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SINGAPORE HE ALTH
MAR⁄ APR 2011
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PHOTO: ALECIA NEO
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Mr Tan’s four-month stay in hospital gave him time to reflect on life.
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Understanding the ABO blood group system involving blood groups that are incompatible is performed, antibodies in the recipient’s body have to be removed. Otherwise, they will attack and destroy the organ from the donor belonging to a different blood group. In transplants, a procedure known as plasmapheresis is used to remove these antibodies. Somewhat like dialysis, the process involves transferring blood from the patient’s body with a catheter to a machine that removes the antibodies. The blood is then returned to the patient. The procedure is done every alternate day until the antibodies are reduced to a level considered safe for a transplant. The risk of rejection is as high as 25 per cent in an ABO-incompatible kidney transplant, compared with 10 to 15 per cent for standard transplants. Infection risks are also higher because of the plasmapheresis procedure, and the extra immunosuppressive drugs that have to be taken to reduce rejection. Still, with today’s advanced techniques, the survival rate is comparable with that of standard transplants – 95 to 100 per cent a year after transplant.
PHOTO: ALECIA NEO
Up until the turn of the last century, all blood was thought to be the same, frequently with tragic consequences during blood transfusions. It is now known that red blood cells, like all cells that make up the body’s tissues and organs, have antigens – either A or B – attached to them. Depending on the antigen attached, blood type is classified as A, B, AB (where both A and B antigens are present) or O (none of the properties of A and B are seen). If an antigen of a type that isn’t present in a person’s red blood cells enters the body, it causes antibodies to be produced to attack it – much like how antibodies are produced to combat germs. For that reason, in a blood transfusion, A and B blood types can only be replaced with blood of the same type, while AB is more flexible and can be replaced by either A or B, making it easier to match. O-type blood can be used in a mixture of blood for donation purposes, and is the most valuable in blood donation. However, O types can only be transfused with O-type blood. Similarly, before a transplant
DR TERENCE KEE, CONSULTANT AND DIRECTOR, RENAL TRANSPLANT, DEPARTMENT OF RENAL MEDICINE, SINGAPORE GENERAL HOSPITAL
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Dr Kee (right) and his team are the first to perform a renal transplant involving a donorrecipient pair with mismatched blood groups at SGH.
Mar⁄ Apr 2011
singapore he alth
03
News
Fixing a failing heart
PHOTO: 101TEAMWORK
Although heart failure is irreversible, new treatments enable patients to regain their quality of life
Dr David Sim (right) explains how an underlying heart condition in Mr Woo Chen Sin (left) led to end-stage heart failure within a few short years.
One moment he was sitting in his car waiting for the light to turn green. The next, everything went black. “As soon as I came round, I drove myself to the nearest Accident and Emergency,” said the then 38-year-old. Doctors diagnosed Mr Woo Chen Sin, a former national youth water polo player and entrepreneur, with non-sustained ventricular tachycardia, an abnormally fast heart rhythm. “Mr Woo was suffering from an underlying disorder of the heart muscle, in which the left heart chamber becomes enlarged and can’t pump blood as well as a healthy heart,” said Dr David Sim, Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS). “This made him more prone to the condition, but its exact causes are often unknown.” Seven years later in 2008, Mr Woo was diagnosed with end-stage heart failure, which is irreversible. He had to give up work, was plagued by constant headaches, and small exertions left him breathless.
of heart failure
Advice for heart failure patients Adopt a healthy diet by reducing salt intake Refrain from bad habits such as drinking alcohol and smoking Seek help from trained counsellors to deal with social problems such as depression Seek help from a social worker to manage treatment costs Follow instructions for your medication closely Monitor your weight daily. If there is a sudden weight gain of 1 to 2kg, which could be due to water retention, inform your doctor
Advice for caregivers Be a source of emotional support and help for patients Ensure patients comply with their medication regime Encourage and help patients give up habits that harm their health Be trained to look out for symptoms which arise in patients and learn how to help them when such situations occur
In focus
Symptoms of heart failure can be categorised into two groups – left- and right-sided heart failure. “The two sides of the heart have different roles – the left side pumps oxygen-rich blood to the body, while the right sends blood into the lungs to pick up oxygen,” said Dr David Sim, Consultant, Department of Cardiology, National Heart Centre Singapore. Left-sided heart failure is the most common type of cardiac failure. Left-sided heart failure
PHOTO: photolibrary
Managing heart failure
Fatigue Shortness of breath Need to sit up while lying down or sleeping to catch one’s breath Inability to lie flat due to fluid in the lungs
PHOTO: vee chin
Symptoms
“Heart failure broadly refers to the inability of the heart to function as a pump,” said Dr Sim. “This means that the heart cannot pump enough blood to meet the body’s demand. Heart failure is the end point for a number of heart conditions – most commonly ischaemic heart disease (when blood supply to the heart is reduced) which damages the heart,” said Dr Sim. In milder forms of heart failure, the heart cannot keep up during exercise, but pumps enough blood when the patient carries out normal activities. In advanced stages, the heart cannot supply enough blood to the body even while at rest. Mr Woo is one of about 5,000 people in Singapore who are admitted to hospital with heart failure every year. The condition is more common in men than in women. “Risk factors include poorly controlled blood pressure, diabetes, high cholesterol, smoking as well as obesity,” said Dr Sim. There is no cure for advanced heart failure as the damage done to the heart is usually irreparable. “For patients in the early stages of heart failure, we prescribe a cocktail of drugs in combination with
lifestyle changes to decrease the risk of complications and dying,” said Dr Sim. “For example, if heart failure is partly brought about by alcohol, we ask the patient to refrain from drinking and recommend taking medication.” “Heart failure patients have to make major lifestyle changes and, sometimes, even stop work altogether,” said Dr Sim. Some patients with advanced forms of the disease may benefit from an implantable cardioverter defibrillator, a device which monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks. “This is useful to prevent the heart from suddenly stopping in selected heart failure patients,” said Dr Sim. Every year, about 30 patients with endstage heart failure come to NHCS, which is the only centre in Singapore to carry out heart transplants. Six to eight of them will need a device to support their heart and/or a heart transplant. An improved device known as Heart Mate II was introduced here in 2009. It takes over the pumping function from the heart and comes with a much smaller pump. This device is more suitable for adults with a smaller build, such as Asians and women. Mr Woo is preparing to receive a Heart Mate II, which will buy him time until a suitable donor heart is available. “I was really surprised that patients with the Heart Mate II were able to lead normal lives,” said Mr Woo. The man, now 47, hopes that with this device, he will be able to return to work while he waits for his transplant.
Right-sided heart failure
Loss of appetite Abdominal discomfort and swelling Swelling of the lower limbs Prominent neck veins
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Tell us
Flawed scheduling = long waiting times? My mother’s appointment with a Clinic C doctor was at 10.45am, but we were made to wait for more than an hour before she was seen. Her queue number was 1045, which reflected her appointment time, and the queue numbers displayed on the queue board showed that the interval between appointment times was a matter of minutes – 1030, 1031, 1032 and so on. Doctors should realistically assess the time they need with each patient before setting appointments. Our long wait suggests that scheduling may not be realistic. Was the extended wait a result of inappropriate scheduling? – Mr Mohamad Ibrahim
Every day, SGH’s Specialist Outpatient Clinic (SOC) doctors see about 3,000 patients. This number includes both a substantial number of new referrals as well as patients returning for regular reviews with our specialists. The queue number reflects the patient’s scheduled appointment time. To ensure that patients need not have to wait months for an appointment to see our specialists, the clinics will accommodate a few additional appointments in the doctors’ clinic sessions in the event that patients do not show up for their appointment. On average, the no-show rate is about 20 per cent.
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Singapore General Hospital Deepak Ghimiray I am currently a medical student at AIIMS (All India Institute of Medical Services) and would like to do a medical elective in Singapore General Hospital. Can you give me an idea of how to go about this? Do you offer accommodation during this period? Jan 15 at 7.52pm 5 people like this Singapore General Hospital SGH does offer medical electives and you can check out undergraduate opportunities at www. sgh.com.sg/Education/Undergraduate-Medical-Education. Students should make their own arrangements for travel, medical and travel insurance, as well as accommodation when they are in Singapore. Jan 17 at 9.23am
Ng Sin Yee We are four pharmacy students at International Medical University (IMU) in Malaysia. We are interested in taking our elective, part of IMU’s pharmacy curriculum, during the semester break (May 23 to July 1, 2011) at SGH. We hope to observe and learn pharmacy practice in Singapore, especially in a hospital environment. Please let us know how we can proceed. Jan 10 at 11.04am 6 people like this Singapore General Hospital Please write to our Postgraduate Allied Health Institute colleagues at pgahi@sgh.com.sg, or refer to www.sgh.com.sg/pgahi for more information. Jan 11 at 2.04pm
Because the health and safety of our patients are priority, our SOC doctors also see urgent cases. In these cases, the urgent need to see SOC doctors is reflected in the tight interval between appointment times or queue numbers. Consultations can be as short as a few minutes and as long as more than half an hour, depending on the complexity of the case. When a case takes longer than usual, appointments inevitably pile up, extending the waiting time for other patients in the queue. Patients who are unable to make their original appointment can call our Central Appointment hotline at 6321-4377 to cancel or change their appointment date.
Singapore Health is online too! We should all do our part to save paper, and ideally, Singapore Health should go online. However, I know it would deprive readers without Internet access of a chance to read about the happenings at Singapore’s oldest hospital. The stories of patients and their experiences always inspire me, and I look forward to reading more stories about how SGH patients manage and cope with their illnesses. I want to thank SGH for continuing this free service. By investing money into a publication, you are not only keeping us up to date, but the articles will also serve as a record of SGH’s history. – Mr Jeremy Cheong We’re glad that Mr Cheong finds the paper useful! We share his view about saving paper, and as he has rightly pointed out, it’s necessary for us to have a print version of Singapore Health as many of our readers do not have access to the Web. To make Singapore Health available to a wider audience, we have published it online as well at www.sgh.com.sg. The online version is often available a few days prior to the print copy being placed at our news stands and other distribution points around Singapore, such as GP clinics and SingHealth Polyclinics.
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Health insurance cover for newborns does not commence before they are 15 or 30 days old. This is because the incidence of a newborn child requiring specialist medical treatment during the first few weeks of life is much higher than in the subsequent weeks and months. Most congenital abnormalities and birth defects are diagnosed during the initial weeks. In order to keep premiums
Tributes My mum was admitted to SGH Ward 76 for several weeks in January. The quality of service we received from the staff there was excellent. I think hotels could learn a thing or two from SGH! My mum and I are really grateful for all the help and assistance rendered by the staff, and again, kudos to SGH for providing excellent service in healthcare. It’s the best I have experienced. - D Li
When Dr Farhad Vasanwala of the Department of Family Medicine and Continuing Care, SGH, saw me recently, I raised some concerns regarding health and medical matters. He took time to understand and explain them to me. I am very grateful to him for his care, concern and professionalism. I feel strongly that if I do not convey my appreciation, I would be doing a disservice in return for the good work of this doctor. - Mdm Tang Seow Chin
I am writing to compliment the nurses at SGH Ward 55B and Dr Tricia Kuo of the Department of Urology. My mother underwent minor surgery for kidney stones in early January and was warded for five days. Throughout her stay, the nurses on duty regularly updated us on her progress. Dr Kuo was very clear and precise in explaining my mother’s condition to us. She even gave me her mobile number, so I can contact her if there are further problems. - Ms Clarissa Soh
My husband had to undergo a scope recently. While we were waiting at SGH’s Clinic D for our turn, I noticed a nurse, Ms Siti Laili Hassan, attending to a patient with a smile. I too was impressed by the compassion she showered on us. I would like to convey my thanks to her for her patience. Keep the smile going, Ms Siti! - Mrs Pamela Wong
affordable, insurers have to exclude this peak period of risk from the insurance cover, so as to bring the overall cost of the insurance down for all consumers. An initial “waiting period” facilitates proper assessment of the applicant’s risk and the issuing of the policy document. Contributed by Monetary Authority of Singapore and Life Insurance Association of Singapore as part of Singapore’s national financial education programme MoneySENSE.
MAR⁄ APR 2011
Fitness Exercise for older people
p14 Wellness Too many vitamins?
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SINGAPORE HE ALTH
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Eating for a speedy recovery
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Nutritious and balanced diets are important for patients undergoing chemotherapy.
Healthy options Sample menu of nutritious food for recovering patients at SGH Normal
Vegetarian
Soft Diet
Breakfast
Boiled eggs & bread
Bee hoon soup
Porridge
Lunch
Roast chicken with steamed rice
Steamed tau hu with mushrooms
Sliced fish kway teow soup
Dinner
Fried fish with ginger & plum sauce
Rice with vegetables
Salmon grilled with thyme
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PHOTO: ALECIA NEO
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Mdm Koay makes it a point to whet the patient’s appetite with attractive food presentation.
PHOTO: ALECIA NEO
Food may be a turn-off for cancer patients, but it’s important to eat well for a speedy recovery. By Priscilla riscilla Wong
Serves 1 Ingredients: 3 cups of water ½ cup of rice, soaked in water Palm-sized piece of fish fillet, sliced and deboned 1cm slice of ginger, shredded ½ tsp salt to taste A sprig of parsley (optional) Preparation: Bring water to a boil, then add the soaked rice. Keep the heat on high
1 2
Boil for 10 minutes till the rice grains have softened or broken up. Reduce the heat to a medium flame
3 4
Add the sliced fish and ginger. Boil for another 5 minutes
Add salt to taste, then turn off the heat. Garnish with parsley and serve warm
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SINGAPORE HE ALTH
MAR⁄ APR 2011
Fitness
Going the distance The benefits of endurance sports for older people. By Annie Tan
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Seniors should go for a health check before participating in endurance training.
PHOTO: GETTY IMAGES
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Training for it
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social outing
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Follow your inclinations. If you loved ball sports and racket games when you were younger, revive your passion
Choosing the right sport Picking the right exercises can build strength in older people without increasing the risk of injury, said Dr Darren Leong, Resident Sports Physician, Changi Sports Medicine Centre, Changi General Hospital.
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Choose a sport that is convenient for you, so it will be easier to stick to the routine
Start with simple sports like brisk walking or Nordic walking, which uses poles (similar to ski poles) to involve the upper body muscles as well as the legs
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MAR⁄ APR 2011
R U O S R A T S
SINGAPORE HE ALTH
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15
16
SINGAPORE HE ALTH
MAR⁄ APR 2011
24;41A0C8=6
SHE TAKES CARE OF WHAT GOES INTO YOUR BODY
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MAR⁄ APR 2011
She loves seeing her patients Dr Irene Chua, Gynaecologist and Obstetrician, KK Women’s and Children’s Hospital, has delivered close to 3,000 babies during her career as a specialist. When she was pregnant, she continued delivering babies, taking a mere three weeks off to have her child, who was delivered via Caesarean section. Even though she was resting at home, she continued to support her patients through their pregnancies. It’s no surprise that this devotion to her patients won her a Superstar award at the Singapore Health Quality Service Award.
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She finds the silver lining Creating hope, spreading cheer and providing quiet encouragement are qualities that make Nurse Clinician Tan Chor Kien stand out in her patients’ eyes. “She makes newly diagnosed myeloma patients feel less hopeless and frightened,” said a patient. Ms Tan works with the Department of Haematology at Singapore General Hospital. Most of Ms Tan’s patients suffer from blood cancer and are either on lifelong medication or in need of a stem cell transplant. The transplant patients, in particular, have a difficult and long journey ahead, without guaranteed success. “One of my transplant patients, a mother of three, became depressed and was ready to give up. So I took her down to the garden and we sat in front of the fountain. Looking at the water, I told her that she is like the water. She has to refresh herself for her children, who are waiting for her to get better. That was a turning point for her and I’m really happy to see her now in her fifth year after a successful transplant,” she said. “Every time she visits, she still remembers the fountain, even though it is long gone!” Sometimes, being with patients and quietly listening to them is all it takes to help them overcome their worries or frustration. But at times, Ms Tan recognises that the support needs to come from another patient.
“Nothing is as convincing as the advice from another patient. Speaking to other patients makes those about to go for transplants realise that success is achievable, but will take time. It helps to measure their expectations. At the end of the day, seeing is believing,” said Ms Tan. For the comforting care she shows her patients and the quiet encouragement she offers them, Ms Tan received the Superstar award for nursing at the inaugural Singapore Health Quality Service Award. But she doesn’t make an impression on just her patients. Her staff also appreciate the encouragement and support from her. She helps them cope and respond to patients, who at times can be frustrated by the slow progress of their treatment or sudden relapses.
Where you can, light up their journeys – whether it is a short flicker or a lasting ray of light – it makes a difference to them. Ms Tan Chor Kien, Nurse Clinician, singapore general hospital
“When disputes arise between patients and staff, we would diffuse the situation first. In the heat of the moment, it is difficult to get through to the staff, so we let them cool off first. The next day, we would call a meeting to discuss the incident and get views from the group on what the best approach is. In that way, everyone will learn from it,” said Ms Tan. Ultimately, caring for patients requires more than just knowing their medical cases, family support and social background. “You have to be there for them through their treatment and recovery process,” said Ms Tan.
You returned to work just three weeks after delivering your own baby. What (on earth!) made you do this? I left some of my closest colleagues in charge of my pregnant patients, but some of these patients were more comfortable with me, so I didn’t want to let them down. Even while I was at home, I answered their questions through e-mail and over the phone. So what made you want to be a doctor? It wasn’t quite a childhood dream, but when I was in my fourth year at medical school, I tried obstetrics and gynaecology and I was inspired by the people in the field. I’ve never looked back. My work motivates me: I find it so fulfilling that I can’t wait to get out of bed every morning to see my patients! Besides passion, what else makes a good doctor? A good doctor has to be there for the patient – she has to be compassionate, truthful and understanding. As a specialist, your skills are a given, so the
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most important thing is to be there for the patient. What’s a typical day like? A typical day starts at 7am with paperwork before my ward rounds. On my rounds, I normally see between five to 10 patients and these are either women recovering from surgery or those in labour, as I’m a gynaecologist and obstetrician. At 8.30am, my morning clinic starts. I see a mix of gynaecological conditions, like fibroids, requests for contraception or diagnostic tests, as well as pregnant women. I try to keep on top of administrative work during lunch, before I start my afternoon clinic, which runs till around 6pm. Three nights a week, I also run night clinics from 6 to 9pm. On the nights when I don’t have clinics, I attend meetings or conduct job interviews. So it’s fair to say that at the moment, I’m a full-time weekend mum! what’s A patient to you? A patient is more than a collection of problems, which is why I try to get to know them. That way, I can better help them with any medical problems or concerns they have. I’m quite close to many of my patients because of that. A memorable incident… One of my patients, a woman in her late 30s, was trying to conceive. When she miscarried at eight months, we were both devastated. The couple tried again, but she had two more miscarriages, which made her reluctant to try anymore. I did some further investigations and was able to help her. She has recently given birth to a beautiful, healthy baby! That was a huge moment for me because she trusted her own body and baby to me – and it felt great to give them that gift! Do you have a role model? My mother. She juggled a job, me, home, and now, at her advanced age, is still helping me care for my baby!
17
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SINGAPORE HE ALTH
MAR⁄ APR 2011
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CHAMPIONS OF QUALITY SERVICE CONGRATULATIONS
to the winners of the Singapore Health Quality Service Award 2011
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19
Wellness
Enough or too much? When it comes to vitamins and minerals, moderation is key. By Thava Rani
k^iVb^c 6 XVc aZVY id hZg^djh ]ZVai] g^h`h! ^cXajY^c\ YVbV\Z id i]Z a^kZg# I]^h ^h WZXVjhZ i]Z WdYn VWhdgWh hdbZ k^iVb^ch Ä hjX] Vh 6 VcY : Ä VcY b^cZgVah dcan hadlan# IV`^c\ bdgZ i]Vc i]Z YV^an gZXdbbZcYZY aZkZah XVc aZVY id V hiZVYn Wj^aYje d[ i]ZhZ hjWhiVcXZh ^c i]Z a^kZg VcY [Viin i^hhjZh l]^X] ^cXgZVhZ i]Z g^h` d[ Vbdjcih gZVX]^c\ idm^X aZkZah# LViZg"hdajWaZ k^iVb^c 8 ^h Ójh]ZY dji d[ i]Z WdYn l]Zc idd bjX] ^h XdchjbZY# Æ:kZc hd!Ç hV^Y Bg ?d]cVi]Vc 9^dc\! E]VgbVX^hi! 9ZeVgibZci d[ E]VgbVXn! H^c\VedgZ <ZcZgVa =dhe^iVa! Æi]Zn XVc WZ ]Vgb[ja ^c V cdgbVa ]ZVai]n ^cY^k^YjVa l]Zc iV`Zc Vi kZgn ]^\] YdhZh dkZg V adc\ eZg^dY#Ç K^iVb^ch VcY b^cZgVah eaVn Y^[[ZgZci gdaZh ^c i]Z egdeZg \gdli] VcY [jcXi^dc" ^c\ d[ i]Z WdYn# K^iVb^c 8! egZhZci ^c [gj^ih VcY kZ\Z" iVWaZh! ^h V WVh^X ^c\gZY^Zci [dg WZVjin VcY ^h Vc V\Zci [dg egdbdi^c\ ldjcY ]ZVa^c\! Bg 9^dc\ hV^Y# HdbZdcZ l]d YdZhcÉi \Zi Zcdj\] k^iVb^c 8 bVn hj[[Zg [gdb WaZZY" ^c\ \jbh VcY [gZfjZci Wgj^h^c\# K^iVb^ch 8 VcY : Ä [djcY ^c cjih VcY d^ah! \gZZc aZV[n VcY gddi kZ\ZiVWaZh Ä Wddhi i]Z WdYnÉh cVijgVa Vci^dm^YVcih id ]Zae bde je ZmXZhh [gZZ gVY^XVah l]^X] XVc ]VhiZc V\Z^c\ VcY XVjhZ XVcXZg# 8Va" X^jb VcY e]dhe]ViZ VgZ XgjX^Va [dg WdcZ [dgbVi^dc! l]^aZ ^gdc ^h ZhhZci^Va [dg i]Z egdYjXi^dc d[ gZY WaddY XZaah# K^iVb^ch VcY b^cZgVah VgZ egZhZci cVijgVaan ^c i]Z [ddYh lZ ZVi# I]jh! ZVi^c\ V WVaVcXZY bZVa l^i] V l^YZ kVg^Zin d[ [gZh] bZVi! \gV^ch VcY kZ\" ZiVWaZh dj\]i id hjeean i]Z WdYn l^i] Vaa i]Z k^iVb^ch VcY b^cZgVah ^i cZZYh# 7ji adc\ ]djgh Vi ldg` VcY i]Z XdckZ" c^ZcXZ d[ iV`Zdji bZVah bZVc bdgZ eZdeaZ VgZ cdi \Zi"
Iron Essential for boosting the body’s immune system and an important component of many enzymes. Also functions as an antioxidant US RDA: 8mg (men), 18mg (women) Food sources: Red meat such as beef, oysters, shrimp, tuna, lentils, kidney beans and cashew nuts Excessive intake: Slight excess causes constipation. Higher excesses may result in gastric mucosal ulceration, and increase the likelihood of multi-organ damage Overdose symptoms: Vomiting and diarrhoea
Zinc Essential for boosting the body’s immune system and an important component of many enzymes. Also functions as an antioxidant US RDA: 11mg (men), 8mg (women) Food sources: Red meat such as beef, oysters, milk, baked beans and chickpeas Excessive intake: May result in copper deficiency Overdose symptoms: Nausea and vomiting
Vitamin A Essential for healthy skin, retinas and mucous membranes US RDA: 700mcg (men), 900mcg (women) Food sources: Yellow and orange vegetables like carrots and pumpkins, spinach, sweet potatoes and cod liver oil Excessive intake: May be harmful to skin and bones, causing weakness and brittleness Overdose symptoms: Tiredness, decreased appetite, vomiting, joint soreness, drying and cracking of lips and skin, hair loss and yellowing of the skin
Mr Johnathan Diong, Pharmacist, Department of Pharmacy, Singapore General Hospital, advocates a balanced meal to meet daily vitamin requirements.
Calcium Crucial for maintaining a normal heartbeat and for normal functioning of nerves and muscles. Acts as a building block for bones US RDA: 1,000mg Food sources: Dairy products such as milk, cheese and yoghurt, vegetables like broccoli and Chinese cabbage Excessive intake: May impair kidney function and decrease absorption of other minerals Overdose symptoms: Nausea, vomiting, loss of appetite and increased urination
PHOTO: PHOTOLIBRARY
K^iVb^ch 6! 8 VcY : VgZ `cdlc Vh Vci^dm^YVcih i]Vi XVc ]Zae egZkZci XVcXZg# 7ji iV`^c\ ZmXZhh^kZ Vbdjcih d[ k^iVb^c 8 XVc XVjhZ Y^Vgg]dZV! dg ldghZ! `^YcZn hidcZh# H^b^aVgan! idd bjX]
i^c\ i]Z^g [jaa gZXdb" bZcYZY YV^an YdhZ d[ k^iVb^ch VcY b^cZgVah# ÆL^i] djg Wjhn ldg` hX]ZYjaZh! > ldcYZg ]dl bVcn d[ jh VgZ VWaZ id bZZi =ZVai] HX^ZcXZh 6ji]dg^inÉh gZXdbbZc" YVi^dc id XdchjbZ ild edgi^dch ZVX] d[ [gZh] [gj^ih VcY kZ\ZiVWaZh V YVn!Ç hV^Y Bg 9^dc\# >c hjX] XVhZh! iV`^c\ V YV^an bjai^k^iVb^c XVc ]Zae ZchjgZ cjig^i^dcVa gZfj^gZbZcih VgZ bZi# I]Z bjai^k^iVb^c iVWaZi XdciV^ch hj[ÒX^Zci k^iVb^ch id egZkZci VcY XdggZXi cjig^" Zci YZÒX^ZcXn! Wji YdZh cdi egdk^YZ i]Z [jaa YV^an gZfj^gZbZci# ;dg ^chiVcXZ! ^i YdZh cdi XdciV^c hj[ÒX^Zci XVaX^jb id bZZi i]Z JH gZXdbbZcYZY YV^an VaadlVcXZ d[ &!%%%b\ d[ ZaZbZciVa XVa"
Vitamin C Helps form strong collagen fibres which are essential for the strength and integrity of connective tissue beneath the skin in the blood vessels, bones, tendons and ligaments. Also acts as an antioxidant US RDA: 90mg (men), 75mg (women) Food sources: Fruits such as oranges, grapefruits and strawberries, vegetables like broccoli and tomatoes Excessive intake: Increases the likelihood of calcium oxalate kidney stones and can deplete the body of copper, another essential nutrient Overdose symptoms: Diarrhoea, stomach cramps and nausea
X^jb [dg Vc VkZgV\Z VYjai# 7ji ^i ]Vh WZXdbZ ede" jaVg [dg bVcn eZdeaZ id iV`Z V kVg^Zin d[ k^iVb^ch VcY b^cZgVah ^c i]Z WZa^Z[ i]Vi aVg\Z Vbdjcih d[ hje" eaZbZcih XVc ]Zae YZaVn V\Z^c\! egZkZci Y^hZVhZ Vh lZaa Vh Zc]VcXZ bZciVa dg e]nh^XVa VW^a^i^Zh# 6ai]dj\] l]Vi ^h Xdc" hjbZY bVn [Vaa WZadl i]Z jeeZg a^b^i d[ idaZgVcXZ [dg i]Vi eVgi^XjaVg b^cZgVa dg k^iVb^c! egdWaZbh Vg^hZ l]Zc k^iVb^ch VcY b^cZg" Vah VgZ iV`Zc ^c ZmXZhh dkZg V adc\ eZg^dY# 6h l^i] Vaa \ddY i]^c\h! bdYZgVi^dc ^h i]Z `Zn id bV^ciV^c^c\ V higdc\ VcY ]ZVai]n WdYn#
20
SINGAPORE HE ALTH
MAR⁄ APR 2011
Beauty
Vanity vs safety Getting your nails done is a great way to pamper yourself, but beware of the dangers. By Stacey Chia Id Vkd^Y cVhin [jc\Va ^c[ZXi^dch! hiZZg^c\ XaZVg d[ hVadch i]Vi YdcÉi hZZb XaZVc ^h cdi Zcdj\]# Ndj Vahd ]VkZ id eVn ViiZci^dc id ]dl ndjg cV^ah VgZ igZViZY# IZX]c^fjZh jhZY ^c bVc^XjgZh XVc lZV`Zc i]Z cV^a! bV`^c\ ^i ZVh^Zg [dg [jc\jh id eZcZigViZ! hV^Y 9g GZ\^cV A^b! 8dchjaiVci! 9ZeVgibZci d[ 9ZgbVidad\n! 8]Vc\^ <ZcZgVa =dhe^iVa# Iddah ]VgWdjg" ^c\ i]Z [jc\^ dg XdciVXi l^i] ^c[ZXiZY eZg" hdch! ^cXajY^c\ hVadc eZghdccZa! XVc Vahd aZVY id [jc\Va ^c[ZXi^dch#
>[ ndj ]VkZ \Veh WZilZZc ndjg cV^a VcY i]Z VXgna^X cV^a! Vc ^c[ZXi^dc XVc WZ ]^YYZc [gdb k^Zl! VcY V adi d[ YVbV\Z XVc WZ YdcZ WZ[dgZ ndj Y^hXdkZg ^i# DR REGINA LIM, CONSULTANT, DEPARTMENT OF DERMATOLOGY, CHANGI GENERAL HOSPITAL
CV^a [jc\Va ^c[ZXi^dch VgZ XVjhZY Wn [jc\^ i]Vi i]g^kZ ^c lVgb VcY bd^hi Zck^" gdcbZcih# I]Zn ^ckVYZ i]Z WdYn i]gdj\] hbVaa Xjih dc i]Z h`^c l]^X] XVc WZ XVjhZY l]Zc Xji^XaZh VgZ Xji VcY ejh]ZY WVX` ! i]gdj\] i]Z hbVaa \Ve WZilZZc i]Z cV^a VcY cV^a WZY! dg i]gdj\] i]Z cV^a ^ihZa[ ^[ ^i ]Vh WZZc lZV`ZcZY Wn cV^a kVgc^h]! gZ" bdkZgh! di]Zg X]Zb^XVah dg ^c_jgn# CV^ah WZXdbZ Y^hXdadjgZY VcY i]^X`Zg! ijgc^c\ \gZZc! l]^iZ dg WaVX` YZeZcY^c\ dc i]Z ineZ d[ [jc\jh#
Don’t let a fungal infection ruin a beautiful manicure.
;jc\Va ^c[ZXi^dch YZkZade bdgZ Xdb" bdcan dc idZcV^ah Vh i]Z bd^hi! YVg` VcY lVgb Zck^gdcbZci ^ch^YZ XdkZgZY h]dZh ^h V ]diWZY [dg [jc\^# 6Xgna^X cV^ah XVc Vahd aZVY id hjX] ^c[ZXi^dch ^[ i]Zn VgZ cdi ÒiiZY egdeZgan# Æ>[ ndj ]VkZ \Veh WZilZZc ndjg cV^a VcY i]Z VXgna^X cV^a! Vc ^c[ZXi^dc XVc WZ ]^YYZc [gdb k^Zl! VcY V adi d[ YVbV\Z XVc WZ YdcZ WZ[dgZ ndj Y^hXdkZg ^i!Ç hV^Y 9g A^b# H]Z VYYZY i]Vi Vcdi]Zg YVc\Zg d[ `ZZe^c\ adc\ VXgna^X cV^ah ^h VXX^YZciVa ^c_jgn id i]Z cVijgVa cV^a# >[ i]Z VXgna^X cV^a ^h XVj\]i ^c dW_ZXih! Wdi] cV^ah XVc WZ g^eeZY d[[#
An ugly problem HdbZ cV^a [jc\Va ^c[ZXi^dch bVn cdi XVjhZ ^gg^iVi^dc! Wji i]Zn h]djaYcÉi WZ ^\cdgZY! hV^Y 9g A^b# ÆI]Z ^c[ZXi^dc XVc iV`Z dkZg ndjg l]daZ cV^a VcY YZhigdn ^i XdbeaZiZan l^i] i^bZ# >[ ndj lZgZ id idjX] Vc ^c[ZXiZY idZcV^a! ndj XdjaY ^cVY" kZgiZcian hegZVY i]Z ^c[ZXi^dc id di]Zg eVgih d[ ndjg h`^c!Ç h]Z hV^Y# IgZVibZcih! [dg ^chiVcXZ! XgZVbh! ide^XVa aVXfjZgh dg dgVa Ygj\h! iV`Z i^bZ# >c[ZX" i^dch VgZ Y^[ÒXjai id igZVi VcY d[iZc! V cZl ]ZVai]n cV^a cZZYh id \gdl VcY gZeaVXZ i]Z ^c[ZXiZY dcZ# >c[ZX" i^dch Vahd d[iZc gZijgc ZkZc l]Zc hnbe" idbh ]VkZ XaZVgZY# I]Z ild Xdbbdc igZVibZcih ^cXajYZ ide^XVa Vci^"[jc\Va
Prevention is better than cure! Take the necessary precautions when decorating your nails.
cV^a hdaji^dch dg aVXfjZg! VcY dgVa Vci^" [jc\Va bZY^XVi^dc# Jh^c\ ide^XVa igZVibZci ^h d[iZc hadl Vh ^i ^h Y^[ÒXjai [dg i]Z bZY^XVi^dc id eZc" ZigViZ i]Z cV^a# 6 bdgZ Z[[ZXi^kZ dei^dc ^h id iV`Z dgVa Vci^"[jc\Va bZY^XVi^dc# 7ji i]^h ]Vh ediZci^Va h^YZ Z[[ZXih! VcY h^b^" aVgan! bVn iV`Z bdci]h id h]dl gZhjaih# Æ>i ^h WZhi id iV`Z \ddY XVgZ d[ ndjg cV^ah VcY Vkd^Y \Zii^c\ V [jc\Va ^c[ZXi^dc ^c i]Z Òghi eaVXZ!Ç hV^Y 9g A^b# Æ>[ ndjÉkZ ]VY ^i dcXZ! ^i ^h bdgZ a^`Zan id gZXjg#Ç
Top tips to avoid a nail fungal infection: 6
1 Keep your nails
short, dry and clean. If your hands are in contact with water often, use rubber gloves to avoid overexposure
If you’ve touched an infected nail, wash your hands thoroughly
2
Use antifungal spray or powder on your feet and shoes
3 Wear open-toed
shoes, or if you are regularly wearing covered footwear, make sure you wear synthetic socks that keep your feet dryer than regular ones
5 Don’t walk
around barefoot in public places
4 Don’t trim or
pick at the skin around your nails, so germs can’t get in
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20 Health+BeautyNailCare V3 path.indd 21
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2/21/11 10:11 PM
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singapore he alth
Mar/Apr 2011
Viewpoint
Banking on tissue BY Assoc Prof Tan Soo Yong
Many of us are likely to hold an established view on organ donation. But how many have thought of a much more fundamental “body part” that is available for donation – bits of tissue cut out during surgery? Consider a fictional character Mdm Foo, a housewife in her mid-50s, who noticed a hard lump in her left breast. As her aunt had died of breast cancer, she saw her doctor immediately. After undergoing a biopsy, her doctor confirmed she had breast cancer and needed surgery to remove the affected part.
We are slowly but surely moving away from the ‘one size fits most’ model of medicine to a personalised approach based on an individual’s specific genetic blueprint.
Foo’s surgeon was able to confirm that her cancer was aggressive and would best respond to a specific treatment, which she then started on. But this still leaves quite a few questions unanswered: Why did she develop the cancer? Are her children likely to get it too? And could it have been discovered earlier, helping her avoid surgery? Extensive research on tumour tissue has provided some answers. So instead of wasting the leftover tissue, patients can donate them to research. Tumour tissue contains the blueprint of a disease, telling researchers what genetic changes it has gone through. Sometimes, researchers can identify a unique change that can be used as a marker of early disease or as a target for new treatments. Naturally, this research cannot be done overnight or by examining just one individual’s tissue material. Investing it right Tissue banks approach patients, like Mdm Foo, to seek their consent to donate any
leftover tissue. But patients may have some concerns: Will I have to undergo another operation? Will research take precedence over my own needs? And will my personal information be kept confidential? Only when the tissue is no longer needed, meaning after information necessary for diagnosis and treatment has been extracted, is the tissue banked for research. The donor will not have to go for another procedure. His identity will also not be disclosed as the source of tissue will be anonymous. The donated tissue is preserved in liquid nitrogen, at temperatures as low as -196°C. This is to ensure researchers can view an exact snapshot of a disease at a particular time. But if she were to donate her tissue, what guarantee does Mdm Foo have that it will be used appropriately? Much like a conventional bank that has been entrusted to invest people’s savings, tissue banks are also prudent about the use of this resource. Access is only granted to studies approved by an institutional review board which safe-
During her preoperative tests, a member of the hospital’s tissue bank talked to her about tissue donation and asked whether she would donate some of the tissue – about to be cut out – to research. But what is tissue donation all about? DNA and the appreciation of tissue With the mapping of the human genome completed in 2003, scientists now have the tools to discover what causes cells to become cancerous, how to recognise them early and come up with more targeted treatments. This research requires tissue material. Following surgery, the tumour is examined by a pathologist to determine what type of cancer it is, how far it has spread and how aggressive it is likely to be. This information enables the doctor to make a diagnosis and determine the best treatment for the patient. The leftover tumour tissue (which is valuable to scientists) is normally discarded, meaning a precious resource that may lead to breakthroughs in cancer diagnosis and treatment ends up in the bin. Let’s return to our example. With the information from the pathologist, Mdm
Leftover tumour tissue helps researchers decode the causes of diseases which can result in better tests and treatments.
PHOTO: photolibrary
Don’t bin leftover tissue removed during surgery!
Instead of disposing leftover tissue, patients can donate it to research.
guards the interests of the community at large and ensures the research meets ethical standards. There is also an oversight committee (composed of senior doctors and scientists) that vets every request for tissue, to ensure donations are used in the spirit that they were donated and lead to new knowledge, benefiting future generations. Banking on a brighter future We are slowly but surely moving away from the “one size fits most” model of medicine to a personalised approach based on an individual’s genetic blueprint. With this, the role of tissue is placed centre stage. According to Time magazine, tissue banks, also known as biobanks, are among the 10 ideas that are changing the world. For a small nation like Singapore, tissue quantity and variety pose certain challenges. Our patient pool is small and some conditions may only be present in one or two individuals per year. For example, the SingHealth Tissue Repository only has one malignant eye tumour sample available out of its repository of some 10,000 pieces of tissue, collected over the last 14 years. In contrast, available breast tumour tissue samples number close to 2,000. But if we can collect sufficient tissue, researchers can identify specific genes that trigger a condition, which means better screening, earlier diagnosis and more effective treatment. But before we hype up the potential of tissue research, we need to think what we would do if we were in Mdm Foo’s shoes. Only if we choose to donate our leftover tissue can the full potential of this relatively young field be realised. Associate Professor Tan Soo Yong is Director, SingHealth Tissue Repository, and Senior Consultant, Department of Pathology, Singapore General Hospital. He also teaches at Duke-NUS Graduate Medical School.
Mar⁄ Apr 2011
singapore he alth
23
Spotlight
Sweet pregnancy The risks are many, but with help from doctors, nurses and other specialists, it’s possible to be diabetic and still have a successful pregnancy
PHOTOs: alecia neo
injections in her seventh month to deal with rising blood sugar levels.
Ms Han Yoke Leng and her husband’s baby was delivered early as it had grown unusually large, despite the efforts of Dr Abel Soh (right) and the team.
BY Thava Rani
Ms Han Yoke Leng’s second pregnancy was a pleasant surprise, but the 36 weeks that followed were filled with many anxious moments. Diagnosed with type 1 diabetes mellitus at 19, Ms Han has to control her blood sugar levels through daily insulin injections. When she became pregnant, the hormonal changes began to interfere with the action of the insulin, leading to insulin resistance and a build-up of blood sugar levels. “In an unplanned pregnancy for a patient whose blood sugar level is not adequately controlled, we need to get the level of blood sugar under control quickly, within a few weeks, if possible, to reduce the risk of a miscarriage or birth defects,” said Dr Abel Soh, Associate Consultant, Department of Endocrinology, Singapore General Hospital (SGH). Apart from high blood sugar levels, the 30-year-old office administrator in a multinational corporation also had to worry about low blood sugar levels which can occur when waiting too long between meals, doing too much exercise, or if too much insulin is taken. Frequent or prolonged instances of low blood sugar levels can have serious consequences: The baby’s growth may be retarded, and/or the mother may experience a seizure. Right nutrition is critical Eating properly – getting enough nutrients without overloading on the calories – can be tricky too. “When I was not pregnant, I could control my carbohydrate intake.
But during pregnancy, it became difficult because I had to ensure the baby was getting the right nutrients and that I also gained the right amount of weight,” said Ms Han. People with diabetes do not produce enough insulin, which is involved in the metabolism of carbohydrates, proteins and fat. Without insulin injections or tablets, their blood sugar levels escalate, especially after a meal, said Dr Soh. Like Ms Han, Ms Jamilah Abdul Latiff, 41, had to be careful about her food intake during her fourth pregnancy. But unlike Ms Han, Ms Jamilah only developed diabetes during pregnancy. The body is sometimes unable to produce enough insulin to counter the insulin resistance caused by hormonal changes during pregnancy, resulting in a form of the disease known as gestational diabetes. It usually goes away after the baby is born, but for some, the diabetes becomes chronic. Although controlling her diet helped Ms Jamilah maintain good blood sugar control at first, she had to start insulin
Teamwork for success Because of the complications that come with diabetes, women like Ms Han and Ms Jamilah are seen by a team at SGH’s Diabetes Centre that includes an obstetrician, an endocrinologist, a nurse and a dietitian. It is essential that all are present to understand the patient’s overall condition, and to decide on a treatment that takes into consideration different aspects of the patient’s needs. For instance, the dietitian advised Ms Han to eat frequent small meals to minimise sugar spikes that occur after each meal. The endocrinologist checked Ms Han’s sugar profiles regularly, and adjusted her insulin doses according to changes in her blood sugar levels. Underscoring the difficulties that can occur with such pregnancies, Ms Han’s baby grew unusually large – a potential problem among women with diabetes. “Unfortunately, despite our best efforts to control her blood sugar levels, the baby continued to grow. The team decided to deliver the baby earlier,” said Dr Soh. Overly large babies are hard to deliver naturally, and may suffer injuries during delivery. They are also prone to diabetes later. Ms Han’s son weighed 4.07kg when he was delivered in December 2010. Ms Han’s first child, a girl, was smaller and weighed 3.5kg at birth. Her first pregnancy, which was planned, was smoother. Before she even became pregnant, Ms Han and her husband made sure her blood sugar levels were under control. “However, many women with pre-existing type 1 or 2 diabetes do not plan their pregnancies, despite being told the risks of having a baby when their blood sugar control is suboptimal,” said Dr Soh. “We are working on improving our pre-pregnancy counselling, so the risks of miscarriage and congenital abnormalities are reduced in early pregnancy for these women,” said Dr Soh.
Risks of being pregnant and diabetic
If you are pregnant and have diabetes, whether type 1, 2 or gestational diabetes, there are risks to you and your baby, according to Dr Abel Soh, Associate Consultant, Department of Endocrinology, SGH. You may be at risk of: having a large baby (weighing more than 4kg), which could mean a difficult delivery, or delivery by Caesarean section having a miscarriage (if you have pre-existing diabetes) or stillbirth aggravating existing diabetes-related problems of the eyes and kidneys developing high blood pressure and excess protein in the urine, a condition known as pre-eclampsia, in the later half of pregnancy developing type 2 diabetes (two to three times more likely than other women) after pregnancy
Your baby may be at risk of: suffering from congenital abnormalities, such as heart anomalies having health problems shortly after birth, such as breathing difficulties, low blood sugar or low calcium levels becoming overweight or obese and/or getting diabetes later in life suffering physical injury during natural delivery (if he is large)
Are you at risk of gestational diabetes? This type of diabetes starts only during pregnancy – most commonly during the second half – and may or may not go away after delivery. You are more likely to develop gestational diabetes if: any of your parents or siblings has diabetes you are overweight with a BMI (body mass index) of at least 25 you have previously given birth to a large baby (more than 4kg) you have previously had gestational diabetes, high blood sugar levels during fasting and/or high blood sugar levels after taking a solution with the equiva-
The team at SGH Diabetes Centre works closely with diabetic patients to ensure a safe outcome for both mother and child.
lent of 75g sugar
24
SINGAPORE HE ALTH
MAR/APR 2011
Money Matters
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37
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Adequate coverage helps put the pieces of your life back together when illness strikes.
FjZhi^dch id Vh` WZ[dgZ iV`^c\ je V ]ZVai] eda^Xn/ Coverage What will my health insurance policy cover? Am I already covered for the same thing under another health insurance policy? Are there any policy exclusions? How is my health insurance policy affected by other schemes that pay for healthcare? Is coverage for a lifetime or only up to a certain age? Is coverage worldwide or for only specified countries or regions?
Premiums How much will I be paying for my health insurance and will I be able to afford the premiums in the long term? How often will the premium be charged and will it be a fixed or variable sum? Will my policy automatically be renewed and what is the penalty if I do not pay my premiums on time? When or under what circumstances will my health insurance policy end?
Claims How do I make a claim? Are there claim limits for each illness, per year or for the lifetime of the policy? Is there a waiting period for the policy? Are there any limits to the benefits that can be paid out from my policy? How will my future premiums and coverage be affected after I have made a claim?
critical illnesses:
1 Major Cancers 2 Heart Attack 3 Stroke 4 Coronary Artery Bypass Surgery 5 Kidney Failure 6 Aplastic Anaemia 7 Blindness (Loss of Sight) 8 End-stage Lung Disease 9 End-stage Liver Failure 10 Coma 11 Deafness (Loss of Hearing) 12 Heart Valve Surgery 13 Loss of Speech 14 Major Burns 15 Major Organ/Bone Marrow Transplantation 16 Multiple Sclerosis 17 Muscular Dystrophy 18 Paralysis (Loss of Use of Limbs) 19 Parkinson’s Disease 20 Surgery to Aorta 21 Alzheimer’s Disease/Severe Dementia 22 Fulminant Hepatitis 23 Motor Neurone Disease 24 Primary Pulmonary Hypertension 25 Terminal Illness 26 HIV due to Blood Transfusion and Occupationally Acquired HIV 27 Benign Brain Tumour 28 Encephalitis 29 Poliomyelitis 30 Bacterial Meningitis 31 Major Head Trauma 32 Apallic Syndrome 33 Other Serious Coronary Artery Disease 34 Angioplasty and Other Invasive Treatment for Coronary Artery 35 Progressive Scleroderma
36 Systemic Lupus Erythematosus with Lupus Nephritis 37 Loss of Independent Existence
HdjgXZ/ A>6 lll#a^V#dg\#h\
Mar⁄ APR 2011
singapore h e alth
25
People
No regrets!
is to inform them that they do. Seeing cancer patients recover after treatment and remain cancer-free for the next 20 or 30 years, and young patients who were initially devastated with the cancer diagnosis coming back years later with their children at their follow-up consultations – these make me feel great and give me tremendous job satisfaction.
At the age of 60, Dr Wong Chow Yin, Senior Consultant and Director, Ambulatory Surgery Centre, Department of General Surgery, Singapore General Hospital (SGH), continues to inspire many doctors and nurses with his dedication and commitment to care. Dr Wong looks back on 36 years as a doctor, including 26 as a surgeon. What are the high points of your career? I am originally from Malaysia, but I studied at the University of Singapore, as it was called in 1975. I worked in various public hospitals before joining SGH in 1988. I started the first breast subspecialty team in Singapore. The Friday Breast Clinic was set up in 1989 to receive all breast referrals from polyclinics. Through the years and with hard work, the clinic remains the premier referral centre even though breast units have been established in other hospitals. I also started the first breast counsel-
PHOTO: 101TEAMWORK
It was his childhood dream to be a doctor, and after nearly four decades, Dr Wong Chow Yin says he has “no regrets”. He remains passionate about treating breast cancer patients and training young doctors ling service in a Singapore hospital. Ms Saraswathi Nagalingam (a Senior Nurse Clinician), was sent for overseas training in 1992 and has been with me since. She attends to the emotional and psychological needs of breast cancer patients while my team and I tend to their medical needs. The department has trained many doctors and nurses over the years. More than 10 breast surgeons trained in SGH are now working in other public hospitals, and several have set up successful private practices. Numerous breast nurses who trained with us have continued the good work elsewhere.
Dr Wong has been a surgeon with Singapore General Hospital since 1988.
with terminal breast cancer, and had badly infected cancer wounds. I had to do a toilet mastectomy to give her a better quality of life. But she died three months later. That was in 1982 when I was a young registrar at Alexandra Hospital. Around that time, I treated another young woman – a bank officer – for breast cancer. She had a mastectomy and chemotherapy. Her fiance left her and the cancer recurred two years later. She told her story – her thoughts and feelings during the illness – to a local magazine.
Why did you choose breast as your subspecialty? I came to choose this as my subspecialty as it was the only area that was still available after the rest of the consultants had chosen theirs! A couple of other incidents also contributed to my decision. One involved a 16-year-old Malay girl waiting for her O-level results. She was diagnosed
What are the best and worst parts of your job? The best part of my job is to tell patients they do not have cancer, while the worst
How do you break bad news to patients? It’s important to understand the anxiety patients feel when they are referred to my clinic. Will the lump in their breast turn out to be cancerous? The possibility of losing the breast, the side effects of chemotherapy and the cost of treatment add to their fear and anxiety. A lot of patience is needed to calm the patients and explain the disease to them. It’s important to convince them that it’s not the end of the world, as with treatment, most of them can be cured. It is also important to be frank with the patients, looking them straight in the eye and maintaining eye contact at all times when explaining the disease and treatment alternatives. It helps a lot when Ms Saraswathi is around as she is able to comfort the patient and provide emotional support. What advice do you have for women? Start doing breast self-examinations when you are in your 20s. Go for a mammogram yearly in your 40s and twice yearly after 50. See your GP or polyclinic doctor when in doubt about a lump.
The art of social work By Erniza Veel
Half a year after her mother’s death, the woman continued to grieve. to help her come to terms with the loss, ms saryna ong, Senior Medical Social worker (msw), National Cancer Centre Singapore (NCCS), encouraged her to put together a collage of her feelings about her mother. “She painstakingly searched for the ‘right’ pictures and organised the placement,” said Ms Ong, who is also Art Psychotherapist, Department of Psychosocial Oncology, NCCS. Once the collage was done, Ms Ong and the woman discussed her memories, guilt and loneliness – all prompted by the collage. “After about five sessions, she was better able to move on,” said Ms Ong. The senior MSW had always dreamt of combining her passions for social work and art. “I never imagined it would be possible as there were no art therapy qualifications available locally then,” she said. However, SingHealth’s sponsorship of her 2008 Masters in Mental Health (Art Therapy) at the School of Medicine, University of Queensland, made her dream possible.
Today, she supports patients both as a senior MSW and art therapist. Her role as an MSW includes assessing and assisting patients with practical needs such as financial or discharge care planning and other practical needs. “Another very important part I play as an MSW is to provide supportive counselling in areas like acceptance of illness, treatment-related issues, depression counselling, grief and bereavement work,” said Ms Ong.
PHOTO: Alecia neo
Saryna Ong uses two essential skills to help her patients
Ms Ong teaches patients to understand and discuss their innermost thoughts and feelings with the help of pictures and art.
I use art to process my feelings and thoughts after sessions. Art therapy has helped me in my own growth, development and insight. Ms Saryna ong, senior medical social worker, medical social services, and Art Psychotherapist, department of psychosocial oncology, national cancer centre singapore
Her expertise as an art psychotherapist is a natural complement. A cancer diagnosis can be devastating to patients and families. “It can stir up a lot of emotions and issues for them. I find art therapy a useful tool. What is difficult to put into words can be expressed visually. Very often, patients begin to talk more through their art.” In one case, a patient drew graphic images of death. Later, she revealed her experience of witnessing a death in the intensive care unit – and her own fear about death. “After another session, she drew a picture of heaven and decided that death might not be so scary, as she
knows where she will go after passing away,” said Ms Ong. She has benefited from art therapy herself. “I use art to process my feelings and thoughts after sessions. Art therapy has helped me in my own growth, development and insight.” The busy MSW also facilitates support groups such as a Chinese language one for cancer patients and group art therapy for patients and their families. During her 11 years at NCCS, her role has also included being a field teacher for social work undergraduates, supervising junior MSWs, as well as giving talks and training for healthcare workers.
26
singapore he alth
Mar⁄ Apr 2011
FYI
Save money, save lives From now till March 31, 2011, spend $5 on a Savemoney Savelives booklet and enjoy fantastic savings on shopping and dining, plus the chance to win fantastic prizes! Save money with more than $1,500 worth of discounts from more than 35 popular brands in your booklet. Save lives as all proceeds will go towards providing medical assistance for needy patients. Win big with scratch-and-win prizes up for grabs, as well as the Grand Lucky Draw prize of a Subaru Impreza 1.5 MT Sedan worth $60,000!*
Older women in Singapore are more depressed than their male counterparts
Booklets are available at: Singapore National Eye Centre lobby, Mon-Fri, 9am-5pm, or call SingHealth Foundation at 63777613 / 6377-7608.
Count me, can?
4,489 aged 60 that women in general had higher But regardless of gender, living alone without a spouse and with only one’s children, and having access to a weak social network, led to a higher probability of experiencing depressive symptoms. The researchers from Duke-NUS Graduate Medical School, Duke University and National University of Singapore also found that for men, a strong social network made a significant difference. It is therefore important for older adults, particularly those living alone, to strengthen their social networks.
Publisher
1. What is one risk a pregnant diabetic woman faces? 2. Which story did you enjoy reading most in this issue of Singapore Health?
Send in your answers and stand to win a box of Sun Chlorella A tablets worth about $55.
Include your name, age, gender, address and telephone number. All winners will be notified via phone or e-mail. Incomplete entries will not be considered. E-mail: editor@sgh.com.sg Post: The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608 Winners of Contest 8 These winners will each receive a box of Collagen Extreme 10000 worth $78. 1. Chen Wenjie 2. Chua Guan Seng 3. Girish R Lakhani 4. Lim Geok Hwa 5. Ulrike Zeitz
Singaporeans
depressive symptom scores than men.
Singapore Health issue 9 contest
Closing date: April 8, 2011 Savemoney Savelives is brought to you by SingHealth Foundation. UEN T02CC1576B The draw for the Subaru Impreza 1.5 MT Sedan will be held on Thursday, May 5, 2011. The winner will be notified by post by Friday, May 20, 2011. *Excludes COE, road tax, registration fee, insurance, IU and number plate.
A study of
and above who live at home, found
event Calendar
3,317 cans
went into making this Taj Mahal replica as part of Singapore General Hospital’s (SGH) recent Go Green Charity Sale. Clothes, bags, books and handicrafts went on sale to raise more than $13,600 for the SGH Needy Patients Fund.
Co-funded
Prizes must be claimed by April 29, 2011.
Answer to In focus (Page 3):
The Breast Cancer Exhibition
Time 10am-6pm daily Venue Science Centre Singapore Price Science Centre admission rates apply Contact Visit www.science.edu.go or call 6425-2500 Mar 27 (Sun)
Eastern Community Health Outreach (ECHO) Health Screenings for Changi Simei residents aged 18 and older
Time 8am-1pm Venue Blk 164, Simei Road Price $2 for basic health screening (ages 18 to 34), $10 for full health screening (ages 35 and above) Contact Visit www.cgh.com.sg/ECHO or Changi Simei Community Club (tel: 6781-6058) from 9am-9pm daily
How Dietitians Can Help You
SingHealth Women’s Forum
Apr 16 (Sat)
Time 10-11am (special interactive sessions), 1.30-5.30pm (forum) Venue Hilton, Grand Ballroom, Level 3 Price $18 per person (forum) or $30 for two. $5 per person (special interactive sessions) Contact marcom@singhealth.com.sg or download the registration form from www.singhealth.com.sg/womensforum Apr 23 (Sat)
Time 2-5pm Venue SGH Postgraduate Medical Institute (PGMI), Room 3 and 4, Block 6, Level 1 Price $5 per person Contact For registration, please call 6326-5284
For more listings, please visit www.singhealth.com.sg/events or the respective institution websites.
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Mar 10 (Thur)
Time 11am-3pm Venue SGH Postgraduate Medical Institute (PGMI), Block 6, Level 1 Price Free
SGH Eczema Public Forum
This device plays an important role in Singapore General Hospital, transporting blood, urine and tissue samples via a network of tubes to the labs for urgent examination, bypassing human traffic on the ground. A 19th-century invention, the pneumatic tube system uses compressed air to propel cylinders through a tube to their intended destination.
Ongoing till Oct 8
All rights reserved. Copyright by SGH (registration no: 198703907Z). Opinions expressed in Singapore Health are solely those of the writers and are not necessarily endorsed by SGH, SingHealth Group and/or SPH Magazines Pte Ltd (registration no: 196900476M) and their related companies. They are not responsible or liable in any way for the contents of any of the advertisements, articles, photographs or illustrations contained in this publication. Editorial enquiries should be directed to the Editor, Singapore Health, 7 Hospital Drive, #02-09 Block B, Singapore 169611. Tel:+65 6222-3322, E-mail: editor@sgh. com.sg. Unsolicited material will not be returned unless accompanied by a self-addressed envelope and sufficient return postage. While every reasonable care will be taken by the Editor, no responsibility is assumed for the return of unsolicited material. ALL INFORMATION CORRECT AT TIME OF PRINTING. MICA (P) 060/06/2010. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).
新加坡中央医院
3月
与新加坡保健服务
4月 2011
集团的双月刊
page 27-28
page 29
page 30
page 31
无私的奉献
切勿掉以轻心
享有清晰视觉
病房提升
平凡英雄 不同而和 再献新生命 虽然血型不合，但一名母亲通过一项新移植手术，能减少手术后器官遭排斥的现象，成功捐肾给她的儿子
新加坡保健服务集团颁发奖项鼓 励积极面对逆境的病人及看护者 文 谢洁仪
之前，有许多病人因与 自愿捐赠者的血型不 合而无法进行移植手 术。我们在成功进行首 个血型不合的移植手术 之后，发现有 的 捐赠者与病人的血型 不合， 我们估计今年 将会从中进行七宗这 类型的移植手术。
图：101TEAMWORK
图：ALECIA NEO
项服务制定医疗方案。纪医生说：“跟 随日本专家学习，让来自不同医疗领域 的移植小组能为所有可能出现的并发症 陈学华的非恶性肿瘤占了脑部的 30% ， 和结果做充分准备。” 将其切除后，他在一星期内就失明了。 2009年11月，在接受ABO血型不相容 不过，这并没有削减他自力耕生以及 肾脏移植手术（以A、 B 和 O 主要血型来 帮助他人的意志。 54 岁的他在失明后， 命名）前，陈崇能的免疫系统必须抑制 学习弹键盘。如今，他在疗养院为乐龄 到一定的水平，以防血型不合的捐赠者 人士表演，同时也是一所音乐学校的客 肾脏遭排斥。如果不加以控制，受益者 户服务部门主管，并负责管理学校的各 免疫系统的抗体将快速攻击捐赠者肾脏， 个分行。 就像人体自然产生抗体对抗病菌一样。 他积极的态度不但启发了他帮助的 人，也深深地影响了照顾他的医疗工作 者。这也是他获颁首届新加坡保健服务 集团的激励人心病人及看护奖的原因。 另外有其他36人也获颁此奖项。 对于能够得奖，陈学华说：“我希望 我的故事能给别人一点启发。” 2008 年 ， 在 一 次 例 行 身 体 检 查 后 ， 陈学华因疑似患有白内障，被转介到新 新移植手术让陈崇能无需等上九年就能换肾。 加坡眼科中心。结果，医生发现陈学华 脑部有一个比网球还要大的肿瘤，而它 眼见儿子因治疗无效而愤怒和绝望，让 正影响了陈学华的视力。肿瘤必须立刻 原文 ThaVa Rani 她倍感难过。 被切除。不过，这将是个既复杂又危险 25% 她也不愿让儿子失去接受移植手术 的手术。陈学华有一星期的时间来准备 正值青少年时期的陈崇能，因为药物无法 的机会，因为长时间接受肾脏透析，会 接受手术。在这期间，他把手头上的公 抑制肾功能恶化，已接受多年的肾脏透 使病人出现并发症而无法接受移植手术。 司业务处理好，并将运输公司转交到妻 析治疗，而且他能获得合适器官捐赠的希 根据全国器官移植组统计，在新加坡， 子名下。 望越来越渺茫。这名年轻人在18岁时被 肾脏移植等候时间平均为九年五个月。 诊断出因遗传而导致肾功能衰竭。 陈女士及其儿子是新加坡中央医院第 陈学华虽然失 因此，当与他的家人讨论其他治疗 一对接受血型不合移植手术的人，但他 去了视力与味 觉，但却过着 建议时，其中一项疗法是为血型不合的 们一点也不担心。 新加坡中央医院肾脏科肾脏移植顾问兼主任 独立、充实的 器官捐赠者和受益者而设的新移植手术， 毕竟，自卫生部修改人体器官移植法 纪怡胜医生 生活。 陈崇能的母亲立刻接受了这个方法。 令，取消逝世病人捐献器官的60岁年龄 这对母子的血型不一样，但他们是唯 上限后，新加坡中央医院的肾脏移植小 一合适的组合，其他家人因种种因素而 组是首个在2010年成功从年迈逝世捐赠 不适宜进行这项手术。在这之前，只有 者移植肾脏的医疗团队。该院也成功将 血型相同的人才适合进行肾脏移植。 一名 75岁母亲的肾脏移植到她 46岁女儿 纪医生说：“在进行移植手术前，陈 5 4 岁 的 家 庭 主 妇 陈 亚 娥 说 ： “ 我 身上。这名母亲也是新加坡年纪最大的 崇能需每隔一天接受类似透析的治疗， 说，‘我们进行吧。’我只是觉得这是 活体肾脏捐赠者。 去除血液中的抗体，直到抗体水平降低 一个可以让我为儿子做一点事的机会。” 血型不合的肾脏移植手术在新加坡中 至可进行移植手术的安全水平。” 央医院属于一项新服务，但新加坡中央 捐赠者的器官受到排斥是所有器官受 希望有个更美好的未来 医院肾脏科肾脏移植顾问兼主任纪怡胜 益者所面临的问题，但对于接受血型不 陈女士和其他家人一样，如果有更好的 医生说：“日本早在 1980 年代就已进行 相容移植手术的病人而言，这个风险更 医疗选择，她不愿让儿子花九到十年边 这种移植手术，并取得成功。” 高。和所有器官移植者一样，陈崇能必 做肾脏透析边等待器官捐赠。陈女士负 他补充，肾脏移植小组花了一年时间 须终生服用免疫抑制药。由于他的免疫 责接送儿子往返医院进行检验和看诊， 数次到日本向专家学习技术，以及为这 > 文转 page 28 > 文转 page 28
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获颁此奖项的安佳娜，就因丈夫患 话的人通常会把感情憋在心理，胡思乱 有慢性骨髓性白血病，而成为了白血病 想。所以我在2003年决定成立一个名为 的“专家”。无论是病症、疗法或最新 亚洲慢性骨髓性白血病互助团体的网络 的药物，她都相当了解。 互助团体。我想，和其他病人多接触对 在动手术前，医生吩咐他将 5 颗松了 她说：“我非常沮丧，但我也是个 他的心理健康有所帮助。” 这个亚洲慢性骨髓性白血病互助团体 的牙齿拔掉。他解释道：“如果牙齿在 实际的人。我丈夫的心情大受影响，根 手术时松脱，我可能会被呛着。在让牙 本没办法想这么多。所以我必须挺身而 的成员日益增加，目前有超过1000个来 自世界各地的会员。不过安佳娜没有因 医把牙齿拔掉前，我告诉他我想趁周末 出，支持他。” 把我爱吃的食物一次吃光。” 安佳娜是个拥有博士学位的化学师。 此而止步，她让一些到新加坡中央医院 手术非常成功，但陈学华的复原之路 她翻遍了网上的资料，阅读无数的研究 接受治疗的外籍病人到她家去，并花时 非常漫长、艰辛。除了失去视力，他也 报告并积极参与各个海外的网络互助团 间照顾其他在医院接受临床药物试验 失去了味觉。他患有幻觉，并经常责骂 体，因为本地没有类似的组织。 的病人。 她解释道：“因为这些病人大老 家人及向医护人员扔杯子等。 她说：“我有幸加入了一个美国雅 偶尔，他回家时会迷路，衣服穿反 虎慢性骨髓性白血病的互助团体。他们 远从印度等地来新加坡接受临床试 时会慌张，不小心撞到人而对方向他道 讨论一种称为‘ Gleevec ’的实验性药 歉时，会觉得不好意思。可是，他却拒 物。有病人已经接受了第一阶段和第二 绝接受别人，甚至是妻子或孩子的帮忙。 阶段的临床试验，而他们的病情获得完 为了自立，他学习如何自己搭巴士、煮 全缓解。” 饭等日常琐事。 安佳娜和丈夫因此向主治医生询问有 他说：“做人必须要有正面思考。你 关治疗。他符合临床试验的条件，所以 必须承认动了手术后，你失去了视觉和 他的主治医生吴耀智副教授也是新加坡 味觉。你必须接受这个事实。然后，就 中央医院血液部门资深顾问让他参与这 继续活下去。不管怎么样，日子还是要 项当时在新加坡进行的临床试验。 过的。这是一条漫长的道路。” 九年后，安佳娜丈夫的病情已经完全 “每天我沿着同样的道路走着，但是 缓解了。 每天都是一个新的体会。”他补充说。 安佳娜一点也不吝啬于和别人分享她 的知识。当时40岁的她，决定成立一个专 无私奉献 为像她丈夫一样的病人而设的互助团体。 3月1日颁发的新加坡保健服务团队的激 她希望通过这个互助团体让内向的丈 励人心病人及看护奖，同时也是为了表 夫敞开胸怀，把内心的感受说出来。 扬在看护方面有杰出献身精神的看护者。 她说：“他非常文静。不过，不爱说
验，所以他们需要很多精神上的支持。 我开始陪他们到医院去接受治疗，并帮 助他们向医生沟通，告诉医生他们是否 感到任何的副作用。” 她也补充说，从照顾自己的丈夫到帮 助其他的病人，是一个很自然进阶过程。 为了让海外病人不要时刻想着自己的 病情，同时也为了疏解他们恐惧和孤单 的心情，她邀请病人到家里吃饭，带他们 到新加坡的旅游景点去散心， 也给他们精神上的支持。 安佳娜把帮助及支持癌症 病患视为她的使命。
图：ELLEN LIM
平凡英雄
3 文接 eV\Z ',
不同而和 再献新生命
图：ALECIA NEO
图：ALECIA NEO
系统已被抑制，他很容易受感染，所以 他无法上学，也需避开人多的地方直到 情况稳定。 一年多后，目前陈崇能是新加坡管理 学院工商管理一年级的学生。 陈崇能说： “在这之前，我只待在家里， 或跟朋友出去玩。在我住院的四个月内， 我意识到我的生活毫无意义。现在，我要 充分利用每分每秒，过个充实的人生。” 在生病期间，陈崇能和母亲的感情更 加亲密。有了母亲的支持和鼓励，陈崇 能更勇于面对他的疾病。 陈崇能在住院的四个月里有时间好好地反省自 己的人生。 他说：“她是我的好朋友。”
纪怡胜医生（右）和队友是首个在新加坡中央医院进行血型不合的肾脏移植手术的医疗团队。
认识ABO 血型系统 直到上世纪末，人们一直以为所 有人的血型都是相同的，以致因输血 而引发的惨痛后果屡见不鲜。 如今，人们已知道红血球就像所 有组成人体组织和器官的细胞，含有 A抗原或B抗原。根据红血球上的抗 原，血型可分类为A型、B型、AB型 （同时含有A抗原和B抗原）或O 型 （既不含A抗原，也不含B抗原）四种。 如果有一种不属于体内红血球的 抗原出现，身体就会产生抗体对抗 它，就像产生抗体对抗病菌一样。 人体内的血液通过一台机器去除抗体 因此，在输血时，A型或B型只能 之后，将血液重新输入病人体内。病 接受相同血型的，而AB型可以接受 人每隔一天就要做一次血浆置换术， A 型 或 B 型 ， 比 较 灵 活 和 容 易 配 对 。 直到抗体降低至一个适合移植的安全 O型适宜捐血给任何血型，是血液捐 水平。 献中最为珍贵的血型。 一般移植手术的排斥风险为10%至 但是，O型只能接受相同血型的 15%，而在ABO血型不相容肾脏移植 输血。 手术中，排斥风险高达25%。由于病 同样的，在接受血型不相容移植 人须要服用更多免疫抑制药以防排斥 手术之前，受益者体内的抗体必须先 和进行血浆置换术，他们受感染的风 被去除。否则，抗体将攻击和摧毁不 险也比较高。 同血型捐赠者的新肾脏。 不过，现今科技发达，接受这种移 在移植手术中，去除这些抗体的 植手术的病人存活率每年高达95%至 方法被称为血浆置换术。这个过程有 100%，跟一般移植手术的病人存活 点像血液透析，通过瘘管或导管把病 率不相上下。
MAR⁄ APR 2011
新脉动
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切勿掉以轻心
帮助年长病人 改善他们的营 养摄取
年长者体重下降可能会有危险 原文 BALVINDER SANDHU
樟宜综合医院的职员一直在寻方设法 改善营养不良的年长病人的诊断和治 疗，最近终于推出了一套方案。由多 名医生、营养师、护士和一名语言治疗 师组成的跨学科团队，提出了几种方 法来改善年长病人的健康状况，包括：
老龄化向来都不是一件轻松的事。年长 者往往须要面对不必要的体重下降及其 引发的健康问题。年长者必须更注重他 们的营养均衡，因为营养不良的后果足 以致命。 樟宜综合医院营养与餐饮服务部门 主任张爱桃说：“老年人体重下降多数 不是特意的，它会引发功能衰退的高风 险，例如不能自己穿衣服或吃东西。这 也会增加死亡的风险。” 如果一个年长病人的肌肉和组织质 量衰退，他很可能是营养不良。这种年 长病人可能会出现呼吸困难、行动不
图：TOM HAN
给营养不良年长者的其 中一种补充营养的方法 是在他们平常的饮食中 增加一些营养品, 例如 蛋白质或热量饮料。
所有被诊断有营养不良风险的住院 病人应转介给营养师，以便能根据 他们的营养评估来提供适当的治疗。 这包括调整病人的日常饮食或指定 一些营养品。
便、体力下降的问题，以及胸部和肺部 受感染的风险也会提高。其他症状还包 括伤口愈合缓慢、疾病难以痊愈和难以 保持身体暖和。 营养不良的年长者很瘦弱、行动缓 慢，而且容易疲劳。肌肉质量和体力会逐 渐衰退，久而久之便会过度消瘦。造成营
养不良的原因主要有情绪忧郁、老年痴 呆、急性或慢性疾病、无法自己进食，以 及靠别人喂食或靠静脉注射来进食。 张爱桃说：“社会问题也会导致年 长者食量下降，尤其是在缺乏看护者支 持、住在养老院、粮食不足和孤独等因 素发生时。其中一种补充营养的方法是 在他们平常的饮食中增加一些营养品， 例如蛋白质或热量饮料。”这些以牛奶 为主的营养品并不便宜，而且不是年长 者特别喜欢的食物。但是，张爱桃表 示，如果他们的饮食受到特定限制，例 如无法忍受某种食物、无法或不愿摄取 足够的营养食品，或者无法安全地准备 食物，让这些年长者摄取营养品可以是
最好的解决方法。 独居和无法自己准备食物的年长者 需要有人帮忙做家务和监督他们的饮 食，以确保他们摄取足够的维生素和矿 物质。有些年长者可能因为不吃凉食或 者水果吃得不够而缺乏维生素或纤维。 那些咀嚼有困难的年长者则可能因为肉 类和蔬菜吃得不够而缺乏蛋白质，导致 肌肉萎缩。 住在医院、疗养院或在居家护理计 划下的年长者普遍出现营养不良的现 象。有鉴于此，张爱桃建议这些机构的 医生、营养师和护士组成团队，定期检 讨和建议均衡的饮食计划，以应对年长 病人的营养需要。
为年长者设计的饮食计划 下午茶/夜宵 一杯牛奶 一份水果
零食 两片全麦饼干 或一片面包 一杯豆奶 一至两片涂植物奶油 或果酱的全麦或白面包 或一小碗燕麦 或一碗汤面或粥 加牛奶的茶或咖啡
午餐和晚餐 早餐
一份（75-90克） 肉类、鱼或鸡肉 新鲜蔬菜 一碗白饭或面包或 印度薄饼 新鲜水果
对于严重营养不良的病人，院方应 在他们的餐牌上注明“营养不良警 戒”，清楚列明营养师规定他们摄 取的食物。这 类病人的床头 也贴上红色标 志，以便提醒 职员他们是营 养不良的高风 险病人。
护士应特别留意高风险病人，确保 他们有进食和摄取营养品。
密切留意病人摄取的食物和排出的 粪便。
每周替病人量一次体重，以便有系 统地检查和检讨他们的进展。
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Mar⁄ Apr 2011
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享有清晰视觉
患上白内障时，晶状体会 变得朦胧或混浊。
别让白内障毁了你的视力
白内障常见于老年人，但也可能发生 全球性的问题 在儿童和青年身上。患者眼睛无法正确 根据世界卫生组织，白内障是全球人类 就为他进行手术。一般上，该种手术 聚焦，导致视力变得模糊或朦胧。 视力下降的主要成因。全球将近一半 是在局部麻醉下进行的日间手术，不需 白内障的主要成因包括紫外线照射、 （ 1800 万 ） 的 失 明 人 士 是 由 白 内 障 造 住院。 黄 丽 萍 （ 48 岁 ， 行 政 人 员 ） 多 年 来 一 新加坡全国眼科中心的白内障手术大 直面对视力模糊、头晕和头痛的问题。 长期服用药物如类固醇和患有某些疾病 成的。 她以为是因为长时间使用电脑而加重了 如糖尿病。白内障大多数发病缓慢，在 新加坡全国眼科中心近期的研究发 多使用一种晶状体乳化的技术，在角膜 初期阶段不会影响视力，但久而久之就 现，超过90% 70岁以上的本地华人患有 划一个非常小的切口，手术后根本无须 近视。 她说：“我一直头痛和偏头痛。我 会造成困扰。视力会变得模糊不清，影 白内障。多数本地白内障患者选择在新 缝合。 感到很沮丧，因为我不知道问题出在哪 响一个人阅读和晚上开车等日常活动。 加坡全国眼科中心进行手术，这里每年 动手术时，医生会摘除患有白内障 里。”去年三月，她再也无法忍受模糊 黄丽萍说：“有时候，我的同事告诉 进行的白内障手术有1万多例。随着人口 的晶状体，然后植入清晰的人工晶状体。 的视力，于是到新加坡全国眼科中心寻 我，他们遇见我时，我并没有跟他们打 老化，到了2020年白内障患者的数量估 这就是所谓的人工晶状体植入术。人工 求协助。经过一连串的眼睛检查后，发 招呼。我不是不想打招呼，我只是没看 计会增加一倍。 晶状体会永久留在患者的眼睛里。根据 新加坡全国眼科中心资深眼科顾问、 患者的需要定制人工晶状体，以矫正视 现她患上一种晶状体混浊的眼疾——白 见他们。” 白内障与综合眼科部兼眼部炎症与免疫 力。这项手术适合大多数患者。但是， 内障。 部主任徐纯碧副教授说，白内障的最初 病人若在手术前已患有某些眼疾，例如 症状通常为视力模糊和近视加重，看到 严重青光眼和永久性的黄斑退化，而几 任何一个年龄层 的颜色会变得暗淡，可能会开始看到灯 乎失明，就无法进行该手术。 都可能患上白内 周围出现光晕、在亮光下视力不佳，以 白内障手术的标准收费为每只眼 障，但它更常见 于老年人。 及阅读和晚上开车有困难。 $2,100至$3,200不等，须视眼科医生的 她也表示，患者应该定期进行眼睛检 资历而定。如果病人要求特殊晶状体， 查，以便及早发现疾病。虽然这种眼疾 例如多焦点的晶状体 —— 可以同时看近 无法预防，但患者可以戴太阳眼镜，以 距离和远距离的物体，或者环形晶状体 保护双眼免受紫外线的照射。患者还可 以减轻散光， 那就须支付更高昂的费用。 以注重饮食均衡、治疗疾病如糖尿病和 徐副教授表示，患者在两三个星期内 戒烟。 就可痊愈，有些人甚至在手术后不需要 使用眼镜。 及早治疗白内障 黄丽萍进行了人工晶状体植入手术 以前，眼科医生要等到“时机成熟”和 后，双眼视力非常好。她说：“我发觉 视力退化，才会为患者摘除晶状体。如 我错过了很多事物。以前所有东西都是 今，由于技术先进，医生可以在患者视 模糊的，但现在我可以看得非常清楚， 力开始变得不清晰而影响到日常生活时， 简直就像是一个全新的世界。” 图：PHOTOLIBRARY
原文 Jessica Jaganathan
一些足部护养的建议 原文 Keith G Emuang
珍妮（非本名）非常喜欢穿高跟鞋，她 在教书生涯中一直穿着高跟鞋教课。长 时间不舒服地站着对她的脚造成损伤。 结果，到退休时，她得了严重的拇囊炎 肿。她大脚趾底的关节处出现肿块，导 致她站立或行走时都感到不舒服。专家 说这种情况非常普遍。 新加坡中央医院足病学医师麦耀铨 说：“脚有问题的病人以女性居多，他 们若不是长时间穿高跟鞋，就是穿了不 合适的鞋。”虚荣心往往是罪魁祸首。 据麦耀铨说，每个月大约有50个女 病人的足部问题都是与高跟鞋有关。越 来越多年轻女性（有些不超过30岁）出 现拇囊炎肿、脚跟骨刺和胶皮硬化等问 题。他说：“高跟鞋对脚无益。如果你 要穿高跟鞋，鞋跟的高度不应超过一、 两寸。” 最好也不要把大脚板挤进窄小的鞋 子里。许多女性认为，足部长水泡是
适应新鞋过程中的必然现象。麦耀铨 说，穿了两三次之后，脚就不应该再长 水泡了。 麦耀铨说：“你穿得下鞋子，不代 表它就很合穿。脚有很多软组织是不能 被压缩的。”如果要确认鞋子是否合 适，你可以把鞋垫取出，放在平地上， 然后把脚放上去比对。如果脚太大，就 表示鞋子太小。 一双好的鞋子除了合穿，也应具备 把脚恰当地往下压的功 能，例如鞋带、带扣 或带子。具有弹性的 橡筋带无法提供充分 的支撑，所以并不理 想。此外，不要忽略
图：Alecia neo
保护您的双脚
鞋后跟，它是用来固定你的脚，在走路 时提供支撑。你可选择鞋后方有坚固支 撑或牢固带子的鞋，也就是说，走路时 穿凉鞋比穿人字拖鞋来得好。糖尿病患 者不适宜穿日式人字拖鞋，因为夹脚处 的摩擦会损伤脚趾间的部位。 女性没有选择正确的鞋子，男性则 缺乏足部卫生的意识。麦耀铨说：“男 性通常会在他们的脚趾间出现细菌感 染，因为他们流汗比较多，而且没有恰 当地擦干他们的脚，也没有每天更换袜 子。”对于光顾美甲中心的女性，他劝 告说：“假如美甲中心的用具没有清理 干净，细菌和病毒就会轻易地从一个顾 客传染给另一个顾客。” 说到底，保持个人的足部健康与卫 生是自己的责任。首先，每个人应该勤 换袜子、滋润干燥部位和选择真正合 穿的鞋子。麦耀铨说：“尽管很 多女性可能在选购鞋子时不太 理智，但让常识情理战胜虚荣 心，才能确保足部健康。” 麦耀铨说，很多年轻女 性选择鞋跟过高、不合穿的 鞋子。 穿窄脚高跟鞋会使拇 囊炎肿的情况恶化。
常见的足部问题 脚癣 脚癣的细菌会造成皮肤疼痛发痒， 然后开始龟裂和脱皮。不注重足部 卫生会使脚癣恶化。人们经常光着 脚走路的地方，例如更衣室、游泳 池和美甲中心，最容易感染脚癣。
足茧 足部经过不断摩擦和挤压，就会逐 渐变厚形成足茧。这通常出现在 脚跟和脚趾侧。平足者较易出现足 茧，特别是在他们的脚心和脚跟内 侧，因为他们的脚心过低，导致这 些部位承受太多压力。其他成因还 包括经常光脚走路或穿不合脚的鞋 子。如果不加以治疗，足茧中心会 堆积死皮细胞，导致鸡眼。
脚跟骨刺 脚跟骨头生长异常（骨头隆起）多 半是由钙质沉积所致，站立或走路 时会感到剧痛。平足、脚心过高的 人或常穿高跟鞋的女性易于患上脚 跟骨刺。
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