may JUN
2014
a Bimonthly Publication of Singapore General Hospital and SingHealth ACADEMIC HEALTHCARE CLUSTER MCI (P) 069/06/2013 www.sgh.com.sg | www.singhealth.com.sg
Best Overall Editorial
Bronze
COntent Marketing Awards 2013
AWARD OF EXCELLENCE
APEX Awards 2013
05
Child-friendly measures reduce the need to sedate kids before MRI scans
no-match transplants now possible with new treatment plan
07
P3
A new technology to isolate cancer cells is a step forward in personalising treatment
新技术突破 肾脏移植 的障碍
10
SingHealth increasingly uses technology to improve patient care and services
P27
21
Photo: ALVINN LIM
Knowing what needs to be treated at the A&E can save money and time
30
以年长者为出发点，透过新颖设计打造 方便易用的乐龄设施
02
singapore health
MAY – JUN 2014 Publisher
Co-funded
ÂŽ
Content Advisor
Tan-Huang Shuo Mei
Group Director, Communications & Service Quality, SingHealth & SGH Editorial Team
Angela Ng (SGH) Lim Mui Khi (SGH) Carol Wee (SingHealth) Ann Peters (SingHealth) Deborah Moh (SGH) Singapore Health is partially funded by SGH Integrated Fund, SingHealth Foundation, Tote Board and Singapore Turf Club to advance the health literacy of Singaporeans.
Read Singapore Health online at www.sgh.com.sg/singaporehealth
Publishing Agent Group Editor-in-chief
Caroline Ngui Group Editor
Joanna Lee-Miller Editorial & Creative Senior Editor
Dora Tay Editor
Serene Foo Sub-Editor
Annabelle Bok ASSOCIATE CREATIVE Director
Jayson Ong
Art Director
Janice Tan Geoffrey Lim Senior Designer
Jolene Tan
Managing Director
Dennis Pua
General Manager
Christopher Chan sales & client management Account Manager, Advertising Sales
Bernard Chen
Assistant Manager, Business development & Client Management
Lim Hui Wen
publishing services senior executive
Preciosa Reynoso Ramos For editorial enquiries, please e-mail editor@sgh.com.sg For advertising enquiries, please call 6319-3022 or e-mail jrani@sph.com.sg All rights reser ved. 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. MCI (P) 069/06/2013. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).
MAY – JUN 2014
singapore health
NEWS
03
Differences no longer hinder
New treatment protocol can help some kidney failure patients find a match among incompatible living donors By Desmond Ng
High-risk procedure for a very few
W
hen a kidney failure patient is found to have high levels of antibodies, a transplant is usually not a treatment option. This is the case even if he has donors willing to give him an organ. But renal doctors at the Singapore General Hospital (SGH) have recently developed a new treatment plan that makes a transplant possible for people who are likely to reject a new kidney because of their high antibody count. The treatment protocol essentially removes the antibodies that target the donor’s cells, allowing the kidney to be transplanted safely.
According to Dr Terence Kee, transplant under the new protocol is a last resort treatment and is not for everyone.
PhotoS: ALVINN LIM
First case under new procotol in 2013 SGH doctors performed the first such transplant last year on a woman in her 30s. Her condition and health continue to be monitored closely, but the transplant patient has become well enough to return to full-time work. “Our first case has given us a lot of optimism. It was an extremely difficult case because the patient had very high levels of antibodies to reduce. But the protocol that we developed allowed her to undergo transplantation safely,” said Dr Terence Kee, Senior Consultant, Department of Renal Medicine, and Director, Renal Transplantation Programme, SGH. “This type of transplant is a last resort treatment and isn’t for everyone, but its success has opened the door to those patients in a similar situation,” he added. People with end-stage renal failure need regular dialysis to remove waste and excess water from the body, or a
Not everyone who fails the pre-transplant T-cell crossmatch test is a candidate for the new transplant protocol. The patient and potential donor must meet strict criteria before the go-ahead is given. The recipient, donor and their families go through many counselling sessions to understand and accept the procedure and its risks. “It’s very high-risk, the patient must be able to accept the risks, and his expectations (of the outcome of the transplant) must be moderated,” said Dr Terence Kee, Senior Consultant, Department of Renal Medicine, and Director, Renal Transplantation Programme, SGH. The patient has to be fit enough to withstand the pre-transplant procedures, including plasmapheresis, to rid the body of antibodies. During plasmapheresis, the patient could suffer complications. The transplanted organ could still be rejected; the chance of a rejection is 40 per cent, versus 10-15 per cent for standard transplants. “The risks are for two people when we are doing a living donor transplant,” said Dr Kee.
The new treatment protocol requires the patient to be fit enough to withstand the pre-transplant procedures to rid the body of antibodies. During plasmapheresis, a procedure similar to dialysis, the patient could suffer complications.
transplant. A new working kidney gives the patient a good shot at a normal life. Before a transplant can take place, a donor has to be found. If the patient doesn’t have a living donor candidate, he will have to join the queue for an organ from a deceased donor. Whichever option, a match has to be found as otherwise, the transplanted organ will be rejected. “In transplantation, compatibility between a donor and a recipient is determined by a special protein called the human leukocyte antigen or HLA, which is found on the surface of our cells and tissues,” said Dr Kee. The more differences there are between the donor and the recipient in terms of the kind of HLA on their cells, the greater the risk of organ rejection. “A transplanted organ is rejected when the body develops antibodies against the recipient’s HLA because of their differences,” said Dr Kee. The antigen acts as a form of unique identity; cells from another person will not be recognised and hence deemed as foreign or as invading germs. Antibodies are generated to protect the body against foreign substances, such as viruses and bacteria. Antibodies, which can develop after pregnancies, blood transfusions and surgeries, may be directed towards the
donor’s HLA, which in turn can cause a rejection of the transplanted kidney. Before a transplant can be carried out, potential donors have to undergo tests to find the closest tissue match with the recipient. A match lessens the chance of the transplanted organ being rejected. Aside from blood and tissue compatibility, it is important that the patient doesn’t have antibodies formed against the donor’s cells. When this happens, the transplant is usually a no-go.
Waiting for the right one Year
No of people on waiting list for a kidney transplant
No of kidney transplants from deceased donors
No of kidney transplants from living donors (Singaporean/PR)
2008
511
46
27
2009
460
41
28
2010
412
36
25
2011
436
36
31
2012
457
23
28
2013
424
34
34
Source: National Organ Transplant Unit > Continued on page 4 ( 华文版本请翻阅至27页 )
04
NEWS
singapore health
MAY – JUN 2014
> Continued from page 3
Differences no longer hinder
Undergoing plasmapheresis As part of SGH’s new treatment, the patient was given a medicine called intravenous immunoglobulin, or IVIG, every month for three consecutive months. She also underwent nine rounds of plasmapheresis, a procedure that is somewhat similar to dialysis, where her blood was extracted and put through
a machine for the antibodies to be removed. At the end of the treatment, the patient’s levels of antibodies had dropped to below the threshold for a transplant to take place. After her surgery, she went through further rounds of plasmapheresis to keep her antibody levels down, and she was discharged after two weeks in hospital.
Our first case has given us a lot of optimism. It was an extremely difficult case because the patient had very high levels of antibodies to reduce. But the protocol that we developed allowed her to undergo transplantation safely. Dr Terence Kee, Senior Consultant, Department of Renal Medicine, and Director, Renal Transplantation Programme, SGH
The patient’s blood is extracted and put through this machine for the antibodies to be removed during plasmapheresis.
Photo: JASPER YU
It’s been more than a year since her transplant in early 2013. She has not had any major complications to date, her kidney is functioning normally, and the antibodies that target her donor cells have not returned. “From studies, we know that over the long term, the antibodies can start appearing again. They can come back right after the transplant, or years after. When they do appear, they are associated with poor outcomes, and can lead to a rejection of the kidney as well,” said Dr Kee. For that reason, patients who undergo this risky procedure are closely monitored after their transplants.
determining genetic identity
1
Mother
Father
2
3
4
Possible HLA combinations for children (1 to 4) Children inherit human leukocyte antigens (HLA) from their parents. Found on the surface of cells and tissues, HLAs help determine genetic identity. Tissue or HLA typing, which is unrelated to blood group or gender, checks how closely the cells of the patient and his potential donor match. The more differences there are, the greater the risk of rejection of the transplanted organ.
Photo: ALVINN LIM
This was the case with the patient who underwent the new treatment protocol. Following a test, known as the T-cell crossmatch, her donor was found to be incompatible as they don’t share the same HLA. Although the two are siblings, their tissues are immunologically incompatible with each other, and these differences also led to the patient having too many antibodies against the donor. In such cases, a transplanted kidney has a more than 80 per cent chance of being rejected if the antibodies are not removed. “In the old days, the patient would have been turned away, but in the last decade or so, advances in transplantation medicine have led to treatment protocols being developed in the US to overcome this barrier,” said Dr Kee.
Sibling love
As potential organ donor and recipient, they were not a match. But seeing his sister’s poor health while on dialysis was enough of a reason for Mr Vincent Yow Kok Kheong to take the risks associated with a complicated new transplant procedure and offer her a kidney and the chance of a normal life. His sister, Ms Yow Sok Fun, 38, had been on dialysis for several years after her kidneys failed in 2009, a complication of the systemic lupus erythematosus she had been diagnosed with. She had to stop working as a teacher – a job she loved with a passion. Worse, dialysis and the disease left her too weak and tired to care for her two young children. “She didn’t look good, so I felt it was worth taking a risk to see her in better health,” said Mr Yow, 35. The high levels of antibodies in Ms Yow’s body meant that a transplanted kidney would be rejected outright, but a new procedure to remove these antibodies could be a way to overcome the problem. Doctors at the Singapore General Hospital warned the Yows repeatedly of the risks that such a procedure brought. The family also underwent extensive counselling to make sure they understood the procedure and the risks. “We did know that if the (transplanted) kidney did not work, it would mean going back to dialysis. That was the worst scenario – and there’s also death, of course – but we felt that at least, we would have tried our best,” said Ms Yow. Ms Yow, her family, and her doctors, had weighed other options. One was the paired living donor programme where the donors of two incompatible
donor-recipient pairs are “exchanged”. But none could be found. She could join the queue for a deceased donor, but with her high antibody level, Ms Yow would have faced a wait that is longer than the average nine years. From studies in the US, they knew that Ms Yow’s chances of survival at five years after a transplant would be about 69 per cent, versus the 80 per cent for someone who tested negative for the crossmatch test and was able to undergo a straightforward transplant. But the 69 per cent rate was about even with someone who received a deceased donor kidney. Given the odds and trade-offs, they figured they could take the risk. The two were also anxious to go through with the procedure, having discussed and considered it for more than two years. For the younger brother, donating a kidney to his sister was the right thing to do. “The decision was a no-brainer. It’s very important that I did this. If you can do something, but don’t do it, what does that say about the kind of person I am? What sort of example would I set?” said Mr Yow, who is single. After they made the decision to go ahead, Ms Yow had to undergo the treatment to bring the amount of antibodies down to a level that was safe for a transplant to proceed. Early in 2013, the transplant took place. Ms Yow now leads a normal life. She is returning to full-time work, is active, and has the energy to play with her children. Her brother has also seen a change in his health – for the better. Because of the need to “protect my remaining kidney, I have adopted a more healthy lifestyle,” he said.
MAY – JUN 2014
singapore health
NEWS
05
The calm before the scan Since the MRI suite became more child-friendly, fewer children have needed sedation before a scan By DESMOND NG
A
child who needs a Magnetic Resonance Imaging (MRI) scan steps into a frightening world dominated by an intimidating machine. But at KK Women’s and Children’s Hospital (KKH), the MRI suite looks more like a children’s playground. The suite is decorated with a jungle theme. There are animal murals on the wall, a 3D toy MRI machine to play with before the scan, and animated movies on TV that they can watch during the scan. Mum or Dad can also stand close by in the scan room and talk to them through a plastic hose – a novel idea that the nurses came up with, as electronic equipment is not allowed inside the suite. This is not just fun and games. There is a serious intent behind it – to reduce the need to put children under sedation during the scan. For children under eight, this means being under general anaesthesia. The child-friendly measures have worked. Since introducing these initiatives, the hospital has seen the number of children under eight who need sedation drop by 25 per cent.
need them to be very still and cooperate for half an hour. If they move, the radiographer will have to repeat that particular segment again, prolonging the session. Our experience is that only about one out of 50 children under eight will stay still for the procedure. Most will fidget a lot and are afraid of the machine.”
By preparing children psychologically for the procedure, the staff have found that they can have some measure of success. The department’s two MRI machines cater for women and children, and about 30 per cent of its patients are under eight. One MRI scan room has a spaceship theme done up by staff in 2008. The jungle-themed room was set up in 2012 but only decorated last year. A professional artist was commissioned to create the vinyl decals of zebras, pandas and macaws in a bid to make the room more child-friendly. Preparing the child Preparation starts the minute a child walks in and registers. He changes into a gown with cartoon motifs. Staff, dressed in uniforms that also bear cartoon motifs, then introduce the child to the
toy MRI machine, and show him what will take place during the scan. The toy is actually a 3D model specially customised for KKH to look and sound like the real thing. The child can slide the toy patient in and out of the tunnel and get used to the whirring sound it makes – the same sound that the real machine makes during the actual scan. The whole preparation period takes about 20 minutes. Next comes the trial session in the MRI machine. To help him keep still, the child can watch his favourite movies on a custom-made TV, which is magnet-safe. There are also soft toys for him to hold on to and although he cannot see his parents or hold their hands, he can hear their voices through the plastic hose, and talk to them as they wait near the machine.
Improve your Quality of Life with
Look Ma – no sedatives! Mr Omar Mahmood, Principal Radiographer, Department of Diagnostic & Interventional Imaging, KKH, said children aged eight and below generally need sedation because they are either afraid of the MRI set-up, or cannot keep completely still for 30 minutes. He said: “We
Begin a New Journey with
FUCOIDAN!
PhotoS: ZAPHS ZHANG
For over ten years, Fucoidan Umi No Shizuku has been providing an amazing
(From top) To prepare the child, staff from the MRI suite will first introduce him to the toy MRI machine to show him what takes place during the scan; vinyl decals of zebras and pandas; according to Mr Omar Mahmood, Principal Radiographer (above right), children under eight generally will fidget a lot during the scan and are afraid of the MRI machine.
range of health benefits of tens of thousands of our customers in need of new hope. Fucoidan is an all natural, bioactive compound, scientifically studied for its immune-enhancing benefits. Fucoidan, the main ingredient in Umi No Shizuku, is only extracted from pristine brown seaweeds, mozuku & mekabu, recognized to have the highest amount of Fucoidan.*
Call for
FREE BROCHURES
on the mechanism of fucoidan!
www.kfucoidan.com | 6640-8893
06
NEWS
singapore health
May – Jun 2014
Three cheers
Three doctors who made huge contributions to medicine in their own fields are being honoured with research and education funds to be named after them By Wong Sher Maine
T
wo of them – Professor Arthur Lim, a renowned ophthalmologist, the late Professor Navaratnam Balachandran, an acclaimed orthopaedic surgeon, will have professorships named after them, while a research and education fund bears the name of Professor Tan Cheng Lim, a pioneer in paediatrics here. All three have made enormous contribution to medicine and patients. In giving their very best, they left legacies which inspire all who come after them. Ahead of his time The Arthur Lim Professorship in Ophthalmology is a recognition of Prof Lim’s work which advanced standards of eye care in Singapore. Launched by the Singapore National Eye Centre (SNEC) and DukeNUS Graduate Medical School Singapore (Duke-NUS), it will be given to outstanding practitioners in ophthalmology. Minister for the Environment and Water Resources, Dr Vivian Balakrishnan, who was a practicing ophthalmologist himself, and a former SNEC Medical Director, described Prof Lim as a “giant ahead of his time”. He said, “The real test of man’s legacy is in the people, the
institutions and the systems that will persist after that giant is no longer on the scene. It is our duty to emulate him by paying it forward and making sure that this legacy grows.” In the 1970s, Prof Lim recruited and worked with surgeons from around the world to introduce microsurgical techniques and intraocular lens implant technology to the region. Together, they taught thousands of ophthalmologists, who returned home to serve and lead the profession. He also established SNEC, the Singapore Eye Research Institute (SERI), and the Department of Ophthalmology at the National University Hospital (NUH) – world-renowned institutions with lea ding o p ht halm o log is t s d oing advanced research. In 1996, he was commended by the Chinese government for raising funds for and establishing eye centres in China, which restored the sight of patients with cataracts. Today, young ophthalmologists are being trained, and thousands have had their sight restored at these centres. Prof Lim once said: “If you perform a
good eye operation, you restore vision to one man. But if you spread the teachings of good quality eye surgery to your colleagues, they will ultimately restore vision to millions of blind victims in the world.” An inspiring teacher The work of one of Singapore’s greatest luminaries in orthopaedics, the late Prof Balachandran, will be commemorated with the proposed setting up of the Balachandran-Kajima Professorship in Academic Medicine.
To be allowed to teach and train is itself a privilege and honour which we must uphold. How wonderful it would be for all of us to be able to learn something new from our own pupils. the late Professor Navaratnam Balachandran, an acclaimed orthopaedic surgeon who was a firm believer in mentoring younger surgeons
Prof Balachandran was known for his legendary care and concern for patients, rich or poor. In his four-anda-half-decade career, he taught many and shaped medicine in Singapore. He set high standards in orthopaedic surgery at the Singapore General Hospital (SGH) and cared deeply for the chronically sick, handicapped, disabled, and those with spinal injuries and congenital deformities. A firm believer in mentoring younger surgeons, he once said, “To be allowed to teach and train is itself a privilege and honour which we must uphold. How wonderful it would be for all of us to be able to learn something new from our own pupils.” One of his students was Professor Tan Ser Kiat, former Group CEO of SingHealth (Clockwise from top) Prof Arthur Lim, a renowned ophthalmologist; Prof Tan Cheng Lim, a pioneer in paediatrics in Singapore; the late Prof Navaratnam Balachandran, an acclaimed orthopaedic surgeon.
and currently Emeritus Consultant at SGH’s Department of Orthopaedic Surgery. “As his disciple, I’ve benefited from and hold a firm belief in his teaching – that we would have failed in our duties and responsibilities if younger clinicians who come after us are not better than us,” said Prof Tan. A pioneer in paediatrics The Tan Cheng Lim Research and Education Fund honours Prof Tan Cheng Lim, who, in his almost 50 years of service, shaped paediatrics and child health in Singapore. As head of paediatrics at SGH from 1977 to 1997, he spearheaded the growth of paediatric medicine as a discipline in Singapore and laid the foundation for the evolution of clinical practices, education and research being furthered by KK Women’s and Children’s Hospital (KKH) today. Currently Emeritus Consultant, Department of Paediatric Subspecialties, Haematology/Oncology Service, KKH, Prof Tan is also Adjunct Professor at Duke-NUS and Yong Loo Lin School of Medicine. A dedicated clinician educator, he has mentored generations of paediatricians, including SingHealth’s Group CEO, Prof Ivy Ng, who said, “I was fortunate to be one of them.” A Festschrift dinner, held on his 75th birthday this year, raised $1.4 million to launch the fund. It will be used to pioneer advances in paediatric medicine, promote innovative research to discover new cures for patients, and prepare paediatric health care leaders of the future.
Giving to Research and Education Recipients of the named funds will be able to pursue advanced research to find new cures and give new hope to patients. For the proposed Balachandran-Kajima Professorship, $1 million has been pledged towards Academic Medicine by Kajima Overseas Asia Pte Ltd. We hope to raise another $1.5 million for the endowed fund to attract a potential Government grant, bringing the total fund to $5 million. If you wish to give towards research and education, please email giving@singhealth.com.sg.
May – Jun 2014
singapore health
NEWS
07
Towards personalised cancer treatment
A new technology to isolate cancer cells in blood samples has the potential to be a powerful tool in how oncologists diagnose, treat and manage cancers By Sol E Solomon
C
This is because everybody’s genetics and biological makeup ARE different, and drugs THAT work for one PERSON may not work for another with a different cancer or tumour type. Mr Johnson Chen, Co-founder and Managing Director, Clearbridge
“CTCs are not a recent discovery, but what is interesting is the (technology’s) ability to harvest the CTCs (at a location which) may not necessarily be next to the tumour. In many cases, the tumours are embedded deep in the body’s cavities and are difficult to reach.” To facilitate the isolation and diagnosis of CTCs, a new centre of research has been set up at the Cytology Lab of the Singapore General Hospital’s (SGH) Pathology Department. The Singapore Circulating Tumour Cell Centre of Research Excellence or CTC CoRE is a collaboration between the
Blood samples drawn from cancer patients are put through Clearbridge’s ClearCell FX system at SGH’s Cytology Lab to separate the cancer cells from other blood components. Thousands of microscopic crescent-shaped cell traps in a single-use biochip help isolate circulating tumour cells (CTCs), which are larger than other components in the blood sample. The size of a cancer cell is about 20 microns (a millionth of a metre) while a red blood cell, for instance, is much smaller at about 7-8 microns.
(From left) Clearbridge founders Mr Johnson Chen and Prof Lim Chwee Teck, SGH’s Assoc Prof Tan Puay Hoon, and NCCS’s Prof Soo Khee Chee.
developer of the technology, Clearbridge BioMedics, and NCCS. Blood samples drawn from cancer patients are put through Clearbridge’s ClearCell FX system at the Cytology Lab to separate the cancer cells from other blood components, and they are then analysed. Taking a small blood sample for diagnosis poses far fewer risks to individuals who might otherwise have to undergo surgery, and face such risks as infection, excessive bleeding and clotting. Also, with advances in science, “a great armamentarium of different technologies” is now at the disposal of pathologists today, said Associate Professor Tan Puay Hoon, Senior Consultant and Head, Department of Pathology, SGH. “We can interrogate the cancer cells to a greater degree with the various techniques. We can take the cells, look at them under a microscope and identify their nature and morphology, or carry out molecular tests, for instance, to determine if a particular cancer is expressing a particular target (which may indicate certain drugs won’t work on the cancer),” Prof Tan said. Through various trials, CTC CoRE collaborators hope to show that the technology is accurate – that its results from using CTCs are as good as those from biopsies, which remain the gold standard of assessing if a tumour is malignant. Should CTCs prove to be effective, oncologists can then begin to structure unique treatments for each patient. Being easy and quick to do, CTC tests can be done more frequently than tissue
Photos: alvinn lim
ancer treatment is becoming more exact and personal. And if a new technology being tested proves true to its promise, cancer patients may be able to get treatment tailored to their conditions easily. The technology involves taking a small blood sample to isolate cancer cells which have detached from a primary tumour for diagnosis. The cells, known as circulating tumour cells (CTCs), are associated with the spread of cancer, and studying them can help build a profile of the cancer, determine how it is changing at any one time, and understand whether a treatment is working or if the cancer has become resistant to it. “If this exciting and innovative idea works out, it will be a big, big step forward in how oncologists diagnose, treat and manage cancers,” said Professor Soo Khee Chee, Director, National Cancer Centre Singapore (NCCS).
biopsies to find out the “real-time” status of a cancer patient’s condition. “We want to see the applicability of this technique on the various forms of cancers that we are treating. Some of (the trials to be done) may be especially useful, such as for resistant tumours, aggressive tumours, or ones that tend to spread, rather than grow,” said Prof Soo. Tumours don’t behave in identical fashion. Some develop slowly and are localised, while others grow to a certain size, then start to spread to the lymph nodes, spilling into the blood’s circulatory system, Prof Soo said. There are also cancers which are very small, and by the time they are identified, have gone via the bloodstream into the liver or the lungs. Breast cancer is one example of how
the new technology may be applied. Of the hundreds of mammograms of women taken each week, an average of 30 to 40 of them are found to be abnormal, requiring a further biopsy to be ordered, said Prof Soo. Both the CTC test and biopsy could be done, with the latter providing a reference, he said. Knowing “what the cells are, how they behave, how they change” can help an oncologist to decide if and how a treatment regime should be modified to best combat a cancer, said Mr Johnson Chen, Co-founder and Managing Director, Clearbridge. “This is because everybody’s genetics and biological makeup are different, and drugs that work for one person may not work for another with a different cancer or tumour type.”
08
NEWS
singapore health
May – Jun 2014
Delivering quality care A record 2,727 health care professionals were recognised for their work at the 2014 Singapore Health Quality Service Award
Services Development Programme grant to use endobronchial ultrasound to help diagnose lung cancer and determine how much the disease has advanced more accurately. As the Director of both the Allergy Clinic and Asthma Programme in SGH, Dr Koh was instrumental in setting up the Severe Asthma Phenotype database to help doctors understand severe asthmatics better. Dr Koh turned to medicine as a career because of her grandmother. A doctor who practised till she retired at 85, her grandmother was her “inspiration and motivation”, Dr Koh said.
By Sol E Solomon
G
oing over and beyond the call of duty for their patients led these four health care professionals to win accolades at the Singapore Health Quality Service Award (SHQSA) 2014. They were among the 2,727 health care professionals – a record number – from 17 institutions who were honoured this year for their outstanding contributions. Notably, community hospitals and nursing homes registered a more than 57 per cent increase in the number of winners – a strong testament to the health care community’s shared commitment to provide the best care for patients at every stage of their lives. The Singapore Health Quality Service Awards, organised by SingHealth, is Singapore’s first dedicated platform to honour health care professionals who have delivered quality care and excellent service to patients.
Dr mariko Koh, Superstar (Clinician)
Dr Mariko Koh is a Senior Consultant with Singapore General Hospital’s (SGH) Department of Respiratory and Critical Care Medicine. She also heads the hospital’s Allergy Centre, Pulmonary Function Laboratory, and Asthma Programme; takes on research; and teaches at the NUS Yong Loo Lin School of Medicine. Despite her many responsibilities, Dr Koh is, at heart, a clinician who always puts her patients first. “Good patient care starts right from the beginning – from the
moment patients enter the hospital compound, till post-treatment and aftercare. It is about total and complete care,” said Dr Koh. To have a clear idea of her patients’ conditions, she puts herself in their shoes, listens closely, and tries to understand their circumstances. “It helps to understand the patient’s perspective, to really listen and to have their best interests at heart. It is about being patient-centric,” she said.
Being patient-centric also means looking for better ways of treatment. Dr Koh, who has been actively involved in clinical research on asthma and lung conditions, received $1.3 million in funding support from the Ministry of Health (MOH) to perform a novel procedure, bronchial thermoplasty, to reduce the frequency of asthma attacks and improve overall asthma control in people suffering from severe asthma. She also received an MOH Health
Photo: zaphs zhang
Mr Mazlan Senawi, Star (Allied Health)
His work can be laborious. And he has there. After her discharge, he was able to been doing the same job for the last nine help her with the exercises that he learnt years. Yet, Mr Mazlan Senawi (far left), as a volunteer. Senior Therapy Assistant, Ang Mo Kio“At that point, I realised that I enjoyed Thye Hua Kwan Hospital (AMK-THKH), helping elderly patients, so I decided to continues to look forward to work at the work at the hospital.” community hospital each day. Mr Mazlan, 48, treats his elderly “I’m always happy at work, and I’m patients as though they are his parents. always looking forward to meeting my When they are depressed, he gives them elderly patients,” said Mr Mazlan. “My “a little tender loving care” or “sayang” in parents taught me to treat every individ- the Malay vernacular. ual with respect, and patients can sense “The elderly have mood swings. So if you’re genuinely nice to them.” it’s very important to talk to them nicely, Always ready with a smile, Mr Mazlan slowly, and to listen to them. You’ll build has had plenty of experience dealing with their trust, (you’ll get to know) what probthe old. lems they’re facing. Once they trust you, The youngest of 10 children, he took it’s not hard to get them to do their exerit upon himself to care for his parents in cises,” he said. their old age. A former hotel chef, Mr Mazlan has marHe volunteered at AMK-THKH as a ried his passion for cooking with his currehabilitation assistant to see how “the rent calling by conducting weekly group staff helped patients” when his late therapy cooking classes for patients. mother was recovering from a stroke Kneading dough and cutting onions
Good patient care starts right from the beginning – from the moment patients enter the hospital compound, till post-treatment and aftercare. Medicine, she said, is a learning process. In that regard, teaching younger doctors has helped Dr Koh in her perpetual quest for better patient care. “When I teach them, I also learn from them. We are always striving to find ways to improve patient care,” she said.
are forms of exercise therapy for patients, who may be recovering from the debilitating effects of stroke, fractures or amputations. In his classes, he teaches the patients how to make pizza, prawn noodles, goreng pisang and ondeh-ondeh. He also holds separate classes for dementia patients. “They all look forward to the class, and everybody participates,” said Mr Mazlan. The classes not only help patients physically but also allow Mr Mazlan to interact better with them. A part of his job involves working with the hospital’s occupational therapists, and helping to break in new therapy assistants. “We are a team,” said Mr Mazlan, who stressed that the award recognising him for good service should include all his colleagues. “I am just happy to be of service to my patients. It is my job.”
May – Jun 2014
NEWS
09
MS Fan Zuoxia, Gold (nursing)
and advice, and her team visits homes after work too. Besides her hospital work, Ms Kang trains confinement nannies to care for babies and assist mothers to breastfeed. She sits on many committees, including the Association for Breastfeeding Advocacy, Singapore. She has even produced a breastfeeding video endorsed by the Health Promotion Board, and in 2010, developed a flip chart on breastfeeding and wrote the book Successful Breastfeeding: A Practical Guide. She regularly contributes to magazines too. Despite her heavy schedule, the youthful 62-year-old said: “I enjoy my work. I don’t feel tired. I can go on from morning until midnight.”
In order to go the extra mile when asked to perform a task, one should ask “Why not me?” instead of “Why is it me?”, said Ms Fan Zouxia. For the Enrolled Nurse at Thomson Medical Centre’s (TMC) maternity ward, this means doing everything possible to make the mothers happy. She teaches new mothers the essentials, like the correct way to hold a baby, change diapers, and breastfeed. New mothers are often anxious about breastfeeding, and they can get distressed if they have problems with inverted nipples or heavily engorged breasts, for instance. Ms Fan understands their disappointment when their initial efforts to breastfeed fail. “I feel happy whenever I see a mother under my care succeed in breastfeeding. It feels especially rewarding to see them embrace their new parenting role and be able to be part of a family’s excitement in welcoming their new bundle of joy,” said Ms Fan, 32. Ms Fan, who is from Harbin, China, used to spend her weekends at the hospital where her aunt worked as a nurse. She had hoped to train as a teacher, but after witnessing the recovery of a patient, changed her mind. Unable to walk when he was admitted to the neurological ward, the stroke patient regained his mobility after about a month of care. Seeing how the
nurses looked after the patient led Ms Fan to appreciate the importance of good care and the role of nurses. Also, seeing the gratitude that Ms Fan’s aunt received from the patient reinforced her conviction to work as a nurse. In Ms Fan’s two years at TMC, she has received more than 70 compliments. She said it was the newborn babies – or more accurately, how they looked at her – who drove her to do her best at work. “Babies are very expressive although they are unable to speak yet. They communicate with their eyes and it’s amazing how they seem to be able to understand what we say sometimes.”
Photo: zaphs zhang
Photo: Mt Alvernia Hospital
Ms Kang Phaik Gaik, GOld (Nursing)
Not being able to breastfeed can worry a new mother. But when she eventually does, the feeling can be overwhelming, not just for the mother but the nurses who have helped her overcome her difficulties. “On our part, we feel rewarded and very fulfilled to have been able to help these mothers. When we go the extra mile for our patients, they remember us for a lifetime,” said Ms Kang Phaik Gaik, Senior Nurse Manager, Parentcraft/Lactation, Mount Alvernia Hospital. When interest among new mothers to breastfeed grew in the 1990s, the hospital looked to Ms Kang, then a ward sister, to specialise in teaching and guiding mothers. Today, she is a lactation specialist, renowned both at home and abroad. Ms Kang became a nurse out of practical considerations. Both her parents were diabetics, and none of their 11 children knew how to care for them. Seeing the care that nurses gave their father at a hospital, she decided to train as one. Ms Kang qualified as a nurse in Scotland, and when she moved to Singapore, began working at Mt Alvernia Hospital – her first and only employer in the city-state. With more than 500 babies delivered at Mt Alvernia each month, Ms Kang and her team are kept busy round the clock. About 100 mothers on average return to the hospital as outpatients to get help
singapore health
Constituents of Genacol® Plus 400 mg of Genacol® per capsule • Genacol® Professional Formula
HELPS TO MAINTAIN JOINT HEALTH Genacol® Plus is a natural health product of superior quality that helps maintain joint health. It also promotes cartilage formation and repair: one single product has two-times more ingredients resulting in a better quality-price value for consumers.
Genacol® is a natural health product used for promoting joint health. Developed for over twenty years by our Research and Development Division, the AminoLock® Sequence Technology which is exclusive to Genacol®, offers an amino acid complex with benefits ten times superior to those of normal hydrolyzed collagen. This innovation, unique to Genacol Corporation, rapidly generates exceptional results for those who desire efficient relief of joint discomfort. Genacol® is the only product available with a specific combination of amino acids supported by a published clinical study. 500 mg of glucosamine per capsule • Glucosamine hydrochloride This kind of glucosamine, the hydrochloride, was chosen because of the purity of its composition, since it has 98% of glucosamine, allowing an optimal absorption. (Derived from crab and shrimp exoskeleton)
What is collagen? Collagen is the fibrous structural protein that makes up the white fibres of the skin (collagen fibres), tendons, bones, cartilage and all the other conjunctive tissues. Thirty percent of our body is made up of collagen. When there is a lack of collagen in the body, everything is affected. Collagen acts as a main catalyst for growth and repairs almost every tissue in the body.
IMPORTANT NOTE: Genacol® Plus has no SODIUM or POTASSIUM.
Arthritic collagen fibres
Distributes and provides supplies to healthcare professionals
What is glucosamine hydrochloride? Glucosamine hydrochloride is a biochemical product naturally present in bone cartilage. This substance allows to slow down the degradation of the cartilage and increases the lubricating effect of the synovial fluid, which is the joint liquid that is secreted by the organism that protects the cartilage from mechanical stress.
Normal collagen fibres
No. 190 Clemenceau Ave #03-33 Singapore • Shopping Centre S(239924) Phone: (65) 6468-4948 • Email: info@genacol.sg
10
NEWS
singapore health
May – Jun 2014
Better patient care with technology SingHealth is using new technologies to provide better, faster and seamless patient care By Wong Sher Maine
Photo: winston chuang
L
ong queues and lengthy waiting times plague the health care system, but new technologies are helping to improve things. SingHealth – Singapore’s largest academic health care cluster – has been successfully introducing these in the past few years. At SingHealth polyclinics, nurses make phone calls to patients with chronic conditions to review and monitor their health status between scheduled doctor’s visits. This means that patients do not have to waste time travelling and queuing. At the National Neuroscience Institute (NNI), experts offer remote diagnosis and treatment to patients from Changi General Hospital and Khoo Teck Puat Hospital, helping to save lives during the crucial three-hour window for effective treatment after a stroke strikes.
At the National Neuroscience Institute, experts offer remote diagnosis and treatment to patients from Changi General Hospital and Khoo Teck Puat Hospital.
Compression Stockings brought to you by
Link Compression Stockings - Decrease venous pressure - Reduce swelling
Link
+65 8181 2995 sales@thelinkmarketing.com
Great Travel tfooor!
- Enhance Circulation - Relieve Symptoms of Varicose Veins sitting positions
Link Compression Sleepcare - Grdual Compression - Soft Cotton with Micro Fiber - Soft Pressure to Relax muscles - Provide Relaxing & comfortable sleep
Other improvements
1
Mobile appointments Patients can use their smar tphones to change, cancel or make appointments for follow-up visits.
2
SMS Alerts Once a patient has registered at the counter for medical treatment, the system will SMS him shortly before his turn.
3
- Soothe long hours of standing &
Tone your legs while you work, sleep or play! Having slimmer looking legs is so easy!
Soothe your tired, achy legs and feet with ...
SingHealth has also employed technology for hassle-free bill payments. Hospital patients who are discharged, or those visiting the Singapore General Hospital’s (SGH) specialist clinics need not queue to pay bills. They can simply head home first and pay online later. Some bills can also be paid online or at Self-Service Automated Machines (SAM), SingPost branches, or 7-Eleven stores. Patients at specialist clinics can also arrange for credit card payment after each visit. SingHealth is also using technology to allow patients to choose the best time to visit hospitals or polyclinics. Its Queue Watch enables patients to view the queue situation at SingHealth’s hospitals and polyclinics online. Patients can also view the queues using the mobile app, Health Buddy, which provides quick access to health tips, appointment bookings, and directional maps to health care centres.
GP availability A list of general practitioners (GPs) and their operating hours, searchable by location, is available via the SingHealth Health Buddy app. Patients can now quickly find and visit GPs in their vicinity instead of flocking to hospitals’ accident and emergency departments.
4
Health management apps Mobile phone apps such as the Singapore National Eye Centre’s (SNEC) My EyeDrops app, can guide and remind patients when to take their medication. This helps them better manage their own health, cutting down on visits to the doctor.
6
Shared database A patient’s medical records are now saved in a shared system – the Electronic Medical Records and Computerised Physician Order Entry – which allows doctors to quickly access diagnostic medical records. Doctors can use the system to make prescriptions or order tests.
7
Ordering medication online Patients can order over-the-counter medicines online, pay by credit card, and have items delivered to their homes.
8
Automated medication Drug dispensing systems at SGH, which pack and assemble patients’ prescriptions, help to cut down waiting time. Today, 80 per cent of SGH patients have their prescriptions filled within half an hour.
Link Compression Stockings & Link Sleeping Care It’s the right choice.
Self-registration Patients going for follow-up appointments at SingHealth’s health care institutions can self-register by scanning their details at special self-registration kiosks (pictured).
Photo: alecia neo
5
May – Jun 2014
singapore health
NEWS
Unique blend of organic soy formula powered by various functional ingredients that makes Soy-Lite beyond ordinary. and minerals, these nutrients provide energy and keep your body functioning at its optimum level.
Enhanced with Japan Fish Collagen Peptides
Enhanced with L-Carnitine
Contains essential amino acids
Bodyline Contouring without crash dieting
Smoother, radiant and supple skin Supports Joint health
Complete essential vitamins and minerals
Complete essential vitamins and minerals
Burns stubborn fats into energy
11
12
upclose
singapore health
May – jun 2014
stub it out World No Tobacco Day
World No Tobacco Day falls on May 31, and it’s a good time to remember that kicking this highly addictive habit has immediate health benefits. Stopping the habit lowers one’s risk of heart attack, stroke, chronic lung disease and many types of cancer
Dangers of smoking-related illnesses Smoking is the main cause of stroke. It causes fatty deposits to build up in blood vessels, narrowing them and causing blockages. When the blood supply to the brain is blocked, brain cells are deprived of oxygen and die, resulting in a stroke. Smoking also increases one’s risk of a heart attack. When blood vessels to the heart are blocked, blood supply to the heart muscles is cut off, killing tissue and causing a heart attack .
90
Tips to help
kick the habit
Cigarette smoke contains more than
4,000 400
What drives the habit? 1 Heavy smoking is likely to be a physical addiction and nicotine patches might be the best option. 2 Behavioural smokers who enjoy the hand-to-mouth action may find a nicotine inhaler helpful. 3 For those who smoke to relieve anxiety or other psychological reasons, consider doing stress-relieving exercises like deep breathing.
different chemicals, of which at least
are poisonous to humans.
Cigarette smoking is the main cause of lung cancer, and is responsible for
five
Text By Denyse Yeo
per cent of all lung cancers. Cancercausing substances, inhaled via cigarette smoke, attack the gene that prevents cancer cells from growing. Lung cancer can start with cell damage from smoking just one cigarette.
Broadcasting the intention to quit to everyone – family, friends, colleagues and bosses – can help prevent failure.
Throw away all cigarette packs, lighters, ashtrays and other smoking paraphernalia.
Display “no smoking” signs in areas such as the bedroom wall, bathroom and office desk. Visual reminders are powerful and can motivate.
Avoid places where smoking is allowed, or stay in a smoke-free environment. Ask friends to stop smoking when you are with them.
times
six
seconds
seven
seven
ten
Smokers who stay smoke-free for 28 days are five times more likely to quit smoking for good.
Worldwide, tobacco use kills one person every six seconds on average, or 5.4 million people a year.
Every cigarette takes seven minutes off a smoker’s life.
Seven Singaporeans die prematurely from smoking-related diseases each day.
On average, smokers die 10 years earlier than non-smokers.
minutes
die
years
Sources: Ministry of Health, Health Promotion Board
May – Jun 2014
singapore health
Seizing every minute
Whether at work or at play, the irrepressible Dr Farah Irani is always hungering to do more By Thava Rani
Photo: Alvinn lim
D
r Farah Irani just can’t slow down. Even in the way she speaks, there is a sense of urgency. The 39-year-old Consultant from the Singapore General Hospital’s (SGH) Department of Diagnostic Radiology seems to be on a mission to seize every minute of the day. Dr Irani completed her training in radiology in Pune, India, where she grew up. Her desire to travel and experience different places saw her working in England, France and Canada, before arriving in Singapore five years ago. “I like city living. I like urban architecture – I think it’s beautiful. This is the longest I’ve stayed in any place. It’s so busy here you don’t realise where the time goes!” Working at the SGH, with its technologically advanced imaging machines, is another plus point. Besides reading and interpreting images or scans, as a radiologist specialising in vascular and interventional radiology (VIR), Dr Irani also
Dr Farah Irani’s desire to travel and experience different places saw her working in England, France and Canada, before arriving in Singapore.
performs minimally invasive treatments with the help of imaging guidance. Her day typically starts early, meeting specialists from other fields to decide on the management of some patients. Then at the catheterisation lab, she starts on procedures. “Some of the common
things we do include tumour ablation. In this part of the world where hepatitis B is very common, we see a lot of liver tumour cases. If these tumours are small enough and for some reason they can’t be removed surgically, we can insert a needle and basically burn the tumour.” Unclogging blocked vessels by inserting a stent graft, opening up narrowed veins with a balloon or closing off a bleeding vessel are all part of a day’s work for Dr Irani. In complex cases, she follows up with the patients in the wards. Apart from being the Deputy Director, VIR, she also doubles up as the Fellowship Director, helping overseas Fellows who are attached to the department with their queries and paperwork. Research is another aspect of medicine Dr Irani is involved in. “I think disease can be quite a discriminator when it comes to affordable care. That’s why I think research is important, not only in terms of what we can achieve, but also to level the playing field.” With so much squeezed into each day,
people
13
it is a rare occasion for her to leave the office when the sun is still up. And when she does, she makes full use of it. From cooking to trekking and climbing, Dr Irani continues to explore and immerse herself in the local environment. She has learnt to dive since coming to Singapore. A huge fan of the theatre and art, she is often at dance or music performances and at the museums. Her biggest passion is, however, travelling. “I think it opens up your horizons and teaches you a lot about different cultures and makes you very aware. It shows you how lucky you are – especially when you travel in South-east Asia,” she said. Dr Irani’s most inspiring trip to date has been “reaching Uhuru Peak, the summit of Mount Kilimanjaro”. She has now set her eyes on travelling to South America, climbing Machu Picchu and visiting Patagonia. Her thirst for anything new keeps her bucket list growing. “I’d like to learn new hobbies. Maybe learn to paint or attend a gourmet cooking class. I’d like to also attempt a triathlon and a marathon, which I’m actually already training for. Also, at some point I’d like to do some voluntary work, possibly in education. I’ve previously worked in rural areas and that was quite insightful,” she added.
14
people
singapore health
May – Jun 2014
For the love of kids This paediatric nurse enjoys taking care of her young charges at work By Desmond Ng
Photo: Wong weiliang
L
ooking after sick children can be challenging, but not for Ms Janice Chan, Senior Enrolled Nurse, KK Women’s and Children’s Hospital (KKH). Now in her seventh year as a paediatric nurse, Ms Chan, 26, said, “I enjoy working with kids. I just like them. I realised this when I did an attachment with KKH as a student nurse.” She finds that chatting with her charges brightens up her day. To help distract them from their illnesses, she shows them a keychain with small toys attached, which she carries around with her. She sometimes also uses stickers to cheer them up, and even sings to them. Ms Chan has also shown a knack for handling anxious parents. “I don’t really blame them. They take time off from their work and they’re also stressed,” she said. Her efforts were recently recognised. She was one of 10 finalists honoured at the 7th Tan Chin Tuan Award for Enrolled Nurses 2013 event. The 10
Paediatric nurse Ms Janice Chan was one of 10 finalists honoured at the 7th Tan Chin Tuan Nursing Award in 2013.
were picked from more than 20 public and private health care organisations in Singapore. “I was thrilled to be a finalist as I didn’t expect it at all. I didn’t think it was a big deal until I realised that most of the others honoured had more than 20 years of experience.” Her supervisor, Nurse Manager Has-
nizah Hassim, said Ms Chan is dedicated and caring, with a friendly disposition that helps her win the confidence and trust of patients, caregivers and colleagues. “She displays good teamwork and commitment in delivering the highest standard of care to her patients. She also takes pride in establishing a trusting relationship with patients, consis-
tently showing respect and empathy for them,” she said. Interest sparked during youth Ms Chan’s interest in nursing was spar ked dur ing her youth, when her mother became the main caregiver to her grandmother who had been diagnosed with dementia. When she was 14 years old, Ms Chan had stood in as caregiver whenever her mother had to make occasional trips to Malaysia. “It’s not easy talking to dementia patients, and it was challenging. My grandma couldn’t recognise some family members, couldn’t swallow well, and sometimes woke up screaming,” she said. It was because of this experience that Ms Chan decided to study nursing after finishing school, and got a scholarship from KKH to do it. It was during an attachment at the hospital that she discovered that she really loved working with children. Recently married to an army regular, Ms Chan’s goal is to become a senior nurse in 10 years’ time. Right now, she is enjoying her work. “I learn something new every day and that keeps me going,” she said. Ms Chan also likes the job security, as nurses are in high demand. But most of all, she likes it when her charges recover. “It’s always great when the kids get well and are able to go home.”
May – Jun 2014
singapore health
Health coverage: Are you overinsured? Many who buy top plans may face a cash crunch as premiums shoot up in later years By SALMA KHALIK
M
any Singaporeans complain about paying high premiums for their health insurance plans, especially after last year’s rather steep rise in premiums – some premiums have more than doubled. But what most of them don’t realise is that they are probably forking out for such high premiums because they have overinsured themselves, and are paying for a level of insurance that they are unlikely to need. Today, more than two million Singaporeans and permanent residents are paying for higher medical insurance coverage than that offered by basic MediShield. They are on Integrated Shield Plans which ride on basic MediShield but offer higher payouts, and are based on private hospital rates or the equivalent of being treated as private patients in a public hospital. This is good, since the basic insurance is pegged to subsidised B2 and C class rates and will not offer enough coverage for those opting for a higher ward class, such as B1 or A class in a public hospital. What is surprising, however, is that more than half of those on Integrated Shield Plans, or 34 per cent of all Singaporeans and permanent residents covered by MediShield, have opted for the most expensive plans available – those pegged to treatment in private hospitals. This does not reflect the actual usage of hospital care today, with less than 20 per cent of local residents opting for private hospitals and the rest going to public hospitals. Do one in three Singaporeans require private hospital medical insurance when fewer than one in five are treated at private hospitals? Why do so many buy insurance plans they are unlikely to use? They do so partly because it is easier to
downgrade a health insurance plan than to upgrade it. Four of the five insurers – NTUC Income, Great Eastern, AIA and Aviva – have plans in all three Integrated Shield Plan categories. Prudential no longer offers Integrated Shield Plans for public hospital B1 wards. Many also buy into the plans when they are young and the premiums are highly affordable. Medisave can fully cover the premiums charged for these private plans until policyholders are 49 years old, so they do not feel the pinch of out-of-pocket payments. But from age 50 onwards, these people will have to top up their premium payments in cash, as the premiums all exceed the $800-a-year cap for premiums paid with Medisave. Each year, up till the official retirement age of 62, they will need to top up their premium payments with cash amounting to several hundred dollars. But again, as many are still working, the amounts appear affordable. Beyond age 62, however, premiums rise steeply, averaging $4,000 a year for those aged 75. The highest premium currently charged is $8,483 a year for a 100-year-old. Today, on average, men can expect to live to 80 and women to 84.5. A man aged 65 in 2012 can expect to live to 83.5, and a woman to 86.9. And average life expectancy is still going up. Already, there are more than 10,000 people aged 90 and older, and close to 1,000 have passed the century mark. Based on current premiums, people on private hospital plans will need to pay between $120,000 and $180,000 in premiums for those 30 years after retirement, depending on which insurer they are with. Unless they buy riders, which pay for the portion of their hospital bill which they will still need to pay in spite of insur-
Annual premiums for Shield plans Private Age MediShield B1 IP A class IP hospital IP 60
$455
$631-$921
$868-$1,205
$1,337-$1,667
70
$560
$1,089-$1,677
$1,486-$2,339
$2,455-$3,000
80
$1,123
$1,621-$3,599
$2,540-$4,738
$3,845-$6,801
89
$1,190
$2,109-$4,245
$3,571-$5,669
$5,172-$7,748
People on plan
34%
14%
18%
34%
IP: Integrated Shield Plan
Source: Ministry of Health
ance, they will still have to pay thousands, perhaps even tens of thousands of dollars, for their hospital treatment. Rider premiums, which start at about $30 a year for children, go up to about $2,000 a year for seniors. The actual amount that policyholders will need to put aside is likely to be far higher, as health inflation has always been higher than general inflation, and premiums will rise as the costs of medical treatments go up. So those who opt for insurance pegged at treatment in private hospitals must ask themselves this basic question: Can they afford the thousands of dollars in premium payments that lie ahead in
Money
15
their post-retirement years? Different people have different priorities, as well as different levels of savings. After doing my maths recently, I’ve decided to downgrade my medical insurance plan. One reader wrote to me to say that she opted for her insurer’s top plan, and pays extra for a rider, so that she will not have to pay any out-of-pocket expenses should she need to be hospitalised. She said: “Even though the premium and rider are costly, I am determined to continue with my plan for as long as I can. In the worst-case scenario, I am willing to cut down on my transport and food to service my plan, including the rider.” She has considered her options and made her choice. But not many people have given as much thought to their Integrated Shield Plans. I prefer to downgrade and spend more on living healthily and getting regular health screenings, to stay healthy and out of hospital. And should I fall seriously ill in my old age, I will turn to public hospitals, which have excellent doctors and whose bills I can probably afford on my downgraded health insurance plan.
This article is adapted from Health Coverage: Are You Overinsured?, The Sunday Times, dated Jan 5, 2014.
16
singapore health
MAY – JUN 2014
Health Xchange
Our experts answer all your questions about health
Baby’s teeth not showing yet My 17-month-old baby girl has only three teeth to date – two lower central incisors and one upper central incisor. She is on solids but her milk intake is poor. We failed to wean her from breast milk to formula milk. We have tried all types, including goat and soy milk, but she drinks only about 300ml of milk a day, which is far below an average toddler’s intake. On the doctor’s advice, we introduced her to cheese when she was eight months old. She is my second child. My first child’s teeth came out on schedule. Should we be alarmed? Delayed eruption of primary teeth is common in infants, with large variations in the timing of such eruptions even among siblings. Generally, the first lower teeth erupt at about six months, but it is not rare for this to be delayed till up to 18 months. It sounds like her teeth are just erupting now, and you can expect all her primary teeth to be out by the time she is three years old. At 17 months, milk alone, whether breast or formula, cannot give her all the nutrition she needs for growth. She needs a balanced diet of solid food. With this, she may need less milk or milk in other forms, such as yogurt or cheese. Your paediatrician can advise you on this.
Haze makes asthma worse
The recent haze has worsened my asthma, and the attacks have become more frequent. What can I do? During an asthma attack, a person’s air passage narrows and this makes breathing difficult. Asthma patients tend to get attacks if the condition is not controlled and their air passages react to triggers in the environment, including the haze. To reduce asthma attacks, it is important that asthma be controlled. An appropriate dose of controller medication may be necessary to achieve this. There are two broad categories of inhaler medication for asthma: Controller medication: Treats lung inflammation and makes them less sensitive (and therefore less reactive) to triggers like environmental pollutants – like the haze. Reliever medication: Provides
Can I do LASIK? On-demand breastfeeding at 18 months places your daughter at high risk of dental decay, since her first teeth are already present. To prevent this, only give her milk at fixed timings through a sippy cup, and brush her teeth before bedtime after a feed. Do not let her suckle through the night. Dr Terry Teo, Senior Registrar, Paediatric Dentistry, Department of Restorative Dentistry, National Dental Centre Singapore
I am short-sighted and have astigmatism and dry eyes. Are people with dry eyes suitable for LASIK? While it is true that LASIK may make dry eyes worse, “bladeless” LASIK with femtosecond laser platforms can now create thinner cornea flaps that reduce the occurrence of persistent post-LASIK dry eyes. Many of my patients have dry eyes as a result of prolonged contact lens usage. However, most of them recover
relief and expands the air tubes that have become constricted during an attack. With the haze, an asthmatic whose asthma is usually under control may find it getting worse, and may need controller medication. Those already on it may need their doctors to adjust the dose. All asthmatics should have a written Asthma Action Plan with instructions on: recognising early symptoms so that appropriate measures may be taken to prevent an attack from worsening; the steps to take if an attack happens; and whether an attack is severe enough to need urgent medical attention. All asthmatics, no matter how well controlled their condition, should have an inhaler on hand in case of an asthma attack. Dr Ng Wai Chung, Consultant, Family Physician, SingHealth Polyclinics
Stiffness in the fingers My fingers often feel stiff, especially in the morning. Could I be suffering from rheumatoid arthritis or an autoimmune disease? Pain and stiffness in the fingers and toes (and sometimes in other joints) are symptoms of rheumatoid arthritis, an autoimmune disorder. The stiffness is normally more severe first thing in the morning, improving with the use of the affected joints, a warm bath, or antiinflammatory painkillers. It is not clear why certain individuals, especially women, develop rheumatoid arthritis, although smoking, infection and genetic factors are thought to increase the risk. The immune system serves to protect us from foreign invaders such as bacteria and viruses, and also to prevent our own cells from growing uncontrollably. Rheumatoid arthritis, systemic lupus erythematosus and other autoimmune disorders can develop when our immune system becomes confused and starts damaging our body instead. As yet, there is no known cure for any of these conditions. Taking glucosamine and chrondoitin supplements has not been conclusively found to prevent or treat rheumatoid arthritis, although there have been significant developments in treatment options for the control of these complex diseases. As treatment is usually targeted at the immune system, patients require close monitoring for side effects, and to ensure a positive outcome. If the pain, stiffness and swelling in your joints persist, do visit your family doctor or a rheumatologist. Dr Yeo Siaw Ing, Consultant, Department of Rheumatology and Immunology, Singapore General Hospital
from dry eyes after treatment, and have LASIK done after that. They usually do not have problems with dry eyes after LASIK. So it is important to treat the dry eye condition before LASIK is performed. However, if you still have significant dry eyes after treatment, we can consider other forms of refractive surgery options, which have a lower risk of inducing dry eyes. Dr Mohamad Rosman, Consultant, Department of Refractive Surgery Service, Singapore National Eye Centre
These articles are from www.healthxchange.com.sg, Singapore’s first interactive health and lifestyle portal.
Topics for discussion in May-June 2014: Women’s pain issues and LASIK
May – jun 2014
singapore health
Opinion
17
Life lessons from cancer
PHOTO: jasper yu
When Ms Sim Peck Cheng found out she had nose cancer, acknowledging her illness was the first step to recovering from her ordeal
By Sim Peck Cheng
I
’m in life insurance, so I’m more careful about my health. For me, if any discomfort persists for more than six months, it has to be checked out. I was at an overseas conference in June 2008 when my nose became blocked, and stayed that way for six months, worsening over time. When the specialist inserted a scope down my throat to view the nasopharynx, the area behind the nose, he looked concerned. He told me there was a small tumour there, which looked to be cancer in its initial stage. The first thought that came to my mind was that cancer patients could die young. I was 32, and my daughter was 2½. I didn’t know what might happen. I locked myself in the toilet, and cried. Waiting for the results was hard for my husband and me. It felt endless. But after feeling agitated and unsettled for a few days, I told myself, “Okay, you can’t be crying forever. Just acknowledge how you feel, accept everything and move on.” I went for PET and CT scans. Doctors told me I had late stage 2/early stage 3 nasopharyngeal or nose cancer. I felt calmer when the radiation-oncologist explained that my illness is highly treatable and that the recovery rate is very high. But first, I had to undergo chemo and radiotherapy over a six-week period. The first week was manageable but things got bad by the fifth. My mouth was inflamed and raw. My salivar y glands were affected. It was difficult and painful to swallow even soft rice porridge. I couldn’t sleep, because my tongue stuck to the roof of my mouth. I couldn’t eat solid food, so I began taking
liquid supplements three to four times a day. Even then, drinking 250ml took an hour because it was very painful, and I threw up everything after that. I felt demoralised. I had to be checked into hospital for dehydration. Lying in bed, I felt sorry for myself. But then I noticed another patient, an elderly woman in her 70s, who was bedridden after a stroke. Thinking about how she would have to re-learn everything, from eating to walking, I felt that maybe, I wasn’t in such a bad place after all. I became determined to eat. That day, I took three hours to eat my porridge but I began to feel stronger.
Finally accepting my illness helped me attain peace of mind. To me, acceptance means understanding that the sickness is now a part of me. Just when I thought I could pop some champagne, I was told I needed a second round of treatment because I hadn’t completed the first round of treatment for chemotherapy. I thought the worst was over, but I had to go through the pain and misery all over again. I was put on a different drug, which affected the nerves in my body and caused my hair to drop. At
least, there wasn’t any nausea. My treatment ended in September 2009, and I went back to work two months later. Today, I still have check-ups every three months. My mouth still feels puffy and spongy. Being ill has brought things into perspective. You focus on the important things in life. You want your loved ones around you, and work comes second. I have cut work to three days a week. And I prioritise – I don’t like to waste time. Finally accepting my illness helped me attain peace of mind. To me, acceptance means understanding that the sickness is now a part of me. Since I could not turn back the clock, I had to learn how to manage it. For instance, I went in for my treatment with a positive attitude and did not let pain or discomfort stop me from completing it. I constantly told myself that it was just like treating a more serious case of the flu. It would have been harder without family support. My husband always acc-
ompanied me to hospital, even in the midst of setting up his own business. My mother looked after my daughter and my aunt cooked for me. Good friends lifted my spirits, and I found comfort in the Nasopharyngeal Cancer Support Group. It held monthly talks on topics such as coping with the side effects of chemotherapy. We exchanged group emails to share our problems. I felt I was not alone. After recovering from my illness, I try to live life normally. I’m happy I can go out and do a day’s work. I set aside more time for myself and my family, and this makes me feel good mentally and emotionally. I look at things positively now. I see that I haven’t lost a lot, but I’ve gained other things. Learning to put everything in perspective, I feel that I live a much more balanced and rewarding life. Ms Sim Peck Cheng, 38, is a Financial Consultant in the life insurance industry.
singapore health
MAY – JUN 2014
Helping patient with difficult test
Recently, I was at the Singapore General Hospital (SGH) for an oesophageal manometry test, which involved passing a small tube through the nose, down the oesophagus and into the stomach. I dreaded taking the test – it wasn’t pleasant – as I am very sensitive to pain and physical discomfort, and prone to vomiting. The moment the tube reached my stomach, I immediately felt like vomiting. However, Ms Eileen Ngai Yee Lin, Senior Staff Nurse, Gut and Liver Lab, SGH, comforted me with words of encouragement. Throughout the procedure, she kept assuring me, telling me to relax and stay calm. Her words and tone of voice had a calming effect on me. I was also amazed at her ability to do so many things at the same time. She was focusing on getting accurate readings from the instrument, while encouraging me and keeping me calm. I was ready to break out in a panic! Although the procedure took a short time, it seemed endless. I was conscious of a hard tube in my throat that couldn’t be swallowed away. But Ms Ngai helped me to complete the test. It is staff like Ms Ngai who make patients’ visits to the hospital less scary and more welcoming. She is a model nurse, with the passion and heart to serve patients. Thank you, Ms Ngai, for your utmost patience, understanding, dedication and professionalism in carrying out your duties. Ms J Kairos
This letter wins a bottle of Ultra Selenium (60 capsules). The product, worth $68.50, is sponsored by United Pharma Pte. Ltd.
Getting to the new heart centre
Now that the National Heart Centre Singapore (NHCS) has moved, how do I get to its new location from the main SGH block?
NHCS
says
You can take the pedestrian underpass near SGH Block 4 to Basement 1 of the new NHCS
building. At the entrance of Block 4, follow the directions to the underpass. Take the escalator or the lift to the underpass which will lead you to the heart centre’s lift lobby C. Alternatively, you can take the campus shuttle bus service. It stops in front of the new building, and this is the last stop on the shuttle bus route. For further details, please refer to the NHCS website at www.nhcs.com.sg.
Financial help for gum treatment
I am a diabetic patient, recently referred to the National Dental Centre Singapore (NDCS) because of severe gum disease. I am required to return frequently for routine gum treatment, but feel burdened by the costs even though I am a subsidised patient. I am a retiree, with no active income and no children for financial support. I cannot use Medisave because gum treatment is a non-surgical procedure. How do I get financial assistance?
NDCS
You may be eligible for Medifund, which was set up by the government to provide affordable health care to all Singaporeans. In April 2013, the Minis t r y of H ealt h e x te n d e d i t s Medifund reach to the NDCS. Medifund works like a financial safety net to help needy Singaporeans who face difficulties with medical or dental expenses even with government subsidies. To ask for Medifund, please approach our counter staff. Your eligibility will be assessed and if Medifund is necessary, our staff will make an appointment for you to meet a medical social worker, who will review your application and recommend your case to the NDCS’s Medifund committee for approval.
says
Waiting for a nursing home bed
After my elderly relative’s condition stabilised following a stroke, we were advised to move her to a community hospital or nursing home for further rehabilitation. We want to place her in a facility that is nearest our home, but have been told that we have to wait for a bed. Why can’t SGH get us a place straight away?
a patient needs to be SGH When cared for in a nursing home or
says
community hospital, a medical social worker will help to apply for a place for him. Acceptance to a community hospital or nursing home depends on a number of criteria set by the facility, including whether there is a vacancy. The Agency for Integrated Care, which oversees the allocation of nursing home beds, will try to accommodate patients’ requests subject to the limited number of nursing home beds. For more details, go to www.silverpages.sg.
I had a crack on my front denture and was very happy with the treatment I received at the National Dental Centre Singapore. I want to thank Dr Eric Yap, Visiting Clinician, Department of Restorative Dentistry, Ms Aisha Begum Hussein, Dental Assistant, and Ms Tan Kai Xin, Dental Technician, Department of Laboratory Works, who went out of their way to get it fixed within an hour and a half. Thank you so much for your effort. - Ms AM Tan
tributes
your say
18
My mother had an electroencephalography test scheduled at the National Neuroscience Institute’s Neurodiagnostic Laboratory. Ms Linda Yong, Senior Medical Techologist, attended to us. She patiently explained the entire test process, as I was concerned with the condition of my mother’s skin after the last test. Ms Yong not only performed the test with confidence and care, but also shared her experiences with us, helping to correct certain misconceptions we had about the effects of the test. I am very impressed with the excellent service we received. - Mdm LH Yeo I went for hand surgery under Dr Andrew Tan recently and would like to thank the ward nurses, doctors and theatre nurses of the SGH Ambulatory Surgery Centre. A s this was my f irst surgical operation, I was very anxious and worried. But your staff did an excellent job of reassuring and calming me. One theatre nurse held my hand while an IV needle was being inserted. As someone with a fear of needles, I very much appreciated that gesture. One of my anaesthetists also went the extra mile by calling me to check if I had any side effects from the anaesthesia, and addressed some of my worries. - Mr R Mak I would like to commend Ms Lim Bee Na, Principal Enrolled Nurse, Urology Centre, SGH. She is a model nurse – very patient, well-mannered and caring. She put me at ease during my procedure, and had a smile on her face throughout. - Ms H Tan
a b o u t yo u r h e a lth e x pe r i e n c e a n d w i n a pr i z e fo r b e s t le t te r 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 a box of Kyäni SunriseTM (30 packs) and a bottle of Kyäni SunsetTM (90 softgels). The products, worth $160, are sponsored by Kyäni Singapore Pte. Ltd.
May – jun 2014
singapore health
YOUR SAY
19
20
FYI
singapore health
May – jun 2014
event Calendar
▲
5-second food rule may be real
Food dropped on the floor and picked up a few seconds later is less likely to contain bacteria than if left for a longer time, according to British researchers. An Aston University study found that there might be some scientific basis to the “fivesecond rule” – the urban myth that it is fine to eat food that has had contact with the floor for five seconds or less. The type of flooring the food is dropped on is another factor. Bacteria, the study found, is least likely to transfer from carpeted surfaces and most likely to transfer from laminate or tiled surfaces to moist foods making contact for more than five seconds.
Date April 4, Friday to June 30, Monday Venue Arts Expressions Wall, SGH Blk 2
Level 1
Cranes for longevity, flowers for new beginnings and remembrance – these were two symbols that members of the SGH Colorectal Cancer Support Group felt represented their experiences with the disease. Eighteen batik-style paintings by colon cancer survivors and patients, their carers, volunteers and staff, are displayed at SGH’s Arts Expressions Wall.
The survey also showed: of people say they would eat food dropped
87% 55% 81%
on the floor, or have already done so
of those who would or have eaten food dropped on the floor are women
of the women who would eat food from the floor would follow the five-second rule
▲
Source: Aston University
Mattress covers may not help allergies
symptoms. The results, published in the Annals of Allergy, Asthma and Immunology, found that mattress covers significantly decrease the level of dust mites in the mattress. But there was no evidence of reduced dust mite allergies, asthma attacks, or symptoms such as wheezing.
photo: getty images
Source: Georgetown University
Hospital, Women’s Tower, Level 1, Patient Education Centre, Room 1 FEE $10 per person (KKJC member); $15 per person (non-KKJC member) REGISTRATION Closes on May 2, Friday. E-mail your contact details to pec@kkh.com.sg or call 6394-1268. Visit kkh.com.sg for more details. Besides helping parents recognise the constructive things they are already doing, this workshop offers strategies to enhance parent-child relationships and raises awareness of specific parenting styles that can improve parents’ interactions with their children.
Alzheimer’s
starts at 10.30am) Venue KK Women’s and Children’s Hospital, Women’s Tower, Level 1, Auditorium Fee $8 per person (lunch will be provided) Registration Call 6394-5038 or 6394-1026 (Monday-Friday, 8.30am-5.30pm) or log on to kkh.com.sg to register. Find out how to diagnose and treat this gynaecological cancer, and learn of the screening/prevention methods available.
Strenuous exercise cuts risk of flu Doing at least two and a half hours of vigorous exercise each week – such as running, fast cycling or rugby – cuts the risk of developing flu, new research suggests. Moderate exercise, such as walking or light jogging, does not appear to have a protective effect, say researchers from the London School of Hygiene and Tropical Medicine, which examined data from its online flu study.
contest
1. How many people were on the waiting list for a kidney transplant in 2013? 2. Which story in this issue did you find the most informative? Closing date: June 3, 2014
Send in your answers and stand to win a bottle of VitaHealth Resveratrol Lifecare (60 capsules) worth $78, sponsored by VitaHealth Asia Pacific (S) Pte Ltd.
Endometrial Cancer – Catch It Before It Kills! Date June 8, Sunday Time 11am-12.45pm (pre-registration
▲
Source: BBC News
Blood test may predict American researchers have developed a simple blood test that can predict with 90 per cent accuracy if a healthy person will develop mild dementia or Alzheimer’s disease within three years. The findings of the team from Georgetown University and six other institutions were published in Nature Medicine. The results will need to be confirmed through larger clinical trials, but such a test could be used to predict the disease two to six years ahead of its onset, and may be useful in the search for treatments. There is currently no cure or effective treatment for Alzheimer’s, and occurrences are expected to double every 20 years worldwide – from 35.6 million individuals in 2010 to 115.4 million by 2050 – according to the World Health Organization.
Enhancing Positive ParentChild Interactions DATE May 10, Saturday TIME 10.30am-12.30pm VENUE KK Women’s and Children’s
▲
Expensive mattress covers make no difference in protecting against dust mite allergies, say US researchers. Scientists from the Tulane University School of Public Health and Tropical Medicine in New Orleans combined results of earlier trials on reducing dust mite exposure and preventing allergy
Art From The Heart
Source: Reuters and BBC
Include your name, age, gender, address and telephone number. Winners will be notified via phone or e-mail. Incomplete or multiple entries will not be considered. E-mail editor@sgh.com.sg Post The Editor, Singapore Health, Singapore General Hospital, Communications Department, #13-01 Surbana One, Blk 168, Jalan Bukit Merah, Singapore 150168 Winners of Contest 27: Each will receive a bottle of Spirulina 100% Extra 10% Deep Ocean Water (750 tablets) worth $69, sponsored by IMI Lifestyle Products Pte. Ltd. Prizes must be claimed by June 3, 2014. 1. Chew Chai Hoe 2. Poniah Wakee Yon 3. See Mui Leng 4. James Yeo Chin Aik 5. Jenny Yeo
Healthy Breastfed Baby Contest 2014
Date June 28, Saturday (Assessment Day) Time 9am-6pm Venue KK Women’s and Children’s
Hospital, Women’s Tower, Training Centre, Level 1 Fee $20 per child (KKJC member); $30 per child (non-KKJC member) REGISTRATION Closes on May 30, Friday. E-mail your contact details to pec@kkh.com.sg or call 6394-1268. Visit kkh.com.sg for more details. This fun-filled event is part of KKH’s efforts to create awareness of and encourage breastfeeding. Visit www.singhealth.com.sg/events or the websites of respective institutions for any changes, more information, and other listings.
MAY – JUN 2014
singapore health
21
YOUR GUIDE TO BETTER LIVING
Is it an emergency?
photo: getty images
Knowing what needs to be treated at the A&E can save money and time. More importantly, queues can be shortened, letting real emergencies be seen quickly. By Sol E Solomon that patients at A&Es experience. More worrying is that people with real emergencies might not get the urgent care they need fast enough. “We don’t turn away anyone who comes to the A&E, but some see the A&E as a sort of a GP clinic plus other services,” said Dr Poh. “Our role is to administer life-saving treatment for emergency conditions such as heart attacks, strokes, and severe injuries from accidents. We initiate treatment for acute medical conditions that require inpatient care, such as severe pneumonia and severe asthma, and life-threatening complications from haematological and oncological conditions,” she said. To make sure emergency cases are seen to quickly, nurses check patients for their vital signs and determine the priority of their treatment based on the severity of their illness – a process known as triage. A senior doctor double-checks the list to make sure the patients are assigned correctly, and those with critical conditions given priority to see a doctor. People whose conditions are not life-threatening or critical often face a long wait, and seeing their GP or family physician might be a faster and cheaper option.
Recognising an emergency Falls
Treat at home If the person is able to stand and walk a few steps, immediately or even some hours after hurting his ankle in a fall, the injury is most likely just a sprain and not a fracture. By following the RICE method – Rest (to avoid putting further pressure on the injury), Ice (to limit swelling), Compression (with a bandage), and Elevation (of the injured limb above the heart wherever possible to limit swelling). By taking oral analgesics such as Panadol to ease the pain. As in most cases, sprains and bruises will improve after a few days. See a GP If the pain, swelling and bruising do not get better or worsen by the third day. An x-ray may be needed to rule out or confirm a fracture. RUSH TO A&E If the person is elderly. It's best to err on the side of caution as many old people suffer from age-related degenerative disease, and an injury to the head or neck can lead to spinal cord injuries.
Not all injuries need the attention of A&E doctors, who can be overwhelmed by far too many cases that are not life-threatening. For example, cuts can be treated at home or at a neighbourhood clinic.
said Dr Juliana Poh, Consultant, Department of Emergency Medicine, Singapore General Hospital. In the main, cuts, even fairly deep ones, can be treated at a neighbourhood clinic. But when a serious injury is involved, especially if there is also a risk of a complication arising from the accident, it is best to go to a hospital’s accident and emergency department (A&E) quickly, Dr Poh added. Not all injuries need the attention of A&E doctors, who can be overwhelmed by far too many cases that are not life-threatening. Having to see patients who can be treated by a general practitioner (GP) or family doctor adds to the long waiting times and frustration
Dr Juliana Poh, Consultant, Department of Emergency Medicine, SGH
A visit to the A&E costs at least $108 – a subsidised basic charge that covers consultation, investigations like urine and blood sugar tests and ECG, as well as basic drugs and nursing care. Charges for other investigations such as CT and MRI scans, if they are required, are additional.
photo: zaphs zhang
a
man slipped and fell down a muddy slope in Pulau Ubin, cutting his leg. Blood began spur ting out, and he pressed down hard on the leg to stop the bleeding. But the bleeding continued. With soil and dirt likely to have entered the gaping wound, the man needed to have it cleaned and disinfected quickly to avoid infection. He was also in danger of losing a lot of blood if he didn’t have the cut stitched up quickly. “When a vein is cut, blood drips and stops quickly when pressure is applied. But when an artery is cut, blood will spurt non-stop even after pressure is applied. The person can lose a lot of blood,”
We don’t turn away anyone who comes to the A&E, but some see the A&E as a sort of a GP clinic plus other services.
At the A&E, Dr Juliana Poh (left) administers life-saving treatment for heart attacks, severe injuries from accidents and other emergency conditions.
> Continued on page 22
22
singapore health
MAY – JUN 2014
> Continued from page 21
Is it an emergency?
If the person is on blood thinning medication, as he will be at risk of serious bleeding.
If the person has high blood pressure or heart failure, or is on blood thinners such as warfarin or aspirin, as bleeding can be more serious, heavier or prolonged. If the person is elderly, because of the association of nose cancer with nosebleeds in this age group. If the person has cancer and is undergoing chemo or radiotherapy. Such treatment can cause the nose lining to become raw and prone to bleeding.
ACCIDENTAL Swallowing OF a bone
photo: getty images
Treat at home By drinking some water. Gulping rice or bread to force down a bone or small denture can worsen the injury. If the pain diminishes quickly after drinking water, it is most likely to be just a scratch or abrasion caused by the swallowed object. See a GP If the bone or object is lodged in the throat as most GPs are equipped to remove small bones from the tonsil area. Rush to A&E If there is persistent sharp pain in the throat or chest, causing difficulty in speaking or swallowing, and/or if there is blood in the saliva, or if the person feels breathless or faint because the bone or object has blocked the airways. If the object cannot be detected easily because it has moved down the throat. A nasal scope, x-ray or CT scan can help locate it.
Fever
Treat at home By taking medicine like paracetamol to lower the fever. See A GP If the fever persists for a few days even after medicine is taken. Rush to A&E If the fever persists for several days and the person also has a rash, as this can mean his blood platelet count is low. If the person has endstage renal failure and is on dialysis, or has just completed chemotherapy or radiotherapy for cancer. These patients have very low immunity and their
Elevated blood pressure, dizziness, breathlessness, and other sudden symptoms
conditions can deteriorate quckly if they have an infection. Doctors must administer antibiotics quickly.
cutS
Treat at home By cleaning the wound as quickly as possible with water to minimise contamination. By using a sterile plaster or dressing to cover the wound. See A GP To have a deep wound stitched up. A tetanus injection and/or antibiotics may be given to avoid infection. Rush to A&E If the wound is deep and open, and bleeding doesn't stop. This may mean that an artery is affected, and emergency care is necessary. If the pain is severe and/or the area around the cut feels numb, as this may mean that a nerve is affected or damaged. If the cut involves broken glass. An x-ray will show if glass fragments have entered the wound, which will have to be removed. If the cut is severe, it will have to be cleaned and stitched, and antibiotics given to avoid infection.
Nosebleeds
Treat at home By applying ice over the forehead, sucking on ice chips, and pinching the soft part of the nose for 10 minutes. Rubbing, picking or blowing the nose very hard can cause the nose to bleed further. Tilting the head backwards does not stop a nosebleed. Doing so actually makes the blood flow backwards and back into the nose. Rush to A&E If the bleeding does not stop or if nose pinching stops it only m o m e n t a r i l y. At the A&E, a procedure known as cauter y may be used to stop it. Most nosebleeds are not emergencies and for cases deemed to b e simple, A&E treatment is likely to be what can be done at home: putting an ice pack on the nose, sucking o n i ce chips, and pinching the nose hard.
Treat at home If a hypertensive person’s blood pressure is higher than normal (say, 160 instead of the usual 140) but he feels completely well otherwise. See a GP If the blood pressure remains high for several days. Rush to A&E If the person suffering from hypertension suddenly becomes incapacitated by severe dizziness. If the person with hypertension experiences chest pains, breathlessness, headache, blurred vision, vomiting, or weakness in an arm and leg, as these can suggest something more serious, such as a stroke.
May – Jun 2014
singapore health
23
Why the fuss W about flossing?
hen it comes to flossing, many people say “I’ll do it tomorrow” because they are too tired or lazy to tango with the floss, particularly before bedtime. But tomorrow – at least where flossing is concerned – seldom comes. Ms Kimberly Chim, Oral Health Therapist, National Dental Centre Singapore (NDCS) estimates that only three in every 10 people floss regularly at night. “Here, people are always in a rush. They tend to brush their teeth for only a minute instead of the required three minutes. Flossing, which needs manual dexterity, may prove too troublesome.”
It may not be everyone’s favourite activity, but flossing is vital to good dental health
Why flossing is essential But flossing, especially before bedtime, is vital. “We encourage flossing, particularly at night, to remove food debris from the day. This is because at night, saliva secretion slows down. Saliva has good bacteria that can combat bad bacteria in the mouth. Its protective function helps rebalance the PH level in the mouth, to control bacteria which damages gums and teeth.” She said brushing cleans only 60 per cent of teeth, but it does not remove bacteria and food debris from tight spots and gum pockets. Floss gets to the parts where toothbrush bristles cannot go – in-between teeth – for a thorough clean. Plaque (dental bacteria) causes gum inflammation. If left untreated, it can lead to severe gum disease called periodontitis, where gum tissue weakens and teeth loosen with the loss of the supporting bone structure. “It is very important to prevent these problems by visiting a dentist or oral health therapist at least once a year. We can also advise on the kind of floss, dental aids or brushes to use for your specific condition. We have had patients with gum disease who made big improvements after diligent oral care.”
Oral Health Therapist, Ms Kimberly Chim, estimates that only three in every 10 people floss regularly at night.
Making a start To overcome the reluctance to floss, Ms Chim recommends starting small. “Ideally, it should take two to three minutes to do the entire mouth, but give yourself five to 10 minutes when you start. “Floss your front teeth first, as they are easier to manipulate. Do one gap at a time. Once you get used to it, try another gap until you reach the back teeth. Before you know it, you’ve done the whole mouth.”
Get the technique right
Ms Kimberly Chim, Oral Health Therapist, National Dental Centre Singapore, explains the steps involved
1
2
teeth. Move it gently down in a sawing motion. Be careful not to push the floss aggressively down on the gum as it will hurt or traumatise the gum. Once bet ween the teeth, curve the floss around the tooth and gently floss the sides of each tooth. This includes using the floss to scoop
3
under the gum line, where bacteria can reside. Back Teeth 4 U s e a s i m i l a r f l o s s ing technique for back teeth. Lengthen the floss, secure both ends with the middle fingers before using the index fingers to push the middle portion of the floss upwards to fo r m a U - s hap e d
4
Tufted Dental Floss Good for cleaning braces, bridges and dental implants, it has three sections: a stiffened portion to guide it into gaps or under dental appliances; a fluf f y, spongy section, which looks thick but easily contracts and expands to clean around appliances and in wide spaces; and regular floss to remove plaque under the gum line.
Regular Floss It is not as thick as tufted dental floss. It is available waxed and unwaxed, with waxed being more popular as it is easier to use. Waxed floss does not splay or split easily when going over rough edges, compared to unwaxed ones. Dentists tend to use waxed floss in their clinics.
Flavoured Floss Gimmicky – they come in strawberry, mint and other flavours, offering a pleasant experience rather than anything medically significant.
Whitening Floss
curve. This is to help one manoeuvre it better. R e p ea t t h e ea r l i e r steps of sliding the floss between teeth and gently scooping under the gum line. 5 Do one gap at a time, and use a fresh section of floss for each gap. When flossing is done properly and gums are healthy, there should be no bleeding.
5
photos: zaphs zhang
Front Teeth 1 Cut an arm's length of floss and coil it around each middle finger. 2 A djus t t h e “ac t i ve” length to between 4cm and 5cm for front teeth, and 10cm for back ones. 3 U s i n g b o t h h a n d s , hold the floss with the thumbs and index fingers, and gently slide the floss between two
TAKE YOUR PICK OF FLOSSES
Whitening floss does not bleach teeth but gives the illusion of whitening because it is coated with microscopic abrasives that will effectively remove particles between teeth for a cleaner and brighter look. It works differently from professional whitening, and does not work any better than regular floss.
Floss Holder It is an F- or Y-shaped holder for a piece of floss. Meant for beginners, young children and those with limited finger dexterity, it is not recommended for those with misaligned teeth. Although different in form from regular floss, the flossing technique remains the same. There may be a toothpick at one end, but exercise caution, as clumsy use of toothpicks can hurt gums.
24
singapore health
May – Jun 2014
Ambushed by atherosclerosis Silent, stealthy hardening of the arteries can, without warning, cause a heart attack. By Karen Tee
T
hirty years ago, Mr Sivarajoo R Kalian was a heavy smoker who often stayed out late with his friends, eating and drinking. But in 1990, when he was 39, he made a life-changing decision out of love for his family – he gave up smoking and started taking care of his diet. “I was motivated to change my life when I realised how unhealthy my habits were and that my family was worried about me,” the 62-year-old said. His lifestyle was worrying his wife and preventing him from spending quality time with his young daughter. Little did he know that the move possibly saved his life. His general health improved steadily with the change, but three years after giving up smoking, he still suffered a heart attack – his first. An angioplasty was done to clear blockages in his arteries. Since then, he has suffered two more heart attacks – in 1996 and 2013 – and undergone multiple angioplasties and a heart bypass.
Coronary atherosclerosis is a degenerative disease which progresses with age even with a healthy lifestyle. but its progression is slower than in those who don’t look after themselves.
stages of atherosclerosis
Healthy artery
Build-up begins
Plaque forms
Dr Aaron Wong, Head and Senior Consultant, Department of Cardiology, NHCS
Atherosclerosis – commonly known as the hardening of the arteries – is still something of a mystery. Exact causes are unknown but doctors say that unhealthy habits, such as heavy smok-
photo: Zaphs zhang
The build-up in the arteries Mr Sivarajoo suffers from atherosclerosis, a disease where the inside of the arteries are blocked by plaque. When the plaque breaks away, it can form blood clots that cause heart attacks. Dr Aaron Wong, Head and Senior Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS), who treated Mr Sivarajoo, said the lifestyle changes Mr Sivarajoo made most likely reduced the severity of his condi-
tion, but unfortunately did not prevent the heart attacks. “There are many unknown factors which increase the risk of a heart attack. What we don’t know, we cannot prevent or treat. But what we do know is that if he had not changed his lifestyle, his risk of a heart attack would have been higher, and one may have occurred much earlier.”
Dr Aaron Wong (left) who treated Mr Sivarajoo R Kalian said the lifestyle changes he made, most likely reduced the severity of his condition.
Plaque ruptures; blood clot forms
ing and a fatty diet, greatly increase a person’s risk of developing it. “When plaque builds up in an artery, it narrows the artery and reduces blood flow,” said Dr Wong. Plaque builds up when cholesterol, white blood cells, calcium and other substances accumulate on an artery wall. In time, the plaque could break off, causing a blood clot. If the clot is large enough, it can block blood flow through a coronary artery and cause a heart attack.
but there is hope. A patient who takes appropriate medical guidance and is willing to modify his lifestyle can live a relatively normal life. “Coronary atherosclerosis is a degenerative disease which progresses with age even with a healthy lifestyle. But its progression is slower than in those who don’t look after themselves. If someone changes his lifestyle, it will definitely reduce his risk of a heart attack, compared to someone else who continues to live unhealthily,” said Dr Wong.
Lifestyle changes are important Those with high cholesterol, high blood pressure, or a family history of heart disease run a high risk of suffering from atherosclerosis, which typically affects men over 50 and women over 60. Smokers, diabetics and people with unhealthy eating habits run the highest risk of developing it. There is no cure for atherosclerosis,
The danger of plaque in arteries According to the Ministry of Health, coronary artery disease is the second most common cause of death in Singapore, after cancer. In 2011, it was responsible for 16.4 per cent of total deaths, slightly down from 18.7 per cent in 2010. Dr Wong said that the narrowing of the arteries can affect the body in a spectrum of ways. For a start, the narrowing
May – Jun 2014
can be so gradual that the body’s natural compensation mechanism causes small capillaries to form, bridging the blockage before the artery is completely blocked. This “natural bypass” prevents patients from having a heart attack even though an artery may be 100 per cent blocked. However, the patient may have angina – the feeling of pain or tightness in his chest during physical exertion – with the pain typically going away when he stops to rest. When the plaque build-up in the artery suddenly ruptures, platelets in the blood will rapidly cover up the rupture, leading to a clot forming, which narrows the artery further. If blood flow is completely blocked, the affected muscle loses its oxygen supply and a heart attack occurs. If the blockage is not opened within 12 hours, the muscle supplied by that artery will be irreversibly damaged. Depending on its severity, a heart attack could lead to death. Patients with atherosclerosis may show no symptoms for decades, until a sudden heart attack occurs. Treatment options Once atherosclerosis is diagnosed, there are three main forms of treatment. Medicine, such as aspirin or statins, can be prescribed to reduce the risk of a heart attack and to treat the risk factors the patient has.
singapore health
25
Atherosclerosis in other parts of the body
Atherosclerosis can occur not just in the heart, but also in any artery in the body. Peripheral arteries These are arteries in the arms and legs. Blockages in leg arteries may cause pain in the legs when walking. If the pain is bearable, the doctor may advise the patient to keep on walking through the pain, to encourage the body’s coping mechanism to build capillaries around the blockage. Limb artery blockages cause poor healing of wounds in
A stent – a metal mesh tube – can be inserted into the blocked artery to keep it open so that blood can flow through. This method is typically used in patients with less severe or complex blockages. The patient can undergo a heart bypass, in which a vein or artery is taken from another part of the body and used to create a bridge around the blockage. Heart bypasses are done in severe conditions when all three arteries to the heart are blocked, and will usually last for about 10 years or more. Those with high cho-
patients with diabetes, and opening can sometimes be detected by putup such arteries with stents or sur- ting a stethoscope to a carotid artery gery may prevent limbs from being to listen for a whistling sound with amputated. every heart pulsation. Carotid arteries The carotid arteries, which are located along the sides of the neck, supply oxygen to the brain. When blockages develop in these arteries, a stroke may occur. A blockage here
lesterol levels, high blood pressure and diabetes are advised to keep these conditions in check through proper medication, as they are risk factors for heart disease. In addition, Dr Wong advises patients who have been treated for heart disease to be particularly vigilant with their lifestyle habits and to continue with their medication, even if their symptoms go away. Reducing the risk The most effective way to reduce the risk of atherosclerosis becoming fatal is to have frequent health check-ups, as early detection is the best way to counter the degenerative effects of the disease.
Renal arteries Atherosclerosis in these arteries, which supply blood to the kidneys, causes a gradual loss of kidney function. It can lead to uncontrolled high blood pressure and kidney failure.
The best way to keep heart disease at bay is to adopt a healthy lifestyle, which includes regular exercise, a healthy diet, not smoking, and maintaining a normal weight. This will not only protect against heart disease, but also stave off a host of other health problems. Mr Sivarajoo, who is now also a diabetic, is off cigarettes, remains conscious of his diet, and stays active by taking weekly hour-long walks for exercise. He is glad that he made that life-changing decision three decades ago. He said that if he had not, he might not have been alive to see his only daughter get married in 2013.
Wide circulation that reaches over 200,000 readers Available at strategic locations Contains authoritative health care news and information Singapore Health is the official publication of Singapore General Hospital and SingHealth
Published bimonthly in a handy Group, the largest health care group in Singapore. tabloid size, the newspaper aims to raise the health literacy level of Singaporeans. Singapore Health is available at Singapore General Hospital, KK Women’s and Children’s Hospital, Changi General Hospital, national speciality centres, and polyclinics under the SingHealth umbrella. It is also available at high-traffic points within the CBD area. Singapore Health ensures your message gets across to your target audience. For advertising enquiries, e-mail Bernard Chen at bernchen@sph.com.sg
26
singapore health
May – Jun 2014
E
2014 年5 – 6月刊
新加坡中央医院与新加坡保健服务集团的双月刊
新闻
27
新技术突破肾脏移植的障碍 新疗法可帮助某些肾衰竭病人在不相容的活体捐献者中找到合适的配对 原文 Desmond Ng
肾衰竭患者体内拥有大量的 抗体时，即便有合适的器 官，移植也不会是最好的治
图： ALVINN LIM
疗选择。 新加坡中央医院的肾脏科医生制 定了一套新的治疗方案，不单可以减 少病人的抗体对捐献者的细胞产生排 斥，还可以让高抗体病人安全地接受 肾脏移植。 去年，新加坡中央医院首次为一名 30多岁的女病人进行这种移植手术。 手术后，她的情况已好转许多，也顺 利地回到工作岗位上。至今，医疗团 队仍然继续密切监测她的病情和健康 状况。 “患者的抗体水平非常高，要把 它降低非但不是件易事还很棘手。然 而，我们研发改良的治疗方案却能够 让她安全地接受移植手术，真是令我 们感到鼓舞，”新加坡中央医院肾脏 移植计划主任及肾内科高级顾问医生 纪怡胜说。 “虽然手术的成功为处于类似处境 的病人开启了新的可能性，不过不是 每个患者都能进行这样的手术，而是 在迫不得已的情况下才能进行的移植 手术，”他补充说。 末期肾功能衰竭患者必须定期接受 透析治疗，除去体内的废物和多余的 水分。 若选择肾脏移植手术，患者就必 须先找到合适的捐献者。如果没有一 个合适的活体捐献者，他就得加入轮
根据纪怡胜医生，不是每个患者都 适合接受新的治疗方案，一般是患 者在不得已的情况下才进行移植 手术。
不是每个‘T细胞交叉配 型’失败的病人都适合 接受新的移植方法。除了 病人和可能合适的捐献者 都必须符合严格的条件标 准，在手术真的可以落实 进行前，准备的路途是很 漫长的。 受益者、捐献者及他 们的家人都必须参与多次 的辅导，以确保大家都了 解和接受治疗的过程和相 关风险。 “这是个风险非常高的 程序，病人必须能够承受 风险，并对移植结果有合 理的预期，”新加坡中央 医院肾脏移植计划主任及 肾内科高级顾问医生纪怡 胜说。 病人必须有十分强健 的身体，以承受移植前的 程序，去消除体内的抗 体。在进行血浆置换时， 病人可能会产生并发症。 此外，移植器官可能 会被排斥。在这种程序 下，发生排斥的机会为 40%，相对于标准移植手 术 的 10% - 15% 。“ 在 进 行活体移植手术时，我们 却需要面对两个人的风 险，”纪医生说。
图： ALVINN LIM
当
指定人群适用 的高风险程序
在移植手术前，患者必须保持良好的状态去接受类似于透析的血浆置换疗法， 以去处体内的抗体。在这段过程中，患者也有可能会产生并发症。
候，从遗体器官捐献者中等候机会。 无论是哪种选择，为了避免移植器官 遭排斥，适合的对象至关重要。 “我们人体的细胞表面有一种被称 为人类白细胞抗原（human leukocyte antigen，简称HLA）的特殊蛋白质。 这就是决定捐献者和受益者之间的相 容性的要素，”纪医生说。 抗原是指外来的侵略者如病毒和细 菌，抗体则是能够辨认‘敌我’的保 卫者。当外来物质入侵体内时，人体 便会产生抗体来保护身体并‘对抗外 敌’。移植的肾脏也一样，会被视为 外来物质，所以才会遭到排斥。 因此展开手术之前，潜在的捐献者 必须先接受各种测试，找出与受益者 最吻合的细胞组织。“捐献者和受益 者之间的HLA差异越大，排斥器官的 风险就会越高，”纪医生说。 配对吻合的组织可以降低移植器 官被排斥的机率。除了血液和组织的 相容性外，更重要的是病人不可对捐 献者的细胞产生抗体。万一发生这种 情况，那么病人就不适宜接受移植手 术了。 曾经这位女病人就有过这样的 问题。当时，医生为她做一项被称 为‘T细胞交叉配型’的试验，结果
发现她与捐献者的细胞并不相容，只 因没有一致的HLA。 两人虽然是姐弟，可是他们的免疫 细胞组织非但不相容，还导致姐姐对 弟弟的细胞组织产生更多的抗体。在 这种情况下，若不消除抗体，移植的 肾脏遭排斥的几率非常高。
肾脏移植手术的统计数字 年份
等候肾脏 移植人数
接受遗体肾脏捐 活体肾脏捐献者人数 献的移植人数 （新加坡公民或永久居民）
2008
511
46
27
2009
460
41
28
2010
412
36
25
2011
436
36
31
2012
457
23
28
2013
424
34
34
资料来源：全国器官移植组
> 文转 page 28
28
新闻
2014 年5 – 6月刊
> 文接 page 27
C
M
Y
CM
MY
CY
CMY
K
图： ALVINN LIM
“若是以前，这类病人应该会被拒 之门外，可是在过去十年间里，不断 进步的移植医学，促使美国医疗人员 研发出新的疗法，克服这个障碍，” 纪医生说。 在新疗法的计划下，病人在 连续三个月里，每月接种一剂静 脉 注 射 免 疫 球 蛋 白 （ i n t ra v e n o u s immunoglobulin，简称IVIG）和接受 九次的血浆置换（与透析类似，通过 机器将体内的血液抽出，净化，再输 回体内），目的就是让她的抗体界限 值下降至安全水平，好让她进行移植 手术。手术之后，她还得继续接受数 次的血浆置换，将抗体水平维持在最 低限。两周后，她便出院回家了。 完成肾脏移植一年后，她的肾功 能正常，没有出现过任何重大的并发 症，也没有再产生排斥捐献者的细胞 组织的抗体。 “从研究结果来说，抗体是有可 能会再次出击的，或许是移植后又或 许是若干年后。如果真发生这样的情 况，后果通常都不会乐观，肾脏也可 能会被排斥，”纪医生说。 基于这个原因，那些接受高危风险 疗法的病人，都必须长期接受密切监 测状况。
图： JASPER YU
新技术突破肾脏移植的障碍
新血浆置换是利用机器抽出血液， 从中去处抗体，再输回体内。
姐弟温情 血虽然浓于水，但作为器官捐献者 和受益者，姐弟俩却丝毫没有那样 的缘分。 当弟弟，邱国强先生看见一直 在接受透析治疗的姐姐，与康复之 路背道而驰，他深感到姐姐应该拥 有一个正常的生活。 于是，他决定了。他要承担所 有的移植手术风险，捐出自己的肾 脏给他姐姐。 姐姐，邱淑芬女士， 38 岁。四 年前因系统性红斑狼疮疾病的并发 症而导致肾衰竭。从那开始，她就 一直在接受透析治疗。 当时，她是一名热爱教育工作 的教师，却不得不因疾病而退下职 位。更糟的是，疾病和治疗让她变 得更加疲倦虚弱，根本无法照顾两 个年幼的孩子。 “她的情况看起来很差，所以我 想只要她好起来，任何冒险都是值 得的，”35岁的邱国强说。 本来，邱淑芬的高抗体体质已 是注定要让移植肾脏遭排斥的命 运，然而一项能够消除抗体的新疗 法却可以改变这个命运。 为了巩固邱氏姐弟所作出的决 定，新加坡中央医院的医生反复的 给予忠告。 姐弟俩也接受广泛的辅导以确 定他们对手术的一切及可能包含的 风险有充分的了解。 “我们当时已经知道，如果移植 肾脏被排斥，我就必须继续接受透 析治疗，或更遭的是我可能会死在 手术台上。但我们认为，至少我们 为了改变用尽了全力，” 邱淑芬说。
邱淑芬和她的家人以及医生也 曾一起衡量过其他潜在的治疗选 项，譬如活体捐献者配对计划。 这个计划是让两对配对不成功 的捐献者和受益者进行一次‘交 换’配对，然而这却没有为邱淑芬 找到合适的移植对象。 另外，医生也想过让她排队轮 候遗体器官捐献者，可是以她的高 抗体水平来说，她的等候时间肯定 会比平均的来得更长。 依照美国的研究结果显示，若 邱淑芬接受移植五年后，她的生存 率应该是约69%，同等于接受遗体 器官捐献。 相对来说，若一名病人在交叉 配型试验中呈阴性结果，还能顺利 的通过传统式的移植手术，其生存 率将为80%。 经过多方的考虑与衡量后，姐 弟俩还是认为值得冒这风险，还希 望尽快完成手术。 对于弟弟来说，为姐姐捐肾是 件理所当然的事。“我必须这样 做。如果可以出手相助，又怎么能 袖手旁观呢？”单身的邱国强说。 就这样，邱淑芬便开始降抗体 水平治疗，直到2013年年初，移植 手术顺利完成。 目前，邱淑芬已回到了工作岗 位，时不时陪孩子玩耍，积极地过 着一般正常的生活。 至于邱国强，对健康理念也有 所改变。 他说正因为需要保护另一个肾 脏，所以必须选择一套比较健康的 生活方式。
2014 年5 – 6月刊
新闻
29
糖尿病
应付终身性的疾病
7
根据预测，到了2030年，40岁以上的新加坡糖尿病患者人数将由目前的400,000人左右， 增加多200,000人，占总人口的10%左右。由于糖尿病是无法完全根治的，因此关键在于控制病情。
胰岛素是胰腺分泌出来调节体内的葡萄糖或血糖代 谢，是人体不可或缺的要素。少了胰岛素，血糖就会 不断累积，进而造成严重的健康问题。糖尿病可分为 两大类型。第一型糖尿病通常发生于体内缺乏胰岛素 分泌的儿童和青少年身上。第二型糖尿病往往与过度 肥胖和不健康的生活方式有关。
9
种常见 症状
目前, 每9名新加坡人之中, 就有1名患有糖尿病。
真菌感染，皮肤和 生殖器官痕痒 尿频
常有饥饿感 原因不明地消瘦 视力模糊
治疗 糖尿病
如何预防第二型糖尿病：
糖尿病是一种
无法被完全根治 的终身疾病，只可通过 各种方法，例如健康饮食， 经常运动，服用药物来平衡 血糖，注射胰岛素，以及 定期监测和控制血糖，来
控制病情。
1 2 3
维持适当的饮食 除了注射胰岛素和服药， 健康饮食有助于控制血糖 水平和体重。 保持健康的体重 如果患者超重，减轻体重 可降低患上糖尿病的风险。 经常运动 运动有助于控制体重，并 保持心脏健康。
健康饮食提示
1 记得食用全麦食品 全麦食品与精制 谷类食物如白米饭 和白面包不一样， 它们含有大量的 维生素、矿物质、 纤维和具有保护 功效的植物化学物 质，比较有益健康。 2 选择富含蛋白质的 食物 选择富含蛋白 质而且脂肪和胆固 醇偏低的食物，例
如瘦肉、鱼类、酸奶、 三豆类和坚果。 3 多吃水果和蔬菜 天然低脂肪，同时 含有高维生素、 矿物质和纤维的 水果和蔬菜，是 健康的选择。 4 少用油、脂肪、 盐和糖 选择少盐、 少加糖和低脂肪的 较健康食物，并 限量喝酒。
600,000
手脚麻木 伤口愈合缓慢
预计糖尿病患者人数
2030年
40 大部分年龄超过
在2013年，新加坡有
400,000 名糖尿病患者
据世界卫生组织估计，全球有超过
347,000,000 人患有糖尿病。
原文 Denyse Yeo
信息来源： 卫生部和保健促进局
30
新闻
2014 年5 – 6月刊
建造更适合年长者 使用的设施 翻新后的芽笼综合诊疗所和新加坡中央医院新诊所， 以年长者为出发点，透过新颖设计打造方便易用的 乐龄设施 原文 JAMIE EE
芽笼综合诊疗所 翻新后的芽笼综合诊疗所已于去年五 月重新开幕。占地6,200平方米、四层 楼高的翻新工程造价六百万元，共花 了四个月来完成。 诊疗所不只换了新面貌，内部环 境更宽敞，能为越来越多的老龄病人 服务，还设立多个适合年长者使用的 设施。 新加坡保健服务集团属下的9间综 合诊疗所有超过60%的病人是40岁以 上人士，而当中30%是65岁以上的病 人。 随着人口老化和慢性疾病越见普 遍，在设计医疗护理流程和设施时都 必须以病人的需求为中心。
除了继续把重点放在预防疾病和及 早诊断与治疗上，在传授护理技能和 疾病知识教育方面，也必须投入更多 的心思和努力，尤其是对年长者及其 看护者。 为此，芽笼综合诊疗所设立了首家 老年医学中心，为患有骨质疏松症、 失智症等老龄问题的患者提供检查和 病情管理。 卫生部兼人力部高级政务部长许连 碹博士在出席重新开幕仪式时说，芽 笼综合诊疗所是个很好例子。 它响应了政府改善综合诊疗所的计 划，兴建新的综合诊疗所，致力改善 和弥补医疗保健范围的不足。
柜台改装
在一楼和二楼的主要诊室范围内设有药房和付款处。新登记处柜台、 药房和付款处柜台的高度比以前更矮，底部内凹，方便轮椅使用者与 职员沟通。另外，等候区内也划出更多空间让轮椅停泊。
有扶手的排椅
地板采用了颜色中和的 防滑地砖。等候区改用有 扶手的排椅，以便病人在 站起来时支撑自己。诊所 内的排椅也改用偏深的 颜色，让老龄病人可以更 清楚地看见它们。
新加坡中央医院的新诊所 新加坡中央医院的新诊所不但看起来 美轮美奂，在设计上更处处为年长者 着想。 刚刚投入服务的消化科与肝病中 心结合了三个普通规模的诊所，变身 成为一个庞大的门诊部。除了更换陈 旧的家具仪器之外，新设计还巧用不 同色调来发挥指引功能。譬如，职员 可以告诉病人，沿着蓝色走廊寻找门 牌，然后在门外等候。
在灯光方面，诊所改用柔和的黄色 灯光，走廊和诊室则选用明亮的白色 灯光，提高清晰照明的效果。 翻新后的L诊所（神经外科、精神 科和康复治疗）和 M 诊所（肾脏和老 年医学疾病）同样也能够找到为年长 者而设的设施。 “我们在现有的体重计旁加了张 特别的椅子，可让虚弱、无法站立或 坐轮椅的病人坐着测量体重，”诊所
护士长范丽贞说。诊所的其他设备 包括可调节高度的检查床，以及电视 屏幕。 “我们的诊所提倡病人教学，” 范丽贞说。举例说，肾病病人经常需 要在会诊前的24小时内定时收集尿液 样本。因为年长者可能会很健忘，所 以肾病专科诊所的电视屏幕上会不断 重复播放一段影片，提醒患者收集样 本的步骤。
可调节高度的检查床
诊室内设有可调节高度的检查 床，协助年长者使用。职员可 脚踩踏板来调节高度。目前， 只有翻新诊所设有这种检查 床，但在不久的将来，这种 检查床会在全院使用。
年长者适用的体重计
在体重计旁附设坐式体重计， 可让老弱、无法站立或坐 轮椅的病人使用。
不断重复播放步骤的电视屏幕
肾病病人经常需要在一天内定时收集 尿液样本来做定期测试。登记处外的 电视荧幕会不停地重播收集尿液样本 的步骤片段，提醒容易健忘的年长者 并加强他们对指示的印象。
2014 年5 – 6月刊
新闻
31
专家解答
40岁的眼睛疲劳
设施近在咫尺
彩色指南
走进接待处就会看到墙上的彩色服务指南，不同颜色代表着不同的服务， 为病人指引方向。例如蓝色代表登记处，绿色代表药房等等。
走廊两旁装了扶手，协助年长者安全步行。
为了避免老龄病人来回走动， 主要的临床服务设施位置，如 糖尿病患者的脚部检查、视网膜 检验等，都设在邻近的地方。
根据以上描述，这些是老花眼 或远视眼常见的症状。老花眼 是眼睛老化过程的自然现象， 通常在40岁左右开始。 若要改善老花眼所造成的近 点阅读困难或远距离的情况， 您可到眼镜店去配置一副阅读 眼睛或老花眼镜。 同时，许多患者都会有干 眼症的问题。如果您双眼发 红、疼痛或感觉象是有砂砾在 眼里一样，您可以在需要集中 视力时，滴一点眼药水来减轻 症状。 眼睛检验次数是没所谓严 格的指引，一般是视个人情况 而定。 例如糖尿病患者应该每年进 行一次视网膜检验，若您家族 里有青光眼患者，您就应该每 年接受一次眼睛检查。此外， 每年去眼镜店做例行检查，也 有助于确保视力健康。某些眼 科医生主张在 40岁以后，每年 检查眼睛一次。
亮眼标志
每个标志采用了大型粗字体和图案，帮助视力不佳的 老龄病人识别标志。主要的标志和目录牌也以四种 官方语言—英语、华语、马来语和淡米尔语来表达。
新加坡全国眼科中心白内障及综合 眼科高级顾问医生王振权
消化系统及肝脏疾病 中心透过设计与颜色 搭配，使病人更容易 找到目的地。
卵巢癌检查
卵巢癌有什么症状？我们可 以通哪些测试来确定是否 患病吗？ 卵巢癌并没有特定的症状。大 多数病人会抱怨腹部肿胀、过 早感到饱腹，以及出现压力 症状，如尿频、便秘和腹部或 盆腔不适或疼痛。 某些女病人甚至可能感觉腹 中有硬块，以及出现月经紊乱 或阴道出血。 女性应该注意自己是否出现 以上症状。如果它们持续超过 两个星期，或不断重复发生， 就应该求诊。 目前没有任何成熟的技术 或具有成本效益的测试能够准 确地测出卵巢癌；血清标志物 或骨盆超声波扫描可能诊断出 卵巢癌。
清晰易懂的指示
为了帮助年长者找到 诊所内的正确房间， 门牌号码的颜色和 设计都经过精心 策划，容易辨认。
年长者专用座位 和轮椅停泊处
新诊所等候室的首 排座位都被标上注明 为年长者专用的 标签。地板上也有 标识轮椅的停泊处。
图：zaphs zhang
安全步行
我 今 年 40岁 ， 患 有 大 约 300度的近视，加上散光和 远视。当我阅读、看电视或 凝望电脑或手机屏幕10分钟 时，眼睛就会感到疲倦。望 向其他地方也需要至少 30 分钟，才能看清远距离 物体。我为什么会有这样的 问题，应该怎么改善情况？ 我应该间隔多久做一次眼睛 检查？
竹脚妇幼医院妇女肿瘤科副主任 兼高级顾问医生林莹贵
32
2014 年5 – 6月刊 ADVERTORIAL