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News > Continued from page 1
Smile – no more glasses!
Excellent results So far, the procedure has a 100 per cent success rate. It is also more accurate than LASIK, which is especially beneficial to those with higher degrees of myopia, between 500 and 1,000 degrees. “This is currently the most advanced procedure available. And it only takes 30 seconds to perform the correction as this laser is extremely fast and uses very low energy, so there is less discomfort for patients,” said Prof Tan. SNEC conducted a study of 24 patients who underwent LASIK and ReLEx (one procedure in each eye) and found that more than 75 per cent of them preferred ReLEx, as there’s less discomfort during and after surgery.
Over the years as we adopt new LASIK technology – just like Blackberry phone models – the results get better. And this is where ReLEx comes in – with it, patients now see even better. Professor Donald Tan, Medical Director, Singapore National Eye Centre
Another patient who has undergone ReLEx is Ms Gayathri Manokaran, a lab researcher who opted for this procedure to correct her mild myopia and astigmatism, so she could continue to pursue her new hobby – diving. “I got my diver’s license recently, but it’s really quite futile if I can’t see underwater,” said the 31-year-old. “The procedure was so painless, I didn’t even realise it was over.” ReLEx also feels more comfortable for the patient because the suction on the eye during the treatment is gentler. “Patients are also able to see the ‘aiming beam’ better because of the gentle suction, so there is almost no occurrence of what doctors call ‘light blackout’ during the treatment as compared to LASIK,” said Prof Tan. Light blackout is a phenomenon in which the laser beam the patient is told to focus on during the procedure vanishes when the patient moves his eye. This temporary disappearance of the focal point can cause panic. However, the incidence of light blackout is dramatically
Refractive Lenticule Extraction (ReLEx)
ReLEx vs LASIK
ReLEx may be more accurate than LASIK, especially for higher degrees of myopia.
ReLEx is faster to perform than LASIK as only one laser is used.
ReLEx may be potentially reversible, while LASIK is irreversible.
1 Procedures such as ReLEx correct refractive errors (which cause myopia) by changing the shape of the cornea.
2
reduced in ReLEx procedures. The benefits of the new procedure are as clear as Ms Yap’s newly perfect vision. “I don’t have to fumble for glasses when I wake up in the middle of the night to attend to my kids. It’s such a relief! You have no idea,” she said. “I love to be able to dress up and leave the house without worrying about glasses or contact lenses,” added Ms Manokaran. What will then become of LASIK? As ReLEx becomes more widely used, it may eventually replace conventional LASIK. “Over the years as we adopt new LASIK technology – just like Blackberry phone models – the results get better. And this is where ReLEx comes in – with it, patients now see even better,” said Prof Tan. With wider use, the procedure will also become more affordable. Currently, ReLEx costs $2,500 per eye including post-operative care. Reversible treatment? Cutting out an intact piece of corneal tissue has given researchers another idea – can this myopic lens be preserved and used later in a person’s life to correct presbyopia or long-sightedness? “Let’s say, you get presbyopia later on in life after ReLEx. In theory, we can retrieve your stored myopic lens, laser away the surplus negative value on the lenses and place them back into your cornea to correct your presbyopia in one eye, essentially providing you with monovision, so one can see near again,” said Prof Tan. A team of researchers at Singapore Eye Research Institute (SERI), the research arm of SNEC, is now looking at freezing and storing discarded lenses in liquid nitrogen, a method known as cryopreservation, commonly used for storing cord blood and stem cells. So when presbyopia eventually occurs years later, a patient could choose to have his cut lens re-implanted into one of his corneas, to counteract the presbyopia and eliminate the need for reading glasses, or to modify refraction if it changes with time. SERI researchers hope to prove the reversibility of ReLEx in initial trials, which started in late 2010.
ReLEx uses a single laser to make a precise incision on the patient’s cornea.
3 The flap is lifted to laser out an intra-corneal lens matching the patient’s refractive error.
4 The lens is removed (and possibly stored cryogenically for later use) before the flap is replaced.
ILLUSTRATIONS: HEYMANS THO
“ReLEx is a natural progression from LASIK. ReLEx performs a very precise cut inside the cornea to laser out a lensshaped amount of tissue to match the degree. We then remove this lens and the myopia is gone,” said Prof Tan.
The flap will take some time to heal, but the patient feels very little discomfort after the surgery.
JAN/FEB 2011
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New tool better predicts cardiac arrest
the science of computer engineering. We’re replacing the subjective assessment of the patient with an objective and standardised risk score.” Even so, said Assoc Prof Ong: “This new triage tool cannot replace a clinician’s judgment. “Its value lies in its ability to accurately quantify the likelihood of patients suffering a cardiac arrest.” With resources such as beds, doctors and nurses being limited, giving priority to the critically ill is key. “If I have two very sick patients that need an intensive care bed, and I only have one such bed left in the whole hospital, who should get it? If for one patient, the tool indicates a risk score of 70, and the other scores a 40, then it is clear which patient should have higher priority to get the
PHOTOS: ALECIA NEO
identify 40 out of 100 patients for urgent care correctly. Now, there is a more accurate test developed by a team of clinician-scientists and researchers from Singapore General Hospital (SGH) and Nanyang Technological University (NTU). The team’s study found it to be able to identify 67 out of 100 patients who needed urgent, crucial care correctly. “Our tool is 50 per cent more accurate in assessing a patient’s risk of cardiac arrest,” said Associate Professor Marcus Ong, Director of Research and Senior Consultant, Department of Emergency Medicine, SGH, and inventor of this tool. The tool uses electrodes that are attached to the patient’s arms or chest, to track signals from the heart, including heart rate variability. The information is transmitted to a machine where it is recorded, and then analysed in combination with other risk factors such as age and blood pressure. Co-inventor and Associate Professor at NTU’s School of Electrical and Electronic Engineering, Lin Zhi Ping, said: “This device combines the art of medicine with
Electrodes track signals from the heart, then combine the results with other risk factors to help medical staff assess a patient’s risk of cardiac arrest.
The Pulse Classic or Mai Jing. In it, he described pulse positions and established 24 different types of pulse. He wrote: “If the pattern of the heart beat becomes as regular as the tapping of a woodpecker or the dripping of rain from the roof, the patient will be dead in four days.” But because calculating heart rate variability involves a number of complex mathematical formulae, its clinical application in evidence-based medicine has been limited. It is only some 2,000 years later that researchers at Singapore General Hospital and Nanyang Technological University have been able to incorporate realtimse heart rate variability into an effective clinical-decision support tool.
The risk
of a regular heart pattern Heart rate variability is the change in time interval between heartbeats, from beat to beat. Since ancient times, decreased heart rate variability – or when the heart beat pattern is unable to adapt to stress or illness – has been associated with an increased health risk. Wang Shu He, the military doctor to Cao Cao’s army in the Western Jin dynasty, published a book known as
resources,” said Assoc Prof Ong. To test the new tool, the team used the data of 425 patients who were seen at SGH A&E for heart-related complaints between November 2006 and December 2007. The new tool correctly identified 70 per cent of patients who suffered a cardiac arrest. Up to 500 patients are seen at the SGH A&E every day. Often about half of them have acute cardiovascular symptoms, such as chest pains, and stand to benefit from this tool, which will help to identify those at risk of severe consequences, such as cardiac arrest. The SGH-NTU team is working with a commercial partner to develop a prototype and start a clinical trial to validate the initial findings. “Currently, the tool is a software installed on a laptop. But carrying a laptop around is not very convenient. So we’re aiming to build it into a small box,” said Assoc Prof Lin. Eventually the tool can be used not just in A&Es, but also in high-dependency wards, nursing homes and even disaster zones.
If for one patient, the tool indicates a risk score of 70, and the other scores a 40, then it is clear which patient should have higher priority to get the resources. Associate Professor Marcus Ong, Director of Research and Senior Consultant, Department of Emergency Medicine, Singapore General Hospital
“This tool can be used to identify those disaster victims who need to be evacuated to more specialist facilities,” said Assoc Prof Ong. The SGH-NTU team presented their data at the SingHealth Duke-NUS Scientific Congress and at the American Heart Association’s Scientific Sessions in Chicago, Illinois. The research was funded by grants from SingHealth Foundation and NTU.
Associate Professor Marcus Ong, Director of Research and Senior Consultant, Department of Emergency Medicine, Singapore General Hospital (SGH), has long been involved in research to improve the access to and the delivery of acute care. Last year, he led a team to look for patterns in 995 calls. Analysing thousands of emergency calls, the team found that Mondays had the highest number of calls. This number gradually dipped as the week progressed. The researchers also found that the number of calls made during the
day almost doubled that made at night. “This may be related to diurnal patterns of the body and hormone activity levels that trigger medical events,” said Assoc Prof Ong. The highest number of emergency calls came from the densely populated eastern part of Singapore, while the neighbourhoods in greatest need of an ambulance were in the north and northeast. This research was published in Annals Academy of Medicine in 2009. Since then, Assoc Prof Ong has led another study to test a simple, low-cost change in ambulance deployment. The
PHOTO: ALECIA NEO
Spotting a pattern
Assoc Prof Ong found patterns in 995 calls that can improve ambulance deployment.
team gradually increased the number of ambulances on standby during the day and reduced the number working overnight, when a smaller number of emergencies are reported. They also spread the locations where ambulances were stationed to cover a wider area. They discovered this significantly reduced the response time of ambulances to calls relating to patients suffering cardiac arrests. Cardiac arrests are usually fatal if patients are not promptly resuscitated and given appropriate medical care. The team published its findings in Academic Emergency Medicine Journal in September 2010.
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Jan⁄ FeB 2011
News
A word of warning
A three-cent drug may save you more than a headache
Although Dr John Chia, Consultant, Department of Medical Oncology, National Cancer Centre Singapore hopes to see more Singaporeans come forward to participate in this trial, which aims to recruit more than 2,600 patients from around the region, he strongly warns against taking aspirin to combat colorectal cancer without medical supervision because: Unmonitored consumption of aspirin can cause stomach ulcers or bleeding from the gastro-intestinal tract. Those who have an allergy to aspirin will have negative or lifethreatening reactions. Patients who are already on anti-coagulants such as Heparin and Warfarin for the treatment of heart diseases, and individuals who have a high risk of bleeding, cannot take additional anti-coagulants.
Cancer specialists hope to prove that aspirin reduces relapse rates for colorectal cancer
BY Jacqueline Chia
Two thousand years ago, Hippocrates, the father of medicine, called willow tree bark, a medicine capable of curing all maladies. While not quite living up to Hippocrates’ ambitious boast, the plant, or more accurately the salicylate-rich extract from which aspirin is made, has been proven to fight aches and pains as well as more serious conditions such as strokes and heart attacks. Now doctors are putting aspirin, a threecent tablet, to the test to stop colorectal cancer from coming back. Colorectal cancer, which affects around 1,500 people a year in Singapore, is caused when polyps in the intestines grow significantly and become cancerous. Even after surgery and chemotherapy, these polyps can regrow and may become cancerous again, which is why the cancer returns for 30 to 40 per cent of patients. “Aspirin and its class of drugs have been shown by robust clinical trials to reduce the onset of polyps by quite a significant degree,” said Dr John Chia, Consultant, Department of Medical Oncology, National Cancer Centre Singapore. “That means aspirin can prevent the precursor lesions (polyps) of colorectal cancer.” Other studies suggest an even more direct link – that aspirin can actually reduce the number of recurring colon cancer cases. “Researchers at Harvard have carried out studies looking at groups of patients who either were or were not taking aspirin. Those colon cancer patients who took aspirin
halved their risk of the cancer recurring, as well as their risk of dying from it,” said Dr Chia. But because these studies are not clinical trials, and the researchers did not actively intervene and assign the patients under observation to take aspirin, there is insufficient grounds to introduce this use of aspirin into clinical practice. “To change clinical practice, you need to do a trial like we are doing, and ours is the first in the world,” said Dr Chia, who with his team is driving the collaboration with hospitals around the region. “We are quite excited. If we succeed, we would really have done something to help people who suffer from colorectal cancer. Not just in Singapore or in firstworld countries, but also in developing nations since aspirin is relatively inexpensive,” said Dr Chia.
Aspirin and its class of drugs have been shown by robust clinical trials to reduce the onset of polyps by quite a significant degree. Dr John Chia, Consultant, Department of Medical Oncology, National Cancer Centre Singapore
Aspirin may be key to preventing the recurrence of colorectal cancer.
After surgery to remove the cancer and completing chemotherapy, suitable patients are asked if they would like to participate in the trial. Patients who consent will be randomly assigned to either receive aspirin or a placebo for three years. The team will closely monitor patients’ health and wellbeing. Rather than being discouraged by the possibility of receiving a placebo, even pa-
tients on a placebo have been found to fare better than those not participating in clinical trials, said Dr Chia. This is attributed partially to the diligent health monitoring that clinical trials require. “If you miss a follow-up, you’ll get a call from us immediately,” said Dr Chia.
Manage your osteoarthritis Viartril®-S provides effective pain relief for sufferers What is osteoarthritis? Also known as degenerative arthritis, this painful condition affects most joints and is caused by the breakdown and eventual loss of the articular cartilage lining the joint surfaces, resulting in the bones grinding against each other and formation of bone spurs. The articular cartilage is a soft tissue buffering between bones of the joints and serves as a shock absorber. As one grows older, this cartilage degenerates from wear and tear, resulting in pain at the affected joint/s. By 2030, 19 to 26 per cent of Singapore’s population over 60 is likely to suffer from osteoarthritis of the knee.
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Cycling for cancer
by paying tuition fees for the patients’ children, for example. Now in its second year, Cycle of Hope was the brainchild of Prof Ooi, and is part of OCBC Cycle Singapore, thanks to the generous support of OCBC and Spectrum Worldwide, the organisers of the event. Cycle of Hope gathers cancer survivors and their supporters for an event which shows cancer survivors can live life to the full. Last year, some 500 participants showed their support. This
Charity cycle ride aims to raise awareness and funds
Instead of roaring F1 cars tearing around Singapore’s Grand Prix route, some 1,000 cyclists will be pedalling a 4km loop of the street circuit on March 6 to celebrate life after cancer. The event, Cycle of Hope, aims to heighten awareness of cancer and how it affects not just patients, but also their families and friends. “A cancer patient’s journey is like a cycle ride,” said Professor London Lucien Ooi, Chairman, Division of Surgery, Singapore General Hospital, and Advisor, National Cancer Centre Singapore (NCCS). “Their journey has ups and downs, easy and difficult parts, but there is always a goal to reach. The bicycle, in a way, represents the patient’s supporters – the healthcare providers, caregivers and family – who carry and accompany the cyclist through it all, however tough the journey may be.” Besides awareness, participants are
encouraged to get sponsorship from friends and family, which will go towards the National Cancer Centre Research Fund. This fund is used to support research projects as well as families of cancer patients,
Cycle of Hope Date: March 6, 2011 Flagoff: 9.45am Register: www.ocbc.cyclesingapore.com.sg Prizes: The 50th registrant wins a bicycle worth more than $300, donated by Lianhe Zaobao Executive Photographer Lee Keng Siang.
PHOTO: OCBC Cycle Singapore
By Nicole Lim
year, organisers are hoping to double that number. “I was there last year with colleagues, supporters and friends from NCCS. The Pink Paddlers were also out in their best shocking-pink outfits, and we hope to see them and many more again this year,” said Prof Ooi. Cycle of Hope is one of many activities organised by NCCS to raise funds and awareness. In November 2010, some 7,000 people took part in the Run for Hope, raising more than $320,000 for the National Cancer Centre Research Fund.
Information at your fingertips From directions to a full listing of doctors, visitors at CGH can access it all on the go By Jessica Jaganathan
Instead of feeling bewildered by a complex hospital layout, visitors to Changi General Hospital (CGH) can now whip out their smartphones, punch in their destination and a life-like 3-D version of the hospital pops up, guiding them to their destination.
PHOTO: Tan Wei Te
The kiosks have been custom-made for wheelchair users.
They can also access this information as well as a directory of specialists via self-service kiosks, located at the entrances to the wards and the Accident and Emergency Department at CGH. The interactive touch screen uses a “way-finding system” to guide visitors to their destination, said Mr Liew Choon Leng, project manager of the 2m-tall 3-D kiosks. Visually realistic, routes are scaleddown dimensions of the hospital, with colour coding cues and floor patterns replicated to make it easier for users to find their way through the hospital. Since its introduction in September 2010, more than 100 patients and visitors have used the system to access directions or look up specialists. Twenty-five-year-old Muhammed Rohani was impressed with the user-friendliness of the kiosk. “It’s easy to understand and the colour characteristics are good, like a computer game,” said the civil servant. At a touch of the screen, visitors can find the nearest doctor’s office, specialist clinic, food court or toilet in four languages – English, Chinese, Malay and Tamil. The kiosks come with two screens, with the lower half appearing at a height appropriate for wheelchair users. The routes mapped out for wheel-
chair users will include taking the lift, instead of escalators to get to their destination. “We have two command screen menu options, one comfortable for standing and one reachable for wheelchairs, which is quite popular,” said Mr Yen Tun I, Assistant Director, Department of Facilities Planning and Development, CGH. “Other features you can find at the kiosk are advertisements. They allow for promotions to be featured, such as pharmacy promotions and announcements of
At a touch of the screen, visitors can find the nearest doctor’s office, specialist clinic, food court or toilet in four languages – English, Chinese, Malay and Tamil.
public forums,” said Mr Liew, who is also Principal Systems Analyst, Information Services, CGH. Two more kiosks will be added this year and will likely be located in the basement near the hospital’s carpark and at a high-traffic area.
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Traditional treatment for a modern problem A new study aims to find out if acupuncture can help men with fertility problems
they are not active enough – acupuncture may be an alternative for couples trying for a family. According to traditional Chinese medicine, commonly referred to as TCM, subfertility is caused by a deficiency of what it refers to as the kidney function. Using herbal remedies and/or acupuncture to strengthen this vital function can help improve the production and quality of sperm. Although there have been studies, “we don’t really know how effective acupuncture is in treating male subfertility”, said Dr Yong Tze Tein, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH). This is because despite its growing popularity, TCM isn’t as well researched as western medicine, said Ms Cui Shu Li, Senior Principal Acupuncturist, SGH. For instance, studies elsewhere in the use of acupuncture to treat male subfertility show positive results, but they can’t clearly isolate acupuncture as the sole cause of the improvement. To explore acupuncture as an alternative for men with certain fertility problems, SGH has teamed up with Singapore Thong Chai Medical
Couple therapy When a couple remains childless after years of trying, the woman is often thought to be the cause. However, blame should be apportioned equally, as about a third of cases is due to the man, with an equal portion attributed to female problems or to problems in both partners. Another 10 to 15 per cent of cases have no known cause. The modern lifestyle, food, environment and late marriage may contribute to difficulty in conceiving in both men and women. Anecdoctal evidence suggests that male subfertility is increasing. “The impression is that sperm quality is deteriorating,” said Dr Yong Tze Tein, Senior Consultant, Department of Obstetrics and Gynaecology, SGH.
A medical technique unique to TCM, acupuncture, with a history of more than 2,000 years, uses sterile silver needles inserted at various acupoints in the body to stimulate blood circulation, regulate the qi and blood, and restore the body’s balance. Bai Hui Guan Yuan
Qi Hai
Zu San Li
San Yi Jiao
Gui Lai
Tai Xi
Tai Cong Shen Shu Ci Liao
PHOTOs: alecia Neo
When it’s a problem with sperm – either what’s produced is insufficient or
Institution to study whether using acupuncture is as effective as earlier studies suggest. The institution already treats men with fertility issues using a combination of acupuncture and herbal concoctions with some success, said Mr Chong Shaw Fong, Chief TCM Physician, Singapore Thong Chai Medical Institution. In the joint trial, eligible participants will undergo 20 hour-long sessions of acupuncture treatment, held twice a week for three months. The participants won’t be given other forms of fertility treatment during this period. During treatment, a TCM physician or acupuncturist certified by the Ministry of Health will administer acupuncture
Needling points
Ms Cui Shu Li (right) and her team embarked on a study to explore the efficacy of acupuncture in treating male infertility.
For that reason, it is not just the wife who will be tested when couples seek treatment at SGH’s Centre for Assisted Reproduction (CARE), said Ms Amy Lee Shaw Ni, CARE’s Chief Embryologist. “It is extremely important in the evaluation of subfertility to consider the couple as a unit in evaluation and treatment.” However, in most cases, the men aren’t keen to step forward and most of the initial tests are done on the wives, she said. The good news is that this trend is slowly changing. Should the husband be found to have for instance, a low sperm count, reduced sperm movement, or too few sperm of normal form and shape, there are currently limited treatment options available. Some men are amenable to hormonal treatment, while some require surgical retrieval of sperm for in vitro
fertilisation (IVF). But for a large majority of men, the cause is not known and that limits management. It could be genetic, but certain lifestyle factors like smoking can play a role. IVF is an option in the treatment of subfertility for both men and women – but the procedure where the woman’s egg cells are fertilised by sperm outside the body and then implanted in the womb, costs about $10,000 and success is not assured. The possibility of conception varies greatly, depending on the age of the female partner. Pregnancy occurs in up to 40 per cent of women below 34 years old, and less than 15 per cent of women older than 40. So for young couples who are not ready for IVF, acupuncture might be an attractive alternative.
illustrations: heymans THO
BY Vishwesh Iyer
to several acupoints at the front and back of the body, with the points electrically stimulated to strengthen the kidney function. In TCM, the kidney is considered vital for procreation, with the kidney function seen to be governing the body’s reproductive organs. The trial, funded by a government grant, will continue till 2012. The researchers hope to study at least 60 eligible participants. Semen samples will be taken before, during and after the acupuncture treatment to assess the participants’ response to the therapy. Participants can receive treatment at SGH, during working hours, or in the evenings at Singapore Thong Chai Medical Institution. Men between 21 and 55 years of age who meet a certain sperm count and activity criteria, who have been unsuccessful in conceiving for at least a year, and have not undergone surgical procedures related to male fertility for at least a year before, can apply to participate in this trial. To participate in the SGH-Thong Chai Medical Institute TCM trial or for more information, call 6326-5925.
During treatment, you will receive acupuncture to these points to unblock the body’s energy flow.
TCM believes illness occurs when the body’s qi movements are blocked, disrupted or unbalanced, and that it can be cured by adjusting these imbalances back to normal through therapy that includes herbal remedies, acupuncture or exercise. Qi, loosely defined as the body’s energy flow, is supposed to circulate in the body’s channels known as meridians. “The patient might experience soreness, heaviness, some tightness or numbness when the needle is inserted,” said Ms Cui Shu Li, Senior Principal Acupuncturist, Singapore General Hospital (SGH). During and after acupuncture, patients might also experience swelling, mild palpitations or bruising. Some patients – less than five per cent – might have unusual symptoms like bleeding, pain or fainting that are temporary and go away quickly.
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News
Bug fixers Sometimes, the simplest ideas make huge differences to the lives of both patients and staff BY Thava Rani
Many improvements made in SingHealth hospitals are the result of enterprising staff spotting and addressing a problem. These changes are often to the advantage of patients too, as these two projects show.
PHOTOS: Vee chin
Sunday walk It was Monday, just two days after surgery on his knee, and Mr Sreekumar Pillai was still in pain. Yet, he was sent to the gym for a second day of walking and other exercises with a physiotherapist. Mr Sreekumar, who was injured in a soccer game in his 30s, was taught exercises to improve breathing, circulation and mobility. As the diseased or damaged portion of his knee joint had been replaced with metal and plastic implants, the 52-year-old aircraft technician was also taught techniques to strengthen the knee and increase the range of movement. “The first two days after surgery are crucial (for recovery),” said Ms Ong Peck Hoon, Principal Physiotherapist, Department of Physiotherapy, Singapore General Hospital (SGH). Patients who receive knee replacements are mostly in their late 60s, suffering from severe osteoarthritis or a knee injury sustained when they were younger. It is important they start physiotherapy as soon as possible to reduce swelling and pain, and post-surgery complications such as deep vein thrombosis and bedsores. They also need to learn to walk again.
“When the patient has been guided to walk a couple of times, he will feel more confident, and will then be more keen to walk on his own, for example, to the toilet with assistance (instead of using a bedside commode or wheelchair). This will help him recover faster,” she said. Certainly, Mr Sreekumar was glad to do the exercises. “If you don’t see the therapist, you most probably wouldn’t move as you don’t know what you should do,” he said. While the principle to get patients up and about quickly is well understood, it is not possible for some patients to start physiotherapy the day after surgery or for them to have uninterrupted daily sessions, as there are no regular physiotherapy services on Sunday. Patients who undergo surgery on Friday or Saturday, thus, face a gap in this service. Mr Sreekumar, for instance, had surgery on Saturday and would have started physiotherapy only on Monday. A challenge by the late Dr Wong Yue Sie, who was SGH Chief Operating Officer, to make services more accessible to patients, prompted
physiotherapists with the Department of Orthopaedic Surgery to look into this issue. In October 2009, the team started a fourmonth Sunday physiotherapy pilot programme for patients who underwent total or partial knee replacement surgery on Friday or Saturday. Ms Ong led the team, which included fellow physiotherapists, Dr Pua Yong Hao and Ms Chong Hwei Chi, and Dr Lo Ngai Nung, Senior Consultant, Department of Orthopaedic Surgery, SGH.
If you don’t see the therapist, you most probably wouldn’t move as you don’t know what you should do. Mr Sreekumar Pillai, 52, patient
The team compared the results of the programme with data from the same four months a year before, and from the four months before the pilot programme, and found that patients in the pilot programme who had the benefit of Sunday physiotherapy generally recovered faster and were discharged earlier (after four instead of five days). Patients discharged a day earlier saved on charges for an additional day. Early discharge also increased bed availability. The project received the best oral presentation award (Allied Health category) at this year’s SingHealth Duke-NUS Scientific Congress, which
Ms Ong helps patients overcome their fear of moving, especially on the first day after surgery, when there is a lot of pain and swelling.
The CGH team developed appetising recipes such as fruity soy shakes for patients with swallowing difficulties.
gathered some 2,000 scientific and medical professionals from SingHealth and overseas to exchange ideas, and learn best practices. More importantly, patients who undergo knee replacement surgery on Friday or Saturday benefit from having access to a physiotherapist on a Sunday. “We are seeing some spine surgery patients as well now. Plans are underway to eventually expand the service to include patients who are likely to benefit from early intervention, such as patients who have undergone hip surgery,” said Ms Ong. Tasting right People with swallowing difficulties often have to put up with unappetising, thickened fluids to maintain a healthy weight. Not surprisingly, Changi General Hospital (CGH) found that more than 70 per cent of these patients disliked the otherwise nutritious concoctions so much, they wouldn’t eat enough. As a result, they became malnourished or ended up back in hospital. To tackle this problem, a team of dietitians and speech therapists cooked up some 60 recipes, using natural foods to thicken the special liquid diets. The recipes, such as fruity soy curd shake or thick spinach soup, are easy to prepare at home. Families who buy commercial powders can save more than $100 a month if they use CGH recipes instead. Since CGH introduced the recipes, more than 70 per cent of patients now eat enough. With patients eating better at home, repeat hospital visits are down and caregivers also feel more confident that they can look after them. To further improve the care these patients receive, the two departments set up a joint clinic. “We thought a combined approach of reviewing malnourished patients with swallowing difficulties would make it easier for patients, who would have to spend less time waiting (for two separate appointments), and for dieticians and speech therapists (who can make a joint assessment of their needs right here),” said Mr Alvin Wong, Dietitian, Department of Dietetic and Food Services, CGH. In the pipeline is a DVD to train caregivers after patients are discharged, as well as a specialist clinic to attend to such patients. Their efforts have won several awards, including the Asian Hospital Management Award for Departmental Service Improvement and a handful of awards from the CGH Quality Convention Forum.
FACTS Our tendons... Our body’s rubber bands By observing the diagram of the human body on this page, we can easily recognize all the space that our muscles, ligaments and tendons occupy. The tendon is composed of thick, white fibres of collagen that are held tightly against one another. These fibres are made up in large part by collagen. Our ligaments act like a connection between the bones. Our tendons act like ties to our internal structure for our muscles and our bones. The tendons and the ligaments of our body act like rubber bands of different sizes. Since our tendons are used to bind our musculature to our bones, and to maintain elasticity and suppleness, our tendons necessitate a large amount of collagen, particularly after an injury or from aging.
Why collagen is better than glucosamine? In the composition of cartilage we find 67% of collagen versus 1% of glucosamine. Glucosamine is an aminosaccharide contrary to collagen which is a molecular complex containing amino acids. Glucosamine is found in interesting quantities only in the liquid of the synovial membrane. Collagen is also found in the synovial membrane but in larger quantities because the protein structure is more abundant in the body. Glucosamine acts more like a lubricant in the joints while collagen contributes to the global regeneration of the joint at all levels: tendons, ligaments, cartilage, muscles, membranes and synovial liquid (lubrification).
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We hear you
Fasting before a blood test Why do I need to fast overnight before a blood test? Will patients taking tests that require fasting be given priority over others? Blood tests are done to check for pregnancy, diabetes, cholesterol and vitamin and mineral problems. There are two main groups of tests that require fasting – blood sugar and lipids tests. Some examples include those measuring levels of blood glucose for patients suffering from diabetes, and triglyceride levels for heart patients. During the day, the normal range of blood sugar and lipids undergoes changes, depending on the ingestion of food and drink. For instance, the concentration of triglycerides – a type of fat in the blood that is often tested as an indicator of heart health – increases after a meal. The effects of a meal on the levels of certain chemical substances in the blood can be felt even after 12 hours. So by fasting overnight, a blood test result will not be influenced by a recent meal. Certain food components can also interfere with the analysis of some types
of tests. For example, a meal rich in fats can cause cloudiness in a blood sample, which might compromise the accuracy of the laboratory analysis. Most of these food-related changes are temporary and can be controlled by a simple overnight fast. About 80 per cent of the tests done every day at SingHealth polyclinics require fasting. Therefore, patients
who are not required to fast are recommended to go for their tests in the afternoon when the polyclinics and SGH specialist outpatient clinic laboratory are less crowded. They should also avoid the day before and after a public holiday when more patients are expected to turn up for tests.
to callers. This is not a general healthline that provides automated or pre-recorded information. In order to bring this service to you, the hospital needs to maintain a whole range of facilities and provide staffing and resources, which incur operating expenses. The charge of 80 cents a minute is meant to cover only some of these costs, so we can continue to maintain this service for our patients and members of the public who need to consult us urgently. The average duration of a call is about 3 to 5 minutes, and costs approximately $3 to $4.
- Department of Pathology, Singapore General Hospital
Pay for advice?
I needed to call KK Hospital for advice when my baby was running a high fever. A friend of mine suggested that I call KK-Ask-A-Nurse, but she also told me that I would be charged 80 cents a minute. Why are these calls charged at a premium rate? KK-Ask-A-Nurse is a telephone advisory service for women and parents who seek reliable expert advice on issues related to pregnancy, gynaecological care and children’s health. The service is available from 8am to midnight every day of the week, including public holidays. The service is manned by experienced and trained nurses, who provide advice
- Associate Professor Ng Kee Chong, Deputy Chairman, Division of Medicine, KK Women’s and Children’s Hospital
Do you have questions about hospital admissions, bills and procedures? E-mail us at editor@sgh.com.sg and we will address them in this section.
from the heart
Tributes
Age is no barrier
I was admitted to SGH Ward 58 for a traffic-related injury and would like to thank the doctors and nurses for their kindness, help and care. The room I was in was also very clean and tidy, thanks to the hardworking cleaner who mopped and cleaned the room in the morning and afternoon. I had a pleasant stay in this ward. - K Kuo
Hira Lal Parsad, Patient Relations Officer, Changi General Hospital, 62, spent the last 41 years (working) in a hospital
How would you describe yourself? I’m careful. I love hygiene and good grooming. I like to smile. I’m courteous and polite. I also like to greet and help people. My uniform is my pride – I always keep it pristine, my shirt crisp and white, and my shoes freshly polished and shiny. Is this something you’ve always wanted to do? I’ve always wanted to help people. I started working for the Thomson Road hospital on July 14, 1969 – 41 years ago! I then worked for the old Toa Payoh Hospi-
tal, and in 1996, I joined Changi General Hospital. During this time, I worked in security, as an ambulance driver, in medical gas supply, and finally as a patient relations officer, a post I’ve held for the past 20 years. I love this job. If I could, I’d work another 41 years for this hospital! We hear you speak many languages… I speak six languages: English, Malay, Chinese, Punjabi, Hindustani and Tamil. Patients are always very happy and surprised when I speak to them in their native language. Sometimes, I act as an interpreter for doctors and patients at the clinics. What is the secret to success in your position? You must willingly do it. Never say no before you’ve tried something. Also, a lot of patience, acceptance and tolerance is needed. Accept the things you cannot change and work out how you can manage your responsibilities and patients’ needs. Never say no. Always try to find a way to do it.
PHOTO: Tan Wei Te
What exactly does a patient relations officer do? As part of the Concierge team, I guard the premises, ensure the safety of the patients and staff, and escort VIPs when they visit. I also attend to warded patients who become violent, and help patients who come to the information counter, often assisting them to their destination. My job is to wait for patients too, helping them from their vehicle and into a wheelchair or onto a trolley.
Always establish and maintain eye contact and greet visitors sincerely, no matter how old or young they are. What are some challenges of your job? Being assaulted by patients and visitors. I was once punched in the face by a drunk visitor. Off-duty police officers nearby arrested him straightaway. The other incidents involved patients on the wards who turned violent. One attacked me wielding a standing fan. But I stepped back, remained calm and let my colleagues restrain them. I tell myself that they are patients and are unwell.
Dr Lim See Lim from National Heart Centre Singapore provided advice on my condition, he was always ready to comfort and encourage me. He was a very helpful and friendly doctor who displayed professional and excellent skills. - Y T Tan On the fourth day after my bypass, I was given sugar lactose and experienced trouble with my bowels. Ms Pedrola Rolyn Almeria from National Heart Centre Singapore brought me to the toilet immediately and helped me undress. She gave me clean trousers and attended to me extremely well. She respected me and was very attentive. She was polite, caring and helpful. - N P Naidu
Jan⁄ Feb 2011
Health
Watch that blood pressure
p16 Fitness Pregnancy fitness
p17 Beauty
What labels tell us
Keep out of children’s reach There are specific medications, mainly prescription-only drugs that are poisonous for young children. “We’ve seen very young infants at A&E who had intermittent breathing (known as apnoea) after being given ‘flu’ medications like chlorpheniramine (a type of antihistamine),” said Associate Professor Ng Kee Chong, Senior Consultant and Head, Department of Emergency Medicine, KK Women’s and Children’s Hospital.
Do you really know what you’re using to medicate your kids? By Jessica Jaganathan Almost half the parents surveyed by Australian researchers said they might have given their children the wrong dose of common overthe-counter drugs, putting their children’s health, and even lives, at risk.
Camphor Pure camphor cubes are sold packaged like sweets in Indian shops for religious burning
Anti-arrhythmics Medicines used to treat heart rhythm disorders Methyl salicylate Found in wintergreen oil and musclepain relief products
Theophylline A drug used to treat respiratory diseases such as asthma Antipsychotics Tranquilising psychiatric medication
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Deadly doses
While parents here are more careful when giving such medicines to their children, a paracetamol overdose is still among the top three most common drug-related emergencies seen at KK Women’s and Children’s Hospital (KKH) Accident and Emergency (A&E) department. Apart from paracetamol, other drugs commonly given in the wrong doses include ibuprofen to bring down a fever, as well as cough and runny nose medication, said Associate Professor Ng Kee Chong, Senior Consultant and Head, Department of Emergency Medicine, KKH. “Over-the-counter medications will have been approved by regulatory authorities such as Health Sciences Authority, and are by nature relatively safe, if taken as instructed,” said Assoc Prof Ng, who is also co-chair and member of the Ministry of Health’s Clinical Practice Guidelines on Toxicology. But confusing instructions are still among the leading causes of medication error, according to overseas studies. Others include lack of dispensers and varying units of measurement. “Also, children grow and what was effective for a younger child may not be enough when he is older and heavier,” said Assoc Prof Ng.
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Oral hypoglycaemics Anti-diabetic drugs
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Calcium channel blockers Used to treat conditions like high blood pressure
kill a
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Antidepressants Antimalarials Drugs used for the treatment of malaria
Narcotics Addictive drugs used to reduce pain and usually to induce sleep
One way for parents to prevent children from taking an overdose of medication is to have only one person responsible for administering medication. “Otherwise, too many cooks may spoil the broth,” said Assoc Prof Ng. Giving different medicines at the same time might lead to an accidental overdose and parents should check the active ingredients to make sure they aren’t the same before doing so. More is not necessarily better either.
A spoonful of what? A spoonful of cough syrup can mean different things depending on where in the world you are. Dose/Country
United Kingdom United States
1 teaspoon
3.55 ml
4.9 ml
1 tablespoon
17.7 ml
15 ml
“Oral medications usually take about 30 minutes to an hour to work. Giving more will not result in the medication working faster,” he said. Potential side effects vary according to the dosage given and the type of medication. For example, while the effects of taking an overdose of runny nose or cough mixture may be felt in four to six hours, liver failure caused by paracetamol poisoning will not occur until two to three days later, said Assoc Prof Ng.
In Singapore, parents have to be aware that when doctors talk about dosages for children, they usually refer to the number of milligrammes the child needs – not millilitres – as concentrations of drugs vary between brands and the former provides a more accurate dosage, said Associate Professor Ng Kee Chong, Senior Consultant and Head, Department of Emergency Medicine, KK Women’s and Children’s Hospital. These dosages are normally calculated based on the milligrammes of medication required per kilogramme of the child’s weight.
If an overdose of medicine is taken accidentally, children should be rushed to the hospital where doctors will first make sure the child’s vital signs, breathing and circulation are stable, and his airway is clear. They will then try to minimise the absorption of the medication into the body by pumping the stomach, inducing the child to vomit or giving oral activated charcoal. If the medicine is absorbed into the bloodstream, an antidote will be given. When in doubt, parents should consult the pharmacist before buying medication for their children, said Assoc Prof Ng.
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Don’t let the pressure build Managing high blood pressure requires more than medicine. By Rachel Chan When he was first diagnosed as suffering from high blood pressure, Mr Ho Teow Seng was a little scared. “I was already diagnosed with diabetes about two years before that,” he said.
happy with the four anti-hypertensives which are keeping his blood pressure under control. “It’s not just about taking medication. To manage a chronic condition like high blood pressure, you need to have a trusting relationship with your doctor,” said Mr Ho. “You need to listen to his instructions on how to take the medicine and follow his advice on lifestyle changes.” Mr Ho takes his medications diligently and cuts down on snacks, oily and salty food. He likes his doctor so much that he has continued to consult him even
“I was worried that if I didn’t control these conditions, my health would worsen.” But the medication his doctor prescribed didn’t agree with him. “I felt giddy and light-headed,” Mr Ho said. Side effects with blood pressure medications are common but mostly mild, said Dr Sng Wei Kwan, Clinic Director, SingHealth Polyclinics – Outram.
Listen to your doctor’s instructions for medication and lifestyle changes as these are tailored for you.
Some 95 per cent of patients suffer from essential or primary hypertension which has no specific identifiable cause.
after he moved, first to Bukit Merah Polyclinic and then to Outram Polyclinic.
what’s new
When is blood pressure high?
Berry powerful
There are usually no symptoms in patients with high blood pressure, which is why it is known as a “silent killer.” But uncontrolled high blood pressure can lead to complications like stroke, heart attacks and kidney failure requiring dialysis. “Some 95 per cent of patients suffer from essential or primary hypertension which has no specific identifiable cause. But there are risk factors relating to hypertension, like a family history of high blood pressure,” said Dr Sng. He advised those who are 40 and above to go for annual health checkups. If they discover that they have high blood pressure, they should adopt a healthy lifestyle, cut down on smoking and alcohol, watch their weight and exercise regularly. They may also need to start taking medication to keep their blood pressure under control. “Pregnant women who suffer from pre-existing high blood pressure or develop hypertension during pregnancy require closer monitoring and should be managed by their obstetricians as they are at higher risk of developing complications,” added Dr Sng.
Managing high blood pressure “It is important that the medication prescribed is tailored to the patient, depending on his pre-existing medical conditions and the allergies or adverse reactions he might have to certain drugs,” said Dr Sng. He added that it is crucial for patients to take their medication regularly, to consult their doctors if they experience any side effects or have difficulty complying to the medication regime.
Black raspberries are high in antioxidants, which some believe can help prevent cancer, heart disease, stroke, and perhaps Alzheimer’s disease. These little berries also have levels of anthocyanins that are four times higher than those found in grapes, promoting good eyesight and hair growth. Aedream’s Bokbunja Black Raspberry Extract packs the goodness of this wonder berry into a delicious beverage that can be drunk on its own, or used in cooking and baking.
A delicious substitute for fizzy drinks.
Zap that pain If you’re putting up with pain as a result of arthritis, muscle strain, tendonitis, neck pain or tennis elbow, don’t! Handy Cure is an FDA-approved medical device which combines low-level laser therapy, infrared radiation, visible red light and static magnetic fields. It provides quick and efficient pain relief in the comfort of your home. Individual results may vary.
Handy Cure is reported to help relieve nagging pains.
Dr sng wei kuan, clinic director, singhealth polyclinics – outram
Eye rescue Staring at the computer screen all day can leave your eyes strained and fatigued. Plus, as we age, the muscles that support the eyes get weaker and our eyesight deteriorates, especially at night. Megami by Sun Chlorella is formulated to help your eyes heal when there is physical fatigue and eye damage from medical conditions. It contains beta carotene that’s essential for the healthy development of the retina and helps delay macular degeneration, and eleuthero, which helps calm the nerves and inflammation of the eyes.
PHOTO: Getty iimages
“Some patients might experience side effects such as lower limb swelling, lightheadedness or a dry cough. While most of them are not dangerous, patients should inform their doctor who will adjust or change the medication to eliminate or minimise any side effects,” he said. Mr Ho saw another doctor and tried again. But the new medications he was prescribed were no better. It was not until he went to his local polyclinic in Marine Parade that he met a doctor who started him on the right medications. Now, the 73-year-old is
White coat syndrome Studies have shown that up to 25 per cent of patients have higher blood pressure readings than normal when their blood pressure is measured at a clinic. “This is referred to as white coat syndrome,” said Dr Sng. “The elevated blood pressure is usually due to increased anxiety patients feel when visiting the doctor.”
To avoid misdiagnosis of high blood pressure, doctors recommend that you take deep breaths and relax. “Don’t smoke or drink caffeinated drinks just before seeing the doctor,” said Dr Sng, as both can affect the reading. “It is best to rest for approximately half an hour before a blood pressure reading is taken.”
Vitamins for the eyes to relieve the strain from staring at computer screens all day.
If your reading is still not within target, your doctor might take the reading again. He might also suggest that you monitor your blood pressure at home with an electronic blood pressure monitoring device, to get a more accurate measure of your normal blood pressure. This can avoid unnecessary increase in the dosage of your medication or changes to your treatment.
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Jan⁄ Feb 2011
Fitness
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An active pregnancy Keeping fit while you’re expecting has many advantages, and makes getting back to your pre-pregnancy weight easier. By Melissa De Silva
1st
trimester (weeks 1-12) Almost any form of exercise except contact sports and skiing can be undertaken safely.
2nd
trimester (weeks 13-27) In this trimester, you may feel at your most energetic, but you should take the intensity of your activities down a notch as the pregnancy progresses. Avoid doing any exercises on your back, particularly after 16 weeks, as the belly presses on major blood vessels, and can make you feel faint and decrease blood flow to the womb. Sit down to lift weights because long periods of standing in one position can lead to a drop in blood pressure and cause dizziness. Overheating can be a problem, so wear cool clothing and drink plenty of water. If you’re doing antenatal yoga, do not try new, advanced poses. Focus instead on improving the technique. For standing postures, use support such as a wall or chair, if needed.
3rd
trimester (weeks 28-42) Running and cycling tend to become uncomfortable and some women may switch from these sports to swimming, walking and water aerobics. In the final three months, the feeling of weightlessness in the water will be very comfortable, and it is safe to continue swimming throughout the pregnancy. Other exercises have an increased risk of injury due to the loosening of ligaments and joints in pregnancy. It is also crucial to avoid ballistic movements, such as jumping or running.
Above: As the pregnancy progresses, and the weight increases, backache is a common complaint among expectant mothers. This easy stretch eases that lower backache.
exercise throughout pregnancy, as long as they make sensible adjustments to their routine. For women who were inactive before conceiving and who wish to get in better shape before the baby comes, it is even safe to begin exercise programmes during pregnancy,” said Dr Tan. However, “a pregnant woman should not exercise to lose weight during pregnancy”.
Before you start Before starting an exercise programme, a pregnant woman should ask her doctor for personal exercise guidelines based on her medical history. “Unless hospitalisation or complete bedrest is advised, most patients will still be able to perform simple exercises like brisk walking even if they have diabetes or hypertension,” said Dr Tan. However, should the woman develop placenta previa, a complication where a low-lying placenta covers part or all of the cervix, then exercise is off limits. “Strenuous exercises can cause some uterine tightening and bleeding, which may mean an early delivery, especially if the bleeding is massive,” said Dr Tan. Exercise is generally safe during pregnancy, although some involve positions and movements that may be uncomfortable or tiring for pregnant women. As the pregnancy progresses, the intensity should be reduced as “the actual level of difficulty is increased with the added weight,” she said. “Walking is a great way to start an exercise programme,” said Dr
Right: Simple yoga poses and stretches on an exercise ball can help relieve backache, constipation and swelling.
Tan, adding that brisk walking is a great low-impact total body workout. Swimming is another good form of exercise as it works many muscles while the water supports the body’s weight, Dr Tan Wei Ching minimising the risk recommends exercise for a of injury and mussmooth pregnancy. cle strain. Aerobics keeps the heart and lungs strong, and aerobics classes for pregnant women, low-impact and water aerobics are good types of exercise. Cycling provides a good aerobic workout, but the growing belly can affect balance, making pregnant women more prone to falls. Stationary or recumbent (where the rider is in a reclining position) biking may be better in the later stages of pregnancy. PHOTO: 101teamwork
Trimesterappropriate exercises
Unless a health condition or complication develops that demands complete bedrest or hospitalisation, women can – and should – do some form of exercise during pregnancy. “Staying fit during pregnancy helps women cope better with the physical demands of pregnancy, labour and motherhood,” said Dr Tan Wei Ching, Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital. Regular exercise, she added, builds bones and muscles, and exercising at least 30 minutes, five to seven days a week can benefit women in a variety of ways. Exercise relieves backache, constipation, bloating and swelling. It can help prevent or treat gestational diabetes – the diabetes that some women develop during pregnancy, which often goes away after delivery. Exercise also increases energy, improves mood, posture and sleep, and promotes muscle tone, strength and endurance. “Medical research has shown that most women can safely continue to
Less suitable sports Runners should be able to keep up with their running during pregnancy, with slight adjustments made to routines as the pregnancy progresses. Strength training can make muscles stronger and help prevent some of the aches and pains common in pregnancy. Racquet sport players can continue to play but in moderation. Some racquet sports such as badminton, tennis and racquetball involve rapid movements and changes in direction. These rapid twists and turns may make pregnant women prone to falls. Another sport where there is a risk of injury and falls is skiing. Skiing in very high mountains (above 3,000m) may also lead to altitude sickness which makes it harder for a pregnant woman to breathe and may cut down on the foetus’ supply of oxygen. Contact sports like ice hockey, soccer and basketball can also result in harm to the pregnant woman and the foetus, while there is a risk of decompression sickness in scuba diving. Such activities should be avoided during pregnancy.
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Beauty The right sequence
Label liability What do labels on a bottle really tell us and are we giving them due attention? Ms May Cheah, Senior Pharmacist, Department of Pharmacy, Singapore General Hospital (SGH), tells us why and what those rows of words are there for. By Thava Rani Name of product Serves as the product’s identity.
Directions for use
Name and address of local manufacturer or importer Useful should there be any product enquiries.
Tells you how and when to use the product, how often it should be used, how much to apply and which part of the body to use it on. Inappropriate or excessive use can lead to skin irritation or allergy. Using a night cream in the day, for instance, exposes the product to the sun which can cause skin reactions. Night creams are usually more oily, and if used during the day when it’s hotter, might cause skin breakouts.
Batch reference Makes it easier for the relevant authorities to withdraw or recall particular batches of the product if required, eg in the event of a defective product or inappropriate content.
Precautions May include instructions such as: For external use only, Keep out of reach of small children, Avoid contact with eyes and mucous membranes or If irritation develops, discontinue use.
Storage Most creams and lotions should be stored in cool, dry places. In hot, humid Singapore, you may think of putting your toiletries in the fridge, but there is a risk of the cream or lotion crystallising. Serums containing chemicals such as vitamin C should be stored in the fridge between 2ºC and 8ºC.
Symbols and logos Known as the universal recycling symbol. Tells you that the packaging components are recyclable.
Indicates the period of time over which the product should be used after opening. Implies that additional information about the product is available elsewhere like in a leaflet, card or tag.
List of ingredients Helps you avoid ingredients you’re allergic to, like lanolin or paraben, or those that you might have a personal or religious conviction against, such as animal oils. Ingredients may be listed by their chemical or botanical names. For instance, tocopherol acetate is the chemical name for vitamin E, while chamomilla recuitia matricaria is camomile and pyrus malus refers to apple. Ingredients are listed in descending order of amount in the product. In lotions, for example, water or aqua is listed first, indicating there is more water (by percentage) than other ingredients in the product.
Something that is not often found on labels is the sequence in which skincare products should be used. Ms May Cheah, Senior Pharmacist, Department of Pharmacy, SGH, advises starting your routine with a cleanser. Once a week, this may be followed by a mask or scrub to exfoliate dead skin. Then, apply toner to restore the pH balance and remove residue from the cleanser. Prescription creams should be applied at this point, as the skin will be more receptive to absorbing the product. Beauty serums and eye creams can be applied after this, followed by a moisturiser to lock in the active ingredients. Finally, protect your skin from damaging UV light with a sunscreen or sunblock.
Glycerin, jojoba oil, shea butter, propylene glycol and sorbitol are some of the more common oils, waxes and emollients used in skincare products, while zinc oxide or titanium dioxide are used as whiteners or sunblock. Sodium citrate or citric acid is commonly added to adjust the pH (acidity and alkalinity) of the product, and stabilisers such as xanthan gum are used to ensure the product has the desired consistency. The amount of the active ingredient is usually low, like alpha hydroxy acids (AHA) in anti-ageing products or a herbal extract in a herbal preparation. This means that the risk of developing an allergic reaction to such substances is usually low.
Some chemicals, though necessary additions, may cause irritation or allergy. These include: sodium lauryl sulphate (SLS), a foaming agent that is found in cleansers, shampoos, bubble baths and toothpaste. It has a drying effect and therefore should be avoided if you have eczema or psoriasis. As an alternative, you can use products containing cocos nucifera (coconut extract). fragrance and colourings (usually labelled as CI followed by a fivedigit number) are notorious allergens. Avoid products containing these ingredients if you have allergic contact dermatitis. acids may dry out the skin. A pH-balanced product is more suitable for sensitive skin. preservatives, for example, paraben (methylparaben, propylparaben) might cause irritation to those allergic to it. Products containing natural ingredients are less irritating to the skin, but tend to be pricier. The choice is ultimately still yours, as cheaper substitutes, for example, mild products (pH-balanced, fragrance-free, colour-free) can work just as well.
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Spotlight
Never too late to stop smoking
People who live or work with smokers and who breathe in second-hand smoke for a long period, are two to three times more likely to develop lung cancer than smokers, said Dr Chan. Indeed, secondhand smoke is more dangerous as the non-smoker directly breathes in the toxic chemicals. These chemicals can linger in the air or on furniture for a long time. Lung cancer is often not detected until it is in an advanced stage because its “symptoms may not occur till very late in the course of the disease”, said Dr Chan. People who experience symptoms such as a cough that doesn’t go away, chest pain, weight loss, breathlessness or blood-streaked sputum should seek medical attention, said Dr Chan.
If you are diagnosed with lung cancer, your best bet to prolong a quality life is to quit puffing immediately By Jacqueline Chia
Lung cancer is usually diagnosed only in its advanced stages when the disease is more difficult to treat. But by immediately quitting smoking, a major cause of this cancer, a lung cancer patient can still experience significant benefits even at a late stage. Treatment of lung cancer includes surgery to remove the cancerous growths and/or chemo- or radiotherapy to kill cancerous cells that have spread around the body. A lung cancer patient who has quit smoking could face fewer complications
10 tips to quit smoking
1
Dr kenneth chan, senior consultant, Department of Respiratory and critical care medicine, singapore general hospital
during surgery and responds better to treatments, among other benefits, said Dr Kenneth Chan, Senior Consultant, Department of Respiratory and Critical Care Medicine, Singapore General Hospital (SGH). “Patients are able to function better in their daily lives and go through surgery
PHOTO: 101teamwork
People who experience symptoms such as a cough that doesn’t go away, chest pain, weight loss, breathlessness or blood-streaked sputum should seek medical attention.
Throw away anything that might remind you of the habit such as lighters or ashtrays.
Dr Chan said that about 85 per cent of lung cancer patients in Singapore are smokers and those that have exposure to second-hand smoke.
with fewer complications. Some studies also suggest that these patients respond better to chemotherapy,” he said. In addition, the risk of developing other smoking-related illnesses such as heart disease and stroke is reduced. The damage that smoking does to the lungs cannot be reversed, but by quitting smoking, the deterioration of the lung function can be slowed to the rate associated with normal ageing, instead of continuing at an accelerated rate. Lung cancer is the leading cause of cancer-related deaths
in Singapore. On average, Singapore sees about 1,000 new cases of lung cancer every year. About 85 per cent of lung cancer cases in Singapore are smoking-related, with a small percentage of patients developing the disease from long-term exposure to second-hand smoke and cancer-causing chemicals such as asbestos.
Smoking is a real physical addiction, with studies showing that an addiction to nicotine is as strong as a heroin or cocaine addiction, Dr Chan said. Temptation, peer pressure, psychological dependence and force of habit are some other reasons why it’s difficult to quit smoking. Dr Chan describes smoking as “a chronic relapsing disorder”. “It’s very easy to pick up a cigarette when you are under stress. Physical withdrawal symptoms exacerbate stress, which can only be relieved by smoking,” he said. Often, the habit is so deeply ingrained in the smoker’s daily
Make it known to your family and friends that you’re quitting and seek their help and support.
3
List your quit buddies who are also thinking of quitting, and non-smoking friends who will support you.
4
Put up “No Smoking” signs where you can see them to remind yourself of your new resolution.
5
Expect withdrawal symptoms and have a plan ready for what you will do when this happens.
6
Prepare a “rescue kit” with sugarfree sweets, handheld games etc to distract you from cravings.
7
Every time you feel the urge to light up, pop a sugar-free mint into your mouth or drink water and let the craving pass.
A chronic relapsing disorder Think you can quit smoking any time? Think again. Willpower isn’t enough and someone trying to quit will need the help and support of friends and family, as well as trained advisors and medication if he wants to overcome his addiction successfully, said Dr Kenneth Chan, Senior Consultant, Department of Respiratory and Critical Care Medicine, Singapore General Hospital (SGH). “It is extremely difficult to quit on your own. Studies have shown that if a smoker tries to quit on his own, his chance of success is less than five per cent,” said Dr Chan.
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8
Check out the “My Quit Plan”, a six-session online quit plan for an interactive and personalised guide to quitting at www.hpb.gov.sg.
routine that he may feel something is seriously amiss if he doesn’t have a cigarette in his hand. “It’s like waking up and forgetting to have your usual morning coffee at breakfast,” he said. Not surprisingly, many smokers take two to three attempts before they are able to give up smoking for good.
9 10
Take up a new sport or exercise to keep your mind off smoking.
Keep trying. Even if you fail, start the quitting process again. It takes more than one try to succeed. For more information, go to Health Promotion Board at www.hpb.gov.sg/smokefree.
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Spotlight
Two sides of the same journey A patient and his wife tell Thava Rani how they helped each other prepare for his liver transplant His story
there was no news of a potential liver donor after 10 months, he decided to accept his son’s offer. As he was about to tell his son, the phone rang. “That was like a call from an angel. Ms Lee, the transplant coordinator, said to be at the hospital in one hour as they had a liver for me,” said Mr Ding. While waiting to enter the operating theatre, “there was still a niggling feeling that my body might reject the liver, but in the end it was all good”, Mr Ding said. Now, 11 months after surgery, Mr Ding wakes up every morning feeling thankful. Every day, he offers prayers and thanks to the deceased donor, and is clearly overwhelmed by his family’s love and support. “I’m truly blessed. Bridget’s positive attitude and bubbly nature really kept me going. Despite their busy lives, my sons visit with their families every weekend, and my wonderful daughtersin-law helped to take care of me when Bridget was not around. Throughout that dark period, I could feel my children solidly standing behind me,” said Mr Ding.
Having liver cirrhosis meant he had a high chance of developing cancer, but when it was diagnosed, it still came as a shock to Mr Anthony Ding. Doctors told him a transplant was his best option, but it would need to be performed within nine months to make sure his body was healthy enough to cope with the major surgery involved in such a procedure. “I did my level best to stay healthy. I did light exercise daily with weights and a complete overhaul of my diet. Bridget, my wife, sacrificed her love for meat and followed suit. She spent a lot of time coming up with creative fish menus and preparing fresh salads using cottage cheese and linseed oil,” said the 71-year-old.
Bridget’s positive attitude and bubbly nature kept me going. Despite their busy lives, my sons visit with their families every weekend, and my wonderful daughters-in-law helped to take care of me when Bridget was not around.
Her story Working for the family business in Cambodia, Mrs Bridget Ding felt the blood drain from her when her husband called with his diagnosis of cancer. “My main concern was that I was not around, because I was always at his side when there was bad news before,” said the 63-year-old former HR consultant. Over the next few months, she shuttled between Singapore and Cambodia frequently to be with her husband, but intentionally did not cut down on her choir or church activities, believing a sense of normalcy would keep his spirits up. Most importantly, she remained cheerful as she did not want him worrying about her. Still, every now and then, things got to her. “Whenever he came back from treatment, he was cranky because he was in pain, and it was a challenge trying to maintain my sanity. So going back to Cambodia each time allowed me to get away from the situation just for a bit. That really helped me cope,” said Mrs Ding. She knew that time was running out for her husband. There was a limit to the number of cancer treatments he could
Whenever he came back from treatment, he was cranky because he was in pain, and it was a challenge trying to maintain my sanity. So going back to Cambodia each time allowed me to get away from the situation just for a bit. That really helped me cope.
Anthony Ding, transplant recipient
Mrs Bridget Ding
PHOTO: 101teamwork
As he waited for a new liver, he underwent treatment to keep the cancer at bay. This left him in pain and physically drained. Previously an enthusiastic go-karter, he found himself sleeping more, unable to have his regular Friday nights out and too sapped to even play with his grandsons. He became depressed. To cope, he read up on his condition and the treatments he was receiving. Music and spiritual books gave him the strength to put up with the pain. He refused to let himself feel down for too long, and tried to make the most of each day. “I think the fact that I’m contented with my life made the difference. If I really had to go, I had enjoyed my days with my wife and children,” he said. While waiting for a donor, his second son Aaron offered to donate part of his liver. Aaron had been meeting quietly with the transplant team and had undergone the necessary tests. Initially, Mr Ding refused, but when
have before a transplant would no longer be an option. Yet when their son, Aaron, the only match in the family, came forward with his offer, Mrs Ding would not accept it. He was still young, had a wife, two kids and a third on the way. “So many things could go wrong. They might not, but the risk was too great. Even our older son Allistair tried to convince us to accept his gift. He assured us he would stand by his brother’s family if anything were to happen,” she said. The turning point came during a liver support group meeting when another patient shared his experience of receiving a liver from his sister, a young mother. That got them thinking. “We were just going to tell Aaron that we’d accept his offer when the phone call came. We knew immediately what it was because Anthony’s voice was quivering. When the call ended, we all got up, and started hugging and crying,” she said. Waiting outside the operating theatre, the family shared a spiritual moment. When the surgeon came out in his scrubs “grinning from side to side”, Mrs Ding knew her husband was going to be fine.
Mr Anthony Ding (right) with his wife, Bridget, were about to accept their son’s offer, when the transplant coordinator called with good news.
Now, their life is finding a new rhythm. Some lifestyle changes aren’t the most pleasant, such as the many medications Mr Ding requires for the rest of his life, or a diet that has switched from fresh food to only cooked meals. Mr Ding’s immune system would not be able to fight infection if he were to contract hepatitis A. But these changes are a small price to pay and Mrs Ding is thrilled with the even closer bond that her family shares. “Looking at the way the children reacted to the situation, we can be rest assured they will always be there for us,” she said.
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Money
Pass on the burden of hefty medical bills With the right Shield insurance plan, you may not have to foot a cent BY LORNA TAN
plans in the market, and are payable with Medisave monies capped at $800 per policy per year. For policyholders aged 81 and above, the Medisave withdrawal limit for insurance premiums is $1,150 per policy per year. Still, it is prudent to buy a hospitalisation plan that is affordable and matches your healthcare expectations. If you are insured under a plan with Class A coverage, you can choose an A class ward in a restructured hospital or any lowerclass ward. But if you opt to be warded at a
what is billed, except for the deductible and co-insurance portions.
Ministry of Health spokesman. The annual premium for basic MediShield for a 35-year-old man is $54. If he upgrades to an integrated Shield plan, the premium may be about $100 to $250 depending on the plan type, said Ms Tang. If you are considering a Shield plan, you should not be older than 75. Other considerations include the time taken to settle a claim and finding out if the Shield insurer provides a Letter of Guarantee for your hospitalisation, so you can get in and out of the hospital without making any payment, said Mr Newman. Having an insurer with a big policyholder base enables the customer to enjoy stable premiums, said Income’s Senior Vice-President and General Manager Lee How Teck. He added that it is a plus point if the insurer has a range of plans, so the customer can downgrade when premiums get costly with old age. Also, avoid getting a new health plan with a new insurer if you have pre-existing conditions, as the new insurer may not cover the pre-existing portion. It is far better to get an upgrade with your current insurer, said Mr Lee. While Shield plans are effective products, they do not provide overseas coverage for non-emergency hospitalisation, said Ms Tang. “It does not provide cover for outpatient treatment, like specialist or general practitioner services, except for certain outpatient treatments such as kidney dialysis and cancer treatment,” she said. Nonetheless, outpatient treatment which leads to or results from hospitalisation may be covered by a Shield plan, subject to a specified period before or after hospitalisation.
As-charged feature The as-charged feature has become a stanHaving an insurer with dard in all Medisave-approved integrated a big policyholder base Shield plans, but there are many who have not upgraded to plans that offer enables the customer to this feature. enjoy stable premiums. medical insurance plan, most, if not all of Shield plans come with deductible and the bill is payable by your insurer. co-insurance components. The former Take Health Minister Khaw Boon Wan pertains to the first layer of charges that for instance, who paid just $8 out of his the policyholder has to bear, which ranges own pocket for bypass surgery in 2010. from $1,500 to $3,000. The co-insurance When contacted, the Ministry of Health payment is the portion shared by the poliprivate hospital, the insurer will pay only a said that out of Mr Khaw’s total hospitalisacyholder, usually 10 per cent of the bill pro-rated portion of your bill. tion bill of about $25,000, $20,000 was paid after taking into account the deductible. for by insurance and $5,000 by Medisave. If you wish to avoid paying for these porMediShield cover Mr Khaw had subscribed to basic tions, Shield insurers offer optional riders Currently, MediShield already covers 88 MediShield since it was launched in 1990 for them, payable via cash. per cent of Singaporeans and of these, 58 and topped it up with a private Medisave“Private Shield plans provide an ideal per cent have topped up with a private approved Shield insurance plan which solution to protect against the costs of seriShield plan for hospitalisation in Class A/ covers Class A and private hospitals. Based ous illness and help ensure the right treatB1 wards and private hospitals. on his age of 56, his annual premium payment is received,” said Aviva Singapore’s “Depending on their preferences, able is in the $330 to $662 band. Chief Executive Simon Newman. they should choose a suitable MedisA significant portion of his bill was Unlike MediShield, which offers cover ave-approved Shield policy. If they absorbed by the Shield plan because it till age 85, these plans offer lifetime don’t plan to go to Class A/B1 or offers an as-charged feature. A traditional coverage which is crucial because our private hospitals, then basic MediShield hospitalisation plan comes with specific medical needs increase with age, said Ms should suffice. The premiums are highly Adapted from an article first published in The sub-limits such as specified dollar benefits Tang Yin Fong, wealth management firm affordable,” said a Sunday Times on October 31, 2010. for room and board, doctor’s fees and proProvidend’s Risk Management Senior Specedures. In a Shield plan, the as-charged cialist. Besides, you do not have to worry Mr Daniel Loh (not his feature removes these benefit limits, about the insurer refusing to renew your real name), 56, was admitted to a which means hospitalisation expenses are policy due to subsequent bad health or restructured hospital for cancer treatment . He payable by insurance claims. Shield plans are also generally underwent three surgical procedures and stayed three days in an ICU B1 ward, five days in a B1 normal ward and 51 days according to more affordable than other in a subsidised ward. He originally had an IncomeShield standard plan non-private Shield which he upgraded to an Enhanced IncomeShield Basic Plan – a B-ward plan Mr Henry Tay (not his real name), in his 40s, was with the as-charged feature. He added a Plus rider that covers the deductible and co-insurance components. His annual premium for his Shield plan is $340 and he admitted for spinal surgery owing to prolapsed disc in the middle of this year. He spent three months pays another $224 in cash for the rider. in a Class A ward at Mount Elizabeth Hospital. In 2008, he had bought a Medisave-approved integrated Aviva MyShield plan His total hospitalisation bill of $47,807 comprised: as well as a rider – MyShield Plus – which covers the co-insurance Room and board and inpatient costs (ICU ward): $2,257 Room and board and inpatient component. The annual premium for his Shield plan is $480, payable by costs (non-subsidised B1 ward): $4,279 Room and board and inpatient costs (subsidised B2 ward): $24,652 Surgical costs: $15,420 Implants and medical Medisave. He pays another $145 in cash for the rider. consumables: $1,199 His total hospitalisation bill of $203,000 comprised: Total amount payable by insurance: $47,807 Room and board: $91,000 Surgeon fee: $27,000 Doctor attendance fee: $51,000 Other inpatient costs: $34,000 Amount payable under IncomeShield: $41,676.30 Amount payTotal amount payable by insurance: $200,000 able under rider: $1,500 (deductible) + Amount payable under MyShield: $180,000 $4,630.70 (co-insurance) = $6,130.70 Amount payable under rider: $20,000 Amount not payable by insurance: $3,000 (deductible) The policy paid the full bill as Mr Loh stayed in the ward that was covered by the health As Mr Tan’s rider does not cover the policy deductible of $3,000, he had to pay that plan and his rider covers amount out of his own pocket. The balboth the deductible ance worked out to $200,000, of which and co-insurance. the co-insurance component was $20,000 or 10 per cent of the total bill, after taking into account the deductible. Had Mr Tay opted for a rider that covers both the co-insurance and deductible, he need not have coughed up a cent.
Imagine receiving a hospitalisation bill of $200,000. If you managed to survive the shock, your next concern will be how to settle it. The good news is that with the right
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People
Twist of fate
To communicate effectively with her patients, she often uses diagrams to illustrate their medical conditions and explains the rationale behind having to take their medication. The most gratifying aspect of her job comes from her interaction with her patients and the ability to gain their trust. “As a doctor, you need to make a connection at the first visit. Interaction
is important because it establishes a relationship with your patient. “A patient learns to trust you and understands that you know enough about their condition. Building on that interaction, you can get to know patients very well,” said Dr Loh. She specialises in conditions of the adrenal and pituitary glands, and works closely with neurosurgeons and urologists on surgery relating to these organs. The adrenal glands are located at the top of each kidney and produce hormones that help the body control sugar, burn protein and fat. The pituitary gland is a pea-sized organ at the base of the brain that secretes hormones responsible for many important functions throughout the body. “The endocrine system is a very finely tuned and well-orchestrated system that involves a lot of interaction between hormones. What I find interesting is the fact that there is a lot of thinking and detective work involved. That always intrigues me,” said Dr Loh. “When the neurosurgeons pick up on a tumour case and need to operate on it, I will do the initial work, ensuring the patient doesn’t suffer from hormonal imbalances, which can increase the risks for the patient during surgery,” she said.
banking, shopping and attending to other personal matters (when these places are less crowded).” What keeps this 13-year SGH veteran going is her passion for the job. “I was very interested in medical science when I was young, and I wanted to work in the healthcare industry after school,” she said. The graduate from Taiwan’s National Yang Ming Medical College found a greater challenge in “a more specialised lab” in SGH after four years of
“working in various pathology departments” in Malaysia. She hopes more people will consider a career in the medical laboratory. “The healthcare industry in Singapore is growing because of the ageing population here. “We are also seeing more patients from overseas coming to Singapore to seek quality treatment. There will be strong demand for medical technologists and it’s a good time for young people to join this profession,” she said.
Endocrinology might have fallen in Dr Loh Lih Ming’s lap, but winning an award certainly didn’t
Fate, said Dr Loh Lih Ming, Consultant, Department of Endocrinology, Singapore General Hospital (SGH), had a role to play in her career as an endocrinologist. “I have run into endocrinologists throughout my career. My current boss was my second-year medical school tutor. I have known her longer than I have known my husband,” said Dr Loh. But her success as a practitioner probably has more to do with her own beliefs rather than fate. Dr Loh was conferred the SGH CEO Service Quality Award last year, a prestigious award that recognises an SGH doctor for outstanding service. Dr Loh believes that with the medical industry, “a lot of lifelong learning” is involved. Besides medical knowledge, doctors should “have a love for people” and be passionate about their job, she said.
Her job goes beyond providing medical consultation services to her patients. Being a “friend and confidante” to her patients, Dr Loh often lends a listening ear when they want to share their personal problems with her.
PHOTO: vee chin
By Rachel Chan
As a doctor, you need to make a connection at the first visit. Interaction is important because it establishes a relationship with your patient.
Dr Loh not only provides medical advice to patients, but also finds time to listen and relate to their personal concerns.
Dr Loh Lih Ming, Consultant, Department of Endocrinology, Singapore General Hospital
Lab support By Joshua Loh
When someone is rushed to Singapore General Hospital’s (SGH) Accident and emergency department (A&E), one of the first people involved in his care is the pathologist. The pathologist has to make a speedy assessment of his blood sample to help doctors determine how best to treat him. “We provide test results in an accurate and timely manner, so doctors can diagnose and treat their patients appropriately,” said Ms Chong Swee Chin, Senior Medical Technologist, Department of Pathology, SGH. It doesn’t matter when a specimen is needed as the clinical biochemistry laboratory in SGH’s Department of Pathology is open 24 hours a day, one of the few backroom units that works through the night. “Specimens may arrive from A&E and inpatient wards anytime, so we have to work round the clock,” she said. For those on the night shift, requests from A&E, the high dependency and
intensive care units are common. Heart patients in ICU, for instance, need constant monitoring. This means blood samples are taken regularly to detect any change in the patient’s condition. On any night shift, a small team of lab technologists tests close to 400 samples with varying degrees of urgency. Urgent specimens from A&E have to be examined and ready within an hour. Work normally peters out after midnight before it gets busy again at dawn. “The peak is from 5.30am to 8.30am when we can receive some 200 samples, mostly to prepare for the doctors’ ward rounds early in the morning,” said Ms Chong. Just two people work a 12-hour night duty that starts at 8.30pm, and lab staff may also be asked to work from 12pm to 8.30pm. Because the department is large, staff need to work either shift only two to three times a month. Most of the time, they work from 8.30am to 5.30pm. While many people may baulk at having to work shifts, Ms Chong said: “I don’t mind. I can make use of the day to do as I like – for example,
PHOTO: Alecia neo
Tucked away from view, medical technologists do important work, quickly and accurately testing blood, urine and other samples to help doctors find the best treatment for patients
Having to assess up to 400 samples on night shifts doesn’t faze Ms Chong Swee Chin, who works quickly to assist patients who require intensive care.
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Jan⁄ Feb 2011
FYI
Pregnancy & peanuts Research from Mount Sinai School of Medicine in New York City found that children whose mothers had consumed peanuts during pregnancy were nearly three times more likely to develop a peanut allergy than those whose mothers avoided peanuts. Also, the more peanuts the woman consumed while pregnant, the greater her infant’s risk of testing positive for the allergy. However, consuming peanuts while breastfeeding didn’t significantly affect the result.
2. Which story did you enjoy reading most in this issue of Singapore Health? Closing date: Feb 9, 2011 Send in your answers and stand to win a box of Collagen Extreme 10000 worth $50.
Occupational Therapists Day
Jan 11 (Tue)
Time 11am-4pm Venue Educational Resource Room, SGH Block 1, Level 1, Rehabilitation Centre Price Free Contact sghOTday@gmail.com to register
SGH O&G/ Neonatal Public Forum
Jan 22 (Sat)
Time 10:15am-4pm Venue Deck on 9, SGH Block 6, Level 9 Price $12 (payment upon registration) Contact 6321-4668
What you told us
Scientists in the UK have developed a procedure using the luminous cells from jellyfish to detect cancers deep inside the body, which are currently difficult to spot. The green fluorescent protein, that enables jellyfish to glow in the dark, works much like regular imaging agents by distinguishing abnormal cells from healthy tissue. It is injected into the
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Singapore Health issue 8 contest 1. What is the name of the latest alternative to LASIK?
Jellyfish used to detect cancer
body and absorbed in large quantities by cancer cells. These then light up brightly when viewed through a special camera. The research team leader, Professor Norman Maitland, believes this will revolutionise the way some cancers are detected. But clinical trials are still five years off.
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SMA Lecturer 2011: Prof John Wong, Dean, NUS Yong Loo Lin School of Medicine
(For doctors, medical students and allied healthcare professionals only) Time 1.30-5pm Venue NUHS Tower Block Auditorium, 1E Kent Ridge Road Price Free Contact Register online at www.sma.org.sg/smalecture
Understanding Heart Valve Disease
Feb 26 (Sat)
Time 1-3.30pm Venue Grassroots Club Auditorium (near Yio Chu Kang MRT Station), 190, Ang Mo Kio Ave 8 Price TBC Contact Hendrick Ou (6436-7928)
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Feb 26 (Sat)
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新加坡中央医院
1月
与新加坡保健服务
2月 2011
集团的双月刊
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您的心跳会 停止吗?
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大手术， 小切口
心脏的健康之道
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账单疑问
眼镜找朋友, 更难了! 随着技术不断改进，连不适合做Lasik激光视力矫正手术的人也能拥有完美视力
效果显著
图：ALECIA NEO
到目前为止，这项手术的成功率是 100% 。它也比 Lasik 激光手术更精准， 对近视度数介于500至1,000度的高度近 视者特别有利。 陈教授说：“这是目前最先进的手 术。整个过程只需要30秒。因为激光仪 非常快速，而且使用的能量很低，所以 病人不会感到太多不适。” 新加坡全国眼科中心研究了24个同时 做了Lasik 激光手术和 ReLEx 透镜取出术 （每眼各做一项手术）的病人，发现超 过 75% 的病人比较喜欢 ReLEx 透镜取出 术，因为手术过程中和手术后感到较少 不适。 接受 ReLEx 透镜取出术的病人会感到 比较舒适的另一原因是因为手术过程所 用的眼撑对眼球的吸力比较温和。
和叶贵芳女士（图右为女儿）一样，进行过屈光角膜透镜取出术的病人，在手术过程中和手术 后，都不会感到有太大的不适。
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ReLEx 透 镜 取 出 术 快
速、无痛,也能有效 矫正高度数近视。
新系统能更准确 预测心搏停止 世界首创的系统能更准确测出病 人心搏停止风险 文 林雪
有许多患有重病的年长病人都须到医院 的急诊部求诊。他们都是患有心脏疾病 的病人。当中有些病人的情况会恶化， 甚至在 72 小时内心搏停止。 这是随时有可能在任何一家医院的急 诊部发生的情景。医护人员必须判断哪 些病人的情况比较危急，哪些病人最有可 能心搏停止，并根据判断立刻进行急救。 目前在医院的急诊部，医护人员一般 靠的是一系列的测试来辨别需要优先救 治的病人。这些测试包括：问诊、评估 病人的症状，如疼痛程度、测量有关的 风险因素，如年龄、血压及脉搏等。不 过，这些测试的准确度只有 40% ，也就 是，在每 100 个病人中只能准确地辨别 出 40 个需要优先救治的病人。 新加坡中央医院的临床科学家和南洋 理工大学研究员现已研制出一套准确度 更高的测试方式。在试验中，准确度高 达67% 。 新加坡中央医院紧急医疗部资深顾 问医生及研究主任王英福副教授，也是 新测试方式的发明人说：“我们的系统 在测量病人心搏停止风险方面，准确度 高出了50% 。” 新系统利用医生在病人手臂或胸口贴 上的电极片收集病人心电图读数，并结
图：ALECIA NEO
会诊后， 32 岁的叶贵芳发现，这项 新加坡全国眼科中心院长陈长慧教授 新手术可以让她告别戴眼镜的日子。 这项新手术不仅适合有角膜破孔现象 叶贵芳女士对严重近视所带来的种种不 的人，而且它快速、无痛，也能有效矫 便，如配戴隐形眼镜、眼睛干涩和夜里 正高度数近视。 去年三月，叶贵芳成为第一批进行 盲目地摸索找眼镜，感到厌倦。于是， 她决定做 Lasik 激光视力矫正手术。 这项“屈光角膜透镜取出术”（简称 陈教授说：“由于吸力比较温和， 不过，医生发现她有角膜破孔（角膜 ReLEx）的新加坡人。 病人可以更好地看到‘目标光束’，不 弧度不规则）的情况，如果做 Lasik 激 Lasik 激光手术需靠两个激光仪将角 象 L a s i k 激 光 手 术 ， 会 发 生 医 生 所 谓 光手术，会导致视力不均。因此，医生 膜组织消融，以矫正视力，但 ReLEx 透 的‘黑视’。” 在最后一分钟取消了手术。 镜取出术只应用一个激光仪。此外， 在手术过程中，医生会要求病人 叶贵芳感到非常沮丧。她说：“他取 ReLEx 透镜取出术使用的新一代激光仪 凝望著一个目标光束。如病人移动眼 消手术是正确的决定，但我非常失望。” 将不需要的角膜组织切成镜片型状，通 睛，这光束便会短暂消失。这种称为 这件事发生在三年前。当时她打消了 过 Lasik 手术所开的角膜瓣口或针孔切 ‘黑视’的现象会使病人惶恐不安。不 念头，认为自己会终身与眼镜和隐形眼 口取出。 过 ， ReLEx 透 镜 取 出 术 可 有 效 降 低 镜为伍。 陈 教 授 说 ：“ Re L E x 透 镜 取 出 术 是 ‘黑视’现象发生的几率。 但去年年初，她丈夫获悉新加坡全国 Lasik 激光手术的自然进展。ReLEx 透镜 这项新手术的好处就像叶贵芳全新的 王英福副教授与其他发明人研制出一套新系 眼科中心院长陈长慧教授及其团队在视 取出术所做的是在角膜内，根据病人的 完美视力一样显而易见。她说：“当我 统为急诊病人更准确的测量出病人心搏停止 力矫正方面所取的进展，便鼓励她去见 近视度数精准地切割出适量的镜片型组 半夜醒来照顾孩子时，我不须要盲目地 的风险。 织。把这镜片取出，近视就不见了。” 陈教授。 > 文转 page 28 > 文转 page 28 文 Jacqueline Chia
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JAN⁄ FEB 2011
新闻 生的专业判断。它的真正价值是在于能 准确地测量出病人心搏停止的风险。” 新系统能更准确预测心搏停止 由于病床、医生、护士等资源有限， 能准确地判断哪些病人需优先医治是一 大关键。 合病人其他资料如年龄和血压，来进行 王副教授说：“如果目前有两个需 分析。 要加护病房床位的病人，而全医院仅有 系统的共同发明人南大电机与电子工 一张加护病房床位。该病床应给哪个病 程学院林芝平副教授说：“这个仪器结 人呢？如果系统显示一个病人的风险指 合了医学的艺术和电脑工程科学，以更 数是 70 ，另一个则是 40 ，我们就很清 客观及标准化的风险评分来取代主观的 楚地知道该给哪个病人优先权及限有的 评估。” 资源。” 王副教授补充说：“即使新系统比目 前的测试方式准确，它不能取代临床医
图：ALECIA NEO
> 文接 page 27
电极片收集心电图读数并结合其它风险因素，以帮助医护人员评估病人心博停止的风险。
> 文接 page 27
眼镜找朋友, 更难了!
中国西晋时期，曹操的随军医 师王叔和撰写了脉学专著——《脉 经》。在书中，他描述了脉冲位置， 并阐述了24种脉象。他在文中写 道：“如果心跳的规律变得像啄木鸟 啄木或雨水从屋顶滴下来一样规律， 就意味着病人将在四天内死去。” 心率变异分析指的是测量连续心跳 但由于计算心率变异涉及到复 速率变化程度的方法。心率变异指 杂的数学公式，因此在循证医学的 的就是心跳与心跳间隔时间的改变。 临床应用一直相当有限。只有在约 自古以来，心率变异降低（也就是 2000 年后，新加坡中央医院与南洋 心脏跳动模式无法适应压力或疾病） 理工大学的研究小组才成功将即时心 一 直 与 常 人 的 健 康 状 况 出 现 问 题 率变异并入一个医疗工具，以帮助医 挂钩。 疗人员作出有效的临床决策。
正常心律 的风险
研究小组以于 2006年 11月和 2007年 12 月之间到中央医院急诊部求助并怀 疑有心脏疾病的 425个病人的资料来对 新系统进行测试。结果显示该系统在 辨别有可能心搏停止病人的准确度高 达70%。 每天有高达500人到中央医院急诊部 求诊。其中有半数患有如胸口疼痛等急 性心血管症状。他们能从这个可以辨别 有可能随时心搏停止高风险病人的新系 统中获益。 中央医院和南洋理工大学的研究团队 目前正和商家合作研制系统的原型以及 展开临床试验来验证最初的研究结果。
屈光角膜透镜取出术 （简称 ReLEx）
1
摸索找眼镜。你完全无法想象，这真的 是一种解脱！”
屈光角膜透镜取出术 只利用单个激光仪在 病人的眼角膜进行精 准的切削。
Lasik激光手术 随着 ReLEx 透镜取出术的应用越来越广 泛，传统 Lasik 激光手术最终有可能会 被淘汰。 陈教授说：“这些年来，我们采用 新的激光科技，就像黑莓手机一样，随 着新型号地推出，效果是越来越好。 ReLEx 透镜取出术就是这样诞生的。如 今有了它，病人可以看得更清晰。” 随着这项手术的应用越来越广泛，它 也会变得越来越实惠。目前做这项手术， 一只眼睛需 $2,500，费用包括手术后的 护理。
2 手术利用激光将角膜瓣 提起，并割除适当厚度 的角膜以纠正病人的屈 光不正。
3
ReLEx 透镜取出术与 Lasik 激光手术的比较
先将割除的角膜完整取 出（并可把割除的角膜 低温贮藏，在若干年后 移植回眼球），然后再 盖回角膜瓣。
ReLEx术比Lasik术更精准，尤其是用
来改善高度数近视。 ReLEx术比Lasik术更快速，因为它只
ReLEx术有还原的可能性，但Lasik 术
不能。
插图: heymans THO
使用一个激光仪。 角膜瓣需要一些时间才 能愈合，但手术后病人 不会感到太大的不适。
林副教授说：“目前，系统是个安装 在膝上电脑的电脑程序。但携带膝上电 脑并不方便。我们希望把系统缩小成一 个小盒子。” 这个系统将来不只可以在急诊部使 用，也可以在加护病房、养老院甚至是 灾区使用。王副教授补充：“它可以辨 别需要疏散到有专业设施的灾民。” 研究小组日前在新加坡保健服务集团 与杜克——国大医学研究院主办的科学 研讨会及在芝加哥举行的美国心脏协会 科学大会上，发表研究结果。 该研究是由新加坡保健服务集团基金 及南洋理工大学拨款赞助的。
角膜还原, 改善老花眼? 把完好无损的角膜组织切除下 来，给了研究人员另一个启发。 这个取出的近视镜片是否可以保 存起来，以便日后用来改善远视 或老花眼呢？ 新加坡全国眼科中心院长 陈长慧教授说：“假设你通过 ReLEx 透镜取出术矫正视力，日 后得了远视或老花眼，理论上， 我们可以取出你保存起来其中的 一片镜片，用激光为镜片调整 度数后，重新植入只眼里的角 膜原位。如此通过单视觉矫规 法，改善你只眼的老花眼，矫正 视力。” 这个方法能改善远视和消除 配戴老花眼镜的需要，也能配合 视力度数随着年纪的变更而修塑 镜片。 目前，附属新加坡全国眼科中 心的新加坡眼科研究所，正在使 用低温贮藏法（一种常用于保存 脐带血及干细胞的方法）来探讨 用液氮冷却及保存镜片的可行性。 新加坡眼科研究所的研究人员 希望，在 2010年年底开始展开的 初步试验可以证明ReLEx 透镜取出 术是可还原的。
Jan⁄ FEB 2011
新闻
新加坡国家心脏中心心内科顾问医 （ Go Red for Women 生陈瑞耀说：“根据2004年发表的全球 Heart ）健康认识调 病例对照研究结果显示，引发心脏病的 查显示，27%的受访 九大风险因素包括吸烟、血脂、高血压、 者认为他们无法预防 肥胖、饮食、进行体力活动、喝酒及社 心脏病。 会心理问题。” 陈医生强调，及早预防 提高意识是女性预防心脏病的第一步 是抵抗心脏病最好的方法。他说：“如 致命的无声杀手 果病人发现胸部不适或用力时感到呼吸 文 黎淑芬 根 据 新 加 坡 心 脏 基 金 ， 新 加 坡 每 天 有 急促等症状，他的动脉很有可能已经有 15 人死于心血管疾病如心脏病或中风。 大约70%或完全阻塞。” 王亚兰女士现年66岁，有两名孙子，但 2008年，心血管疾病占所有死亡原因的 她依然充满活力，看起来比实际年龄年 32.4%，亦即每三个新加坡人中就有一人 预防为首 轻至少10岁。看到她体力充沛，你很难 死于心脏病或中风。它也是新加坡女性 至于王亚兰的案例，由于她是高风险患 想象她曾经连走10步梯极也会气喘吁吁。 死亡的主要原因，但大多数女性都不知 者，所以她须要接受新加坡国家心脏中 她说：“每次走上天桥，我都觉得很 道这件事。陈医生说：“年轻女性通常都 心的心血管疾病的康复和预防心脏病计 累。每走几步梯级，我就要休息一下， 不易患上心脏病，但到了更年期，她们 划，进行治疗。这项计划相当全面，有 因为我喘不过气来。我看电视也会觉得上 患上这个疾病的机率就会明显提高，与 助于心脏病患者康复，以及帮助有罹患 气不接下气，还会无缘无故感到焦虑。” 男性不相上下。” 心脏病风险的人培养新的健康生活习惯 女 性 普 遍 对 心 脏 健 康 都 存 有 误 和个人化的体育锻炼。 经过一连串检测，王亚兰被诊断患上 解。新加坡心脏基金的 高血压、高胆固醇和轻微糖尿病。这些 陈医生说：“心脏康复是疗程中很重 2006 年 “ 珍 爱 女 人 心 ” 要的一部分，但往往为人所忽略。结果显 因素都可能致使她 罹患心脏病。 示，只要遵循这项计划三个月，病人即使 没有更换药物，血压也会明显下降。” 在参于该计划后，王亚兰就开始轻快 步行和进行其他适当的体能活动。她发 现自己的体力和整体健康都有明显改善， 而且可以轻松地走上天桥。 她尽力改变自己的生活方式，在烹饪 时坚持少油去脂的处理方式。她也不再 是从前那个每天抽30根烟的“烟鬼”。 王亚兰说：“关键是要节制和提高自我 意识。我必须爱护自己，才能照顾我的 家人。” 女性到了更年期，就拥有和男性同等的罹患心脏病风险。 图：photolibrary
与心对话
越大未必越好 注意您的体重，以免危害健康 文 颜淑雯
一年半前， 43岁的符淑兰无法一口气爬 上一排楼梯。 这名育有三个孩子的母亲体重 81 公 斤，身体质量指数超过 31 ，远远超过 18.5 至 22.9 的健康水平。这意味着肥胖 增加了她出现各种健康问题的风险，例 如心脏病和糖尿病。超重让她觉得自 己“很丑”，她喜欢的衣服也没有合适 的尺码。她怀疑自己睡觉时打鼾，是和 体重有关。她非常担心自己的情况，于 是向新加坡中央医院的康跃中心寻求协 助。康跃中心提供一站式服务，帮助人 们解决与生活方式有关的健康问题，例 如肥胖和胆固醇（血脂）问题。
要走五公里路才能找到食物的环境，不 管你是否有肥胖遗传基因，都不可能 变胖。” 2004年全国健康调查显示，肥胖 （ 身 体 质 量 指 数 为 30 或 以 上 ） 的 新 加 坡人占了 6.9 %，而在 1998 年，这个比 例只有5.2%。康跃中心去年就接待 了 750 个寻求肥胖及相关疾病治疗的新 病人。 符淑兰在怀第一胎前只有51公斤。她 同意环境是一大因素，到处都能找到 各种美食是一种持续不断的诱惑。她 说：“就像其他新加坡人一样，我喜爱 鸡饭和叻沙。每次我的孩子没有吃完他 们的食物，我就会把剩下的吃完。”
改变生活方式与饮食习惯
康跃中心为病人提供一套全面计划，以 控制他们的体重。由多名医生、营养师、 天生肥胖？ 有些健康问题如符淑兰所面对的甲状腺 物理治疗师和职能治疗师组成的跨学科 功能减退（甲状腺激素分泌不足而引发 团队将设法解决病人现有的健康问题， 的症状），可导致体重增加或不易减肥。 然后为病人设计一套减肥计划。如果病 有些体重问题也可能是遗传所致。但是， 人有任何心理问题，中心也会请心理学 不良的生活习惯往往才是真正的罪魁祸首。 家来帮忙。 新加坡中央医院内分泌科顾问兼 研究显示，一个胖子即使只是减掉 康跃中心肥胖与代谢小组组长谭光慧 原本体重的 10%，也可大幅度地改善一 医生说：“虽然遗传基因让你更容易变 些与肥胖有关的慢性疾病，例如高血压、 胖。但是，如果你生活在一个每天需 高胆固醇和糖尿病。
康跃中心为符淑兰设计一套个人化减肥计划， 让她重现苗条身材。
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保持心脏健康 的五大妙方 注意饮食 少吃盐和脂肪，以 便有效地降低血压。
常做运动 尽量每天运动至少
半小时，但不要做任何剧烈运 动，尤其当你刚开始运动时。你可 选择游泳、轻快步行、慢跑和有氧 健身操。你还可以少乘电梯，多走 楼梯，以及在回家时提前一两个站 下车走回家。
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控制压力和保持充足的 休息 缺乏睡眠和压力太大会
增加罹患心脏病的风险。最理想是 每晚睡六至八小时。
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戒烟 抽烟会损坏血管壁和体
内的自然化学平衡，使你易于 发生动脉阻塞。如果你戒烟时遇到 困难，可请医生开适当的药给你。
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不要滥用酒精 每隔一天
喝一杯红酒对心脏有益，因 为它可增加良好胆固醇的水平， 但饮酒过量是绝对不允许的。 如果你在服药，应咨询医生的 意见，确保药物不会和酒精产生 作用。
通常第一阶段的治疗永远是最艰难 的，因为病人必须改变他们的生活方式。 他们应采用“缓慢和持续”的方法来达 到减肥的目的，例如一个星期减掉大约 半公斤至一公斤。这比遵循一些过度减 肥计划更为安全，因为它不会带来破坏 性的影响，包括矿物质流失导致心跳停 止和心悸。 符淑兰改变她的生活习惯和保持 甲状腺激素分泌正常后，成功甩掉了 15公斤。她说：“刚开始做运动时，我 还以为自己快要晕倒。但现在，我 多么健康，最近还参加了 10 公里竞走 活动。”
常见的减肥误区 1 为了减肥，我一定要去健身房 或购买昂贵的健身器材。 减肥不一定要去健身房。简单的轻 快步行也是有效的减肥方法之一。 常做体能活动，如运动和在家锻炼 身体，也能达到一定的效果。
2
节食期间，我不应 该摄取碳水化 合物，因为这类食 物会让我变胖。 停止摄取碳水化 合物及提高蛋白 质和脂肪的摄取
可在短期内有效的减肥，但同时也 会提高罹患肾病和胆结石的风险。 长远的瘦身要诀，在于降低总卡路 里的摄取，就是说，你应适量的减 少碳水化合物的食物。
3
既然我在节食，我可 以不吃正餐，以减少 卡路里的摄取。 不吃正餐会让你感到 饥饿，之后你可会吃 得过饱。你应该改为 全天小量、健康和低 卡路里的饮食习惯。
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新脉动
Jan⁄ Feb 2011
大手术，小切口 新技术越来越进步，促使“锁孔手术”越来越不具创伤性
改用微创手术。随着这种技术的不断改 良和医生对它的适应，可用微创手术的 病况也会越来越多。黄教授说：“微创 手术有助于医生继续探索其他形式的手 少痛、少失血量和快速康复促使微创 术，例如经自然腔道手术。这是一种可 手术成为现今外科最重要的发展之一。 通过各种自然腔道如口、肛门和阴道切 但 是 ， 当 微 创 手 术 或 俗 称 的 “ 锁 孔 手 除患病器官和组织或肿瘤的手术，但它 术”于20世纪80年代末开始出现时，人 的发展仍未趋成熟。” 们对它是喜忧参半。 传统外科手术须切开一个五至十公分 少痛手术 长的大切口，以便观察和去除体内的异 微创手术须要三至四个切口，其中一个 常生长部位或肿瘤，但微创手术只须把 给带有摄像镜头的腹腔镜，以便医生观 仪器和设备放入一个大约一公分的小切 察内腔，其他切口则给一些特制微型手 术工具。近期，新加坡正在测试一个特 口，就可通过远程控制台进行手术。 新加坡中央医院外科组处长黄平仁 教授说：“微创手术是行得通的，但须 要时间去解决一些安全问题和改良使用 方式，医生也须要花点时间去适应。到 了 20世纪 90年代，当这些问题得以解决 时，各个医疗领域便开始广泛使用微创 手术。” 以往，医生须要花费很大力气去解释 微创手术的好处，以说服病人选择这种 手术。竹脚妇幼医院妇产科微创手术主 任兼资深顾问郑思敏副教授说：“如今， 如果他们不适于进行微创手术，我们还 须要花费一番唇舌才能说服他们选择传 新加坡中央医院外科组处长黄平仁教授 统手术！” 妇产科医生最先广泛使用这项新仪 器，亦称腹腔镜手术，来检查子宫和输 卵管。 制端口，希望未来所有的仪器都能通过 建立在微创手术的基础上 这个特制端口经由一个切口进入体内。 1989年，新加坡中央医院首创先河，进 去年九月，一群以郑副教授为主的医 行胆囊微创手术。这是东南亚第一例微 生团队为一个出现子宫外孕（指受精卵 创手术，人们对它有更多的认识，并且 在子宫外壁着床）的34岁妇女，进行全 开始接纳这项错综复杂的手术。 球首例单一端口手术。整个手术通过肚 许多过往须要进行切开手术的病况， 脐的一个切口（或端口）把一些特制仪 包括心脏、结直肠、胃肠道、耳、鼻、 器放进体内，去掉的组织也通过同一个 喉、妇产、神经、骨骼和胸椎，如今都 切口取出。郑副教授指出，由于子宫外 文 Keith G Emuang
图：101.teamwork
手术越来越精准，效 果越来越进步，最终 受益的是我们的病 人。机器人肯定是未 来的手术平台 。
正在进行模拟训练的郑思敏副教授说，越来越多病人要求做微创手术。
孕的组织很大，如果使用传统手术，可 能会导致整个子宫受到创伤。为了保 住该名妇女的生育能力，医生选择了这 个方法，而且没有留下任何疤痕。他 说：“病人都表示不太感到疼痛，也很 惊讶她们的肚脐只留下一道近乎看不见 的细微疤痕。但对于医生来说，这种手 术有一定的挑战性。” 以往的微创手术有好几个切口，医生 不会面对体内器官的方向问题。但现在 只有一个切口，他们就必须适应动作受 限制的手术。医生靠调整弧形仪器获得 三维效果，能更形象化地掌握体内状况 和整个手术过程。郑副教授说：“就像 你早上开左边驾驶的汽车，稍后在同一 天内却改用右边驾驶的汽车。单一端口 手术不会完全取代传统的微创手术，但 假以时日，谁知道它不会呢？”
图：Alecia Neo
新闻
黄平仁教授说，外科医生未来动手术时，可能 甚至不须要在病人身上切一个切口。
机器人的出现
行两个相关手术。黄教授说：“手术越 用机器人辅助手术让微创手术更先进。 来越精准，效果越来越进步，最终受益 新加坡中央医院在2003年首次把达文西 的是我们的病人。机器人肯定是未来的 机器人手术系统引进新加坡。这套系统 手术平台。” 结合机器人技术、特殊微型仪器和电脑 竹脚妇幼医院的医生也希望把最新的 辅助技术，能增强经验丰富的外科医生 手术技术和机器人技术结合，让病人获 进行微创手术时的技能。 得更大的好处。郑副教授说：“越来越 今年 4 月，新加坡中央医院引进了更 多手术可以或将可通过单一切口来完成。 先进的达文西机器人手术系统。它能让 但愿我们能看到越来越多单切口手术和 医生在进行手术时更灵巧、更精准，甚 机器人结合，减少病人手术后的不适和 至能让两个不同领域的外科医生同时进 加快康复的过程。”
腹泻不可轻视
腹泻一般属非紧急情况，但若饮水不足，它便会促成严重的后果
腹泻有可能发生在紧张的时分，例如上 考场时、面试或上台前。这些情况也堪 称为表演焦虑腹泻，一旦紧张的时刻过 去，腹泻的问题也随之消失。 在新加坡保健服务集团属下的红 山综合诊疗所看诊的陈友生医生说， 除了同心身相关的因素（即因精神或 情绪受影响而引起的身体状况）外， 腹泻也是几种病况的症状，包括肠道 感染。 陈医生说：“它也可能是对抗生 素，或过度使用泻药来治疗便秘，乳糖 不耐症，或肠胃过敏而出现的反应。” 如同发烧一样，许多人相信腹泻是 身体抵抗机制在起作用，以帮助排掉体 内的毒素或其他有害的物质。 陈医生说：“在新加坡，腹泻通常 是因为吃了生冷、未熟透或不干净的食 物，或是暴露在空气中数小时的熟食。 至于婴孩，未经消毒的奶瓶是导致腹泻 的原因。” 通常在腹泻时，每日会排便三次以 上，所排泄的物状是稀薄或呈水的，此 症状也会在数日内减缓。但是对婴儿或 免疫力较弱的人来说，腹泻是有可能造 成生命危险的。 在新加坡政府医院儿科病人当中， 大约有5%须入院接受治疗是因患上了 肠胃感冒。 腹泻也可能是一些较严重病症的症 状，例如肠道癌、发炎性肠道疾病（肠
道受抗体攻击）、缺血性肠病（肠壁缺 血）和糖尿病等，但这些颇为少见。
更大的隐患 无论是什么原因，倘若腹泻时没有定时 补充液体和盐分，病人有可能会同时患 上由腹泻引发但无关其疾病的并发症。 陈医生说：“严重脱水可能导致患 者出现肾衰竭等并发症。脱水也可引发 其他病症，严重的话还可能导致死亡， 因此必须及早医治。补充水份确实是治 疗腹泻的关键。” 在一些卫生条件差的发展中国家， 污水和垃圾未能妥善清理，也没有干净 的饮用水，所以腹泻导致严重脱水的情 况非常普遍。 病人因严重腹泻而送到医院治疗 时，医生通常会给他们打点滴来补充液 体和盐分。一旦确认病症的主因后便会 给病人服食抗腹泻药、药用炭片、含菌 补充剂或抗生素等药物治疗。 医院也会收取病人的粪便，检查是 否受感染。如果在粪便中发现血迹或病 人体重下降，则可能用窥镜检查肠道和 进行其他检测。 事实: 服用抗腹泻药物非治愈方法, 因为该药物无法治疗导致腹泻的潜 在疾病。况且成人服用的抗腹泻药 物不一定适用于孩童。
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