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Tumpua n

Senyum – tidak

NOV/DIS

2011

SINgApO

lagi berce rmin ma ta!

Penglihatan sempurna LASIK kerana termasuk bagi merek prosedur a yang didapa yang telah diperbaiki ti tidak sesuai

rE hE ALTh

M3

dur ReLEx supaya beliau kan hobi dapat menerus menyela mnya, berkata: dur ini tidak “Prosesakit, saya ia telah tidak sedar selesai.” pun Ini bererti Prosedur pembetu ReLEx adalah yang lebih kerana lekapan lan pengliha lebih tepat dan tan dan sesudah lebih selesa “Para pesakit pada mata lebih selesa semasa lembut. juga dapat ReLEx adalah pembedahan. suluhan melihat “Prosedu sasaran’ ‘alur r dari prosedur perkembangan dengan kerana lekapan semulaja lebih baik LASIK. di membua tiada kejadian yang lebih lembut Prosedur t irisan ReLEx ini, jadi yang kornea dengan amat tepat agai ‘pemada yang disebut doktor sebdalam menggu man cahaya’ memoto nakan laser dijalanka semasa ng sekeping n berband tisu berbentu untuk yang dipadank ing dengan rawatan LASIK,” kata k prosedur lensa Prof an Tan. kepada diperluk ialah fenomen Pemadam darjah an. Kami an cahaya yang a di mana kemudia lensa ini memfok n membua dan miopian pesakit us kepada perlu ya akan hilang,” ng Prof Tan. suluhan semasa “Ini prosedur alur laser ini dijalanka paling maju merupakan prosedur kata akan menghil terdapat n dan ia yang ia hanya pada masa akkan matanyaang jika pesakit mengam kini. Dan mengger . Pemadam untuk melakuk bil masa 30 berkuran an cahaya gan dalam an pembetu saat sahaja jauh laser ini prosedur Pada masa lan amat ReLEx. tenaga yang pantas dan menggukerana kan bayaran ini, prosedur ReLEx sangat sedikit, nakan dikena$2,500 setiap selesa kepada penjagaa bererti lebih mata termasu n sesudah pesakit.” Para pesakit k pembeda gunaann yang puannya ya yang han. Peng), merasaktelah menjalan semakin Hasil yang sahaja akan i ReLex an ketidaks meluas bukan cemerla membua elesaan seperti Cik Frances Sejauh ini, ng pui tetapi tnya lebih yang kurang Yap (bersama prosedur akhirnya dimamsemasa kadar kejayaan ReLEx mempun akan juga tikan LASIK. dan sesudah anak peremmenggan Oleh Jacquel 100 peratus yai lebih tepat NOVpembedahan. ine chia dan adalah daripada ReLEx ini prosedur Satu kajian memoto yang dijalanka LASIK. ng keluar yang berbentu DIS sekeping ke atas 24 n oleh SNEC orang pesakit k lensa untuk tisu masalah jalani prosedur yang telah rabun jauh. 2011memperbaiki LASIK dan menBosan dengan dikeluar Tisu ini dur bagi ReLEx (satu kan sama kemudia setiap mata) prosekanta cermin n ada melalui seperti yang mendapa daripada lekap dan mata, Cik ti flap biasa mereka memut uskan TerbiTan lebih sukakan75 peratus LASIK atau digunakan dalam Frances ReLEx kerana prosedur melalui Yap bergantu prosedur untuk mereka HosPiTal besar pembedahan irisan lubang semasa dan merasa lebih menjal ani dan ng kepada para penyelid kunci, sesudah LASIK. singaPur a selesa membata keadaan pembeda Namun, Cik Gayathri lkan prosedur Kajian Mata ik di Institut mata. han. doktor KuMPul an saat akhir. Singapu Manokar tersebut penyelid bahagia . ra (SErI), an, 31 pada saatDoktor ik makmal n singHealTH mendapa ces mengala Nasiona kajian pusat Mata yang memilih tahun, ti Cik Franl Singapu mi masalah M4 prosememula ra (SNEC) sebagai yang dikenali kan lubang butang tahun lalu proses percubatelah kungan (di mana an korneany membuk dan berharap dapat kelengmaSa M3 a tidak boleh tikan memaDa m sekata) menyeba boleh diterbal prosedu r reLEx yang M2 tidak seragam bkan pengliha lampau Memoto ikkan. lagI tan yang selepas tIDak – kornea yangng keluar tisu SeNyum “Beliau telah membua prosedur LASIK. M2 lengkap IN mata! mencetu tepat tetapi keHamIl aN Prosedur ini telah t bercerm skan idea saya berasa keputusan yang menyim baiki ralatseperti ReLEX memYap, 32 kecewa,” pan lensa untuk yaNg maNIS tahun, yang kata Cik nyebabk refraktif (yang supaya miopia ini HIDup SepeNuH ia an rabun pasrah harus gunakan memerubah jauh) dengan kehidup boleh digunakan cermin mengbentuk an HatINya dalam seumur hidupny mata dan kornea. hari nanti seseorang kemudia kanta lekap a. Tetapi, n suaminy masalah untuk membet pada tahun a telah ulkan presbiop lalu, memuju dekat. ia berjump atau k beliau rabun a dengan supaya ReLEX menggun “Kataka Profesor Pengarah Donald Perubata ser saja presbiop n anda mengala akan satu Tan, n, Pusat untuk Singapur ia laMata Nasional a (SNEC), di kemudia dalam kehidup mi tepat pada membuat insisi an anda setelah n kornea tang kemajua hari selepas reLEx. pada pesakit. n yang dicapaimembaca tenprosedu teorinya etulan pengliha r mengam , kita dalam pembbil tan yang anda yang semula lensa boleh Prof Tan diusahak kepada miopik dan pasukan an oleh terima kasih laser untukdisimpan, gunakan nya. Semasa membua boleh didapati, mendapa negatif ng nilai yang selesa Prof Tan, lebihan tkan nasihat pada lensa Lutut palsu dan menana Cik Yap dari mendapa prosedur t tahu tentang kornea anda mnya semula itu baru yang pada yang palsuuntuk teknologi komputer untuk bukan sahaja masalah kirinya dengan mereka Flap ini presbiop membetulkan sesuai gantikan lutut (SGH) pada diangkat mata. Ini ia pada lubang butang,yang mempun keluar lensa untuk Besar Singapura sebelah yai masalah pada dasarny di Hospital intro-kor melaser member tetapi juga an pada Dissepadan sakit dan a akan nea yang i Diperkenalk G emuanG dengan cepat, tidak sebberkesan dan anda anda pengliha tan Oleh Keith pesakit. ralat refraktif bulan Januari. ini dikenali kan masalah dalam membet mono lalu, teknik semula,” dapat melihat dekat ember tahun Lutut (Perulkata profesor teruk sekalipurabun jauh (miopia) Keseluruhan Tan, pengara n Penggantian n. Pada yang h perubat Donald – menggunaka lalu, Cik berja- agai bulan Mac Lensa ini para penyelid an, SNEC. Yap telah Khusus Pesakit) Mohd Tahir diambil tahun menjadi ik sedang mencub rakyat untuk membantu kinan disimpan(dan kemungringan. alatan Puan Manisah salah yang a komputer Singapur untuk itu seorang langkah gawetan teknologi membek menyim a yang lutut palsu menjalan krio untukmelalui penlan dengan pan lensa u dan begitu sebepertama meletakkan di masa i prosedur dari digunaka dikeluar yang telah beliau tidaklah doktor bedah akan datang) ReLEx (Ekstrak yang untuk mendapattikul Refrakti n hasil kan di dalam hidup Tapi keadaan daripada sakit nitrogen flapbebas tepat dua dekad, beliau f). si Lencecair sebelum pembedahan ini ditutupsebelum Lin, akhirnya , yang hampir Dr Chin Pak lum ini. Selama Tidak seperti semula. dikenali satu kaedah yang Apalutut yang melemahkan sebagai Moh Tahir, bersamalutut yang baru. kan penyesuaian prosedur kesmenggu Puan Manisah sebenar pula. pengaw (cryopre dengan masalah mengganti nya dengan LASIK, etankrio servatio tepat, ia nakan duapembedahan yang semasa pembedahan n), yang digunak laser dan ya. pembedahan yang terus membelengu dipasang dengan tisu korneasejenis an biasa mengew pergerakann yang semasa untuk bila lutut palsu darah tali dalam menyim ap panduan tepat sakit di akitan dan membatas pan lebih lama lagi. lihatan, prosedur membet ulkan dalam program saya merasa Apabila pusat dan sel induk. umur, pengboleh bertahan l, rod ReLEx sebenar. digunakan satu presbiop “Pertama kali Walauberbeza kerana laser kan dan konvensiona menggu ia akhirnya dialami pada awal 90an. “Setiap pesakit nakan n “pembedan teknik sahaja. Tanpayang membolehka beberap Melalui teknik tulang ia sering lutut saya ialah a “pemmengew dan gaya hidup tisu yang seseora digunakan dalam boleh bergerak, apkanSemasa ng pesakittahun kemudia ara initidakkomputer diperluk jantina, bangsa Flap dilakukan. pelurusan yang baru dan inimeman, untuk menana an, laser pun saya masih memaka n perkara-perk boleh meranyang dahan maya” n kesilapan setelah beberapa pulih, tetapi doktor bedah ini membolehka m semula memilih ini,generasi pembedahan digunakan maya” saluran n masa untuk yang telah boleh menyebabka bengkak. Namun, saya menjadi sangat lensanya bedahan dalam prosedur hanya sedikitpesakit merasa gkan sebelum pelurusan dalam lutut yang perlu dilakukan dipertimban dalam salahdipotong keluar tulangketidaks Pak Lin, Konsukkan rod syaf saan berdiri, tahun, masalah selepas cang pemotongan kata Dr Chin maklumat satu kornean ke pusat dalam untuk mengata saya tidak boleh Semula pembeda eledilakukan,” tulang itu mengirim tulang – rongga han. n Pembinaan teruk sehingga tanpa merasa i sumsum dan selepas si masalah ya di Amerika presbiop Perkhidmata syarikat mengandung Orthopeg atau tidur sultan, ia lemak, yang atau mengub menyangkun Pembedahan boleh suai pembias n embolisme ini kepada sebuah juga amat teruk prosedur Dewasa di Jabatan makan saya acuan memotong an jika ia ah – boleh menyebabka memasuki mengiku pasaraya sakit. Selera supaya satu yang menjalankan berubah mengikut t masa. mana tisu lemak juruwang sebuah dik di SGH, ini adalah unik keadaan di sistem pernaterjejas,” kata jam itu. dibuat. Acuan masa sebudan menjejas terjejas 54 tahun itu. selama setengah mengambil aliran darah lutut yang yang berusia sebagai pesakit tersebut, Pertama sekali, dan digunakan masa n MRI kemufasan. menggunaka lan untuk dibuat ini memerlukan dihasilakan diimbas n ikut ukuran Teknik baru dan masa satu dimensi akan Penyesuaia yang lebih singkat satu imej tiga anak itu menjalani dian, orang pembedahan anestesia, dua n mengIbu baru untuk menggunaka . yang pendek pembedahan prosedur pembedahan doktor bedah besar semasa juga Namun, para satu risiko menilai persiapan pembedahan ortopedik akan individu dan Masa untuk peralatan pesakit secara nan kerana sedikit dikurangkan dan pensaizan memberi saranan-sara tahap diperlukan terlebih mereka berdasarkan sahaja yang dan sejauh telah ditentukan kesakitan pesakit bahan implan

dahan

FOTO: ALECIA

NEO

dengan pembe

Rawatan yang bole diterbalik h kan?

Ekstraksi Lentikul Refraktif (ReLEx)

ILuSTrASI:

hEYMANS

ThO

FOTOS: TAN

WEI TE

at Lutut yang ku

Perlukan lutut

baru?

upaya mana kekurangan Puan Manisah ialah sendi yang mereka, seperti ya sangat Sendi lutut antara tulang yang pergerakann kompleks di tulang kaki lututnya yang terbatas oleh kesakitan punggung dan yang lebih dan teknik ini rosak teruk bahagian bawah engsel ini Buat masa sekarang, sangat. n satu set peralatan yang amat besar. Tulang tempurung membolehka dalam dilindungi oleh disesuaikan oleh implan yang telah tetapi bahan Prosedur standard mengambil lutut dan dikelilingi lutut dan cecair yang pembedahan mungkin tiga penggantian ligamen, otot pergerakan licin. satu hingga n mengikut ukurantidak lama lagi. masa antara menggalakka termasuk lutut boleh dilakukan keseluruhan jam dan pemulihan, masa berusia Penggantian dibentuk seperti mereka yang n fisioterapi mengambil Sendi palsu bulan. kerana membolehka sesuai untuk tiga dan tahun asli 80 kira-kira dan yang ini terjadi di antara 60 lutut yang normal. Osteoartritis sendi pergerakan dari bahan implan tahun, 95 peratus selama 15-20 apabila rawan dan boleh bertahan telah rosak kepada bagaimana bergantung Lutut palsu menjejas fungsi lutut itu digunakan. lutut. Pembedahan n penggunanya sendi boleh membolehka mengganti bergerak seperti berjalan dan ia tidak boleh merubah kehidupan normal, tetapi aktiviti lasak seseorang yang lutut sendi bertahan dengangunung atau berlari mengalami ini rosak teruk seperti mendaki jika kegiatan yang telah n maraton, terutama dan menyebabka kerap dilakukan. kesakitan yang

dahulu. an perbanding n keduaAsas untuk telah menggantika Puan Manisah lutut kanannya – pertama – n pembedua lututnya 2009 menggunaka – pada April

dahan standard. n lutut yang “Setelah menggantika lebih awal dan bergerak kedua, saya boleh lebih awal. Saya juga berhenti kepada pendarahan terlalu bergantung , tidak perlu pembedahan sakit selepas yang ubat penahan dengan pembedahan berbanding 2009,” katanya. saya jalani pada seperti ini tidak merasa “Saya telah 30an,” katanya. sejak saya berusia

banyak.

01-08-10 CancerMgt + SpineSurgery V5 WF path R3.indd 1

21/10/11 2:41 PM


02

singapore he alth

Nov⁄ Dec 2011

News

The auditors are in the house Healthcare experts check patient safety and quality standards at SGH to see the ceiling. The reason? In the event of a fire, would smoke and flames spread to other rooms through the false ceiling? They also looked at patient files, going through their history and checking that the protocol and procedures were consistent for each department that the patient was seen in. The doctors, nurses and other healthcare personnel involved in the care of that particular patient stood by for questions, which could be about anything.

An auditor (left) queries hospital staff about how food is prepared for patients. Another auditor (right) checks to see if the false ceiling provides a passageway for fire to spread to other rooms.

“What’s your ‘aha!’ moment?” That was the formidable question that confronted some of the staff of Singapore General Hospital (SGH) earlier this year. The question, posed by one of four healthcare experts during a five-day audit of the hospital’s procedures and services, was meant to find out what new insights the healthcare team – doctors, nurses, allied health and other professionals – learnt when they were surveyed. The experts were in SGH for the onceevery-three-years check that awards hospitals with the prestigious Joint Commission International (JCI) accreditation – an assurance to patients of the high safety

and quality standards the accredited hospital operates under. For SGH, the visit in July by four experts – healthcare professionals at US hospitals – was the third time it was being audited and re-accredited. SGH was first accredited in 2005. For five days, the four went around the hospital, with SGH representatives in tow to facilitate their probing. Every morning, before they started their rounds, the auditors presented their findings and feedback – how things were done well, what could have been done better and what needed to be addressed. Meticulous checks In their rounds, nothing escaped their

scrutiny. They looked, they poked, they asked tough questions. They went everywhere – and anywhere. In the kitchen, they were shown the vegetable-cutting room where high-tech equipment is used to prepare vegetables hygienically. At the pharmacy, an auditor checked stocks and storage conditions. In a place that acts as a functional living room for patients with mobility problems such as walking or getting up, the auditor pointed out the importance of having chairs with armrests to provide support to make it easier for people to get up. In a quiet corridor, an auditor asked

In their rounds, nothing escaped their scrutiny. They looked, they poked, they asked tough questions. They went everywhere – and anywhere.

And, of course, there was that question – What’s your “aha!” moment in this? JCI accreditation isn’t just about passing a safety check. The audit forced staff to step back and think about what they did, and why they followed certain procedures. While the question kept staff on their toes during the five days, it also represents the learning that continues long after.

We cleared the JCI safety audit KK Women’s and Children’s Hospital Latest accreditation: Nov 29, 2008 National Cancer Centre of Singapore Latest accreditation: Sep 25, 2010 National Dental Centre of Singapore Latest accreditation: Dec 11, 2010 National Heart Centre of Singapore Latest accreditation: Jul 21, 2011 Singapore General Hospital Latest accreditation: Jul 16, 2011 Singapore National Eye Centre Latest accreditation: Dec 18, 2009 SingHealth Polyclinics Latest accreditation: Sep 10, 2011

During the investigative sessions, an auditor inevitably asks hospital staff: “What is your ‘aha!’ moment?” The audit is as much about whether the hospital’s procedures and services meet JCI standards as it is about the new insights which investigations reveal about the work that is done every day.


NOV⁄ DEC 2011

singapore he alth

News

Pick up health tips before you see the doctor

On top of its original videos, Wellness TV has produced more than 100 SingHealth clips with input from its doctors and other staff. The video library is growing, with more than 200 clips to date, and ranges from more serious medical issues such as cancer treatment to lighter lifestyle tips on food and diet, exercise, hobbies, beauty and even cooking programmes.

SGH rolls out Wellness TV in waiting areas

Waiting time can be converted to learning time. I felt a video would be better received than printed material.

PHOTOS: Vernon WONG

Mr Yasuo Yokoi, founder of wellness tv network

TV screens showing bite-size, health-related video clips are being progressively installed in the waiting rooms of SingHealth institutions.

BY Thava Rani

Waiting to see the doctor, the patient faced his queue slip and the electronic queue number display on the wall. Just then, an idea came to mind – one that would spawn a new business for Mr Yasuo Yokoi. “Waiting time can be converted to learning time,” said the 59-year-old, who thought about how unproductive waiting time could be put to good use. “Entertainment that promotes a healthy lifestyle for waiting patients,” he thought. The concept began to take shape. Mr Yokoi is the man behind Wellness TV Network, which is dedicated to educating and entertaining patients in the waiting area. With a quarter of a century’s experience in advertising and another 11 years in broadcast media, Mr Yokoi certainly had the industry knowledge to set up a media company. But for his idea to take off, he had to convince healthcare group SingHealth to agree to install a TV network, and develop medical content together by sharing health and medical information in a bite-size, easy-to-understand format. “I felt a video would be better received than printed material. And I knew miniclips were the way to go. Having many short clips to capture the various interests of different people is better than showing one long clip,” said Mr Yokoi. That was in 2008. Today, his partnership with SingHealth is stronger than ever. Following the first screen installed at Singapore National Eye Centre in March 2010, Mr Yokoi has added more than 200 television and media player sets at other SingHealth institutions, such as National

A patient waiting to be seen at SGH’s Clinic G, Ms Choy Oi Lin, said: “I find the programmes educational and informative. Before Wellness TV, the clinic used to show the news and some sitcoms, but I find these more useful.” Mr Yokoi is passionate about the concept of Wellness TV and, in this, he has the support of his father who lives in Japan. “My father’s mission for me was to contribute to Singapore society. That’s what keeps me going and this is my life’s work,” he said.

Now showing When

Programmes are shown daily from 8am to 6pm (Mon-Fri) and 8am to 1pm (Sat).

What

Medical issues like cataract, LASIK, coronary artery disease, pacemakers, stroke prevention, diabetes, asthma and pregnancy, as well as lifestyle topics such as food nutrition, yoga, pilates, bag designing, flower arrangement and gardening. Every three months, 20 to 30 per cent of the content is refreshed, but certain programmes like Benefits of Hand Washing are perpetual messages.

Where else

Some programmes are available on YouTube, so viewers who are interested in Wellness TV clips can continue watching them at home.

Clinic-specific programmes

Wellness TV programmes are customised for each clinic, unlike broadcast TV which shows programmes that don’t target any particular group. For instance, programmes for National Heart Centre Singapore include more heartrelated content than those for other places. Clips for SGH’s Obstetrics and Gynaecology clinics show content relevant to their patients.

In focus

Mr Yasuo Yokoi (top), the founder of Wellness TV, and his team (above) worked closely with SingHealth to produce health programmes to entertain and educate patients in the waiting areas of the healthcare group’s clinics.

Heart Centre, KK Women’s and Children’s Hospital and SingHealth Polyclinics. Tailor-made healthcare programmes are shown on screens to entertain and educate patients in the waiting area. More recently, Wellness TV made its debut at Singapore General Hospital (SGH) and its programmes can now be viewed at the Specialist Outpatient Clinics at Block 3 and the Obstetrics and Gynaecology clinics at Block 5, and will be progressively extended to other clinics.

Can you guess what this is? See page 24 for the answer.

03


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Why collagen is important? 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).

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Nov⁄ Dec 2011

singapore he alth

07

News

Specialised clinic opens at heart centre

PHOTO: alvinn lim

The new Cardiomyopathy Clinic at NHCS provides more specific care for patients suffering from this condition

Dr Tang Hak Chiaw (right) says the dedicated sessions at the clinic will help physicians treat and manage patients like Mr Tan Chuan Hock (left) better.

By Thava Rani

Walking up a flight of stairs caused him great distress. He needed to rest every third or fourth step, just to ward off that worrisome, uncomfortable feeling in his chest and left arm. Still, he didn’t think much of it. It was only during a routine company medical checkup that Mr Tan Chuan Hock’s condition was picked up. Unlike his previous checkups, this one required him to undergo a treadmill test which highlighted abnormalities in his electrocardiogram (ECG). He was immediately referred to a specialist at the National Heart Centre Singapore (NHCS). Never heard of it Following various tests and scans, he was diagnosed with hypertrophic cardiomyopathy (HCM) – a condition where there is an unexplained thickening of the heart muscles. “I was worried because I hadn’t heard of it. None of my friends have it. But at least, I finally understood why I became breathless when playing a strenuous game of badminton,” said Mr Tan. Now, he takes his medication daily and tries to take it easy on and off the court. The staircase is less of an issue for

the 55-year-old businessman too, as the discomfort is less severe and comes on only if it is a long flight. “While his medication doesn’t reduce the thickened muscles, it helps control his symptoms, like keeping his blood pressure in check,” said Dr Tang Hak Chiaw, Consultant, Department of Cardiology, NHCS. Are you at risk? Patients with HCM can also develop complications such as atrial fibrillation (abnormal heart rhythm) and sudden cardiac death (see box). Knowing if they are at risk can make the difference between life and death, which is why patients like

Mr Tan now consult Dr Tang at the newly opened Cardiomyopathy Clinic at NHCS. Set up in March 2011, the clinic runs once a week and sees about 10 patients each time. It eventually expects to receive some 300 patients. “HCM is not new but, with the Cardiomyopathy Clinic, we can manage these patients better as we know what to anticipate and what the best treatment is,” said Dr Tang, who was trained at a hospital with the highest cardiomyopathy patient load in the UK. At the clinic, not only does Dr Tang treat the symptoms, he also actively looks out for possible complications, conducts risk assessment for sudden death and recommends the necessary treatment to prevent it. He is in the process of setting up a registry too, so the clinical manifestation in the local population of the various races can be studied. “Because of the dedicated session here, I have more time and tend to ask more questions. I think I have a better understanding of my condition and its risks now,” said Mr Tan. Screening relatives As the condition is hereditary, Dr Tang also encourages screening for the immediate relatives. Parents, siblings and children of patients have a one in two chance of having the condition too. “Two of my brothers had a stroke when they were in their 40s, and there’s a possibility that my father died from this condition at age 55. I told my siblings about the condition, but they have not done anything about it,” said Mr Tan. With the clinic in place, NHCS hopes to increase awareness of the condition and highlight the importance of screening relatives.

HCM and sudden cardiac death in young adults HCM is a known cause of sudden cardiac death in young adults. A study in the US has shown that it is the most common cause of sudden cardiac death in adults under 35 years old. In Singapore, the sudden deaths in young adults have been attributed to other causes. According to Dr Tang Hak Chiaw, Consultant, Department of Cardiology, NHCS, all HCM patients need to take additional precautions and avoid

participation in strenuous activity. For those with risk factors, additional interventions such as implanting an implantable cardioverter defibrillator may be warranted to prevent sudden cardiac death. Risk factors include a substantially thickened wall, a family history of sudden death and the presence of abnormal heart rhythms such as ventricular tachycardia and unexplained fainting spells.

Quick facts on HCM What is hypertrophic cardiomyopathy (HCM)? A thickening of the heart muscles can arise in hypertension or in some valve-related heart conditions, but a diagnosis of HCM is given when the cause of the thickening is not known Thickening usually occurs at the septum (muscular wall that separates the left and right sides of the heart) How common is it? Studies overseas indicate the occurrence is about 1 in 500 in the general population What are the symptoms? Most patients do not have any symptoms In those who do, the more common symptoms are chest pain and breathlessness on exertion. Others include fainting spells or palpitations What causes it? Currently, up to 60 to 70 per cent of the time, an abnormal gene can be detected in an affected patient The cause in the rest is still not known When will I get it? An inherited gene may be present, but a patient is not born with the condition It usually manifests in the teenage years when the heart starts to grow, but can also occur at the age of 30, 40 or even 50 How would I know if I have the gene? Genetic testing (not available locally) can identify the culprit gene The test can be done overseas, but it may be costly and take a few months before the results are known What should I do if an immediate relative has HCM? Anyone who has an immediate family member diagnosed of the condition should get screened Screening involves an electrocardiogram and echocardiogram How is it treated? In 80 per cent of patients, medication is able to control the symptoms If symptoms cannot be controlled, further interventions can be done, like surgery to remove excess muscle, but not all patients are suitable candidates for this What happens in the long term? Complications such as atrial fibrillation may develop, increasing the risk of stroke Congestive heart failure and sudden cardiac death are possible complications


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News > Continued from page 1

Smart drugs to battle cancer

PHOTO: GETTY IMAGES

A cocktail of drugs may be needed to battle cancer that has developed resistance to the treatment.

The signs are encouraging. Mrs T’s stage four breast cancer appears to have stabilised since she began her cancer treatment.

first-line regimen” in patients with a certain type of metastatic breast cancer. This new drug, developed by Genentech, a member of the Roche Group, could join the ranks of “smart” cancer drugs that target malignancies based on their molecular characteristic. Roche has said it plans to submit pertuzumab for approval with healthcare authorities, as the trial is showing that patients with advanced breast cancer using the new drug are living much longer without the disease getting worse – in what is termed progression-free survival. If successful, CLEOPATRA will add to the world’s arsenal on what seems to be mission impossible – the war on cancer.

Both drugs showed exceptional success in patients with advanced melanoma. These were huge achievements in the field of targeted therapy. Roche and BMS are also planning to study whether the two drugs may be more effective if used in combination. Still, the hope a new drug brings remains tempered by the emotional and mental anxiety of living life as a cancer survivor. “What cancer survivors fear is a relapse. Every time a cancer relapses and

Less side effects than chemo In the protracted battle against the deadly skin cancer melanoma, two drugs hurdled Food and Drug Administration approval in the US this year – ipilimumab and vemurafenib. Ipilimumab, marketed as Yervoy from Bristol-Myers Squibb Co (BMS), aims to boost the patient’s immune system to fight advanced stage melanoma, while vemurafenib, known as Zelboraf from Roche and Japan’s Daiichi Sankyo Co, works by blocking a genetic mutation that is seen to help the melanoma grow.

PHOTO: PHOTOLIBRARY

Mrs T’s battle Enter the new smart drugs A poster child of the new molecular drugs is Glivec – which has transformed the treatment of chronic myelogenous leukaemia (CML) and gastrointestinal stromal tumours (GISTs). “For example, if GIST has spread all over the body, the usual survival is less than a year. But nowadays, with this drug, you could easily be alive four to five years later. This is an example of how the goal is not to go for the cure, but to go for containment and converting cancer into a chronic disease.” Another drug is pertuzumab, a treatment which has passed initial safety assessments and is completing phase three trial. Known as CLEOPATRA (which stands for Clinical Evaluation Of Pertuzumab And Trastuzumab), the study evaluates whether the drug can be part of “a

At stage four, Mrs T’s cancer had spread from her breast to her liver. She opted to take part in the CLEOPATRA trial to give herself the chance of winning her fight against cancer, although she does not know if she is getting the drug because it is a double-blind trial.

Dr Yap Yoon Sim is treating Ms T’s cancer as part of the CLEOPATRA trial at NCCS.

The CLEOPATRA trial Mrs T, a breast cancer survivor, is taking part in the CLEOPATRA study at NCCS (see box). She doesn’t pay for her cancer treatment because she agreed to participate in the clinical trial of pertuzumab. But once “smart drugs” reach the market, they can get expensive, especially without insurance. The NCCS is one of several medical centres worldwide participating in CLEOPATRA, which is a randomised, double-blind, placebo-controlled trial to eliminate any bias from doctors or patients if they know they are receiving the new drug. Mrs T’s stage four breast cancer appears to have stabilised since she began her treatment. Dr Yap Yoon Sim, Senior Consultant, Department of Medical Oncology, who is treating Mrs T, said the signs are encouraging. “The problem is that we can’t always tell patients that they have been cured of the cancer because, in general, stage four for most cancers is not curable. But with improvement in treatment options, it is not impossible. At the same time, if we say that they are totally cured, it may not be true, because one day it may come back,” Dr Yap said.

Mrs T found cancer in her left breast when she was 53 years old. She underwent a mastectomy, chemotherapy and radiation therapy, and seven months after her diagnosis, she was in remission. That was 2002. Seven years later in early 2009, despite vigilant mammograms and full blood count checks, the cancer returned – it had metastasized into her liver. It was stage four cancer. Mrs T, who chose to be anonymous, then decided to participate in CLEOPATRA – a trial of a new drug known as pertuzumab to combat latestage breast cancer. Mrs T’s therapy includes chemotherapy – at least for her first nine treatments until she complained of serious numbness in her hands and feet – and Herceptin, another “smart” anti-breast cancer drug. CLEOPATRA is her third “drug”, but she doesn’t know if she is among half of the 808 patients in the global

clinical trial who are receiving pertuzumab. Every three weeks, Mrs T goes to National Cancer Centre Singapore for her intravenous treatment of anti-cancer drugs. Every nine weeks, she sits for a CT scan of her chest and abdomen and radionuclide imaging to check the status of her cancer. In late August, Mrs T was up to her 45th intravenous treatment since she relapsed over two years ago. She is 62 years old now and her condition has stabilised. “Even though it is a trial, it’s a double blind, so you don’t know if you get the new drug. Only the company knows. I thought, ‘Why not?’ Maybe the new drug will have more breakthrough. This trial, they pay for everything… and if I get the new drug, then I would be getting better that much more,” she said.

PHOTO: ALVINN LIM

“If you think of cancer as elusive terrorists, you’ll know it is a frustrating and long war because you usually can’t get rid of all of them once they have left their hiding place and spread across the world. Let’s say a surgical strike wipes out all the terrorists hiding out in the mountain. You think you’ve eradicated them. But then, there’s this lone terrorist on a plane to Libya, another crossing the border to Pakistan and yet another flying to the United Kingdom. You don’t always know where they are. “You normally can’t fight every single cancer cell that has spread, just as it’s hard to defeat every single terrorist in a cell somewhere deep in a jungle. You just have to contain them. You have to create a drug and a strategy that can contain them systemically,” Dr Toh said.

the battle of drugs against cancer begins again, the chances of further drugs working get less and less because of ensuing resistance,” said Dr Toh. Over time, a cocktail of drugs for one cancer may become ineffective as the cancer changes and/or builds up resistance to the treatment, usually prompting a new set of drug therapy. Many cancer patients live longer and live in much better shape than they might have otherwise, by moving on to available new treatments once their current cocktail loses its potency. The fact that more drugs are now available means treatments can be combined and sequenced to keep the cancer in check.


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NOV⁄ DEC 2011

News

Wait till morning A toothache might hurt badly, but it’s not considered an emergency unless there is an infection and swelling About 80 per cent of all dental cases seen at the A&E of Singapore General Hospital (SGH) are toothaches. While traumatising, they do not warrant a trip to the A&E and can wait till the morning. The real emergencies Dr Lai Juen Bin, Associate Consultant, Department of Oral & Maxillofacial Surgery, National Dental Centre (NDC) of

Singapore explained that the A&E is only equipped to handle urgent dental cases such as road accident victims who have a fractured upper or lower jaw, mid-face, or teeth. Facial fractures need immediate attention because if left untreated, the bones will set unevenly, leading to a misaligned jaw and subsequent difficulty in eating. Emergency cases – usually injuries from accidents or trauma – need immedi-

ate attention. They include uncontrolled bleeding (from the gums), facial swelling due to dental infections, loosened or dislodged teeth, broken teeth, mid-face fractures, and severe cuts to the gums, lips or cheek. Others are severe tooth infections which have spread to the face, causing facial swelling or neck swelling. These must be treated immediately. If left untreated, the swelling can eventually cut off the air supply.

dental X-ray. Because of this, patients with toothache who seek A&E treatment may be reluctant to undergo a procedure as permanent as tooth removal – especially when it’s uncertain exactly which tooth is causing the trouble. But no one is turned away. “Patients who come in will be treated. However, it is advisable that they seek dental treatment afterwards, at NDC or any other dental clinic*.” Pain relief at home Dr Lai said toothaches can be alleviated at home with over-the-counter painkillers most of the time. For simple toothaches, painkillers such as paracetamol or aspirin, or anti-inflammatory drugs are prescribed. These can be taken at home. In the A&E, walk-in patients are registered, triaged by a nurse, examined by a medical officer, then, depending on the severity of the problem, seen by a dental officer or an oral maxillofacial surgeon. What may also be given for temporary relief is a local anaesthetic injection and medicated dental fillings to soothe the tooth. Patients who get these fillings must return to a dentist to have the temporary fillings replaced with proper ones. NDC operates from Mondays to Fridays, 8am to 5.30pm. Consultation is by appointment only. For more information on toothaches, dental trauma and emergencies, visit the Conditions and Treatment Glossary at NDC’s website – www.ndc.com.sg.

Patients who come in will be treated. However, it is advisable that they seek dental treatment afterwards, at NDC or any other dental clinic. Dr Lai Juen Bin, Associate Consultant, Department of Oral & Ma xillofacial Surgery, National Dental Centre of Singapore

Patients can manage the pain of toothaches at home with painkillers rather than visiting the accident and emergency department.

Non-emergency cases In contrast, common dental problems such as extractions, root canal treatments, scaling, dentures, crowns, bridges and implants are considered non-emergencies. Dr Lai said the A&E is not fitted with the necessary equipment for these common dental problems. For example, there’s no

*Corporate Dental Clinic at 38 Haig Road (after-hours hotline 9670-7300) is an emergency dental clinic.

Getting to grips with the problem An elderly cancer patient’s handgrip can predict how long he can live, and may be useful in determining treatment

In the last decade, studies have linked the strength of a person’s handgrip to his body strength and lifespan. Now, National Cancer Centre Singapore (NCCS) researchers have tested how it relates to survival in elderly cancer patients. The results of their study – on 249 newly diagnosed patients aged 70 years and above – were presented at the American Society of Clinical Oncology’s Annual Meeting in Chicago this year. Dr Ravidran Kanesvaran, Associate Consultant, Department of Oncology, NCCS, and principal investigator of the study said: “Our study concluded that low handgrip strength consistently related to higher chances of early death in elderly cancer patients.” He said that there are numerous handgrip studies related to survival but the NCCS study is in a niche area focusing

on patients in this age group. The results will pave the way for more research to be done to help doctors decide how aggressively (or not) to treat the cancer in their elderly patients. Currently, some may be under-treated if their family or doctor has doubts about their ability to tolerate treatment. Stronger grip, better survival While the study is still in its infancy, interim results strongly indicate a positive relationship between handgrip

A dynanometer, like the one shown here, is used in handgrip testing of elderly patients. PHOTO: NCCS

BY Ruth Loh

strength and overall survival. “We hope the information will enable us to better stratify the elderly into appropriate risk groups for physicians to make informed choices regarding their treatment.” He added: “Patients in the study who were of the same age, weight, height, performance status, nutritional status, gender and stage of disease were found, for each pound of excess force shown in the handgrip test, to have a three per cent increased likelihood of survival.” In other words: Stronger grip equals better survival. Dr Ravidran said, at present, the preliminary study results will not change the way oncology is practiced, but it provides an impetus for researchers to explore the role of handgrip tests further, and may in future impact the lives of patients.

How is handgrip testing done? Patient remains in a standing position

With hand slack against the thigh, the patient clutches the handle of the handgrip dynanometer

The patient is asked to squeeze as hard as he can

As he begins squeezing, he is asked to extend his arm upwards till his fist is at shoulder height

The test is done twice with both hands and the best score is recorded


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Tell us

Confusing queue numbers at clinics As a frequent visitor to Singapore General Hospital’s (SGH) specialist clinics, I am puzzled by the numbering system. Patients are given a queue number that reflects their appointment time. For instance, 1030 for a 10.30am appointment and 1400 for a 2pm appointment. This means patients with the same appointment time, but seeing different doctors in different rooms, will have similar queue numbers. The only thing that differentiates the queue numbers of patients with the same appointment time is the number of the room printed above the queue number. For aged or illiterate patients, this numbering system can be confusing.

Would it be better to issue all patients in each clinic with a unique, unrepeated sequential number? - Mr John Hoe Koo Cheng

Every day, 3,000 patients come to SGH to be seen at its various Specialist Outpatient Clinics. The current queue numbering system allows our staff at the clinics to keep track of patients with appointment times. Patients are seen according to their appointment times, and the queue number reflects the scheduled appointment time. Even if a patient is early for a 10.30am appointment and registers at 9am, the queue number will still reflect the given appoint-

ment time. This is to avoid a situation where many patients come for their appointments early to try to be seen first. The current system allows the clinics to manage their patient load more efficiently and fairly, and keep waiting time short while accommodating a few more appointments for urgent reviews. We welcome your suggestion to improve the numbering system. Coincidentally, SGH is studying a new system to make it easier for patients to check their queue numbers.

This letter wins a Cadi T560 Ear and Forehead Thermometer worth $96.

Tributes I’m a new patient at Marine Parade Polyclinic and was recently encouraged by my doctor to have a pap smear done. As it was my first one, I was understandably nervous but, thanks to the reassuring and friendly help of polyclinic midwife Ms Tan Chee Eng and senior staff nurse Ms Zainah Bee, the test was made easier for me and they put me at ease. Simple gestures by these nurses have made Marine Parade Polyclinic stand out not only as a place with great service, but also as one that serves from the heart. - Mdm June Ng

AND WIN A PRIZE FOR BEST LETTER Letters must include your full name, address and phone number. Singapore Health reserves the right to edit letters and not all letters will be published. Write to editor@sgh.com.sg or The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608, or talk to us on Facebook.

The winner will receive a Solax Memory Foam Pillow worth $55.

Facebook us!

Singapore General Hospital Grace Nwe For a nursing or nurse’s aid job in Singapore, does the hospital recognise a Bachelor’s degree in Nursing Science (B.NSc) from Assumption University in Thailand? Like · Comment · Sep 12 at 11.35am 3 people like this Singapore General Hospital To apply to SGH for all nursing-related jobs, applicants must have certification that is recognised by Singapore Nursing Board. You can find the list of recognised certifications for nurses at www.snb.gov.sg.

Kath Leen Lentija Hi, may I know if SGH is hiring registered nurses? And what are the qualifications that you are looking for? Thanks. Like · Comment · Sep 6 at 1.18pm 2 people like this Singapore General Hospital Hi Kath, generally for all nurses, we require a National ITE Certificate or degree/diploma in nursing from a recognised institution. If you are interested to join us, you may send us your resume or find out more at www.sgh.com.sg/joinus.

Two trips for prescription I have cardiovascular problems which require daily medication. I went to the National Heart Centre Singapore (NHCS) to get a repeat prescription, but was told it would take two to three working days before I could pick up my prescription and medication. I had to make two trips and take time off work twice to get a repeat prescription. NHCS should review its processes to make it easier for patients to get their repeat prescriptions. Patient safety is of paramount importance to us. To issue a repeat prescription, our doctor has to review the patient’s medical records to ensure the most current prescription is dispensed. As a national centre for cardiovascular disease, NHCS handles the highest cardiac workload in Singapore and, thus, our doctors may not be able to attend to requests for repeat prescriptions immediately. To minimise inconvenience, we encourage patients to place their requests via phone, and pick up the prescription when it is ready. Alternatively, patients may request for the medicines to be delivered to them for a fee.

Rushed down but couldn’t register Three days after giving birth, I had a skin problem and went to Sengkang Polyclinic for a checkup. The website stated that registration closed at 12pm, so I rushed down and was there at 11.35am. However, I was informed that registration had been closed because the clinic was overcrowded. I was told to come back for the afternoon session. I think it is not fair for people like me, who rush down in time for the morning session, to be sent away like that!

I usually don’t read health or medical information but was pleasantly surprised with Singapore Health. I particularly hope you can expand the space given to Fitness and FYI. - Mr H.C. Swee

I would like to convey my sincere appreciation and commendation to Mr Chang Wei Terk, Pharmacist, Singapore General Hospital (SGH), for going beyond the hours of duty to serve me. I took a second dose of 3mg warfarin by mistake one evening and panicked. Not knowing what to do, I called Mr Chang for advice. To my surprise, Mr Chang, who was on holiday in Malaysia, answered and advised me about my problem, putting me at ease. His selfless concern, thoughtfulness and care for his patients are really extraordinary. He is not only an asset to SGH, but also an angel to his patients. - Mdm KS Pang

We try our best to attend to as many patients as possible daily. When the clinic is crowded, we close registration to ensure our doctors have sufficient time, in the interest of patient safety, to provide appropriate treatment and care for each patient. The last registration for all SingHealth polyclinics is at 4pm. But emergency cases will be attended to immediately. Our clinics are particularly busy on the eve of public holidays and the day after, Mondays and Saturdays. The public can check the number of patients in the clinic via Queue Watch at the SHP website – http://polyclinic.singhealth.com.sg.


Nov⁄ Dec 2011

Wellness Keep the home safe for stroke patients

p16 Wellness Get tips from an expert on managing eczema

p17 Beauty

Big promises in little jars

singapore he alth

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p18

Placenta praevia It is a condition that can threaten mother and child. But with proper medical management, a happy outcome is possible. By Angeline Neo

Placenta praevia

When the placenta lies in the lower part of the uterus and covers the cervix, it can cause bleeding.

What is placenta praevia? Placenta praevia is diagnosed when the placenta lies in the lower part of the uterus and partially or completely covers the cervix in a pregnancy more than 24 weeks. Due to its location, it can bleed spontaneously during the pregnancy. “All pregnant women with bleeding must be checked out by their specialists.

Photo: ellen lim

centa completely covered her cervix, with the potential to remain like that in later pregnancy and block the baby’s path, interfering with a natural birth. Then, there was the problem of bleeding. She started bleeding at 28 weeks of pregnancy and had to be admitted to hospital. At 29 weeks, she chose to transfer to KK Women’s and Children’s Hospital (KKH) where she saw Dr Lim May Li, Head of KKH’s Peripartum Unit, who works with the hospital’s high-risk pregnancy team. At 32 weeks, she started bleeding again. “In cases of placenta praevia, bleeding can occur anytime and may be recurrent. Monitoring in a hospital gives the advantage of quicker treatment. Sometimes, bleeding can be so severe that every minute really counts,” said Dr Lim. Mrs Lee’s baby was delivered at 37 weeks by C-section and both mother and baby were fine. Another mother, Mrs Goh (not her real name), who also had placenta praevia, had a different experience. After her baby was delivered by C-section in the operating theatre, there was heavy bleeding and Dr Lim was called in to help. The

bleeding was coming from the placental bed (where the placenta had been attached to the uterus). Dr Lim explained that in a situation like this, one option is to use a Rusch balloon – a balloon infused with water, which is placed inside the womb to apply pressure to the raw surface of the uterus where the placenta has been attached. It works like a tourniquet to stem the bleeding. If this does not work, there is a need to reopen the uterus and apply stitches to the bleeding areas. In the worst case scenario, a hysterectomy is required as a lifesaving measure. Mrs Goh was successfully managed with the Rusch balloon. “The balloon has been used successfully in patients, so it’s worth trying. If it works, you don’t need the more drastic hysterectomy,” said Dr Lim.

Dr Lim May Li (right) says prompt and efficient management by a multidisciplinary team is the key to ensure the best possible outcome for mother and baby.

In placenta praevia, the bleeding tends to be painless. If there is bleeding, be it spotting or light bleeding only, go to the hospital immediately for a checkup.” Dr Lim stressed the importance of antenatal care and vigilance. “In cases of placenta praevia, especially when there has been associated bleeding, there is a need to monitor the baby’s growth with an ultrasound scan,” she said. There are two ways of scanning: transabdominal (tummy scan) or trans-vaginal (vagina scan). “The vaginal scan is a better way to assess the location of the placenta. But if the mother is already bleeding, an abdominal scan would be done,” said Dr Lim. Women with placenta praevia with no bleeding do not need complete bed rest or hospitalisation. However, torrential bleeding is more serious and needs immediate medical attention, as the mother is at risk of shock and requires resuscitation including blood transfusion. Immediate delivery may be necessary when there is severe bleeding, as the baby is at risk too. “We do encounter such extreme situations. Prompt and effective management by a multidisciplinary team (an obstetrician, anaesthetist, nursing, haematologist and neonatologist) is the key to ensure the best possible outcome for both mother

Normal placenta

and baby,” said Dr Lim, who sees two or three placenta praevia cases per year.

Managing the pregnancy As placenta praevia cannot be prevented and there is no way to predict who will get it, the doctor needs to bear in mind the possibility that a woman with bleeding in pregnancy may have placenta praevia. But Dr Lim said there are certain risk factors associated with the condition. They include previous C-sections and multiple pregnancies. Dr Lim said that as with managing any pregnancy, in placenta praevia, the aim is to prolong the pregnancy for as long as possible to full term.

illustrations: heymans tho

Mrs Lee (not her real name), in her early 30s and pregnant with her first baby, was diagnosed with placenta praevia at 24 weeks after an ultrasound scan. Her pla-


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Nov⁄ Dec 2011

Wellness

Helping stroke patients cope Making changes to the home can reduce stroke patients’ dependence on their caregivers eating

Depending on the severity of the stroke, they may have lost the full or partial use of their arms, legs or other parts of the body. In severe cases, the stroke patient may even be totally paralysed. Getting up, sitting down, walking, eating, dressing and going to the bathroom – these everyday actions which are done automatically and quickly may suddenly take a long time to perform or require the help of others. When the stroke patient’s condition has stabilised and he returns home, basic modifications to the home can help the patient move about safely and more easily, said Ms Lindy Cheong, Occupational Therapist, Singapore General Hospital (SGH). Before the patient returns home, Ms Cheong will visit his home to make an assessment and recommend what changes can or need to be made. “I look at the home environment to see what might obstruct the patient’s safe and easy movement and what might trip him. The environment should be as clutter-free as possible,” she said. Even very small rooms can be modified. “Furniture can be rearranged to

make a very small room more spacious and friendly, especially for a patient who is wheelchair-bound. In a flat where the bathroom is very tiny and can’t fit a shower chair or both the caregiver and patient, changes can be made to another room or area. For instance, some patients may shower in the kitchen,” Ms Cheong said. Some basic modifications to the home include installing grab bars and anti-slip mats in the toilet and bathroom to help prevent the patient from slipping or falling. Patients who are not able to stand are advised to use a shower chair. Ramps can be installed to allow a wheelchair or commode chair to be easily moved. Visibility is important and lighting should be bright. A night light installed in the bedroom is a safety feature in case patients need to get up at night. There are also many devices and implements available to help patients with everyday activities like putting on their clothes, eating and cooking. Being unable to perform what used to be easy tasks can be a source of frustration for a stroke patient with mobility problems who is seeking to be more independent.

Following a stroke, patients may have limited arm or hand movements, and simple tasks like eating can suddenly become difficult. Customised cutlery and modified plates, bowls and cups can help overcome such difficulties. In the picture above, the patient uses a plate with a raised rim that prevents spillage and makes spooning food easier. He also uses a spoon that has been modified to make it easier on the wrist when taking food from a plate and into the mouth.

PHOTOs: Justin loh & Alvinn lim

Buttoning a shirt, tying shoelaces, or holding a spoon can become very difficult for people who have suffered a stroke.

Cutlery with rubber handles provides a better grip and prevents slipping, while an angled spoon is easier for a person with limited wrist or hand movements to use.

Grooming A long-handled, curved comb is easier to use because a patient with limited arm movements doesn’t have to raise his arm too high or far behind to reach the back of his head.

bathing The bathroom, often wet and slippery, is the place where falls tend to occur. In the picture above, a bar and a shower seat make the bathroom a much safer place for someone with limited flexibility and movement. A corrugated grab bar offers a stronger and safer grip than a simple steel grab bar, which can be slippery when wet.

Dressing A stroke patient who has normal movement in only one hand can find it stressful buttoning his shirt. A buttonhook that works somewhat like a needle threader allows him to button his shirt quickly and easily. A dressing stick (a long stick, with a hook at one end, which can help pull up trousers, socks or sleeves) and a shoehorn are other devices that help people who have trouble putting on their clothes.

cooking The safety of patients is paramount when dealing with sharp tools like cooking knives. Below, a special chopping board, which is secured tightly to the table and has a device to grip the food, can help reduce the risk of injury by leaving the user’s hand free to focus on using the knife. The chopping board has strong suction cups on its base which securely fasten the board to the tabletop, preventing movement while chopping. An adjustable clamp (the black part) holds food items of various sizes securely. As it can be easily adjusted with one hand, this board can be used by a person who has lost movement in either hand.


NOV

Terbitan Hospital Besar Singapur a dan Kumpul an SingHealth.

DIS 2011

M2

M2

M3

M4

Hidup sepenuh hatinya

Kehamilan yang manis

Senyum – tidak lagi bercermin mata!

memadam masa lampau

Lutut yang kuat Oleh Keith G Emuang

Puan Manisah Mohd Tahir berjalan dengan langkah yang ringan. Tapi keadaan beliau tidaklah begitu sebelum ini. Selama dua dekad, beliau hidup dengan masalah lutut yang melemahkan yang terus membelengunya dengan kesakitan dan membatas pergerakannya. “Pertama kali saya merasa sakit di lutut saya ialah pada awal 90an. Walaupun saya masih boleh bergerak, ia sering bengkak. Namun, setelah beberapa tahun, masalah lutut saya menjadi sangat teruk sehingga saya tidak boleh berdiri, menyangkung atau tidur tanpa merasa sakit. Selera makan saya juga amat teruk terjejas,” kata juruwang sebuah pasaraya yang berusia 54 tahun itu. Penyesuaian ikut ukuran Ibu dua orang anak itu menjalani satu prosedur pembedahan baru untuk meng-

gantikan lutut kirinya dengan yang palsu di Hospital Besar Singapura (SGH) pada bulan Januari. Diperkenalkan pada Disember tahun lalu, teknik ini dikenali sebagai Penggantian Keseluruhan Lutut (Peralatan Khusus Pesakit) – menggunakan teknologi komputer untuk membantu doktor bedah meletakkan lutut palsu itu sebelum pembedahan untuk mendapatkan penyesuaian yang hampir tepat semasa pembedahan sebenar pula. Apabila lutut palsu dipasang dengan tepat, ia boleh bertahan lebih lama lagi. “Setiap pesakit berbeza kerana umur, jantina, bangsa dan gaya hidup dan teknik ini membolehkan perkara-perkara ini dipertimbangkan sebelum pembedahan dilakukan,” kata Dr Chin Pak Lin, Konsultan, Perkhidmatan Pembinaan Semula Dewasa di Jabatan Pembedahan Orthopedik di SGH, yang menjalankan prosedur selama setengah jam itu. Pertama sekali, lutut yang terjejas akan diimbas menggunakan MRI kemudian, satu imej tiga dimensi akan dihasil-

FOTOS: TAN WEI TE

Lutut palsu yang selesa boleh didapati, terima kasih kepada teknologi komputer

Puan Manisah Moh Tahir, bersama Dr Chin Pak Lin, akhirnya bebas daripada sakit hasil dari sejenis pembedahan mengganti lutut yang baru.

kan dan digunakan dalam program komputer yang membolehkan “pembedahan maya” dilakukan. Semasa “pembedahan maya” ini, doktor bedah merancang pemotongan yang perlu dilakukan dan selepas itu mengirim maklumat ini kepada sebuah syarikat di Amerika supaya satu acuan memotong boleh dibuat. Acuan ini adalah unik mengikut pesakit tersebut, mengambil masa sebulan untuk dibuat dan digunakan sebagai

Perlukan lutut baru? Sendi lutut ialah sendi yang kompleks di antara tulang punggung dan tulang kaki bahagian bawah yang lebih besar. Tulang engsel ini dilindungi oleh tempurung lutut dan dikelilingi oleh ligamen, otot dan cecair yang menggalakkan pergerakan licin. Osteoartritis terjadi apabila rawan sendi telah rosak dan menjejas fungsi lutut. Pembedahan mengganti sendi boleh merubah kehidupan seseorang yang mengalami sendi lutut yang telah rosak teruk dan menyebabkan kesakitan yang banyak.

Sendi palsu dibentuk seperti yang asli dan membolehkan pergerakan lutut yang normal.

Buat masa sekarang, teknik ini membolehkan satu set peralatan yang telah disesuaikan dalam pembedahan tetapi bahan implan mengikut ukuran mungkin boleh dilakukan tidak lama lagi. Penggantian keseluruhan lutut sesuai untuk mereka yang berusia di antara 60 dan 80 tahun kerana 95 peratus dari bahan implan ini boleh bertahan selama 15-20 tahun, bergantung kepada bagaimana lutut itu digunakan. Lutut palsu membolehkan penggunanya berjalan dan bergerak seperti normal, tetapi ia tidak boleh bertahan dengan aktiviti lasak seperti mendaki gunung atau berlari maraton, terutama jika kegiatan ini kerap dilakukan.

Namun, para doktor bedah ortopedik akan menilai pesakit secara individu dan memberi saranan-saranan mereka berdasarkan tahap kesakitan pesakit dan sejauh mana kekurangan upaya mereka, seperti Puan Manisah yang pergerakannya sangat terbatas oleh lututnya yang rosak teruk dan kesakitan yang amat sangat. Prosedur standard penggantian lutut mengambil masa antara satu hingga tiga jam dan pemulihan, termasuk fisioterapi mengambil masa kira-kira tiga bulan.

panduan tepat yang semasa pembedahan sebenar. Melalui teknik konvensional, rod pelurusan yang digunakan dalam tulang boleh menyebabkan kesilapan dan memasukkan rod pelurusan dalam saluran tulang – rongga pusat dalam syaf tulang yang mengandungi sumsum tulang – boleh menyebabkan embolisme lemak, keadaan di mana tisu lemak memasuki aliran darah dan menjejas sistem pernafasan. Teknik baru ini memerlukan masa pembedahan yang lebih singkat dan masa yang pendek menggunakan anestesia, satu risiko besar semasa pembedahan. Masa untuk persiapan pembedahan juga dikurangkan kerana sedikit peralatan sahaja yang diperlukan dan pensaizan bahan implan telah ditentukan terlebih dahulu. Asas untuk perbandingan Puan Manisah telah menggantikan keduadua lututnya – pertama – lutut kanannya – pada April 2009 menggunakan pembedahan standard. “Setelah menggantikan lutut yang kedua, saya boleh bergerak lebih awal dan pendarahan juga berhenti lebih awal. Saya tidak perlu terlalu bergantung kepada ubat penahan sakit selepas pembedahan, berbanding dengan pembedahan yang saya jalani pada 2009,” katanya. “Saya telah tidak merasa seperti ini sejak saya berusia 30an,” katanya.


M2

singapore he alth

NOV⁄ DIS 2011

Berita

Hidup sepenuh hatinya

dari jantung kepada keseluruhan tubuh, kerosakan injap boleh melumpuhkan atau menyebabkan kematian. Para pesakit selalunya berasa lemah dan termengah-mengah walaupun dengan hanya melakukan aktiviti biasa seperti menaiki tangga. Dr Peter Ting, Konsultan, Jabatan Kardiologi, NHCS, menasihatkan orang ramai yang mengesyaki mereka mungkin menghidapi penyakit injap jantung supaya mendapatkan penilaian. Katanya: “Walaupun jika keadaan penyakit mereka adalah ringan dan belum memerlukan pemindahan, mereka harus mengambil langkah berjaga-jaga untuk mengelakkan daripada kemudaratan. Sebagai contoh, ketika mereka bersenam, mereka harus melakukannya dengan seorang teman dan pastikan tidak melakukan apa-apa yang terlalu lasak kerana mereka mempunyai risiko akan rebah.” Jika didiagnos atau dirawat terlalu lewat, jantung mungkin telah menjadi terlalu rosak dan melakukan penggantian injap melalui pembedahan tidak akan berkesan. Perubatan hanya akan mengurus simptom, tetapi tidak boleh membaiki kerosakan tersebut. “Malangnya, masalah injap jantung adalah satu masalah mekanikal. Jika sebuah paip bocor, tiada lain yang boleh anda lakukan melainkan menggantikan bahagian yang bocor itu,” kata Dr Ting.

Injap jantung baru memberi pesakit harapan baru dalam kehidupannya Oleh Claire YEO

Setiap kali En Quek Siow Kiak masuk ke bilik yang sunyi, dia terdengar bunyi klik datang dari dadanya. Ini membuat dirinya, isteri dan anak lelakinya berasa hairan. “Saya tidak sedar bunyi itu datang dari injap jantung mekanikal yang ditanam dalam tubuh saya ketika saya berusia 13 tahun,” kata En Quek, 44 tahun, yang dilahirkan tanpa injap jantung. Selepas pembedahan, dia perlu memakan ubat mencairkan darah untuk seumur hidupnya, tetapi berhenti memakannya setelah ibunya meninggal dunia. Ketika giginya sakit dan dia berjumpa seorang doktor gigi, doktor tersebut telah terus merujuknya ke Pusat Jantung Kebangsaan Singapura (NHCS). Di sana, seorang doktor telah menasihatkannya supaya membatalkan saja rancangannya untuk bermain bola pada tengahari itu kerana risiko beliau rebah dan mati semasa permainan tersebut adalah sangat tinggi. Sebaliknya, En Quek menerima injap pengganti manusia, atau homograf, yang

En Quek Siow Kiak boleh berlari naik beberapa mata anak tangga tanpa merasa mengah setelah menerima injap jantung yang didermakan.

merupakan rawatan standard untuk keadaan sepertinya. En Quek adalah di antara kira-kira 10,000 orang dewasa Singapura yang dilahirkan tanpa injap jantung atau mempunyai injap jantung yang tidak normal. Injap juga boleh rosak kerana usia atau atas sebab keadaan jantung yang lain. Oleh kerana empat injap jantung mengawal aliran darah

Injap yang mana harus digunakan Dr Lim Yeong Phang, Konsultan Kanan, Jabatan Pembedahan Kardiothoraks, NHCS

Kehamilan yang manis oleh Thava Rani

Sejak Cik Han Yoke Leng didiagnos menghidap penyakit diabetes mellitus jenis 1 pada usia 19 tahun, beliau harus mengawal kadar gula dalam darah melalui suntikan insulin setiap hari. Ketika beliau mengandung anak keduanya, perubahan hormon semasa hamil mula menganggu tindakan insulin menyebabkan ketahanan insulin dan peningkatan kadar gula dalam darah. Terlalu banyak gula dalam darah boleh menyebabkan komplikasi bagi dirinya sendiri dan bayinya. “Dalam sebuah kehamilan yang tidak dirancang bagi seorang pesakit di mana kawalan gula dalam darah tidak dikawal secukupnya, kita perlu mengawal kadar gula dalam darah dengan cepat, dalam masa beberapa minggu, jika boleh, untuk mengurangkan risiko keguguran atau kecacatan semasa lahir,” kata Dr Abel Soh, Konsultan Madya, Jabatan Endokrinologi, Hospital Besar Singapura (SGH). Selain daripada kadar gula dalam darah yang tinggi, pentadbir pejabat berusia 30 tahun itu juga perlu memikir-

kan tentang kadar gula dalam darah yang rendah yang boleh berlaku apabila jarak waktu makan di antara satu dengan yang lain terlalu lama, melakukan terlalu banyak senaman atau jika terlalu banyak insulin yang telah diambil. Kadar gula yang rendah yang sering berlaku atau terlalu berpanjangan boleh menjejas pertumbuhan bayi atau menyebabkan sawan kepada si ibu. Mereka yang menghidap diabetes tidak mengeluarkan cukup insulin yang diperlukan dalam metabolisma karbohidrat, protein dan lemak. Tanpa suntikan insulin atau pengambilan ubat melalui mulut, kadar gula dalam darah mereka yang menghidap diabetes akan bertambah, terutama selepas makan. Tidak seperti Cik Han, Cik Jamilah bte Abdul Latiff, 41 tahun pula, mula menghidap diabetes semasa kehamilan keempat beliau. Dikenali sebagai diabetes gestasi (semasa mengandung), ia berlaku apabila bayi tidak boleh mengeluarkn insulin yang cukup untuk membalas ketahanan insulin yang disebabkan oleh perubahan hormon semasa kehamilan. Diabetes jenis ini selalunya akan hilang setelah bayi dilahirkan, tapi bagi kira-kira dua hingga lima peratus

FOTO: alecia neo

Perubahan dan risikonya banyak, tetapi dengan bantuan dari para doktor dan jururawat, seseorang yang menghidap penyakit kencing manis boleh melalui kehamilan yang berjaya

Cik Jamilah Abdul Latiff mula menghidap kencing manis semasa kehamilan beliau dan terpaksa mulakan suntikan insulin semasa hamil tujuh bulan untuk menangani kadar gula dalam darah yang semakin meningkat.

kehamilan, ia akan menjadi penyakit kronik. Disebabkan komplikasi yang timbul kerana diabetes, wanita seperti Cik Han dan Cik Jamilah dirawat oleh satu kumpulan di Pusat Diabetes SGH terdiri daripada seorang ahli obstetrik, seorang pakar endokrinologi, seorang jururawat dan seorang pakar pemakanan. Seb-

berkata injap mekanikal boleh diharapkan dan dapat bertahan lama, tetapi pesakit mesti mengambil ubat mencairkan darah seperti warfarin untuk seumur hidup mereka. Injap biologi – yang berfungsi baik tetapi tidak bertahan begitu lama – adalah pilihan yang baik bagi mereka yang tidak boleh mengambil warfarin. Dr Lim juga merupakan Pengarah Perubatan, Bank Homograf Kardiovaskular Kebangsaan yang ditubuhkan oleh NHCS bagi memastikan akses yang cepat dan dimampui untuk mendapatkan injap jantung manusia. Adalah agak mudah mencari pemadanan injap jantung, katanya. “Tidak ada risiko penolakan, tidak perlu mengambil ubat supaya tubuh tidak menolak organ baru (ubat imunosupresan) dan penerima derma pula tidak perlu dipadankan melalui jenis darah mereka.” NHCS menggalakkan lebih ramai orang supaya menderma injap jantung mereka. Sejauh ini, 20 pesakit, hampir separuh daripada mereka kanak-kanak, telah dapat memanfaatkan injap jantung dari 30 orang penderma. En Quek berterima kasih atas pemindahan homografnya. Katanya: “Ia telah memberi saya satu kehidupan yang baru dan yang lebih baik.” Tetapi ini tidak menghalangnya daripada tersedar sekali sekala dari tidurnya pada waktu malam, diselibungi perasaan takut, memikirkan bahawa jantungnya telah berhenti... kerana dia tidak lagi mendengar bunyi dari injap jantung mekanikalnya yang lama.

agai contoh, pakar pemakanan itu akan menasihatkan Cik Han supaya makan dengan kerap tetapi sedikit untuk mengurangkan kenaikan kadar gula mendadak yang berlaku setiap kali selepas makan. Pakar endokrinologi pula akan memeriksa profil gula Cik Han dengan tetap dan menyesuaikan dos insulinnya mengikut perubahan kadar gula dalam darahnya. Bayi Cik Han membesar dengan luar biasa – satu potensi masalah di kalangan wanita yang menghidap diabetes – dan pasukan perubatan itu memutuskan untuk menyambut kelahiran bayi itu lebih awal. Melahirkan bayi yang terlalu besar secara normal adalah sukar, mungkin tercedera semasa dilahirkan dan akan mudah menghidap penyakit diabetes dalam kehidupan mereka di masa depan. Bayi lelaki Cik Han dilahirkan seberat 4.07kg pada Disember 2010, lebih berat dari anak pertama beliau – kehamilan yang dirancang – yang dilahirkan seberat 3.5kg. Sebelum beliau hamil, Cik Han dan suami telah memastikan kadar gula dalam darahnya terkawal dan mengalami perubahan minimal. Cik Han juga memakan vitamin tambahan, termasuk folik asid untuk membantu menghalang kecacatan semasa lahir seperti spina bifida (pertumbuhan korna spida yang tak lengkap) pada janin. “Namun, ramai wanita yang sememangnya ada diabetes jenis 1 atau 2 tidak merancang kehamilan mereka walaupun sudah diberitahu risiko mempunyai bayi jika kawalan gula mereka di bawah paras optimal,” kata Dr Soh.


NOV/DIS 2011

singapore h ealth

M3

Tumpuan

Senyum – tidak lagi bercermin mata! Penglihatan sempurna termasuk bagi mereka yang didapati tidak sesuai dengan pembedahan LASIK kerana prosedur yang telah diperbaiki

FOTO: ALECIA NEO

Ini bererti pembetulan penglihatan yang lebih tepat dan lebih selesa semasa dan sesudah pembedahan. “Prosedur ReLEx adalah perkembangan semulajadi dari prosedur LASIK. Prosedur ReLEx membuat irisan yang amat tepat dalam kornea dengan menggunakan laser untuk memotong sekeping tisu berbentuk lensa yang dipadankan kepada darjah yang diperlukan. Kami kemudian membuang lensa ini dan miopianya akan hilang,” kata Prof Tan. “Ini merupakan prosedur yang paling maju terdapat pada masa kini. Dan ia hanya mengambil masa 30 saat sahaja untuk melakukan pembetulan kerana laser ini amat pantas dan menggunakan tenaga yang sangat sedikit, bererti lebih selesa kepada pesakit.”

Para pesakit yang telah menjalani ReLex seperti Cik Frances Yap (bersama anak perempuannya), merasakan ketidakselesaan yang kurang semasa dan sesudah pembedahan.

Bosan dengan kanta lekap dan cermin mata, Cik Frances Yap memutuskan untuk menjalani pembedahan LASIK. Namun, doktor membatalkan prosedur tersebut pada saatsaat akhir. Doktor mendapati Cik Frances mengalami masalah yang dikenali sebagai lubang butang (di mana kelengkungan korneanya tidak sekata) yang boleh menyebabkan penglihatan yang tidak seragam selepas prosedur LASIK. “Beliau telah membuat keputusan yang tepat tetapi saya berasa kecewa,” kata Cik Yap, 32 tahun, yang pasrah harus menggunakan cermin mata dan kanta lekap seumur hidupnya. Tetapi, pada tahun lalu, suaminya telah memujuk beliau supaya berjumpa dengan Profesor Donald Tan, Pengarah Perubatan, Pusat Mata Nasional Singapura (SNEC), setelah membaca tentang kemajuan yang dicapai dalam pembetulan penglihatan yang diusahakan oleh Prof Tan dan pasukannya. Semasa mendapatkan nasihat dari Prof Tan, Cik Yap mendapat tahu tentang prosedur baru yang bukan sahaja sesuai untuk mereka yang mempunyai masalah lubang butang, tetapi juga cepat, tidak sakit dan berkesan dalam membetulkan masalah rabun jauh (miopia) yang teruk sekalipun. Pada bulan Mac tahun lalu, Cik Yap telah menjadi salah seorang rakyat Singapura yang pertama yang menjalani prosedur ReLEx (Ekstraksi Lentikul Refraktif). Tidak seperti prosedur LASIK, yang menggunakan dua laser dan mengewap tisu kornea untuk membetulkan penglihatan, prosedur ReLEx menggunakan satu laser sahaja. Tanpa mengewapkan tisu yang tidak diperlukan, laser generasi baru yang digunakan dalam prosedur

ReLEx ini memotong keluar sekeping tisu yang berbentuk lensa untuk memperbaiki masalah rabun jauh. Tisu ini kemudian dikeluarkan sama ada melalui flap biasa seperti yang digunakan dalam prosedur LASIK atau melalui irisan lubang kunci, bergantung kepada keadaan mata.

Rawatan yang boleh diterbalikkan?

Ekstraksi Lentikul Refraktif (ReLEx) Prosedur seperti ReLEX membaiki ralat refraktif (yang menyebabkan rabun jauh) dengan merubah bentuk kornea.

ReLEX menggunakan satu laser saja untuk membuat insisi tepat pada kornea pesakit.

Flap ini diangkat untuk melaser keluar lensa intro-kornea yang sepadan dengan ralat refraktif pesakit.

Lensa ini diambil (dan kemungkinan disimpan melalui pengawetankrio untuk digunakan di masa akan datang) sebelum flap ini ditutup semula.

Flap ini memakan masa untuk pulih, tetapi pesakit merasa hanya sedikit ketidakselesaan selepas pembedahan.

Ilustrasi: HEYMANS THO

Oleh Jacqueline Chia

Hasil yang cemerlang Sejauh ini, prosedur ReLEx mempunyai kadar kejayaan 100 peratus dan adalah lebih tepat daripada prosedur LASIK. Satu kajian yang dijalankan oleh SNEC ke atas 24 orang pesakit yang telah menjalani prosedur LASIK dan ReLEx (satu prosedur bagi setiap mata) mendapati 75 peratus daripada mereka lebih sukakan prosedur ReLEx kerana mereka merasa lebih selesa semasa dan sesudah pembedahan. Cik Gayathri Manokaran, 31 tahun, penyelidik makmal yang memilih prose-

dur ReLEx supaya beliau dapat meneruskan hobi menyelamnya, berkata: “Prosedur ini tidak sakit, saya tidak sedar pun ia telah selesai.” Prosedur ReLEx adalah lebih selesa kerana lekapan pada mata lebih lembut. “Para pesakit juga dapat melihat ‘alur suluhan sasaran’ dengan lebih baik kerana lekapan yang lebih lembut ini, jadi tiada kejadian yang disebut doktor sebagai ‘pemadaman cahaya’ semasa rawatan dijalankan berbanding dengan prosedur LASIK,” kata Prof Tan. Pemadaman cahaya ialah fenomena di mana pesakit perlu memfokus kepada suluhan alur laser semasa prosedur ini dijalankan dan ia akan menghilang jika pesakit menggerakkan matanya. Pemadaman cahaya jauh berkurangan dalam prosedur ReLEx. Pada masa ini, prosedur ReLEx dikenakan bayaran $2,500 setiap mata termasuk penjagaan sesudah pembedahan. Penggunaannya yang semakin meluas bukan sahaja akan membuatnya lebih dimampui tetapi akhirnya akan juga menggantikan LASIK.

Para penyelidik di Institut Kajian Mata Singapura (SERI), bahagian kajian Pusat Mata Nasional Singapura (SNEC) telah memulakan proses percubaan tahun lalu dan berharap dapat membuktikan prosedur ReLEx boleh diterbalikkan. Memotong keluar tisu kornea yang lengkap ini telah mencetuskan idea untuk menyimpan lensa miopia ini supaya ia boleh digunakan dalam kehidupan seseorang kemudian hari nanti untuk membetulkan masalah presbiopia atau rabun dekat. “Katakan anda mengalami presbiopia dalam kehidupan anda di kemudian hari selepas prosedur ReLEx. Pada teorinya, kita boleh mengambil semula lensa miopik anda yang disimpan, gunakan laser untuk membuang nilai negatif lebihan pada lensa itu dan menanamnya semula pada kornea anda untuk membetulkan masalah presbiopia pada sebelah mata. Ini pada dasarnya akan memberi anda penglihatan mono dan anda dapat melihat dekat semula,” kata Profesor Donald Tan, Pengarah Perubatan, SNEC. Para penyelidik sedang mencuba untuk membeku dan menyimpan lensa yang telah dikeluarkan di dalam cecair nitrogen, satu kaedah yang dikenali sebagai pengawetankrio (cryopreservation), yang biasa digunakan dalam menyimpan darah tali pusat dan sel induk. Apabila presbiopia akhirnya dialami beberapa tahun kemudian, seseorang pesakit boleh memilih untuk menanam semula lensanya yang telah dipotong keluar ke dalam salah satu korneanya untuk mengatasi masalah presbiopia atau mengubah suai pembiasan jika ia berubah mengikut masa.


singapore he alth

NOV⁄ DIS 2011

Memadam masa lampau Berfikirlah dahulu sebelum mendapatkan tatu kerana kaedah yang paling maju sekalipun tidak dapat memadamkan keseluruhan pigmen pada tatu.

Sebagai satu contoh membuang tatu, berikut adalah contoh yang paling mudah. Pada awal 1990an, pelakon Amerika, Johnny Depp, telah berpisah dengan temanitanya ketika itu, pelakon Winona Ryder. Apa yang pernah di tulis sebagai “Winona Forever” pada bisepnya, telah dibuang suku kata “na” dan kini tatunya berbunyi “Wino Forever”. Apabila perhubungan terputus di tengah jalan, apa yang akan berlaku kepada idea spontan untuk memaparkan nama temanita anda pada bisep anda atau nama teman lelaki anda pada pergelangan kaki anda? Mudah sekali, pilihan terbaik untuk membuang tatu ialah dengan menggunakan teknologi laser. Ia mensasar kepada pigmen tatu. Ia tidak invasif. Cara ini lebih baik daripada kaedah - jangan mencuba ini di rumah atau melakukannya sendiri - iaitu mengempelas atau membakar kulit dengan kimia. Namun, walau dengan teknologi maju sekalipun, menghilangkan dakwat tersebut tidaklah mudah. “Laser pada tangan yang salah dan bila dihidupkan kuasanya... boleh membakar pesakit dan menyebabkan parut yang sangat teruk,” kata Profesor Colin Song,

Beritahu kami Kenapa saya harus tunggu sedangkan saya telah buat janji temu? Saya sampai 45 minit lebih awal daripada janji temu saya pukul 2.30 petang tetapi saya diberi nombor giliran 1430. Nombor saya hanya dipanggil pada 3.30 petang. Pesakit-pesakit yang datang lebih lewat dapat berjumpa doktor pakar lebih awal daripada saya. Ada juga orang yang tidak ada nombor giliran terus masuk kebilik konsultasi tanpa dipanggil. Kenapa? Klinik-klinik pakar pesakit luar berjumpa 3,000 pesakit setiap hari. Pesakit ditemui mengikut waktu-waktu janji temu yang ditetapkan untuk mengelak situasi di mana mereka datang lebih awal dan berharap dapat berjumpa doktor dahulu. Ini akan menyebabkan kekeliruan dan lebih ramai lagi pesakit terpaksa tunggu lebih lama. Ini juga menyebabkan kesesakan di klinik-klinik itu. Nombor giliran menunjukkan waktu janji temu pesakit yang telah dijadualkan. Walaupun anda datang lebih awal,

Konsultan Kanan dan Ketua Jabatan Plastik, Pembedahan Pembentukan Semula dan Estetik, Hospital Besar Singapura (SGH). “Ia mestilah dilakukan oleh orang yang terlatih dalam menggunakan laser.”

Tiada huraian menyeluruh Para pesakit juga harus sedar bahawa mereka tidak akan dapat memadamkan masa lampau mereka sepenuhnya. “Tidak kira berapa bagus teknologi laser itu, pasti masih ada bayangan tatu tersebut,” kata Prof Song. Selain hubungan asmara yang terputus di tengah jalan, sebab-sebab lain untuk membuang tatu dalam sebuah masyarakat berbilang ethnik di Singapura termasuklah agama, bantahan ibu bapa dan kadang kala untuk mendapatkan pekerjaan.

Pembuangan tatu telah jauh berubah daripada cara perubatan di rumah seperti memberus dengan garam dan pengupasan asid yang menyebabkan parut yang berlebihan.

Pembuangan tatu menyakitkan Sejauh mana keseluruhan tatu boleh dibuang bergantung atas tatu tersebut – warna, usia, saiz dan lokasinya – serta jumlah rawatan yang perlu dijalani oleh pesakit.

Kiri: Ia memerlukan banyak rawatan menggunakan teknologi laser, salah satu kaedah yang paling maju, untuk membuang tatu. Kanan: Laser mensasar kepada pigmen tatu, memecahkan warnanya sehingga menjadi zarah yang boleh dikeluarkan oleh proses semula jadi dalam tubuh.

Tatu yang berwarna warni bererti ia akan memerlukan proses pembuangan yang lebih menyeluruh dan menyakitkan, kerana setiap kumpulan warna memerlukan kalibrasi laser yang berlainan. Tambahan pula, laser tersebut hanya perlu menembusi kulit sahaja sedalam yang ditembusi pigmen tatu itu. Jika kuasa laser terlalu lemah, warna tatu tidak akan berpecah dan dakwatnya tidak akan hilang. Sebaliknya, jika kuasanya terlalu kuat, ia boleh membakar atau merosakkan tisu sihat disekelilingnya.

nombor giliran anda tetap menunjukkan waktu janji temu anda. Tetapi jika anda terlewat, nombor giliran anda akan mengikut waktu anda sampai. Ini memberi laluan kepada klinik-klinik untuk mengendalikan jumlah pesakit dengan lebih cekap dan adil. Walaupun pesakit-pesakit diberikan waktu janji temu untuk berjumpa doktordoktor pakar, seringkali mereka terpaksa menunggu kerana konsultasi buat setiap pesakit berbeza, bergantung pada kerumitan yang dialami pesakit. Keutamaan mungkin diberi kepada pesakit-pesakit yang perlukan perhatian segera. Doktordoktor pula mungkin tergendala atau terpaksa meninggalkan klinik untuk menangani kes-kes kecemasan. Untuk memastikan waktu menunggu janji temu pendek, klinik-klinik juga akan menyelitkan beberapa janji temu tambahan dalam sesi berjumpa doktordoktor pakar ini untuk menggantikan pesakit-pesakit yang mungkin tidak hadir untuk janji temu mereka. Masa menunggu di klinik akan menjadi agak lama jika semua pesakit datang. Pesakit-pesakit yang anda lihat masuk ke bilik konsultasi tanpa dipanggil, mereka ini sebenarnya pesakit-pesakit

dalam peti sejuk, atau malahan dalam ruang pembeku. Ubat-ubatan demikian cepat luput jika disimpan pada suhu bilik, akan menjadi beracun atau kurang berkesan. Beberapa contoh ubat-ubatan yang perlukan penyejukan ialah suntikan hormon yang digunakan semasa proses IVF (pensenyawaan invitro) dan vial yang mengandungi insulin Ada hanya sedikit sahaja ubat-ubatan yang memerlukan pembekuan, tetapi sebagai contoh ialah suntikan vaksin. Namun tak semua ubat-ubatan perlu disejukkan. Malahan, ia mungkin terjejas oleh suhu yang turun naik dalam peti sejuk di rumah. Satu lagi masalah ialah ubat-ubatan itu menjadi beku dengan tidak sengaja, menjadi rosak dengan kristal air pejal yang terbentuk. Para pesakit dinasihatkan supaya membaca label farmasi dengan teliti sebelum menyimpan ubat-ubatan mereka di rumah. Hanya ubat-ubatan yang mempunyai arahan “Disimpan dalam peti sejuk. Jangan bekukan” harus disimpan dalam peti sejuk, lebih baik lagi di bahagian utama, jauh dari bahagian pintu atau liang ruang menyejuk. Jika ragu-ragu, bertanyalah kepada ahli farmasi anda.

FOTOs: Colin Song

Oleh JR Wu

“Di masa lalu, anda menukar tatu dengan parut. Hari ini, kami dapat mencerahkan tatu anda tanpa meninggalkan parut, dengan syarat anda menggunakan teknologi laser dengan bijak,” kata Prof Song. Ringkasnya, cahaya laser berdenyut pendek dikalibrasikan dengan gelombang cahaya dalam spektrum pelengkap warna tatu yang disasar. Cahaya laser diserap oleh tatu tersebut, pigmen tatu berpecah di bawah kesan laser diikuti dengan proses semula jadi sistem kekebalan tubuh yang akan mengeluarkan pecahan pigmen tersebut daripada kulit.

FOTO: photolibrary

M4

yang kembali untuk mendapatkan keputusan ujian-ujian yang diarahkan doktor bila mereka berjumpa doktor awal lagi. Kami ingin ambil kesempatan ini untuki mengingatkan pesakit-pesakit supaya menelefon nombor hotline Pusat Janji Temu (Central Appointments), 6321-4377 sekurang-kurangnya tiga hari bekerja sebelum janji temu mereka samada untuk membatalkan atau menukar tarikh janji temu mereka sekiranya mereka tidak dapat hadir pada janji temu asal mereka. Ruang ini boleh diisi untuk pesakit-pesakit lain.

Menyimpan ubat-ubatan Saya telah membeli ubat untuk bekalan tiga bulan. Patutkah saya menyimpannya dalam peti sejuk? Cara menyimpan ubatubatan dengan betul adalah penting untuk memastikan kerberkesanan dan kemujarabannya. Semua ubat-ubatan mestilah disimpan di sebuah tempat yang sejuk, kering dan jauh daripada cahaya matahari dan lembapan. Sebahagian ubat-ubatan memerlukan cara menyimpan yang khusus seperti di


Nov⁄ Dec 2011

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Wellness Scratching the itch caused by eczema can lead to swollen, raw and sensitive skin.

Stop that itch!

More than half of the patients who suffer from atopic dermatitis – an itchy skin disorder – develop it before they reach two years of age.

Since she was a child, 15-year-old Catherine* has suffered from an itchy skin disorder which leaves her with red, scaly skin. The itching can be severe, especially at night. After scratching, the skin becomes swollen, raw and sensitive. The angry red patches often appear on the hands and feet, the inside of the elbow and the back of the knee. Catherine has atopic dermatitis or atopic eczema – a skin condition which affects nearly 21 per cent (or one in five) of people in Singapore. “Atopic dermatitis is a relatively common disease and it has a characteristic pattern,” said Dr Pang Shiu Ming, Director and Senior Consultant, Dermatology Unit, Singapore General Hospital (SGH). A form of skin inflammation, eczema is broadly applied to a range of persistent skin conditions that include symptoms of dryness and a recurring skin rash. Excessive bathing, harsh soaps and sweating can trigger an eczema attack. Eczema can be controlled by medication and moisturisers. Typically, more than half of the patients who suffer from atopic dermatitis develop it before they turn two years of age. However, the condition can affect people of all ages. For many, the condi-

tion clears upon reaching adulthood, while for others, the condition flares up occasionally, sometimes for years. People with eczema also usually have other allergic conditions like asthma, allergic rhinitis or hay fever. Some think eczema may be due to an overly hygienic environment, said Dr Pang. “If you are in a very hygienic environment, you may not be exposed to many kinds of bacteria, which increases your likelihood of having eczema,” he said. In people with eczema, their immune systems tend to react more easily to a wider range of harmless influences, such as dust mites and animal fur.

People who have been exposed to all kinds of bacteria at an early age tend not to react as easily as others who have not had this exposure, usually those living in a super-clean environment. “In countries where hygiene levels are low, people are likely to have been infected by many kinds of bacteria from a very young age. As a result, the skin develops its own protection against atopic dermatitis,” Dr Pang added. “In more urban environments where hygiene standards are much better, children are not exposed to all these bacteria and are, therefore, more likely to develop eczema.” Recent studies, said Dr Koh Hong Yi, Registrar, Department of Dermatology, SGH, suggest that the majority of patients who suffer from eczema have a protein mutation in their skin called filaggrin, which results in the weakening of the skin’s natural protective barrier. They also tend to have reduced levels of fats in their skin, causing it to be drier than normal. “Another difference in the skin of eczema sufferers is the higher amount of bacteria living on their skin. All of us have bacteria on our skin, but we also have this chemical known as anti-microbial which protects us from bacteria. On the skin of patients with atopic dermatitis, the level of this protective antimicrobial is much lower, which allows more bacteria to stay on the surface of the skin,” Dr Koh said. People who suffer from severe eczema are sometimes prescribed a drug to suppress their overactive immune systems, said Dr Pang. When the condition improves, topical steroids are then used to control lingering eczema in certain areas of the skin.

inflammation • Set aside enough time every day to apply medication and moisturisers • Creams, especially non-steroid ones, can be refrigerated before use to reduce any burning sensation

*Catherine is not a real patient but might be any eczema sufferer who first got the condition as a child.

Dr Pang Shiu Ming says the prevalence of eczema cases in Singapore may be due to our overly hygienic environment.

Showering tender loving care on your skin Do

Don’t

Restoring the skin’s protective barrier Limit frequency and duration of baths and use warm water Use a mild, fragrance-free cleanser when washing your face and body

Reducing inflammation • Use steroid creams as prescribed • Apply moisturisers • Use wet wraps for acute, oozy

For milder cases of eczema, antihistamines are given to control itching, while steroid creams of different strengths and non-steroidal creams calm the skin when eczema flares up. Other treatments can also include light therapy (phototherapy), which exposes the skin to various wavelengths of light for different periods.  Using a fragrance-free moisturiser or skin cream is also important as dry skin can exacerbate the condition. For this reason, people who suffer from eczema have to avoid soaps, fragrances and harsh detergents. Eczema sufferers are also encouraged to do light exercise such as swimming after their condition stabilises. However, sporting activities which cause heavy sweating should be avoided in order not to aggravate the eczema.

PHOTO: alvinn lim

PHOTO: photolibrary

Little is known about eczema – a common skin problem that affects many people, usually starting in childhood. By Rachel Chan

Take long showers Use hot water as it promotes water loss through the skin Clean with soap as it may damage the skin’s protective barrier and irritate the skin Use bubble baths, scented soaps or oils as they may irritate the skin

Preventing irritation Wear loose cotton clothing or natural fibre fabrics Switch on the air-conditioner before entering the room Get sufficient rest Learn how to manage stress well Avoid excessive heat

Wear wool or synthetic fabrics as they can cause irritation Indulge in habitual scratching Eat food which you are allergic to Engage in activities which promote perspiration


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Beauty

Let’s face it

Dr Wang’s tips on... Beauty myths

Here’s a dermatologist’s take on the effectiveness of store-bought anti-wrinkle and whitening products. By Ruth Loh

Shi, Consultant, Department of Dermatology, Changi General Hospital (CGH), warned against expecting too much from something in a bottle. “Anti-wrinkle products can delay the signs of ageing, but not prevent or banish wrinkles. Only plastic surgery can do that,” Dr Wang said, adding that wrinkles, such as smile lines and crow’s feet, are formed by facial expressions and appear with age, sometimes by the early

necessarily. What matters is that you are comfortable with the product.”

or late 30s. The facial skin, once taut over bones, also sags because of a loss in bone mass, which changes the facial skeleton.

Start young, stay young: “You can’t PHOTO: Allen Lim

Many women will try any product that promises the fountain of youth. But dermatologist Dr Wang Yi

Expensive creams are better: “Not

Creams, glorious creams As for whitening products, she said: “No matter how much you use, they won’t make you as fair as Nicole Kidman, unless that is your constitutive colour – the natural colour of your skin not exposed to the sun.”

Vitamin A derivatives, which have some effect on skin, are found in many beauty products.

Dr Wang Yi Shi: “My advice to those who want to stay fair is to use a sunblock, avoid the sun and apply vitamin A cream at night.”

So does this mean we need to swipe all the beauty products from our dressing table? Not necessarily. Dr Wang said many products are “decent”, produced by reputable companies and have some anti-wrinkle effect. They contain small amounts of ingredients found in more potent prescriptive products, such as pigment lightening creams given for conditions like melasma (also known as the mask of pregnancy) to combat brown patches on the face. Because of this, off-the-shelf products may have fewer side effects but are less effective. “However, beauty companies often tout their special ingredients as the next big thing, for example, stem cells which they claim can alter genes in the skin. In theory, it sounds good, but there is very little science behind it.”

Vitamin A remedy

Practising what she preaches Dr Wang Yi Shi, Consultant, Department of Dermatology, Changi General Hospital, lets us in on her personal beauty secrets. Cleansing: “I use a cleanser to wash off soap and grime, but it doesn’t make a big difference what you use. Go for something affordable which suits your skin type. Teens with oily, pimple-prone skin can use something stronger than what older women with drier skin can.” Night Creams: “I use a prescriptive vitamin A cream two to three times a week at night. It unclogs pores to prevent acne. I started using it in my 20s when I was acne-prone. It also speeds up the turnover of skin, and slows

down the appearance of wrinkles and fine lines. It can make your skin more sensitive to the sun, so you can’t use it in the day and go out into the sun. I also use an alpha-hydroxy acid cream two to three times per week to exfoliate and remove dead skin cells.” Sunblock: “Mine is an inexpensive, off-the-shelf sunblock.” Extras: “I have intense pulse light done once every six months. It’s like a photo facial for skin rejuvenation and is supposed to help with uneven pigmentation.”

The only scientific study she is aware of is on vitamin A derivatives, which are used widely in beauty products. “They have been shown to have some effect in delaying the signs of ageing, by slowing down the degeneration of collagen and elastic tissue in the skin,” she said. “Retinoids (vitamin A-derived topical agents) have undergone medical studies published in journals and are considered credible. Retin-A must be prescribed, but the gentler vitamin A creams can be bought off the shelf.” Other active ingredients in antiwrinkle creams are antioxidants such as vitamins C and E, glutathione and alphahydroxy acids (fruit acids) such as glycolic acid and lactic acid. Antioxidants are thought to slow down the damage in skin cells, while fruit acids exfoliate dead skin, leaving the complexion more radiant.

Staying fair Whitening products, besides vitamin A, usually also contain vitamin C, alphahydroxy acids, liquorice and kojic acid (a natural skin lightener derived from mushrooms).

delay wrinkles by using anti-wrinkle creams when you’re young. Teens and 20-year-olds have natural oils in their skin and often don’t need a moisturiser in humid Singapore.”

Other products

1

Steroids for whitening: “While

they temporarily make you fairer, they should be used only under medical supervision.”

2

Oral tablets: “There’s not enough

3

Eating collagen: “There is no

4

Fillers: “A mixture of hyaluronic

5

Lasers and intense pulse light:

evidence to suggest they have any direct benefits.”

evidence that eating collagen will infuse your skin with it. The only way is to use fillers.”

acid and animal collagen is injected into the skin to fill out sagging areas of the face, or create a more pronounced chin. The effect can be dramatic.”

“Lasers penetrate, heat and tighten collagen. It can result in subtle to mild improvement.”

“While store-bought products can lighten most common pigmentation problems, they seldom completely clear them,” said Dr Wang. “Often, the fairness women achieve is because they avoid the sun. My advice to those who want to stay fair is to simply use a sunblock, avoid the sun and apply a vitamin A cream at night. “Sun protection also cuts your risk of skin cancer and protects against early wrinkling,” she said. For those who enjoy sea sports or are out in the sun for long periods of time, a sunblock of at least SPF 30 is recommended. It must be reapplied every two to three hours, as its effectiveness wears off. But the flip side of the coin is not getting enough sun. “If that’s the case, monitor your vitamin D levels at the doctor’s clinic and take a supplement if necessary,” she said.


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Spotlight

Don’t forget your calcium pills

PHOTO: allen tan

Many kidney patients don’t realise the importance of taking these

Ms Doris Lim reminds her patients who are about to be discharged to take their calcium pills regularly.

BY Vivien Chan

When kidneys don’t function properly, the amount of phosphorus – the mineral that works with calcium to form strong bones – starts to build up in the body. Without treatment, an elevated phosphorus level leads to a decline in the amount of calcium in the blood – and possibly, fractures, bone disease and heart problems later. So for kidney failure sufferers, an important element of their treatment plan is calcium. Yet, many patients don’t take their calcium pills regularly, said Ms Doris Lim Wei Feng, Nurse Clinician, Singapore General Hospital (SGH).

Patients gave reasons like ‘I tend to forget during meals’ or ‘I forgot to take my medication along to work with me’. Ms Doris Lim Wei Feng, Nurse Clinician, Singapore General Hospital

“When the patients are in hospital, not taking their phosphate binders (calcium) isn’t an issue because their medicines are given to them regularly,” said 29-year-old Ms Lim.

“But when they return home, they or their caregivers may forget to give the calcium pills,” she added. Although it is routine for nurses to brief patients and their caregivers about their post-hospital medication, it is not uncommon for patients to return for their review later and tell doctors and nurses that they have not been taking their calcium. “Taking the phosphate binder medi-

cation is very important because it helps to lower the phosphate levels in their blood,” Ms Lim said. Troubled by the seemingly many lapses among her patients, Ms Lim decided to find out why and how widespread this problem was, the reasons patients don’t take their calcium tablets, and what the hospital can do to ensure that they don’t fall back on this important supplement. Together with her nursing colleagues, Ms Elena Ayob, Ms Pang Shui Li, Ms Juliet Chong and Mr Michael Pelayo, Ms Lim started the study in early 2010. The team interviewed 94 warded patients over four months. The patients, aged between 40 and 72, all had end-stage renal failure. Of the 94, only 15 were taking their phosphate binders as instructed. Ms Lim said: “Those who did not comply gave reasons like, ‘I tend to forget during meals’ or ‘I forgot to take my medication along to work with me’.” But Ms Lim noticed that while they forgot their phosphate binders, they seldom forgot their other medication. “Some of these patients take as many as eight different tablets a day for other conditions such as diabetes and hypertension. They don’t forget to take their other medications because they can feel the effects of skipping those,” said Ms Lim. For instance, the level of glucose in the blood can rise to dangerous levels if a person with diabetes forgets to take his daily medicine. But the effects of

not taking calcium pills regularly will show up only much later. Some patients said that they were already on a long list of medications and calcium pills had no obvious effect on them. “They fail to take their phosphate binders as instructed because they don’t understand the importance,” she added. To address this, the nurses began driving home the importance of taking phosphate binders while they are in hospital. They remind the patients and caregivers each time they are given their medicines. When the patients receive their medicines at their discharge, this reminder is again given. The reminders don’t stop there; when checking on the patients at home, nurses also drum into them about taking phosphate binders regularly. For this, the team won the Young Investigators’ Award (Nursing) at SGH’s Annual Scientific Meeting in April. Ms Lim, who has been with SGH since 2002, said: “Our study not only addressed an important issue for patients, it highlighted the importance of giving patients and their caregivers constant reminders as part of good nursing practice. “We were surprised by the win, but my team and I felt rewarded, especially as we felt the study also created awareness of this issue among patients’ caregivers.”

Getting enough nutrients A healthy lifestyle and a diet that is rich in the essential nutrients can help ensure good health, especially as we get older As we age, our bodies will experience physiological and metabolic changes. Fluctuations in our metabolism – the rate at which our body transforms energy to run various functions – can affect the absorption of essential nutrients. In addition to the usual essential vitamins and minerals, older people need more of certain nutrients such as calcium and vitamin D. Inadequate vitamins and minerals can lead to all kinds of medical problems, some of which can be serious for the elderly. A diet with a variety of whole grains, fruit, vegetables, lean meat, legumes, and dairy products can help fulfil these fundamental needs. Fluids are also necessary for good hydration.

A nutrient-rich diet is important for the body to have enough calories for energy, with complex carbohydrates as one of the main sources, protein for cell repair, fat- and water-soluble vitamins, and minerals for overall well-being. A deficiency in vitamins and minerals can put men and women over the age of 50 at risk of the following problems: Calcium and vitamin D – Increased bone loss, leading to a higher risk of osteoporosis and bone fracture Iron – Anaemia because iron is essential for carrying oxygen from the lungs to tissues Zinc – An impaired immune system and a poorer sense of taste and smell Folate – Pernicious anaemia (a type of anaemia), as folate is needed for the formation of red and white blood cells

Proper nutrition and vitamins are especially important for old people.

Vitamin B12 – Poor function of cells in the gut system Prolonged deficiency can result in the degeneration of the nervous system and a decline in brain function. A lack of vitamins, especially of the B-complex group, could lead to a decline in the person’s cognitive abilities. When the person is old and frail, recovery from surgery or illness may be slower. While it’s important to have enough calories, too much fats and sugars can a bad thing. We can become fat, which can in turn lead to a host of health problems such as diabetes, high blood pressure and cardiovascular disease.


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Viewpoint

Up close and personal with cancer

memories of how he courted his wife whom he loved dearly, and how proud he was of his two sons. He told me I was like the daughter he never had. I was at his bedside with his wife and sons when he died, and I cried buckets. They lost a husband and father. I lost a friend. He left a lasting impression and gave me a reason to continue my work with cancer patients – to be their friend, daughter, confidante!

Ms Flora Yong, an oncology nurse with 15 years of experience, has seen how cancer can devastate lives. That’s why she strongly advocates regular screening, as early detection could save lives I’ve seen cancer from both sides of the fence – as a nurse looking after patients and as a member of a family where the disease struck more than once. I’ve seen

I learnt that while circumstances may colour our lives, we can choose their colour. We can choose to feel defeated or hopeful and happy. There are no hopeless situations, only people who feel hopeless about them.

the fear and pain it causes. Lives lost. And it’s made me a firm believer in early detection and regular screening. As an oncology nurse, I’ve laughed and cried with patients – some of them former colleagues who once looked after cancer patients themselves. I’ve watched them struggle with and triumph over it. But some, alas, succumb to it.

Facing our own mortality I myself had a close brush with the disease two years ago. Doctors found two tumours, the size of golf balls in my bladder and adrenal gland. I endured a 41/ -hour operation to remove them. 2 Fortunately, both were benign. Recently, some cell changes were detected during my regular mammogram and I needed to undergo an open biopsy for a closer look at the changes. Thanks to breast cancer screening, these cell changes were detected early and removed so they would not cause problems in the future. Having gone through a biopsy and operation to remove tumours, I realise that nothing in your experience as an oncology nurse prepares you to face a possible diagnosis of cancer. Knowing about cancer does not make it easier for you to face your own mortality. In fact, it can make it worse because you have seen how it can end. Now, I understand the fear patients have while waiting for the

PHOTO: PHOTOLIBRARY

Cancer’s hit my family Cancer hit close to home for me. My father was diagnosed with nasopharyngeal cancer in the 1990s, an aunt died of cancer when she was 36 and a cousin was diagnosed with it a few years ago. My father was newly retired in Malaysia when he felt a lump in his neck which, after tests, was found to be cancerous. The family was devastated. He was fit, didn’t drink or smoke, ate healthily, played sports and did volunteer work. His only vices were mahjong with friends and Toto. Radiation therapy left him with darkened skin and painful mouth ulcers which made eating difficult. He also began to lose some hearing and the function of his salivary glands. I had to be the pillar of strength for him and the family. It was emotionally and psychologically draining. I felt helpless, unable to do anything but offer words of encouragement. His fight was short – a mere two years from diagnosis to treatment, relapse and finally succumbing to the disease. Cancer is not choosy and can strike anyone, so it is important to go for screening regularly to detect it early.

results of their biopsy, and how families of cancer patients struggle to cope emotionally and psychologically. The pain is real and it goes deep. Oncology nurses deal with death every day while helping patients live to the fullest. We have to reach deep for that strength to carry on caring. We cry when a friend or colleague loses his battle with cancer. But then we dry our tears and go on – that’s what we do. And we do it with pride. Many patients dig deep for that strength too. Many have been an inspiration. They have much to teach about life because they have stared death in the face. From them, I learnt that while circumstances may colour our lives, we can choose their colour. We can choose to feel defeated and despondent, or hopeful and happy. There are no hopeless situa-

tions, only people who feel hopeless about them. Whether we are patients or nurses – it is this strength that pulls us through, energises us and propels us forward when times are tough, the odds long and the chances slim. I remember an old lady who always made me smile. She came for weekly treatments for colorectal cancer, accompanied by her maid. She would get up to sway to the tune of her favourite evergreen songs coming from the radio in the treatment room. She was full of life, although her own life was slowly ebbing away. I also remember an elderly former government official with lung cancer who spent his last weeks in the ward. He would get breathless from just brushing his teeth. He told me stories about Singapore before independence while I wiped his back in the mornings. He shared

Cancer is not choosy Cancer does not discriminate. It can claim anyone. Don’t be complacent and think it can’t happen to you. It’s important to screen for early detection. If my father had known this, he would have been first in line and would still be around to play a good game of mahjong, but cancer screening was not widely promoted in Malaysia then. With my family history I cannot guarantee I won’t be next. I get screened yearly and remind my family members to do the same. I urge everyone over 40 to go for screening. Early detection is one of the best weapons against the disease. Contact the National Cancer Centre Singapore’s Cancer Helpline (6225-5655) for more information about early detection and screening. It can save your life. I no longer work directly with cancer patients, but spend my time raising awareness and funds for cancer research because, without research, more people will lose their lives to this disease. Research brings knowledge, breakthroughs and advanced treatments which can save lives. By supporting it today, we may find a cure tomorrow.

Ms Flora Yong, Community Partnership Manager, National Cancer Centre Singapore, uses her experiences as an oncology nurse to raise awareness and funds for cancer research. Previously a Senior Nurse Manager in charge of public education, she also ran the Cancer Helpline, which helps sufferers access information, support and links to community resources.


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People

KKH’s Paediatric Epileptologist By Angeline Neo

As the Head of Neurology at KK Women’s and Children’s Hospital (KKH), Dr Derrick chan and his team deal with a range of brain disorders in children – from serious paediatric neurological conditions such as stroke, nerve disorders and brain inflammation to common complaints like headaches and developmental delays. But the bulk of his work involves children with epilepsy. Dr Chan specialised in epilepsy at the Hospital for Sick Children in Toronto, Canada, returning with new skills which have already made a difference in the lives of patients here. As a paediatric epileptologist, he works closely with a team comprising a neurosurgeon, a psychologist, therapists, EEG technologists, neurology nurses and social workers to manage patients with complicated epilepsy, and select and evaluate those suitable for epilepsy surgery. Before epilepsy surgery is recommended, Dr Chan evaluates the patient and scans and studies the brain. He analyses the electroencephalogram (EEG) to map the location of seizures in the brain.

The team discusses the options and approach together with colleagues from Singapore General Hospital (SGH) and National Neuroscience Institute (NNI). Selected patients require a process known as Extraoperative Subdural EEG Monitoring which involves putting electrodes on the surface of the patient’s brain for several days, followed by surgery to remove the areas producing seizures. This allows detailed monitoring of the activity from the brain’s surface during seizures and, hence, pinpoints the exact location causing them. With such detailed mapping and planning, the surgeon Dr Ng Wai Hoe can go in and take out only the bits that are causing the problem and conserve the parts that perform important functions, Dr Chan said. Success stories include a 10-year-old girl who had weekly seizures since age one. Medication did not work and the seizures were getting more frequent. After surgery, the seizures were controlled with medication. Another was a nine-year-old girl who also had seizures from a young age. She had the temporal lobe on one side removed and is now seizure-free. Dr Chan said surgery is not the last option, but has to be the right one. “In selected patients, surgery is very valuable.”

Beyond the hospital Big-hearted nurse continues to show her care and concern even after her patients are discharged

Many patients suffering from liver, gall bladder and pancreatic illnesses come to rely on Ms Julianah Bee Abdul Latif’s care and attention long after they are discharged. They first meet Ms Julianah Bee, Nurse Clinician (Specialty Care), Singapore General Hospital (SGH), when they are admitted to SGH for surgery. She explains the operation and their condition to them, their families and caregivers, and teaches the caregivers how to look after the patients after they are discharged. “I tell them about their condition and what to expect from the operation. I also teach them and their caregivers how to look after wound dressings and tubes before they go home,” said Ms Julianah Bee. Often, her care extends beyond the hospital. One patient asked her for help to dress her wounds, so now, once a week after her shift, Ms Julianah Bee makes her way to the patient’s home to change her

dressing. “I just like to make sure that my patients are doing well when they are at home too,” said Ms Julianah Bee. “I jumped at the chance to take this role as it allows me to interact more with patients and teach them about the nature of their disease, care and treatment.”

Dr Derrick Chan specialised in epilepsy while in Canada and, since returning, has already made a difference in the lives of patients here.

And with the right patients, doctors prefer to operate sooner rather than later. “If we wait a long time, they tend to develop deficits. If the epilepsy is allowed to continue, they may get other cognitive, memory and behavioural problems.” Dr Chan, married with two children aged six and eight, chose paediatric neurology because he finds it extremely ful-

Not surprisingly, she takes a close interest in her patients’ health and life outside the hospital and often ends up forming a strong bond with her patients and their families. “I got to know a patient six years ago and became close with him and his family. We visited each other’s homes during festive seasons and became good friends,” said Ms Julianah Bee. But the patient died recently. “Working on a surgical ward, I see most of my patients leave here feeling better. But some, such as those suffering from liver

PHOTO: ALECIA NEO

By Ruth Loh

PHOTO: ALLEN TAN

Dr Derrick Chan Wei Shih explains the nature of his job and why he chose to specialise in this branch of medicine

Going beyond the call of duty to teach and help her patients is normal for Ms Julianah Bee, who does it all out of love for her profession.

filling to help children recover fully and go on to lead normal lives. “A child’s brain has a tremendous ability to repair itself, more so than in adults, so we can do more. Even when we can’t completely resolve their problems, like in cerebral palsy, we can make the quality of their lives better.” Epilepsy usually manifests in the preschool or primary school years. The severity ranges from a twitching of the lips to a generalised seizure that does not stop. “Those patients end up in intensive care and we have to do a lot of work to try and protect their brain, minimise the harm and improve the condition. But it’s worth it. We have patients who’ve been in intensive care for months and eventually walk, talk and return to normal life,” said Dr Chan. Neurology has benefited from technological advances and there is more improvement in store. “We’re working on automated video analysis for patients with seizures and quantitative analysis of brainwaves to help us pinpoint where the seizures start.” Dr Chan’s long-term goal is to build a comprehensive epilepsy programme in KKH. Since returning from Canada, he has set up a ketogenic diet clinic, a specialised epilepsy clinic and a dedicated epilepsy monitoring suite. He is also encouraging the team to include more diversity and subspecialties. “We have the building blocks – the clinics, the people and the skills. What we want to do is keep developing and advancing,” he said.

cancer, can come back for treatment and it’s difficult for me to cope when they pass on. Thankfully, this doesn’t happen often,” said Ms Julianah Bee. But despite these challenges, she remains passionate about her job, which her mother inspired her to pursue when she was young. “My mother trained to be a nurse back in the ’60s, but she never finished her three years of nursing school. So she looked to one of her children to fulfil her dream,” she said. Motivated by the many stories her mother shared about her nursing days with her and her siblings, Ms Julianah Bee enrolled on a nursing course at Nanyang Polytechnic after her O levels. Ever since she graduated from the polytechnic, she has been working at SGH. “I always say that to be a nurse, you must really love – not just like, but truly love – what you do. Like doesn’t cut it. You have to love your work before you can love the people who come to you,” she said. Her dedication to her patients has not gone unnoticed. Over the years, Ms Julianah Bee has been the recipient of 10 awards which recognise her contributions to patient care. “My motto is to surpass my patients’ expectations. I make sure I am an expert at what I do, so I can offer my patients the best advice and information. I want them to know I am there for them,” said Ms Julianah Bee.


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Nov⁄ Dec 2011

FYI Answer to In focus (Page 3):

Diving on land

event Calendar

Singapore Health issue 13 contest

Speech therapy day

It was initially developed to combat diving disorders such as decompression sickness and gas embolism – a consequence of divers rising to the water surface too quickly. But forcing a greater amount of oxygen to be dissolved in the bloodstream proved to be equally effective in treating conditions such as wounds that don’t heal, thermal burns and diabetes-related ulcers. Hyperbaric oxygen therapy involves breathing pure oxygen at air pressure two to three times greater than normal, which forces more oxygen to be dissolved in the bloodstream. This heavy concentration of oxygen stimulates blood vessel growth and enhances the immune system’s ability to fight infection. Patients undergoing hyperbaric oxygen treatment stay inside a hyperbaric chamber (below), which looks very much like the inside of an airplane or submarine. During treatment, the air within is compressed to a level equivalent to that at 14m below sea level for about two hours. A nurse accompanies patients in the pressure chamber during treatment, which is known as a “dive”. Despite its name, neither the nurse nor the patients wear a diving helmet, although it has

come to symbolise the therapy. During a “dive”, patients wear an oxygen hood or mask to breathe in the compressed oxygen. At Singapore General Hospital’s Hyperbaric and Diving Medicine Centre – the first comprehensive and integrated facility in Singapore serving the civilian community – Senior Staff Nurse Hayden Tan (below) is a seasoned “diver”. He performed his first dive on Mar 12, 2008 and his 500th in July this year, and is the first SGH employee to do this. As of Oct 6, he had made 554 dives. After he “surfaces” each time, he is not allowed to “dive” again for another 16 hours to allow the nitrogen bubbles in his body to dissipate.

1. What is one benefit of keyhole spine surgery vs open spine surgery? 2. What is your favourite story in this issue of Singapore Health? Closing date: Dec 14, 2011 Send in your answers and stand to win five bottles of Ultra IQ Plus worth $62.05 each.

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Smokers are

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more likely to get a lung infection and die from tuberculosis than non-smokers. Source: BBC

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

An informative forum for seniors

Winners of Contest 12 These winners will each receive a Betadine Gift Pack worth $35.50.

Source: BBC

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

Spring to Life SingHealth Silver Years Forum 2011

Nov 12 (Sat)

Email: editor@sgh.com.sg Post: The Editor, Singapore Health, Singapore General Hospital, Communications Department, Outram Road, Singapore 169608

women were diagnosed with breast or cervical cancer last year, according to new global figures.

Co-funded

Learn more about how speech therapists help patients and participate in games such as “Swallowing Pinball”, “Thickener Speed Drinking” and “Tongue Twister”. Time 11am-3pm Venue Postgraduate Medical Institute (PGMI), Block 4, Level 1 Registration Free

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

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Forum Topics Keep your gut well (Improve your colon health) by Dept of Colorectal Surgery, Singapore General Hospital (SGH) Good food, good life (Healthy nutrition for the elderly) by Dietetics and Nutritional Services, SGH Brain health alert (Don’t let dementia get you down) by Dept of Neurology, National Neuroscience Institute How to ease chronic pain (Strategies and treatment options) by Pain Management Centre, SGH Time 12.30pm-4.30pm Venue Concorde Hotel (formerly Le Meridien Hotel, nearest MRT station Dhoby Ghaut) Price Registration $10 (for one person) $18 (for two people) Closing date for registration Nov 7 Contact For information, call 6377-8511 or email marcom@singheath.com.sg For more information and other listings, please visit www.singhealth. com.sg/events or the respective institution websites.

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


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NOV⁄ DEC 2011

新脉动

27

新闻

治疗心脏衰竭

虽然心脏衰竭无法逆转,彻底恢复健康,但新的 治疗方式让患者能再次过有素质的生活 足够的血液。严重的患者,即使在休息 时,心脏也无法输送足够的血液。 沈医生说:“每年有5千人与邬振兴 一样因心脏衰竭进入医院接受治疗。通 常,男患者比女患者为多。造成心脏衰 竭的因素包括没有控制好血压,糖尿 病,高胆固醇,抽烟及过度肥胖等。” 心脏衰竭并没有治愈的方法,因

图:101teamwork

给看护的忠告 患者精神上的支持 确保病人准时服药 鼓励和帮助病人戒掉危害身体 健康的恶习 学会注意病人发病的征兆及学 习在病发时如何帮助他们

沈庆龙医生(右)解释像邬振兴先生(左)的患者如何在几年内从患有心脏问题进入末期心脏 衰竭。

控制血压不能单靠药物

被诊断出患有高血压的何添胜先生(译 名)是既担心又害怕。他说:“大约在 两年前,我已被诊断出患有糖尿病。我 担心如果不好好控制这两种疾病,我的 健康会越来越糟。” 但是,他无法适应医生开给他的药 物。何先生说:“它让我觉得头昏眼 花。” 何先生因此转换医生,尝试新的 药,但情况并没好转。 这种情况一直持续到他在马林百列 综合诊所求诊时遇到了孙伟光医生。孙 医生开了适合他的药物。如今,73岁的 何先生须服用四种抗高血压药才得以控 制住他的血压。 现任欧南园综合诊所所长的孙医生 说,抗高血压药物所带来的副作用其实

处理心脏衰竭 给心脏衰竭病人的忠告 饮食健康,减少盐分的摄取 不要有喝酒和抽烟的恶习 向受训的辅导人员了解如何处 理问题,如忧郁症 向社工了解如何处理治疗费用 遵守服药的指示 每日检查体重,如突然增加1至 2公斤,可能是水肿导致,应通 知医生

别让血压升高 原文 Rachel Chan

移植手术的中心, 其中6至8人需要仪器 辅助心脏,或心脏移植手术。 一个名为Heart Mate II的改良仪器, 在2009年引进新加坡。它代替心脏泵 血,体积也较小,适合身材较小的人 士,如亚洲人和妇女。 邬振兴准备装上Heart Mate II。这仪 器能给他更多时间等待适合的心脏捐献 者。他说:“我很讶异装上Heart Mate II 的病人仍能过正常人的生活。”。 现年 47 岁的邬振兴希望利用这个仪 器让自己能在等待进行移植手术期间重 新开始工作。

相当常见,但多属轻微症状。 他说:“有些病人可能会出现下肢 肿胀、头昏眼花或干咳等副作用。虽然 大多副作用不会造成生命危险,但病人 应该告诉医生,让医生调整或更换药 物,以消除或减轻任何副作用。” 因为孙医生开了适合他的药物,何先 生因此很喜欢找孙医生问诊。即使孙医 生被调到红山综合诊所,之后再调到欧 南园综合诊所,何先生继续找他看诊。 现在,何先生不仅定时服用药物, 还减少吃零食、油腻和咸的食物。 他说:“我必须照医生的指示来服 用药物,及遵从他提出改变生活方式的 建议。若要控制慢性疾病如高血压,我 必须和医生建立起互信关系,这不单是 服用药物的问题。”

声杀手”的原因。但是,如果不加以控 制,高血压会引起并发症如中风、心脏 病和需要进行透析的肾功能衰竭。 孙医生说:“大约 95 %原发性高血 压病人并没有任何具体的成因。但跟 高血压有关的风险因素包括高血压家族 病史。” 他规劝 40 岁及以上的人每年做一次 健康检查。如果发现患有高血压,就应 该采纳健康的生活方式、减少抽烟和喝 酒、注意体重及常做运动,也必须开始 服用药物,以控制血压。 孙医生补充道:“早就患有高血压 或在怀孕期间发现患上高血压的孕妇需 要由她们的妇产科医生密切监督,因为 她们出现并发症的风险较高。”

说:“这被称为白大衣综合症。血压升 高通常是因为病人看医生时感到害怕所 引起的。” 为了避免误诊,医生建议你深呼吸 和放轻松。孙医生说:“看医生前不要 抽烟或喝含咖啡因的饮料,因为它们会 影响血压读数。测量血压前大约半个小 时,最好可以稍作休息。” ���果你的血压读数未达到预期目 标,医生可能会再次进行测量。医生也 可能会建议你在家里使用电子血压计, 监督自己的血压,以便更精准地读取你 正常血压的读数。这有助于避免不必要 的增加用药剂量或改变治疗方式。

控制高血压 孙医生说:“按病人的需要开药是很重 要的,医生必须以病人之前的病情和他 对哪些药物过敏或有不良反应作为考量 依据。” 他补充道,病人应定时吃药。如出 现任何副作用或对依从服药指示有任何 困难,也应向医生咨询。

血压什么时候会升高?

白大衣综合症

患有高血压的病人大致上是不会出现任 何症状。这也是它为何会被称为“无

研究显示高达 25 %的病人在诊所测量 血压的读数比平时测量来得高。孙医生

图:Gettyimages

他原本在车内等着交通灯转绿,刹那间, 他感觉周遭一片黑暗,便晕了过去。当 时 38 岁的邬振兴说:“当我醒来时, 我即刻开车到最近的急诊部门去。” 邬振兴曾是国家队的水球选手和企 业家。医生诊断邬振兴患上非持续性室 性心动过速,一种不寻常的快速心跳。 新加坡国家心脏中心心内科部门顾 问沈庆龙医生说:“邬振兴的心肌功能 失调,左心房肿大,不能如健康的心脏 泵血。” “这造成他的病况,但真正的病因 却往往无法确定。” 2008 年,病发后七年,邬振兴被诊 断出已患上无法逆转的末期心脏衰竭。 他不得不放弃工作,并且长期受到头 痛的折磨,稍微勉强自己劳动就会喘不 过气。 沈医生说:“心脏衰竭广泛的指心 脏失去泵血的功能。这表示心脏无法输 送足够的血液以满足身体的需求。心脏 衰竭是许多心脏疾病的终点,最常见的 是缺血性心脏病(当输往心脏的血液减 少)导致心脏衰竭。 轻微的心脏疾病,患者只是在运动 时跟不上,但在休息时,心脏仍能输送

为心脏的坏损是无法恢复的。沈医生 说:“对初期患者,我们会通过药物和 改变生活方式进行治疗,以减低并发 症和死亡率。例如,如果心脏衰竭的 导因是酒精,我们会规劝病人诫酒和 服药。” 沈医生补充说:“心脏衰竭病人需 要大幅度地改变生活习惯,有时甚至需 要停止工作。” 一些严重患者可植入介入式心脏复 律除颤器并从中获益。这是一种监测心脏 频率的仪器,当感应到不正常的频率时, 它会发出电击。沈医生说明:“这能有效 防止病人的心脏突然停止跳动。” 每年,约有 30 个末期心脏衰竭病患 者到新加坡国家心脏中心求诊。新加坡 国家心脏中心也是新加坡唯一进行心脏

听从医生对药物和改变生活方式的指示,因为 这都是为你量身定制的。


28

新脉动

NOV⁄ DEC 2011

保健:美容

爱美与安全 接受专业修饰指甲是宠一宠自己的好方法, 但也要小心

为了避免指甲受到真菌感染,除了避免 到看起来不太整洁的美甲沙龙,你也必 须留意对方怎么为你修饰指甲。 新加坡樟宜医院皮肤科顾问医生林 苏萍说,专业修饰指甲所采用的方式会 使指甲变弱,让真菌容易滋生。受真菌 污染的用具或和感染人士接触过的用 具,包括修饰指甲的服务员,都有可能 使你受到真菌感染。 指甲真菌感染是由容易在高温及潮 湿的环境下繁殖的真菌所造成的。它通 过几种不同的方式,包括皮肤的小创口 (通常是修剪指甲周围表皮时所造成 的)、指甲和甲床之间的缝隙,或直接 通过被指甲油等化学物质或创伤而变弱 的指甲入侵体内。 指甲因此会变色、变厚,也因真菌 的种类而变绿、白或黑。 指甲真菌感染较常出现在脚指甲, 因为鞋子里潮湿、黑暗以及高温的环境 是真菌的温床。没有装置好的水晶指甲 也有可能造成感染。

1

保持指甲短和干爽 林医生说:“如果你的指 整洁。如果你的双手 甲和水晶指甲间有缝隙,受感 经常和水接触,用塑 染的部位可能被遮盖,在你发 胶手套来避免指甲长 现之前,情况可能已经相当严 时间浸泡在水中。 重了。” 她补充说,留长的水晶指甲 的另一危险就是不小心损害到真指 不要修剪或 甲。如果水晶指甲被东西卡住,两层指 抠指甲周围的 甲有可能都被剥开。 皮肤,避免细 菌入侵。

2

如果你的指甲和水晶指 甲间有缝隙,受感染的 部位可能被遮盖。在你 发现之前,情况可能已 经相当严重了。 新加坡樟宜医院皮肤科顾问医生林苏萍

专家说

健康交流站 我们的专家为您解答有关应付背和膝盖疼痛的问 题并告诉您减轻体重的几种方法

体重管理 如果我选择通过抽脂手术来去除 多余的脂肪,我患上心脏疾病的 几率是不是会自动降低?这是不 是达到身体健康的捷径? 无论是因为过年 过节、喜欢吃 零食或是受到感 情或工作上的压 力,大多数人都会 经历一些体重波动。然而,从 什么情况这“一些”波动会变成“过 多”呢?一般上,当一个人摄取比消耗 更多的热量时,多余的脂肪留在体内就 会导致肥胖。 抽脂手术是一项从身体某些部位抽

6

不要在 公共场所赤 脚走动。

5

3 如果触摸

在脚上和 鞋里使用抗真 菌喷雾剂或抗 真菌粉。

穿露趾鞋。 但如果你经常穿鞋 子,应确保自己穿 上比一般袜子较能 保持双脚干爽的合 成纤维袜子。

丑陋的问题 林医生说,有些指甲真菌感染虽然不会 让人感到不舒服,但也不应该被忽视。 “真菌感染可以蔓延到你整个指 甲,并随时间完全毁掉它。如果你触摸 了受感染的脚指甲,你可能会无意中感 染到你皮肤其他部位。” 治疗这种感染需要时间,但可以用 药膏、外用漆或口服药等药物医治。真 菌感染通常不容易治疗,况且一个健康 的指甲也需要时间生长来取代受感染的 指甲。即使症状消失了,感染往往还是

会复发。两种较普遍的治疗方式包括外 敷抗真菌指甲液或指甲漆以及口服抗真 菌药物。 使用外敷药物通常需要比较长的时 间才会奏效,因为药物比较难渗透指 甲。较有效的方法是服食抗真菌药物。 但是,这可能带有副作用,也可能需要 好几个月才能看到效果。 林医生说:“最好的方法就是好好 照顾你的指甲,避免受到真菌感染。一 旦被感染,它复发的几率会很高。”

腰背痛

我们建议腰背痛患者进行游泳或其 他水中运动,例如水中有氧运动。与跑 步等负重运动相比,水的浮力更易于背 部关节和腰椎间盘的活动。 热身可以伸展运动时所用到的肌肉 组织。伸展至肌肉拉紧但无疼痛感的 程度为宜,然后保持十秒钟并重复三至 五次。

我丈夫患有腰背痛,我担心可 能是腰椎间盘膨出所引起的。 他经常运动而且每周至少跑步 一次,可能因此使他的情况恶 化。有什么运动方式对腰背痛 患者最适宜或最安全?我听说 伸展运动对热身很重要,但哪 一种最适宜呢?

出皮下脂肪组织的外科手术,例如大 腿、下巴、屁股、腹部及胸部。要降低 患上心脏疾病的几率,您不仅需要减少 皮下脂肪也必须减少内脏脂肪。这是唯 有通过健康饮食及运动才可以达成的。 在抽脂手术过程中,只有限量脂肪 能够被安全地抽出来。它不但不能让您 达到减肥的效果,也不会降低因过重而 患上疾病的几率。抽脂手术是一种整形 手术,主要是用来改善身材曲线。这是 当运动和体重管理都无法有效地去除身 体的肥胖部位或“顽固”脂肪时,才会 采取的步骤。抽脂手术对那些会提高心 脏疾病风险的主要因素,如血液胆固 醇、抽烟、少运动、糖尿病及高血压 等,不会有任何的影响。

腰背痛是一种慢性疾病,主要特征为腰 背部持续钝痛或锐痛,是现今最常见的 疼痛疾病。

- 竹脚妇幼医院高级营养师林秀珠与整形外科及

80% 的成年人在一生之中的某个时期都曾有过 腰背痛。

美容专科客座顾问医生谭仁

4

了受感染的 指甲,立刻 洗手。

- 新加坡中央医院理疗科资深理疗师许慧冰

膝盖疼痛 放射科技师的报告显示我两个 膝盖都有轻微的关节退行性改 变以及小小的骨刺。我的身体 质量指数是20.4。我该如何停 止或扭转这个状况?我曾经有 跑步和跳绳的习惯,不过目前 已经停止了。

图:photolibrary

原文 Stacey Chia

如何避免 指甲受真 菌感染:

您膝盖关节的退行性改变是永久性的, 没人能阻止衰老的过程。如果您的膝盖 不疼痛,我强烈建议您继续运动。然 而,剧烈运动如弹跳或跑上梯级对您膝 盖的伤害将比游泳或室内健身脚踏车来 得大。 - 新加坡中央医院矫形外科顾问医生陈


Nov⁄ Dec 2011

焦点

家长的力量 原文 Goh Hui Chin

育有 4 名孩子的何甘燕女士曾惧怕与全 家人一起出国度假。她那只有 5 岁大的 小儿子雷德弈患有自闭症,经常会因环 境和日常生活的改变而大发脾气,因而 影响旅游兴致。 何女士说:“即使是在家里,我们 也不一定能好好的管教他。日常生活的 任何改变都会让他很沮丧而大发脾气。 单单去学校上课都会让他哭个不停。” 德弈和许多自闭症儿童一样,如果 他无法预料日常上的变化,就会让他感 到很焦虑。 为了帮助德弈的父母更了解他,竹 脚妇幼医院的儿科医生建议何女士和她 的丈夫参加院方展开的一项试验性计 划。这项计划旨在教导他们一些策略和 技巧来帮助应付德弈,避免他乱发脾气 和使性子。

图:alecia neo

一个全新的计划,教导家长如何进一步了解和更 好地管教行为有问题的孩子 父母可参与的计划

以面对因旅行而带来的改变,我们给他 看一些人们穿着冬装和北海道的图片。 当德弈得穿上冬装时,他并没有显得难 以适应。在八天的行程里,他都是很平 静和放松的,完全没有出现他大发脾气 的状况。” 这项为期三年的试验性课程将开放 给1500个家庭参与,由竹脚妇幼医院医 生推荐的父母都可以参加。课程费用获 得高度津贴。 竹脚妇幼医院儿童发展部门主任兼 高级顾问医生林淑美副教授说:“我们 要采用一项实际和贴切的计划,让所有 有需要的人都可以参加。我们与澳大利 亚育儿研究中心合作,将该中心的课程 按照本地的情况作出改良。” 竹脚妇幼医院将密切研究这项试验 性计划以确保它能达到预期的效果。林 副教授也说:“进行这些课程是为了衡

新加坡中央医院的感染控制科主任强调,培养简单的良好 卫生习惯,便可对抗超级病菌

图:101teamwork

原文 Jacqueline Chia

林美玲医生说,对抗致命的超级病菌是每一个人 都必须承担的责任,人们应该养成良好的卫生习 惯,防止病菌传播。

MRSA ,但并不是每一个住院病人都会

感染这种超级病菌。而且不是每一个 感染 MRSA 的人都会发病。不过,它可 能导致免疫系统薄弱的人出现严重并 发症。 新加坡中央医院感染控制科主任 林美玲医生说,一项针对新加坡中央 医院及国大医院为感染 MRSA 病人展开

29

量它对孩子的行为可能带来的影响,我 们会在这期间展开研究。” 另一名家长汪先生也参加了这项课 程,如今与 4 岁儿子以诺的关系比以前 好多了。在这之前,虽然以诺并没有任 何行为发展上的需要,但汪先生仍认为 他难以管教。 汪先生说:“我叫他做一些简单的 事情,例如刷牙,都非常困难。我的协 导员建议我让他选择他喜欢的牙刷。让 我感到惊讶的是,他不再拒绝刷牙,反 而变得喜欢刷牙了。”

何甘燕女士(左)发现,课程中教导的技巧,能 帮助她管教好患有自闭症的五岁儿子雷德弈。

何女士是首批在本地参加“培养良好 行为计划”试验性课程的家长。这项 课程让父母和看护者进一步了解有行 为问题(自闭症和过动症引起的问 题)的儿童所面对的困难,并找出更 有效的方法来管教孩子,避免他们的 行为问题恶化。 儿童因为无法清楚的沟通,使他们 感到被误解和沮丧,才会经常引发这些 行为问题。对父母来说,这些状况也会 让他们感到心烦和懊恼,因为他们会觉 得孩子的行为不端。 这项为期六个星期的课程包括了一 堂概论课和五堂正课,每一堂课长达两 个半小时。何女士上了这项课程后,觉 得自己变得更有信心再度尝试全家出游 度假。 何女士说:“我们很惊讶,一些简 单的做法如事先安排和沟通,便能给德 弈带来舒适感和安全感。” 她说:“为了让他做好心理准备,

超级病菌崛起 他醒来时咳嗽、感到身体虚弱和全身酸 痛。他以为只是普通的感冒。可是,不 到 24 小时,他便逝世了。验尸结果显 示,这名男子是死于超级病菌MRSA所引 起的肺炎。 这是几年前在美国发生的一起病 例,尽管或许这是发生在感染 MRSA 病 人中的一个极端例子,但这起病例突 显了 MRSA 病菌( Methicillin-Resistant Staphylococcus Aureus,抗甲氧苯青霉 素金黄色葡萄状球菌)的侵略性。 医学界在1980年代首次确认MRSA的 存在,之后,便广泛地出现在全球各 地。过去,医学界认为病人只会在医院 里感染MRSA病菌;如今,这种超级病菌 已在社区传播,任何人都有可能在任何 地方感染MRSA。 M RSA 通 过 人 与 人 的 接 触 传 播 , 例 如握手或触摸 MRSA 病人摸过的东西。 MRSA 带菌者会在他们到过的地方留下 病菌。 尽管住院病人极有可能在医院感染

新脉动

的研究显示,“他们在住院期间死亡 的几率,比没有感染 MRSA 的病人高出 10.2倍”。 林医生也说,这项在2007年底至 2008年初进行的研究也发现,感染 MRSA 的病人在留医时间,比一般病人 长4.6倍,而且与医院有关的费用也比一 般病人高出 4 倍。这些病人大多数会出 现并发症,在出院 6 个月后须再度入院 接受治疗。这导致他们面对更高的门诊 和住院治疗费用。 虽然这项研究的主要对象是医院 里免疫力较弱及比一般人更容易感染 MRSA 的住院病人,但研究结果也突显 了良好卫生习惯的重要性。 MRSA 会 被 称 为 超 级 病 菌 , 是 因 为 它有很强的抗药性,可以对抗多种抗 生素。 虽然一些抗生素仍可以治疗 MRSA引 起的感染,但大部分感染 MRSA 的病人 还是得依靠自身的免疫系统来打败这 种超级病菌。因此,体质较弱的老年病 人感染 MRSA 后,生命很有可能会受到 威胁。 MRSA 能通过不同的途径感染人体。 最常见的是皮肤感染,它看起来就像青 春痘或黄水疮。 MRSA 有时也会扩散到 体内其他器官,而导致病人面对死亡的 威胁。 医学界在未来几年应该很难研发出 对抗 MRSA 及其他超级病菌的新型抗生 素。林医生说,尽管这种情况令人担 忧,但好消息是,良好的卫生习惯能有 效阻止这种超级病菌的传播。

我们很惊讶,一些简单 的做法如事先安排和沟 通,便能给德弈带来舒 适感和安全感。 何甘燕女士的五岁儿子德弈患有自闭症

他说:“他必须按照他自己的方式 来做事,所以以诺现在不只使用一支牙 刷,而是两支牙刷,一支刷下颚牙齿, 另一支刷上颚牙齿。” 他也说:“在参加了这项计划后, 我和儿子的关系大为改善,也让彼此更 了解对方。”

与时间赛跑

新加坡中央医院感染控制科主任林美 玲医生说,对抗新型超级病菌的药物 研发进度还追不上这种超级病菌的进 化步伐。 林医生说:“新型病菌随时都可 能来袭。目前一种新型超级病菌极有 可能正在诞生,只是我们不知道它什 么时候会出现。我们只能做好预防的 准备。” 当新型超级病菌出现时,我们必 须阻止它扩散,避免它演变成一种流 行病。要做到这一点,唯一的办法就 是阻止它在社区传染开去。 超级病菌的出现,部分原因在于 抗生素的广泛使用及随意开出抗生素 给病人服用。林医生说:“许多人因 为他们的病症消失了,就停止服用抗 生素。然而,不服完抗生素,只会消 灭掉一些病菌,那些残留下来的病菌 就会产生抗药性。多年下来,这些抗 药性病菌进化成型并开始扩散。这种 情况就导致了超级病菌的出现。” 科学家持续地研发新的药物,以 便能跟上新型病菌的演化步伐,但我 们必须等上很多年,才能使用这些新 型药物。 林医生说:“研发新型抗生素 需要创意、知识和至少10年的时间。 然而,当新型抗生素面市时,它可能 已无法有效对抗某些种类的病菌。我 们已经用尽所有点子与时间了。”


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新脉动

Nov⁄ Dec 2011

保健:旅游

平平安安,环游世界 如果你时间有限,只能参观一间寺 庙,那肯定要到大昭寺。金瓦屋顶上的 法轮两侧各有一只金鹿,已成为大昭寺 的特有标志,吸引了许多游客参观其 庞大的建筑群。藏王松赞干布于七世纪 下令兴建大昭寺,用来存放他的两位妻 子 — 尼泊尔的尺尊公主和中国唐朝的 文成公主入藏时所带来的佛教文物,而 这些也是她们的部分嫁妆。如今,大昭 寺依然是西藏的历史和宗教中心,成千 上万的朝圣者会到其阴暗、宽阔的内寺 朝拜众神和菩提萨 (指引众生的悟道 之人)。

旅行忠告 游客可以停下来欣赏宏伟的布达拉宫。这是达赖喇嘛在1959年离开中国之前的住所。

西藏:站在天堂的入口

干燥凉爽的气候而被当地人称它为日光 坐拥许多寺庙的西藏是佛教徒前往朝拜 之城。 的圣地。由于它位于喜马拉雅山的高原, 布达拉宫坐落在海拔3700米的红山之 因此它也是登山爱好者想征服世界最高 巅,是不可错过的景点。它由白宫和红宫 峰的热门选择。 组成,是达赖喇嘛的住所,一直到1959年 很多游客都以西藏自治区首府拉萨作 他离开中国在印度成立了“流亡政府”。 为出发点。拉萨,意为诸神之地,海拔 布达拉宫内还保存着大量珍贵的雕塑、 超过3500米,是世界上最高的城市之一。 壁画、经文、佛像、古董和首饰,是西 这座古城是达赖喇嘛居住的地方,因其 藏历史、宗教、文化和艺术的宝库。

巴布亚新几内亚:最后一片未开 发的土地 美国艺术家马克·詹金斯(Mark Jenkins )曾经说过,真正的探险是亲 身体验这个世界。毫无疑问,被视为地 球上最后一片未开发土地的巴布亚新几 内亚,绝对可以让你有亲身体验世界的 感受。 巴布亚新几内亚位于印度尼西亚的 最东部、澳大利亚的北部,是世界上 最大的国家之一。这里大部分的热带 雨林和山脉都未经开发。其人口由几百 个传统部落组成,他们拥有各自的土著 语言、艺术、舞蹈、武器、服装、音乐 及其他形式的文化。大多数人居住在 乡村,靠耕作、狩猎和采集野生植物 为生。 塞皮克河发源于巴布亚新几内亚的 中部高原,是世界最大的河流系统之 一,也是亚太区最大的未受污染淡水湿 地生态系统。在 900 公里长河流沿岸的 村落里,有一种叫做Haus Tambarans又 称灵屋的传统建筑。它有精心建造的屋 顶和雕刻精美的木柱,是举行集会、宗

教仪式、成人仪式和礼拜的场所。 这里可进行的活动包括在珊瑚礁和 二战时留下的沉船一带潜水、观鸟、狩 猎式钓鱼和远足。历史上著名的科科达 山道连接巴布亚新几内亚的北部和南 部,穿过森林、溪流、橡胶园、陡峭的

气候:拉萨气候干爽,全年阳光普 照,须准备保暖的衣服、墨镜、防 晒油和帽子。高山症:高海拔地区 的空气稀薄,可引致高山症,造成 轻微头痛和反胃等症状。Wijaya医 生说:“最严重的情况是,它可 损害肺部和脑部,这种情况会致 命。”心肺有问题的人会难以适应 西藏恶劣的气候条件。

山谷和村庄,曾经是第二次世界大战期 间日本和澳大利亚军队的战场。远足者 需要 4天至 12天才能走完 96公里长的科 科达山道。时间的长短须视远 足者的身体状况 而定。

出发前的准备 去偏远地方旅行时,想要在邻里药 房找到一瓶退烧药扑热息痛,可能 会比买个熊掌还难。因此,尽早为 旅程做好准备是值得的。 健康问题极其重要,到旅游诊 所全面了解你的旅游目的地,将 有助于避免任何不愉快的经验。 新加坡中央医院传染病科顾问兼 旅 游 诊 所 主 任 L i m i n W i j aya 医 生 说:“旅游规划不只是注射疫苗和 准备药丸。在进行旅游健康咨询 时,旅游诊所的医生会提供日常 预防措施和与特定国家相关的建 议,以尽量减少跟旅游相关的健康 风险。 比如,一些疫苗 注射(如狂犬病疫 苗)需要一个月的 时间来完成,因此 游客应在出游前的 四至六周到访旅游 诊所。 Wijaya 医生说:“如果他们因 种种原因无法提早来,即使不能完 成整个疗程,我们还是建议他们来 会诊。” 旅游诊所的营业时间是周一至 周五,早上8时30分至下午5时。旅 游诊所可以帮游客准备急救包,里 头有基本物品如包扎用品和适用于 相关旅游目的地的药物。 旅游诊所位于新加坡中央医 院第三座一楼的G诊所内的五号 诊房。 图:Vee chin

图:photolibrary

不管是征服全球最高的其中一座山脉,还是在原始森林远足,都能让人兴 奋不已。不过,谨慎规划是必要的。因为恶劣的天气状况、疾病和其他危 险都有可能缩短你的旅程。《新脉动》向新加坡中央医院传染病科顾问兼 旅游诊所主任Limin Wijaya医生了解旅游时要注意的事项

旅行忠告

巴布亚新几内亚的山坡上可找到无毒的紫晶蟒和传统的草屋。

气候:巴布亚新几内亚的白天很 热,夜晚很冷。饮用水的卫生:远 足时须不断补充水分,因为腹泻是 常见症状。不过,干净的饮用水在 那里并不普遍,而且饮用溪流的水 前必须先过滤。蚊虫传播的疾病: 染上疟疾、骨痛热和丝虫病(由一 种寄生性线虫引起的疾病)是非常 危险的。睡觉时,游客应使用驱虫 剂和蚊帐,以免蚊虫叮咬。野生动 物的危险:在大海和溪流洗澡时, 应小心海蛇、毒鱼和水母。


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