WWW.SINGHEALTH.COM.SG • WWW.SGH.COM.SG MAR/APR 2020

MCI (P) 056/10/2019

THE FLAGSHIP IN FOCUS PUBLICATION OF THE SINGHEALTH DUKE-NUS ACADEMIC MEDICAL CENTRE

Page 7 Healthy cells left alone in prostate cancer trial

IN FOCUS

Page 10 ECMO ups pneumonia So, this is survival chances

what it HEALTHWATCH feels like to be old! Not a robot but old-age simulated by an “age suit”. It highlights how the loss of muscle strength makes the elderly more prone to falls Page 16 READ MORE ON PAGE 3 The real cause of back and neck pain

01 SingHealth Issue 58 Cover V1.indd 7 17/2/20 3:02 PM SGH200 PAGE 02

The history of Singapore General Hospital (SGH) is the history Counting of medicine in Singapore. The first general hospital for British troops was established in Singapore in 1819, but it was only in 1821 that it began serving the general populace — marking the down to PUBLISHERS true beginnings of SGH. As the countdown to SGH’s bicentennial begins, Singapore Health will present snapshots showing changes in 2021 medicine and its various disciplines in the past 200 years.

Photo: SGH CO-PUBLISHERS The roots of

orthopaedic Photo: Vernon Wong

surgery ® Staffed by general CONTENT ADVISOR surgeons in the early Group Chief Communications Officer, SingHealth days, the discipline is now Audrey Lau

highly specialised, with EDITORIAL TEAM surgeons operating in Lim Mui Khi, Ann Peters, Tina Nambiar, Lydia Ng seven areas, such as spine, sports medicine, and Read Singapore Health online at musculoskeletal tumours. A mock-up of a spine procedure using an advanced imaging system, known as the O-arm, to guide surgeons. www.sgh.com/ by Professor Andrew Tan singaporehealth Head and Senior Consultant charge of chronic ulcers and hand forefront of research and innovative Department of Orthopaedic Surgery deformities in leprosy. processes, harnessing technology Singapore General Hospital The department started to grow and partnering leading biomedical in stature and eminence after the companies to improve patient care. PUBLISHING AGENT he development of late Professor N Balachandran took The department’s specialists have ThinkFarm Pte Ltd orthopaedic surgery over in 1980. He spearheaded several been quick to introduce and adopt Managing Director in Singapore mirrors service improvements for people with new technologies in orthopaedics, Christopher Tay closely that of the disabilities, spinal injuries, chronic such as artificial intelligence and 3D Editor US and UK. Before World War II sickness, and congenital deformities. printing, scoring many firsts in the T Dang Hui Ling (1939-1945) and up to the early He was also involved in setting up country and region. Not surprisingly, 1950s, orthopaedic conditions were orthopaedic surgery departments in the department is recognised as the Head, Creative managed by general surgeons other hospitals, including Tan Tock leading centre for minimally invasive Sean Lee with an interest in musculoskeletal Seng Hospital, Alexandra Hospital, orthopaedic and robotic surgery. Art Director trauma and fractures. No systematic and the now-defunct Toa Payoh Indeed, given its size as well Lee Lily or structured programmes were Hospital, playing a crucial role in as the breadth and depth of its available, and equipment and improving the practice in Singapore. clinical services and experience, the Head, Client Relationship instruments were crude. department is well placed to lead in Jessie Kek It was only in 1951 that the using such technology responsibly. Teaching, research For advertising enquiries, practice was established as a Importantly, Prof Bala placed Through well-designed clinical please call 6831 1299 or email separate clinical entity, and great emphasis on teaching and pathways and care integration, [email protected] five years later in 1956 that the training the next generation of it is the only orthopaedic Department of Orthopaedic specialists so that patients could department internationally to Surgery came into being. The benefit from better care. That legacy offer a unique suite of clinically All rights reserved. Copyright by Singapore Health Services Pte Ltd (registration no.: first batch of local orthopaedic continues today. Not only is SGH’s audited presurgery, surgery, and 200002698Z). Opinions expressed in Singapore surgeons were trained in the Department of Orthopaedic Surgery post-surgery care programmes. Health are solely those of the writers and are 1950s, undergoing basic clinical the oldest in Singapore, it is today A recent initiative is the same-day not necessarily endorsed by SGH, SingHealth Group and/or Thinkfarm Pte Ltd (registration training before proceeding to the largest and most established discharge for some hip replacement no.: 201226362G), and their related companies. Britain for a postgraduate degree orthopaedic department in the patients, which cuts short a typically They are not responsible or liable in any way for the contents of any of the advertisements, in the discipline. country. It boasts seven orthopaedic three-to-four day hospital stay articles, photographs or illustrations contained In the 1950s, poliomyelitis was subspecialties, including spine, adult and lowers costs for patients. More in this publication. Editorial enquiries should be directed to the Editor, Singapore Health, rampant, affecting many young reconstruction, sports medicine, of such short-stay procedures are 168 Jalan Bukit Merah, #13-01 Surbana One, children. Orthopaedic surgeons were trauma, musculoskeletal tumour, expected to become available, Singapore 150168. Tel: +65 6222 3322. Email: [email protected]. Unsolicited material will involved in their rehabilitation, as foot and ankle, and acute care. Two benefitting patients undergoing not be returned unless accompanied by a doctors generally did not want to subspecialties have also been spun other orthopaedic procedures. self-addressed envelope and sufficient return be involved in treating the disease off into full departments in recent The department sees up to a postage. While every reasonable care will be taken by the Editor, no responsibility is and others such as tuberculosis, years — Hand and Reconstructive quarter of Singapore’s orthopaedic assumed for the return of unsolicited material. osteomyelitis, septic arthritis, and Microsurgery, and Plastic, patients, handles more than 126,000 ALL INFORMATION CORRECT AT TIME OF PRINTING. MCI (P) 056/10/2019. Printed in crippled children. In those days, Reconstruction and Aesthetic Surgery. outpatient visits a year, and performs Singapore by Times Printers Pte Ltd (registration orthopaedic surgeons also took The department is at the over 8,000 surgeries annually. no.: 196700328H).

02 SGH200 + Glory Box.indd 2 17/2/20 11:50 AM PAGE 03 COVER

Dr Samuel Chew (right) putting a young Mr Nigel Chew through the moves in his “age suit”, which makes him feel like a frail old man. The straps stiffen his joints as in arthritis, a device under his feet creates a loss of sensation, and the goggles reduce his vision.

If you have very good muscle health, you cannot have weak bones. But if you have strong bones, you could still have very poor muscle health. Dr Samuel Chew Adjunct Assistant Professor, Department of Geriatric Medicine, Changi General Hospital

While sarcopenia is evident in the frail and old, a surprising finding in the study was that it can also affect healthy seniors, said the study’s principal investigator, Dr Samuel Chew, Adjunct Assistant Professor, Department of Geriatric Medicine, CGH. The study, called Strengthening Health in Elderly through Nutrition, was conducted by CGH, Photos: Justin Loh Photos: SingHealth Polyclinics, and Abbott to look at the impact of nutrition on the elderly. Phase 1 of this two-part study Can you future-proof looked at 400 healthy people in Singapore aged 65 and older, and found that despite their apparent health, one in five were at risk of low muscle strength. Women fared old age? worse, with 25 per cent of them r Nigel Chew, 27, can General Hospital (CGH), can now having low muscle mass compared Even healthy old usually bound up the seriously empathise with the aged. to 15.5 per cent of men. people who are stairs two or three But he is lucky to be forewarned More than half the participants steps at a go. But in a long way in advance, so he can did not have enough vitamin D, independent, eat well, Man “age suit”, he moves like a frail take steps to avoid some of the which is provided by sunlight, old man. health problems associated with and is important for muscle and have no diseases The suit makes him feel what it ageing. One of the main lessons function, immunity, and bone is like to be aged. he has learnt is the importance of health. The irony is that they can have low muscle Some 20kg to 30kg are piled building and maintaining muscle live in Singapore, where there is mass, which puts them on to simulate loss of muscle mass, which essentially means sunshine all year long, so they strength. Straps stiffen his joints muscle strength. should have been able to get at risk of falls. But this and restrict his movements to sufficient vitamin D easily. show him what arthritis feels like. Why muscle strength? The significance of the findings can often be reversed. A device covers the soles of his A recent local study has underlined is that the participants were by Suki Lor feet to simulate a loss of sensation the importance of having good not those usually at risk, such as in his feet (as in the case of muscle mass in old age. Low patients who were elderly, with diabetes) so that he can hardly muscle mass (sarcopenia) not only multiple chronic medical illnesses, feel the ground he walks on. affects overall health, but also or critically ill. Mr Chew, an executive with makes walking difficult and puts a “This was a very unique group the Office of Innovation, Changi person at risk of debilitating falls. of participants. They were

03-04 Cover - story.indd 3 17/2/20 11:51 AM COVER PAGE 04

mostly healthy, independent and for recovery from illness, Muscle medicine people living in the community, injury, and surgery. The “medicine” for low muscle mass is exercise. This is where who eat normally, and have no “We need an ample amount of polyclinics can help patients, said Dr Tan Ngiap Chuan, Adjunct illnesses or past history of them,” muscle mass. Having just enough Associate Professor, Director of Research and Family Physician, said Dr Chew. may not be truly enough because SingHealth Polyclinics. In Phase 2, which will be it can be undermined by an illness, “Family physicians can provide guidance on a proper exercise completed this year, 800 elderly injury, or surgery to the point programme, which could include calf-strengthening exercises. We participants at risk of being where a person can no longer want to standardise the way we measure muscle health, so that malnourished will be placed on walk. When lower-limb strength is we can chart progress,” he said. oral nutritional supplements. absent, a person has a three to six One easy way to gauge muscle health is to measure the Researchers want to find out times greater risk of falling than circumference of the patient’s calves. If it is less than 33cm in how it will affect their nutritional they normally do.” men and 32cm in women, it reflects a higher risk of lower muscle status, and their rates of hospital However, it is often not too mass. Exercise can increase the measurement. admission and re-admission. late to increase and maintain it. “The muscle mass status is Two simple exercises for muscle health: Losing muscle after 65 modifiable,” Dr Chew added. Given these findings, Dr Chew • A single leg stand-up test: Sit down and lift one leg off the ground. expects the population at large to Then try to stand upright with one leg balancing in the air. Hold the Asian data helps have even higher rates of muscle An important aspect of the study position for 3 seconds. mass loss than the study group. was getting Asian data about According to Dr Chew, 30 per cent of elderly nutrition. Professor Teo older people living in the community Eng Kiong, Chairman, Medical are at risk of malnutrition, and the Board, CGH, said that such data risk of losing muscle mass increases has been lacking because the exponentially by about 13 per cent majority of previous data yearly after age 65. was Western-based. He said that there is a He said that this data can correlation between muscle and now be used to establish Asian bone health, and gains to be had norms on nutritional standards for by targeting muscle health. “If you the Nutrition Health for Elderly have very good muscle health, you Reference Centre at CGH, which cannot have weak bones. But if you aims to be a leader in nutrition have strong bones, you could still health for the Asian elderly. have very poor muscle health. Dr Low Yen Ling, Director “Muscle health comes from of Nutrition Research and activity to which the bone — a Development at Abbott in the living matrix — responds. The Asia Pacific, noted that the more weight and pressure you put focus of current research is on on the bone, the stronger it gets.” “promoting better nutrition Muscle mass is important not in elderly people living in the only for mobility. “Muscles also community, so that they can keep store amino acids needed for healthy, lead active lives, and not normal functioning of the body, end up in the hospital”.

How much protein to eat? If an elderly person with weak muscles can get up from a sitting to • Sit-to-stand for calf and thigh muscles: Stand up from an a standing position, he armless chair with your arms folded across your chest, then sit can regain some of the down. Do this 20 times at least twice a day. lost strength through resistance training exercises and good nutrition. The latter means eating high-quality protein in appropriate amounts. However, there is misinformation about protein intake, which leads to some older adults eating too little and avoiding certain proteins without any scientific basis. The recommendation is to consume 1.2g of protein for every 1kg of body weight, which translates to 72g of protein for someone weighing 60kg. Older adults need to have at least three small meals a day that are rich in protein and energy, and avoid big dinners. This is advisable as smaller meals tend to be better tolerated, said Ms Magdalin Cheong, Deputy Director and Head of Dietetic and Food Services, CGH. If their diets are balanced, vitamin and mineral supplements would not be necessary. “In the Asian context, for a normal person who’s eating everything, animal protein sources like chicken and fish are the best. For a vegetarian, we have to look at plant sources.” The latter includes pulses, soy, and bean products, such as kidney beans and chickpeas. For those who can eat dairy products, milk and cheese are good alternatives to help increase protein intake.

Adapted from Maguire 2013

03-04 Cover - story.indd 4 17/2/20 11:51 AM 05 Adv - MDIS.indd 20 17/2/20 11:51 AM IN FOCUS PAGE 06

surgery, and need to wait six months before engaging in strenuous activities. The ankle prosthesis lasts about 25 to 30 years. But the new method has its shortcomings, too, said Dr Anandakumar. Compared to the traditional method, the lateral approach takes about an hour longer because an external frame must be fitted around the ankle joint for accurate realignment during surgery. Also, approaching from the side involves cutting through the fibula bone, the slender calf bone on the lateral or outer side of the lower leg. “Any surgery has its fair share of advantages and disadvantages. It’s a matter of selecting the right surgery for the right patient.” Seek help early The most common cause of ankle arthritis is usually a neglected ankle fracture or severe sprain, which damages stabilising

Photo: Justin Loh Photo: ligaments there. Dr Anandakumar Vellasamy explaining how the lateral total ankle replacement surgery works, using the external “Over time, abnormal frame that is fitted around the patient’s ankle during surgery to ensure accurate alignment. biomechanics of the affected joint cause certain areas of the ankle cartilage to degenerate. The lack of ankle stability from the initial injury can cause malalignment of the joint, further stressing the cartilage. New surgery for This creates a vicious cycle that worsens the degeneration,” explained Dr Anandakumar. About 1 per cent of the severe ankle arthritis population suffers from this 66-year-old engineer removed and replaced with degenerative condition, which A new type of with severe ankle a prosthesis that mimics the involves the wear and tear of the ankle surgery, known arthritis became functions of a normal ankle. This cartilage of the tibiotalar (ankle) the first patient in allows it some range of motion. joint. In severe cases, the ankle joint as the lateral total ASingapore to receive the new With the new method, the cartilage may be completely worn lateral total ankle replacement surgeon accesses the ankle using a down, resulting in severe pain as ankle replacement surgery at Sengkang General lateral approach, coming in from joint bones grind against each other. Hospital (SKH). the outer side of the ankle. Dr Anandakumar said patients surgery, is now Before surgery, he had are first encouraged to take available at Sengkang debilitating pain from end-stage The pros and cons conservative pain relief measures, ankle arthritis. He could not walk The lateral approach avoids but surgical intervention may be General Hospital. without pain, and it affected his important blood vessels and necessary if symptoms cannot work and quality of life. nerves at the front of the ankle. be controlled by these measures by Eveline Gan He went for the surgery only Dr Anandakumar said a unique or medication. Conservative after medication and other advantage of visualising the joint measures may include wearing conservative measures no longer from the side is that the surgeon comfortable shoes with provided any pain relief for him. can cut along the joint curvature, modifications, calf stretching, The surgery was done by removing the diseased portions muscle-strengthening exercises, Dr Anandakumar Vellasamy, more accurately while conserving and maintaining a healthy weight. Consultant, Department of healthy normal bone. As a result, There are other alternative Orthopaedic Surgery, SKH, who patients have a lower risk of surgical methods, including ankle was trained in Switzerland and post-surgical complications. fusion surgery, where the joint is performed five such surgeries They also have better joint fused, but this method obliterates there previously. motion. “In recent large-scale movement in the joint completely. Dr Anandakumar said total studies, patients who underwent Dr Anandakumar advises patients ankle replacement is a surgical the lateral approach have considering surgery to speak option for patients over the age of shown a significant increase in to their surgeon to get their 60 who have severe ankle arthritis. the range of joint motion after perspective, as well as convey It involves replacing the damaged surgery,” he added. their expectations of the surgery. ankle joint with a prosthesis. For Dr Anandakumar’s patient “Don’t wait too long to seek an Traditionally, the surgery in SKH, retaining joint motion was opinion as the longer the disease (known as the anterior approach) important because he needed to progresses, the stiffer the joints is done via an incision at the move around in his job. become, and the more difficult front of the ankle. The diseased Patients usually resume normal the surgery will be to realign the portions of the joint are then activities six to eight weeks after joint,” he said.

06 InFocus - Ankle Surgery.indd 6 17/2/20 11:52 AM PAGE 07 IN FOCUS

Direct intervention Cryotherapy treatment attacks only cancer cells in the prostate while leaving the rest of the organ intact.

by Sol E Solomon Photo: Vernon Wong hen prostate cancer complications that may arise of life assessment and is diagnosed, after treatment. This is why prostate-specific antigen treatment usually we want to explore a middle- (PSA) blood test, followed by involves either ground treatment that is not so a magnetic resonance imaging radiotherapy or surgical removal damaging, yet will treat prostate (MRI) scan and biopsy W Dr Tay Kae Jack is leading a of the organ. While effective, cancer effectively,” said Dr Tay a year after. study to identify the effectiveness of these standard treatments can Kae Jack, Consultant, Department So far, some patients focal cryotherapy on prostate cancer. also bring on problems — some of Urology, SGH. have reported temporary long-lasting or even permanent — “The treatment should not pain and bruising, but no such as incontinence, impotence, affect patients’ quality of life,” serious complications. scrotum) into the tumour under and injury to the rectum added Dr Tay, who is leading In focal cryotherapy, the ultrasound guidance. Argon gas and bladder. the study. aggressiveness, stage, and is then pumped through the To avoid these damaging location of the cancer need to cryoprobes to freeze the cancer side effects, a team of Singapore Aided by imaging be accurately determined. This cells at -40°C. The procedure is General Hospital (SGH) urologists Between March 2019 and early is possible with the Mona Lisa, performed as a day surgery in is studying the use of a treatment January 2020, SGH recruited 18 a robotic biopsy system that an operating theatre and takes known as focal cryotherapy, which out of a targeted 30 patients combines MRI and ultrasound about 45 minutes to complete. essentially targets and freezes the with localised prostate cancer scan, which was developed by tumour in the prostate at very low to participate in its trial. Their SGH’s Urology Department New treatment option temperatures to kill the cancerous tumours had to be aggressive and engineers from Nanyang Focal cryotherapy has been cells. The healthy cells around the and less than 1.8cm in diameter. Technological University (NTU). used to treat cancers of the tumour are then not affected. After undergoing the procedure, In the procedure, three to four bone, kidney, cervix, liver, and “Prostate cancer patients often these patients need to return to 15cm needle-like cryoprobes are lung. However, it has not been find themselves in a dilemma the SGH Urology Centre every inserted through the perineum used to treat prostate cancer in after being told of the possible quarter to complete a quality (the area between the anus and Singapore. It is estimated that 30 to 40 per cent of all prostate cancer patients could benefit from focal cryotherapy. If the results of the study are positive, the hospital could offer it as a treatment option. Prostate cancer is the third most common cancer among men and the seventh most frequent cause of cancer death in Singapore. In many cases, prostate cancer is slow-growing and may take years to grow to a size large enough to become detectable. Some prostate cancers, though, can be aggressive, growing quickly out of the prostate and spreading to other parts of the body. However, because of greater public education and awareness, the disease is increasingly being detected at the early stages, when it is usually treatable. Between 2010 and 2014, prostate cancer occurred in 28.6 out of 100,000 men, but the death rate was 5.6 out of 100,000 men.

Argon gas is pumped through the cryoprobe to freeze the cancer cells at -40°C.

07 InFocus - Frozen.indd 7 17/2/20 11:52 AM Photos: Justin Loh IN FOCUS PAGE 08 Rejuvenation of SGH Campus takes shape When completed, the ECC-NDCS building will bring SingHealth group one step closer to delivering seamless, quality patient care.

aving the future She noted that as part of the Singapore General continual push for improvement, (bottom picture: 5th, 6th and 8th from left respectively) Minister of State Hospital’s (SGH) SGH has developed a new care for Health Dr Amy Khor, SingHealth GCEO Professor Ivy Ng, and SingHealth Elective Care Centre protocol for patients undergoing Chairman Mr Peter Seah looking at a model of the future SGH Campus. H(ECC) and National Dental Centre hip replacement surgery, a common Singapore (NDCS) in the same procedure at the hospital. Patients completed and opened its doors phase 2 developments for the new building was no design accident. suitable for hip replacement under to patients in late 2019. SGH Complex will commence as Indeed, the ECC and NDCS the new protocol can be discharged The ECC and NDCS building part of the Master Plan. will house dedicated facilities within 23 hours, instead of staying is being built on the site of the When fully completed, the and clinical services for elective in the hospital for an average of former New Bridge Road bus campus will combine the best or scheduled surgical and dental four days for such a procedure. terminal, next to Outram Park in facilities and technology, put services, taking Singapore Health A shorter inpatient stay reduces MRT Station, which serves the the patient at the centre, and be Services (SingHealth) group one patients’ risk of exposure to North-East, East-West, and the integrated with the larger network step closer to achieving its hospital-acquired infections upcoming Thomson-East Coast of community hospitals, and long-term vision of consolidating and costs. Lines. Following its completion, primary and home care providers. outpatient care, scheduled surgical Likewise, the new NDCS will services, and dental services to also leverage on new technologies meet growing healthcare needs. to improve care delivery, such For instance, NDCS’s proximity as 3D printing, which allows for to the SGH ECC means greater more accurate treatment planning convenience for patients with and shorter treatment time. Mild to Moderate complex conditions, such as For example, patients requiring head and neck cancer requiring dentures will benefit from Medical Conditions? maxillofacial prosthetic 3D-printed dentures, being faster rehabilitation following surgery. to fabricate than traditionally “When completed in 2026, the made dentures. Your GP building will bring us a step closer to achieving our vision of ‘One Campus, can treat it! Expanding capacity Scan to learn One System’ to deliver seamless, The future SGH ECC will be a more The is an initiative quality care for our patients,” said dedicated facility for planned GPFirst Programme by Changi General Hospital (CGH)’s Accident & Professor Ivy Ng, Group CEO, surgeries and procedures for Emergency Department in partnership with over 200 SingHealth. She was speaking at orthopaedic, otolaryngological, and participating GP clinics in eastern Singapore. the groundbreaking ceremony of breast-related conditions. Having the building in January, which was a separate facility for scheduled Patients with mild and moderate symptoms are officiated by Dr Amy Khor, Senior procedures means that the main encouraged to visit their GPs first to seek treatment at Minister of State, Ministry of Health, SGH will be able to handle more the GP clinics instead of going to the A&E at CGH. and Ministry of the Environment and acute, complex, and emergency Water Resources. procedures. Every year, more than Should the patient be referred by his or her GP via GPFirst: Describing SGH and SGH 97,000 surgeries and procedures are Campus as “a major provider performed at SGH. The number is Accorded higher priority over other non-emergency cases of care” in Singapore’s public expected to rise with Singapore’s healthcare system, Dr Khor said: ageing population. $50 programme subsidy* for their A&E “One of the key objectives of Since February 2016, when attendance fee at CGH Singapore’s healthcare system the SGH Campus Master Plan to is to ensure that everyone has enhance facilities and increase For more information, visit www.GPFirst.sg access to appropriate care in capacity for growing healthcare Like us on Facebook at gpfirst.sg a timely, cost-effective, and needs was unveiled by Prime seamless manner. As SGH designs Minister Lee Hsien Loong, the *Terms and Conditions apply and plans for this new facility, I Campus has been a hive of am heartened that SGH is seizing activity. Construction has begun the opportunity to introduce on a new National Cancer Centre new ways to organise itself, and Singapore (NCCS) and a new innovate to bring better care and Emergency Medicine Building. The value to patients.” Outram Community Hospital was

08 InFocus - ECC.indd 8 17/2/20 11:54 AM

*Terms and Conditions apply PAGE 09 IN FOCUS

associated hypertension may disappear, too. The source of the excessive aldosterone can be detected using the new scan. This non-invasive scan is done by injecting a radioactive tracer into the patient to light up problem areas. It takes less than an hour to do, emits less radiation than a conventional CT scan, and is able to detect small growths and excessive aldosterone in the adrenals more accurately than the existing test, said Dr Puar. The existing test, adrenal vein sampling, is done under local anaesthesia by inserting a catheter through a vein from the patient’s groin to draw blood samples. Usually, patients have to stay overnight in hospital. But the adrenal vein sampling test does not always produce conclusive results. “In many centres, up to 50 per cent of

Photos: Justin Loh Photos: procedures are unsuccessful and The medical team monitoring the results as the patient is being scanned. hence inconclusive. Fortunately, CGH has had a 100 per cent success rate over the last five years,” said Dr Puar. New scan for Living with one gland If only one gland is abnormal, the patient may proceed with surgery to remove the abnormal curable hypertension gland, which would halt the excessive hormone production and Clinical trials are underway on a new scan that can detect the cause potentially cure the hypertension. Surgery is not possible if both of a certain type of hypertension, making it potentially curable. glands are affected. “We offer surgery if only by Eveline Gan one gland is affected, because the adrenals are necessary for or years, The scan, which is only available producing cortisol, an important Mr Lim In in the clinical trial, pinned down the steroid needed for life. With the Chong’s cause of his hypertension, paving other adrenal gland remaining, abnormally the way for a potential cure. a patient can live a normal life,” Fhigh blood pressure said Dr Puar. levels kept him on Why it’s curable He added that some patients tenterhooks. While there is no cure yet for most prefer to take medication for Diagnosed with types of hypertension, Mr Lim’s life instead of surgery, but others hypertension since type — primary aldosteronism — want surgery when they find that he was 21 years old, is different, because it is possible it may cure their hypertension Mr Lim, now 43, has to cure if the cause can be found. once and for all. However, some been taking pills for the The condition occurs when may still have hypertension after last two decades to keep tiny benign growths found in one the surgery because of other his condition in check. or both adrenal glands (located contributing factors and would His greatest fear is above the kidneys) produce too still need medication, but usually getting a stroke, and he much aldosterone, a steroid at a lower dose. has every reason to fear this. hormone that regulates blood “Generally, the less medicine Hypertension affects one in four pressure, said Adjunct Assistant the patient takes, the better, as Patient Mr Lim (centre), adults in Singapore, and accounts Professor Troy Puar, Consultant each has its potential risks and who is about to undergo the for almost half the deaths from Endocrinologist, CGH, who is side effects,” said Dr Puar. scan, is flanked by Dr Troy cardiovascular disease. leading this multicentre trial. Mr Lim opted for surgery to Puar (left) and Associate Professor Roger Foo, Recently, Mr Lim was given a Too much of aldosterone remove his abnormal adrenal NUS Yong Loo Lin School new scan — the 11C-Metomidate causes salt retention in the gland. “I’ve been on medication of Medicine and Senior PET/CT — as part of a 25-patient body, which drives hypertension. for more than 20 years, but it was Consultant Cardiologist, National University clinical trial conducted by Changi About 5 per cent of people with just masking and not fixing the Heart Centre. General Hospital (CGH), together hypertension have high levels of problem. With surgery, I hope with the Clinical Imaging this hormone. my hypertension can be cured. At Research Centre (CIRC) at the When the adrenal gland that the very least, I hope to improve National University of Singapore’s is overproducing this hormone my condition and take less Yong Loo Lin School of Medicine. is removed through surgery, the medication,” he said.

09 InFocus - Hypertension.indd 9 17/2/20 11:53 AM Photos: Vernon Wong IN FOCUS PAGE 10 Dr Sewa Duu Wen sets up the extracorporeal membrane oxygenation (ECMO) machine on a mannequin. ECMO delivers oxygen into the bloodstream without injuring the lungs.

Rescue therapy hinking it was just a Respiratory and Critical Care blood clots, stroke, infection, When ICU regular flu bug, Mr Heng Medicine, SGH. kidney failure, and even death. mechanical ventilators Wee Heng, 19, popped a “ECMO is used as rescue The ECMO service at the few paracetamol tablets therapy. ECMO is not a cure. It MICU was introduced in 2009 are inadequate, Tand waited for his symptoms — supports patients, and acts as a during the H1N1 pandemic. high fever and cough — to pass. bridge for the lungs to recover,” Since then, the team has been respiratory ECMO Instead, his illness worsened and, he added. progressively increasing the can temporarily within days, he was admitted to a Patients like Mr Heng with capability and expertise of the hospital’s intensive care unit (ICU) severe pneumonia or respiratory ECMO service. replace the functions with severe pneumonia. failure need intensive ventilator Two years ago, the service At the ICU, Mr Heng was support. Pushing oxygenated air was reorganised and a large of the lungs hooked up to a mechanical at very high pressures into the multidisciplinary ECMO team ventilator machine to help lungs over an extended period is now available round the to oxygenate blood him breathe. But doctors were can injure the organ, said clock. The team includes and remove concerned the intense ventilator Dr Sewa Duu Wen, Senior ECMO-trained physicians and support might hurt his lungs, Consultant, Department of nurses, cardiothoracic surgeons, carbon dioxide. and he was recommended Respiratory and Critical Care perfusionists, respiratory extracorporeal membrane Medicine, SGH. therapists, intensive care by Annie Tan oxygenation (ECMO) therapy, “With ECMO, we are able pharmacists, physiotherapists, where oxygen is delivered directly to reduce the intensity of the and medical social workers. into the bloodstream, bypassing mechanical ventilator and give According to Dr Phua, before the lungs. patients a higher chance of 2018, an average of eight patients Mr Heng was then sent to surviving the episode,” said underwent ECMO a year, and the Singapore General Hospital Dr Sewa, who is also Director of survival rate was about 60 per (SGH), one of two public hospitals the Medical Intensive Care Unit cent. Survival rates are now more offering the treatment. (MICU) at SGH. than 80 per cent, he said. “ECMO is life support therapy About 50 per cent of patients for patients with acute reversible Better survival chances treated with ECMO at SGH lung disease. If their conditions Nevertheless, ECMO isn’t without come from other institutions. are still deteriorating even its risks; and while it can save The youngest person treated at when they are on conventional lives, it isn’t for everyone. SGH was 16 years old. Patients mechanical ventilator support, Patients have to be carefully stay on ECMO for about six days they could be at risk of dying of selected to make sure that they (although they are at the MICU severe lung failure,” said Dr Phua are able to tolerate ECMO, for about two weeks), before Ghee Chee, Senior Consultant which has been associated with being moved to the wards to stay and Head, Department of complications, such as bleeding, another 25 days or so.

10 InFocus - ECMO.indd 10 17/2/20 11:52 AM PAGE 11 AT A GLANCE About haemophilia Haemophilia is a genetic disorder that affects the blood’s ability to clot. It mostly affects boys.

When a cut occurs 17 Haemophilia A

Clotting factors in the blood Deficiency of APRIL CLOTTING FACTOR 8 combine with platelets World to make the blood sticky and stop bleeding quickly. Haemophilia 1 IN Haemophiliacs don’t have Awareness 10,000 enough clotting factors Day MALES and will bleed for a longer duration than other people. About 1/3 EACH OF PEOPLE WITH HAEMOPHILIA A have mild, moderate, and severe forms of the disorder respectively SINGAPORE Haemophilia B MORE THAN 200 PEOPLE ARE Deficiency of Bleeding ESTIMATED TO CLOTTING FACTOR 9 SUFFER FROM • Bleeding that does not HAEMOPHILIA. 1 IN stop or continues for an 50,000 extended period OR MALES • Nosebleeds that take a A B long time to stop THERE ARE Diagnosis is determined by • Bleeding gums TWO TYPES OF measuring factor 8 or 9 in the blood. • Skin that bruises easily HAEMOPHILIA. • Pain and stiffness around joints (because of bleeding in the spaces Good practices of the joints) • Avoid contact or strenuous sports • Avoid strenuous sex • Be careful not to take medicines X and Y that affect the blood’s ability to clot Haemophilia usually runs in • Maintain proper oral hygiene families, and is caused by a change in a gene (found on the X chromosome) that provides instructions for making the Upping the factors clotting-factor proteins. Boys get one X and one While there is no cure, treatment can bring about Y chromosome from their good quality of life. Prolonged bleeding is treated parents, while girls get two by increasing the level of factor 8 or 9. X chromosomes. So when boys inherit a faulty X chromosome from their

mothers, they may have a Information provided by disease like haemophilia. Associate Professor Tien Sim Leng Director, Haemophilia Centre Girls rarely get haemophilia Senior Consultant, Department of Haematology, Singapore General Hospital but become carriers if they get a faulty X chromosome. (SGH), and SingHealth Duke-NUS Blood Cancer Centre Head, Blood Bank and Cytogenetics, Department of Clinical Pathology and A third of haemophilia cases are not inherited, but are Molecular Pathology caused by spontaneous mutation in a gene. Ms Yeam Shin Yen Nurse Clinician, Blood Bank Laboratory, SGH

11 At a glance - Haemo V1.indd 11 17/2/20 11:54 AM PEOPLE PAGE 12

two regular days allows her to During the night, she makes spend time with her parents, sure the sensors stay on and with whom she lives. She has are working properly. She helps Getting a good older married siblings. patients take them off if they At the time, she had need to use the toilet, and puts little understanding of sleep them on again after. night’s sleep disorders, but has grown Although she would be alerted passionate about the subject if something is amiss, she spends It’s most rewarding for this sleep technologist over the years. Today, she has a good part of the night looking learnt enough to train others — at a computer screen to make sure when her patients enjoy better quality of life not just colleagues interested in the test is going well. Two or three the science, but also healthcare technologists work the night shift, because they can sleep well. professionals from other which means they can take turns countries in the region. to rest. On her day shifts, Ms Tay by Sol E Solomon analyses the sleep data collected Into the night and guides patients on using their The Sleep team, of which devices correctly. Ms Tay is a member, The most common conditions comprises psychologists, seen at the unit are sleep apnoea psychiatrists, neurologists, (interrupted breathing during otorhinolaryngologists and sleep) and insomnia. For those with respiratory specialists, as well sleep apnoea, a device known as as other sleep technologists. She continuous positive airway pressure conducts sleep studies or sleep (CPAP) needs to be used during tests that monitor patients while sleep. Ms Tay makes sure that they sleep. The tests track the patients get a well-fitting mask and different stages of sleep that that they understand how it is used. patients go through to determine Because of poor sleep, her if and why patients are not patients tend to be short- sleeping well. tempered. But when they tell her “On the night shift, I have to set they have had the best sleep in a up the sleep test sensors — all 24 of long time following treatment — as them — on patients. I then check did one patient — that is her best that they are working well before reward. “It means the treatment recording starts,” said Ms Tay. was effective,” Ms Tay said. Photo: Vernon Wong Photo:

leep Technologist Ms Jade her 12-hour night shift. Working Tay truly understands out at the gym also helps her what some of her patients sleep better. go through. “After working in this field for SMs Tay works two nights so many years, I’m used to it,” every week as part of her job said Ms Tay. at Singapore General Hospital’s Indeed, when she holidays in (SGH) Sleep Disorders Unit, a different time zone, she doesn’t putting her at risk of developing have much of a jet lag. “It just the kind of problems that her feels like a night shift.” patients go through: poor or While some may shun shift interrupted sleep. work, especially long night ones, it While she does experience was the night work and flexibility some of these issues, she that drew Ms Tay to her job. Fresh employs some of the “tricks” out of school in 2013, Ms Tay, that she teaches patients to help who graduated with a Diploma her adjust. Before the day of her in Biotechnology from Temasek night shift, she goes to bed later Polytechnic, saw the SGH ad, and and wakes up later. She also tries the rest is history. to nap before going to work to Working two 12-hour nights, get enough rest before pulling then a sleep day, followed by

12 People - Jade.indd 12 17/2/20 11:54 AM PAGE 13 PEOPLE Photo: Vernon Wong

Social dance and love of the pancreas Dr Damien Tan found his twin loves — his wife and work on the pancreas — through his can-do and open attitude to life.

by Thava Rani

r Damien Tan believes was planning to further his medical cancer patients survive beyond complex, higher-risk procedures. in living life to the education overseas in a subspecialty, five years after treatment. But 90 per cent of the cases are the fullest. In that sense, he was asked if he would consider “When I came back, I started regular bread-and-butter kind, so we he’s open to whatever training in performing pancreatic doing a lot of research to improve help out wherever needed,” he said. Dlife has to offer. endoscope procedures, an the early detection of pancreatic Dr Tan is also Director for Still, it’s a surprise that one of uncommon area of speciality. cancer. Research is what really Advanced Endoscopy Fellowships the things that Dr Tan tried while “By my nature, I said ‘sure’. I drives me because I know, if I want for his department, and has a hand living at his university hostel was trained at two top centres abroad, to make a difference, the science in training doctors from different social dancing. It is not something and I saw nothing but pancreas is important. I can do a biopsy; I parts of the world, such as the that many men — in particular, patients because the scopes for can put in a stent; but I need to do Philippines, Pakistan, and Bahrain. adventurous ones like Dr Tan, who pancreas were all advanced cases,” research so that I can help patients Despite his heavy responsibilities, are keen on deep-sea diving and said Dr Tan, Senior Consultant, survive beyond that threshold.” he sets aside time for his family. mountain trekking — would try. Department of Gastroenterology Just as he has put aside his “I like spending time with [my two But thanks to his can-do and open and Hepatology, Singapore General more daring streak now that he young sons]. We enjoy playing disposition, he met his wife at the Hospital (SGH). has a family, which includes two soccer, swimming, or doing outdoor dance class. “Pancreatic cancers are not young sons, Dr Tan also has had to stuff. Holidays with the family That attitude also led to Dr Tan common but highly deadly — one balance his time between research are great. We like Hokkaido in specialising in the pancreas — a of the worst cancers to have,” and his work as the recently particular — the good food and specialty that he would devote his said Dr Tan, noting that only appointed Medical Director of simply chilling out,” he added. life’s work to. Years back, when he about 5 per cent of pancreatic SGH’s Endoscopy Centre, which Thankful that his wife includes the Ambulatory Endoscopic supports and understands his Centre (AEC), and Inpatient and work commitments, he is equally Lung Endoscopy Centre (ILEC). appreciative that he has not Set up more than three years had to miss any birthdays or ago, the AEC is where patients can important family moments yet. I can do a biopsy; I can put in a have their gastrointestinal tract “It’s truly a privilege to be stent; but I need to do research assessed via scopes for possible doing what I do. I see people at cancers or other conditions. It is their most vulnerable moments, so that I can help patients also one of the biggest in Singapore, and every word I say or every survive beyond that threshold. seeing over 30,000 patients a year. touch I give can make a Ensuring smooth workflow within difference. Knowing that helps, Dr Damien Tan the Centre takes up much of his especially at times when I need Senior Consultant, Department of Gastroenterology time. He also chips in by performing to drive back [to hospital] at 3am and Hepatology, Singapore General Hospital a number of these procedures. to help a bleeding patient. The “There are five or six of us here, who smile from a patient or a grateful are trained in advanced endoscopy, relative really keeps me going,” allowing us to handle the more Dr Tan said.

13 People - Damien v1.indd 13 17/2/20 11:55 AM HEALTHWATCH PAGE 14

Cancers that can hit the young ne of the hardest 1,000 new patients in the last five “For example, sarcomas or Diagnosed with challenges for young years. Worldwide, about 1 million bone cancers tend to be more cancer in the prime of people with cancer cases are diagnosed each year, common in 16- to 20-year-olds. is coming face-to- according to the World So if a young person has their lives, adolescents Oface with their own mortality. Health Organization. persistent knee pain, he should The diagnosis, coming at a time Dr Poon said that in the get x-rays done to ensure it is not and young adults when they are full of energy and 16- to 24-year-old age group, bone cancer.” face challenges not dreams, can floor them. lymphomas, sarcomas, certain While there is no single red “The diagnosis and treatment types of brain tumours, and germ flag to look out for, persistent commonly seen in affect their emotional well-being, cell tumours (including testicular symptoms that last for more than social life, and sense of identity, cancer) feature more prominently. a week should be looked into more other patient groups. and it derails their future plans,” In the 25- to 39-year-old group, carefully. Depending on the cancer by Eveline Gan said Dr Eileen Poon, Consultant, cancers resembling those in the type, symptoms may include Division of Medical Oncology, older adult population, such as weight loss, swollen lymph nodes, National Cancer Centre Singapore breast, colon, lung, and head pain, changes in bowel habits, or (NCCS), who has handled many and neck cancers have become swelling of the testes. of these cases and is passionate more common. “The main take-home message about helping these patients. is that when young patients have “Even those who survive No clear cause complaints about a persistent the cancer may face fears of a But what causes it? Several symptom, they should not be second cancer due to treatment- factors are at play, including easily dismissed,” said Dr Poon. related complications or genetic environmental and lifestyle While early detection is predisposition. Other issues factors, such as smoking, important, those diagnosed in include challenges of reintegrating obesity, and stress. the later stages should not give back into society after Dr Poon said many patients do up hope. “These cancers may be treatment, fertility problems, not have a strong family history of aggressive but are not necessarily and long-term follow-ups, cancer, although some may have a death sentence. In certain with some lasting five to inherited defective genes, which types, such as lymphoma and 10 years.” make them susceptible to getting osteosarcoma, some patients cancer young. For many of them, diagnosed at the advanced stages On the rise it may simply be due to “the luck may still achieve long-term In Singapore, of the draw”. survival,” she said. Adolescent and Young “All of us are born with a Adult cancers refer set of genes, some of which to cancers that affect may be more prone to people aged 16 to 39 mutation. As a result, cancer The NCCS Adolescent and years old. There are no may develop. But with the Young Adults Oncology Support official local statistics on current scientific technology, Group was set up in 2017 to offer the prevalence here, but we cannot exactly pinpoint how psychosocial support to patients Dr Poon believes such cancers and when this happens.” during and after treatment. It is open to patients and are on the rise. survivors in Asia aged 16 to 39. She said in the last four to five Early detection helps For more information on Persistent symptoms years, NCCS has seen an average She said better diagnostics have the support group, email to in young people should [email protected]. not be easily dismissed, of 350 to 450 new cases each helped early detection, but said Dr Eileen Poon. year, translating to more than everyone has a role to play in this.

14 HealthWatch - AYA Cancers.indd 14 17/2/20 11:55 AM PAGE 15 HEALTHWATCH Shrimp Paste Chicken (4 servings)

Ingredients • 450g chicken drumlets (remove skin) CHEF’S TIP 1/2 egg • This dish uses shrimp paste, 30g shrimp paste • which is typically sold in jars. 2 tsp sugar • Do not confuse this with dried 1 tsp oyster sauce • shrimp paste or belachan that is 11/2 tsp tapioca flour • made from small shrimps. • 11/2 tsp oil • pinch of red colouring powder • oil for deep-frying Method 1 Marinate chicken with all ingredients for at least 1 hour. 2 Deep-fry chicken until golden brown. 3 Serve hot. HEALTH TIP Estimated nutrient content Balance a deep-fried dish with low- (per serving) calorie dishes for other meals of the • Energy 186kcal day. Low-calorie dishes are usually • Carbohydrate 8g prepared using lean cuts of meat or a • Protein 16g cooking process that requires minimal • Fat 10g oil or fat, such as steaming, grilling, • Sodium 450mg boiling, roasting and baking. Adapted from Where is the Fat? Cookbook, • Cholesterol 55mg a publication by Singapore General Hospital

15 Healthwatch - Recipe Shrimp_paste_chix.indd 15 17/2/20 11:56 AM HEALTHWATCH PAGE 16 Don’t blame it all on posture Bad posture is not orldwide, eight in lifestyle. Besides lacking strength, system or musculoskeletal system 10 people suffer many of them tend to remain in the to get stronger.” always what causes back pain regularly, same position for extended periods, Dr Liu recommended at least neck and back pain. and five in 10 neck causing tension to build up. 150 minutes of moderate exercise pain.W Most assume bad posture is “Due to technological weekly. She suggested starting It could be weak the cause. advancements, most people shop slow, and gradually increasing “It’s not true,” said Dr Bernice online, go out less often, and do the intensity and duration of the muscles. Here are Liu, Principal Physiotherapist, not exercise. So their muscles do workout. Desk-bound workers should Sengkang General Hospital (SKH). not get stimulated,” she said. also do simple stretches every two some exercises to “Studies show that people who The simple solution is to start hours to release any tension. reverse that. have all types of posture, including moving, so that joints get less stiff “Chronic backaches and good posture, suffer neck and and muscles get stronger. neck aches become a real by Annie Tan back pain. The most common “People who stand or walk a concern if they make people fear reason is because their muscles lot at work may think they are moving, making them weaker are simply not strong enough to already exercising, but exercise and/or stiffer, and creating a carry them through the day.” needs to be structured and vicious cycle.” About 80 to 90 per cent of repetitive, and hit a certain Here are some exercises Dr Liu’s patients have a sedentary intensity for the cardiovascular demonstrated by Dr Liu:

Stretching exercises Strengthening exercises Repeat these exercises 10 times, holding each position for Do three to five sets of these exercises, with eight to three to five seconds. 12 repetitions in each set.

Forward Bend Seated Squats Sit on a chair, bend forward, and Stand in front of a chair with your reach as far as you can towards feet shoulder-width apart, and your feet. Allow your head and place your hands on your waist. neck to follow through with the Sit down and stand up again to movement. Take a deep breath strengthen the thigh and buttock before coming back up. This muscles. To increase the difficulty, stretches your back muscles to do not sit fully, but simply touch reduce stiffness and tightness. the chair and stand up.

Back Bend Shrug Sit with your back rested against Lift your shoulder towards your a chair with a low backrest. Place ears. Then, slowly lower them and your hands behind your head return to the starting position. to support your neck. Then lean For additional strength training, backwards, open up your arms, do this with a water bottle in and take a deep breath before each hand. coming back to your original position. This relieves tension in the back, especially if you have been working in a hunched position for a long time.

Bow and Arrow Wall Push-Ups Imagine that you are using a Stand facing a wall with your feet bow and arrow. Put your right hip-width apart, and place your hand forwards and your left hand palms shoulder-width apart on it. backwards, both as far as you can. Slowly bend your elbows and lower Keep your chest uplifted and your your upper body towards the wall. gaze ahead. Repeat the action Maintain your head and neck on the other side of your body. position as you lower yourself to This helps with movement in your the wall. Then, push yourself up shoulders and upper back. until your arms are straight again. This helps strengthen your arms, shoulders, and chest. Photos: Justin Loh Photos:

WHEN TO GET A PHYSIOTHERAPY REFERRAL Seek medical treatment if your • Sudden loss of bladder and/or bowel control • Fever or chills neck or back pain is accompanied • Sudden onset of gait disturbances • Neck pain accompanied by upper limb by any of the following: • A recent trauma pain, or backache accompanied by lower • Autoimmune conditions limb pain. • Recent unexplained weight loss or a history of cancer

16 HealthWatch - Dont blame it all on posture.indd 16 17/2/20 11:56 AM PAGE 17 HEALTHWATCH (Left to right): Dr Tricia Kuo, Dr Cherylin Fu, Associate Professor Emile Tan, and patient The small scar at the end Mr Leong. of Mr Leong’s spine, now barely visible, is where a pacemaker was implanted to stimulate nerves in that area.

Urology, Singapore General Hospital (SGH). At SGH, the procedure has been available since 2010, but it was Photos: Justin Loh Photos: only in recent years that it has gained interest among patients. I declined because I didn’t want Since 2015, eight patients to walk around with wet pants.” have had the device implanted Now, his life has been permanently — five for urological No more transformed. “I’m very happy conditions and three for because there’s no more faecal incontinence. leakage, and no more According to Dr Cherylin Fu, incontinence problem.” Senior Consultant, Department wet pants of Colorectal Surgery, SGH, In better control patients under the trial phase Sacral neuromodulation gives patients enhanced Sacral neuromodulation involves have to record the number of implanting a small pacemaker-like incontinent incidents, such as quality of life and restores their independence. device into the sacral area, which soiled underwear or leakages. is at the end of the spine. The The data are compared with that r Leong used device sends electrical impulses before they went on the trial, and to dread going to stimulate the nerves located the device is considered effective out. He suffered in the lower back, just above the if patients get at least a 50 per from urinary sacral area. The specific sacral cent reduction in the number Mincontinence, which meant he was nerves involved are the third and of incidents. unable to reach the toilet in time fourth, which regulate bladder “Patients can be very when he felt the urge to urinate. and bowel activity. The intensity effectively treated, with up to He often wet himself as a result. and frequency of the pulses can 76 per cent reduction in their But after undergoing a procedure be modified by both the physician overactive symptoms, and faecal known as sacral neuromodulation, and the patient through an incontinence symptoms reduced he is happily free of that problem. external programmable device. by at least half in 70 to 80 per He had sought treatment for Although it is little known cent of patients,” said Dr Fu. another issue — he often woke and isn’t offered widely in this In Singapore, 10 to 40 per cent up in the night needing region, sacral neuromodulation of the population is estimated to to go to the toilet, but is a well-established procedure suffer from some form of urinary wasn’t able to pee. in the West, having been incontinence, and 4.7 per cent He had a urinary introduced some 20 years ago to from faecal incontinence. retention problem, treat urinary incontinence. The Although the number of which meant that procedure benefits specific types patients who have undergone although his of urinary incontinence, such the procedure at SGH may bladder was full, as overactive bladder or urge be relatively small, “sacral he was not able incontinence, and patients whose neuromodulation has made to empty it due faecal incontinence is due to anal significant difference in the to a dysfunction sphincter muscle weakness or quality of life for patients, in the muscles that defect, pelvic nerve injury, restoring function and control urination. or weakness. independence,” said Associate Tests later Patients whose condition isn’t Professor Emile Tan, Head, found that he also helped by medication and who Department of Colorectal suffered from urge aren’t keen on surgery can be Surgery, and Director of the incontinence due to an offered this option. After they are Gastrointestinal Function overactive bladder. evaluated and have met certain Unit, SGH. “I didn’t feel the need to pee. criteria, patients go through a Mr Leong, for one, has been But when that sensation came, short trial phase. If the device is able to get better sleep than it was too late to get to the found to be effective, they can before. Compared to having to bathroom,” said Mr Leong. have the device permanently wake up every one to two hours “When my friends asked me to implanted, said Dr Tricia Kuo, previously, he is now able to sleep join them at the coffee shop, Consultant, Department of for about five hours at a stretch.

17 HealthWatch - No more wet pants.indd 17 17/2/20 11:57 AM ASK OUR EXPERT PAGE 18 Q&A Can supplements Healthier way to enjoy bubble tea

help my eyes? I love bubble milk tea but I’m worried about putting on weight. How many calories are there in a regular After a very long day, bubble tea? If I ask for less sugar, would that help? my eyes sometimes feel tired. Sometimes there’s A regular bubble milk tea with tapioca pearls contains more than 300 pain, and once or twice, there was a calories. The sugar or calorie content of the bubble tea does not come sudden instance of lights. Is eye solely from the sugar in the beverage, but also the toppings, milk, pressure building up and affecting creamer, or cream added. Cream, for instance, contains at least 30 per the retina? If so, what are the early cent fat, so the higher the cream content in the drink, the more calories and late-stage symptoms? I often take the drink will contain. supplements. Do I need those with According to the Health Promotion Board, no more than 10 per cent of a person’s dietary more ingredients for eye health? energy should come from added sugars. If bubble tea is taken with all the sugar and toppings offered, your weight may increase from the extra calories. A regular bubble milk tea with sugar and cream can also lead to elevated blood sugar levels in individuals with diabetes. Bubble tea will have fewer calories when “less sugar” or “no sugar” is asked for. In addition, bubble teas with no toppings will also have fewer calories. Tea, whether it is green, black or red, and with no added sugar, milk or other toppings, is approximately 0kcal. Besides asking for less sugar, toppings, milk, cream or creamer, replace pearls with lower-calorie options, such as aiyu jelly and aloe vera.

MS PEH HUI YEE Senior Dietitian, Department of Dietetics, Singapore General Hospital

At what age can my child get braces?

When can a child wear braces? Are the risks It is very common for our eyes to feel tired greater for wearing braces during childhood after a long day, particularly if we have been as opposed to wearing it during later years? doing a lot of reading or computer work. This What are the benefits of wearing braces at a young is due to eye strain and dryness in the eyes. age? Does it mean shorter wearing time? Dry eyes occur after reading or doing near work for a prolonged period of time, There are three types of braces that are used for different purposes and ages: fixed appliance as we often forget to blink when we are (metal or ceramic braces that are attached on the teeth and linked together by orthodontic concentrating during those tasks. This can wires), growth-modification appliance (face mask or twin block), and removable appliance cause discomfort, eye redness, and a sense of (bite plate). pressure in the eyes, but can be resolved by The earliest age for your child to start wearing braces will depend on the condition that needs using lubricating eye drops regularly. treatment. It is best to get an evaluation from an orthodontist. Seeing flashing lights in your vision can be Common repercussions of braces treatment include tooth decay and gum disease. It is difficult due to the degeneration of the vitreous jelly to compare the risks associated with wearing braces during childhood versus adulthood, as the at the back of your eyeball. This degeneration severity of these conditions depends on a person’s susceptibility. Maintaining good oral hygiene is normal with age, and is not associated with during the course of the treatment will prevent undesirable side effects. elevated pressure in the eyeball. However, Early braces treatment can help correct the following: if this is the first time you are seeing l The eruption of permanent teeth that may be stuck in the jaw (alveolar) bone flashing lights, I advise you to have an eye l The growth direction of upper or lower jaws for patients with jaw growth disharmony examination. Oral supplements are usually not l Poor bite, and prevent future or further damage to permanent teeth necessary if you have a balanced diet. l Bad habits, such as thumb or digit sucking If problems are corrected during the earlier stages, further treatment may be shorter and simpler. DR CHAN CHOI MUN Senior Consultant, Medical Retina Department, DR SONG YI LIN Singapore National Eye Centre Associate Consultant, Department of Orthodontics, National Dental Centre Singapore

Back pain after a sneeze Older people may be more prone Is it possible to hurt my back when I sneeze? I to suffer sneeze-related back pain felt pain in the back the other day after sneezing. as they may already suffer from Should I have gone to see a doctor? disc desiccation or degeneration. Degenerated discs are not as strong Back problems caused by sneezing are fairly common. At SGH, we see in withstanding sudden changes in around 10 to 20 patients a week who complain of back pain or shooting pressure, and this can lead to disc pain in the lower limb after sneezing or while stifling a sneeze. These damage or a slipped disc. patients are usually between 20 and 50 years of age. The intervertebral disc bears the The first thing to do is to rest. A warm towel or heat pack placed most impact when we sneeze. One over the back for 15 minutes can bring about relief. If the pain is should refrain from bending forward when sneezing. Bending forward bearable, do some light stretching. If the pain is severe, seek treatment adds pressure to the spinal discs. Sneezing also builds up to 3.5 times of from a general practitioner (GP) early. The GP will examine you for the disc pressure when one is lying down. Thus, bending forward while nerve compression symptoms, and after which he may refer you to an sneezing adds several times the force on the disc, which increases the orthopaedic surgeon. risk of injury. Often, pain that lasts for more than six weeks may warrant a magnetic DR REUBEN SOH resonance imaging (MRI) scan to find out the extent of the injury. Senior Consultant, Department of Orthopaedic Surgery, Singapore General Hospital

18 Ask Our Expert V1.indd 18 13/2/20 5:38 PM PAGE 19 COMING SOON DID YOU KNOW... Toddler Feeding Workshop Colorectal Cancer Date: 21 Mar (Sat) Awareness Month if you have any sleep-related symptoms, … that Time: 10am-12pm Public Forum such as loud snoring, apnoea episodes and/or Venue: Patient Education Date: 28 Mar (Sat) excessive daytime sleepiness, you can be diagnosed Centre Room 1, Women’s Time: 10am-12.15pm and treated when you visit the Lung Clinic – Changi Tower Level 1, KK Women’s Venue: Peter & Mary Fu and Children’s Hospital (KKH) Sleep Assisted & Ventilation Centre at Changi General Hospital (CGH)? Auditorium, Level 4, National Fee: KK Parenting Club: $10 The Centre saves patients crucial inter-referral time by combining the Cancer Centre Singapore, expertise of a diverse group of specialists to provide diagnostic, intervention, per member/non-KK Parenting Club: $15 per participant 11 Hospital Crescent, and treatment services for numerous common and complex sleep conditions. Registration and enquiries: Singapore 169610 To diagnose obstructive sleep apnoea, a sleep physician will arrange for a Call 6394 1268 (Mon-Fri, Registration: Call 6225 5655 diagnostic sleep study to be performed at the CGH Sleep Laboratory, which is 10am-4pm) or email to (Mon-Fri, 8.30am-5.30pm) accredited by the Australasian Sleep Association and National Association of [email protected] Testing Authorities, Australia. Conducted in English, this The Sleep Lab conducts both day and night studies, running more than Join us for an informative session forum will cover treatment 900 a year. Parameters, such as brain waves, eye, chin and leg movements, with our Dietitians and Speech options for colorectal cancer body position, airflow and respiratory efforts, oxygen levels, as well as snoring and Language Therapists, as and dietary tips. they share strategies for are monitored throughout the night. The sleep technologist analyses the stress-free mealtimes. raw data, and the sleep physician creates a report that helps diagnose the Speech, Language and Literacy Workshop patient’s condition. When Food is Medicine: Designed to simulate the home environment and keep patients Eating Disorders Date: 18 Apr (Sat) comfortable, there are six rooms, each with en-suite toilets and television. Treatment and Recovery Time: 10am-12pm Venue: Patient Education There are also infrared synchronised cameras that work in the dark to capture Date: 21 Mar (Sat) Centre Room 1, Women’s Tower the patients’ sleep positions and behaviour without disturbing them. Time: 9.30am-12.30pm Venue: Learning Space, Level 1, KKH Fee: KK Parenting Club: $10 per patients can be conscious when undergoing some procedures Block 6 Level 1, Singapore … that General Hospital member/non-KK Parenting Club: if they were given sedation, and not general anaesthesia? Registration and information: $15 per participant In sedation, medications are administered either orally or Visit https://www.sgh.com.sg/ Registration and enquiries: Call intravenously to produce a state of calm and relaxation. about-us/calendar-of-events or 6394 1268 (Mon-Fri, 10am-4pm) Patients are not totally unconscious and may still be aware http://sghed2020.eventbrite.sg or email to [email protected] of their surroundings. Sedation is given for minor procedures; Find out about eating like anaesthesia, it is aimed at reducing discomfort. At Singapore General Pick up useful tips from our disorders at this public Hospital (SGH), for instance, outpatient diagnostic endoscopic procedures Speech Therapist on how you can forum, where speakers are routinely performed under sedation, not general anaesthesia. include SGH psychiatrists, support and nurture your child’s General anaesthesia, on the other hand, is usually given to patients art therapist, occupational language and literacy skills. This undergoing invasive surgical procedures. Patients become completely therapist, dietitian, and workshop will cover information unconscious, and will not feel pain or discomfort. Both sedation, mental health nurse. The week on speech, language, and literacy especially if excessive, and general anaesthesia can bring on side effects starting 2 March 2020 is Eating development between the ages and complications. Disorders Awareness Week. of 1 and 4.

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