE课程，亚洲首个此类课程的口号。之前，糖尿病患者必须遵循医生的营养指示，医生处方中的一些饮食计划虽然可以维持患者的血糖水平并匹配刻板的胰岛素剂量，但却让患者很难再享受美食。 DAFNE课程赋予一型糖尿病患者吃东西时根据食物匹配胰岛素剂量的技能，此外还教育这些患者如何应对发病和低血糖状况、如何安全有效地锻炼身体以及如何应对在社交场合喝酒和跳舞。

计算碳水化合物的数量自2011年4月DAFNE课程开办以来，新加坡中央医院已举办了两次培训班。每班最多只限 8 名学员，在连续五天(分散在

图：ALECIA NEO

让糖尿病患者重新掌控生活

吴淑雅医生（左）说，在 DAFNE 课程中，营养师卡拉小姐（右）会教导患者如何衡量食物所含的碳水化合物，从而自行调整所需的胰岛素剂量。该课程也专对新加坡本地特定的人口和饮食而设计。

周末和公共假日)的时间内教授一系列的课程。组织小班是旨在鼓励学员分享和比较彼此的经验，甚至在这密集课程结束后，小组会保持联系并进行定期检讨。 DAFNE培训班获得世界领先的制药公司赛诺菲-安万特新加坡公司 ( Sanofi-Aventis Singapore ) 以及血糖仪

(家中使用血糖监测仪)制造商雅培诊断公司 ( Abbott Diagnostics ) 的支持，目前是免费开放给新加坡中央医院的一型糖尿病患者。与其他国家推出同类课程相似，新加坡中央医院的 DAFNE 课程也专门针对新加坡本地特定的人口和饮食而设计。该课程的重点是教育患者如何计算他们将消耗的碳水化合物。教材包括小贩中心美食真实份量的图片，如炒条和‘叻沙’，以及常见的水果和蔬菜模型。营养师教导患者如何衡量食物所含的碳水化合物，从而让他们能够计算出自己所需要注射的胰岛素剂量。课程提倡患者先使用仪器称重，直到他们可以惯于准确目测食物中的碳水化合物。

遗传与生活方式因素一型糖尿病

二型糖尿病

发病年龄段

以40岁以下的人群为主

以40岁以上的人群为主

体重

一般与超重无关

通常与超重有关

原因

遗传倾向

遗传倾向、胰岛素抵抗、胰岛素消耗、生活方式因素

触因

可能是病毒和感染

肥胖、缺乏运动、药物 (如类固醇）、手术

治疗方法

胰岛素

改变生活方式、药物、胰岛素

Jan⁄ Feb 2012

新脉动

新闻

遏制“杀手”

图：allen tan

及早进行治疗可以提高中风患者的生存率，甚至可以痊愈

除了药物及手术治疗，物理治疗也是中风病人康复过程中的一个重要环节。新加坡中央医院的高级物理治疗师陈美玲说，长期躺在床上会导致肌肉收缩。莫哈默医生表示，最近的调查显示运动治疗可以在很早的阶段开始。在新加坡中央医院，物理治疗师在中风病人住院期间就开始疗程，护士也鼓励病人尽量多下床走动。莫哈默医生说：“在进行物理治疗时，我们让病人活动他们的手脚和关节。我们相信这样的运动可以改善病人的情况。” 曾经中风的林先生相信物理治疗对他的病情起了一定的作用。他说：“那些运动很容易，也帮我活动手脚。物理治疗师在一旁帮助，并教导我如何进行这些运动。每次大概1个小时左右。” 病人出院后，除了药物治疗及定期复诊，他们仍必须持续地接受物理治疗及定期做运动。

及早行动，拨打995 国立脑神经医学院，神经科注册医生莫哈默·阿莫说，了解中风症状并提早接受治疗非常重要。你可以通过以下四个步骤察看一个人是否出现中风现象：脸部问题叫他微笑。如果他的脸部歪曲或下垂，他有可能是中风了。手臂叫他把双手举在空中。其中一只手臂或双手无力或麻痹，并无法将双手举高都是中风的症状。语言叫他说话。如果他口齿不清或无法说话，他有可能是中风了。时间立刻拨电话叫救护车。

莫哈默医生（左）说，病人在中风症状出现的首3至4小时内服食一种溶解血凝块的药物可遏制病情恶化。

原文 Rachel Chan

去年 6 月某日，林先生早上起床时，赫然发现嘴巴歪曲，而且说话困难。现年 74 岁的林先生怀疑自己在夜里中风，因此赶紧叫女儿把他送进医院接受急诊。在新加坡中央医院接受检查后，医生证实林先生中风并给予治疗，其中包括物理治疗等。三天后，他出院了。半年后，他痊愈了。

尽早治疗效果好林先生是少数幸存者。每三个中风患者当中只有一人能够活下来，另一人会终生残疾，其余的人将会死亡。在新加坡，中风是导致死亡的第四大原因、也是导致残疾的最大原因。每年，全球有 1500万人中风。不过，林先生能痊愈并非只是侥幸。他决定尽快寻求治疗可能是最重要的原因。国立脑神经医学院脑神经科注册医生莫哈默·阿莫说，严重中风可以导致残废甚至死亡，尽早治疗可以阻止轻微中风变得更严重。莫哈默医生说：“如果病人在出现中风症状的首 3 个半小时内接受治疗，医生可以让他服食一种溶解血凝块的药物，遏制病情恶化。”他补充说，如果病人在24小时内接受治疗，其他疗法如手术、物理治疗等也可以有效地遏制病情恶化。这急救时间窗非常重要，因为像抗血凝药等强而有力的药物只有在中风后的首3、4小时内才能发挥其药效。中风症状有可能在出现后的几小时内消失，让病人误以为情况并不严重。因此，他们可能延缓求诊，甚至完全不寻求治疗。莫哈默医生说：“我们的数据显示，新加坡中央医院超过半数的中

风病人在症状出现后的24小时，才前来求诊。” “不过，如果不进行治疗，轻微中风可能演变成中度中风，而中度中风可变成严重中风。”

不要卧病在床提早治疗是关键。在最短的时间内通过药物或手术，将血液及氧气输送到出血或受阻的脑部，可以帮助制止或扭转脑细胞所受到的伤害。当脑细胞永久性受损后，它们所控制的身体部位将无法正常活动，甚至完全动弹不得。这也就是为什么许多中风病人一边的身体瘫痪、行走或说话有困难。

高级物理治疗师陈美玲通过活动及运动帮助病人恢复手脚的使用。

尽早接受治疗有分别吗？目前物理治疗已经是中风病人康复过程中的一项主要疗程。不过，一项新的临床试验正在探讨，尽早让出现症状后的中风病人实行较为激烈的复健运动是否对病人的康复有帮助。新加坡中央医院是参与这项临床试验的多个中心之一，其他包括澳洲、新西兰、英国及亚洲的医院。国立脑神经医学院，神经科注册医生莫哈默·阿莫说：“我们知道物理治疗对病人有帮助。但是，尽早治疗，也就是在病人中风后的24小时内进行物理治疗会有分别吗？我们认为会有分别，但是我们不确定。” 莫哈默医生也是这个名为AVERT

既尽早复健临床试验的首席调查员。他说，在全球各个医院，病人从出现中风症状到第一次接受物理治疗的时间长短不一。有些病人甚至会花半天的时间躺在床上什么也不做，并一天只花13％的时间进行有助于复原的活动。新加坡中央医院的高级物理治疗师陈美玲说，在临床试验中，医院让中风病人在住院期间通过活动及运动来帮助他们恢复手脚的使用。陈美玲说：“护士也参与其中，帮助病人复健。与其帮病人洗澡和更衣，护士也会尽量让病人自己参与这些活动。” 参与这项临床试验的病人必须达到

一些审核标准，其中最为重要的是，他们必须在中风症状出现24小时内接受治疗。陈美玲说：“所有的病人都会接受物理治疗，不过参与临床试验的病人将接受更“密集”的治疗。他们会做一样的运动，不过，参与临床试验的病人会做得比较多。可能是一般病人的3至4倍。” 当病人出院后，这段疗程就会结束。不过医院会在病人中风的3个月和1年后观察他的复原情况。这项临床试验将为期3年。莫哈默医生说：“如果结果显示尽早的较激烈治疗有显著的疗效，我们希望可以将它并入疗程的一部分。”

新脉动

JAn⁄ Feb 2012

保健：健康

液排出体外的管道；女性的尿道大约是 4公分长，男性的尿道则大约有20公分长。这意味着细菌很快就可以通过女性的尿道进入泌尿系统的其他器官。此外，女性的肛门和阴户很接近，细菌可以更轻易地从肠道进入尿道，然后进入膀胱。

王医生说：“当年轻女性的性生活变得活跃后，她们更容易出现泌尿道感染。这通常被称为蜜月膀胱炎。” 由于荷尔蒙分泌出现变化，处于更年期的女性也会出现泌尿道感染。她们的膀胱失去弹性，导致膀胱里的尿液难以完全排出。这意味着膀胱里的细菌没有排出体外。其他原因则包括没有经常上厕所、小便匆忙及小便时没有完全排出膀胱里的尿液。王医生举例说，憋尿会提高泌尿道感染的风险，因为细菌留在膀胱里的时间更长，可能会附着在膀胱内壁上，导致泌尿道感染。

导因和风险因素

预防灼痛感

性交是导致泌尿道感染的常见因素，尤其较容易发生在年轻女性身上。

王医生说，良好的个人卫生习惯是预防感染的第一步，您应该每天仔细清洗身体和生殖器的部位。他说：“上厕所之后应该从前向后擦拭，并且每天清洗肛门和阴户之间及周围的皮肤。在性交前后清洗这些部位也会降低女性出现泌尿道感染的风膀胱险。一些人认为，能够排除湿气的内裤也有用，例如那些有棉质裤裆的内裤。尽量避免穿湿的泳衣和尼龙衣物。”

女人的难言之隐如果您在上厕所时感到阵阵灼痛，是时候接受检查了原文 Jessica Jaganathan

刚去完厕所后仍然感到尿急？因为太过疼痛，而害怕上厕所？您不是唯一面对这种问题的人，因为多达半数的女性会在生命中的某段时期出现泌尿道感染的病症。而且，这种病症如同唇疱疹，不时会复发。泌尿道感染是一种细菌感染，是细菌进入膀胱或肾脏后繁殖增生而引起的。它可感染泌尿道的任何一个部位，包括肾脏、膀胱、连接肾脏和膀胱的泌尿管或尿道。这种病症虽然引起疼痛，但如果能够及早治疗，对大部分女性来说并不是严重的感染。不过，它会严重影响女性的生活品质。竹脚妇幼医院妇女泌尿及骨盘重造科顾问医生王兴福说，在大多数的病例里，感染只是局限于下泌尿道，即膀胱和尿道，而这部分的感染相当容易治疗。

肾脏

女性的隐疾

尿道

虽然男性也会出现泌尿道感染，但女性较常面对这个问题，因为她们的尿道比男性短很多。尿道是将膀胱里的尿

专家说

健康交流站我们的专家为您解答有关运动伤害和眼皮下垂的疗法

运动伤害我应该如何避免网球肘？应该怎么治疗呢？网球肘常见于网球选手中，它主要是在肘关节外侧有疼痛及酸痛等的现象。它通常是因为过于使用前臂肌而引起的，并不是因为做家务或反复举起重物而造成的。减少对前臂肌过度施加压力可以避免网球肘。

使用正确的挥拍动作，如减少直臂击球，将可以避免患上网球肘。另外，您也可以使用护肘来减少挥拍时对手肘所造成的压力。打球前应做好充分的热

女性卫生喷雾剂、有香味的清洗液和泡澡可能刺激生殖器的部位，所以应该加以避免。出现感染的迹象除了有频尿及小便疼痛外，你也可以留意自己是否有其他征兆，包括尿液太过温热及出现异味、尿液中带有血迹或尿液浑浊、发烧、下腹部疼痛、迫切需要小便、反胃作呕及背痛，这些征兆显示肾脏可能受到感染。

治疗感染要确定女性病人是否出现泌尿道感染，医生会进行抽检及尿液检查，然后才开出抗生素给女病人服用。服用抗生素后，感染的症状通常在几天后便会消失。不过，即使症状消失了，女性病人也应该服完医生开出的抗生素，以确保细菌彻底被消除。至于因为性交而重复出现的感染，治疗方法包括让病人在性交前后服用单剂量处方的抗生素。虽然出现泌尿道感染的人应该看医生接受治疗，但其实多喝水和蔓越莓汁也有一定的效果。事实上，研究发现，蔓越莓汁含有一种能够防止细菌附着在膀胱内壁的酸性成分，从而降低膀胱感染的可能性。维生素C也含有酸性成分，所以有同样效果。咖啡、酒精饮品和辛辣食物会导致症状恶化，应该忌口。患有糖尿病的人及难以控制小便的人应该维持严格的糖分摄取量，以避免感染扩散到肾脏。王医生说：“预防泌尿道感染的最重要方法，就是维持良好的个人卫生习惯。”

身运动，如伸展前臂肌腱和通过手腕卷曲运动以加强前臂肌。治疗方法包括冰敷按摩、服食非甾体类消炎药、注射类固醇，以及体外震波疗法（一种通过用低频率声波聚焦于受伤部位的物理治疗法）。樟宜综合医院运动医学中心副顾问医生田和兴

扭伤或拉伤时，应该用冰敷或热敷？这两种治疗有什么差别？每次应该敷多久？在使用这些疗法时，应该注意哪些事项？在受伤后，受影响的部位会因身体自然恢复而肿大。使用冰敷将限制血液流向受伤部位，有助于消肿及减少疼痛。相反的，使用热敷将会让更多血液流向受伤的部位，使它更肿胀。冰敷通常适用于急性伤害，并能在受伤后的48小时内使用。为了避免冻伤，您应把冰块包在毛巾里，然后把受伤的部位抬高，轻轻地按压在受伤的部位上。每次敷20分钟，每两小时一次。樟宜综合医院高级物理治疗师蓝耀忠

眼部整形手术我其中一个眼睑的角落似乎有下垂的现象。从我观看的电影里，眼皮手术必须从额头上开刀，手

术后患者则会有头痛的困扰。眼皮手术能根治我的问题吗？导致眼皮下垂的原因有几个可能的情况。在中年或老年人当中，通常是因为年纪的增长而产生眼皮下垂。您应该向眼部整形外科专科医生咨询，了解情况的严重性以及相关的治疗方式。您提到的手术是内窥镜提眉手术，是个需要在额头上开个小切口来治疗眼皮或眉毛下垂的手术。一些病人在手术后，会在前额部位有持续性的疼痛。适合您眼皮问题的手术将因情况而异。整形手术的效果从来都不是持久性的。新加坡全国眼科中心眼整形术高级顾问谢丽龄副教授

Jan⁄ Feb 2012

新脉动

保健：美容我会不会因为使用过多种美发产品而不经意地导致自己脱发？过度使用美发产品确实会对头发造成压力和损害，进而导致脱发。

恼人的脱发问题

打破脱发因素的迷思，阻止发际线继续后退原文 Ruth Loh

许多人以为脱发问题多数只发生在男性身上，但其实男性和女性受脱发问题困扰的几率相等，只不过脱发的情况在男性身上较为明显。樟宜综合医院皮肤科副顾问医生张慧莹指出，这是因为男性较易于出现秃头。他们的发际线会不断后退，直到剩下围绕着双耳的部分头发，因此这让男性的脱发问题看起来较为明显。女性则倾向于出现头发分线处变薄的情况，这种脱发问题较不容易被察觉。不论男性或女性，基因遗传是脱发的主要原因。张医生说：“有超过1000个基因与脱发问题有关。” 她补充道，即使某个人出现脱发问题，他的兄弟姐妹可能不会有这方面的困扰，而且父母的脱发问题也不一定会遗传给孩子。张医生说：“如果你因基因遗传而出现脱发问题，你是无法做些什么来加以挽救，这是无可奈何的事实。” 不过，基因遗传不是脱发的唯一因素。非遗传性脱发是因身体

不寻常地分泌过量化学物质所导致的。这种化学物质称为双氢睾酮（dihydrotestosterone）。张医生说：“压力应该是第二常见的脱发原因。”这可能是生理、情绪或精神上的压力。重大的激素分泌改变会提高双氢睾酮的分泌量。这些改变包括怀孕、女性更年期和男性更年期，它们都会提高这种激素的分泌。双氢睾酮会导致毛囊收缩，缩短它们的寿命，让它们无法继续生长正常的头发。张医生说：“不过，虽然双氢睾酮是皮脂（毛囊周围腺体分泌的一种油脂）里一种常见的化学物质，但油性头皮的人不一定较容易出现脱发问题。是否会出现脱发问题，取决于毛囊受双氢睾酮的影响有多严重。”

解决脱发问题的办法让人感到欣慰的是，目前有好几个疗法可对抗秃头。张医生说，第一种疗法是敷在头皮上促进生发的药剂米诺地尔（minoxidil）。不过，这种疗法可能需要长达一年的时间才能见效。如果这种疗法没能取得预期中的效果，医生就

焦点

施比受更快乐叶玉婵女士证明，只要有心做善事，年龄不是障碍

很多人都会为慈善捐款，但没有多少人会像叶玉婵女士那样，为社会较不幸的人士投入那么多的时间、精力和金钱。高龄81岁的叶女士每个月都会到新加坡中央医院，捐献$100给新加坡中央医院贫困患者基金。如果她在某个月没有时间到新加坡中央医院捐款，她会在下一个月补上，并捐出$200。事实上，叶女士的这份善心背后有一段长达50多年的慈善之路。叶女士自 1950年代开始就投入公益，以各种不同的方式捐献给慈善机构、疗养院和较

图：allen tan

原文 Ruth Loh

叶玉婵女士经常制作婴儿手套、靴子，甚至是洋娃娃，作为慈善义卖。虽然她已经无法在民众俱乐部为年长者煮食，她依然每个月捐出她以前购买食材时花费的$100给新加坡中央医院贫困患者基金。

不幸的群体。叶女士擅长缝纫，她在求学时期学会了这门手艺，所以平时就以缝纫来增加当护士的收入。性格坚定勇敢的叶女士说：“我有两个孩子要抚养。做一些婴儿服装、

我最近在工作上面对的压力，会不会造成我的发际线后退？压力是造成脱发的一大因素。虽然基因遗传也扮演一定的角色，但任何形式的压力，例如生理、情绪或精神上的压力，都会对你的头发造成影响。

头发的迷思

社会上有很多关于脱发问题的迷思和无稽之谈。樟宜综合医院皮肤科副顾问医生张慧莹为你解答这些疑问。

5 吃太多盐或味精会不会导致脱发？目前没有确凿证据显示盐、味精或其他食物会造成脱发。不过，为了你的健康着想，最好还是避免吃含有太多盐或味精的食物。

4 口服营养品如草本营养品锯棕榈是否有效？到目前为止，只有一项研究显示锯棕榈对生发具有明显的效果。

会给患者口服药物。医生会开出非那雄胺（finasteride）给秃头的男性服用，非那雄胺可降低双氢睾酮的分泌。至于秃头的女性，医生则会开出安体舒通（spironolactone），这种药物可减少降低睾酮的分泌，相应地降低双氢睾酮的分泌。这些疗法的成功率大约有60％。另一种疗法是头发移植。和其他疗法一样，头发移植可能也要长达12个月

玩具和其他东西，可以帮我赚取额外收入。”如今，叶女士的孩子已经长大，她目前有5个年龄介于16岁至30岁的孙子。以娴熟针线活著称的叶女士逐渐发现，她可以利用这个技能帮助贫困者。当时是竹脚医院助产士的她（那是她第一份工作，也是她唯一做过的工作），自愿教导老年人一些手工艺。近30年来，叶女士是许多老人院熟悉和受欢迎的人物。她定期拜访这些老人院，还给老人家带来日用品。她说：“我通常会带一些饼干、爽身粉、肥皂、牙膏等日用品。” 她也在加冷、哥南亚逸、水车路等地区的民众俱乐部为年长者煮饭。她不但自愿拨出自己的时间，还免费供应煮食用到的食材。叶女士在2003年加入了狮子乐龄之友协会，并在2007年至2009年担任该协会明地迷亚支部的主席。身为狮子乐龄之友，叶女士照顾住在一房式组屋和靠政府福利金生活的年长者。她逐家逐户地派送日用品和食品：这一家派送肉和蔬菜，另一家则派送洗衣粉和清洁剂。在这段过程中，她结交了不少朋友。叶女士对较不幸者的关爱获得卫生部的表彰。卫生部在1978年颁发优秀奖给叶女士，并在1985年颁发长年服务奖给她，以答谢她当护士照顾病患所

3 草药和药水如芦荟、迷迭香、橄榄油和其他草药对生发有没有效？虽然这些草药闻起来很芬芳，一些甚至会对你的头皮造成轻微的刺痛感，但它们的效力都没有科学根据。到目前为止，这些草药仍未被证实能有效治疗脱发。

的时间才能见效。不过，头发移植有接近100％的成功率。头发移植疗程需4到12个小时，这包括从没有脱发的部位摘取头发，将之剪成短毛发，然后逐一移植到脱发部位。樟宜综合医院平均每两个月便进行一次头发移植手术。张医生说，为了取得更好的效果，人们应该注意自己头发的生长情况，因为目前仍没有什么有效方法可预防脱发。

帮助有需要的人新加坡中央医院的筹款与发展部门接受帮助贫困患者的捐款。新加坡中央医院每年拨出$60万元以帮助贫困患者，让他们接受医疗及其他服务。这些病人当中，有不少是家里唯一的经济支柱，须要抚养孩子和照顾患病父母或家庭成员。想要了解更多有关如何捐款的详情，请与新加坡中央医院筹款与发展部门联络。电话：63213736 或6321-6378，电邮地址： giftstosgh@sgh.com.sg。奉献的30年之久。狮子乐龄之友协会也在1999年颁发杰出服务奖给叶女士。如今，叶女士的膝盖问题让她无法继续进行照顾老年人的繁重工作。不过，这并没有阻止她散播爱心。自 2010年中开始，她每个月都会到新加坡中央医院捐出$100。问她为什么选择每个月捐出 $100时，她说：“以前我每个月为慈善煮食时，我每次大概花$100购买食材。现在我无法煮食了，我想继续捐出同样数额的款项。”

新脉动

Jan⁄ Feb 2012

焦点

甜蜜孕事

糖尿病。孕妇的体内有时会因荷尔蒙的改变而无法分泌足够的胰岛素来对抗胰岛素抵抗，导致妊娠期糖尿病。这种糖尿病通常在婴儿出世后就会消失，但在一些情况下有可能变成慢性糖尿病。起初，佳敏拉能以控制日常饮食来保持良好的血糖水平，但她在怀孕的第 7个月就必须开始注射胰岛素以控制血糖值的飙升。

患有糖尿病的妇女在怀孕时虽然要面对不少风险，但是有了医生、护士及其他专人的帮助，还是可以顺利生产

团结就是力量

图：alecia neo

因为糖尿病所带来的并发症，像韩玉玲及佳敏拉一样的妇女都由新加坡中央医院糖尿病中心的多学科的综合医疗团队照顾。团队成员包括妇产科医生、内分泌科医生、护士以及营养师，缺一不可。看诊时每位成员都必须在场，一同了解病人的整体状况，并经过对病人各方面的需要，对症下药。比如，营养师建议韩玉玲少食多餐，以减少血糖在进食后飙升的几率。内分泌专科医生则按时检查韩玉玲的血糖纪录，并依据她的血糖值调整胰岛素的份量。此外，患有糖尿病的妇女在怀孕过程的其他方面也比一般情况来得困难。韩玉玲的胎儿长得异常的大，这也是患有糖尿病妇女怀孕时潜在的问题。苏医生说：“虽然我们已经竭尽所能控制她的血糖，但是，胎儿还是不断地长大。所以团队决定提早让胎儿出世。” 让孕妇自然分娩过大的婴儿是艰难的，并可能在分娩过程中受伤。婴儿们也有可能在日后患上糖尿病。韩玉玲尽管苏华逸医生（右）及他的团队已经尽了最大的努力，韩玉玲的宝宝仍因为过大而必须提早生产。的儿子在2010年12月出生时，体重是 4.07公斤。韩玉玲的第一胎是个女儿，体格比就很困难了，因为我必须确保胎儿有足原文 Thava Rani 够的营养，自己也要达到应有的体重增较小，体重是3.5公斤。因为是有计划加标准。” 生育，所以比较顺利。她在怀孕之前，苏医生说，患有糖尿病的人，体内夫妇俩都确保韩玉玲的血糖值受到控制。韩玉玲的第二胎是个意外的惊喜。可是，无法分泌足够的胰岛素来促成碳水化合苏医生说：“虽然许多患有第一型接下来36周的怀孕期却充满了许多的物、蛋白质及脂肪的新陈代谢。如果不和第二型糖尿病的妇女都知道血糖低于不安。注射或服食胰岛素，尤其是在进食后，标准而怀孕的风险，但她们仍往往不计韩玉玲在19岁时被诊断患有一型糖他们的血糖值就会飙升。划生育。” “我们正在加强怀孕前的辅导工作，尿病。她每天必须注射胰岛素来控制血和韩玉玲一样，41岁的佳敏拉在怀糖。当她怀孕时，她体内荷尔蒙的变化第4胎时也要特别注意饮食。不过和韩希望能减少这些女性在怀孕初期流产或便开始影响胰岛素的效用，导致胰岛素玉玲不同的是，她是在怀孕期间才患上婴儿出现先天性畸形的风险。” 低抗，使血糖值增加。新加坡中央医院内分泌科副顾问医生苏华逸说：“无法良好控制血糖值的病人如果意外怀孕、我们必须尽可能在几个星期内把血糖值控制好，才可以减少流产或胎儿畸形的风险。” 在一间跨国公司任职文员，现年 30岁的韩玉玲，除了过高的血糖值之外，她也要担心可能造成血糖过低的情况，如两餐之间的时间相隔太久，运动量过高，或摄取过量的胰岛素。经常或长时间让血糖过低可造成严重的后果。胎儿的成长可能会受影响，母亲也有可能会癫痫发作。

适当营养是关键要从适当的饮食中摄取足够的营养却又不能有过多的热量，是件不简单的事。韩玉玲说：“没有怀孕时，我可以控制碳水化合物摄取量。但在怀孕期间，这新加坡中央医院糖尿病中心的综合医疗团队和糖尿病患者密切合作，确保母子平安。

糖尿病患怀孕的风险根据新加坡中央医院内分泌科副顾问医生苏华逸，如果怀孕并且患有糖尿病，无论是第一型、第二型或妊娠期糖尿病，和的宝宝都有一定的风险。可能会：怀有特大婴儿（超过4公斤），分娩

时可能有困难或须要剖腹产分娩原本患有糖尿病）或胎死腹中使原有的糖尿病相关的眼睛及肾脏问题恶化在怀孕后半段，患上高血压及尿内蛋白质过多，也就是先兆子痫在生产后患上第二型糖尿病（几率比一般妇女高出两、三倍）流产（如果

的宝宝可能会：患有先天性疾病，如心脏缺陷等在出世不久患健康问题，如呼吸困难、低血糖或低钙质过重或痴肥及/或在长大后患糖尿病因长得太大在自然分娩时受伤

是否有患上妊娠期糖尿病的风险？这种糖尿病只在怀孕期间产生。最常见是在怀孕期间的后半段，而不一定会在生产后自然消失。如果有以下症状，较可能患上妊娠期糖尿病：的父母或兄弟姐妹患有糖尿病曾经生产过特大婴儿（超过4公斤）曾经患有妊娠期糖尿病，在禁食期间有过高血糖及/或在进食含75克糖份液体后血糖过高过重，身高体重指数值超过25

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