10 Rules of Blood Pressure Monitoring Using Tensoval duo control Blood Pressure Monitors 1. Measure daily at the same time, ideally in the morning as your blood pressure changes throughout the day 2. Do not smoke or take tea/coffee before taking your blood pressure 3. Rest your arm on a table and sit down while taking your blood pressure 4. Go to the toilet before taking your blood pressure 5. Avoid eating a heavy meal before taking your blood pressure 6. Do not move while taking your blood pressure 7. Do not talk while taking your blood pressure 8. When taking a second reading,rest for one minute 9. Always record you blood pressure down 10. Blood pressure measurement should be done daily BHS – British Hypertension Society A/A Grade Accuracy Tensoval ® duo control. Simply more secure. LISTEN TO YOUR HEART
Gastric bypass surgery can help people with serious diabetes and other chronic medical conditions brought on by obesity. Read about how the procedure helped two heavily overweight SGH patients and the changes they had to make to their eating habits and lifestyle in the latest issue of Singapore Health. In the same issue, learn about how people with severely dry eyes found relief with a newly developed eye drop made from their own plasma, how SGH prepares meals for its patients, as well as tell us what you think – about health in general or about our publication – and stand to win more than $100 worth of supplements. 华文版的新闻包括减肥手术有效逆转糖尿病和其他并发症,用自身血液制成润眼液能缓解干眼症,皮肤科医生对抗皱和美白产品的见解和了解健康保险计划所涵盖的范围及须注意的时限。
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Transcript
10 Rules of Blood Pressure MonitoringUsing Tensoval duo control Blood Pressure Monitors
1. Measure daily at the same time, ideally in the morning as yourblood pressure changes throughout the day
2. Do not smoke or take tea/coffee before taking your blood pressure3. Rest your arm on a table and sit down while taking your blood pressure4. Go to the toilet before taking your blood pressure5. Avoid eating a heavy meal before taking your blood pressure6. Do not move while taking your blood pressure7. Do not talk while taking your blood pressure8. When taking a second reading,rest for one minute9. Always record you blood pressure down10. Blood pressure measurement should be done dailyBHS – British Hypertension Society
A/A Grade Accuracy
Tensoval ® duo control. Simply more secure.LISTEN TO YOUR HEART
02 SINGAPORE HEALTH JUL⁄ AUG 2012
News
Student volunteers befriend patients and visitors as part of their school project
Fundraising for a good causeAug 27 – SGH Block 2/3(outside SpecialistOutpatient Clinics on Level 1)
Aug 28 – SGH Block 2/3(outside SpecialistOutpatient Clinics on Level 1)
Aug 29 – SNEC lobby
Aug 30 – SNEC lobby
Aug 31 – KKH, Women’sTower Podium
Highlights
Student volunteers from Fairfield Methodist School (Secondary) stationed themselves at SGH Block 3 in late May and early June, andgot visitors and patients to paint on white glazed tiles, which helped enliven the hospital environment.
The painted tileswill be used tocommemorateNational Day.
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Dummy helps doctors sharpen skills
Jul⁄ Aug 2012 singApore heAlth 03
Can you guess what this is?See page 26 for the answer.
News
At Singapore General Hospital’s (SGH) Medical Intensive Care Unit, patients lay quietly in their beds. Many were uncon-scious and were breathing with the help of ventilators. Suddenly, one of them started coughing and gasp-ing for breath. That triggered an alarm and, within seconds, a team of young doctors, nurses and a respiratory thera-pist rushed to his bedside.
They swung into action to maintain his airway, breathing and circulation, monitor his vital signs and initiate emer-gency treatment. One of the medical team members asked: “Hello? Mr James Tan? Can you hear me?”
“I have difficulty breathing,” the patient mumbled.
“What are the latest vital signs?” the medical team leader asked. “BP (blood pressure) is low. Can we prepare to intu-bate the patient? BP is 54/2...”
“Mr Tan, because you’re breathless, we’re going to put a tube into your lungs to help you breathe. Prepare the oral laryngoscope and endotracheal tube.”
Soon, Mr Tan’s condition stabilised and the worst was over.
It was not a real emergency but a simulation of an urgent medical situation which doctors, nurses and other medical professionals have to respond to at any time. And Mr James Tan was actually a life-size doll.
Still, the team showed they had learnt their lessons well by swiftly and confi-dently responding to the “emergency”.
Helping the hospital create the emer-gency situation realistically is a crucial piece of machinery – the sophisticated,
high-tech doll or manikin capable of emu-lating complex medical conditions and responding to treatment.
Although such so-called high-fidelity manikins have been used at SGH’s Insti-tute for Medical Simulation and Educa-tion (IMSE) since 2008, this was the first time one was “called into action” in a hospital ward – with the participants, doctors, nurses and therapist on actual duty, attending to real patients in the intensive care unit.
In comparison to training at the hos-pital’s simulation training centre, “the real life ward setting, the ventilator and other equipment made it easier for us to be immersed in the situation”, said Dr Jona-than Yap, an Internal Medicine Resident.
“The experience was more realistic (compared to that in a simulation lab).”
According to Dr Peter Mack, Senior Consultant, Department of General Sur-gery, and Director, IMSE, SGH, this more realistic approach to training, known as an in-situ simulation, became possible after recent technological advances enabled wireless manikins to be produced. The trainer manipulates the manikin’s “body functions” by controlling signals from a laptop.
“In the ward, participants can check that their equipment and drugs are in order and things are within reach, that they know what to do and where to reach for their equipment. It is a chance for them to find out where the gaps in their processes are and how they work in the real world, and know what can really go wrong,” Dr Mack said.
Simulation in the hospital ward offers valuable opportunities to identify
In focus
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By manipulating controls on a computer, a trainer can bring on a “heart attack”, “lung collapse” or other medical conditions in the manikin.
With the help of a high-tech lifelike doll, SGH staff train for emergencies in simulated real situations
potential dangers and flaws in the clinical systems, the environment and the acute care team. Having doctors and nurses attend to a wireless manikin like a real patient enhances their learning, corrects their mistakes, fine-tunes their skills and improves team communication. Simu-lated training also allows participants to experience rare clinical scenarios as often as necessary, and helps them keep
up with changing technology, with the ultimate aim of increasing patient safety and delivering quality care.
“In the simulation laboratory, partici-pants often say, ‘We are unfamiliar with this artificial environment, which is why we did things wrongly; but in the ward, we’ll be fine.’ But will they? The only way to find out is to have the situation play out in a real-life setting,” Dr Mack said.
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In-situ simulation is a more realistic approach to training, with manikins like this one being used in the wards to emulate medical conditions.
Donation to a public cord blood bank is strongly encouraged by organisations such as the American Medical Associa-tion and the European Group on Ethics in Science and New Technologies. Cord blood from a different person (not the patient’s own cord blood) is most com-monly used for cord blood transplants, as another person’s cord blood will not con-tain the genetic deficiencies that caused the disease, which led to the need for a transplant.
The bank aims to increase its cord blood units from its current inventory of 8,100 to 10,000 by 2014. “If we have between 10,000 and 20,000 cord blood units, we would have a 60 to 80 per cent chance of finding a suitable match for transplantation for the majority of Singa-poreans,” said Dr Hwang.
He added that bone marrow regis-tries around the world have a large pool of Caucasian donors but comparatively fewer Asian donors.
As a result, 65 to 80 per cent of Asian patients in need of bone marrow or blood stem cells for transplant are unable to find a suitable match. This is made worse as patients have only a one-in-four chance of finding a match among siblings.
about 40 to 60 per cent of Singaporeans in need of stem cell transplants cannot find a suitable match,” said Dr Hwang, who is also an Assistant Professor with Duke NUS Graduate Medical School. He thinks the key reason for the low donation rate is the lack of awareness about donations.
“Some mothers may fear donating or choose to keep the cord blood for their own baby or family’s use in the future.”
Doctors in the haematopoietic stem cell transplantation field currently favour public donation, as studies suggest that the chance of using one’s own cord blood is very small and currently does not give better results in treatment.
04 singapore health Jul⁄ aug 2012
News
Wanted: More cord blood donors
In March this year, the Singapore Cord Blood Bank (SCBB) made a land-mark announcement that it had facili-tated its 100th cord blood transplant since its official opening in 2005. The cord blood came from its banked inventory and was donated by an unrelated donor.
It was a major milestone for SCCB. However, the non-profit bank, which is Singapore’s only public cord blood bank, is still looking for more cord blood dona-tions to help other Singaporeans in need of haematopoietic stem cell transplants (blood stem cell transplants).
Drawn from the umbilical cord of a baby after delivery, cord blood is a rich source of self-renewing blood stem cells that can develop into different mature blood cell types, which can save lives after a blood stem cell transplant. Blood stem
cells have proved highly effective in the treatment of blood cancers such as leukae-mia and lymphoma.
The stem cells in cord blood are naive (without prior exposure to any bacteria, virus, parasite or other stimuli) and are unlike bone marrow blood cells. The matching between a cord blood donor and recipient is also less stringent com-pared to the matching requirements for bone marrow cells.
Few mothers donate to SCBB Collecting cord blood presents minimal risk, and is painless and non-invasive, but few mothers in Singapore donate it to SCBB. Of the 35,000 or so births each year, only 10 per cent of mothers donate.
The donation rate could be much better, said Dr William Hwang, Medical Director, SCBB, and Head and Senior Consultant, Department of Haematology, Singapore General Hospital.
“The bank’s limited units mean that
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As the Singapore Cord Blood Bank celebrates facilitating its 100th cord blood transplant, it is appealing for more donors
BY Jamie ee
Enlarging the poolHe said that, “with cord blood, there is an increased chance of finding a match because it can be partially mismatched to the patient when used for transplants”.
Agreeing, Associate Professor Tan Ah Moy, Head and Senior Consultant, Paediat-ric Subspecialties, KK Women’s and Chil-dren’s Hospital, said: “When you donate cord blood to a common shared resource like the SCBB, more patients are able to access and benefit from it. Although there is a one-in-four chance of a match among siblings, it doesn’t mean every child will find a match among his siblings. In these instances, we still have to search through SCBB for a suitable match.”
To raise awareness here, Dr Hwang and his counterparts have been giving talks to the public and the medical com-munity. Also, to include donors from minority races, SCBB has reached out to organisations like Majlis Ugama Islam Singapura (MUIS) for their endorsement of cord blood donation.
It has had some effect. Mr Steve Sobak, CEO of SCBB, said: “Through various media, obstetricians/gynaecologists, clinic and hospital staff, as well as word of mouth, expectant mothers are coming forward to donate their cord blood. But we need more to increase the chances of patients finding a suitable match.”
Teng Hong Yi (far left, pictured here with his mother Ms Regina Soong and his two siblings) underwent cord blood transplantation two years ago.
Why I donatedWhen her son, Cristan, was born last year, housewife mandy loh, 32, donated his cord blood to sCBB.
“my husband and i decided that we were not going to store the cord blood in a private bank. so rather than discarding it, we thought we should donate it to someone who needs it,” she said.
“it is a good option that mothers should think about because it really brings hope to another person.
“there is so much beauty in bringing a child into this world and mothers can share this joy by giving hope to other people who may be suffering.”
When primary 6 pupil teng hong Yi was nine, he was diagnosed with chronic myelogenous leukaemia, a rare blood cancer. his condition did not improve even after being on medication for a year.
so, his doctor, associate profes-sor tan ah moy, head and senior Consultant, paediatric subspecial-ties, KK Women’s and Children’s hospital, recommended a haemato-poietic stem cell transplant.
his parents and two siblings were tested and tissue-typed, but none were found to be suitable donors. so they turned to sCBB for help. on their second search, they found a
perfect match. his mother ms regina soong, 33, said: “i knew from the doctors and nurses that it was not common to get a match, so i didn’t think we’d be so fortunate to find one and, what’s more, a 100 per cent match.”
two years ago, the Yishun primary pupil underwent cord blood transplantation and, today, the cancer is in remission.
“i will definitely encourage parents to donate their baby’s cord blood because it gives another person a shot at life. if they don’t donate it, it will be discarded and go to waste,” said a thankful ms soong.
A perfect match from a stranger
For more information, visit www.scbb.com.sg. To donate, please call 6394-5011 or write in to [email protected].
If we have between 10,000 and 20,000 cord blood units, we would have a 60 to 80 percent chance of finding a suitable match for transplantation for the majority of Singaporeans.Dr williAm hwAng, meDiCAl DireCtor, SingApore CorD BlooD BAnk
A sensible, balanced diet, regular exercise and good sleeping habits can give a boost to energy and lead to good health. Other ways of boosting the metabolism include:
Build more muscle mass As muscle burns more calories than
fat, building up more lean muscle will help burn more calories every day. Doing some weight-bearing exercises, such as weight-lifting or walking, will add muscle mass and burn calories.
Avoid skipping meals Significantly decreasing the caloric
intake will slow the metabolic rate as the body enters “fasting” mode and reacts by hoarding fat and burning lean muscle for energy.
Get adequate sleep Not sleeping enough a�ects the
levels of appetite-regulating hormones, and the capacity to metabolise carbohydrates in the body. The metabolic rate nosedives as less fat is burned for energy.
Eat enough protein Protein forms the building blocks
for muscle, and having inadequate protein can lead to the loss of desirable, lean muscle mass.
Drink less alcohol Alcohol slows the fat-burning
process. The body needs to burn calories from alcohol before fat can be lost through diet and exercise.
Adapted from Beautiful Inside Out,
The SingHealth Guide to Women’s Health,
produced by Reader’s Digest for SingHealth.
To measure the resting metabolic rate, a small plastic hood or canopy
is put over the head of the participant who is lying down on a comfortable bed. The canopy measures the amount of oxygen
and carbon dioxide breathed in and out by the participant. This is based on the principle that gases and heat are produced and
used when the body expends energy to power its basic functions while it is at rest. The participant has to remain still and quiet, but
not fall asleep during this test, which takes about half an hour.
People who are interested in taking part in the study can call Miss Stephanie Tan at 6326-6794 or
Generally, participants have to be healthy, and not pregnant or
experiencing significant weight loss or gain, to participate in the study.
They will need to spend a weekday morning at
SGH Lifestyle Improvement and Fitness Enhancement (LIFE) Centre,
and fast and refrain from smoking as well as moderate to
vigorous activity 10 hours before the test.
By using a small plastic hood, Miss Stephanie Tan (left) is able
to measure the amount of oxygen and carbon dioxide a patient breathes in and out while at
rest. She will use the data to develop a formula
for estimating resting metabolic rates.
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SGH kick-starts a new study to establish a more accurate formula for calculating the metabolic rates of Singaporeans
BY JAMIE EE
To find out their body composition, participants stand on a scale that sends a harmless electric current
up through the body.
When someone suddenly collapses
If the victim is unconscious and notbreathing, call 995 for an ambulance
Start CPR early to get the bloodflowing
If there is an automated externaldefibrillator (AED), use it to deliver anelectric shock to the heart
* The AED, a simple device that can be used by anyone, is able to analyse the heart rhythm and prompt the first-aid provider to deliver the electric shock if necessary. * A registry that lists venues with AEDs can be found at www.myheart.org.sg.
Where can I get trained in CPR and AED techniques?The following centres providecourses in CPR and AED:
Singapore Heart Foundation
Singapore Civil Defence Force
St John Ambulance Singapore
Singapore Red Cross Society
JUL/AUG 2012 SINGAPORE HEALTH 07
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SGH embarks on world’s first study to improve survival chances of sudden cardiac arrest patients
BY THAVA RANI
The best time to deliver an electric shock to the chest may be during the upstroke of a CPR compression. “Early CPR is important at that point to get some blood flowing,” said Associate Professor Marcus Ong as Ms Samantha Yong looked on.“With the residual oxygen in the blood, the heart is prepared, giving it a greater chance of restarting when a defibrillator is used.”
interviews and counselling at SGH Life-style Improvement and Fitness Enhance-ment (LIFE) Centre. Staffed by a multi-disciplinary team of doctors, dietitians, physiotherapists, psychologists, occupa-tional therapists and medical social work-ers, the centre promotes integrated and holistic care for patients with lifestyle-related medical conditions, such as eating disorders and obesity.
Since his 20s, Mr Lawrence had been seeing Dr Tham Kwang Wei, Consultant, Department of Endocrinology, SGH, and Director, Obesity and Metabolic Unit. It was only late last year that he made up his mind that he was ready for the procedure and the commitment it entailed.
“He was first referred to the Diabetes Centre at SGH as a 19-year-old after he was diagnosed with type 2 diabetes during his national service pre-enlistment screen-ing,” said Dr Tham.
“He was a typical diabetic. He battled with his weight for a long time. He would lose 10kg and bounce back with a 15kg weight gain. He had been seeing us for a good seven years. Then he disappeared off the radar and came back about a year later with very poorly controlled diabetes. His blood pressure was high and his cho-lesterol levels were off the charts. I said, ‘Look, you are young and you can’t go on like that. You are a candidate for a heart attack at 40.’ And that was when we dis-cussed surgery.”
For Ms Rozita, the turning point came a year later when she was in and out of the hospital four times for a host of medi-cal problems which included diabetes, inflamed stomach ulcers, sleep apnoea and an ovarian cyst.
Fed up that her weight was causing her so many problems, she opted for gastric bypass. “I told my husband, ‘I don’t care if you allow me to or not, I am signing the consent form for the surgery.’”
Such determination and commitment is key when assessing patients for bariat-ric surgery, said Dr Shanker Pasupathy, Senior Consultant, General Surgery, and Director, LIFE Centre, SGH.
“There is a common misconception that the operation will fix everything and, after that, you will go on with your life. But that is not true. The surgery is a reset button and, after that, you embark on a new life, not just in terms of eating but your whole approach to life.”
Patients who go to LIFE Centre learn to modify their eating habits. “We talk about eating, selecting food and being relaxed. They need to understand that these are important and they need to make changes. Undergoing surgery to lose weight will help them only 20 to 30 per cent of the way,” Dr Shanker said.
Bariatric procedures – whether it is a gastric bypass, gastric lap band surgery or gastric sleeve surgery – are doomed to fail if patients do not make dietary and lifestyle changes, he added. They could regain all the weight they worked so hard to lose in the first place.
Post-surgeryAfter surgery, a patient’s stomach is reduced to the size of a tiny pouch that is attached to the middle portion of the small intestine. Eat more than what the pouch can handle and the patient will throw up. Mr Lawrence typically eats a slice of bread for breakfast, a small piece of fish for lunch and a small piece of chicken for dinner. “Less carbohydrates, no fried chicken, which I loved, and no rice. I no longer remember what rice tastes like.”
Ms Rozita, who admitted she used to not know the word “full” when it came to food, has taught herself to say “no” to a lot of it.
She and Mr Lawrence are now commit-ted to a life of careful eating, exercise, a regimen of daily supplements and regu-lar visits to LIFE Centre to monitor their progress. They have become advocates of a healthy lifestyle as family members and friends follow their new habits. Mr Law-rence’s family alone has collectively lost over 30kg since his surgery.
“That one person who has had surgery and has been taught about eating becomes a nucleus of change for the family,” Dr Shanker said.
Patients are helped by the support of others in the same boat. Prospective patients and people going through the various post-operative phases attend sup-port group meetings at LIFE Centre, held every other Wednesday evening.
Distributes and provides supplies to healthcare professionals
Why collagen is important?In the composition of cartilage we fi nd 67% of collagen versus 1% of glucosamine.Glucosamine is an aminosaccharide contrary to collagen which is a molecularcomplex containing amino acids. Glucosamine is found in interesting quantities only in the liquid of the synovial membrane. Collagen is also found in the synovialmembrane but in larger quantities because the protein structure is more abundant inthe body.
Glucosamine acts more like a lubricantin the joints while collagen helps the tendons, ligaments, cartilage, muscles, membranes and synovial liquid (lubrifi -cation).
Our tendons... Our body’s rubber bandsBy 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 fi bres of collagen that are held tightly against one another. These fi bres 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.
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Mrs Ng Guan Lee stores the narrow tubes containing the plasma eye drops in her freezer, and breaks off a segment of the tube for use every day. She has undergone a painless one-hour procedure to extract the plasma from her blood.
PH
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Water (for moisture)
Oils (for lubrication)
Mucus (for even spreading)
Antibodies and special proteins (for resistance to infection)
Special glands located around the eyes secrete these components. An imbalance of these can cause dry eyes.
How do I know my eyes are dry?When tears are not effective in lubricating your eyes, you may experience:
Pain
Light sensitivity
A gritty sensation
A feeling of sand in the eye
Itching
Redness
Blurring of vision
News> Continued from page 1
Plasma to the rescue
JUL⁄ AUG 2012 SINGAPORe HeALTH 11
was using them every half an hour, especially when I had to work on my computer for a long period. After a while, I started getting a gritty feel-ing in my eyes. On some days, my eyes became so inflamed, I had to rush to the emergency department,” said the 55-year-old procurement manager in the telecommunications industry.
When she was approached to be part of a study to try new eye drops made of her own plasma, Mrs Ng was more than willing to give it a go.
Commercial products are not able to completely replicate the tears we produce, which contain many proteins. Research-ers from the Singapore Eye Research Institute (SERI) and Singapore National Eye Centre (SNEC) believe that the clos-est substitute is plasma – the yellowish fluid in blood that carries all the different blood cells.
These are definitely encouraging results. When we recently announced the findings at an international meeting, the audience was equally enthusiastic.dr LOUIS TONG, CONSULTANT, SINGAPOrE NATIONAL EYE CENTrE, ANd LEAd INVESTIGATOr OF THE PLASMA EYE drOPS STUdY
Mr Hoesny also tried several over-the-counter eye drops and eye gels, but found relief only when he joined the study and started using the plasma eye drops.
Patients in the study undergo a pain-less one-hour procedure, similar to a blood donation, to extract the plasma from their blood. The plasma is then placed in narrow tubes clamped about an inch apart.
Stored in the freezer Patients store these tubes in the freezer and break off the required segments for their daily use. Some, like Mr Hoesny, even double-bag them before keeping them in the freezer to ensure they do not get contaminated. Although patients have to ensure the segment they are using remains in a cool environment throughout the day, neither Mrs Ng nor Mr Hoesny considers it a chore.
“I don’t think it’s an inconvenience at all. In fact, it is worth the trouble because it really improved my dry eyes,” said Mrs Ng, who stores her eye drops in a baby
food container, which is then kept in an insulated bag.
Researchers optimisticThe improved comfort experienced by patients is backed by observations of the study team.
“We observed reduced damage on the epithelial cells (cells at the surface of the eye) after six weeks of treatment. These are definitely encouraging results. When we recently announced the findings at an international meeting, the audience was equally enthusiastic,” revealed Dr Tong.
The team is optimistic that treatment based on this principle may, in future, become the gold standard in dry eye treatment for challenging cases. In the meantime, the team will continue with an observational study for one to two years to look at the long-term effects of the treatment.
Future availabilityThe plasma eye drops will be manufac-tured at the Blood Services Group (BSG) of
Health Sciences Authority of Singapore, which will also aid in storing them for the individual patient.
“As the freezing facility at BSG is reli-able and more spacious, patients can have half their stock of plasma eye drops stored there. When they run out of their supply about five or six months later, they can collect the other portion without having to undergo another plasma extraction process,” explained Dr Tong.
For patients like Mr Hoesny, it is good news indeed. “The plasma eye drops are purely from our plasma, so they are very safe and effective. I was lucky to be part of the study. Although I will now need to pay for them as the study period is over, it will still be a lot cheaper than buying over-the-counter eye drops which are not completely effective,” he said.
“While its composition is not perfectly identical to tears, plasma contains many proteins that are present in tears. The proteins provide a normal, anti-inflam-matory environment for the eye surface and, therefore, plasma could well be a tear substitute,” said Dr Louis Tong, Con-sultant, SNEC, and lead investigator of the study.
Oh, what a relief!Dry eye, a common condition that affects the quality of life of its sufferers, is caused by multiple factors such as ageing, trauma to the eye or certain disease con-ditions. It may also be a side effect of cer-tain drugs or treatment. For example, Mr Hartono Hoesny, 61, developed dry eyes after undergoing a bone marrow trans-plant for cancer.
“I had the transplant about 10 years ago. After that, I developed various reac-tions that affected my mouth, skin and nails. But my eyes bothered me the most because it felt like there was sand in them,” said the supervisor of a food dis-tribution company.
Isfazrina IsmailCalled admission at 6394-1220 from yesterday till today, nobody picked up. Need to ask regarding my delivery admission. Like · Unlike · April 18
0 people like this
KK Women’s and Children’s Hospital Hi Isfazrina, the correct number for Admissions is 6394-1200. Do try to call again. Alternatively, you can email [email protected] if the enquiry is on KKH’s maternity packages. Hope this helps!April 18 at 10.26am · Like · Unlike
Sean HooHi. Is there a cure for scoliosis posture without operation? Can going to sports medicine help? Or whom do I see?Like · Unlike · April 26 at 4.37am
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Singapore General Hospital Hi Sean, you can go to your GP or family physician for a preliminary examination, then ask for a referral to an orthopaedic specialist at SGH. April 26 at 9.36am · Like · Unlike
I went to Bukit Merah Polyclinic for some administrative issues and consultation, and was amazed and delighted by the excellent service there. The sta� who attended to my wife and me were professional, courteous, dedicated and friendly. One of them was Health Attendant Nurrul Aine binte Hussaini and the other was Senior Nurse Anabukkarasi Sakadevan Naidu. Please commend them for their excellent service.- Impressed
I am writing to say that you have such wonderful and dedicated sta�. When my daughter was hospitalised at National Heart Centre Singapore for myocarditis and subsequently at Singapore General Hospital’s Rehabilitation Centre, the family went through an extremely stressful period. However, the commitment and professionalism of your sta� made us feel we were in good hands. They were there for us in many ways.
They kept in touch with us, comforted and encouraged us when we were down, explained things when we were confused and were available when we needed support or someone to talk to. They gave us the best medical care.
My daughter is now under-going therapy at the Society for the Physically Disabled. My family will always treasure the love we received from your sta�. My heartfelt thanks to all of you. - Peter Lim
I would like to express my thanks and gratitude to the sta� of SGH’s Department of Obstetrics and Gynaecology for its warm and e�cient service.
My wife is into her 12th week of pregnancy, and experienced some spotting. We were concerned and I took her to see a doctor. I understand that it typically takes some time to see an obstetrician and an appointment usually needs to be made. The nurse who took my call was very understanding and helped arrange a checkup for me in the early pregnancy unit on the same day. We didn’t have to wait long to see the doctor on duty. A checkup was performed and we were assured that all was fine. We found the entire experience very positive and are looking forward to our next appointment. Keep up the excellent service!- M Soh
12 SINGAPORE HEALTH JUL⁄ AUG 2012
Tell us
immediately. The foreign doctor may also not be able to understand the local accent and vice versa.
But in my opinion, it really shouldn’t matter whether the healthcare pro-fessional is a foreigner or Singapor-ean as long as the service given is competent.- Mr Chim Wai Chong
I refer to the Viewpoint article Where are you from, Doctor? in the May/Jun issue of Singapore Health.
From the letters to the press, it apparently matters whether the doctor is a foreigner or Singaporean. People are concerned if the foreign doctor is attuned to the local culture and lan-guage, and whether he is as competent as his local counterpart.
For instance, the patient may get frustrated if the healthcare professional isn’t able to understand why he is reluc-tant to undergo surgery. There may be issues specific to the local context that the foreign doctor may not understand
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I tried to register on behalf of my elderly and immobile parents at the polyclinic, but was advised by the counter sta� that my parents have to be present during registration. I understand the need to verify a patient’s identity, but I feel that verification is more important during consultation than at registra-tion. Also, only the patient’s name has to be verified, so why do patients need to be present at registration?
I have been advised to have a blood test and was told that I need to visit the hospital. Can you issue me with a medi-cal certificate for this?
No MC for blood test
Why patient has to be present at registration
Doc’s nationality shouldn’t matter
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 [email protected] or The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608, or talk to us on Facebook.
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Tributes
My father died a few months ago. Why does Singapore General Hospital (SGH) continue to send us SMS reminders of his clinic appointments?
Puzzled by SMS reminders
JUL⁄ AUG 2012 SINGAPORE HEALTH 13
Our experts give advice on breastfeeding and floaters in the eye
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Food fearsWhat does baking and having a meal in a group have in common? They are part of a treatment strategy that fights eating disorders. By Jamie Ee
NutritionFollow SGH kitchen sta� as they prepare lunch for patients
p16-17 p18WellnessIt’s easy to protect your child against hepatitis
JUL/AUG 2012 SINGAPORE HEALTH 15
PH
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Feeling fat or overweight despite a dramatic weight loss
Being preoccupied with weight, food, calories, fat grams and dieting; or being extremely concerned with body weight and shape
Refusing to eat certain food, worsening to not eating whole categories of food
Feeling anxious and intensely fearful about gaining weight or being fat
Denying hunger
Developing food rituals such as eating food in a certain order, rearranging food on a plate or cutting food up into tiny pieces
Giving excuses to avoid meals or situations involving food
Withdrawing from friends and activities
Having irregular menstrual periods
Having an excessive or rigid exercise regimen
Those who su�er from eating disorders may be anxious at the sight of butter and sugar.
Those who su�er
disorders may be anxious at the sight of butter and sugar.
YOUNG AND
FEMALE
Eating disorders are getting more common, with an
average of
120 new cases seen
at SGH LIFE
Bulimic patients
tend to be in their late
teens to
30s
About
90per cent of
people su�er-ing from an
eating disorder are women
Anorexic patients
tend to be in their early
teens to
20s
Ms Florence Chiang (left) conducts a
weekly baking class for patients who have
eating disorders.
16 singapore health Jul⁄ aug 2012
Nutrition
Lunch is servedimagine having to cook several meals a day for over 1,000 patients with different dietary needs. that’s the job of sgh Food services Department. We take a peek inside its kitchen as it whips up lunch
8am: Breakfast is over, get ready for lunchThe cooks and kitchen helpers, num-bering 31 at any one time, work two shifts – from 6am to 7.30pm – with a small group in as early as 5am to pre-pare breakfast. The main kitchen closes at around 7.30pm, but a satellite kitchen in the main hospital block stays open for another hour. At the wards, biscuits and milk drinks are available for patients who get hungry between meals or late at night. A variety of meals cater to different tastes, and dietary and reli-gious requirements.
Spices and seasoning for each dish are
carefully measured and prepared
according to the recipe and the
number of orders.
Rice porridge is cooked in huge vats and is served plain or used to make pork or halal chicken congee.
For patients on a low-sodium diet,
no soya sauce is added to the little
saucers of cut chilli.
10.15am-12pm: Roll out the trolleysThe cooks dish the food onto plates according to order chits attached to each tray. The orders indicate the patients’ preferences and dietary restrictions. The order chits for halal meals are printed on green paper. The Food Services staff check the orders before they print the chits, and also before the meal trays are loaded into the trolleys bound for the wards.
The trolleys have a cold compartment to keep fruits and desserts fresh and separate from a compart-ment preheated to 75ºC.
A last check is made before the trolleys are locked and sent to the wards. There, the food is reheated for 20 minutes so patients are served a hot meal.
To make sure orders are served
correctly, food order chits for
each patient are printed, and
arranged by ward and bed numbers.
Left: After cook-ing, kitchen staff dish the meat and rice onto plates and soup into bowls placed on trays, reading off the individual order chits attached to each tray.
Below: At every meal, samples of food that is cooked and served to patients are taken. This is a safety precaution to allow the hospital to quickly track down the source of contamination in the event of food poisoning. SGH is ISO 22000, including HACCP, compliant. This means it ensures food safety – through approved safeguards in areas with the potential for contamination.
Right: Chicken is roasted in trays for a Western meal. Pork, a Chinese mainstay,
is also available. Fish is served as
fillets because of the danger
of bones.
Top and right: Not everything
can be done with technology: Some
vegetables are prepared by hand,
though most are cut and washed in huge
machines.
(Left) For dessert, patients who are
diabetic get a larger portion of fruit such
as watermelon, papaya or apple.
JUL⁄ AUG 2012 SINGAPORE HEALTH 17
8.30-10.15am: Boil, fry, roast, bake
Top and right: Vegetables
stay fresh and colourful, and
retain their goodness in the
halal chiller.
Floors can get dirty and oily after
cooking, and are cleaned after every
meal preparation and when necessary.
Right: Trays holding crockery
and eating utensils must fit well in the
trolleys. Constantly striving to improve
their operations and meal services, Senior
Manager Mdm Koay Saw Lan and Executive
Chef Tan Loon Liang check out alternative
crockery designs.
Preparing the menusWestern, Chinese, Muslim and vegetar-ian meals are available at each meal. Only the Chinese meal is non-halal.If their choice isn’t available on the regular menu, patients can ask for the a la carte menu of mostly Asian-style noodles, while new mothers sticking to tradition can order nutritious food from the Chinese confinement menu.
What it takes to feed a hospital:1,300 meals prepared each time 100kg of rice used a day 26 white and 61 wholemeal loaves of bread served at breakfast110 trolleys used to transport meals to the wardsYoungest cook is 36, who started work at SGH Food Services at 25
Oldest cook is 68 Longest service of 32 years is by a
53-year-old cook
Watching the clock: Sta� work at various times, but the
two main shifts are from 6.30am to 2.30pm, and from 10.30am to 6.30pmA small group starts as early as 5am to cook breakfast
Satellite kitchen at ward 72 stays open till 8.30pm for late ordersBreakfast is served from 7-8am, and the food trolleys leave the kitchen at 6.45am
Lunch is served from 11.30am to 1pm, and the food trolleys leave the kitchen at 11amDinner is served from 5-6.40pm, and the food trolleys leave the kitchen at 4.30pm
What the colours mean: Green-, blue-, grey-patterned plates
and bowls for halal diet; pink and maroon for othersCooks wear white, kitchen helpers wear green and those who do the washing and housekeeping wear blueP
HO
TOS
: VEE
CH
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Left: Everything is huge in the kitchen. Vegetables like the cabbage fried in this wok can feed 80 people.
18 SINGAPORE HEALTH JUL⁄ AUG 2012
Wellness
A jab in timeProtecting your child against hepatitis is not as hard as you think. By Thava Rani
Beware of cockles and needles
Protect your child
The disease is essentially an inflammation of the liver, which may be due to a viral infection or exposure to toxic substances, alcohol or certain medication. Although hepatitis A, B and C are similar in nature, the virus that causes each disease is di�erent.
The ABCs of hepatitis
Hepatitis A Hepatitis B Hepatitis C
Caused by Hepatitis A virus Hepatitis B virus Hepatitis C virus(HAV) (HBV) (HCV)
Symptoms Tiredness, loss of appetite, fever, nausea, vomiting, stomach pain, weight loss, joint pains, yellowing of eyes and skin (jaundice), dark urine, pale stools
In children Less than six yearsold. Usually do not experience noticeable symptoms, with jaundice occurring in only about 10 per cent
Older Experience more children severe symptoms,
with more than 70 per cent developing jaundice
Complications Recovery usually Ninety per cent of About 15 to 20 takes several weeks children may become per cent may developor months without chronic hepatitis B chronic liver cirrhosiscomplications carriers. Of these, or cancer, although
up to a third may this may take develop chronic decades in childrenliver cirrhosis (liver hardening which can lead to liver failure) or even liver cancer
Vast majority of infections are “silent” or without symptoms
Infants in Singa-pore are vaccinatedagainst hepatitis Bas part of a nationalprogramme
Three doses of vaccine adminis-tered: at birth, at one month and at five to six months First two doses o�er rapid protec-tion, while the third extends protection for as long as possible
Generally, repeatvaccinations are notnecessary
Protection is believed to last at least 25 years for many children, and is probably lifelong for someRepeat testing and jabs are advised in children (or adults in later life) if they are at risk, such as if they come into contact with an infected person, require blood transfu-sions or engage in high-risk sexual behaviour
It is not recom-mended for somechildren
Those who develop a life-threatening allergic reaction to a previous dose of vaccine Those who have known allergies to any vaccine constituents such as yeast
Hepatitis B or Ccan be transmitted
through infectedblood left on
contaminatedneedles or razor
blades. Hepatitis A,however, is easilyspread by eatingraw or partially
cooked shellfishor unsanitary
food, like a bananaserved peeled.
It was during the euphoric years after World War II that Western industrialised nations (with the notable exception of the US) first established the foundations of the modern welfare state.
Based on an egalitarian vision of society, one of its tenets was that citizens would enjoy universal access to health-care, funded either by taxes (as it was in Britain, Canada and Sweden) or state-mandated social insurance schemes (the practice in France, Germany and the Netherlands).
Unfortunately, the euphoria did not last long. Well before the recent global financial crisis, healthcare costs in many developed countries were already spi-ralling out of control, fuelled by ageing populations, rising patient demand and escalating costs associated with advances in medical technology. What was once “affordable” grew into a crushing burden.
Healthcare comes at a costHealthcare does not come free. Someone must pay. But who and how? And having settled that question politically, what if healthcare costs grow (they inexorably will, as new treatments and more effective drugs come on stream) into a bottomless pit? There are no easy answers, which is why no country appears to be completely happy with its healthcare system, with many in the midst of reform (and some even moving in contradictory directions with each change of government).
Much of the current debate on health-care reform revolves around the key issue of sustainability. Apart from rationing and queuing, various governments have in recent years sought to achieve this by diversifying funding sources, encour-aging greater individual responsibility through co-payments and turning to the free market in order to deliver healthcare services more efficiently.
It is in this light that the concept of national health insurance and its rel-evance to Singapore, as extolled by advo-cates, such as Dr Jeremy Lim (The Moral Case for Health Insurance for All; The Straits Times, April 26, 2012), ought to be examined.
National health insurance entails a state-mandated, risk-pooling system into which all must pay, and from which all will benefit, so the burden on any one individual is ameliorated.
The idea of universal health coverage is a noble one. But it does not automati-cally lead to better healthcare at afford-able costs. On the contrary, countries with such healthcare systems invariably strug-gle with cost containment, since increased
Singapore’s multilayered healthcare financing system has enabled it to achieve the same goal of universal access to healthcare, while keeping services afford-able and ensuring the system remains sus-tainable in the long term. Over the years, it has purchased for Singaporeans good health outcomes, comparable and often superior to those of other developed coun-tries, at a much lower cost. The country’s total health spending is at four per cent of its gross domestic product (GDP), com-pared with countries of the Organisation for Economic Cooperation and Develop-ment, which spent an average of 9.6 per cent of their GDP on healthcare. In the case of Taiwan, the figure is 6.6 per cent.
The system is not perfect, but it has served Singaporeans well for the last 28 years. Rather than totally redesigning it, what is required is to continue building on its strengths while addressing existing gaps (such as tackling coverage for costly, non-catastrophic illnesses). Greater efforts should also be made to balance efficiency with compassion (for example, showing more flexibility in the implementation of the safety net so no one falls through the cracks).
And yes, the next phase of the evolution of the healthcare system should continue to be shaped by the national conversation regarding the kind of society Singapore wants to be. But make no mistake – despite claims to the con-trary, there is no “magic bullet”.
Viewpoint
Who should pay for healthcare?
The writer is Associate Professor at the Yong Loo Lin School of Medicine and Saw Swee Hock School of Public Health, National University of Singapore. This article was first published in The Straits Times on May 9, 2012.
Patients in a Class C ward at Changi General Hospital, which has six beds in a room. Some Class C wards have eight beds.
access must necessarily mean increased utilisation of healthcare services, not to mention the greater potential for abuse, fraud and wastage.
Indeed, a close examination of health-care systems worldwide suggests that there has to be a more nuanced and mul-tidimensional approach to healthcare financing, and that a one-size-fits-all approach would, at best, be a partial solu-tion. The current trend towards hybrid and structurally complex healthcare sys-tems seems to bear this out.
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While the idea of universal health coverage is noble, there is no one-size-fits-all solution that balances citizens’ needs with rising healthcare costs
JUL⁄ aUG 2012 SinGaPOre HeaLTH 19
Singapore’s multilayered healthcare financing system has enabled it to achieve the same goal of universal access to healthcare, while keeping services affordable and ensuring the system remains sustainable in the long term.
government expenditure account for only 57 per cent of total health expenditure at the national level, with individuals forking out a significant proportion out of pocket.
Furthermore, because of high con-sumption and the inability (politically) to raise premiums to cover rising costs, the scheme was plunged into financial difficulties just a few years after it was introduced in 1995. Since then, NHI’s defi-cit ballooned further – to NT$60 billion (S$2.6 billion) in 2009.
Singapore’s system worksIn contrast to Taiwan, Singapore’s health-care financing system consists of multiple channels of financial support. The 3M system – Medisave, MediShield and Medi-fund – treats the majority of healthcare consumers as co-paying partners, while making special provisions for the minor-ity who cannot afford the co-payment.
Aside from 3M, Singaporeans have access to government subsidies at public hospitals. Thus, the basic medical needs of all Singaporeans, including the minority without insurance cover, are taken care of. In addition, the government periodi-cally pays money (from budget surpluses) into the savings schemes of low-income families and the elderly.
Such an approach not only counters the “moral hazard” generally associated with free-for-service, third-party reim-bursement (Singaporeans know this as the “buffet syndrome”), but also avoids providing the rich with healthcare handouts (as would be the case under a universal coverage system that ignores income status).
BY Lim meng Kin
Consider Taiwan’s National Health Insurance (NHI). It is a mandatory, single-player health insurance scheme that covers the entire population, with con-tributions from households, employers and the government. While the coverage is meant to be extensive, NHI and other
Jul⁄ Aug 2012 singApore heAlth 21
Viewpoint
Most of us have probably seen advertisements – like those hanging from bus and MRT hand-rails, plastered on lightboxes and websites or printed in news-papers – recruiting healthy indi-viduals for clinical research. I never really paid attention to them. I was never going to take part in a clinical trial.
I was wrong.During my student days, my friends
took part in trials out of curiosity or to earn a bit of extra cash. At the time, I was never in such a need of money to consider this income opportunity and definitely not curious enough.
In 2006, the UK was shaken by the “elephant man disaster” at Northwick Park Hospital. Six healthy young men took part in a study of a targeted cancer therapy, which was being tested for the first time in humans. Within hours of get-ting the drug, they were all in intensive care with something close to multi-organ failure. They swelled up so much that the local media dubbed them the “elephant men”. None have fully recovered. I was glad that I’d never been foolish enough to risk my life like that.
Then, I joined the healthcare indus-try. Suddenly, I was reading about clini-cal trials all the time. I was talking to patients whose disease had been stabi-lised by a trial drug when everything else had failed. There were also stories of patients who did well for a while before the disease caught up with them again. But they all had one thing in common –
Becoming a guinea pig for the greater goodHealthy volunteers who take part in clinical trials accept the potential risks in the hope that taking part will benefit patients in future
they took part because they hoped that, if this didn’t work for them, it would benefit patients in future.
I was also talking to doctors who were trying to raise awareness of ongoing trials to attract more healthy volunteers. Unlike patient volunteers, who suffer from illnesses that cannot be treated or for whom current treatment options no longer work, healthy volunteers don’t stand to gain any personal health bene-fits. The researchers said it is often harder to recruit healthy subjects.
As memories of the “elephant men” faded, and feeling safe in the knowledge that only a few studies allowed young women to take part, I enthusiastically vol-unteered myself to one of the researchers. Little did I expect her to tell me that they were about to start a trial that required both men and women.
Half hoping that she would forget my pledge, I didn’t think much about it again. But she did remember. Still, I wasn’t really
worried about taking part in a clinical trial because I had the right to change my mind about participating at any point – even after signing on. But the least I could do was find out more about the study.
So I found myself listening to the prin-cipal investigator of the study explain the trial details – how it was going to work, what kind of study it was and what was required of me.
This procedure is now standard for any clinical trial involving healthy and patient volunteers. But, as recently as the last century, doctors saved patients’ lives by taking chances with treatments that were not fully understood or tested. In 1937, Professor ES Monteiro decided to give a patient, who had been admitted to the old Singapore General Hospital with cardiac beri beri, a dose of vitamin B1. A deficiency of vitamin B1 was suspected – but not yet proven – to be the cause of beri beri. Within half an hour of getting the treatment, the patient sat up in bed, confounding the nurse’s expectations; she had already laid out a sheet in anticipation of the patient’s death. Prof Monteiro used the treatment on other patients after that, achieving a 100 per cent success rate.
There are also instances where such lack of control and protocol led to the exploitation of research subjects. The infamous Tuskegee syphilis study is prob-ably the best-known example. In this study, about 400 poor African-Americans with syphilis were recruited for a study on “bad blood” – a term used to describe various ailments including syphilis. They never got the treatment they needed (even after penicillin became available) because the scientists wanted to observe how the disease developed. All the participants died. In 1997, President Bill Clinton apolo-gised for this atrocity.
Since then, safeguards have been put in place. I was benefiting from the prin-ciple of informed consent that has been
enshrined in research ethics since the end of World War II. Throughout the explanation by the principal investigator, I felt pretty comfortable with the idea of taking part in the study. Nothing much was required of me, the only down side was that the study included a followup period of several years.
But when the principal investigator got to the side effects, which included very rare instances of a possibly fatal con-dition, my heart stopped. He said that the chance of this happening was very small, but he could obviously not guarantee that it wouldn’t happen. Gulp.
Was I ready to risk my health, and pos-sibly my life, to help test this new drug? Or could I become an “elephant woman”?
BY Nicole lim
A doctor briefing a healthy volunteer about a clinical trial to ensure he understands what it entails before he gives his consent to taking part.
A group of healthy volunteers passes the time with different activities. They are taking part in a study that requires them to stay in a unit for an extended period of time.
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If I developed this rare side effect, I’d regret it forever. But then I realised that if all the other potential volunteers felt like I did at that particular moment, and if eve-ryone walked away, then this drug – good or bad – would never be available. Even the incident in the UK didn’t stop people from supporting clinical research, and count-less treatments have since been launched, including a vaccine against cervical cancer and a treatment for Hepatitis C. There will always be some risk. Even taking a fully licensed medicine involves risks. It is just that you know what the risks are.
I am a firm believer in modern medi-cine. If this drug proved effective, then yet another potentially fatal disease (one that I could very easily get) could be thwarted. Surely that was worth taking a small risk for?
A postscriptThese days, most serious studies have multiple “arms”, which are like teams. Participants in each arm either get the test drug or a placebo. When I signed up for the study, neither the doctor nor I knew which arm I was in. It was only sev-eral years after the first consultation that I finally found out. It turned out that I had received the placebo. I felt disappointed. Somehow, my contribution seemed less meaningful than it would have been had I been given the trial drug.
Nicole Lim works for SingHealth. She has been living in Singapore for close to five years.
If this drug proved effective, then yet another potentially fatal disease (one that I could very easily get) could be thwarted.
22 SINGAPORE HEALTH JUL⁄ AUG 2012
Spotlight
Young children are not the only ones who can get hand, food and mouth disease. Adults and youth are vulnerable too
The usual symptoms
Are adults more resistant?
How can I protect myself against it?
Wash hands regularly and observe general hygiene measures
Avoid exposure to nasal discharge, saliva, faeces or body fluids of an infected personDo not share eating utensils Keep toys, books, eating utensils, towels and clothes separate
Avoid close contact such as hugging and kissingClean and disinfect toys and appliances thoroughly if previously used by someone with HFMD
What should I do if I contract HFMD?The disease is self-limiting, which means it will usually clear up in five to seven days. During that period, you should ensure you get enough rest and fluids. Change to a soft diet if mouth ulcers cause too much pain.
What complications should I look out for?
Shortness of breathDrowsiness and disorientation
Severe headache Neck sti�ness
Vomiting Poor oral intake
Fits
See a doctor immediately if such signs are observed.
BY THAVA RANI
DR NG CHUNG WAI, CONSULTANT FAMILY PHYSICIAN, SINGHEALTH POLYCLINICS (OUTRAM), AND CHAIRMAN,SINGHEALTH POLYCLINICS INFECTIOUSDISEASES & INFECTION CONTROL COMMITTEE
HFMD may show up as ulcers in the throat and mouth, and on the tongue. The disease can also cause sore throats.
The disease can also lead to fever and a general feeling of being unwell.
If mouth ulcers are a problem, a soft
diet with food like porridge may be more
easy to consume.
What you should know about HFMD:
How it is treated
PH
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Y IM
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ES
High blood pressure (BP) is called the ‘silent killer’ because there are often no symptoms.
Even though you feel well, you could have had it for years without knowing.
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It’s smarter to monitoryour blood pressurebefore you fall sick.
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By THAVA RANI
A silicone eye is hardly something you would expect to see on a visit to the National Dental Centre Sin-gapore (NDCS). But then again, Dr Teoh Khim Hean is not your average dentist.
Artificial eyes, ears, jaws and other facial prosthetics are tools of his trade. Senior Consultant and Director, Department of Restorative Dentistry, NDCS, Dr Teoh, whose work is in prosth-odontics, is also a specialist in maxillo-facial prosthetics.
The only such specialist in NDCS and one of a handful in Singapore, Dr Teoh was trained in maxillofacial prosthetics at the prestigious Memorial Sloan-Kettering Cancer Center in New York.
Patients at NDCS who see him for prosthetics generally have facial defects brought on by horrific accidents or after they have had cancer surgery. With his knowledge of medicine and dentistry, he crafts prosthetics that “plug” gaps in the face and jaws.
The work calls for artistic flair, as the artificial parts have to blend seamlessly with facial features and skin tones. Inter-estingly, he counts portrait photography as a hobby.
The artist in the dentistAmong a rare breed, Dr Teoh Khim Hean’s work requires medical expertise, a kind heart and a touch of artistry
can do more for these patients, and it’s so rewarding when you see them doing well, or having some normality handed back to them,” he said.
This dentist with a big heart has more that he wants to do. He hopes that NDCS will one day be home to a regional train-ing centre for maxillofacial prosthetics, as such expertise is needed in Asian Third World countries, which tend to have a high incidence of oral cancers.
Currently, he is engaged in training others in the subspecialty at NDCS. He said that to succeed in this field, entrants need two qualities: passion and perseverance.
“The demanding circumstances we work in call for perseverance to see cases through from start to finish. And pas-sion drives us to pursue better outcomes for our patients, to see them healed and whole again.”
The prosthetics are not permanently attached to the face but can be taken out and cleaned every day. They minimise the disfigurement and offer patients hope and confidence to face the world again.
Many patients who see him are emo-tionally devastated, desperate, and dis-traught by their illness and ravaged appearance. He often finds himself having to counsel as well as treat them.
the prosthesis. He recounted how an elderly cancer patient, in this situation, chose not to seek further medical care.
“She felt that she had gone through so much in the previous six to eight months. She told me: ‘I’ve lived enough. I’ve seen enough, I don’t want to continue.’” The scene was so distressing that Dr Teoh’s nurse could hardly hold back her tears.
Emotionally draining but rewardingDr Teoh confessed that the work can take a toll on emotions, which is probably why, he said, not many people are inclined towards maxillofacial prosthetics.
He unwinds by spending time with friends or colleagues, and occasionally taking vacations. However, despite the emotional challenges he faces, he is moti-vated to soldier on.
“You carry on because you feel you
People
Supporting medical researchAs a clinical research coordinator, Ms Liew Yee Yun helps doctors with their research studies at the National Heart Centre Singapore
My job is to… Help principal investigators conduct their research studies. I approach patients, explain the study to them and if they agree, recruit them for the study.
Careful planning, precise coordina-tion, meticulous data collection and dili-gent pouring through of case notes are all part and parcel of my job.
I work very closely with doctors, nurses and technicians. Currently, I’m working on two studies with another potentially in the pipeline.
In the seven months I’ve been here…I have become better at approaching people and understanding doctors’ hand-writing. I’m also grateful for the help I have received from my colleagues.
What most people don’t know about me is that… I can be really stern. Because I look soft and innocent, people, especially my
colleagues, don’t expect me to be aggres-sive. However, I don’t think you can accom-plish much at work if you’re stern.
The one thing I’ll never forget is… The day a patient, whom I had been follow-ing up on, died. I had spoken to him a few days earlier to confirm our appointment.
But when he did not show up, I called
24 singapore health JUl⁄ aUg 2012
Bahru. It helps me relax since I’m so far away from work.
On special occasions like Mother’s Day, my siblings and I will cook a special meal for our parents.
I am… An introvert. Previously, I worked as a lab technician where there was no need for me to interact with people and I was quite happy with that.
But after four years, I realised I needed a change. I decided to challenge myself with a job like this so I could improve my communication skills.
I think research is… A very important aspect in the practice of medicine. Although we may not see results immediately, in the long run, it helps to improve patient care.
It’s a much-needed part of medicine because it pushes us to be better and not settle for the current status quo.
I smile the most when I am… Listening to patients’ experiences and life stories. Whether they end up participating in the study or not, they all appreciate the sharing session.
Within the next five years… I would like to take more courses to improve my skills at work.
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Dr Teoh Khim Hean is one of only a few maxillofacial prosthetics specialists in Singapore.
his mobile phone. His wife informed me that he had died that morning from a heart attack. I was shocked. It made me think how fragile life is.
Life outside work is… All about family. I like spending time with my family and I particularly enjoy the times we go back to our house in Johor
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Ms Liew Yee Yun enjoys listening to patients as they share their life stories.
He has had patients who had their faces “fixed” after the surgery, only to have a relapse; they needed another round of surgery, which, in turn, destroyed all the earlier work to make
The demanding circum-stances we work in call for perseverance to see cases through from start to finish.Dr TeoH KHiM HeAN, SeNior CoNSuLTANT AND DireCTor, NATioNAL DeNTAL CeNTre SiNgApore
25 Header PATH.indd 21 18/6/12 4:43 PM
Moderate exercise is good enough for the heart
Source: Mayo Clinic Proceedings
PUBLIC FORUM:Aches and Pain in Women: Give Pain a CrackTime 2pm-4pmVenue KKH Auditorium, Level 1, Women’s TowerRegistration To register, please call 6394-5038Price $5 per personLearn about musculoskeletal pain and nerve conditions, as well as the common types of pain that women su�er from, and discover the recent advances in pain medication.
PUBLIC FORUMS:• Pregnancy to Parenthood:
Tips from Experts• Age Well, Live WellTime 2pm-4pm (registration starts at 1pm)Venue Ra�es City Convention Centre, Level 4Registration For registration and online payment, visit www.singhealthacademy.edu.sg/sdc/publicforums; for enquiries, call 6377-8709 or email [email protected] $15 per forumReceive tips on topics related to pregnancy and parenting, and get insights into ways of staying healthy while ageing.Registration closes on Jul 25. Seats are confirmed only upon full payment. Refreshments will be provided. Each participant will receive a free goodie bag.
PUBLIC FORUM:Pelvic Floor Disorders – Staying in ControlTime English session (1pm-2.30pm) Mandarin session (3pm-4.30pm)Venue Toa Payoh HDB HubRegistration Call 6321-4671 or 6326-6106, or email [email protected] before Aug 15 to preregister and get a goodie bag while stocks lastPrice FreeFind out about urinary and faecal incontinence, as well as other pelvic floor disorders and their treatment.
EVENT CALENDAR
Visit www.singhealth.com.sg/eventsor the websites of the respective institutions for more information and other listings.
26 SINGAPORE HEALTH JUL⁄ AUG 2012
FYI
All rights reserved. Copyright by SGH (registra-tion no: 198703907Z). Opinions expressed in Singapore Health are solely those of the writ-ers 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 adver-tisements, articles, photographs or illustrations contained in this publication. Editorial enqui-ries should be directed to the Editor, Singapore Health, 7 Hospital Drive, #02-09 Block B, Singa-pore 169611. Tel:+65 6222 3322, Email: [email protected]. Unsolicited material will not be re-turned unless accompanied by a self-addressed envelope and su�cient return postage. While every reasonable care will be taken by the Editor, no responsibility is assumed for the return of un-solicited material. ALL INFORMATION CORRECTAT TIME OF PRINTING. MICA (P) 070/06/2012. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868E).
Editorial TeamAngela Ng (SGH), Lim Mui Khi (SGH), Tina Nambiar (SingHealth), Ann Peters (SingHealth), Deborah Moh (SGH), Wendy Seah (SGH)
Singapore Health is partially funded by SGH Integrated Fund and SingHealth Foundation to advance the health literacy of Singaporeans.
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Jul 14(Sat)
1. Where is cord blood drawn from and why is it important?
2. Which story in this issue did you find the most informative?
Closing date: Aug 6, 2012
Singapore Health issue 17 contest
Include your name, age, gender, address and telephone number. Winners will be notified via phone or email. Incompleteor multiple entries will not be considered.
Email: [email protected] Post: The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608
Winners of Contest 16Each will receive a Backjoy device worth $64.90.
Send in your answers and stand to win a bottle of Genacol Collagen (30 capsules) worth $20.
Prizes must be claimed by Aug 6, 2012.
1. Alicia Chia2. Choo Hang Yong3. Eng Yuen Yee4. Cheryl Lim5. Lim Kheng Seah
Aug 4(Sat)
A Cardi� University study has shown that a brain-training
technique that helps people control activity in a specific part
of the brain could help treat depression. Researchers at the
university used MRI scanners to show eight participants how their brains reacted to positive
imagery. After four sessions, their depression improved significantly.
But there was no improvement in eight others who were asked to think positively, but did not
see images as they did so. The scientists said further research with more people is needed to test the technique’s long-term