Singapore Health Jul-Aug 2011 by Singapore General Hospital

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One-stop centre for women’s problems A multidisciplinary team comes under one roof to serve endometriosis patients at KKH tion that affects up to one in 10 women. KKH alone saw 1,200 women who underwent surgery related to endometriosis last year. This and the severe impact the condition has on the lives of women, plus the high chance of recurrence, prompted the hospital to set up the one-stop KK Endometriosis Centre that offers a comprehensive range of services and adopts a patient-centred approach. “As the combination of symptoms, severity and specific needs of these patients is diverse, we felt that the availability of a multidisciplinary team of doctors and medical support staff will be optimal to provide holistic care to such patients,” said Dr Cynthia Kew, Associate Consultant, Minimally Invasive Surgery Unit, Department of Obstetrics and Gynaecology, KKH.

BY Thava Rani

Thirty-three-year-old Andrea Lim (not her real name) went to KK women’s and children’s hospital (kkh) with severe menstrual cramps and bowel problems. After assessing her condition, the gynaecologist referred her to the colorectal surgeon, who did a colonscopy. With the results and their combined experience, the doctors discussed the options with her. She chose to undergo surgery, where scar tissue distorting her uterus and large bowel, was removed. After the operation, she received counselling from the nurse coordinator, and also completed a questionnaire which helped the team better understand the impact the condition had on her daily life. Andrea is one of an increasing number of women in Singapore suffering from endometriosis, a gynaecological condi-

For more information, call the Endometriosis Centre’s coordinator hotline at 9834-8034.

About endometriosis Dr Cynthia Kew, Associate Consultant, Minimally Invasive Surgery Unit, Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, answers some typical questions patients have about endometriosis. What is endometriosis? A condition where the lining of the uterus, or the endometrium, is found outside the uterus, such as in the ovaries, fallopian tubes, pelvis or lower abdominal cavity What are the symptoms? Severe menstrual pain, chronic pain in the lower abdomen or pelvic region, painful sexual intercourse, infertility Other symptoms unrelated to periods or none at all What types of surgery can help? Ablating (burning off) or excising (removing) endometriosis lesions Ovarian cystectomy (removal of a cyst from the ovary) Complete removal of the uterus and ovaries, which means immediate menopause. Therefore, it is reserved for women nearing

Round-the-clock drug therapy A new computer system allows more thorough review of patient prescriptions during the night

the expert and up-to-date knowledge of drugs, pharmacists serve as an important link in the treatment chain to ensure that the drugs and dosage which doctors have ordered are appropriate. They look out for known allergies and other details in a patient’s medical history and condition that might affect the effectiveness of the medication, or that might react with the drugs he is already taking. Working hand in hand with doctors and nurses, pharmacists can – and do – intervene if they deem a medicine being prescribed to be unsuitable for the patient, and suggest more appropriate alternatives. At the pharmacies – both outpatient and inpatient – pharmacists check and review prescriptions received every day. Inpatient pharmacies serve patients during their hospital stay as well as when they are discharged. Pharmacists – usually clinical pharmacists who hold higher or postgraduate degrees in pharmacology and related

PHOTOS: ELLEN LIM

A pharmacist does more than just dispense the medicines the doctor ordered. With

Pharmacists review doctors’ prescriptions and offer patients advice and recommendations round the clock.

disciplines – also regularly accompany doctors on ward rounds. They share their expert knowledge in the use of medication and provide advice on usage. At Singapore General Hospital (SGH), the review of all patients’ prescriptions is now round the clock, with a small number of pharmacy staff working at night since

December 2010. According to Mr Lim Mun Moon, Deputy Director, Department of Pharmacy, SGH, the review of patients’ orders became possible after the implementation of an electronic management system. The system puts drug administration, including records of patients’ medication, online.

menopausal age or with very severe symptoms The above are usually accomplished through laparoscopic (keyhole) surgery Are there non-surgical methods of treating the pain? Painkillers Hormonal therapies - First line (fewer side effects): oral contraceptives, progestogens - Second line (more side effects): GnRH analogue, danazol - Levonorgestrel intrauterine system Other alternative therapies: counselling, thiamine, vitamin E, high frequency transcutaneous nerve stimulation, local heat and herbal remedies Can endometriosis affect my chances of pregnancy? Yes, about 25 to 50 per cent of subfertile women have endometriosis, making it a significant cause of subfertility Besides surgery, assisted reproduction like intrauterine insemination (IUI) and in-vitro fertilisation (IVF) may help

“With the electronic system, we can deploy just a few pharmacists on night duty and they are able to review all orders online,” said Mr Lim. “With the previous paper-based records, it was difficult to have enough pharmacists physically going around the wards to check on medication orders.” Pharmacists, added Ms Lim Ching Hui, Principal Clinical Pharmacist, SGH, are able to review orders “remotely” from the pharmacy, instead of physically going to the wards or having the wards send patients’ records to them. There are 28 wards in SGH. Having a night pharmacy with two pharmacists and three pharmacy technicians, who assist the pharmacists in supplying medicines to the wards, helps to provide “a consistent level of care to patients at all hours of the day, improving patient safety”, Ms Lim said. Previously, a pharmacist was assigned to be on call over the night, and pharmacy-related services were provided by pharmacy technicians specially trained to review medication under supervision. Doctors and nurses could dispense medication, but only from stocks kept in the wards. Urgent requests were relayed to the on-call pharmacists. SGH, like other healthcare institutions, is increasingly using IT to enhance safety and make it more convenient for patients, as part of a national objective to create a single health record for each patient. This allows his medical history to be accessed easily.

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Root cause

National Dental Centre of Singapore cuts waiting time for patients with braces

It should have few emergencies, but National Dental Centre (NDC) of Singapore’s Department of Orthodontics, where its specialists correct misaligned teeth or jaws, was seeing unusually high numbers of patients walking in without an appointment. Puzzled by the number of unscheduled appointments, Dr Chan Feng Yi, Registrar, Department of Orthodontics, NDC, led a team to tackle the problem. “We wanted to improve the quality of care by finding out why patients came for unscheduled visits,” she said. Most of the department’s patients are seen for misaligned or irregular teeth, and are fitted with braces to correct the fault. The team discovered that although patients came back for their scheduled visits every six to eight weeks to have their braces reviewed and adjusted, many also made impromptu visits because of problems such as rubber bands breaking, wires poking their gums as well as other small discomforts. Braces are fitted to correct crooked or gap teeth as well as over- or underbites. Metal brackets are fitted to each tooth and are connected by a wire, held in place by elastic bands. The dentist will tighten the wire gradually to force the teeth into the right position. Rubber bands are also used for some patients to apply additional pressure to move jaws in directions that the braces alone can’t. The rubber bands are hooked around specially created hooks, which form part of the braces. As the braces force the teeth to straighten, the wire may work itself

Soft wax can dull sharp wire edges and provide relief from the braces rubbing against the cheeks.

out of the back bracket, or get bent so it rubs or pokes into gums or cheeks at the back of the mouth, causing discomfort. The rubber bands can also snap. “Most patients who walked in were not in pain, but unsure about what to do. By explaining how braces work and the problems they might have during the first appointment, we let them know that their problems can wait and be addressed during their scheduled visits,” said Dr Chan. The problem of the rubber band breaking was solved by discarding the orangecoloured bands, which were found to be weaker than bands in other colours. As for wires poking into gums and cheeks, Dr Chan said: “As teeth shift, it’s normal for the wire to start poking the gums. We started to give all our patients wax, which can cover the sharp parts of any wires poking out, to ease the discomfort. Sometimes, we take it for granted that patients who start using braces are fully aware of the changes that will take place and can take the discomfort. Now, we routinely give them wax,” she said. But walk-in visits are sometimes necessary, such as when retainers (worn to keep teeth straight after braces are discarded) are lost. “If this happens, we ask them to come in to see us, as patients cannot do without their retainers for long,” said Dr Chan.

PHOTOS: 101TEAMWORK

Stacey Chia

Patients with braces saw their waiting time reduced, thanks to an initiative by NDC that halved the number of walk-in appointments.

In focus

Better dental care is not just limited to patients receiving orthodontic treatment. The new $3.7 million electronic dental record system at National Dental Centre (NDC) of Singapore is the first custom-built solution that seamlessly integrates all major aspects of patient management in a large-scale dental institution. The system is also linked to the larger SingHealth Electronic Medical Records, which give dentists easy access to a patient’s medical history, lab test results and drug allergy alerts. With quick and timely access to a patient’s updated dental history and preexisting medical conditions, dentists can now provide more thorough

assessments within a shorter period of time. NDC, the first dental specialty centre in Asia to receive Joint Commission International’s accreditation, sees more than 150,000 patients a year. Prior to this, physical records were kept in a 440 sq m room, a space which can now be converted into 15 consultation rooms. Then Health Minister Khaw Boon Wan wrote in his blog that patients stand to benefit the most from this upgrade to the electronic system, and can expect better services and more accurate treatment. Noting the space saved due to the reduction of paperwork and storage needed, he said: “Less is truly more.”

PHOTO: ALECIA NEO

Digital dental care with Electronic Medical Records

Can you guess what this is? See page 26 for the answer.

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At ground level An improved, spring-loaded ankle brace helps patients with neurological conditions, such as stroke or cerebral palsy, walk easier BY Angeline Neo

old Janice Ng is able to take a few steps, she has to mentally map the distance she wants to go first, even if it’s just to cross the room. Every step is deliberate, never random. Ms Ng has cerebral palsy, a walking and motion disorder caused by damage to the motor control centres of the developing brain. Cerebral palsy may affect one limb, all four, or a combination, making movements abrupt, jerky, uncontrolled and uncoordinated. In Ms Ng’s case, she suffers from “toe-walking” – a condition where her heel and toes don’t rest flat on the ground when she is standing, resulting in her being balanced precariously on her toes. When walking, her feet aren’t able to perform the full range of movements that most people are able to. Not surprisingly, she is prone to tripping and falling. A brace, known as an ankle foot orthosis, worn on the lower leg and foot to support the ankle, can help people like Ms Ng walk more normally by holding the foot and ankle in the correct position. However, conventional devices can be rigid, preventing the “up-down motion in a natural walking movement”, said Ms Celia Tan, Senior Principal Physiotherapist, Singapore General Hospital (SGH), and Deputy Director of its Allied Health Division.

Above: The improved ankle foot brace features a movable ankle joint and a spring at the back. Right: The ankle foot brace is slim and unobstrusive, and easily fits into shoes.

PHOTOs: Alvinn Lim

Walking is such an easy, natural movement that few of us give it a second thought. But before 25-year-

Every step for Ms Janice Ng, 25, has to be deliberate and well-thought through to prevent falls, as cerebral palsy has caused her to have a condition known as toe-walking.

To address this shortcoming, SGH physiotherapists and a team of Ngee Ann Polytechnic final-year mechanical engineering students worked together to develop an improved device, one which has a moveable ankle joint and a spring at the back. According to Ms Dawn Tan, Principal Physiotherapist, SGH, the device “enables the patient to lift the foot, clear it off the ground and land on his heel”. The result is a more natural walk and easier mobility. The device gives patients better control of their ankles, which are often weak because muscles in the area lack exercise. With improved control, patients

have a lower risk of tripping or falling. The project, a winner at SingHealth’s Allied Health Innovative Practice Award 2010, was among the many innovations churned out by Ngee Ann Polytechnic’s aspiring engineers. Under an SGH-Ngee Ann Polytechnic programme, in place since 2004, final-year students and hospital staff work to develop devices to improve care and therapy for patients. In the last seven years that Ms Celia Tan has helmed the programme, the hospital has patented three new devices. “The arrangement allows us to combine our medical experience with the technical expertise that the students have acquired. We give the ideas, they build the prototypes and, together, we create something that is currently unavailable in the market, or construct a better device that can be more efficient

in aiding patients’ therapy,” she said. Building a prototype for a medical device usually takes about nine months. During this time, Ms Tan or a therapist works closely with each group of four to six students. The students sometimes visit the hospital to see therapists at work and speak to patients to understand their requirements. It took the team 18 months and two attempts to build the improved leg brace. The first model was bulky with a side-loaded spring – functional but not perfect. With fine-tuning, a second prototype was produced – this time, it was lighter, more wearable and effective. It is still undergoing changes, and the team is looking next at ensuring a proper fit. “If the fit is not right, the patient may suffer blisters and discomfort, which may deter him from using the brace, and stop him from benefiting from proper physiotherapy. An improper fit will also affect control of the ankle, causing more trips or falls,” said Ms Tan.

I’m actually starting to make a little progress and walk better. I hope that in the long run, I won’t have to hunch and can have a proper, upright posture when I walk. Ms Janice Ng, a cerebral palsy patient

The foot brace brings hope to patients like Ms Ng, who is testing the device. “I’m actually starting to make a little progress and walk better. I know once we get the fit right, it will help me tackle the problems I have. I hope that in the long run, I won’t have to hunch and can have a proper, upright posture when I walk,” she said. Ms Ng, who will graduate from university this year, said: “People always tell me that after I graduate, I should get a desk job. But I love to meet and talk to people. I want to move around and see new places. With this leg brace, I’ll be able to move around and experience things I’ve never tried before.”

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Just a minute PHOTOs: alecia Neo

Heart attack patients stand a better chance of survival with an on-site check run by paramedics

tion of many others has been preserved. “The aim is to reduce the door-toballoon time, for patients needing acute angioplasty, as much as possible,” said Assoc Prof Ong, referring to the time taken from the moment patients enter the doors of the hospital to the moment they get the angioplasty. On-site ECG transmission by paramedics has done just that, cropping an average of 37 minutes off the door-to-balloon time for public hospitals, according to a study that was presented at SGH’s Annual Scientific Meeting in April this year. Assoc Prof Ong was the principal investigator of the nationwide study, which involved all restructured hospitals, National Heart Centre Singapore and SCDF. Before this study, an ECG was done

Dos and don’ts Do Call 995 for an ambulance. The paramedics are trained to stabilise the patient’s condition with medication, and the ambulance is equipped with a defibrillator to resuscitate the patient should the heart stop en route Give clear instructions to the paramedics on finding the patient’s home, have someone wait at a visible location to guide the paramedics and hold the lift open if the patient lives in a high-rise building, so as to save time Get ready the patient’s personal effects such as personal identification, medical benefit identification, insurance and other documents for admission Have the patient seated in a location where he can be transferred easily to a stretcher Give a clear account of what happened. Let the paramedics know about any drug allergies or past medical history Don’t Drive or take public transport to the hospital, even if the patient lives nearby. The patient’s condition may deteriorate en route, and it is safer to wait for an ambulance. Ambulances also get priority on arriving at A&E

More lives have been saved after Associate Professor Marcus Ong introduced a system to prepare A&E staff for heart attack victims who are en route to the hospital.

BY Thava Rani

All it takes is a minute. But that extra minute – for paramedics to run an electrocardiogram (ECG) on a person suspected of having a heart attack – could mean life or death. Running an ECG at the patient’s home, instead of at the hospital, allows the results to be transmitted to Accident and Emergency (A&E) quickly. This, in turn, enables A&E doctors to begin preparations for treatment, including activating the procedure for opening a blocked artery, while the patient is in the ambulance en route to the hospital. “The sooner the artery is unblocked, the less the damage, and the better the patient’s chances of survival,” said Associate Professor Marcus Ong, Senior Consultant, Department of Emergency Medicine, Singapore General Hospital (SGH). In a heart attack, a blockage or clot in an artery cuts off oxygen supply to the heart, damaging the muscles. A person whose heart muscles are badly damaged can eventually suffer heart failure. He also has a high risk of dying from complications, such as abnormal heart rhythms. Depending on the type of heart attack, doctors may perform an

angioplasty where a catheter is inserted and a balloon is inflated in the coronary artery to open it up, restoring blood flow and oxygen to the heart. A stent can also be placed to keep the artery open. About half of the 3,000 heart attack patients who seek treatment at public hospitals every year require acute angioplasty.

The sooner the heart artery is unblocked, the less the damage, and the better the patient’s chances of survival. Associate Professor Marcus Ong, Senior Consultant, Department of Emergency Medicine, Singapore General Hospital

In the past two years, an estimated 30 additional lives have been saved each year by Singapore Civil Defence Force (SCDF) paramedics, who perform this check on suspected heart attack patients at their homes. In addition, the heart muscle func-

Ignore the pain

only after the patient arrived at the hospital. Activation of the angioplasty team and other preparations could take place only then. Now, with some 250 paramedics trained and 46 SCDF ambulances upgraded, on-site ECG has become routine. All preparations at the hospital are made while the ambulance, carrying the patient, is en route. When the ambulance arrives, everything is ready and waiting for the patient. A revision of workflow processes also contributed to bringing down the median door-to-balloon time from 88 minutes to 51 minutes. At SGH, for instance, a mass paging system was put in place to activate the angioplasty team, which is particularly crucial at night when doctors need to be recalled from home to the hospital. To further improve a patient’s chance of survival, a greater understanding and awareness about dealing with a heart attack, such as recognising the signs and symptoms as well as the appropriate response, are needed, Assoc Prof Ong said. “So far, we’ve only been looking at door-to-balloon time, but what is more important is the symptom-to-balloon time (the time when the patient first starts having severe chest pain). “We hope public education can make a difference here.”

Get anxious about time wasted when the paramedics perform an on-site ECG

Maybe it’s a heart attack Severe chest pain and a combination of the following symptoms can mean a person is having an acute heart attack, said Associate Professor Marcus Ong, Senior Consultant, Department of Emergency Medicine, Singapore General Hospital.

1 Severe chest pain is often

described by patients as the worst pain of their lives and likened to something very heavy pressing on the chest

2 Pain that appears to spread up to the neck or down to the left arm

3 Breathlessness 4 Sweating 5 Feeling faint and/or nausea 6 A history of heart problems 7 Patient is elderly, smokes or suf-

fers from diabetes, high blood pressure and high cholesterol

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News At death’s door and back

team – two perfusionists who operate the machine, a cardiac surgeon and a doctor – is activated. They rush to hospital in ambulances, taxis or their own cars. Still, he gave it a try Dr Su Jang Wen, Consultant, Department of Cardiothoracic Surgery, NHCS, was the first to arrive. “Fortunately for Cherie, the medical officers and nurses were already doing CPR before the ECMO team arrived. They were very efficient,” he said, adding that despite CPR, in most cases of heart failure, the outcomes from using the ECMO machine are poor. There is also a high risk of organ damage, even if patients survive. Since 2003, the machine has been used on 205 patients with heart failure.

Doctors decided to use the ECMO machine on Cherie because she was very young. “Her life was about to start. We thought – let’s give her every single chance we can. We asked her parents and they said ‘go ahead’,” Dr Su said. The ECMO machine works through two tubes inserted into the body at the patient’s groin. A pump in the ECMO machine draws deoxygenated blood through one tube. The artificial lung in the machine removes the carbon dioxide

Her life was about to start. We thought – let’s give her every single chance we can. We asked her parents and they said ‘go ahead’. Dr Su Jang Wen, Consultant, Department of Cardiothoracic Surgery, National Heart Centre Singapore

and puts oxygen in the blood, before sending the blood back into the body through the other tube. “The pump acts like a heart with enough pressure to send blood throughout the body to support the other organs. There are no gaps in pumping. It works continuously,” Dr Su said.

Dr Su Jang Wen used the ECMO machine to keep Cherie’s heart ticking even as she went into a coma after the heart attack.

The prognosis was unclear While the machine kept Cherie’s heart ticking, she was in a coma. Her family was told to prepare for the worst – that even if she survived, she could be paralysed due to brain damage. Dr Su wrestled with the

possibility that she might be permanently in a wheelchair or suffer from cerebral palsy if she survived. After seven days, with her heart function back, she was taken off the machine. Cherie said that Dr Su’s face was the first she saw after regaining consciousness. The love of parents But Cherie couldn’t move her legs or hands much and could only whisper. Dr Su credits much of her recovery to the devotion of her parents. “Every morning on my rounds, I’d see both parents. They were there 24 hours. “Her father stopped working to take care of her. He would carry her from the bed to the chair, and move her fingers and legs as instructed by the physiotherapists. He was hopeful, smiling and optimistic. Her mother helped look after her, as the nurses could not be there every minute. “Her parents really helped with her mobility, to prevent her body from getting stiff. It was very touching. They really cared for her,” he said. When she left the hospital, she still had difficulty walking and could only speak in a whisper. She was asked to return immediately if she felt even the minutest chest pain. The quiet teenager proved to be a fighter. Less than two months after Cherie’s discharge, Dr Su got a phone call to say she was in the hospital to see him. She literally skipped into his room. “I just couldn’t believe it. When she left, she could walk but with some assistance, and was still unable to move her limbs easily.” Cherie had come to see him not for chest pains, but to be certified fit to return to school. A keen student who is No. 2 in her class, she turned down an offer by her school principal to take a year off school

Staying alive Another patient saved by the Extra Corporeal Membrane Oxygenator (ECMO) team was health industry executive, Mr Foo, 42, who had a heart attack while driving back to his office after lunch. He was reduced to driving at a crawl, but made it back. “I was trying to catch my breath. I was sweating. I felt nauseated and giddy. I knew I was having a heart attack,” he said. When the pain subsided, he called a meeting and told startled colleagues: “I need to go off, I am having a heart attack.” A colleague drove him home and later to the Accident and Emergency (A&E) department of the nearest hospital, where he was admitted in stable condition. The next day, when doctors were putting a stent in his left main artery, his heart failed. They gave him cardiopulmonary resuscitation (CPR) and used a defibrillator, but after an hour, they called in the ECMO team. Dr Tan Teing Ee, Senior Consul-

Dr Tan Teing Ee (left) and his team used the ECMO to support Mr Foo, a heart attack victim, while they reopened his blocked artery.

tant, Department of Cardiothoracic Surgery, National Heart Centre Singapore (NHCS), who dashed down to the hospital with the ECMO team, said: “It was touch and go.” Mr Foo was promptly supported with the ECMO machine and transferred to NHCS for further management. As

his right main artery was blocked too, doctors put in another stent to reopen that artery while he was supported by the machine. After five days on the ECMO machine and under sedation, Mr Foo regained full consciousness. “Coming out of sedation, I heard the familiar voice of my

PHOTOS: ALVINN LIM

> Continued from page 1

Ms Angeline Chern Suan Choo, Senior Perfusionist, Perfusion Unit, NHCS, pushes one of the six life-saving ECMO machines in Singapore down the corridor of the Intensive Care Unit. All six machines are kept at NHCS and are ready for use at a moment’s notice.

after her recovery. She wanted to make up for the time away, excel in her exams and be a teacher one day. The experience has taught her that life isn’t all about academic achievement. “My friends say I’m now a much happier person. I won’t be overly concerned about school and studies, but will focus more on my family and friends. There are a lot of people my age who think if they don’t score well at school, it’s over. I want to let them know it isn’t. “Life can be unpredictable. You have to treasure every minute.”

boss. I was very cold and disoriented, but she reassured me and calmed me down.” Three months after his discharge from hospital, he went for a heart bypass surgery to correct the blockage in another artery. Mr Foo, who has familial hypercholesterolemia, a genetic condition which resulted in him having high cholesterol from childhood, said he has always studiously checked his blood pressure and cholesterol every year, exercised regularly and watched his diet. The attack caught him by surprise, although two months before it, he experienced chest pains, which went away after resting. He said: “In hindsight, I should have seen to it immediately.” These days, he is mindful of maintaining his sense of wellbeing and calm. He takes medication to manage his cholesterol levels and continues to exercise regularly. “I am learning to take it slow and be more conscious of my wellbeing. That’s my priority now.”

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A joyful giver Mdm Theresa Yip shows that age is no barrier to a charitable heart BY Ruth Loh

Many people give to charity, but few have dedicated as much of their time, effort and money to the less fortunate as Mdm Theresa Yip. Every month, the 81-year-old drops by Singapore General Hospital (SGH) to donate $100 to the SGH Needy Patients Fund. If she isn’t able to make it one month, she makes up for it by giving $200 the month after. Behind this humble act has been a lifelong journey of charity that started in the 1950s when Mdm Yip began giving to charities, homes and the less fortunate in many ways. An excellent dressmaker who learned her skills in school, she put them to good use supplementing her income as a nurse. “I had two children to raise,” the feisty Mdm Yip, who now has five grandchildren aged 16 to 30, said matter-of-factly. “Sewing and knitting baby clothes, toys and other things helped me earn extra money.”

Lions Befrienders. Between 2007 and 2009, she was director of the club’s Bendemeer branch. As a Befriender, she looked after elderly people living in one-bedroom flats and on government welfare. She distributed household necessities door-to-door – meat and vegetables at one home, laundry powder and washing detergent at the next – making friends along the way. Mdm Yip’s love and care for the less fortunate was recognised by the Minis-

try of Health, which honoured her with a Merit Award in 1978 and a Long Service Award in 1985 for dedicating 30 years to nursing. In 1999, the Lions Befrienders Section gave her an Outstanding Award. Nowadays, her knees won’t allow her to continue with her gruelling pace of work supporting elderly people, but they can’t keep her away from her mission of

love. Each month, as she has since mid-2010, Mdm Yip pops into SGH to hand over a gift of $100. When asked why she chose to give $100 a month, she said: “When I cooked for charity once a month, I spent about $100 each time on ingredients. Now that I no longer cook, I want to continue to donate the same amount.” Far left: Mdm Theresa Yip regularly knits baby mittens, booties and even dolls for charity sales. Although she no longer cooks for old folks at community clubs, Mdm Yip continues to donate the monthly $100 amount which she used to spend on ingredients. Left: Every month, she comes to SGH to contribute the sum to the SGH Needy Patients Fund.

PHOTOs:

Allen ta

When I cooked for charity once a month, I spent about $100 each time on ingredients. Now that I no longer cook, I want to continue to donate the same amount. Mdm theresa yip

Funding medical research Noted for her fine needlework and the beautiful clothes she made, Mdm Yip later turned her skills to benefit the needy. Then a midwife at Kandang Kerbau Hospital – her first and only employer – she volunteered to teach handicraft skills to elderly people. For nearly 30 years, Mdm Yip was a familiar – and welcome – presence at many homes for elderly folks. On her regular visits, she brought household items to the residents. “I took biscuits, powder, soap, toothpaste – all those daily necessities,” she said. She cooked meals for old folks at community clubs in Kallang, Kolam Ayer, Kreta Ayer and the like. Not only did she volunteer her time, Mdm Yip also contributed ingredients for the meals she cooked. In 2003, Mdm Yip joined the

Without funds, many good ideas remain ideas, with no possibility of being turned into treatments that improve patients’ lives, or even offering a cure from disease The discovery of penicillin in 1928 revolutionised medicine and marked the start of modern antibiotics, without which people would have continued to die from what are now known to be easy-to-cure infections. Although Sir Alexander Fleming discovered penicillin by chance, he had been actively searching for anti-bacterial agents after seeing many soldiers with infected wounds die from sepsis during World War I. Research – and the important role it plays in medical treatment – is a key component of the work staff at Singapore General Hospital (SGH) do. Many

clinicians involved in research at SGH have made discoveries and innovated care delivery benefitting patients. But medical research is a lengthy process that requires many rounds of studies, including large human trials in the later stages, before an idea becomes an established treatment. Besides taking years to complete, research is also often highly expensive. Research is mostly self-funded in Singapore, and money for many of the projects undertaken comes from donations. With limited funds, some promising research projects remain just good ideas without a chance to benefit patients.

Help where it is needed most Singapore General Hospital’s Fundraising and Development Office collects donations that help needy patients. Every year, some $600,000 is paid out to help needy patients receive medical treatment and other services. Many of these patients are often the sole breadwinners of their families, supporting young children and sick parents or family members. For more information about how to make a donation, call SGH Fundraising and Development Office at 6321-3736 or 6321-6378, or email giftstosgh@sgh.com.sg.

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Redesign counters to ease traffic If possible, please think about redesigning the cashier’s counter at the Specialist Outpatient Clinics (SOCs). Singaporeans tend to crowd around “exit areas”, be it on buses or MRT trains. Perhaps, a barrier and a different seating arrangement can help open a smooth passage for entry and exit (no costs involved). I raise this comment after experiencing “ease of payment” at National Heart Centre Singapore, Singapore National Eye Centre and SingHealth Polyclinics. – Mr Wong Mun Wah

Thank you for your suggestion. As we upgrade our facilities, we will review our processes and work on how to ease congestion further at bill payment areas. To avoid crowding at the tight registration and bill payment area at SOCs, we request that patients leave their forms in a tray, be seated and wait for their names to be called. Patients who wish to avoid the crowd and not wait for payment can also register for our free Service Express, which allows patients to leave immediately after consultation. Their bills are settled via

AND WIN A PRIZE FOR BEST LETTER Letters must include your full name, address and phone number. Singapore Health reserves the right to edit letters and not all letters will be published. Write to editor@sgh.com.sg or The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608, or talk to us on Facebook. The winner will receive a Beiersdorf hamper worth $100 containing a pH5 Creme Shower Oil, two Gentle Cleansing Gels and one Hyaluron Filler Day.

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Singapore General Hospital Victoria Jones Preece Hello, can you help? I am in the UK and we have been advised that my sister has been admitted. I am aware you will have issues with patient confidentiality. Can you tell me the best person to contact to get some details? Her name is Coleman. Thank you. May 4 at 9.41am 5 people like this Singapore General Hospital Hi Victoria, I believe we have found your sister. We do have a female patient by the last name of Coleman admitted to us two days ago. Please email our colleague at ims@sgh.com.sg and he will link you up. May 6 at 10.25am Victoria Jones Preece You are fantastic, thank you. May 6 at 11.43am

Manta Ray Lee Hi, I am Thomas Lee. The following is what I have noticed in the May/Jun 2011 issue of Singapore Health. Page 25 (Translated text)

...在骨管也就是骨中央装置骨髓的空隙，置入导向杆也可能导致脂肪栓... 试译：(My suggestion) ...把导向杆置入骨管（位于骨干，功能是储存骨髓）也可能导致脂肪栓... May 6 at 12.43am 7 people like this Singapore General Hospital Hi Thomas, thank you for your suggestion. We’ll continue to finetune the translation. Do continue to support Singapore Health. May 6 at 8.27am

a standing order through their credit card, GIRO or SGH cash deposit account. Documents, including receipts, are mailed out within seven working days. Service Express covers bills for consultation, laboratory and other services rendered at the SOCs and patients can use it to pay bills for family members and other patients. The service is available immediately for credit card and cash deposit accounts (the minimum deposit is $200), and after the bank’s confirmation for GIRO payments. Application forms are available at clinic counters.

Need earlier appointment I am a regular patient at National Heart Centre Singapore (NHCS) and often wait for a long time for my appointments. I’ve tried to arrive earlier, so I can be slotted in at a convenient time. However, the clinic staff refused to give me an earlier appointment time, even when I arrived two hours before my appointment. – Mr Sammy Nathan At NHCS, we handle a heavy patient load. We seek the understanding and cooperation of our patients to abide to their appointment times, to ensure smooth running of the clinic session and to prevent disruptions and inconvenience. Sometimes, the clinic may seem to be seeing a lull in appointments, but this could be because patients are undergoing tests in another section of the clinic and will return for further consultation. The doctor may also be using this time to write up the notes for the previous patient, order relevant tests, issue prescriptions or review medical notes. With a fixed time appointment system, we hope to minimise your inconvenience and ensure that you are seen in a timely manner.

Extra bed Why do I need to pay for a bed for my wife when she accompanied me after my surgery? – Mr Ben Chong To keep costs down, we offer minimum facilities at our wards. That’s why we charge for extra beds. We understand that after surgery, patients may want a family member to keep them company in the ward. But we also recognise that not all patients require a family member to stay with them there. In addition to extra beds, which are available only in Class A single rooms,

Tributes I picked up a copy of Singapore Health when I was visiting a patient at SGH and have since been a regular reader. I particularly like the coverage – a nice balance between your new technology, medical information and focus on people. Keep it up! - Dr Linda Fang

I went to Geylang Polyclinic to see if I could get an x-ray for a persistent cough, which didn’t show any signs of going away despite two courses of antibiotics. I went on a Monday, which I would usually avoid because of the crowd. But I could not delay the visit as I was scheduled for surgery the next day. I want to commend Dr Jason Chan who saw me and took the time to answer all the questions I had about my condition. He was truly professional and very patient. - June Long

We are foreigners who started going to Singapore General Hospital (SGH) following a friend’s recommendation. My mother, who suffers from long-term ailments, was seen by Dr Dennis Chua, Medical Officer, Unit of Occupational Health and Epidemiology, SGH, and Professor Tay Boon Keng, Emeritus Consultant, Department of Orthopaedic Surgery, SGH. We were also pleasantly surprised by the service at SGH, and felt that the medical care given was comprehensive, professional and value for money. This has greatly changed our perception of public healthcare in Singapore and we look forward to the follow-up visit in the next few months. - Ms SL

items such as slippers and toiletries are also available at a cost. Patients and their family members can also request for extra meals, including those offered to Class A ward patients. The following are items available on request and their costs: Item

Price (+GST)

Extra meal

$25.68

Class A ward meal

$18.73

Slippers

$5.78

Toiletries pouch

$6.63

Extra bed

$44.08

jul⁄ aug 2011

Tech

Rehab can be fun

p16-17 Nutrition

Cancer patients share their recipes

singapore he alth

p18

Connecting the ABCs There is more to writing than simply using a pen to form letters. It involves motor, visual and perceptual skills

Which finger? If your child holds his pen or pencil in what seems to be an awkward manner, but has no complaints or is able to write legibly and quickly without pain or problems, it is okay to let him be, said Ms Natalie Chew, Senior Principal Occupational Therapist, Singapore General Hospital. “We are all made differently, and some children and adults may have developed a non-standard grip,” she said. Most people are taught one of two standard ways of holding a pen or pencil: the tripod, where the pencil rests on the middle finger; or the quadropod, where the pencil rests on the ring finger. The wrist should generally be relaxed.

months

• Builds tower with two cubes

• Builds tower with four cubes • Throws a ball • Shows preference for one hand

• Builds tower with six cubes • Scribbles with crayons • Turns pages of book, one at a time

• Builds tower with nine cubes • Copies circle and cross • Draws man on request • Colours simple pictures • Recognises capital letters • Can snip paper with scissors • Can thread large beads on a string

• Builds gate with cubes • Copies a cross • Writes mostly capital letters, some lowercase letters • Can do buttons and zippers with help • Can catch a bouncing ball

years

These milestones are a guide to give parents an indication of when to expose their children to various skills like cutting with the scissors. Children develop at different rates with variations of three to six months, or even longer. If there are concerns, parents should consult their paediatrician.

• Grasps objects between thumb and index finger, eg. small biscuits

years

• Picks up small objects • Can hold a spoon

9 months

years



• Grasps objects in palm • Transfers from one hand to another

months

for hand function and writing

• Builds a pyramid with five to six cubes • Draws a man with details • Copies a triangle • Colours pictures carefully • Writes lower-case letters • Copies words • Can cut a square within 0.5cm of the line

years

Children with visual-perceptual deficits may perceive shapes differently.

The tripod (left) and the quadropod (right) methods of holding a pencil.

Developmental milestones

years

tual difficulty sees three separate lines. Kids with this difficulty find it particularly hard to remember and write Chinese characters. “So many strokes need to be connected in a specific way, so children with visual-perceptual difficulty may find it challenging to write Chinese characters well. We don’t address this by getting them to practise Chinese writing, but we try to find out why they have this difficulty in the first place,” said Ms Chew. Other children may write poorly because they have less muscle strength than their peers, “perhaps because they spend a lot of time indoors and have less opportunity to use their muscles”, said Ms Chew. Writing badly may also be due to poor control of the hand that holds the pen or pencil, and this may be the result of poor body coordination. “To write neatly, you must have good posture. If there is less stability (because of poor posture), there will be less control of the wrist,” said Ms Chew. “It’s really about having a holistic perspective of the problem. Therapy isn’t just about training them to write,” she added. Games and exercises to build strength and develop good posture and coordination are used to help the child develop. To strengthen his muscles, the child may be asked to climb, crawl or push something heavy. To develop motor strength in the muscles of the hand, he may

months

A child should be able to draw a simple stick figure by age three, said Ms Natalie Chew.

be given playdough to mould or pinch. Before the child is asked to draw a picture of a man, an aid known as Mat Man – a game which involves putting shapes (representing parts of the body) in their correct positions to build the figure of a man – is used to help increase awareness or perception. “Some kids have very poor awareness of their own bodies. When they draw a person, the drawing may not have a body, or have hands that are sticking out of the head,” said Ms Chew. Poor awareness can show up as a difficulty in differentiating between left and right. For instance, the child may write “b” when he means to write “p”. Or, he may have to constantly look at his hand when writing. A child with this difficulty will find it hard to keep up with the rest of his class when copying notes from the board. “If children are constantly being told by teachers that they need to write better or faster, they may lose confidence. This may affect their motivation for learning in school,” said Ms Chew.

months

to write properly may have difficulty making sense of what he sees, insufficient hand strength, or poor hand control, balance and coordination. That is why children who are sent to occupational therapists for help with their handwriting difficulties are not asked to write, but given activities and games to assess their motor and perceptual skills, said Ms Natalie Chew, Senior Principal Occupational Therapist, Singapore General Hospital. “We try to figure out the reason for the child’s writing difficulty, which could be related to his motor-muscular skills, or be more of a visual-perceptual deficit. This means that what they see, what they process and what they perceive may not match 100 per cent,” said Ms Chew. For instance, most people “automatically complete the picture of a triangle” when they see three unconnected lines that roughly correspond to the shape of a triangle. But a child with a v isual-percep -

PHOTO: alecia neo

Poor handwriting isn’t just about not being able to form ABCs or 1,2,3s properly. A child who struggles

• Copies a diamond • Writes simple words from memory • Knows right from left • Ties shoe laces

5 6

(Reference: Peabody Developmental Assessment)

singapore he alth

Jul⁄ Aug 2011

Tech

Fun and games in rehab Gaming technology is set to revolutionise rehab therapy Crowds of kids having fun chasing cartoon animations projected onto the floor or groups of friends gathering for Nintendo Wii parties are nothing unusual. But now, games like these are making a foray into a whole new territory – healthcare. KK Women’s and Children’s Hospital (KKH) and Singapore General Hospital (SGH) are studying these games to see whether young and old patients who need rehabilitative therapy can benefit from them. At KKH, a team of experts worked with academics from Singapore Polytechnic to develop a prototype game, which uses cartoon images on the floor to entice children with gait and balance problems to do their exercises. The kids are asked to hop after animated frogs and stamp on crabs emerging from the sand. After each successful hop or stamp, the frog moves on and more crabs appear elsewhere in the sand.

which are necessary for recovery. Ms Ong Ghim Hui, Senior Physiotherapist, Rehabilitation Department, KKH, said up to five out of 10 children compromise their recovery by not completing the exercises. By using games in therapy, children can follow and enjoy their progress more easily. “In this way, we hope to keep them interested longer. The games motivate them to practise to do better during the next session of the game,” she said. “If we get children to like therapy, we can overcome a big part of the challenge.”

Computer games for adults

If we get children to like therapy, we can overcome a big part of the challenge. The games motivate them to practise to do better during the next session, and advance to the next level of the game. Ms Ong Ghim Hui, Senior Physiotherapist, Rehabilitation Department, Kk women’s and children’s hospital

The game is designed to measure how these children move – how they use their legs, how their feet land, and how fast they stamp or jump. To capture all these, sensors, which send back measurements to the therapist for analysis, are attached to their shoes. The game is part of the hospital’s trial to study how customised computer games can make rehabilitation more fun for children. Many children find it hard to concentrate on the repetitive exercises,

As older adults also get bored with repetitive exercises, a similar study is being carried out at SGH. Researchers there are experimenting with the Nintendo Wii gaming technology in a trial study to evaluate whether using it makes strengthening, balancing and cardiovascular exercises more enjoyable and suitable for 60 to 85-year-olds. Older adults are less likely to participate in many outdoor sports, so the

Colourful graphics are projected onto the floor to entice children undergoing therapy to hop or stamp accordingly.

researchers are looking at using this technology to make the exercises acceptable to them, said Mr Kwok Boon Chong, Physiot herapist, Department of Physiotherapy, SGH. “By introducing exercises through this technology, we hope older people will be keen to participate.” By making therapy more fun, it is hoped that patients will get the full health benefits of completing their rehabilitative exercises. If the technology is found to be effective, the researchers also hope that easy-to-follow games can eventually be done at home, reducing the contact time between patient and physiotherapist, and possibly resulting in shorter therapy sessions and reduced costs.

Potential to transform rehab While gaming technology in healthcare is still in its infancy and there is no clear

Keeping track To monitor their condition, more than 300 rheumatoid arthritis patients now use the smartphone health diary web application that Singapore General Hospital (SGH) launched in March – the first such app in the country. The web app, in the form of a questionnaire that patients complete daily, seeks to assess the patient’s overall condition. It asks the patient questions such as the level of difficulty in getting out of bed that day, buttoning his shirt and doing other

daily activities. Patients also key in a pain score and an overall health assessment score. The system then generates a number, which correlates with the DAS28, an internationally recognised scoring system specifically for the disease, which tells the patient how good or bad the arthritis is at that point. The app also records and trends the results. “The app helps to fill the gap

international data on its potential role, those involved in these trial projects feel that a wider application is possible. “For broad rehabilitative purposes, where you’re looking at improving overall fitness and flexibility, a technology like the Wii has great potential. Because we’re relying on an existing technology, it is easier to introduce it to patients and less costly, as it is already mass produced,” said Mr Kwok. One group of patients who may benefit from this technology in future includes stroke patients, whose body functions have been significantly impaired on one side. “However, if you want to address specific impairments, such as gait and balance, specific software may need to be created to address such needs in a clinical way,” said Mr Kwok. Mr Leo Kee Hao, Senior Lecturer, School of Mechanical and Aeronautical Engineering, Singapore Polytechnic, who spearheaded the development of the floorprojection game, agreed. “Once the technology we’ve developed is installed, it can be used for many things. The key will be to

between patient visits. The patient sees the doctor every three or four months, and may not remember all the details,” said Mr Eugene Sim, Executive, Department of Rheumatology and Immunol-

Jul⁄ Aug 2011

Disabling pain

create content with the clinicians to meet the different needs of their patients.”

“It felt like I had a knife in my right knee,” said the otherwise healthy Mr Chiu Yeo Ding. The 88-year-old piano tuner was subsequently diagnosed with rheumatoid arthritis by doctors at Singapore General Hospital (SGH). Rheumatoid arthritis is a chronic inflammatory disorder that affects the joints and, less frequently, the skin, eyes, lungs and other organs, according to Mr Chiu’s doctor, Dr Jon Yoong, Consultant Physician, Department of Rheumatology and Immunology, SGH. “It is the most common autoim-

mune rheumatic disorder and it affects about one per cent of the population, or about 45,000 people. About 75 per cent of patients are women, but it affects all races, often beginning between the ages of 20 and 45 years,” he said. In autoimmune disorders, the body’s immune system attacks its own tissues. It still isn’t known what causes rheumatoid arthritis, but some people seem more likely than others to develop the disease. It causes joint stiffness, pain, swelling and, sometimes, organ damage. Its severity varies among patients, and some patients may not realise they have the disease as the symptoms may be mild. They may feel persistent tiredness or mild joint stiffness.

It is the most common autoimmune rheumatic disorder and it affects about one per cent of the population, or about 45,000 people. It affects all races, often beginning between the ages of 20 and 45 years.

Paradigm shift needed

ogy, SGH, who played a key role in the development of the app. “With this app, the patient can provide the doctor with more information, helping the doctor manage the condition better.”

Dr Jon Yoong, Consultant Physician, Department of Rheumatology and Immunology, Singapore General Hospital

PHOTO: alecia Neo

If studies prove that interactive technology is popular and effective, researchers hope to see it being offered alongside conventional rehab services in therapy for individual groups. “While we’re studying how individual children interact with our floor games, they can also be used in group therapy sessions. This will add a further element of interest for the children by providing a platform for social interaction and competition,” said Ms Ong. Mr Kwok is already testing the modified Wii software in group therapy. “We’re testing this in small groups at the moment and combining it with other standard exercises,” he said. But this technology is still some two to five years away from being implemented in hospitals. If proven effective, it will provide patients with an alternative that may produce better and faster results at a lower cost.

“It is very important to diagnose rheumatoid arthritis as early as possible,” said Dr Yoong. Delayed treatment can lead to permanent damage of the organs and joints, and research has shown that prompt treatment improves the chances of the joints and organs remaining healthy. To diagnose rheumatoid arthritis accurately, the doctor makes an evaluation that usually includes blood tests and x-rays. The patient is prescribed appropriate medication, and may also see a rheumatology nurse clinician, physiotherapist and occupational therapist for subsequent care.

Rheumatoid arthritis need not be a disease of lifelong pain. By Thava Rani Four years ago, he was struck by sudden pain in his leg in the middle of the night. The pain was so severe that he was unable to walk.

singapore he alth

Dr Jon Yoong (left) explains to his patient, Mr Chiu Yeo Ding, why inflammation caused by rheumatoid arthritis can lead to pain around the joints.

The IT team took about two months to develop the app. Mr Bien Michael Philip Geroche, Systems Specialist, Integrated Health Information Systems, who was also involved in the development of the app, said: “It is accessible via any smartphone, but we designed it especially for the iPhone. Being web-based, it can also be accessed on a desktop.” The app is offered to all rheumatoid arthritis patients at SGH, as well as nonSGH patients. “While keeping notes in a diary is an alternative, it is not very practical to carry one around everywhere. Besides, the smartphone penetration in Singapore is incredible,” said Dr Jon Yoong,

Consultant, Department of Rheumatology and Immunology, SGH. According to a recent report, smartphones made up 70 to 80 per cent of all mobile phone sales in Singapore. “If the patient is older and not tech savvy, younger family members can help out, which encourages the family to participate in the patient’s disease management,” he added. The app is a collaboration between SGH’s departments of Rheumatology and Immunology and Information Technology, and Integrated Health Information Systems. The app can be downloaded at https://mobilecare. sgh.com.sg.

Keeping a record of the patient’s condition between his three- to four-monthly consultations is important in managing his condition. At SGH, rheumatoid arthritis patients are encouraged to maintain a diary, either via a notebook or the smartphone web application recently launched by SGH. “It helps to empower the patient and, at the same time, it gives us something objective to work with. In this way, we can get an accurate picture of the disease and make better clinical judgments,” said Dr Yoong.

If left untreated, rheumatoid arthritis can lead to deformity.

singapore he alth

JUL⁄ AUG 2011

Nutrition

Eat to heal

The recipes were modified by Ms Chang Yok Ying, Principal Pharmacist, National Cancer Centre Singapore (NCCS), who was the nutritional consultant of the book. “We wanted patients to still enjoy eating as a way of weathering their journey during treatment,” she said. She said once treatment is over, the diet is stricter – almost vegetarian – depending on how severe the condition is. “We were not looking at reducing calorie intake, as many physicians are already concerned about the drastic loss of weight in patients.” However, she did adjust the oil, sugar and salt content. Salt encourages the proliferation of cancer cells and oil can promote cancer growth, she said. She removed one recipe from the original list, because preserved pork was used. “Preserved meat contains nitrites which increase the risk of cancer.” Much thought also went into garnishing the dishes. “Making food presentable can really help improve appetite,” she said. Ms Chang recommends the soups in particular, because they retain nutrients and are easy to eat. “You don’t even have to chew. Although some vitamin C may be lost by boiling, you still have nutrients such as amino acids from the meat.” Her favourite is Lean Meat Soup with Starfruit and Sweet and Bitter Apricot Seeds because of its contrasting tastes. “The

Cancer patients share their favourite recipes in a new cookbook. By Stacey Chia

Just when she needed to keep up her strength, cancer patient Angela Mak found that eating became yet another mountain to scale. The cancer treatment caused her to lose her sense of taste and smell, and made swallowing an excruciating task. She went from someone who enjoyed dinners and trying out recipes, to being restricted to mushy food. But the assistant professor at Nanyang Technological University’s (NTU) Wee Kim Wee School of Communications and Information found a companion in her baby daughter. The infant was just starting to eat semi-solids then. “I had someone to share porridge and oatmeal with,” said Ms Mak,

cer -fightin n a c g fo Top o

Ms Chang Yok Ying modified the recipes to make them more healthy.

Red beans have a high antioxidant rating and can protect cells from free radicals which cause cancer

Apples

contain flavanoids and polyphenols which help fight cancers

Asparagus Avocados are high in vitamins, dietary fibre, potassium, folic acid and copper Broccoli contains isothiocyanates which have been shown to encourage the body’s production of cancer-fighting enzymes

Pumpkins

contain alpha-carotene, a strong antioxidant that boosts immunity

are full of cancer-fighting compounds like selenium as well as vitamins A and C

Turmeric

contains curcumin extracts which help alleviate the side effects of radiotherapy and chemotherapy

Potatoes

provide fuel for the body and are rich in immunity-boosting vitamin C

Lean meat soup with starfruit and sweet and bitter apricot seeds

Serves 4 Ingredients: 4 medium-sized starfruits 5 honey dates 600g of lean meat 25g of sweet and bitter apricot seeds 2 litres of water Method: 1 Remove the core and sides of the starfruits. Slice into pieces 2 Wash the honey dates 3 Wash and blanch the lean meat 4 Put all the ingredients into a claypot and boil over a slow flame for two hours 5 Serve Note: This soup is not suitable for patients with kidney failure.

PHOTOS: ALECIA NEO

Ms Angela Mak (extreme right), who found swallowing painful while on radiotherapy, contributed her favourite soup recipes.

who was diagnosed with Stage 3 nose and throat (nasopharyngeal) cancer five months after giving birth to her first child. Ms Mak’s story, related in Sharing Plates, a new cookbook for cancer patients, is not uncommon. Other contributors had similar experiences. Mr Teo Thiam Chye lost his sense of taste and smell following facial surgery, after a relapse of Stage 2 nasopharyngeal cancer. But he found a way to continue enjoying his meals. “I’m still able to use my other senses to enjoy my food – I can look at the food and I can feel the textures. I ask my wife if something tastes nice and if she says yes, I eat more.” Jimmy, who also had nasopharyngeal cancer, recalled how ulcers from radiotherapy made eating pure torture. He would close his eyes and put his head down to swallow, so that his family wouldn’t see him cry. Once a firm believer in Chinese herbs, he now believes in simplicity. “Papayas, pineapples, apricot seeds, turmeric and lemongrass really helped ease the side effects,” he said. Nor Asmah, who was told she had Stage 4 colon cancer and a 50-50 chance of surviving surgery, found that baking and beading helped relieve her stress during treatment. She didn’t let the side effects of chemotherapy trouble her. She just covered up the blisters with henna and carried on cooking.

Recipe

soup is very nutritious. Starfruit is high in dietary fibre, vitamin C, copper, potassium, and sweetens the soup naturally.” Ms Chang said the book can benefit everyone, not just cancer patients. “The recipes are not only healthy and tasty, but easy to prepare as well,” she said.

To purchase a copy of Sharing Plates, which is jointly produced by NTU and NCCS, please call NCSS’ hotline 6236-9440 or email your order via www.nccs.com.sg. The book costs $15 and all proceeds will go towards cancer research and helping families of cancer patients.

Jul⁄ Aug 2011

singapore he alth

Spotlight

Body warming

Beat the heat with these tips:

Staying hydrated and adequately protected from the heat may save you more than just a sunburn – it may save your life

Diuretic and some psychiatric drugs can prevent the body from losing heat quickly

BY Rachel Chan

People who are obese or old have to be particularly careful not to dehydrate or overheat. Old people may not be able to move about easily, turn on the fan or air conditioner when the weather gets too hot, or drink as frequently as they should. But drinking enough water and sitting in a cool environment are important in hot weather

The weather’s getting hotter but it’s not marathoners or extreme sports enthusiasts who are catching the attention of doctors. Doctors who treat people

Left: Dr Phua Ghee Chee (right) and Dr Chew Huck Chin (left) are seeing more elderly spa visitors who suffer from heatstroke. Right: An ICU nurse prepares the misting room. Nozzles above and below the misting bed ensure the patient’s body is coated all over with a fine mist of lukewarm water.

While proper hydration is crucial before marathons or any exercise, water may not be best as it doesn’t help replace the salt lost through sweating. An imbalance of salts leads to cramps or weakness of the arms. Isotonic drinks may be better Avoid exercise when feeling unwell, as it can make you more likely to suffer from heat exhaustion

An ICU doctor and nurse monitor the patient’s condition during treatment.

Older people are usually not as fit and may suffer from other medical conditions, making them more likely to suffer from complications when hit by heatstroke. Dr Phua Ghee Chee, Consultant, Department of Respiratory and Critical Care Medicine, Singapore General hospital

When training for a marathon, be sure to practise outside to get used to weather conditions. Running in the gym is vastly different from running in hot, humid weather

photos: Alecia Neo

for heatstroke have noticed the quiet emergence of another group of patients seeking treatment for heat-related disorders: elderly spa clients. One of them, a woman in her 70s, fell asleep in the sauna, and was unconscious by the time staff at the spa found her. She was rushed to Singapore General Hospital (SGH) with a very high body temperature. Doctors managed to cool her down, by lowering her temperature to normal, but she later died because of complications related to other medical conditions. At least one other elderly woman is known to have suffered from heatstroke after staying too long in a sauna or steam bath. She too eventually died. Dr Phua Ghee Chee, Consultant, Department of Respiratory and Critical Care Medicine, SGH, said: “(Treating people for) exertional heatstroke is less common now, because people are more aware of the dangers of doing strenuous exercise or sports without proper hydration or preparation.”

“Non-exertional heatstroke – usually seen in the elderly or extremely young – is becoming more common. Older people are usually not as fit and may suffer from other medical conditions, making them more prone to suffer from complications when hit by heatstroke. As for small kids, they can’t regulate their body temperatures as well as adults.” Many people may not realise they are getting heatstroke until the condition becomes severe. Many symptoms such as thirst, profuse sweating, giddiness and nausea may be dismissed as minor discomforts. Without treatment, the body temperature can go sky high, rising to at least 41°C, and the person can become confused and disoriented. Heatstroke can cause seizures, brain injury, and problems with the liver, kidneys and circulation, and affect the blood’s ability to clot. When the body is severely dehydrated, “blood pressure drops as blood vessels dilate, and not enough oxygen is

supplied to the kidneys. Muscles are also not getting enough blood supply, causing cells to start leaking enzymes and proteins, which then clog up the kidneys,” said Dr Chew Huck Chin, Associate Consultant, Department of Respiratory and Critical Care Medicine, SGH. One of the fastest ways of removing heat from the body is by spraying it with a fine mist of lukewarm water. “We spray the body from all directions with finely misted room-temperature water. A fan blows to evaporate this water off the skin. When water evaporates, it lowers the body’s temperature very quickly,” said Dr Phua. “The bigger the area that is misted, the faster the body is able to lose heat,” Dr Phua added. Ice-cold water is unsuitable because it causes the patient to shiver – the body’s natural reaction to keep warm – and that causes heat to be retained instead. When rushed to the intensive care unit (ICU), heatstroke patients may have low blood pressure and may not be breathing adequately, so a breathing tube and an intravenous drip are usually used. An ICU

A quick way of cooling the body is to dip a sponge or towel in cold water and press it on the neck, armpits and groin area. If heat symptoms persist, seek medical attention immediately Thirst is not as good an indicator of dehydration as the colour of the urine. A clear colour means the body is well hydrated People suffering from multiple long-term medical conditions such as hypertension and diabetes should get out of saunas, hot tubs or steam rooms when they feel giddy or faint, have a headache, nausea or cramps. It’s best to go with someone who is able to help you if you suddenly feel sick

doctor and nurse are also with the patient in the cooling room to monitor his condition. A rectal thermometer is inserted to check his temperature. For very severe cases of heatstroke, a device known as an endovascular cooler is inserted into the large blood vessel in the thigh, much like dialysis, to cool the blood. Another method is to run water – through a tube inserted either through the nose to the stomach, or surgically – to cool the body. For milder forms of heat disorders, special cooling blankets (cooled to low temperatures), cooling pads or ice packs are used.

singapore he alth

Jul⁄ Aug 2011

Spotlight

Giving life with a heart Insight into the emotionally complex and challenging job of transplant coordinators

supporting recipients

Samuel Tan (not his real name) suffered from heart failure and, for many years, was shuttling in and out of hospital while getting through polytechnic .

Ms Tee Ping Sing calls organ donation “the greatest gift one can make”.

BY Valerie Lee

supporting donors

The man knew that a time would come when his son, suffering from a kidney problem since he was young, would need a transplant. So for years,

Post-transplant care Her job doesn’t end there. “After the operation, a patient’s willpower is very

> Continued on page 21

PHOTO: alecia Neo

Instead of feeling sorry for himself, Samuel carried on with his studies, although he missed doing things boys his age do, such as playing football. Meanwhile, Ms Kerk Ka Lee, Heart and Lung Transplant Manager, National Heart Centre Singapore (NHCS), was keeping a lookout for a donor heart for him. Inspired by his perseverance and maturity, she said: “He was a bright young chap with an uncertain future because of his weak heart, but he persevered through a long hospitalisation, juggling his studies and hospital visits.” At 20, his situation became critical, and doctors feared he had mere weeks to live. After two tries, she found a suitable heart for him. The heart transplant was a success and, the following year, he celebrated his 21st birthday at a party organised by NHCS Heart and Lung Transplant Patient Support Group, which includes staff and patients. One of the staff members even baked him a cake. After finishing his studies in poly, he started work and later attained his bachelor’s degree. As a heart transplant coordinator, Ms Kerk is one of those who make the important call to potential recipients when a donor heart is available. “If it’s a patient’s first call from us, he is usually overwhelmed, happy and will anxiously

wait for more details,” she said. But it’s not always good news. Sometimes, tissues don’t match or the heart is unsuitable for transplant, leaving patients, understandably, disappointed. Each year, about 25 to 30 donor hearts pass through NHCS, but only three to six of these are suitable for transplant. Once the heart is removed from the donor, it must be transplanted within four hours. Ms Kerk usually has only four to six hours to make the necessary arrangements. As soon as she’s informed that a heart is available, she snaps into action. The job is emotionally demanding, as many patients are in a critical condition and, for them, the operation could be a turning point in their lives. The first thing she does is to identify primary and secondary recipients, in case the heart is unsuitable for the first recipient. “Patients are usually selected based on blood type, body weight and medical urgency. Other factors include the waiting period and frequency of hospital admissions,” said Ms Kerk, who was an operating theatre nurse previously. After suitable recipients are selected, she contacts them to begin a six-hour fast. She also coordinates tests to determine the suitability and functionality of the heart and alerts the medical team, including the heart surgeon and anaesthetist. She stays for the whole duration of the operation and updates the family of the recipient constantly.

photo: ellen lim

BY Annie Tan

Ms Kerk Ka Lee (left) fulfils her role as a transplant coordinator by interacting closely with patients and their families throughout the entire transplant process.

he prepared for the surgery by keeping fit. That day came when the son was in his 30s and the father in his 50s. “When the father was pushed out from the theatre, he struggled to say ‘thank you’,” said Ms Tee Ping Sing, Transplant Coordinator, Transplant Section, Singapore General Hospital. “That was when I felt that I helped fulfil a father’s wish – to give his son a new lease of life. He had wanted to do it for so long and it was finally done.” Not all transplants evoke such feelings of warmth from both the donor and recipient. Many of the cases that Ms Tee undertakes often have a flipside. When the transplant involves a brain-dead donor – usually a young accident victim or an older person who has suffered a fatal stroke – her work is much harder, both physically and emotionally. As a donor transplant coordinator, Ms Tee liaises with the families of potential organ donors and organises the donation procedure. Well informed about all aspects of organ transplant, Ms Tee, together with a medical social worker, advises and supports the family throughout the process. “I believe in transplants. I have seen the joy of patients who have undergone a transplant and recovered. They’re no

longer on dialysis and look so much better when they come back for reviews,” said Ms Tee, who specialises in supporting kidney transplant donors and patients. “But it can also be very, very stressful when families strongly object to organ donation,” she added. Singapore’s Human Organ Transplant Act (HOTA) allows for organs such as the kidneys, liver, heart as well as the corneas to be removed for transplant from someone who is brain dead. “Every individual has the right to make a choice on organ donation, and that choice will always be respected. But by choosing to remain in the system, by not opting out, one can benefit several seriously ill patients after he passes on. That is the greatest gift one can make,” said Ms Tee. Indeed, HOTA has led to shorter waiting times for patients waiting in line for an organ. Kidney failure patients, for instance, now wait about nine years for a replacement organ. Also, there have been 49 deceased kidney transplants on average every year, versus just five before HOTA was implemented. Still, families can – and often do – turn angry when they have to face the reality that they have come to the end of the road, and that their brain-dead relatives cannot recover or be kept on life support indefinitely. They confront Ms Tee with questions such as: How can you say he is dead? He is still breathing. His body is still warm. How dare you say he has passed away? What is brain death? “What they want is time, time, time

> Continued on page 21

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singapore he alth

Viewpoint

Zero sum game In healthcare, as in life, situations or relationships don’t always have to be win-lose, where one side profits at the expense of the other, says Dr Chong Yeh Woei

situation where one side wins and the other loses. For instance, when a cake is divided into unequal slices, some get bigger portions than others. We often try to replace zero sum games or win-lose scenarios with winwin situations. When people barter goods or services, the transaction is win-win, as both sides consider what they bought to be more valuable than what they sold. However, there are also lose-lose transactions when both parties suffer. These, together with win-win circumstances, are regarded as “non-zero sum” situations.

overall costs are passed to them. At some point, medical tourists will look to less costly treatments elsewhere, while local patients may move to the public sector or seek treatment with healthcare service providers in other countries. We may well become the Monaco of healthcare: If you cannot afford it, please don’t even bother to ask. Another win-lose situation is the loss of goodwill between doctors and patients, as fees rise in tandem with property

The rising cost of medical space – the result of rentals being chased into bubble territory – is a win-lose situation. The “loss” will be felt by patients who have to pay higher fees, as increased overall costs are passed to them.

Why am I talking about these fancy game theories? It is because I have noticed the creeping onset of more win-lose situations and lose-lose situations in the private healthcare sector. The rising cost of medical space – the result of rentals being chased into bubble territory – is a win-lose situation. As new price benchmarks are set, landlords adjust rentals. Banks, perceiving doctors to be good credit risks, are happy to lend them more money. This situation will continue to escalate if no one puts on the brakes. The “loss” will be felt by patients who have to pay higher fees, as increased

nition and status they enjoy. This creates a healthy tension between fees charged and the professional craft. When this balance is unhinged by overcharging, patients may perceive the value of the doctor’s professional services as falling short. In particular, should the treatment result in a poor outcome, doctors may face unhappy patients and even legal action. An interesting case in point: Patients are demanding refunds as an option to avoid lawsuits.

Cutting a cake unequally will result in a win-lose situation, as one party gets the larger share. Similarly, as medical costs rise, the loser is the patient who has to bear the increased financial burden.

career. The very nature of such traits would have kept such people in their place and prevented them from moving into top leadership positions. However, in today’s very fluid world, marked by waves of change, innovation, uncertainty and reinvention, these individuals can emerge as top dogs based on their ability to sell themselves. In the final analysis, the essence of qualities prized in healthcare is the antithesis of narcissism. We should be aware that these toxic leadership styles have no place in today’s world, and should not be tolerated in our profession. Adapted from an article in SMA News January 2011.

values. Private sector doctors are expected by society to put their patients’ interests above those of their own. In return, society allows them the right to self-govern the profession, and gives them the recog-

On a more optimistic note, we can have a win-win situation with our professional colleagues. When we work together, share information, socialise, treat junior colleagues with patience

PHOTO: SMA News

We may have come across the term “zero sum game” without quite understanding its impact on our daily lives. It describes a

and kindness and behave respectfully to senior colleagues, the working environment suddenly becomes more positive. I urge everyone to leave negative workplace dynamics – intrigue, manoeuvring, backstabbing, envy, jealousy, gossip – at the door when arriving for work every morning. Win-win situations can be gained by treating your nurses, allied healthcare professionals, medical students and ward assistants in a civil and kind manner. After all, we are the leaders of healthcare, and in today’s world, an autocratic, narcissistic, destructive or toxic style of leadership will not be tolerated much. The effective leader tends to be self-aware, self-regulated, motivated by reasons that transcend money or status, empathic and equipped with good social skills. In quieter times, negative leadership traits would have surfaced early in a person’s

Dr Chong Yeh Woei is President of the 52nd SMA Council. He has been in private practice since 1993 and has seen his fair share of the human condition.

singapore he alth

JUL/AUG 2011

Money Matters

Reading the fine print

Some points to remember when purchasing a medical insurance policy

When buying an insurance policy, it is important to understand the clauses that may affect claims later Mdm Tan switched health insurers and after the new plan kicked in, she suffered a mild stroke and was admitted to hospital. Upon discharge,

keep premiums affordable for everyone. Insurers have to balance between giving more generous coverage to individuals versus covering more people at a basic level. The likelihood of claims arising from a preexisting condition is higher, which means more claims have to be paid. If insurers are to cover these risks, they would need to charge higher premiums to cover the high payouts. Higher premiums mean fewer people can afford even basic health insurance, which does not serve the public interest. So, when changing or replacing an existing health insurance policy, the insured person suffering from preexisting medical conditions may find himself without coverage for those

she filed a claim with the insurance company, but her request for the insurer to pay her medical bills was rejected. The insurer had learnt that Mdm Tan was diagnosed shortly before for high blood pressure. She did not declare the condition in her insurance application as she thought it wasn’t serious. But Mdm Tan’s hospitalisation was deemed to be related to a preexisting medical condition that she should – but did not – declare in her application form. Keeping premiums affordable A preexisting condition is an illness or disability that an applicant has, or has had, before signing up for an insurance plan. It is common for insurance contracts to have a preexisting condition exclusion, although its definition differs among insurers, with some more stringent than others in their definition. Preexisting exclusions are used to

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It is important to read the terms and conditions in a health insurance policy that may affect your ability to make a claim when the need arises.

conditions if the new policy has a preexisting medical condition exclusion. Clarify in writing Besides preexisting conditions, a medical insurance policy may have other exclusions. For instance, general outpatient medical services and alternative or complementary treatments, including traditional Chinese medicine (TCM), are commonly excluded. Insurers may also restrict coverage or charge higher premiums for people with

certain medical conditions, or who are exposed to occupational hazards, as the possibility of a claim being made by these groups is higher than that for people who are not exposed to these risks. To avoid having claims rejected or the policy being declared void by the insurer, applicants should disclose all information factually and accurately to the insurer. They should also be clear about disclosures or definitions of terms like preexisting conditions or material information. If in doubt, they should check with their insurers. To avoid any misunderstanding, clarification should also be made in writing.

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Mr Tee bought a medical expense insurance policy. Several months later, he began experiencing bouts of intense heart palpitations with fainting spells. He consulted a cardiologist and was found to have a congenital heart condition that could be treated with minor surgery requiring hospitalisation. Before the surgery, Mr Tee had asked if the surgical and hospitalisation costs would be covered under the policy, but was shocked to learn that while the policy did cover congenital disorders, claims for such coverage could be made only two years after the start of the policy. The period specified in his health

insurance policy is known as the waiting period and is the time that must pass before some or all of the healthcare coverage can begin. During this time, a claim cannot be made. Coverage may only come later Insurers impose a waiting period to prevent policyholders from buying policies only after they are aware of their illnesses and claiming medical expenses soon after. Another condition that insurers may impose is the deferred period – a period of time that must lapse after disability or sickness occurs, before benefits are paid. Benefits may only be disbursed after the insured person has been disabled or sick for more than a set number of days.

JUL⁄ AUG 2011

singapore he alth

People

The art of development

I would most want to discuss medicine and science with… Galileo Galilei. I want to talk to someone who has influenced the field of science and medicine in a dramatic way. Like the Industrial Revolution – which is attributed to a change in people’s thinking rather than technology – Galileo also brought about such a change, which made all other scientific discoveries possible. I would like to find out what made him think so differently despite the political and religious pressure to conform.

I always wanted to be… a pilot, but then I developed myopia. I chose medicine because I had interest in neurosciences. Later during my training, I also discovered my passion for surgery. Neurosurgery was the perfect marriage between the two.

I think I am… efficient in time and resource management, something I only noticed after my wife pointed that out. I plan my day in great detail, even the route I walk within the hospital.

I smile when… my patients recover from operations. Especially in neurosurgery, the recovery can be quite remarkable. As a researcher, what makes me smile is getting to the bottom of a particular condition and finding innovative ways to treat it. It’s not just about groundbreaking discoveries, but about identifying windows of opportunity where new knowledge can make a difference.

The best analogy for the work I do is… I guess, that of a brain engineer who ensures all the connections are in good working order.

My motivation is… to see things develop. I’m definitely not creative in the artistic sense, but I like to use my creativity to develop new things – be it a new programme or clinical service.

PHOTO: alecia neo

Associate Professor Ng Wai Hoe, Senior Consultant, Department of Neurosurgery, National Neuroscience Institute, is a rare breed. Besides being a neurosurgeon, he also has a PhD in research. Thava Rani finds out what makes him tick

Associate Professor Ng Wai Hoe hopes patients have a positive outlook on their condition, and realistic expectations of their recovery.

I’m unhappy when… there’s a bad outcome from surgery. Doctors are human, and we become close to our patients, so bad outcomes affect us just as much. In neurological diseases… patients and their family may not fully appreciate how serious the condition is and the risks of an operation. Surgery may not always “fix” things. We can only prevent the condition from getting worse, so sometimes, they may have unrealistic expectations of their recovery – like how much they will recover and how fast. My plans for the future include… embarking on expanding the field of functional neurosurgery into pain man-

Three decades and counting After receiving numerous awards in more than 30 years as a nurse, Mdm Lim Suh Fen still experiences joy in winning By Stacey Chia

If Mdm Lim Suh Fen, Assistant Director of Nursing, National Heart Centre Singapore (NHCS), has to live her life all over again, she said she would still choose to be a nurse. Her passion was ignited when she was caring for her ailing father with whatever knowledge she had gleaned from working in a doctor’s clinic. “It inspired me to join nursing. I love working with people and having the privilege to care for patients, whether physically, spiritually or emotionally.” Over the years, this passion has brought her numerous awards, including nursing’s most prestigious honour here – the President’s Award for Nurses – last year. This once-in-a-lifetime award is given to only three nurses a year. “Being recognised for my work and contribution has spurred me on to do even more for my patients, staff and community,” she said. With her long years in nursing, people often tap her wealth of experience. A recent request was for her to help in the planning of a new, larger heart centre, now being constructed on SGH Campus.

The new centre, two times larger than the current one and set to open by 2013, will be a digital heart hospital, integrating clinical systems with technology to improve processes and patient care. Scrutinising details Mdm Lim is no stranger to planning work. When the current heart centre was being built, she was asked to set up and run the one-stop cardiac outpatient centre. Armed with that experience and years of managing the Cardiac Clinics’ Appointment Unit and Resource Centre, she now has a clear idea what patients need and how the new building can meet these needs.

agement, and trying to build our epilepsy service. I also hope to spend more time with my son and daughter as they’re still at a stage when they want to be with their parents! The quality I value most in a patient is… a positive outlook. It’s quite humbling and inspiring to see a patient stay positive despite a potentially life-threatening disease. To relax means… spending time with my wife and kids, taking a walk along the beach or going for a run. I used to run marathons, but at 40, I don’t think that’s very good for my joints. So now, 10km is the max.

Wish your nurse a

Happy Nurses’ Day

She is currently looking at the smallest details – from the layout of services to the choice of furniture and fittings – to maximise space and ensure privacy for patients. To make sure facilities are easily accessible to patients, she is focusing on directional signages and the positioning of patient greeters at strategic locations. She also wants to consolidate ancillary services in clinics, so patients don’t have to be sent to other departments. “I want to make sure that from the moment patients step into the centre, they can easily find everything. This will cut their waiting time and ensure they don’t get lost.” Despite all the changes brought about by technology and scientific advancement which will be present in the new building, the focus will remain on seamless care delivery. Nursing will not lose

on Aug 1

its patient-centred focus, Mdm Lim said. Nurses will also be more involved in coordinating patient care, so a patient’s outpatient visits can be reduced. She said the biggest challenge nurses face now is their role in the job. “Today, nursing goes beyond the hospital walls. Nurses not only have close relationships with patients when they are in hospital, but extend care when patients return home, by teaching and supporting their caregivers in providing continued care.” Her advice to aspiring nurses comes from her own experience. “You must have a lot of passion to want to be with patients and care for them, as well as to help their families heal or manage patients’ medical problems. Caring is central to nursing and it has to come from within you.”

Mdm Lim Suh Fen was awarded the President’s Award for Nurses in 2010, in recognition of her outstanding contribution to the profession.

singapore health

Jul⁄ Aug 2011

FYI

SingHealth staff raise funds for needy patients SaveMoney SaveLives, a SingHealth Foundation fundraising effort, raised more than $200,000 – the highest in the campaign’s history – for needy patients at SingHealth institutions. The funds go towards providing quality medical treatment for needy patients, as well as caring for their emotional, mental and financial needs.

The campaign offered participants the chance to win a lucky draw prize. Ms Gladys Lin, a research administrator at National Heart Centre Singapore, was the lucky winner of a Subaru Impreza 1.5MT Sedan – a perfect present for her wedding in September. The campaign was supported by Atos Wellness and Motor Image Enterprises.

event Calendar

Singapore Health issue 11 contest 1. What is the name of the machine that doctors used to keep Cherie alive after her heart attack? 2. Which story did you enjoy reading most in this issue of Singapore Health? Closing date: Aug 12, 2011 Send in your answers and stand to win a two-month supply of Viartril-S 500mg 90s worth over $130.

Lucky couple unlocks the secret to wedded bliss.

Eat Smart, Move More, Love Life!

A group-based programme specially designed for women who wish to control their weight Time Please contact programme coordinator for exact dates and time Venue KK Women’s & Children’s Hospital, Fitness Centre, Level 2, Children’s Tower Price $275.50 for 10 sessions Contact For registration, please call 6394-8782 / 6394-8488 or email sportsmed@kkh.com.sg

SOTA Rocks!

School of the Arts students will perform jazz, latin, as well as rock and roll to entertain patients and visitors Time 7-7.45pm Venue SGH, Block 6, Deck on 9 Price Free

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

Stroke triggers Researchers at University Medical Centre in Utrecht studied 250 patients over three years to identify what might cause blood vessels of the brain to burst. Ruptured blood vessels can lead to stroke. Coffee was responsible for one in 10 cases of blood vessels bursting. The following are the various risk factors, all of which trigger an increase in blood pressure to the brain, and their contribution to the percentage of cases of ruptured brain vessels:

Coffee

10.6%

7.9%

Vigorous exercise Nose blowing Sex

5.4%

4.3%

Straining to defecate Drinking cola

3.6%

3.5%

Being startled Being angry

2.7%

1.3%

Bottle-feeding increases obesity risk Babies who are bottle-fed until the age of two are more likely to be obese when they start school, a US study said. Writing in the Journal of Pediatrics, researchers found that children who

were still regular bottle users at 24 months were 30% more likely to be obese when they reach five and a half years old.

Experts say bottle-feeding can make babies consume too many calories. The research found 22% of two-year-olds studied were using a bottle as their main drink container, or were put to bed with a bottle containing a caloriefilled drink. Nearly a quarter of this group were found to be obese by the age of five, compared with 16% of children who had not been using a bottle at the age of two. This suggests that parents should stop using a bottle by the child’s first birthday to reduce the risk of overfeeding. Source: BBC.com

Source: BBC.com

Publisher

From Jul 2 (Sat)

Co-funded

Email: editor@sgh.com.sg Post: The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608 Winners of Contest 10 These winners will each receive a Solax Memory Foam Pillow worth $55. 1. Cyril Dominic Chelliah 2. Julia Matrawi 3. Ng Siang Cheng 4. Santhi Sabrina 5. Steven Tan Choon Huat Prizes must be claimed by Sept 2, 2011.

Aug 5 (Fri)

River Valley Primary School children will celebrate the nation’s 46th birthday with song, dance and wushu performances Time 7-7.45pm Venue SGH, Block 6, Deck on 9 Price Free

Sleep Disorders Public Forum

Aug 27 (Sat)

Time 9.30-11.30am Venue SGH Postgraduate Medical Institute, Block 6, Level 1, Rooms 3 and 4 Price $5 (includes tea break) Contact For registration, please call 6326-6202 or email gnrsdu@sgh.com.sg For more information and other listings, please visit www.singhealth. com.sg/events or the respective institution websites.

Answer to In focus (Page 3): This multicoloured fabric-and-string web, one of several artworks put up at Singapore General Hospital recently, was created by Ms Ketna Patel, a British Indian artist based in Singapore, and multimedia artist Foo Ai Wei. The artwork exaggerates the subtle and encourages the viewer to see what they may not usually notice.

Publishing Agent

Managing Director Dennis Pua

Creative Director Alex Goh

General Manager Christopher Chan

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Senior Designer Jolene Tan

Senior Editor Low Ching Ling

Executive, Client Management Jacklyn Ong

Associate Editor Jason Lim

Account Manager, Advertising Sales Jobina Ong

Editorial Team Angela Ng (SGH), Lim Mui Khi (SGH), Tina Nambiar (SingHealth), Nicole Lim (SingHealth), Ann Peters (SingHealth)

Sub-Editor Winnie Fong

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Singapore Health is partially funded by SGH Integrated Fund and SingHealth Foundation to advance the health literacy of patients in SingHealth institutions.

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

Content Advisor Tan-Huang Shuo Mei Group Director, Communications & Service Quality, SingHealth & SGH

Jul 29 (Fri)

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

新加坡中央医院

7月

与新加坡保健服务

8月 2011

集团的双月刊

page 29

施予第二次机会

page 30

一段经历，两个故事

page 30

page 31

致命剂量

验血之前须禁食

在死亡关口捡回一条命一群尽责的医护人员和一台仪器，把一名年轻人从死亡关口拉了回来

他们的效率很高。” 他也补充道，在多数心脏衰竭的个案里，即使进行了心肺复苏，使用ECMO仪器的结果还是不尽如人意。即使病人得以存活，器官遭到损害的可能性也很高。自 2003 年起，这台仪器已抢救过 205 个心脏衰竭的病人。 ECMO 仪器的运作原理是从病人的腹股沟插入两根插管，仪器内的血泵会通过一个插管泵出脱氧血液，然后仪器内的人造肺会排出二氧化碳，把氧气注入血液中，再通过另一个插管把血液泵回病人体内。苏医生说：“血泵就像有一定血压的心脏，负责把血液输送到体内各个器官。泵血过程是持续不断的。”

超声聚焦医治前列腺癌新加坡中央医院首创非侵入性前列腺癌疗法原文 Keith G Emuang

图：ALVINN LIM

目前，男性患上前列腺癌的几率是30年前的4倍。每100名被诊断患上前列腺癌的男性中，就有约 4 人会因病去世。随着新加坡的人口迅速老化，这个趋势预计也将日益加剧。虽然能在患病初期测出癌症，但其治疗却可能带来后遗症，让病患感觉丧失男性尊严。前列腺，指的是构成部分男性生殖系统的附属性腺。前列腺癌的传统治疗包括前列腺切除手术、放射治疗、植入放预后具有不确定性射性粒子（近距离放射治疗），以及利虽然林宝惠的心脏恢复跳动，但她还是用低温阻碍癌细胞的代谢（冷冻治疗）。新加坡中央医院泌尿科高级顾问郑畏处于昏迷状态。苏医生也通知她的家人林宝惠（右）在经历心脏停止跳动45分钟的心脏病后，成功痊愈。图为她和母亲开心的合照。要做好最坏的打算。因为即使她活下来，三副教授说：“很不幸的，现有的治疗也可能因脑部缺氧伤害而瘫痪。此外，都会引发持久的副作用。这些副作用将到医院进行检查，诊断结果发现她患上苏医生也不排除她得终生坐轮椅或出现对前列腺癌症病患的生活素质产生很大文李君玲一种罕见的心脏肌肉炎，也就是急性病大脑性瘫痪的可能。的影响。 “其中，最常见的是尿失禁以及性无毒性心肌炎。任何年龄和性别的人都有七天后，她的心脏功能恢复正常，不可能患上这种无法预知的疾病。过去五再需要依赖仪器。林宝惠笑着说，苏医能。” 很少人会有像林宝惠那样死而复生的年里，新加坡有九人不幸罹患这种疾病，生是她苏醒后看到的第一张脸孔。尽管如此，新加坡中央医院与新加坡国立癌症中心合作进行的一项临床试验，经历。只有三人，包括林宝惠，得以存活。将能为患有低风险初期前列腺癌的病患去年 12 月，还 15 岁的林宝惠因急性医生发现她心脏的功能只有 10% 到心脏衰竭被送入医院，尽管医护人员进 20%。当时她的情况迅速恶化，并出现提供一种无副作用的治疗选择。这项治疗运用的是相同于女性子宫行紧急抢救，她的心脏仍停止跳动长达急性心脏衰竭，医生便立刻把她送进加 45分钟。最后，只有在医生使用人工心护病房进行心肺复苏。45分钟后，虽然肌瘤治疗中所用的磁共振引导超声聚焦疗法。在磁共振的引导下，外科医生将肺机来取代林宝惠的心脏和肺功能后，医生不断增加肾上腺素的剂量，但她的准确地找到肿瘤及周围的组织，并精准她的生命才慢慢地恢复。林宝惠很可能心脏还是无法恢复跳动。于是，院方寻会因此而瘫痪，但很幸运的她现在已完求ECMO团队的协助。无误地将超音波聚焦，把肿瘤“烧除”。这个称作前列腺癌磁共振引导超声聚焦全康复。目前，新加坡一共拥有六台 ECMO 仪距疗法的手术将不会对肿瘤附近的细胞如今，她就像其他正常健康的学生一器，全设在新加坡国家心脏中心，随组织造成伤害。样四处跑动，今年还准备参加 O 水准考时准备提供支援。当新加坡国家心脏直至今年三月，已经有 18 名来自印试。中心接到电话要求使用 EC MO 仪器时，林宝惠之所以能活着，除了因为她 ECMO 团队包括两名操作仪器的灌注师、度、意大利、俄罗斯以及新加坡，年龄介于50至75岁的局部性低风险前列腺癌年轻和拥有顽强的恢复能力之外，还有一名心脏外科医生和一名医生就会乘坐病患接受治疗。当中，有 7 名病患在本一群永不放弃的医护人员，以及现代科救护车、德士或开车赶到医院。地接受治疗。目前，新加坡是参与这项技带来的奇迹。那台帮助林宝惠恢复心世界首创的国际多中心试验的最大临床跳的仪器是一种称为体外膜式氧合器他还是尽力抢救（简称ECMO）的人工心肺机。新加坡国家心脏中心心胸外科顾问医生试验中心。据郑副教授说，这个非侵入性的治疗苏章文第一个抵达医院。他说：“庆幸苏章文医生在林宝惠因心脏病陷入昏迷后，以能在提供有效治疗的同时，减少对前列从胸痛到心脏衰竭的是，在ECMO团队抵达之前，那里的医体外膜式氧合器来保持她的心脏跳动。一开始，林宝惠感到胸部疼痛。她被送生和护士已经在为林宝惠进行心肺复苏。 > 文转 page 28 > 文转 page 28

新脉动

JUL⁄ AUG 2011

新闻

前列腺癌

> 文接 page 27

超声聚焦医治前列腺癌腺功能区以及周围器官结构所产生的有害副作用。不仅如此，它还能解决病患的另一担忧。郑副教授说： “这是一个重要的进展。虽然前列腺癌在初期就能确诊，不过我们却一直很注意不要给某些病患过度治疗，譬如对他们进行前列腺切除手术或放射性治疗等。” “这项新疗法可以算是一种折中的解决方案，尤其适用于医治患有初期前列腺癌的年长者。” 病患可以在新加坡国立癌症中心接受这项日间手术。在手术过程中，病患必须躺卧，并将双脚抬起。医生随后会将一个能量转换器，即一种能把一类能量转换成另外一类能量的器具，置入

前列腺是男性生殖器官的一部分，它是一个核桃般大小，处在直肠之前，膀胱之下的腺体。它环绕着从膀胱输尿至阴茎的尿道。前列腺主要需要睾酮（男性荷尔蒙）以正常运作，其中的作用包括在射精时产生运输精子的精液流体。当前列腺细胞异常生长，前列腺便会扩大，推向尿道和膀胱，阻碍正常尿流。在前列腺开始生长的癌细胞可能会留在前列腺内，也有可能扩散至附近的淋巴结。在某些情况下，它也可能会扩散到骨头、膀胱、直肠或其他器官。前列腺癌在发病初期一般不会出现明显征兆，因此，前列腺癌检查尤其重要。随着病情的恶化，病患或许会发觉自己频尿和尿急，但尿液却减少，或在尿液中发现血迹。

图：101TEAMWORK

病患的直肠。医生在整个过程都无需在及控制热量的分布，标明应被烧除的肿病患身上做任何切口。瘤部位。新加坡国立癌症中心肿瘤影像学科主由于治疗需要极高度的准确性，因此任及高级顾问邱文庆医生说：“有了磁病患必须全程保持不动。他们可能需要共振的引导，便能够将几百个单独和通常进行脊髓硬膜外麻醉或全身麻醉。整个无害的音波聚焦在病患体内深处的某个治手术平均需要约三个小时完成。疗点上。当这些音波交错时，所产生的一般上，病患在一、两天内便能够恢超声波就有足够的能量，破坏癌细胞。” 复正常生活，生活素质也不会改变。郭医生补充，这个概念，就类似利用自2010年8月开始试验至今，病患除放大镜将太阳光线聚焦，由此起火，或了偶尔小便有困难，并没有出现任何严在纸上烧出一个洞来。重的并发症。医生也表示，没有病患出他说：“这项科技非常精确，甚至能现病情复发的情况。够针对小如一毫米，也就是半粒米大小郑副教授说：“希望当这项临床试验的面积做出治疗。” 成为正规疗程后，更多患有初期前列腺手术进行时，实时磁共振测温表和三癌的男性能够接受治疗，恢复美满的性左起为郭仁辉医生, 郑畏三教授和邱文庆医生。他们是以微创术治疗前列腺癌的其中几位先锋。维累积剂量显示器等仪器都会帮助监视生活。”

图：PHOTOLIBRARY

新加坡国立癌症中心肿瘤影像科高级顾问医生郭仁辉（左）以磁共振影像来准确地找到肿瘤的位置，再将超音波聚焦，利用热量把它烧死。

前列腺因肿瘤（红色部位）肿大会阻碍正常尿流。

> 文接 page 27

活着真好

在死亡关口捡回一条命

苏醒后，她的手脚不太能活动，而且只能低声细语。苏医生把林宝惠的康复归功于她父母亲24小时无间断的悉心照料。“每天早上巡房时，我都会看到他们两人。她父亲放下工作来照顾她。他会把她从床上抱到椅子上，按照理疗师的指示活动她的手指和腿。他经常脸带微笑，保持乐观，充满希望。由于护士不能每分每秒都待在那里，所以她母亲就帮忙照她。她的父母亲尽心尽力地帮助她活动四肢，以避免她身体僵硬。这让我很感动。” 当她出院时，她走路还是有些困难，说话还是很小声。院方要求她即使只是感到轻微的胸部疼痛，也要立刻回到医院检查。事实证明，这个有坚强决心的文静少女，是一个战士。出院不到两个月，苏医生就接到电话说林宝惠在医院想见他。她几乎是蹦蹦跳跳地进入他房间。“我简直不敢相信，因为她出院时，还需要别人搀扶才能走路，动作还很笨拙。” 林宝惠来见他，不是因为胸痛，而是想获得苏医生的批准重返校园。校长建议她休学一年，但她拒绝了。她想弥补失去的时间，在考试中获得好成绩，将来当个好老师。

图：ALVINN LIM

父母亲的爱

新加坡国家心脏中心灌注科高级灌注师庄璇珠推着其中一台抢救生命的ECMO仪器。中心共有六台仪器，随时准备提供紧急支援。

这次经历让林宝惠明白考取优异成绩不是生命的全部。“我的朋友说我现在变得更加开朗。我不会过分重视学校和学业，而是会更关心家人和朋友。有很多跟我同龄的人都认为如果他们在学业上的表现不理想，他们就完了。我想告诉他们不是这样的。” “生命难以预测，你要珍惜每一分每一秒。”

42岁的保健业行政人员符先生是另一个被ECMO团队救活的病人。他在吃午餐后开车回公司途中突然心脏病发作。他放慢车速，慢慢地把车驾回公司。他说：“我呼吸急促，而且不停地冒冷汗，也很想吐。倒退泊车变得很困难，当时我知道自己心脏病发作。” 当他的疼痛纾缓后，他走进公司召开会议，并告诉惊愕的同事们说：“我必须先离开，我心脏病发作。”一个同事开车送他回家，之后再送他到邻近医院的急诊室。隔天，当医护人员在他的左大动脉进行支架置入术时，他的心脏突然停止跳动。他们替他进行心肺复苏和使用去纤颤器，但一个小时后，他们决定寻求ECMO团队的支援。跟ECMO团队一起赶到医院的新加坡国家心脏中心高级顾问医生陈廷毅说：“当时的情况十分危急。” 医护人员立刻使用 ECMO仪器来抢救符先生，并把他转到新加坡国家心脏中心做进一步治疗。由于他的右大动脉也阻塞，因此医生一边使用 ECMO 仪器，一边置入另一个支架重新撑开右大动脉。

陈廷毅医生和其团队利用体外膜式氧合器抢救心脏病爆发的符先生。他们一边使用该仪器，一边重新撑开阻塞的大动脉。

靠 ECMO仪器和药物镇静过了五天后，符先生才完全恢复知觉。出院后三个月，他做了心脏绕道手术，解决另一条动脉阻塞的问题。符先生从小就患上一种称为家族性高胆固醇血症的遗传病，所以他每年都得进行血压和胆固醇检查，并且定时运动和控制饮食。心脏病发作前两个月，他感到胸痛，但休息后就纾缓了。这次心脏病发作让他措手不及。他说：“我事后才了解，胸痛的时候就应该马上去看医生。” 这些日子，他更加注意自己的状况和保持心情平衡。他服用药物控制胆固醇水平，而且继续定时做运动。“我在学习放慢脚步和更加注意自己的健康。这是我现在最重要的事情。”

Jul⁄ Aug 2011

新脉动

观点

施予第二次机会

器官捐献常态化给了许多等待踏上新生命旅程的新加坡人一线新希望文黄平仁教授

起源于 1818 年，有人第一次把“移植法”描述为“将人体细胞以输血方式从一个人的身上输送到另一个人的身上”。其次在 1905 年，眼角膜细胞成了第二个能被移植的人体组织。直到 1945年，器官移植手术首次在美国波士顿成功地在一对双胞胎之间进行肾脏移植。相隔八年后，当医学界对人体免疫系统有了更深的了解及发现了免疫抑制治疗后，才首次成功地把遗体的肾脏移植到活人体内。从那时起，许多的‘第一次’ 接踵而来 — 肺部（1963年）、胰脏（1966 年）、肝脏（ 1967 年）、心脏（1967 年）、骨髓（ 1973 年）、小肠（1988年），到目前的多器官移植。沿着上述进展，人们对人体组织分类和免疫学日益了解也使我们成功地开发免疫抑制剂。在获得诺贝尔医学奖的得主当中有不少是移植手术的专才，他们包括因在器官移植手术技术领域的先锋工作而得奖的卡雷尔（ 1912 年）、因免疫系统相关工作而得奖的多塞特、斯内尔以及贝纳塞拉夫（1980年）、因免疫抑制疗法得奖的希青、埃利恩和布拉克（1988年）、以及成功完成人类首个肾脏移植的默里和首个成功完成骨髓移植手术的汤姆斯（1990年）。这充分肯定了器官移植手术对于改善人类生活所作出的重大贡献。

在本地在1970年，我们见证了首起肾脏移植手术的成功。于1990年，便开始进行心脏和肝脏移植，直到2000年的肺部移植手术。为了解决人们死后不愿意捐献器官而导致可移植的肾脏短缺问题，国会在

新加坡保健服务集团的管理层和众器官移植协调员，在去年7月份举行的首个新保集团器官移植意识周的感谢会上合影。

1987年通过了一项人体器官移植法令，以假定和自愿同意为基础；如果国人不表明自己拒绝在死后捐献肾脏，他将被视为自愿捐出遗体内的肾脏。在这项法令生效后，遗体肾脏移植率有了显著的提高，从 1979 年至 1987 年之间每年的 4.7 起已增加到 1988 年至 2004 年之间每年的40.8起。由于眼角膜、肝脏和心脏也同样面对捐献者短缺的问题，人体器官移植法令在2004年1月6日修订，将这些器官都列入在内。自 2009年 11月 1日起，人体器官捐献法令为了进一步扩大捐献者的人数而再次修正。除非个别选择退出捐献计划，所有21岁以上、心理健康健全的新加坡公民和永久居民都受法令约束。人体器官移植法令足以解决我国移植器官的需要吗？在新加坡，每年都有近 500 名病人在等待获得器官移植，但他们当中有很多人都等不到手术的那一天。

使用活体捐献的肾脏或肝脏移植已经越来越普遍。然而，要在一个健康的人身上开刀并取出器官会涉及一定的风险和道德争议，因此，它不能完全取代遗体器官移植。无论是活体还是遗体器官移植，要满足国人的需要，两者是一样重要的。

人体组织和器官的捐献不但能够挽救生命，也是一个人能给予另一个人最伟大的礼物。

在推行人体器官移植法令的过程中，新加坡卫生部展开了一项名为“ Live On ”的意识运动，以鼓励人们在死后捐献器官。该运动旨在成为一项以支持器官捐献的长期公共教育计划，这肯定是值得支持与赞扬的。虽然有些人认为“除非选择退出，否则视为同意”的人体器官移植法令过于严苛，但也改变不了人体器官和组织确实能挽救生命的事实，而且应该被视为一个人能给予另一个人最伟大的礼物。“Live On”希望可以推广这样的观念。

为人民服务心脏、肺部和肾脏需要在数小时内被移植到受益者体内，但其他器官如眼角膜和皮肤则可储存备用。

新加坡保健服务集团在去年宣布，为了提供更完善的病人护理和治疗，集团打

算整合旗下所有的器官移植计划并设立综合移植服务中心，旨在提高公众和旗下医疗机构的医疗护理人员对器官移植的认知。我们以口号“生命的礼物、希望的源头”来实行与反应支持人体器官移植法令如同给予他人生命和希望。随着新加坡朝向发达国家迈进，新加坡人的信念和价值观也必须更具公民意识。珍惜生命多于死亡是关键。 15 年前，当我在澳洲一个肝脏移植单位工作时，我发现当地人行善的文化素养很强，以致每个人都认为捐献器官是理所当然的。我们经常在感恩仪式或晚宴等公共场合上看到捐献者一家人当众被表扬。接受器官捐献的病人和他们的家属也会非常坦率且毫无保留地表达他们被给予机会而获得重生的感激之情。去年，新加坡国家心脏中心主办了一个感谢午餐会，庆祝心脏移植进入第 20 年和肺部移植进入第 10 年。在餐会上，我们看到受益于器官移植的病人分享他们在人生转捩点上的经验，并由衷感谢医护团队，尤其是对匿名的捐献者，他们更是万分感激。

施予生命你要如何伸出援手？只要您不选择退出人体器官移植法令，在你逝世后，你的肾脏、心脏、肝脏和眼角膜都可以挽救一条生命。你也可以在医疗（治疗、教育及研究）法令下，主动表示愿意在死后捐出人体器官移植法令所没有涵盖的器官。心脏、肺部和肾脏必须在数小时内从捐献者体内取出，然后移植到器官衰竭者体内。其他器官如眼角膜、皮肤和心瓣膜则可被储存到需要时才使用。在新加坡保健服务集团的综合移植服务中心，眼角膜被存放在新加坡全国眼科中心的新加坡眼库、皮肤则储存在新加坡中央医院的皮肤组织库，用来帮助严重烧伤的病人；而心瓣膜、血管组织和气管则被存在国家心脏中心的全国心血管移植片存库。此外，新加坡中央医院和竹脚妇幼医院的骨髓和肝细胞计划则储存治疗用的血液。最后，让我简洁地和大家分享一句话来表达器官捐赠：把你的器官和身体组织留下，天知道我们这里需要它。

黄平仁教授是新加坡中央医院外科手术组处长，掌管11个外科部门。他也是新加坡国立癌症中心的顾问。黄教授也任教于杜克—新加坡国大医学研究院，同时是研究院的外科总书记处主任。

新脉动

Jul⁄ Aug 2011

新闻

致命剂量你真的知道自己给孩子吃了什么药吗？原文 Jessica Jaganathan

澳大利亚调查人员发现，将近一半的受访家长给孩子服用常见非处方药的剂量可能有误，使孩子的健康，甚至生命受到威胁。虽然新加坡家长在给孩子服用这类药物时相对来很小心，但服用过量的扑热息痛（paracetamol）依然是竹脚妇幼医院急诊室三大最常见与药物相关的急诊之一。竹脚妇幼医院急诊科主任兼高级顾问黄纪铳副教授说，除了扑热息痛，其他常见用错剂量的药物包括退烧用的依布洛芬（ibuprofen），以及止咳和伤风的药物。同是卫生部毒理学指引委员会成员兼联合主席的黄副教授说：“非处方药物都必须得到监管机构如卫生科学局的

钙通道阻滞剂樟脑治疗疾病如高像糖果一样包装的血压纯樟脑块可在印度店铺找到，供宗教燃烧之用

批准，如果遵照指示水杨酸甲酯见于冬青油和服用，基本上是相对安舒缓肌肉疼痛全的。” 的产品致命。不过，海外研究显示，岁儿童一让口服降血糖药足以指示不清楚依然是用药错抗精神病药物抗糖尿病药列药物下的抗抑郁药误的主要原因之一。其他安神药一片剂麻醉剂茶匙或一原因包括缺乏分配器和测成瘾性药物，能舒缓疼痛和通常用来抗心律失常药量单位不同。治疗心律不齐的药促进睡眠黄副教授说：“此外，孩子会长大，适合孩茶碱子年幼时期的剂量，会随治疗呼吸系统疾病着他年龄增长和体重增加而（如哮喘）的药变得无效。” 家长可选定其中一人专门负责喂食副作用会在四到六个小时内发作；若服药物，以预防孩子服用过量药物。用过量的扑热息痛，肝功能衰竭会在两黄副教授说：“要不然，人多反而至三天后才发生。误事。” 如果不小心用药过量，应尽快送孩同时给孩子服用不同药物也可能会子入院。首先，医生将确保孩子的脉不小心造成用药过量，所以家长应检查搏、呼吸和血液循环稳定，以及呼吸道有些药物，主要是处方药，对年幼并确保药物不含有相同的活性成分。孩子来说是有毒的。畅通。服用更多不一定更好。黄副教授然后，医生将替孩子洗胃、催吐或竹脚妇幼医院急诊科主任兼高说：“口服药物通常需要大约30分钟至给他口服活性炭，以减少身体对药物的级顾问黄纪铳副教授说：“我们在一个小时来发挥作用。服用更多不会使吸收。如果药效已渗入血液，医生将给急诊室看过很小的婴儿服用如扑尔药效发挥更快。” 孩子服用解毒剂。敏（ chlorpheniramine ，一种抗组潜在的副作用会随着服用剂量和药胺药）的感冒药后出现间歇性呼吸黄副教授说，家长在购买药物给物种类而有所不同。黄副教授举例说孩子时，如有任何疑问，应先咨询药（也就是呼吸暂停）。” 明，若服用过量的止伤风或止咳药水，剂师。

避免让儿童接触

一段经历，两个故事

一个病人和他的妻子述说他们俩如何互相扶持，为肝脏移植手术做好准备祈祷，感谢逝世的肝脏捐赠者，以及家人的爱和支持。安东尼说：“我真的很幸福。布丽姬特乐观的态度和活泼的个性成了我继续走下去的动力。虽然我的儿子们生活忙碌，但他们每个周末还是会带着一家大小来看我。当布丽姬特不在时，我的儿媳妇会帮忙照顾我。在那段黑暗的时期，我感受到我的孩子们给予我的无限支持。”

原文 Thava Rani

图：101teamwork

他的故事虽然知道肝硬化很有可能会演变成肝癌，但被医生确诊患上肝癌时，安东尼仍然感到很震惊。医生告诉他，肝脏移植手术是他最好的选择。 71 岁的安东尼说：“我尽我所能维持身体健康，也彻底改变我的饮食习惯。我的太太布丽姬特为了配合我，也舍弃她最爱的肉食。她花了很多时间设计出一道道以鱼类为主的创新料理，以及选用松软芝士和亚麻籽油来准备新鲜的沙拉。” 在等待新肝脏的同时，安东尼也接受治疗以免癌症恶化。这个过程很辛苦，让他精疲力竭。曾经是卡丁车发烧友，安东尼发现自己比以前需要更多的睡眠，甚至没有多余的精力陪孙子们玩。因此他感到非常沮丧。音乐和心灵书籍让他拥有力量忍受痛苦。他尽量保持心情开朗，让每一天过得有意义。他说：“我觉得知足常乐让我的生活改变不少。如果我真的离开这个世界，至少我跟太太和孩子们都度过了美好的时光。” 在等待器官捐赠者时，他的次子艾伦决定捐出他的部分肝脏。艾伦暗中跟器官移植小组进行讨论

抗疟药治疗疟疾的药

安东尼和他的太太布丽姬特正打算接受他们儿子的建议时，就接到器官移植协调员的好消息。

还做了一些必要的检查。安东尼起初不愿意接受儿子的肝脏。可是， 10 个月后仍等不到好消息时，他决定接受儿子的捐赠。当他要告诉儿子他的决定时，电话便响起来了。安东尼说：“那就像是一通由天使打来的电话。器官移植协调员李慧玲通知我说他们有个适合我的肝脏，但我必须在一小时内到达医院。” 在等着被推进手术室时，安东尼说：“那时，我还是有点担心我的身体是否会排斥新肝脏，但结果非常理想。” 动手术至今已过了一年半，安东尼每天早上起床都心存感恩。他每天都在

她的故事布丽姬特在柬埔寨经营家族生意。当她丈夫打电话告诉她他得了癌症时，她感觉有如心在淌血。曾经担任人力资源顾问的布丽姬特（63岁）说：“当时我最忧心的是我不在他身边。因为以前每当发生不好的事情时，我总会陪在他身旁。” 在接下来的几个月里，为了可以陪伴丈夫，布丽姬特不断地往返新加坡和柬埔寨两地。她没有刻意削减她的合唱团和教会活动，因为布丽姬特相信照常生活可让安东尼保持精神振奋。更重要的是，她得保持心情开朗，因为她不希望丈夫担心她。尽管如此，她还是经常感到困扰。布丽姬特说：“每次他接受治疗后，他的脾气就会变得很暴躁，这也造就了我保持理智的一大挑战。所以每次回去柬埔寨都能让我暂时摆脱这个状况。这真的对我有很大的帮助。”

他们的次子艾伦是家里唯一适合捐赠肝脏给安东尼的人。不过，当他建议捐出部分的肝脏时，布丽姬特却表示不赞成。因为他还年轻，有太太和两个孩子，而且第三个孩子即将出世。她说：“很多事情都可能出错。或许真的会没事，但风险还是太大了。连我们的长子也游说我们接受他的一番好意。他向我们保证，万一发生了什么事情，他会负责照顾弟弟的家人。” 在一次的肝脏互助小组聚会，一名病人分享他曾接受他妹妹的肝脏，那时她还是一位年轻妈妈。这段经历成了转折点，让他们重新考虑儿子的建议。

布丽姬特乐观的态度和活泼的个性成了我继续走下去的动力。安东尼

有幸的是，安东尼不需要接受儿子的捐献。如今，他们的生活已找到新的规律。虽然有些改变令人难以适应，例如安东尼的余生都得服用大量的药物，以及不能吃生食，只能吃熟食。要是安东尼因吃生食而患上A型肝炎，他的免疫系统将无法抵抗感染。这些改变对安东尼来说只不过是很小的代价。布丽姬特看到一家人的关系更为密切，感到非常高兴。

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