Singapore Health May June 2015 by Singapore General Hospital

may jun

2015 the flagship publication of the SingHealth Duke-NUS Academic Medical Centre MCI (P) 173/05/2014 www.sgh.com.sg | www.singhealth.com.sg

AWARD OF EXCELLENCE

APEX Awards 2014

New molecular test can tell how cancer will respond to treatment

Eye vessel damage can reflect damage in the brain, heart and kidneys

Robot surgery to treat severe form of endometriosis

使用免疫疗法对抗癌症

P27

Photo: alvinn lim

Using ImmunOtherapy to combat Cancer

Travel health tips for seniors

痔疮不一定是令人尴尬的问题，最主要是了解成因和治疗方法

singapore health

may– jun 2015 PublisherS

Co-PublisherS

Content Advisor

Tan-Huang Shuo Mei

Group Director, Communications & Service Quality, SingHealth & SGH Editorial Team

Angela Ng (SGH) Lim Mui Khi (SGH) Ann Peters (SingHealth) Deborah Moh (SGH)

Read Singapore Health online at www.sgh.com.sg/singaporehealth

Publishing Agent

Group Editor-in-chief

Caroline Ngui Group Editor

Joanna Lee-Miller Editorial & Creative Senior Editor

Dora Tay Editor

Serene Foo Sub-Editor

Annabelle Bok ASSOCIATE CREATIVE Director

Jayson Ong

Art Director

Geoffrey Lim Senior designer

Fish Chan

Managing Director

Dennis Pua

General Manager

Christopher Chan sales & client management Account Manager, Advertising Sales

Lin Mi’er

Senior executive client management

Janice Low

publishing services senior executive

Lin Feng

For editorial enquiries, please e-mail editor@sgh.com.sg For advertising enquiries, please call 6319-3022 or e-mail jrani@sph.com.sg

All rights 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, 168 Jalan Bukit Merah, #13-01 Surbana One, Singapore 150168. Tel:+65 6222 3322, Email: editor@sgh.com. sg. Unsolicited material will not be returned unless accompanied by a self-addressed envelope and sufficient return postage. While every reasonable care will be taken by the Editor, no responsibility is assumed for the return of unsolicited material. ALL INFORMATION CORRECT AT TIME OF PRINTING. MCI (P) 173/05/2014. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).

MAY– JUN 2015

singapore health

NEWS

Immunotherapy has arrived Immunotherapy has been gaining ground and has emerged in recent years as a possible new cancer treatment no other treatment options available to them, became completely cancer-free and have remained cancer-free for some years now. However, it is not yet clear if they have all been cured. Still, CAR T-cell therapy is being hailed as a major breakthrough in the treatment of leukaemia. Dr Toh’s own study group has been working on harnessing the body’s own T-cells and re-engineering them to attack viral proteins on virally-driven cancers such as nasopharyngeal cancer.

By sol e solomon

Vaccines: There are two main types of cancer vaccines – those which reduce the risk of cancer (prophylactic vaccines) and those which treat established cancer (therapeutic vaccines). Prophylactic vaccines are given to reduce the risk of people getting specific cancers. Among those now available are vaccines to prevent Hepatitis B (thus reducing the risk

Photos: alvinn lim

patient with cancer can potentially be treated with one or more of the five pillars of cancer treatment – surgery, chemotherapy, radiation, hormone therapy and targeted therapy. Now, immunotherapy can be considered part of the arsenal for some cancers. Cancer immunotherapy consists of treatments (now mostly within clinical trials) that boost the immune system, allowing the body’s own defences to combat cancer. Encouraging results from some landmark clinical trials in the last three to five years have demonstrated some very dramatic clinical responses in certain cancers, said Dr Toh Han Chong, Senior Consultant, Division of Medical Oncology, and Deputy Director, National Cancer Centre Singapore (NCCS). Dr Toh is Principal Investigator of a recent immunotherapy clinical trial in Singapore (see box). He said that immunotherapy has emerged as a real and promising new treatment because of a much better understanding of how the immune system works, following many years of intense research into cancer immunology. Medical science now knows more about how the immune system works, and this intricate knowledge is translatable into new, more effective drugs today. A prestigious journal, Science, voted cancer immunotherapy as their overall Breakthrough of the Year in 2013. “Cancer cells are good at disguising themselves, but new knowledge has helped us figure out how they do this in greater detail, and how we can recognise some subtle differences between cancer cells and normal cells, so as to design sophisticated immunotherapy drugs that exploit this weakness in cancer’s Achilles heel. With the use of immunotherapy, the immune system can actually recognise and combat these cancer cells in a much more precise manner now while sparing normal cells,” Dr Toh said. There are different types of cancer immunotherapy. Some rely on harnessing the patient’s own blood as the main source of treatment development, while others use laboratory-made or commercially manufactured immune system proteins and antibodies. The main forms of immunotherapy include vaccines, antibodies, cytokines and T-cell therapy.

According to Dr Toh Han Chong, encouraging results from some landmark clinical trials in the last three to five years have demonstrated some very dramatic clinical responses in certain cancers.

of liver cancer) and vaccines that induce immunity against human papillomavirus thus reducing cervical cancer risk. Therapeutic vaccines are given to people who already have established cancer. These train the immune system to recognise and destroy cancer cells existing in some amount in the human patient. While there are many ongoing trials evaluating therapeutic cancer vaccines, only one has been FDA-approved so far – Sipuleucl-T, or Provenge – and this is for the treatment of advanced prostate cancer. T-cells: Grown in the laboratory using a patient’s own blood, T-cells are gaining traction as an important form of immunotherapy. Dr Toh describes them as the body’s fighting soldiers. These T-cells can be engineered to become very sophisticated highly-trained soldiers that can be developed to target protein(s) on the cancer cells, grown to very large numbers, sometimes in the billions, to be then reintroduced to the patient to specifically attack the cancer existing in the body. Dr Toh said several studies have shown dramatic success of one particular form of T-cell therapy, that of the chimeric antigen receptor (CAR) T-cell therapy, against leukaemia that has become resistant to conventional treatment. After getting this therapy, many patients with acute leukaemia, who had

Antibodies: Antibodies are like guided missiles, homing in on cancer cells or the surrounding immune cells to effect their function of containing the cancer. They can either directly kill cancer cells or activate a patient’s immune system to fight the cancer. “New types of antibodies that activate the immune system to fight cancer (anti-PD1 and anti-PDL1) have been especially successful in melanoma (skin cancer) treatment. They are also looking exciting for lung cancer, Hodgkin’s lymphoma and other cancers such as bladder and gastric cancers,” said Dr Toh. Cytokines: These signalling proteins produced by white blood cells help the

With the use of immunotherapy, The immune system can actually recognise and combat these cancer cells in a much more precise manner now while sparing normal cells. Dr Toh Han Chong, Senior Consultant, Division of Medical Oncology, and Deputy Director, NCCS

Putting immunotherapy into perspective, Dr Toh said that like other treatments, it works well on some cancers and not others, and that even within a particular cancer, it works well for some patients and not others. The field is still evolving; globally, tremendous resources are now being poured in to assess the true benefit of different kinds of cancer immunotherapy on many types of cancer. “Chemotherapy treatment goes back over 60 years and is a cornerstone in the treatment of many types of cancer. With radiotherapy, there’s going to be > Continued on page 4 ( 华文版本请翻阅至27页 )

CTL (cytotoxic T-cells) are the killer cells which attack the cancer.

Tumour

Grown in a laboratory using a patient’s own blood, T-cells can be engineered and then reintroduced to the patient to specifically attack the cancer existing in his body.

immune system to recognise and destroy cancer cells. They include interferons, which help the immune system boost the ability of certain immune cells to attack cancer cells and slow their growth, and interleukins, which help those immune cells grow and divide more quickly in order to destroy the cancer.

Antigen-specific T-cells activation in lymph nodes

Subcutaneous injection of vaccine

NEWS

singapore health

maY– JUN 2015

> Continued from page 3

Immunotherapy has arrived

Cancer vaccine clinical trial starts in Singapore increasingly more accurate radiation therapy technology, and radiotherapy will undoubtedly continue to be a pillar in cancer therapy. So too for surgery which in many cases, is the crucial mode of treatment to eradicate cancer. These remain the standard bearers of cancer treatment, as well as targeted therapy and hormone therapy for some cancers. And now, we can add immunotherapy to the list.”

Mrs Janet Quah, who has Stage 4 breast cancer, took part in the cancer vaccine clinical trial at NCCS.

The National Cancer Centre Singapore (NCCS) has begun a Phase 1 clinical trial of a novel cancer vaccine. The main objective of any Phase 1 oncology trial is to assess the safety and toxicity of the drug, where relevant, and to establish a correct dose for it. This first-in-human clinical trial uses a weakened adenovirus (in this case a common cold virus) that encodes a target protein (MUC-1), linked to a very powerful immune booster, to potentially improve immune activation and attack on the cancer. This therapeutic vaccine is aimed at some of the most common cancers in Singapore: lung, colon, breast, ovarian and prostate cancers. Developed by US biotechnology company MicroVAX, the vaccine is injected under a patient’s skin, and aims to stimulate his immune system into attacking the MUC-1 protein on the cancer cells. MUC-1 is found on the cell surfaces of many cancers, including ovarian, breast, prostate, colon, pancreatic and lung cancer.

What is unique to this vaccine is that MUC-1 is attached to another protein, CD40L, which is a potent immune enhancer that can boost the immune system. The virus forms the backbone of the construct of these two proteins, aiding the immune system in attacking the cancer by moving into the body’s cells and eventually stimulating the body’s white cells to home in on the MUC-1 protein expressed on the cancer. One patient, Mrs Janet Quah, 60, who has Stage 4 breast cancer, said: “My family was initially worried about the vaccine, so we discussed it. But it wasn’t something I had to think about for a very long time.” Her biggest concern was side effects. “Then again, I had side effects from chemotherapy. I was worried that I’d have some reaction, but there was none – no rash, no fever, nothing.” The trial also attracted a patient from Finland, Jane (not her real name), 52, whose husband, a doctor, found information about the trial online (www.clinicaltrials.gov)

while searching for treatments for his wife. Jane has Stage 4 ovarian cancer, and had consulted and been treated by oncologists in Europe before deciding to join the trial in October last year. Initially she flew to Singapore from Helsinki every fortnight, then monthly, for treatment at first, and then for follow-up visits. She has remained stable with no side effects. “I don’t feel worse, I don’t feel better. I feel the same, which means that I feel pretty good, lead a normal life, and even do sports.” She was a little concerned when first given the vaccine. “I didn’t know if it would affect me or if I would experience side effects, so I was a little bit nervous, but that went away in a couple of minutes.” Take part NCCS plans to recruit over 20 patients for this Phase 1 trial. Cancer patients interested to par ticipate can contact NCCS’ clinical research coordinator via +65 6436-8431 or chong.hui.shan@ nccs.com.sg.

may– Jun 2015

singapore health

new frontiers

Predicting treatment and responses Molecular kit can better diagnose kidney cancer, and help select the best care for patients

you to go right into a tumour itself to learn more about how it grows, and how fast it does, oncologists don’t have to wait months to assess the effectiveness of a treatment”, said Dr Ravindran Kanesvaran, Consultant, Division of Medical Oncology, NCCS. A patient can sometimes suffer side effects, some serious, while awaiting a response during treatment. Moreover, the cost of cancer drugs can be high; the main first-line therapy for this type of late-stage kidney cancer is sunitinib, which costs about $5,500 per month.

By AJ Leow

hen a patient is diagnosed with stage 4 kidney cancer and the disease has spread, treatment usually includes drugs that are directed at destroying cancer cells throughout the body. The drugs are costly, and can bring on side effects such as high blood pressure, bleeding and heart problems. Also, patients’ responses to treatment and survival outcomes can vary. But a new molecular test kit has been developed to better group clear cell renal cell carcinoma patients, which then allows doctors to improve their understanding of their patients’ responses to therapy and their survival outcomes. Kidney cancer patients have few symptoms initially, and in the late stage, the disease is usually incurable, so treatment is aimed at prolonging good quality of life. Clear cell renal cell carcinoma, one of the commonest types of kidney cancer, accounts for about 75 per cent of the kidney cancers recorded in Singapore. “We are now able to look at a tumour itself by asking how the cancer cells behave at the molecular level, and tell if a patient will respond positively or otherwise to a particular drug,” said Professor Tan Puay Hoon, Head and Senior Consultant, Department of Pathology, Singapore General Hospital (SGH). “It’s a step towards more focused and individualised treatment for patients,” she said. The new test – the result of research and tests carried out over more than two years by SGH, the National Cancer

(Clockwise from bottom left) The research team for the molecular test kit includes Dr Yukti Choudhury and Dr Wei Xiaona, both IBN Postdoctoral Fellows, Prof Tan Puay Hoon, Head and Senior Consultant, SGH, Dr Ravindran Kanesvaran, Consultant, NCCS, and Dr Tan Min-Han, IBN Team Leader and Principal Research Scientist.

A clear cell renal cell carcinoma tissue sample seen under the microscope.

Centre Singapore (NCCS) and the Institute of Bioengineering and Nanotechnology (IBN) – adds to the array of traditional tools used by doctors to determine the type of cancer that a patient has. Renal cancer is usually assessed by size and the extent it has spread, while prediction tools such as the prognostic nomogram designed by the Memorial Sloan Kettering Cancer Centre uses various clinical factors, such as the patient’s fitness level and haemoglobin levels, to estimate the duration of survival. Because the molecular tool “enables

It’s a step towards more focused and individualised treatment for patients. Professor Tan Puay Hoon, Head and Senior Consultant, Department of Pathology, SGH

“With the molecular test, patients are ‘stratified’, whereas in the past, they were given a drug, and then scanned after three months to see if they had improved,” said Dr Kanesvaran. Not all patients respond to this type of care. Some patients may not need therapy as their cancer is slow-growing, and others need urgent treatment because their cancer is aggressive, he said. “So the tool can help in selecting the best care for the patient,” Dr Kanesvaran said.

High costs, unpredictable outcomes motivated development of cancer test kit The high costs of cancer care, the unpredictable outcomes and occasional futility of even the best available drugs were the motivation behind the development of the new molecular test kit developed by Singapore General Hospital (SGH), the National Cancer Centre Singapore (NCCS) and the Institute of Bioengineering and Nanotechnology (IBN), said Dr Tan Min-Han, Team Leader and Principal Research Scientist, IBN, and Visiting Consultant, NCCS. “Some patients can be observed for years on end, some benefit from immediate treatment including surgery

or targeted therapy, and for some, treatment may be futile. Experience is required in making the right judgement for patients,” said Dr Tan. “We hope our assay will play a role in helping that judgement,” he said. Kidney cancer is among the 10 most common cancers affecting men in Singapore, according to The Singapore Cancer Registry (2009 to 2013). About 250 new kidney cancer cases are diagnosed each year. The molecular kit has been validated at NCCS and SGH. This was conducted with nearly 280 tissue samples from SGH’s Department of Pathology archives. The samples

are from clear cell renal cell carcinoma patients who underwent surgery at SGH between 1999 and 2012. “High quality tissue samples are crucial in achieving significant findings in biomedical research. As an academic medical centre, we wish to promote the translation of research into advances in health care and personalised medicine. The development of this test kit for patient care, utilising the robust tissue archive that we have at SGH, is a good example of this,” said Professor Tan Puay Hoon, Head and Senior Consultant, Department of Pathology, SGH.

The kit will be further tested in a larger study to make sure the results can be replicated and that it works in a rigorous and scientific manner, said Dr Ravindran Kanesvaran, Consultant, Division of Medical Oncology, NCCS. For the next phase, the researchers will be sitting down to discuss various things such as study design and funding, seeking approval from the Institutional Review Board, and other administrative details. The team’s breakthrough study was recently reported in European Urology, the prestigious official journal of the European Association of Urology.

New frontiers

singapore health

MAY– JUN 2015

The eyes are windows to... the body New research is showing doctors that by inspecting a patient’s eyes, they can get clues as to whether his heart, brain and kidneys are being affected too

esearchers from the Singapore Eye Research Institute (SERI) have found that damaged blood vessels in the eyes can indicate damage elsewhere in the body, including the heart, brain and kidneys. In one study, they found that abnormal eye vessels indicate that the patient may develop cardiovascular disease and suffer a heart attack or stroke later in life. If the patient’s kidneys are functioning abnormally, in addition to having abnormal eye vessels he is seven times more likely to develop cardiovascular disease in the future. Assistant Professor Carol Cheung, Research Scientist, SERI and Duke-NUS Graduate School of Medicine, who led the study team, said that eye vessels are a window to early vascular damage elsewhere in the body. “The body’s systems are interconnected. Damage in retinal blood vessels reflect widespread small vessel disease not only in the eye but also vital organs elsewhere in the body, for example the brain, heart and kidneys.” The study on the risk of cardiovascular disease involved 3,400 Chinese, Indians and Malays in Singapore, aged 40 to 80. Researchers tracked them for six years using non-invasive retinal imaging. Tracking involved using retinal cameras to take snapshots of the inner surfaces of their eyes to check for damage in their blood vessels. Urine tests were used to check kidney function. Too much protein in the urine can indicate that the kidneys are not working well. The aim of the study was to find a way to more accurately identify which patients are more likely to develop cardiovascular disease in the future. “If doctors know which patients are at risk, they can start treatment or advise them to change their diet and lifestyle to prevent or

decrease their risk of cardiovascular disease,” said Prof Cheung. The study team is currently using their findings to refine existing cardiovascular disease risk prediction. They hope to develop a risk prediction algorithm by refining a computer programme that measures changes in blood vessels in the eye. “Eventually, we hope to create a single eye imaging test, paired with a urine test, that can estimate a patient’s cardiovascular disease risk.” In another study, the team found that if there is abnormality or damage to the optic nerve, the patient may be at risk of Alzheimer’s disease in the future. In this investigation, they tracked how damage to the optic nerve provides clues to a patient’s risk of Alzheimer’s disease. Examining patients from three hospitals, they used optical coherence tomography to study their optic nerves in great detail.

Early screening advised There are little or no symptoms in retinal abnormalities, which makes early screening a necessity. These abnormalities are usually linked to existing vascular diseases, such as diabetes and high blood pressure. They can also be caused by age, smoking, high cholesterol and other systemic disorders. They can in turn cause eye diseases such as diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion and age-related macular degeneration. If eye abnormalities are not controlled, they can lead to vitreous haemorrhage, retinal detachment and blindness. If the condition progresses, symptoms may include blurred/fluctuating vision, spots floating in the field of vision, patches of vision loss, and difficulty with colour perception. This is why screening is necessary, said Assistant Professor Carol Cheung, Research Scientist, Singapore Eye Research Institute (SERI) and Duke-NUS Graduate School of Medicine. Retinal abnormalities are diagnosed by an ophthalmologist via a dilated eye exam, which patients with hypertension or diabetes should go for every year. In severe cases, laser treatments or injections may be used to seal or remove abnormal blood vessels. If caught early, no treatment is needed, but a comprehensive health check must be done and systemic conditions such as hypertension or diabetes controlled.

Researchers from SERI have found that damaged eye vessels can indicate damage elsewhere in the body, including the heart, brain and kidneys.

“It’s like an MRI of the eye. We can now look at all 10 layers of the eye and see how much neuronal damage there is in the brain. Nerve damage causes diseases such as Alzheimer’s.” But why use the eye to study the brain, instead of going directly to the brain? “The eye is a very special organ. Anatomically, it is connected to the brain by the optic nerve. From there, we can potentially and easily assess the neuronal damage in the brain,” said Prof Cheung.

It’s like an MRI of the eye. We can now look at all 10 layers of the eye and see how much neuronal damage there is in the brain. Assistant Professor Carol Cheung, Research Scientist, SERI and Duke-NUS Graduate School of Medicine

She said that more research needs to be done in both studies to replicate their findings, which the team hopes to publish this year. “If corroborated, we will have a more robust result.” These findings could lead to better screening tests in a few years.

Photo: alvinn lim

By Denyse Yeo

Assistant Professor Carol Cheung says that the study team hopes to develop a risk prediction algorithm by refining a software programme that measures changes in blood vessels in the eye.

may– jun 2015

singapore health

NEWS

Point out the right drug

photo: Alvinn Lim

Clinic team produces pictorial catalogue of most common topical medications to help elderly patients easily identify the drugs they are using

(From left) Led by Senior Staff Nurse Wong Wanjun, the team comprising Dr Koh Hong Yi, Nurse Clinician Lisa Chew Li Yong, Clinic J’s manager, and Ms Yeo Shuan Khiag, Assistant Manager, devised a pictorial catalogue of topical medications to help patients quickly and accurately identify the medicines that they have been taking.

By SUKI LOR

heir names sound vaguely similar. Their packaging and colours are similar too. But they might not be, so how can one tell the difference? That is the problem that many patients face when asked by their dermatologists about the topical medications they are using. But since last year, patients who are seen at Singapore General Hospital’s (SGH) Clinic J for skin problems have been able to communicate more effectively with their doctors to get the right medication, thanks to an initiative by a team led by Senior Staff Nurse Wong Wanjun. Ms Wong, 30, and her team devised a pictorial catalogue of topical medications to enable patients to quickly and accurately identify the medicine that they have been taking. This helps them to avoid being prescribed medicines that have not worked for them in the past, and get those that are effective. Patients with common chronic skin conditions such as eczema and psoriasis may be prescribed topical medications that come in gel, cream or lotion form. For severe cases, steroid-based topical medications of different strengths might also be given. During consultations, the dermatologists might ask their patients what had worked well for them before and what did not. “Patients with a long history of skin

conditions might have tried a number of therapies, so their doctors will ask them what they have used and what was good for them to avoid prescribing something which might not be so effective,” said Ms Wong. When the patient isn’t able to give a definitive answer, the doctor will have to trawl through his medical notes, a time-consuming task. “Some patients ‘doctor-hop’, so their records won’t be with us,” said Ms Wong. In such cases, the doctor might give the patient something without an active pharmaceutical ingredient, such as a moisturiser, to avoid prescribing something that might be ineffective or have an adverse effect on the patient. The patient is then asked to bring the medication he has been using to his next appointment, or to return another day. Many steroid medications, said Ms Wong, are available in different strengths and different forms. Their names might also be similar. The fact that many patients with such conditions are elderly doesn’t help. “We thought of something more pictorial which the patient can just point to,” she said, recalling that the project was sparked off by a casual chat she had with Dr Koh Hong Yi, Associate Consultant, Department of Dermatology, SGH, over lunch. They noted how younger and more tech-savvy patients often took photos of their medications with their smartphone cameras to show their doctors.

The team, which includes Clinic J’s manager, Nurse Clinician Lisa Chew Li Yong, and Ms Yeo Shuan Khiag, Assistant Manager, Specialist Outpatient Clinics – Operations, SGH, took about a month in late 2013 to come up with the concept and produce the charts. The final product is an A4-size catalogue of the 120 to 150 topical medications most commonly prescribed by the clinic’s dermatologists, and has been in use since early 2014. The team’s efforts to improve patient safety clinched them a Singapore Health Age-Friendly Award last year. The project had earlier won second prize in the Singapore Healthcare Management 2014 Congress Poster Competition, in the Risk Management category. The catalogue, said Ms Wong, has saved time for both patients and hospital staff. Having a patient flip through the catalogue and point to a picture of the topical medication that he is using takes five to 10 minutes, compared to the 15 to 20 minutes that it takes for a doctor or nurse to probe him. As a result, the clinic’s dermatologists are able to use their time more productively now. Patients also benefit from shorter waiting times to see their doctors, and may also require fewer consults.

We thought of something more pictorial which the patient can just point to. Ms Wong Wanjun, Senior Staff Nurse, SGH

The A4-size catalogue contains the topical medications most commonly prescribed by Clinic J’s dermatologists – their names, packaging and colours can be similar.

There is also less confusion. “Sometimes, it is only when patients go to the pharmacy to fill their prescriptions that they realise that the carton that is physically in front of them is the wrong medicine, one that hadn’t worked before, or is not the one that they prefer to use. These patients then have to go back and consult the doctor again,” said Ms Wong. Nurses used to get five to 10 calls a month regarding wrong prescriptions, which require them to spend time retrieving the patients’ case sheets, but the number has dropped by half since the catalogue was introduced, said Ms Wong. Describing the Singapore Health AgeFriendly Initiative Merit award as a pleasant surprise, she said: “We didn’t expect it as our project was a very simple initiative. More importantly, we feel that this chart can help our patients and doctors,” she said.

NEWS

singapore health

may– jun 2015

Knowing makes the difference Students are more willing to donate their organs after learning about what it entails By Chua Hwee Leng

Photos: Wong Wei Liang

f teenagers know the facts about organ donation, they will be more willing to donate their organs, according to a winning survey by a team of students from Holy Innocents’ High School. The students found that those who learnt about the Human Organ Transplant Act (HOTA) were less likely to opt out of the Act. The proportion of students saying they would opt out fell from 39.5 per cent to 21.9 per cent after they attended a lecture on the topic. HOTA allows for the heart, liver, kidneys and corneas of all Singaporeans and Permanent Residents aged above 21 to be transplanted in the event of death. The sur vey of 80 students also revealed that a classroom lecture on organ donation is more effective than simply asking students to research the topic on their own, underlining the importance of educating students about organ donation. The study, which took the top prize in the secondary schools category, was one of 19 poster entries sent in for the inaugural SingHealth Transplant Youth Symposium. Poster topics ranged from using health science technology to advance the transplant rate, to how social and religious factors affect attitudes towards organ donation. Marcus Tan, 15, a member of the Holy Innocents’ team, said that researching the topic gave him a deeper understanding of how organ donation can help save lives and dispel misconceptions. He said: “At first I didn’t know about skin donation, but through this process, I learnt that skin will only be taken from the back and from behind the thigh, so the deceased can still have an open casket send-off. It’s not as scary as I thought, so I’m more open to skin donation now.”

Students from Holy Innocents’ High School and Hwa Chong Institution with Dr Amy Khor, Senior Minister of State for Health, Prof Ivy Ng, Group CEO of SingHealth and members of the SingHealth management team at the inaugural SingHealth Transplant Youth Symposium. Dr Khor was the guest of honour at the event, which was part of SingHealth’s Transplant Awareness Week activities.

The winning team in the tertiary institution section came from Hwa Chong Institution. The team focuse d on Singaporeans’ knowledge of and attitudes towards organ donation. They found that those below 30 were most receptive towards organ donation, while those above 60 were least willing to donate. A large number of respondents across all age groups remained on the fence as they “had never really thought about it”. Team leader Clara Quek said: “This clearly shows that organ donation is rarely discussed. But it’s important for us to take a stand on this issue early, so that if a decision needs to be made, there are fewer grey areas regarding the true decision of a deceased person.”

The team noted that while HOTA mandates the donation of specified organs in the event of death, lack of awareness of the deceased’s decision may lead to hesitation on the family’s part. This can delay transplants, and time is vital in saving lives. Every year, 15 patients here die while waiting for an organ transplant.

it’s important for us to take a stand on this issue early, so that if a decision needs to be made, there arefewer grey areas regarding the true decision of a deceased person. Clara quek, STUDENT, team leader, Hwa Chong Institution

The winning team in the tertiary institution section came from Hwa Chong Institution. They focused on Singaporeans’ knowledge of and attitudes towards organ donation.

Professor London Lucien Ooi, Director of SingHealth Transplant, said that while HOTA allows the removal of the heart, liver, kidneys and corneas in the event of death, other organs such as the lungs, pancreas or skin can only be collected if the deceased had previously pledged to donate them under the Medical (Therapy, Education and Research) Act (MTERA), or if their family members decide to make the pledge on

behalf of their deceased loved ones. The scheme allows people to pledge their organs or any other body parts for use in transplants, education or research after their deaths. Health care practitioners understand that it can be difficult for family members to commit without prior discussion with the deceased, as they would not want to risk disrespecting the deceased’s wishes should he have had no intention of donating. The Hwa Chong team suggests encouraging people to sign the MTERA opt-in form, and requiring family members to sign as witnesses, as this can promote discussions about organ donation among family members. Being informed of a loved one’s decision can reduce family members’ trauma when faced with a decision. Each year about 100 patients receive kidney, liver, heart, or cornea transplants in public hospitals, but the wait time for a transplant has also increased. The average waiting time for a kidney transplant, for example, is nine years. The Ministry of Health is encouraging people to discuss organ donation with family members and loved ones. At SingHealth’s Transplant Awareness Week in October last year, Dr Amy Khor, Senior Minister of State for Health said: “As a result of this open sharing, we hope that families will be more ready to honour the organ and tissue donation decisions of their loved ones when called upon to do so.” The SingHealth Transplant Youth Symposium was part of SingHealth’s Transplant Awareness Week activities.

may– jun 2015

singapore health

NEWS

Photo: Ministry of Defence

One-stop cardiac fitness centre Located at NHCS, the new centre will mean better, faster, more comprehensive screening tests and access to cardiac specialists for national servicemen By SUKI LOR

he Singapore Armed Forces (SAF) Cardiac Fitness Centre (SCFC), which opened earlier this year, is offering national servicemen a one-stop service for any issue relating to cardiac fitness. To optimise cardiac fitness screening for servicemen, the centre offers them specialised cardiac screening investigations and treatment under one roof. If initial tests raise red flags, the servicemen in question will be sent for specialised screening at the National Heart Centre Singapore (NHCS). Tests include exercise electrocardiogram (ECG), to assess the heart’s response to physical exertion on a treadmill, and echocardiography, which uses sound waves to create moving images to show the heart’s size,

pumping capacity and structural defects. Also, CT scans can show calcium deposits in arteries – an early sign of coronary heart disease. The SCFC’s central location makes for faster testing. “For the soldiers, it will translate into shorter waiting time and more comprehensive health care checks, without them having to run to a few different places,” Mr Chan Chun Sing, Minister, Prime Minister’s Office, said at the centre’s opening. He said that pooling the SAF’s and NHCS’ resources will benefit Singapore as a whole. “The sharing and analyses of data will allow us to make our cardiac screening – not just for the SAF but for the entire Singapore – better and faster.” He described it as a win-win situation: the SAF can benefit from the advances and capacity of the civilian health care

National servicemen can now get specialised cardiac screening tests and treatment under one roof.

system, and the civilian system can draw upon the capabilities and capacity of the SAF. Rear-Admiral (Dr) Kang Wee Lee, SAF’s Chief of Medical Corps, said the centre will allow the SAF to better collate and study the cardiovascular risk profiles of pre-enlistees and servicemen. He said the SAF will continue to work closely with NHCS “to leverage the latest cardiac screening modalities and best medical practices to ensure its cardiac screening protocols remain robust and relevant”. Adjunct Professor Terrance Chua, NHCS’ Medical Director, said that while it is not possible to prevent heart disease in Singapore, the SAF is uniquely positioned to help reduce risks as all able-bodied

Singaporean men pass through its ranks. Through its robust heart screening protocols, it has been able to improve the armed forces’ overall cardiac fitness by identifying treatable heart conditions in its servicemen. He said that tests under SAF’s screening protocols have helped to detect disease in many who did not display symptoms. Since using CT scans to detect calcium deposits in arteries in 2011, the SAF has identified early coronary atherosclerosis (buildup of plaque in the arteries) in more servicemen each year. The tests enable those at higher risk to take steps to improve their lifestyles, to avoid life-threatening complications like heart attacks.

NEWS

singapore health

may– jun 2015

Designing for the future Former office space makes way for two new and modern medical wards with space-saving and safety features

game of musical chairs of sorts is being played at Singapore General Hospital (SGH) Block 6. When SGH doctors moved out of their offices there into new premises at the Academia, the vacated space was transformed into “decanting wards to facilitate the enhancement of fire protection works,” said Mr Raphael Heng, Assistant Director, Facilities Development, SGH. The refurbishment also provided an opportunity for the hospital’s administrators to remodel and update the designs of A, B1 and B2 class wards. Many of the new features of the wards will be replicated in other SGH wards that will be renovated in stages in the coming years. “The features in the new Wards 66 and 67 are designed to enhance

the comfort and safety of patients, especially the elderly. For instance, sensors alert the nurses on duty when a patient tries to get out of bed, and a light at each bedside table comes on automatically at night,” said Ms Gin Cheng Yam, Deputy Director, Nursing, SGH. The wards exude a sense of space and serenity, helped by soft lights and warm wall colours. Supplies are kept in built-in cupboards close to patients, and trolleys are parked in storage bays. As a result, the corridors outside the rooms are wide and have few obstructions, for recovering patients to walk and exercise in. The handrails that run the length of the walls offer them muchneeded support. Helping immobile patients from their beds has become easier and safer. A patient lifter system allows nurses to

safely and comfortably lift patients off their beds and into their wheelchairs. After seeing their patients, doctors, nurses and therapists often huddle outside the wards to discuss their care. But such scenes will soon be a thing of the past. Large rooms with workstations are now available for them to hold their discussions or work on their post-consultation reports. This increases patient safety and privacy while also providing medical staff with a place to work and rest. The wards boast space efficiency too. Built-in medical panels and removable cabinets mean that anytime more beds are needed, B1 rooms can be quickly converted into B2 ones. Lockers and overbed meal tables that fit together neatly beside each bed are other space-saving features.

1 The refurbished wards are spacious and have soothing soft lights and warm wall colours. 2 A patient lifter system helps nurses to safely and comfortably move patients. 3 Removable cabinets mean that beds can be quickly added when needed. 4 Lockers and overbed meal tables fit neatly beside each bed, saving space. 5 Nurses can do their work while keeping a close eye on patients in the room. With the new design of the nurses’ station, they have a broad, unobstructed view of patients. 6 There is a large room with workstations for hospital staff to hold discussions or work on their post-consultation reports.

Photos: alvinn lim

By Sol E Solomon

mayâ&#x20AC;&#x201C; Jun 2015

singapore health

may– jun 2015

Health Xchange Forgetting people’s names I forget the names of people with whom I interact daily. My shortterm memory is so short that, when I go online, I forget what I logged on to check in the first place if I happen to be distracted by another page. Is this a sign of mild cognitive impairment? Symptoms such as forgetting family members’ names may be a concern. However, the situation could be simply due to a low concentration span arising from poor sleep, excessive stress or depression. I would advise you to get a consultation with a doctor. Dr Nagaendran Kandiah, Senior Consultant, Department of Neurology, National Neuroscience Institute

Our experts answer all your questions about health

Flying during pregnancy I am pregnant and plan to fly to Europe for a short holiday. Is it safe for me to fly? There is currently no evidence to suggest that flying is harmful to a healthy pregnant women and her baby if the pregnancy is straightforward and uncomplicated. Neither is there evidence to suggest that air travel causes early labour or the waters to break early in uncomplicated pregnancies. Certainly, there is increased risk of discomfort, such as leg swelling from fluid retention, nasal congestion (which can lead to ear problems with the drop in air pressure) and pregnancy sickness. Different airlines have different policies for expectant mothers. Most airlines will ask for a letter confirming the due date and fitness to travel for pregnancies beyond 28 weeks. As the risk of going into labour increases after 37 weeks, most airlines will not allow women whose pregnancies are past that period to fly. Some airlines have even tighter rules, so you will need to check before flying.

Pregnant women are at greater risk of getting deep vein thrombosis (DVT), in which a blood clot forms in the leg, calf or pelvis. Sitting in the cramped conditions of an airplane heightens the risk of DVT. An aisle seat is convenient for pregnant women as they can get up to stretch their legs and walk around the cabin every half an hour or so. Toilet breaks are also more frequent during pregnancy. Wearing flight stockings or graduated elastic compression stockings (which can be prescribed by a doctor or obtained via a physiotherapist), also helps. The risk of DVT can persist for up to six weeks after delivery. Obesity and previous episodes of DVT are other risk factors. Keeping well hydrated by drinking water regularly and reducing caffeine intake are also sensible things to do on a long flight. Dr Tan Eng Loy, Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital

PhotoS: Ashok Tholpady/Jozef Polc/123rf

These articles are from www.healthxchange.com.sg, Singapore’s first interactive health and lifestyle portal.

Please visit our website listed above to find out the discussion topics for May-Jun 2015.

MAY– JUN 2015

singapore health

upclose

the silent killer Hypertension, even when severe, may not give rise to any symptoms. The long-term effective control of blood pressure is crucial in reducing the risks of complications of this chronic illness

FAST FACTS

In more than 90 per cent of >90% cases, the cause of hypertension is unknown. The remaining cases may be due to kidney disease, narrowing of certain blood vessels or hormonal imbalance. Smoking, obesity and diabetes increase the chance of developing hypertension. Older people are at a higher risk of getting high blood pressure. Hypertension increases the risk of developing atherosclerosis, which is the hardening and narrowing of the arteries. If left untreated, it can cause coronary heart disease, heart failure, stroke, kidney failure and peripheral artery disease, which is the narrowing of blood vessels in the limbs.

TEXT: NG HUI HUI

30-69 years old

Slightly less than one in four Singapore residents aged between 30 and 69 suffer from hypertension.

Blood pressure is typically recorded as a pair of numbers. Systolic pressure, the first and higher of the two numbers, measures pressure in the arteries when the heart beats. Diastolic pressure, the second and lower of the two numbers, measures pressure in the arteries between heartbeats. Normal pressure is less than 130/80 mm HG. Those with hypertension should: Know the target levels for blood glucose, blood pressure and blood cholesterol. Lose weight if obese. Take antihypertensive medication as prescribed. Quit smoking and exercise regularly.

diet TIPS

Limit intake of all types of fats. Replace saturated with unsaturated fats such as nuts, vegetable oils and fish. Limit cholesterol intake. Foods high in cholesterol include organ meats, egg yolk, squid, fish roe, shellfish and animal fats. Increase fibre intake as it can speed up the removal of cholesterol from the blood. Fibre is found in oats, oat bran, barley, fruits, vegetables, legumes and whole grains.

Take early action

Keep Body Mass Index (BMI) between 18.5kg/m² and 23kg/m². BMI is a measure of a person’s weight in relation to his height. Reducing excess weight will help lower your cholesterol level. High cholesterol clogs the arteries and the heart has to strain much harder to pump blood through them. As a result, blood pressure becomes abnormally high. Exercise for 150 minutes per week, each time for at least 10 minutes. Regular exercise lowers blood pressure by keeping the heart and blood vessels in good condition. Limit alcohol intake to two standard drinks per day. A standard drink is 220ml of beer, 100ml of wine, or 30ml (about two tablespoonfuls) of spirits.

Sources: Ministry of Health, Health Promotion Board

pioneers

singapore health

may– jun 2015

Helping patients to return home Mr Peter Lee and other medical social workers helped the profession to advance dramatically in the early days By Wong Sher Maine

e persevered when his parents in Malaysia cut off his allowance after he switched to social work from the marine engineering degree course he was taking at university. And at a fairly young age, he was made the head of medical social workers (MSWs) at Woodbridge Hospital (now known as the Institute of Mental Health). But prospects were so poor at the time for MSWs that Mr Peter Lee left the profession to build up a nest egg for his young family through other means.

“In those days, career prospects were very poor, and there was little training for MSWs and other paramedics. As a breadwinner with two sons to support, I felt I had to do something for myself although my heart was – and always has been – in social work,” said Mr Lee. He returned to his beloved profession when he was asked some years later to set up an MSW unit for the National Skin Centre. Thanks to the efforts of pioneers like himself, the opportunities for MSWs today are “fantastic”, said Mr Lee, 76, Master Medical Social Worker (Clinical), Singapore General Hospital (SGH).

They have plenty of opportunities for post-graduate training, a clear career path with better salaries, and promotion prospects, he said. The job scope has also changed, partly in response to society’s different demands. In the past, MSWs faced big tasks. For Mr Lee, who also worked at Tan Tock Seng Hospital (which treated mostly tuberculosis patients at the time), the now-defunct Trafalgar Hospital (for lepers) and the National Skin Centre, past challenges included the extreme poverty faced by many patients, and the lack of discharge facilities available to them.

PhotoS: Singapore Press Holdings, alvinn lim

In those days, career prospects were very poor, and there was little training for MSWs and other paramedics. Mr Peter Lee, Master Medical Social Worker (Clinical), SGH

Many mentally ill patients at Woodbridge Hospital (above), now known as the Institute of Mental Health, were abandoned by their families because of the social stigma attached to the illness, said Mr Peter Lee (right).

For instance, many mentally ill patients were abandoned by their families because of poor understanding and the social stigma attached to the illness. Even when their conditions had improved and they could be discharged, “they were stuck in Woodbridge. Nobody wanted them”, Mr Lee said. One of the initiatives he worked tirelessly towards was the setting up of so-called sheltered workshops, to help patients pick up skills so that they could reintegrate into the larger community. “With little community support, a lot depended on the actions of

MSWs. We had to convince our bosses to put in place rehabilitative or outpatient programmes,” Mr Lee said, adding that at one point, a halfway house of sorts was rented to house patients. He also knocked on the doors of factories to urge them to give the patients some simple jobs to do, so that they could earn some money. Some employers were only prepared to take on patients who had been rehabilitated by MSWs, as that was a guarantee of their ability to function normally. A letter from doctors was not enough as it only meant that the patients were medically fit, he said. Providing the patients with jobs, no matter how small, helped in their social rehabilitation and gained them some financial independence. More importantly, it helped their families become more accepting, paving the way for them to return home. Mr Lee said that he has always felt called to look after the disadvantaged, and that seeing the gratitude and happiness in the faces of those he has helped gave him immense satisfaction and a sense of meaning. Even though MSWs have ready resources and programmes for the needy, they must constantly look for gaps, evaluate the effectiveness of new programmes, and provide feedback to senior management and the authorities, said Mr Lee, who was head of SGH’s Medical Social Services Department from 1993 to 2004. Through the years, Mr Lee has seen many of his initiatives formalised as standard hospital practices and services. Despite his advanced age, he continues to work at SGH as he feels that “there is so much more that I can contribute”. Indeed, many of the MSWs that he has mentored have gone on to become stars in their own right, including the current head of the department, Ms Esther Lim.

Happy days

may– jun 2015

singapore health

Professor Charles Ng recalls the early years of his career, starting SGH’s O&G department from scratch By Suki Lor

We met in my house until 2am or 3am, planning what we wanted to achieve, putting together collective ideas, working our guts out.

Photo: Jasper Yu

he man who started Singapore General Hospital’s (SGH) obstetric s and g ynaecolog y (O&G) department failed his final O&G exams at the University of Cambridge twice. But guidance from the “brilliant” late English obstetrician and gynaecologist Peter Huntingford helped Professor Charles Ng sail through on his third attempt. More importantly, that experience taught him not to become disheartened by failure – a lesson that he has imparted time and again to the young doctors he has mentored through the years.

Professor Charles Ng delivered SGH’s first frozen embryo baby in the late 1980s. The baby, Luke McCarthy (below), is now 26 (above, left).

PROFESSOR CHARLES NG, Emeritus Consultant, O&G, SGH

“Because I failed and took one whole year studying it, I got to know O&G better than any other subject. When I returned to Singapore, my first posting was at KK (Kandang Kerbau Hospital, now known as KK Women’s and Children’s Hospital), where I was the best houseman in town. Everyone was so impressed by this silly guy from the UK who knew so much,” said Prof Ng, Emeritus Consultant. “That’s why I tell my medical students: Your undergrad career doesn’t matter. It’s what you do after you finish that does.” His list of achievements is impressive: Gold Medallist of the 1970 Royal College of O&G’s MRCOG (Member, Royal College of Obstetricians and Gynaecologists) examination, the first Singaporean to receive this distinction, and MRCOG examiner for the Royal College as well as for the Royal Australian and New Zealand College of O&G. Looking back, Prof Ng said the happiest time of his life was when he was starting the O&G department at SGH in the 1980s. “I chose people who were like-minded, progressive and who didn’t mind working hard. We met in my house until 2am or 3am, planning what

we wanted to achieve, putting together collective ideas, working our guts out,” said Prof Ng, who at 75 has lost none of his exuberance, humour and passion. He was clear that the team would be divided into the main sub-specialities of maternal foetal medicine, gynaecologic oncology, reproductive medicine, and urogynaecology. Specialising in these areas meant that they could train the next group of doctors in these areas locally before they were sent overseas on attachments. The contacts made overseas were indispensable in gaining a foothold in the best hospitals for subsequent doctors to receive further training, said Prof Ng. “Our philosophy from day one was that we would teach the next generation of specialists. No one was to be selfish and keep what they learnt to themselves. You benefited, so you must pass on the knowledge,” he said. In those early days, the department faced challenges such as having limited operating theatre space and time. But they were unfazed, and went on to introduce then-new advances like continuous foetal monitoring during labour, ultrasound scanning and endo-

CMY

pioneers

scopic or keyhole surgery. Indeed, O&G was the first SGH department to perform keyhole operations as Prof Ng had picked up the skills from Professor Huntingford. “We then taught (SGH’s) general surgeons how to do a (keyhole) gall bladder removal ,” said Prof Ng. Seeing how technology changed the way that medicine was practised, he was adamant that his doctors keep up or be left behind. He also insisted that they attend overseas conferences regularly to learn from their peers and to return with fresh ideas. When the department wanted to introduce in-vitro fertilisation, it invited London’s King’s College Hospital to train the team of doctors, nurses and embryologists so that “we hit the road running from day one”, said Prof Ng. Today, SGH’s one-stop multi-disciplinary Centre for Assisted Reproduction (CARE) trains others from around the region. “The happiest years of my life were spent starting this department, being able to put ideas into practice, and more importantly in having a young team of people who were able, keen to learn, and who shared my vision, to help put that vision into practice,” said Prof Ng, whose father, wife and son are also doctors. That the O&G department has continued to thrive for well over 25 years “is a tribute to all the pioneers who started it”, he added.

Money

singapore health

MAY–JUN 2015

Enhancing care choices

With a wider range of intermediate and long-term care services offered in the community, caregivers and patients can now better balance daily care arrangements and their other commitments. Referrals to many of these services are made through the Agency for Integrated Care (AIC)

RESPITE SERVICES

Centre-Based Weekend Respite Care that the staff are putting in to provide (CBWRC) this needful service.” Launched in July 2014, CBWRC offers caregivers a few hours or a day away Nursing Home Respite Care (NHRC) from their caregiving commitments Caregiving is deeply meaningful but over during the weekend. Services include prolonged periods, it can be emotionally assistance with activities of daily living and physically challenging. Respite care (ADL), medication administration, gen- services such as the NHRC programme eral exercises, social activities and meals. support caregivers by providing patients “Having been in the industry for years, with seven to 30 days of nursing care we felt it was highly necessary to operate and ADL assistance in a nursing home. during the weekends. This is especially to Caregivers often use this service when aid patients with dementia and their fam- there are disruptions in the home, such ilies. This service is important as it offers as when the main caregiver is away. relief to families and also ensures that Said Ms Christina Loh, Director of patients are cared for by professionals Nursing, Man Fut Tong Nursing Home, when they are away from their families,” “We have been taking in private respite said Ms T Amu, Centre Manager, SASCO cases all along and are happy to allocate Day Activity Centre for the Elderly. two beds, one male and one female, for Ms Linda Ho, whose father has this subsidised service.” dementia, said: “He used to roam around When Ms Liow Chin Chin’s domestic the neighbourhood all day and we were helper went on home leave, she sought concerned for his safety. It was a relief to assistance from the service to care for her learn that SASCO is open on Saturdays. mother. Sharing her experience, she said, This has enabled my mother, who is my “I am very impressed with the professionfather’s main caregiver, to rest properly alism of the nursing home staff. They have and for us to go to work knowing he is really taken good care of our mother.” safe. We really appreciate the extra hours

CENTRE-BASED CARE

Senior Care Centres (SCC) Offering both social and health care services, SCCs are one-stop day care facilities providing maintenance day care (custodial, social activities, caregiver training), dementia day care (group/ individualised activities), community rehabilitation (physiotherapy/occupational therapy, community reintegration), and centre-based nursing (nursing care, medication administration). “This integrated facility offers added convenience as elderly patients don’t have to visit various centres for different services,” said Ms Jenny Lim, Centre Manager, St Luke’s ElderCare. She added, “We are pleased to be able to bring care closer to home so that the elderly can age gracefully within their community. We are also fortunate to have a pool of mature workers who are familiar with their needs and are able to interact with them well.” Ms Peggy Lim, a caregiver, was recommended the Centre when it became increasingly difficult to go out to run errands because she was fearful about leaving her mother, Mdm Ng Aik Siew, 95, alone at home. Enrolling Mdm Ng at St Luke’s ElderCare not only gave Ms Lim peace of mind, but also helped her mother to expand her social circle. Ms Lim said: “The care staff are very helpful and the people take good care of my mother. I can rest easy knowing that she is in good hands.”

Singapore Programme for Integrated Care for the Elderly (SPICE) Those eligible for nursing homes can now remain in the community, thanks to the efforts of SPICE centres. Providing both centre- and home-based care, a multi-disciplinary team (medical, nursing and allied health professionals) and a case manager customise a range of services (meals, nursing, rehabilitation and personal services) in collaboration with hospitals and doctors in the community. “This ser vice supports patients and their families in their aspiration to remain living at home. This equates to a better quality of life and the preservation of personhood,” said Mr Adam Ang, Senior Manager, Sunshine Welfare Action Mission (SWAMI) Home. This service has also led to fewer admissions to nursing homes and hospitals. Mdm Saodah Masor, 59, a SPICE client at SWAMI, said: “When I first came, I had many questions. I was depressed and unable to walk. Now, I feel very comfortable and look forward to coming every day to meet my friends. With everyone’s encouragement, I can now stand and even walk with a walking frame. This has enabled me to cook and maintain my house, activities that I enjoy a lot.”

Photos: St Luke’s ElderCare, Thye Hua Kwan Moral Charities, SPH Library

Senior Care Centres such as St Luke’s ElderCare offer both social and health care services, making it more convenient for patients and their caregivers.

Home-based care services such as the ICS offered by Thye Hua Kuan Moral Charities (top) and Care@Home by NTUC Health (bottom) provide alternatives to families who want to care for their elderly dependants at home.

MAY–JUN 2015

singapore health

Caregivers can engage Nursing Home Respite Care services offered by places such as the Singapore Christian Home (left) when they are away or there are disruptions at home.

HOME-BASED CARE

Senior Home Care (SHC) Formerly known as Home Help, SHC offers two main areas of services — SHC (Meals and Escort/Transport) which includes meal delivery and medical escort/transport services and SHC (Ensuite) which provides care options (personal hygiene, housekeeping, cognitive stimulating activities, medication reminder services and higher personal care tasks). To be eligible for the SHC, patients must either live alone or have a frail/working caregiver and require assistance with activities of daily living (ADL) or instrumental activities of daily living (IADL). ADLs include bathing/showering, dressing, eating/feeding, mobility and personal hygiene/grooming, while IADLs include the ability to use the telephone, shopping for needs, food preparation, housekeeping, laundry, taking transportation, taking medication as prescribed, and the ability to handle financial matters independently. Ms Pang Sze Yunn, Head of Home Care, NTUC Health, said: “Care@Home services provide an alternative to families who want to care for their elderly dependants at home. Other than basic home help, our iCare officers can also assist patients with physiotherapist-prescribed exercises. We are always happy when our patients enjoy improved independence as a result of our care. Our motivation comes from the positive impact we make in their and their families’ lives.” One of the many patients who have benefited from SHC is 76-year-old Mdm Lee Ah Huay. Formerly bedridden, her condition significantly improved after seven months of home therapy with her iCare officer,

Ms Tan Ah Mai. Now, Mdm Lee has recovered sufficiently to leave her home and receive care at Silver Circle (Jurong Central). Interim Caregiver Service (ICS) A patient’s transition from hospital to home can come with its share of challenges. ICS aims to address these concerns by providing a trained caregiver to tend to a patient’s care needs (personal care, medication administration) for a limited period while family members make permanent arrangements (orienting a new caregiver, placement in a care facility) to meet their new health care needs. The service is provided for up to 144 subsidised hours and has been implemented at six restructured hospitals and four community hospitals. When Mr Tan Boon Ngee’s 96-yearold father was discharged from hospital, he opted for ICS. He said: “ICS is a fantastic service and has helped my domestic helper learn proper procedures and become more confident in providing good care for my father.” Said Ms Sangeetha Francis R, Programme Manager, Thye Hua Kwan Moral Charities, the first ICS provider: “This service has helped reduce caregivers’ stress and the hospital bed crunch situation. We are pleased to offer this service and to meet these needs.”

This article is adapted from Enhancing Care Choices, which was published in the December 2014 issue of mosAIC, a publication for community care providers by the Agency for Integrated Care. For more information, visit www.aic.sg or contact Singapore Silver Line at 1800-650-6060.

singapore health

MAYâ&#x20AC;&#x201C; JUN 2015

may– jun 2015

singapore health

your say

Relevant, easy to understand I wish Singapore Health was more widely available as I am only able to get hold of a copy when I am at SGH to participate in a research study. I love the many reports on medical advances and health studies as I find them relevant, interesting and easy to understand, especially the ones by SGH researchers. It is the best health publication by a hospital here that I know of. I feel it is on par with any full-fledged health magazine. The paper is always a pleasure to read and I found the article on HPV infection (Cervical infection related to sexual behaviour, smoking, education) in the last issue most informative and enlightening.

CAN HELP SUPPORT CARTILAGE, PROMOTE JOINT HEALTH AND MAINTAIN JOINT FLEXIBILITY & MOBILITY

Ms Maria Chan May Li

you don’t want to miss a single copy of Singaeditor Ifpore Health, subscribe to the online edition at

s a y s

www.sgh.com.sg/about-us/newsroom/singapore-health/Pages/2015.aspx. It is usually available a few days before the print copy is distributed around SGH, its sister hospitals on the SGH Campus, and at selected MRT stations. Online subscribers are alerted by email when new issues are available. This letter wins a bottle of Viartril®-S Capsules (500mg) and a box of Viartril®-S Sachets (1500mg). The products, worth $130.50 (before GST), are sponsored by Pharmline Marketing Pte Ltd.

Blood vessel

Fascicule

Collagen fibers

Bone

Tendon Muscle

Confusion over CHAS, PG cards

Now that I have the Pioneer Generation (PG) card, must I still bring my Community Health Assist Scheme (CHAS) card when I visit the SGH Specialist Outpatient Clinic (SOC)? I was told at my neighbourhood general practitioner’s (GP) clinic that I only need to present my PG card as it gives a higher subsidy.

SGH

When visiting a GP, the PG card will give the highest s a y s benefits, so only the PG card needs to be presented for verification. For instance, a patient with the blue CHAS card will receive a subsidy of $18.50 when he sees a doctor at a private GP clinic or polyclinic for a common illness like a cold or cough, while an orange CHAS card holder will not get any subsidy on his bill. But if he has a PG card, regardless of whether he is a blue or orange CHAS card holder, he will receive a higher

subsidy of $28.50 for each visit. However, both PG and CHAS cards need to be presented at SGH’s SOCs because PG cards confer an additional 50 per cent subsidy off subsidised bills. For instance, a patient with a blue CHAS card will be given a 70 per cent subsidy on the cost of SOC services and 75 per cent on medication. If he has a PG card, he will get another 50 per cent off the subsidised bill. A non-CHAS PG cardholder, though, will only get a 50 per cent subsidy. For the convenience of SGH patients, the hospital’s computerised records system includes details of their CHAS and PG status. So patients seen at the SGH’s SOCs will receive their subsidies even if they forget to bring their CHAS and/or PG cards. However, as with all benefits cards, patients should present the relevant cards for easy verification. For more information on the CHAS and PG schemes, visit www.chas.sg or www.cpf.gov.sg/pioneers/pg.asp.

2 BOTTLES PROMOTION of Genacol 90 capsules for only

$89

Exclusively at GST included (UP $50 each)

Valid from May 6th till June 30 th 2015. Please call for more information.

Our tendons... Our body’s rubber bands By observing the diagram of the human body on this page, we can easily recognize all the space that our muscles, ligaments and tendons occupy. The tendon is composed of thick, white fibres of collagen that are held tightly against one another. These fibres are made up in large part by collagen. Our ligaments act like a connection between the bones. Our tendons act like ties to our internal structure for our muscles and our bones. The tendons and the ligaments of our body act like rubber bands of different sizes. Since our tendons are used to bind our musculature to our bones, and to maintain elasticity and suppleness, our tendons necessitate a large amount of collagen, particularly after an injury or from aging.

Why collagen is important?

about your he alth experience 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 two bottles of Wild Alaskan Salmon Oil capsules and a bottle of Robovites Complete tablets. The products, worth $134.10, are sponsored by VitaHealth Asia Pacific (S) Pte Ltd.

In the composition of cartilage we find 67% of collagen versus 1% of glucosamine. Glucosamine is an aminosaccharide contrary to collagen which is a molecular complex containing amino acids. Glucosamine is found in interesting quantities only in the liquid of the synovial membrane. Collagen is also found in the synovial membrane but in larger quantities because the protein structure is more abundant in the body. Glucosamine acts more like a lubricant in the joints while collagen helps the tendons, ligaments, cartilage, muscles, membranes and synovial liquid (lubrification).

Marketed and distributed by Medica Solutions Pte Ltd

(65) 6468-4948 • info@genacol.sg

FYI

singapore health

MAy– jun 2015

New car park opens

event Calendar

▲

on SGH Campus as others close

Community Care Forum 2015: A Conversation About Tomorrow’s Care DATE May 15-16, Friday-Saturday TIME 8.30am-5pm VENUE Grand Copthorne Waterfront Hotel

As construction of a new community hospital on the SGH Campus advances, two public car parks have closed. But additional parking for some 600 vehicles is now available at the new open-air Car Park H on Macalister Road, next to the existing multi-storey Car Park H. Since end-April, Car Park E (opposite Singapore General Hospital Block 3) and the URA car park on Kampong Bahru Road (near the National Heart Centre Singapore) have been closed.

Singapore FEE $550 ($400 for participants from Voluntary

Welfare Organisations) REGISTRATION Log on to www.ccf15.sg to register. For health care professionals working in the aged and mental health sector, the forum will focus this year on how to make the intermediate and long-term care model more cost efficient and client-centric.

▲

MSCP (H) shuttle bus stops

Campus bus stops

Bilingual Public Forum: Gynaecological Cancers (妇科肿瘤)

Eat well for

healthy lungs

Source: Reuters Health

Gratitude for happiness

Source: The Huffington Post

Oversleeping

might lead to stroke Sleeping more than eight hours a day might cause stroke, a new study by a group of UK researchers has found. They tracked close to 10,000 people for almost a decade and found that those who slept more than six to eight hours had a 46 per cent higher-than-average stroke risk. The researchers speculated that long nights of sleep may be related to increased inflammation, which can eventually lead to cardiovascular problems. They added that “prolonged sleep might be a useful marker of increased stroke risk in older people, and should be tested further for its utility in clinical practice.” Source: Neurology journal

Among the top 10 cancers affecting women in Singapore are uterus, ovarian and cervical cancer. This forum educates attendees on cancer signs and symptoms, risk factors, recommended screenings, treatment options and recent advances in medical science.

BVH FUNd-Raising Carnival

DATE Jun 6, Saturday TIME 11am-6pm VENUE Hougang Central Hub, 90 Hougang

Avenue 10 (next to Hougang Mall) REGISTRATION Call 6248-5755, e-mail

community@bvh.org.sg or log on to www.bvh.org.sg for more information. Join Bright Vision Hospital (BVH) for a day of fun and games. The 318-bed community hospital is hosting a carnival to raise funds to better care for the 1,200 new patients it receives every year.

▲

Feeling down? Saying “thank you” will lift the spirits. Studies say that being grateful promotes well-being, improves human relationships, and builds a stronger immune system. When positive emotions reign, the heart’s rhythm becomes smooth and harmonious, the non-profit Institute of Heartmath found.

(registration starts at 9am and 11am respectively) VENUE Peter and Mary Fu Auditorium, National Cancer Centre Singapore, 11 Hospital Drive REGISTRATION Call 6225-5655 (MondayFriday, 8.30am-5.30pm) for more information or to register.

▲

A diet high in whole grains, vegetables and nuts might help protect the lungs from developing chronic obstructive pulmonary disease (COPD), say researchers from the French National Institute of Health and Medical Research in Villejuif. The study tracked the health of more than 120,000 men and women over a decade. The researchers calculated that those who ate the most whole grains, vegetables and nuts, and least red meats and sugars, were up to a third less likely to develop COPD – even if they smoked – than those who followed the worst diets.

PHOTOs: 123RF

DATE May 23, Saturday TIME 9.15am (Mandarin), 11.15am (English)

CancerWise Workshop: Familial and Hereditary Cancer: Why Your Family’s Health History is Important DATE Jun 20, Saturday TIME 1.30pm-3.30pm (registration starts at

1pm)

contest

1. Name one possible new cancer treatment. 2. Which story in this issue did you find the most informative? Closing date: June 4, 2015 Send in your answers and stand to win a bottle of Spirulina 100% Extra 10% Deep Ocean Water (750 tablets) worth $59, sponsored by IMI Lifestyle Products Pte Ltd.

VENUE Peter and Mary Fu Auditorium, National

Include your name, age, gender, address and telephone number. Winners will be notified via phone or e-mail. Incomplete or multiple entries will not be considered. E-mail editor@sgh.com.sg Post The Editor, Singapore Health, Singapore General Hospital, Communications Department, #13-01 Surbana One, Blk 168, Jalan Bukit Merah, Singapore 150168 Winners of Contest 33: Each will receive a tube of Bone Health cream (10% Glucosamine Sulphate Plus Bio-Calcium and Chondroitin), worth $49.50, sponsored by Urah Transdermal Pte Ltd. Prizes must be claimed by June 4, 2015. 1. Lim Hoon Cheng 2. Mary Low 3. Ong Boon Eng 4. Rahimah Hamid Sultan 5. Yeong Yuen Joo

Cancer Centre Singapore, 11 Hospital Drive REGISTRATION Call 6225-5655 (Monday-

Friday, 8.30am-5.30pm) for more information or to register. Family history is a useful predictor of predispositions to certain diseases. This workshop maps out that relationship, and discusses the various factors to be considered before opting for genetic testing.

Visit www.singhealth.com.sg/events or the websites of respective institutions for any changes, more information, and other listings.

MAy– jun 2015

singapore health

Don’t just grin and bear it

Have excessively painful menses examined as it may indicate a severe form of endometriosis. By Sol E Solomon

evere menstrual pain may suggest something more serious than the monthly period. Yet, many women tend to ignore it, dismissing the pain as merely a discomfort and inconvenience that they have to put up with. The intense pain may be a symptom of a severe form of endometriosis, a condition where tissue grows outside the womb instead of lining it. Each month, the misplaced tissue responds to the hormonal cycle by building up and breaking down. The bleeding that results, unlike menstrual fluid, is not excreted but builds up, leading to growths or cysts. The growths can cause scarring and stick anywhere in the pelvic cavity, but more commonly to the skin lining the pelvis, bowels and ovaries. Very severe endometriosis is associated with infertility, pain during menstruation, bowel movements, urination or sexual intercourse, and can even damage the kidneys, said Dr Peter Barton-Smith, Senior Consultant, Depar tment of Obstetrics and Gynaecology, Singapore General Hospital (SGH). “When endometriosis is in the later stages of development, it becomes like superglue,” said Dr Barton-Smith. The endometriosis can stick to the bowel or grow around the ureters, squeezing them and restricting the flow of urine from the kidneys. Women with endometriosis may feel pain, but many don’t know they have the condition until they seek help. For some, the disease occurs with no symptoms. “Endometriosis is a common condition that affects an estimated 8-10 per

cent of women in their reproductive years. Of the women with the condition, 10-15 per cent of them, or one to two in every 100 women, are likely to have the severe form, known as deep infiltrating endometriosis,” said Dr Barton-Smith. The gold standard for diagnosing endometriosis is laparoscopy, where a tiny camera is inserted into the abdomen to allow the surgeon to see inside. A generally trained gynaecological sonographer can diagnose endometriotic cysts in the ovaries by performing a transvaginal or transabdominal ultrasound scan. However, only a sonographer trained in detecting deep infiltrating endometriosis via transvaginal ultrasound (or transrectal scan for women who have not had sexual intercourse) is able to look for the more serious form of the disease. This is because transabominal scanning is not sensitive enough, said Dr Barton-Smith.

Operating fully on voice command via a wireless Bluetooth headset, the ViKY Uterus Positioner gives surgeons full control of the position of the uterus during minimally invasive surgery. (bottom, right) Dr Peter Barton-Smith demonstrates how ViKY works.

These techniques are very recent but accuracy levels are now so good that severe diseases, other than in the ovaries, can be reliably diagnosed. There is no cure for endometriosis, and it isn’t clear what causes it either. Medication and surgery can help control the symptoms of endometriosis, especially when the disease is in the early stages. Drugs may slow the progression of the disease and have also been shown to partially reverse it in some cases, said Dr Barton-Smith. Medication is also prescribed to reduce pain, but it does not address infertility – this requires surgery or assisted conception. Surgery is considered for patients whose deep infiltrating endometriosis has led to a constriction of the ureter,

> Continued on page 22

No risk of moving uterus when robotic hands hold it in place Human hands get tired when held in the same position for hours. This is not a concern when the hands belong to a robot. For this reason, the ViKY Uterus Positioner now does the job of a junior surgeon when Dr Peter Barton-Smith, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital, performs minimally invasive surgery using another robot, the da Vinci surgical system. Operating fully by voice command via a wireless Bluetooth headset, ViKY provides him with full control of the position of the uterus during minimally invasive surgery. Normally, a second doctor assists him by manually controlling the position of the uterus during surgery. “With the new technique, an assistant is no longer needed to position and maintain the uterus according to the surgeon’s needs,” said Dr Barton-Smith. It can be tiring for the junior surgeon to maintain the traction required on a uterus during a procedure’s critical phases to avoid injuring the ureters, and ensure stable positioning. With robotic surgery, patients experience lower levels of blood loss, fewer complications, shorter hospital stays and faster recoveries.

singapore health

May– jun 2015

> Continued from page 21

Don’t just grin and bear it

and long-term complications are lower with this method. Using a robotics-enhanced surgical system for laparoscopy also allows for a better view and more accurate, less tiring surgery.

One to two in every 100 women are likely to have severe deep infiltrating endometriosis.

Endometriosis can develop anywhere in the pelvic cavity Patches of endometriosis

Fallopian tube

Ovary

Spine

Womb lining (endometrium)

Womb (uterus)

Dr Peter Barton-Smith, Senior Consultant, Department of Obstetrics and Gynaecology, SGH

Bladder Dr Barton-Smith, who regularly turns to robotic surgery for more difficult deep infiltrating endometriosis cases, said that of the 65 deep infiltrating endometriosis

Asian women appear to be more prone to severe endometriosis number than the 12 to 15 cases a year that he got on average in the UK, where he had a tertiary referral practice for deep infiltrating endometriosis. Endometriosis appears to run in families in some cases. There is also evidence that Asian women experience higher levels of bleeding than Caucasians when menstruating. “That would imply that retrograde menstruation is likely to be more common,” he said. Retrograde menstruation is one of the likeliest explanations for endometriosis. It happens when menstrual blood Asian women appear to be containing endometrial cells flows more prone to deep infiltrating back through the fallopian tubes and endometriosis, the serious form into the pelvic cavity instead of out of of the disease, than their Western the body, and sticks to the walls and counterparts, said Dr Peter surfaces of organs. Barton-Smith, Senior Consultant, Women in Singapore also tend Department of Obstetrics and to avoid hormonal contraceptives, Gynaecology, Singapore General unlike European women. “Among Hospital (SGH). European women, there is a very But it is merely an observation high percentage of use of oral that he hopes to confirm through a contraceptives. Contraceptives are a prevalence study of the disease. “It’s medical treatment for endometriosis. just a gut feel for now. We’ve already So they are inadvertently protecting tripled (the number of deep infiltrating themselves against endometriosis endometriosis surgeries) that we did while delaying motherhood to in the UK per year at SGH in 2014,” Dr pursue their careers. But, the use of Barton-Smith said. hormonal contraception is Singapore In 2013, 12 women underwent is very low,” he said. robotics-assisted surgery for the Among the different races in disease at SGH. In 2014, he treated Singapore, Indian women appear to 41 women at SGH for the same be less prone to endometriosis than condition, a significantly larger Chinese and Malay women, he added.

Rectum Urethra

cases that he has handled since 2010, none have experienced major complications of the bowel or ureters, which are most likely to occur. Still, Dr Barton-Smith said, occasional complications are inevitable even though robotic technology so far appears to pose less risk. He noted that a 2014 study that he co-published with an international group of surgeons found a 1.3 per cent rate of major complications to the bowels and ureters. None were bowel injuries. The study of 164 cases of severe endometriosis was one of the largest series of robot-assisted keyhole surgeries for the disease published in Surgical Endoscopy, the peer-reviewed publication of the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association for Endoscopic Surgery. “The aim of surgery is to remove all

Vagina

possible lesions, not just cysts. Otherwise, patients tend to end up undergoing multiple surgeries because the deep infiltrating endometriosis on their pelvis lining and bowels was not taken out initially,” he said, noting that 80-90 per cent of patients said they have less pain after surgery, while their chances of fertility are improved by up to 60 per cent. So it is important for women to be properly screened for the disease. Robotic surgery involves using a robot with four mechanical arms bearing a high-definition 3-D keyhole camera, surgical cutting instruments, and grasping forceps. The highly flexible arms are inserted through tiny incisions in the abdomen, and are manipulated by the surgeon, seated at a control console some distance away from the patient on the operating table.

photos: alvinn lim / 123rf

is interfering with their ability to conceive, giving them significant pain, or if they cannot tolerate the side effects of medication. Laparoscopic surgery can be used to clear endometriosis, and in the hands of an expert endometriosis surgeon, is preferable to open surgery as the disease can be seen and isolated more easily with fewer complications. Both methods come with the risk of complications, however. “There is at least a 6.7 per cent risk of delayed major complications to the bowel and ureters with conventional laparascopy. The difference is in the surgical technique used to remove the endometriosis – shaving the endometriosis off the surface of the bowel; cutting around it, lifting it out and then stitching the hole closed; or removing an entire segment of the bowel and then rejoining it,” said Dr Barton-Smith. Most expert endometriosis surgeons now choose to shave the endometriosis off the bowel as the risks of both short-

Ms Vargilia Bridget Welford, 28, pictured here with Dr Peter Barton-Smith, was diagnosed with deep infiltrating endometriosis after suffering severe abdominal pain for months.

MAY– JUN 2015

singapore health

Dealing with brain tumours

They are hard to detect and when spotted, aggressive surgery with minimal injury is needed. By Wong Sher Maine

tumours would be at slightly elevated risk of this but it’s rare. In most cases of brain tumours, patients have no family history of the condition,” said Prof Ng. In general, people who are at slightly higher risk of brain tumours include those over 65 years old, Caucasians, men, and those who have been exposed to radiation therapy treatment for cancers such as leukaemia. There is no evidence that it is caused by mobile phone use, injury, or mental stress, said Prof Ng. Brain tumours are not as easy to detect as other common cancers, and symptoms vary according to location and size. Function is usually affected first. If the tumour is in the section of the brain that controls vision or speech, the patient’s vision will become blurred and he will have problems finding the right words to express himself. If the tumour is located in a superficial part of the brain, it may cause seizures – the patient’s hands may jerk and he may see flashes of light. A growing tumour may put pressure on the brain, causing headaches, nausea, vomiting and loss of appetite. “Any constant persistent headache with increasing severity, especially in the morning, warrants investigation,” said Prof Ng.

The increase in pressure can also lead to swelling of the nerves around the eyes. Prof Ng said: “I recently operated on a patient who had gone for a routine health screening. The doctor who examined his eyes noticed that the nerves around his eyes were swollen. A scan revealed that he had a brain tumour.” However, Prof Ng said that many symptoms of brain tumours may not actually be caused by brain tumours, but by other illnesses. “It’s important to see a doctor if you have symptoms that persist or are bothersome.” Treatment is similar to that of other cancers – a combination of surgery, radiation and chemotherapy. Benign tumours, which are generally slow-growing, are curable, but the worldwide survival rate of the most serious malignant brain tumours ranges from 12 to 14 months. Sometimes, patients ask the surgeon to remove the whole tumour but this may not be advisable. As the brain is a delicate and complex organ, one wrong move can result in the loss of faculties such as speech or limb movement. Prof Ng said: “You can remove anything from the brain, but at what risk? The surgeon must do the most aggressive

The scan shows a large brain tumour in the right fronto-temporal region (the black oval shape on the left of the image). The yellow tracts represent a roadmap of important nerve fibre tracts that provide doctors with useful information for surgery.

surgery with minimum injury, so that the patient gets the survival benefits without compromise to his ability to function.” To ensure accuracy, NNI uses the latest technology, including a machine that precisely maps out every portion of the brain and a state-of-the-art MRI machine in its Operating Theatre.

photo: alvinn lim

he brain contains many different types of cells, and as a result, there are more than 100 different kinds of brain tumours which can occur. These cancers can grow in brain cells, blood vessels, nerves or even the membranes that cover the brain. There are two broad categories of brain tumours – primary and secondary. Primary brain tumours start in the brain. They are relatively uncommon, have no known cause and are rarely genetic. Secondary brain tumours start in organs such as the lung, breast or colon, and in time, move to the brain. They are the more common category seen. Associate Professor Ng Wai Hoe, Medical Director of the National Neuroscience Institute (NNI), said that 55 to 60 per cent of his brain cancer cases are secondary brain tumours. “In the past, patients generally succumbed to cancer before it got to their brains, but now, because they are surviving longer, cancers have time to spread to the brain.” As cancer cases increase in Singapore, brain tumours are also set to rise, but it is hard to tell who is susceptible. “With regards to primary brain tumours, anyone who has two first-degree relatives like parents or siblings with brain

According to Associate Professor Ng Wai Hoe, 55 to 60 per cent of his brain cancer cases are secondary brain tumours. Secondary brain tumours start in other organs and in time, move to the brain.

The former (machine) is like a brain GPS system that allows surgeons to scan a patient’s brain in real time during surgery to locate a tumour, decide if it can be removed safely, and see what is left behind. The MRI machine allows the surgeon to perform updated scans with which to update the brain GPS system during surgery. This is similar to updating the maps used for navigation. A team from NNI is also conducting a trial involving a special fluorescent dye: Injected into the bloodstream, it illuminates cancer cells under a special light so that surgeons can see and effectively remove more of a tumour. NNI surgeons also perform awake craniotomy, in which a patient is wide awake during brain surgery. “This is done when a tumour is very close to a critical area which, say, controls the hand. As we are operating near the area, we ask the patient to move his hand so that we know we are not damaging the area. The moment he starts to feel a bit of weakness, we stop the surgery to prevent permanent damage.” Prof Ng said that patients tolerate such surgery well. “No one’s complained so far and studies have shown that these patients are quite happy and comfortable during surgery.”

singapore health

May– jun 2015

A glass of wine every day is good for health. Although wine – especially red wine – contains antioxidant polyphenols that protect against cardiovascular disease and cancer, daily consumption of alcohol can damage the liver. For women, it increases the risk of breast cancer because alcohol disrupts the body’s ability to absorb folic acid, a B-vitamin with anti-cancer properties.

A raw food diet is healthier because heat destroys the nutrients and natural enzymes in food. Enzymes boost digestion and fight disease. Not many foods can be eaten raw. One has to be careful with raw animal products, including dairy products, seafood and meat, which preferably should be cooked to kill bacteria. Rice, wheat and other grains, on the other hand, need to be cooked to make them

Standing at a desk is healthier than sitting down. The body burns a few more calories standing up than sitting – about 30-50 calories more per hour spent standing. For reference, one Oreo cookie has 50 calories!

If fruit is eaten with other foods, it ferments and rots in the stomach, causing indigestion. Fruit can be eaten at any time, and with other foods. The body produces digestive enzymes to help it break

digestible. So a typical raw food diet tends to be plant-based, consisting of fruits, vegetables, seeds, nuts, eggs and some sprouted grains. Raw food diets tend to lack protein, iron, calcium and certain vitamins such as B12, as these nutrients are more readily available from animal sources. If one avoids overcooking, there is little harm and plenty of benefit in consuming a mixed diet of raw and cooked food.

down and digest protein, fat, and carbohydrates. Besides, the stomach has a high concentration of hydrochloric acid, which will kill any bacteria before it is able to reproduce. So fermentation cannot take place in the stomach.

photos: 123rf

It's true! Or maybe not... Advice on how to stay healthy abounds but not all of it is sound. Singapore General Hospital's LIFE (Lifestyle Improvement and Fitness Enhancement) Centre gives the low-down on some popular beliefs

Duck fat and lard are healthier than processed vegetable oils because they are natural and have high levels of monounsaturated fat, which are better for people with heart disease. Duck fat and lard in their original, unprocessed form have more saturated fat than healthier oils such as olive oil. Saturated fat raises the level of cholesterol in the body. However, commercially available fats and oils – from both

animal and plant sources – undergo hydrogenation to prolong shelf life and for convenient packaging. This chemical processing changes the natural balance of unsaturated and saturated fats and creates unhealthy trans fats which are associated with heart disease.

7 6

All the fat in fish is good fat. Only about 30 per cent of the fat in fish is “good” omega-3 fat (the exact percentage varies, depending on the type of fish). The rest is a mix of “bad” fat which raises cholesterol levels, and fat which has no special health benefit. Tuna, for instance, has 23 per cent “good” fat and 33 per cent “bad” fat, while salmon has 27 per cent “good” fat and 16 per cent “bad” fat.

People with diabetes should eat special food for diabetics, like sugar-free biscuits. Sugar-free biscuits and other special foods for diabetics are conveniently packaged with detailed information, making it easier for people with diabetes to keep track of their calorie intake. But it is not necessary for diabetics to consume such commercially prepared foods. They should, in general, reduce their intake of carbohydrates, especially simple carbohydrates like sugar, white bread and sweet drinks.

Leave a few lady’s fingers in a glass of water to steep overnight. Drinking the infusion regularly will cure diabetes. Lady’s finger extracts have been shown in laboratory studies to have antioxidant properties and to lower blood sugar and lipid levels in mice and rats. However, no clinical studies have been done on people to prove that okra extract can be used to treat diabetes. Antioxidants are a broad range of compounds that can counter cell damage caused by free radicals. The best known antioxidants are vitamins A, C and E.

To lose weight, it is better to take many small meals rather than three big meals a day. When trying to lose weight, the overall daily caloric intake is more important than whether one eats a small or a large meal. There is no difference between three meals of 600 calories each and six meals of 300 calories each!

MAY– JUN 2015

amily holidays are a good time for retirees to explore exotic locations and strengthen family bonds. But before any tickets are booked, it is important to ensure that they are healthy and well-prepared for the trip. Elderly travellers should inform their regular family doctor about their travel plans so that they can sort out any health issues which may potentially pose a problem during the trip. The doctor can provide medical advice, for example, on diet and activities, and recommend the necessary vaccinations before they travel. Travel advice and pre-travel preparations should be customised for the individual, but here are some general measures from Dr Ng Chung Wai, Family Physician, and Chairperson, Infection Control and Infectious Diseases, SingHealth Polyclinics.

Medication

Patients who are on long-term medication should ensure that they carry enough supplies with them, along with: • A list of their medical condition(s) • An alert card or pendant that clearly states their allergies, if any • A complete list of their regular medications, with the name, dosage and daily frequency of each medicine • A memo bearing their regular doctor’s name and contact details

Deep vein thrombosis (DVT) – a blood clot in the deep veins of the lower limbs

Occupying an aisle seat gives elderly travellers the freedom to get up, stretch their legs and do simple exercises. This should be done every hour or two to maintain good blood circulation. They should also avoid sedative drugs, which may result

The Family Travel Medicine Kit

in reduced movement, and dehydrating drinks such as alcohol and coffee. Travellers who have had major surgery within the past six weeks, a previous case of DVT, or are suffering from cancer are at a high risk of developing DVT. They may need to check with their doctor for preventive measures such as the use of special compression stockings during each flight.

Diabetes

Ms Lee Yu Jie, Clinic Pharmacy Manager, SingHealth Polyclinics – Sengkang, advises families to ensure that their travel medicine kit includes medicines for common minor ailments. These include diarrhoea, allergies, fever, motion sickness, coughs, rashes, cuts, constipation and the like. Medicines to take include charcoal tablets and oral rehydration salts for diarrhoea, paracetamol for fever and pain, anti-allergy pills, and pills for motion sickness and gastritis. She advises that medicines and prescription advice should be clearly labelled and hand-carried. Amounts of liquids and gels must not exceed travel limits, although exceptions can be made for certain medical reasons (check with individual airlines). Carry a duplicate supply in checked-in luggage, in case the carry-on luggage gets lost or stolen.

It would be good for diabetics to: • Inform the airline in advance about their condition, so that an appropriate diet can be ordered for flights and they are prioritised at meal times. • Carry some snacks or sweets on board to prevent hypoglycemia (low blood sugar), in case meals are delayed. • Ensure that their travelling companions are aware of the symptoms of hypoglycemia. • Keep some medication, including insulin if required, with them on board the plane, instead of packing everything in their checked-in luggage.

Dementia

Pe ople tr avelling with an elderly family member with dementia can: • Inform the airline in advance about the elderly traveller’s condition, to get priority boarding. • Ensure that he or she carries a memo or wears a wrist tag with relevant details such as the names and contact details of family members, and the hotel at which they are staying, at all times. • Get additional help. An extra person for vigilance against potential wandering is paramount when one relative is momentarily preoccupied, for

photo: 123RF

Travel health guide for seniors While it would be fun for grandma and grandpa to join in the family holiday, extra care and precautions are called for

singapore health

example at custom clearance or with baggage collection. • Ensure there is a sufficient supply of necessities, such as diapers, to deal with incontinence.

Asthma

Those with asthma should take precautions when travelling to areas with higher levels of pollen or dust, or where the air is colder and drier. Essential items to bring include their asthma medication inhalers and antihistamines such as Clarityne and Zyrtec. Those with a history of severe allergic reactions should carr y doctor-prescribed oral steroid medication, antihistamines and, if applicable, an EpiPen auto-injector.

Food, Water, Sleep

It is good practice to avoid eating undercooked meats, drinking tap water and using ice cubes. Wash hands with soap and water or use a sanitising rub before eating and after using the restroom. Try to get enough sleep and eat a balanced diet when travelling.

Vaccinations

Getting the appropriate vaccinations before travelling is important. As vaccination requirements vary with place and change with time, travellers should check in with their doctors before they set off. The following websites may be helpful: • The Travel Clinic, Singapore General Hospital: www.sgh.com.sg/Clinical-Departments-Centers/travelclinic/ Pages/TravelClinic.aspx • Comprehensive vaccination information (US-based): wwwnc.cdc.gov/ travel • Ministry of Health Singapore: www. moh.gov.sg

singapore health

May– jun 2015

Small but dangerous Gall bladder cancer often escapes early diagnosis, making the prognosis usually poor for the patient. By Thava Rani

he gall bladder is a small, pearshaped organ just beneath the liver. If cancer is detected here in its early stages, when it is still confined within the organ, there is a good chance of a cure. However, gall bladder cancer typically presents with vague symptoms, rendering it almost undetectable in its early stages. One study by four doctors from the National Cancer Centre Singapore (NCCS) showed that the majority of patients presented an unresectable locally advanced disease at the point of diagnosis. At this stage, the cancer had usually already invaded the nearby organs and lymph nodes. The study’s lead researcher, Dr David Tai Wai-Meng, Consultant, Medical Oncology, NCCS, said that the gall bladder is situated deep inside the body, so early abnormality is not seen or felt during routine physical examinations.

Liver

Gall bladder cancer Gall bladder Stomach

Large intestine

Small intestine

photos: 123rf

The gall bladder is situated deep inside the body, so early abnormality is not seen or felt during a routine physical examination.

Loss of appetite is one of the symptoms associated with gall bladder cancer.

Often, early gall bladder cancer is only uncovered by chance when a patient is having another procedure done, such as removal of the gall bladder due to gallstones. Even when the cancer has grown enough to cause symptoms, diagnosis could still be delayed because the symptoms may be too vague. And by the time it is discovered, the cancer may already be in its advanced stages. Symptoms associated with gall bladder cancer include abdominal pain, fever, loss of appetite and unexplained weight loss. Other symptoms such as jaundice, nausea and vomiting may also occur when the cancer invades the surrounding organs. All these symptoms can be caused by other more common but benign gall bladder conditions too. “Symptoms such as unintentional and

Stages in gall bladder cancer There are four stages in gall bladder cancer. Stage I The cancer affects only the gall bladder wall. Stage II The full thickness of the gall bladder wall is affected by the cancer. It has not spread to the lymph nodes or organs close by. Stage III The cancer has spread to the nearby lymph nodes or to the liver, stomach, colon or small intestine. Stage IV The cancer has spread very deeply into two or more nearby organs, or to distant lymph nodes or organs such as the lungs.

significant loss of weight and appetite should raise concern. Medical consultation should be sought as soon as possible in such cases,” said Dr Tai. Gall bladder cancer is not ver y common in Singapore. It affects about 1.7 in every 100,000 people in the population. In comparison, the most common cancer, colorectal cancer, affects 33.7 in every 100,000 people. Seniors and people with diabetes are more prone to developing it. Some lifestyle factors such as obesity and smoking are also known to increase the risk. Though not entirely proven, an unhealthy diet has also been linked to it. “Most of the risk factors are related to some form of inflammation or irritation in the gall bladder. For instance, having recurrent gallstones is one of the more common risk factors. Cholecystitis, which is the long-term inflammation of the gall bladder, is also a potential risk,” said Dr Tai. These were found to be true in the local context. Data from the same NCCS study showed that about a quarter of gall

bladder cancer patients had gallstones prior to developing cancer, while another 12 per cent had cholecystitis. “Another condition involving chronic inflammation is porcelain gall bladder, in which calcium forms on the wall of the gall bladder. People with this condition are also at higher risk, as are people with chronic infections of the gall bladder – these include Salmonella infections,” said Dr Tai. Surgery offers a good chance of a cure if the cancer can be removed completely. Unfortunately, in most cases the cancer has already spread beyond the gall bladder or is located in a difficult place which is inaccessible by surgery. If surgery is not a good option because of the size or location of the cancer, a patient’s treatment choices include chemotherapy and radiation therapy. These can help to relieve symptoms and may help to prolong life. Surgery may be done not to cure but to relieve pain or prevent complications. Such treatments are known as palliative procedures. “For example, if the cancer is blocking the bile duct that connects the gall bladder to the intestines, the patient may experience jaundice. Doctors may consider bypass surgery or the use of a stent to relieve such obstructions,” said Dr Tai.

Most of the risk factors are related to some form of inflammation or irritation in the gall bladder. For instance, having recurrent gallstones is one of the more common risk factors. Dr David Tai Wai-Meng, Consultant, Medical Oncology, NCCS

Because of its aggressive nature and tendency towards being diagnosed at an advanced stage, gall bladder cancers can be very hard to treat. “Given the current limited options available to patients and rapid deterioration after diagnosis, we try to offer enrolment into clinical trials of new treatments whenever possible,” said Dr Tai.

2015年5– 6月刊

新加坡中央医院与新加坡保健服务集团的双月刊

对抗癌症的免疫疗法免疫疗法不断取得进展，并在近年来被认为是对抗癌症的新疗法

病嵌合抗原受体T细胞疗法（chimeric antigen receptor），杜医生说，已有几项研究取得了非常显著的成功。由于白血病对传统疗法已起不了良好作用，许多急性白血病患者在没有其他治疗选择的情况下接受了这种疗法后，癌细胞完全消灭，病患者还能保持好几年无癌的状态。然而病患者是否已经完全根治或会旧病复发，仍有待证实。即便如此，嵌合抗原受体T细胞疗法依然被视为治疗白血病的重大突破。

原文 Sol E Solomon

免疫疗法主要类型癌症免疫疗法有许多类型，一些是利用患者本身的血液作为发展治疗的主要来源，一些则是由实验室培育或商业人工合成的免疫系统蛋白和抗体。免疫疗法的主要类型包括癌症疫苗、抗体、细胞因子和T细胞疗法。疫苗：癌症疫苗主要有两类，既预防性和治疗性疫苗。预防性疫苗能够降低人们患上某种癌症的风险，如乙型肝炎疫苗（防患肝癌的风险）和人类乳头状瘤病毒疫苗（防患子宫颈癌的风险）。治疗性疫苗是供给已患上癌症的病患者。这些疫苗能够“训练”免疫系统识别并破坏病患者体内现有的癌细胞。虽然目前有许多评估治疗性疫苗的试验正在进行中，唯有一种癌症疫苗（Sipuleucl-T或Provenge）已获得美国

Photos: alvinn lim / 123RF

在

抗癌的过程中，癌症患者可接受一项或多项的治疗法，既手术、化疗、放疗（也称电疗）、激素疗法和靶向疗法。在不久的将来，一种称为免疫治疗法也会加入这5大疗法一起对抗癌症。目前还处于临床试验阶段，这个疗法就是结合多种能让人体增强自身的免疫系统，从而达到抗癌效果的疗法。新加坡国立癌症中心副院长兼肿瘤内科高级顾问杜汉忠医生，也是该疗法的临床试验的首席调查员说： “进行了3到5年的临床试验，这个疗法所呈现出的表现和临床反应，实在是令人鼓舞。” 他坦诚说，这要归功于多年不断的钻研癌症免疫学术里和知识的累积，令医药业界对免疫系统运作细节有深层的了解，并进一步将之转化为效力更高的药物，使癌症免疫疗法成为潜力无边的新疗法。 “癌细胞善于伪装自己。但新知识让我们仔细地了解整个伪装的过程，分辨出癌细胞与正常细胞之间一些细微差别，好让我们能够针对其弱点，设计出更精密的免疫治疗药物，加以‘打击’ 癌症。如此一来，免疫系统便可以在 ‘保护’正常细胞的同时也可以精确的识别并对抗癌细胞，”杜医生说。免疫治疗的疗效不是任何癌症都能发挥作用。即使是同一种癌症，反应也不一。这点与其他疗法是相同的。不过，杜医生说，免疫治疗这块领域仍在蜕变中，希望往后有不同的免疫治疗法来对抗不同的癌症。

杜汉忠医生说，免疫治疗这块领域仍在蜕变中，希望往后有不同的免疫治疗法来对抗不同的癌症。

食品药物管理局批准。这个疫苗是用来治疗晚期前列腺癌症。 T细胞：T细胞是一种具有攻击癌细胞蛋白功能的淋巴细胞，在免疫疗法里担任着举足轻重的角色。T细胞多在实验室里以病患者本身的血液培育。杜医生的研究小组一直致力于研究如何利用和改造人体T细胞。针对白血

抗体：抗体犹如导弹，具有歼灭癌细胞或启动免疫系统制止癌症的功能。新类型抗体（anti-PD1和anti-PDL1）在黑素瘤（皮肤癌）的治疗上特别成功。对肺癌、霍奇金淋巴瘤和其他癌症，如膀胱癌和胃癌也有令人满意的作用，”杜医生说。细胞因子：由白细胞产生的蛋白信号帮助免疫系统识别并破坏癌细胞。其中包括干扰素和白细胞介素。干扰素协助免疫系统刺激某些免疫细胞去攻击癌细胞并减缓它们的生长能力，而白细胞介素则协助免疫细胞快速生长和分裂，以破坏癌细胞。

T细胞多在实验室里以病患者本身的血液培育。它可以被改造后重新注入患者，专攻他体内的癌细胞。

淋巴结的抗原特异性 T细胞活化 CTL (毒性T细胞) 是攻击癌症的杀伤细胞

肿瘤

皮下注射疫苗

新闻

在新加坡进行首癌症疫苗临床试验新加坡国立癌症中心目前正在针对患任何阶段肿瘤或癌症病患者，进行第一阶段新癌症疫苗的临床试验。其目的是为了评估疫苗的安全性和是否含有任何毒性，并从中调整药剂量。这是首次以人体做试验接种。使用的疫苗是经过编入强化免疫靶向性蛋白（MUC-1）的腺病毒（一种弱化流感病毒），用注射的方式将疫苗注入病患者的皮下组织，刺激免疫系统并攻击癌细胞里称为MUC-1 的蛋白质。这是许多癌症，包括卵巢癌、乳腺癌、前列腺癌、结肠癌、胰癌和肺癌特有的蛋白，也是本地最常见的癌症类型。这个疫苗是由美国生物技术公司MicroVAX所研制。其独特之处是在于MUC-1蛋白可以连接到另一种蛋白（CD40L）上。CD40L蛋白是一种威力强大的免疫增强剂。将结合这两种蛋白的腺病毒注入体内，不仅能大大的提升免疫系统，还可以刺激白细胞（又称白血球）攻击锁向，消灭癌细胞。其中一名试验参与者是60 岁患有第4期乳癌的王花蓉女士。王花蓉说： “我家人起初对疫苗感到有些质疑，我也担心疫苗可能带来的副作用。经过一番讨论后，我决定不再迟疑，速速进行试验。不过话说回来，化疗也曾给我带来副作用。从我被注射疫苗到现在，我的身体完全没有出现任何异状，看来我是白担心了呢。” 来自芬兰的简(Jane–非真名)女士也是参与试验的病患者之一。自从她的医生丈夫在网上（clinicaltrials.gov）发现有关该试验的信息，便陪同妻子从赫尔辛基飞往新加坡接受疫苗接种治疗。52岁的简女士患有第4期卵巢癌，参与试验之前也曾去过欧洲顶尖肿瘤专家那里接受治疗。简女士接种后状况一直保持良好稳定，并没有出现任何副作用。 “我不觉得自己的情况有所好转或更严重。我觉得我还是和以前一样，过着正常的生活和做做运动，感觉还蛮好的。” 新加坡国立癌症中心计划招聘20余名癌症患者参与这项第一阶段新癌症疫苗临床试验。有兴趣参与者可以致电 +65 6436-8431或发送电邮至

chong.hui.shan@nccs.com.sg 联系临床研究协调员。

新闻

2015年5– 6月刊

世界无烟日

吸烟是个非常容易上瘾的习惯。戒烟带来的健康效益有助于降低心脏病发作、中风、慢性肺疾病和许多其他癌症风险。

吸烟如何危害相关疾病吸烟是中风的主要因素。它会令脂肪在血管内沉积起来，使血管变窄然后造成堵塞，切断供给大脑的血液，引起脑细胞缺氧而中风。同时，吸烟也会增加心脏病发作的风险。当心脏血管被堵塞时，供应至心脏肌肉的血液就会被切断，令组织死亡并引起心脏病发作。

4,000 400

如何铲除恶习？

香烟烟雾含有超过

1 对香烟物质上瘾的重烟瘾者，尼古丁帖片是最适宜的选择。 2 对习惯性手部动作的吸烟者可以使用尼古丁吸入器替代香烟。 3 通过吸烟来舒缓焦虑或其他心理负担的吸烟者，可考虑进行减压运动，例如深呼吸。

种不同的化学物质，其中至少

吸烟为肺癌致病原因占百分之

原文 Denyse Yeo

戒烟建议

种是对人类有毒的。

当我们吸入香烟烟雾时，致癌物质也会被连同吸入。这些物质会攻击防癌细胞生长的基因。只要一根烟就可以令细胞损伤，引发肺癌。

5倍

6秒

7 分钟

吸烟者若可以停止吸烟28天，成功戒烟的机会会提升5倍

在全球，每6秒就有1人因吸烟而致命，相等于 1年540万人

每根香烟能让吸烟者减寿7分钟

告诉家人、朋友、同事和上司关于戒烟的决定，可以减低戒烟失败的可能性。

扔掉所有香烟、打火机、烟灰缸和其他与吸烟有关的随身物品。

多呆在无烟的环境中，在睡房、浴室避免到吸烟和办公室周围展示“禁烟” 区。当您和朋友在一起时，告示牌，制造请他们不要视觉提醒和吸烟。鼓励作用。

7 人死亡新加坡每天有7人因为吸烟相关疾病而提早离世

10 年平均来说，吸烟者比非吸烟者早死10年

资料来源：卫生部和保健促进局

2015年5– 6月刊

健康

更年期女性更易患上心脏病停经后的妇女继雌激素水平下降，导致坏胆固醇水平增加，心血管疾病风险也可能会被提高

陈医生说： “我们必须记住，高胆固醇只是心血管疾病的众多致病因素之一。要减低风险，就应当顾及所有所周知，高胆固醇水平能增加因素。” 患上心脏病的风险。 “首当其冲就是改变饮食习惯。譬如对于上年纪的，尤其是更年过度肥胖人士必须减重。只需减去区期女性来说，更是令人不安的消息，因区5%至10%的体重便可改善胆固醇为雌激素水平的下降会增加体内‘坏’ 水平。” 胆固醇水平。再来是远离含有饱和脂肪心脏病很少发生在年轻或尚未停经（u n s a t u r a t e d f a t）和动物脂肪的的女性身上，显然是因为雌激素能够降食物，例如猪油、酥油、黄油、奶油、低低密度脂蛋白（LPL，俗称为‘坏’胆奶酪，巧克力以及含有椰子油等植物产固醇）水平，同时提升高密度脂蛋白品和加工食品，例如饼干、蛋糕和冷冻（HDL，俗称为‘好’胆固醇）水平。比萨饼等。可是随着雌激素水平下降，停经后陈医生说，饱和脂肪不应超过每人的女性终究还是会面临与同龄男性一每天7%的卡路里摄取量，取而代之，人样类似心血管疾病的风险。们应该多吃全麦食品、水果和蔬菜，因新加坡中央医院内分泌科顾问医生为它们含有较健康的单元不饱和脂肪陈鸿樟表示说，这是一个自然的过程（monounsaturated fat）以及多元不饱也没有一个特定医疗方式能够阻止它和脂肪（polyunsaturated fat）。发生。除了饮食方面，运动也可以帮助减他说： “心血管疾病绝少发生在尚未少‘坏’胆固醇和增加‘好’胆固醇。陈停经的女性身上。但是停经后，发病的医生建议，每天定时进行中等强度的机率就会增加。因此，停经被视为是心运动，例如每周至少五次轻快步行和血管疾病其中一个致病的因素。” 游泳20至30分钟，对减轻体重也很有陈医生补充说，不良的饮食习惯或帮助。懈怠的生活方式是造成体重增加和体此外，女性应该定期检查她们的胆重指数偏高，并引发心脏病的关键因素。固醇水平。美国心脏协会建议20岁以任何人不论性别都不该养成这些恶习。上的人士应该每隔五年进行一次胆固

众

醇检查。已超过50岁并拥有高胆固醇水平或其他致病因素的女性，则应该向医生咨询以了解检查胆固醇水平的频率与次数。

首当其冲就是改变饮食习惯。譬如过度肥胖人士必须减重。只需减去区区5% 至10 %的体重便可改善胆固醇水平。新加坡中央医院内分泌科顾问医生陈鸿樟

如果纵然改变了生活方式，却还是无法降低胆固醇至健康水平。在这样的情况下，医生可能会为她们开斯达汀（Statin）等药物的处方。陈医生说： “因为高胆固醇的潜在成因如老化和更年期是不可逆转或更改的，所以需要利用药物来帮助她们降低胆固醇水平。” “当胆固醇水平显著下降时，医生可以减少药剂量，但很少病人可以完全停药。”

除了饮食方面，运动也可以帮助减少‘坏’胆固醇和增加‘好’胆固醇。

胆固醇的好与坏胆固醇是存于人体细胞里像蜡状的物质，用来制造荷尔蒙、维生素D和消化食物的物质。胆固醇以脂蛋白(lipoprotein)在体内移动，并可分为两大类：

红曲米和蒜头等食物可降低胆固醇吗？许多人认为食用‘ 天然’食物必定是既安全又能助于降胆固醇水平的最佳方法，但效果充其量只是一般而已。这些食物不曾经过广泛研究，也从不曾被认证有减少胆固醇的功用。所以比较可取的方法还是运动，避免摄取饱和脂肪以及服用斯达汀等药物。服用控制胆固醇的药物会造成副作用吗？大部分用于降胆固醇的药物，效果因人而异，副作用也相当低。斯达汀是最被广泛研究的降胆固醇药物，许多项研究显示它能够稳定地降低心血管疾病病发的机率。其副作用包括肌肉疼痛、消化不良和肝脏酶增加。尽管如此，它的好处还是胜于坏处。

高密度脂蛋白（HDL）是小型的、密集的分子，负责把胆固醇送到肝脏，让肝脏把胆固醇排出体外。因此，HDL 被称为‘好’胆固醇。

PHOTOs: 123rf

原文 Lediati Tan

低密度脂蛋白（LDL）把体内大部分胆固醇运送到个别细胞之中。与HDL相比，LDL的体积较大，密度和稳定度都较低。LDL容易氧化和堵塞动脉，导致心脏病发生。因此，LDL被称为‘坏’胆固醇。

健康

2015年5– 6月刊

痔疮不一定是令人尴尬的问题

轻微性症状轻微的患者可通过调节纤维素的摄取，包括水果、蔬菜和谷物的食用量，减轻症状。这是因为摄取过多或过少的纤维素，都可能导致硬便。医生也可能建议使用乳霜和软膏等药物。

了解痔疮的成因和治疗方法

治疗选择

原文Lediati Tan

持续性如果痔疮持续出血或造成痛楚，就可能需要进行简单的治疗程序，包括：

用橡皮筋结扎痔疮硬化剂注射治疗医生会在内痔的根部医生会把化学溶液套上三条小型的橡皮注入痔疮组织内，筋，切断其血液供应。使痔疮收缩。一个星期内，痔疮就会萎缩脱落。

你

知道吗？痔核或俗称的痔疮其实是我们人体结构的一部分。“痔疮是位于我

们的肛管内的‘血管衬垫’，有助于我们排便，”新加坡中央医院结直肠外科顾问医生王德庆说。可惜大众媒体经常错用‘痔核’和‘痔疮’ 这两个名词，使它们变成痔疾的代名词。同时兼任新加坡中央医院肛肠超声波及生理学实验室主管的王医生说，痔疮只有在过度肿胀，导致出血、疼痛或从肛门突出等症状时，才会造成问题。 photo: jasper yu/123rf

严重性在更严重的情况下，若侵入性疗法对痔疮起不了作用，就需要进行手术。这些手术通常是无需住院的日间手术，包括：

传统式痔切除术通过开放式手术，切除多余的痔疮组织。环状切除术利用特殊的仪器，在肛门内切除多余的痔疮组织。痔动脉结扎术通过使用特定的超声波仪器，准确地识别痔血管的位置。然后把血管缝合起来，切断血液供应，减少肿胀和出血。

治疗方法要视情况而定，轻微的话则使用药物消除肿胀，严重的话可能得进行手术去切除多余的组织，或两者兼施。新加坡中央医院结直肠外科顾问医生王德庆

这可能是因为排便、怀孕分娩甚至是严重腹泻（便秘会使情况更严重），过度用力并导致腹内压力一直持续增加，因而造成血管肿胀。痔疮可以归类为内痔或外痔。内痔是因过度肿胀而突出体外，是真正的痔疮。外痔则是因为排便时用力过度而在肛门外形成的血块，这种情况较常见于25岁至50岁之间的人群，性别不拘。至于孕妇，王医生说，当胎儿逐渐成长，它的重量会压在孕妇的盆

王德庆医生表示，让疗痔疮恢复正常位置是治疗的主要目的。

腔静脉上，分娩时，母亲因为必须用力地把胎儿推出来，所以才会引起痔疮肿胀的风险。不过庆幸的是，痔疮会像怀孕期间腿部肿胀的情况一样会慢慢消退。王医生表示，让疗痔疮恢复正常位置是治疗的主要目的。 “治疗方法要视情况而定，轻微的话则使用药物消除肿胀，严重的话可能得进行手术去切除多余的组织，或两者兼施。” 每种方法都各有优势。 “为了达到最佳疗效，外科医生必须为每个患者选择最适当的疗法，再按患者的情况来调整，”王医生说。同时，患者必须改掉容易引发症状的坏习惯，例如习惯性过度用力排便，或习惯性的呆坐在马桶上阅读或玩手机。患者每天也需要饮用足够的水分和摄取适量的纤维素，以预防硬便或避免动手术。

2015年5– 6月刊

焦点

终身健保涵盖面扩大

综合健保双全还要买吗? 终身健保今年底全面落实后，无论是否已有病症的国人，都将受保。既然终身健保福利大大提高，人们是否有必要购买提供额外保障的综合健保双全？

终

没有选择主治医生权的 B 2 和 C 级病房留医，那么基本终身健保就已足够，无需投保IP计划。二、保费将随年龄上涨，你今后是否还负担得起？ IP保费按年龄风险计算，年龄层相同的受保人属同个风险群。年龄层越大，生病概率越高，保费也就随之增加。加上通货膨胀等因素，保费更会进一步增加。受保人不可只看当下的保费，也应考虑终身须投入多少，退休时是否能负担比年轻时高几倍的保费。三、可全额索偿（as-charged）保单是否值得投保？终身健保和IP都设有抵扣额和共同承担保险部分。但最基本的终身健保有索赔顶限，而许多IP不设索赔顶限，全额索赔。这意味着受保人的床费、膳食、药物等都可向保险业者索赔，使受保人及家人更安心。当然，全额索赔IP的保费会比那些有索赔顶限的IP来得高。四、你是否已患有疾病，疾病又是否属于受保范围？受保前患上的疾病通称为“已有病症”。视病情轻重，保险业者可能不承保已有病症者，或在承保时设下索偿限制，或以其他方式管理他们的风险，如

征收额外保费。受保人投保后患病，就无需担心限制。但他们若要升级或改投其他保单，就会成为已有病症者。若只是降级保单，则不会面对限制。

象会自然而然的消失，所以不必作任何治疗。但是若您忽然感到眼前有一群小黑点逐渐变成蜘蛛网状的影像，又或者感到眼睛像是被一条黑色的‘帘子’遮盖了整只眼时，这便是视网膜破裂造成眼部出血，和视网膜脱落的症状。请立刻到医院的急诊室求诊。

整到您舒适的位置，尽量在途中取得休息。您也可以在椅背上加一个腰部支撑垫，帮助您减轻腰部得承受的压力，舒缓腰部疼痛的状况。若经过以上建议，情况仍然不见好转反而继续恶化，又或者您的双腿感到疼痛、无力或麻痹等经脉受压的症状，无法安稳地行走，或发烧、发冷、体重减轻或没胃口，那么您应该立即向医生求诊。

原文首次刊登于早报星期天2014年10月5日。

illustration: 林德生

（deductible）和共同承担保险（coinsurance）转移给保险业者，然而该保费不能用保健储蓄支付。身健保（MediShield Life）本地居民虽有约六成已投保综合健将于今年年底全面推行，所保双全，但大部分IP受保人却没物尽有国人包括已有病症者在内，其用，就像购买了头等或商务舱机票，都可以使用保健储蓄支付保费，成为却坐在经济舱一样。受益保人。譬如，60％的属私人医院IP受保人受保人一旦患重症，若选择在政府选择在政府医院留医或70％的A等级医院留医治疗，所有医疗和任何病房 IP受保人选择在低等级的病房留医。级别的费用将能索偿与B2和C级病房大东方财务服务董事陈为玮指出，相同的索偿额。受保人也能索偿癌症综合健保双全为受保人提供更多灵活化疗和洗肾等重症门诊费。性和选择，让他们自由选择病房、无须由于终身健保覆盖面比现有的健等候留院等。保双全（MediShield）更广泛，受保人 IP受保人的主治医生若从政府医院自掏腰包支付医药费也会大大减少。转入私人领域，病人仍能接受该名医生既然如此，人们还需要购买提供额的治疗。外保障的综合健保双全（Integrated Life Planning Associates总裁王连 Shield Plan，简称IP）吗？万表示，人们在考虑投保、断保或投保综合健保双全是公共保险和私营什么级别的IP时，应该先检视本身情况保险二合一的重症医保。公共部分是然后问自己几个问题，再决定：即将被终身健保取代的健保双全，主一、一旦住院，你希望在什么级别的病要覆盖B2和C级病房的基本费用。私房留医？营部分则由私人保险业者，提供政府在政府医院留医的病人，无论病房医院A和B1级病房以及私人医院不同级别，都能接受同等的治疗。可是不同级别病房的住院费用等。级别病房的床位、设施、医生人选、津综合健保双全也提供附加险贴率方面等也会有所不同。（rider），把受保人必须承担的抵扣额若受保人宁愿在多床位、少设施、原文沈越

专家解答

预防三手烟

竹脚妇幼医院呼吸内科主任及高级顾问医生张运豪

新加坡全国眼科中心白内障和综合眼科高级顾问医生王振权

新加坡中央医院矫形外科高级顾问医生郭常明

患有严重的腰痛问题

眼睛内出现闪烁光线我总觉得我的右眼有道光一闪一闪的，为什么？我今年65岁，患有高血压、高胆固醇和糖尿病。病情皆处于受控稳定的状况。这个闪光感是表示附在视网膜上的萎缩玻璃体正随着眼睛移动而移动。这个现

我时不时会感到腰痛。通常贴一块膏药布就可以帮我舒解疼痛，可是最近腰痛发作次数越来越频繁，疼痛也越来越严重，连驾车都有问题，为什么？腰痛是一种常见问题。大多数无需做太多治疗，疼痛感也会自然而然地消失。另外，坐着比站着还要对背部的椎间盘多50%的压力，所以长时间坐着的人容易腰痛。若您经常坐着，建议您每30至60分钟站起来走走。若是驾驶，把车座位调

photos: getty images, Frank Siteman/Science Faction/Corbis

三手烟会造成怎样的危害？我们要如何预防受到三手烟的伤害？三手烟是指吸烟后残留或附在室内或室外任何表面和角落，例如烟者或旁人的身上、衣服、墙壁、地板、家具、地毯等的烟草残余物质。这些物质会释放回空气中然后再被吸入人体内，或和一般室内污染物质起化学作用，促成致癌的混合物。三手烟可严重的危害到非吸烟者，尤其是触摸含有有害物质玩具后把手指放进嘴巴里的婴儿和小孩，以及孕妇和未出世的胎儿。残余物会随着时间累积。它不会因打开窗户让房间通风或开风扇、冷气机等途径而消除掉。保持无烟环境是最好的方法。

2015年5– 6月刊

ADVERTORIAL