01-02-04 News-ABO and IPC Awards 160211 V4 path R2.indd 1 22/2/11 6:46 PM

02 SINGAPORE HEALTH MAR⁄ APR 2011

News

Dr Kee (right) and his team are the first to perform a renal transplant involving a donor-recipient pair with mismatched blood groups at SGH.

Up until the turn of the last century, all blood was thought to be the same, frequently with tragic consequences during blood transfusions.

It is now known that red blood cells, like all cells that make up the body’s tissues and organs, have antigens – either A or B – attached to them. Depending on the antigen attached, blood type is classified as A, B, AB (where both A and B anti-gens are present) or O (none of the properties of A and B are seen).

If an antigen of a type that isn’t present in a person’s red blood cells enters the body, it causes antibodies to be produced to attack it – much like how antibodies are produced to combat germs.

For that reason, in a blood transfusion, A and B blood types can only be replaced with blood of the same type, while AB is more flexible and can be replaced by either A or B, making it easier to match. O-type blood can be used in a mixture of blood for donation purposes, and is the most valuable in blood donation.

However, O types can only be transfused with O-type blood.

Similarly, before a transplant

Understanding the ABO blood group system

involving blood groups that are incompatible is performed, antibod-ies in the recipient’s body have to be removed. Otherwise, they will attack and destroy the organ from the donor belonging to a di�erent blood group.

In transplants, a procedure known as plasmapheresis is used to remove these antibodies. Somewhat like dialysis, the process involves transferring blood from the patient’s body with a catheter to a machine that removes the antibodies. The blood is then returned to the patient. The procedure is done every alternate day until the antibodies are reduced to a level considered safe for a transplant.

The risk of rejection is as high as 25 per cent in an ABO-incompatible kidney transplant, compared with 10 to 15 per cent for standard trans-plants. Infection risks are also higher because of the plasmapheresis procedure, and the extra immuno-suppressive drugs that have to be taken to reduce rejection.

Still, with today’s advanced techniques, the survival rate is comparable with that of standard transplants – 95 to 100 per cent a year after transplant.

DR TERENCE KEE, CONSULTANT ANDDIRECTOR, RENAL TRANSPLANT,DEPARTMENT OF RENAL MEDICINE, SINGAPORE GENERAL HOSPITAL

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Mr Tan’s four-month stay in hospital gave him time to reflect on life.

Mar⁄ apr 2011 singapore health 03

Can you guess what this is?

In focus

See page 26 for the answer.

News

One moment he was sitting in his car waiting for the light to turn green. The next, everything went black. “As soon as I came round, I drove myself to the nearest Accident and Emer-gency,” said the then 38-year-old.

Doctors diagnosed Mr Woo Chen Sin, a former national youth water polo player and entrepreneur, with non-sustained ventricular tachycardia, an abnormally fast heart rhythm.

“Mr Woo was suffering from an underlying disorder of the heart muscle, in which the left heart chamber becomes enlarged and can’t pump blood as well as a healthy heart,” said Dr David Sim, Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS).

“This made him more prone to the condition, but its exact causes are often unknown.”

Seven years later in 2008, Mr Woo was diagnosed with end-stage heart failure, which is irreversible. He had to give up work, was plagued by constant headaches, and small exertions left him breathless.

“Heart failure broadly refers to the inability of the heart to function as a pump,” said Dr Sim. “This means that the heart cannot pump enough blood to meet the body’s demand. Heart failure is the end point for a number of heart conditions – most commonly ischaemic heart disease (when blood supply to the heart is reduced) which damages the heart,” said Dr Sim.

In milder forms of heart failure, the heart cannot keep up during exercise, but pumps enough blood when the patient carries out normal activities. In advanced stages, the heart cannot supply enough blood to the body even while at rest.

Mr Woo is one of about 5,000 people in Singapore who are admitted to hos-pital with heart failure every year. The condition is more common in men than in women. “Risk factors include poorly controlled blood pressure, diabetes, high cholesterol, smoking as well as obesity,” said Dr Sim.

There is no cure for advanced heart failure as the damage done to the heart is usually irreparable. “For patients in the early stages of heart failure, we prescribe a cocktail of drugs in combination with

Dr David Sim (right) explains how an underlying heart condition in Mr Woo Chen Sin (left) led to end-stage heart failure within a few short years.

lifestyle changes to decrease the risk of complications and dying,” said Dr Sim. “For example, if heart failure is partly brought about by alcohol, we ask the patient to refrain from drinking and rec-ommend taking medication.”

“Heart failure patients have to make major lifestyle changes and, sometimes, even stop work altogether,” said Dr Sim.

Some patients with advanced forms of the disease may benefit from an implant-able cardioverter defibrillator, a device which monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks. “This is useful to prevent the heart from suddenly stopping in selected heart fail-ure patients,” said Dr Sim.

Every year, about 30 patients with end-stage heart failure come to NHCS, which is the only centre in Singapore to carry out heart transplants. Six to eight of them will need a device to support their heart and/or a heart transplant.

An improved device known as Heart Mate II was introduced here in 2009. It takes over the pumping function from the heart and comes with a much smaller pump. This device is more suitable for adults with a smaller build, such as Asians and women.

Mr Woo is preparing to receive a Heart Mate II, which will buy him time until a suitable donor heart is avail-able. “I was really surprised that patients with the Heart Mate II were able to lead normal lives,” said Mr Woo.

The man, now 47, hopes that with this device, he will be able to return to work while he waits for his transplant.

Fixing a failing heartAlthough heart failure is irreversible, new treatments enable patients to regain their quality of life

Symptomsof heart failure

symptoms of heart failure can be categorised into two groups – left- and right-sided heart failure. “the two sides of the heart have different roles – the left side pumps oxygen-rich blood to the body, while the right sends blood into the lungs to pick up oxygen,” said Dr David sim, Consultant, Department of Cardiology, national heart Centre singapore. left-sided heart failure is the most common type of cardiac failure.

Left-sided heart failure Fatigue shortness of breath need to sit up while lying down or sleeping to catch one’s breath

inability to lie flat due to fluid in the lungs

Right-sided heart failure loss of appetite abdominal discom-fort and swelling

swelling of the lower limbs

prominent neck veins

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Managing heart failure

Advice for heart failure patients adopt a healthy diet by reducing

salt intake refrain from bad habits such as

drinking alcohol and smoking seek help from trained counsellors

to deal with social problems such as depression

seek help from a social worker to manage treatment costs

Follow instructions for your medication closely

Monitor your weight daily. if there is a sudden weight gain of 1 to 2kg, which could be due to water retention, inform your doctor

Advice for caregivers be a source of emotional support and

help for patients ensure patients comply with their

medication regime encourage and help patients give up

habits that harm their health be trained to look out for symptoms

which arise in patients and learn how to help them when such situations occur

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08 News-Arthi+SHFamous V4 path.indd 9 22/2/11 11:53 AM

11 HealthXchange Ver V4 path.indd 10 2/21/11 10:05 PM

Every day, SGH’s Specialist Outpatient Clinic (SOC) doc-tors see about 3,000 patients.

This number includes both a substan-tial number of new referrals as well as patients returning for regular reviews with our specialists.

The queue number reflects the pa-tient’s scheduled appointment time. To ensure that patients need not have to wait months for an appointment to see our specialists, the clinics will accom-modate a few additional appointments in the doctors’ clinic sessions in the event that patients do not show up for their ap-pointment. On average, the no-show rate is about 20 per cent.

12 singapore health Mar⁄ apr 2011

My mother’s appointment with a Clinic C doctor was at 10.45am, but we were made to wait for more than an hour before she was seen.

Her queue number was 1045, which reflected her appointment time, and the queue numbers displayed on the queue board showed that the interval between appointment times was a matter of min-utes – 1030, 1031, 1032 and so on.

Doctors should realistically assess the time they need with each patient before setting appointments. Our long wait suggests that scheduling may not be realistic. Was the extended wait a result of inappropriate scheduling? – Mr Mohamad Ibrahim

WRITE IN AND WIN A PRIZE FOR BEST LETTERletters should be no longer than 400 words and must include your full name, address and phone number. Singapore Health reserves the right to edit letters and not all letters will be published. send your letter 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.

My mum was admitted to sgh Ward 76 for several weeks in January. the quality of service we received from the staff there was excellent. i think hotels could learn a thing or two from sgh! My mum and i are really grateful for all the help and assistance rendered by the staff, and again, kudos to sgh for providing excel-lent service in healthcare. it’s the best i have experienced. - D Li

When Dr Farhad Vasanwala of the Department of Family Medicine and Continuing Care, sgh, saw me recently, i raised some concerns regarding health and medical matters. he took time to under-stand and explain them to me. i am very grateful to him for his care, concern and professional-ism. i feel strongly that if i do not convey my appreciation, i would be doing a disservice in return for the good work of this doctor. - Mdm Tang Seow Chin

i am writing to compliment the nurses at sgh Ward 55B and Dr tricia Kuo of the Department of Urology. My mother underwent minor surgery for kidney stones in early January and was warded for five days. throughout her stay, the nurses on duty regularly updated us on her progress. Dr Kuo was very clear and precise in explaining my mother’s condi-tion to us. she even gave me her mobile number, so i can contact her if there are further problems. - Ms Clarissa Soh

My husband had to undergo a scope recently. While we were waiting at sgh’s Clinic D for our turn, i noticed a nurse, Ms siti laili hassan, attending to a patient with a smile. i too was impressed by the compassion she showered on us. i would like to convey my thanks to her for her patience. Keep the smile going, Ms siti! - Mrs Pamela Wong

Tributes

Singapore Health is online too!We should all do our part to save paper, and ideally, Singapore Health should go online. However, I know it would deprive readers without Internet access of a chance to read about the happen-ings at Singapore’s oldest hospital.

The stories of patients and their experiences always inspire me, and I look forward to reading more stories about how SGH patients manage and cope with their illnesses.

I want to thank SGH for continuing this free service. By investing money into a publication, you are not only keeping us up to date, but the articles will also serve as a record of SGH’s history. – Mr Jeremy Cheong

We’re glad that Mr Cheong finds the paper useful! We share his view about saving

paper, and as he has rightly pointed out, it’s necessary for us to have a print version of Singapore Health as many of our readers do not have access to the Web. To make Singapore Health available to a wider audience, we have published it online as well at www.sgh.com.sg. The online version is often available a few days prior to the print copy being placed at our news stands and other distribution points around Singapore, such as GP clin-ics and SingHealth Polyclinics.

Singapore General Hospital

Deepak Ghimirayi am currently a medical student at aiiMs (all india institute of Medical services) and would like to do a medical elective in singapore general hospital. Can you give me an idea of how to go about this? Do you offer accommodation during this period? Jan 15 at 7.52pm

5 people like this

Singapore General Hospital sgh does offer medical electives and you can check out undergraduate opportunities at www.sgh.com.sg/education/Undergraduate-Medical-education. students should make their own arrangements for travel, medical and travel insurance, as well as accommodation when they are in singapore.Jan 17 at 9.23am

Ng Sin YeeWe are four pharmacy students at international Medical University (iMU) in Malaysia. We are interested in taking our elective, part of iMU’s pharmacy curriculum, during the semester break (May 23 to July 1, 2011) at sgh.

We hope to observe and learn pharmacy practice in singapore, especially in a hospital environment.

please let us know how we can proceed. Jan 10 at 11.04am

6 people like this

Singapore General Hospital please write to our postgraduate allied health institute colleagues at pgahi@sgh.com.sg, or refer to www.sgh.com.sg/pgahi for more information.Jan 11 at 2.04pm

Facebook us!

Because the health and safety of our patients are priority, our SOC doctors also see urgent cases. In these cases, the urgent need to see SOC doctors is reflect-ed in the tight interval between appoint-ment times or queue numbers.

Consultations can be as short as a few minutes and as long as more than half an hour, depending on the complexity of the case. When a case takes longer than usual, appointments inevitably pile up, extending the waiting time for other pa-tients in the queue.

Patients who are unable to make their original appointment can call our Cen-tral Appointment hotline at 6321-4377 to cancel or change their appointment date.

15-day gap till covered Health insurance cover for newborns does not commence before they are 15 or 30 days old. This is because the incidence of a newborn child requiring specialist medi-cal treatment during the first few weeks of life is much higher than in the subsequent weeks and months.

Most congenital abnormalities and birth defects are diagnosed during the initial weeks. In order to keep premiums

affordable, insurers have to exclude this peak period of risk from the insurance cover, so as to bring the overall cost of the insurance down for all consumers. An initial “waiting period” facilitates proper assessment of the applicant’s risk and the issuing of the policy document.

Contributed by Monetary Authority of Singa-pore and Life Insurance Association of Singa-pore as part of Singapore’s national financial education programme MoneySENSE.

Flawed scheduling = long waiting times?

Tell us

Eating for a speedy recovery

MAR⁄ APR 2011 SINGAPORE HEALTH 13

Food may be a turn-o� for cancer patients, but it’s important to eat well for a speedy recovery. By Priscilla Wong

Preparation:

1 Bring water to a boil, then add the soaked rice. Keep the heat on high

2 Boil for 10 minutes till the rice grains have softened or broken up.

Reduce the heat to a medium flame

3 Add the sliced fish and ginger. Boil for another 5 minutes

4 Add salt to taste, then turn o� the heat. Garnish with parsley and

serve warm

Serves 1

Ingredients:3 cups of water½ cup of rice, soaked in waterPalm-sized piece of fish fillet, sliced and deboned1cm slice of ginger, shredded½ tsp salt to tasteA sprig of parsley (optional)

Recipe

Normal Vegetarian Soft Diet

Breakfast

Lunch

Dinner

Boiled eggs & bread Bee hoon soup Porridge

Roast chicken with steamed rice

Steamed tau hu with mushrooms

Sliced fish kway teow soup

Fried fish with ginger & plum sauce

Rice with vegetables

Salmon grilled with thyme

Healthy optionsSample menu of nutritious food for recovering patients at SGH

Nutritious andbalanced dietsare important forpatients undergoingchemotherapy.

Mdm Koaymakes it apoint to whetthe patient’sappetite withattractive foodpresentation.

Fitness Beauty p20Nail care tips

Exercise for older people

WellnessToo many vitamins?

p19

Food may be a turn-o� for cancer patients, but it’s important to eat well riscilla Wong

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14 SINGAPORE HEALTH MAR⁄ APR 2011

Fitness

The benefits of endurance sports for older people. By Annie Tan

Going the distance

Hit the trackDR DARREN LEONG, RESIDENT SPORTS PHYSICIAN, CHANGI SPORTS MEDICINE CENTRE, CHANGI GENERAL HOSPITAL

Training for it

Picking the right exercises can build strength in older people without increasing the risk of injury, said Dr Darren Leong, Resident Sports Physician, Changi Sports Medicine Centre, Changi General Hospital.

Choosing the right sport

Start with simple sports like brisk walking or Nordic walking, which uses poles

(similar to ski poles) to involve the upper body

muscles as well as the legs

Choose a sport that is

convenient for you, so it will be easier to stick to

the routine

Follow your inclinations. If you

loved ball sports and racket games when you were younger, revive your passion

Involve your spouse, family or

friends, so you can make it a social outing

Seniors should go for a health check before participating in endurance training.

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Streamlining blood banking procedures

MAR⁄ APR 2011 SINGAPORE HEALTH 15

Simple steps to improve waiting times

Top service performers in public healthcare were honoured with a new dedicated award in January. Singapore

Health Quality Service Award recognises that healthcare service excellence is uniquely challenging. “We

need a separate platform to recognise healthcare service champions. They inspire fellow healthcare

workers to give their best to patient care, and others to join the profession,” said Mrs Tan-

Huang Shuo Mei, Group Director, Communications and Service Quality, SingHealth

and Singapore General Hospital. The award celebrated champions from 11

healthcare institutions, including SingHealth institutions, Bright Vision

and St Andrew’s Community Hospital. “We also invite other public

healthcare institutions including NHG, NUHS, JGH, AH

and community hospitals to join the award,” said

Professor Tan Ser Kiat, Group CEO, SingHealth.

The award was commended by Ms Yong Ying-I,

Permanent Secretary, Ministry of Health (MOH).

“The MOH Patient Satisfaction Survey has helped

healthcare institutions improve service standards. The

new award further supports this e�ort by recognising and

showcasing the good work of our healthcare workers.”

OUR STARS

SHE TAKES CARE OF WHAT GOES INTOYOUR BODY

16 SINGAPORE HEALTH MAR⁄ APR 2011

SHE’S MORE THAN JUST A VOICE

ANCILLARY CATEGORY

Porckodi Lallayah

Patient Service Assistant,

Singapore General

Hospital

ALLIED HEALTH CATEGORY

Christine Ong

Chief Dietitian,

KK Women’s and

Children’s HospitalMDM PORCKODI LALLAYAH, PATIENT SERVICE ASSISTANT, SINGAPORE GENERAL HOSPITAL

CliniCian Category

Dr Irene Chua

gynaecologist and obstetrician,

KK Women’s

and Children’s Hospital

nursing Category

Tan Chor Kien

nurse Clinician,

singapore general

Hospital

MAR⁄ APR 2011 singAPoRe heAlth 17

Creating hope, spreading cheer and providing quiet encourage-ment are qualities that make Nurse Clinician Tan Chor Kien stand out in her patients’ eyes.

“She makes newly diagnosed myeloma patients feel less hopeless and fright-ened,” said a patient. Ms Tan works with the Department of Haematology at Singa-pore General Hospital.

Most of Ms Tan’s patients suffer from blood cancer and are either on lifelong medication or in need of a stem cell trans-plant. The transplant patients, in par-ticular, have a difficult and long journey ahead, without guaranteed success.

“One of my transplant patients, a mother of three, became depressed and was ready to give up. So I took her down to the garden and we sat in front of the foun-tain. Looking at the water, I told her that she is like the water. She has to refresh herself for her children, who are waiting for her to get better. That was a turning point for her and I’m really happy to see her now in her fifth year after a success-ful transplant,” she said. “Every time she visits, she still remembers the fountain, even though it is long gone!”

Sometimes, being with patients and quietly listening to them is all it takes to help them overcome their worries or frus-tration. But at times, Ms Tan recognises that the support needs to come from another patient.

Dr Irene Chua, Gynaecologist and Obstetrician, KK Women’s and Children’s Hospital, has delivered close to 3,000 babies during her career as a special-ist. When she was pregnant, she con-tinued delivering babies, taking a mere three weeks off to have her child, who was delivered via Caesarean section. Even though she was resting at home, she continued to support her patients through their pregnancies. It’s no sur-prise that this devotion to her patients won her a Superstar award at the Sin-gapore Health Quality Service Award.

You returned to work just three weeks after deliver-ing Your own babY. what (on earth!) made You do this?I left some of my closest colleagues in charge of my pregnant patients, but some of these patients were more com-fortable with me, so I didn’t want to let them down. Even while I was at home, I answered their questions through e-mail and over the phone.

so what made You want to be a doctor?It wasn’t quite a childhood dream, but when I was in my fourth year at medical school, I tried obstetrics and gynaecology and I was inspired by the people in the field. I’ve never looked back. My work motivates me: I find it so fulfilling that I can’t wait to get out of bed every morning to see my patients!

besides passion, what else makes a good doctor?A good doctor has to be there for the patient – she has to be compassionate, truthful and understanding. As a spe-cialist, your skills are a given, so the

most important thing is to be there for the patient.

what’s a tYpical daY like?A typical day starts at 7am with paper-work before my ward rounds. On my rounds, I normally see between five to 10 patients and these are either women recovering from surgery or those in labour, as I’m a gynaecologist and obstetrician. At 8.30am, my morning clinic starts. I see a mix of gynaecolog-ical conditions, like fibroids, requests for contraception or diagnostic tests, as well as pregnant women.

I try to keep on top of administra-tive work during lunch, before I start my afternoon clinic, which runs till around 6pm. Three nights a week, I also run night clinics from 6 to 9pm. On the nights when I don’t have clinics, I attend meetings or conduct job interviews. So it’s fair to say that at the moment, I’m a full-time weekend mum!

what’s a patient to You?A patient is more than a collection of problems, which is why I try to get to know them. That way, I can better help them with any medical problems or concerns they have. I’m quite close to many of my patients because of that.

a memorable incident…One of my patients, a woman in her late 30s, was trying to conceive. When she miscarried at eight months, we were both devastated. The couple tried again, but she had two more miscarriages, which made her reluc-tant to try anymore. I did some fur-ther investigations and was able to help her. She has recently given birth to a beautiful, healthy baby! That was a huge moment for me because she trusted her own body and baby to me – and it felt great to give them that gift!

do You have a role model?My mother. She juggled a job, me, home, and now, at her advanced age, is still helping me care for my baby!

She loveS SeeIng her paTIenTS

She fInDS The SIlver lInIng

“Nothing is as convincing as the advice from another patient. Speaking to other patients makes those about to go for transplants realise that suc-cess is achievable, but will take time. It helps to measure their expectations. At the end of the day, seeing is believ-ing,” said Ms Tan.

For the comforting care she shows her patients and the quiet encourage-ment she offers them, Ms Tan received the Superstar award for nursing at the inaugural Singapore Health Quality Service Award.

But she doesn’t make an impres-sion on just her patients. Her staff also appreciate the encouragement and support from her. She helps them cope and respond to patients, who at times can be frustrated by the slow progress of their treatment or sudden relapses.

Where you can, light up their journeys –whether it is a short flicker or a lasting ray of light – it makes a difference to them.

Ms Tan Chor Kien, nurse CliniCian, singapore general hospiTal

“When disputes arise between patients and staff, we would diffuse the situation first. In the heat of the moment, it is difficult to get through to the staff, so we let them cool off first. The next day, we would call a meeting to discuss the incident and get views from the group on what the best approach is. In that way, everyone will learn from it,” said Ms Tan.

Ultimately, caring for patients requires more than just knowing their medical cases, family support and social background. “You have to be there for them through their treatment and recovery process,” said Ms Tan.

Making the di�erenceIncreasing uptake of a simple panel test helps save lives

18 SINGAPORE HEALTH MAR⁄ APR 2011

CHAMPIONS OF QUALITY SERVICE

CONGRATULATIONSto the winners of the Singapore Health

Quality Service Award 2011

TEAM

EFFORT

Enough or too much?

MAR⁄ APR 2011 SINGAPORE HEALTH 19

Wellness

When it comes to vitamins and minerals, moderation is key. By Thava Rani

Essential for boosting the body’s immune system and an

important component of many enzymes. Also functions

as an antioxidant

US RDA:8mg (men), 18mg (women)

Food sources: Red meat such as beef, oysters,

shrimp, tuna, lentils, kidney beans and cashew nuts

Excessive intake: Slight excess causes

constipation. Higher excesses may result in gastric mucosal

ulceration, and increase the likelihood of

multi-organ damageOverdose symptoms: Vomiting and diarrhoea

Iron

Essential for healthy skin, retinas and

mucous membranes

US RDA: 700mcg (men),

900mcg (women)Food sources:

Yellow and orange vegetables like carrots and pumpkins, spinach, sweet potatoes and cod liver oil

Excessive intake:May be harmful to skin and bones, causing weakness

and brittlenessOverdose symptoms: Tiredness, decreased

appetite, vomiting, joint soreness, drying and

cracking of lips and skin, hair loss and yellowing

of the skin

Vitamin A

Crucial for maintaining a normal heartbeat

and for normal functioning of nerves and muscles. Acts as

a building block for bones

US RDA: 1,000mg

Food sources: Dairy products such as

milk, cheese and yoghurt, vegetables like broccoli and

Chinese cabbageExcessive intake:

May impair kidney function and decrease absorption

of other mineralsOverdose symptoms:

Nausea, vomiting, loss of appetite and increased urination

Calcium

Helps form strong collagen fibres which are essential

for the strength and integrity of connective

tissue beneath the skin in the blood vessels, bones,

tendons and ligaments. Also acts as an antioxidant

US RDA:90mg (men), 75mg (women)

Food sources:Fruits such as oranges,

grapefruits and strawberries, vegetables like broccoli

and tomatoesExcessive intake:

Increases the likelihood of calcium oxalate kidney

stones and can deplete the body of copper, another

essential nutrientOverdose symptoms:

Diarrhoea, stomach cramps and nausea

Vitamin C

Mr Johnathan Diong, Pharmacist, Department of Pharmacy, Singapore General Hospital, advocates a balanced meal to meet daily vitamin requirements. P

HO

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BR

ARY

Essential for boosting the body’s immune

system and an important component

of many enzymes. Also functions as an

antioxidant

US RDA:11mg (men), 8mg (women)

Food sources:Red meat such as beef,

oysters, milk, baked beans and chickpeas

Excessive intake: May result in

copper deficiencyOverdose symptoms:Nausea and vomiting

Zinc

1 Keep your nails short, dry and clean. If your hands are in con-tact with water often, use rubber gloves to avoid overexposure

20 SINGAPORE HEALTH MAR⁄ APR 2011

Beauty

Getting your nails done is a great way to pamper yourself, but beware of the dangers. By Stacey Chia

Vanity vs safety

An ugly problemPrevention is better than cure! Take the necessary precautions when decorating your nails.

Top tips to avoid a nail fungal infection:

2 Use anti-fungal spray or powder on your feet and shoes

6 If you’ve touched an

infected nail, wash your hands

thoroughly

5 Don’t walk around barefoot in public places

4 Don’t trim or pick at the skin

around your nails, so germs can’t

get in

3 Wear open-toed shoes, or if you are

regularly wearing covered footwear, make sure you

wear synthetic socks that keep your feet dryer than

regular ones

DR REGINA LIM, CONSULTANT, DEPARTMENT OF DERMATOLOGY, CHANGI GENERAL HOSPITAL

Don’t let a fungal infection ruin a beautiful manicure.

26x36cm_fullpagead.indd 1 11/30/2010 4:56:11 PM

20 Health+BeautyNailCare V3 path.indd 21 2/21/11 10:11 PM

22 singapore health Mar/apr 2011

Viewpoint

Many of us are likely to hold an established view on organ donation. But how many have thought of a much more funda-mental “body part” that is avail-able for donation – bits of tissue cut out during surgery?

Consider a fictional character Mdm Foo, a housewife in her mid-50s, who noticed a hard lump in her left breast. As her aunt had died of breast cancer, she saw her doctor immediately. After under-going a biopsy, her doctor confirmed she had breast cancer and needed surgery to remove the affected part.

Banking on tissueDon’t bin leftover tissue removed during surgery!

BY Assoc Prof TAn soo YongFoo’s surgeon was able to confirm that her cancer was aggressive and would best respond to a specific treatment, which she then started on. But this still leaves quite a few questions unanswered: Why did she develop the cancer? Are her children likely to get it too? And could it have been discovered earlier, helping her avoid surgery?

Extensive research on tumour tissue has provided some answers. So instead of wasting the leftover tissue, patients can donate them to research.

Tumour tissue contains the blueprint of a disease, telling researchers what genetic changes it has gone through. Sometimes, researchers can identify a unique change that can be used as a marker of early disease or as a target for new treatments.

Naturally, this research cannot be done overnight or by examining just one individual’s tissue material.

Investing it rightTissue banks approach patients, like Mdm Foo, to seek their consent to donate any

We are slowly but surely moving away from the ‘one size fits most’ model of medicine to a personalised approach based on an individual’s specific genetic blueprint.

Leftover tumour tissue helps researchers decode the causes of diseases which can result in better tests and treatments.

leftover tissue. But patients may have some concerns: Will I have to undergo another operation? Will research take precedence over my own needs? And will my personal information be kept confidential?

Only when the tissue is no longer needed, meaning after information nec-essary for diagnosis and treatment has been extracted, is the tissue banked for research. The donor will not have to go for another procedure. His identity will also not be disclosed as the source of tissue will be anonymous.

The donated tissue is preserved in liquid nitrogen, at temperatures as low as -196°C. This is to ensure researchers can view an exact snapshot of a disease at a particular time.

But if she were to donate her tissue, what guarantee does Mdm Foo have that it will be used appropriately?

Much like a conventional bank that has been entrusted to invest people’s savings, tissue banks are also prudent about the use of this resource. Access is only granted to studies approved by an institutional review board which safe-

guards the interests of the community at large and ensures the research meets ethical standards.

There is also an oversight committee (composed of senior doctors and scientists) that vets every request for tissue, to ensure donations are used in the spirit that they were donated and lead to new knowledge, benefiting future generations.

Banking on a brighter futureWe are slowly but surely moving away from the “one size fits most” model of medicine to a personalised approach based on an individual’s genetic blue-print. With this, the role of tissue is placed centre stage.

According to Time magazine, tissue banks, also known as biobanks, are among the 10 ideas that are changing the world.

For a small nation like Singapore, tissue quantity and variety pose certain challenges. Our patient pool is small and some conditions may only be present in one or two individuals per year. For example, the SingHealth Tissue Reposi-tory only has one malignant eye tumour sample available out of its repository of some 10,000 pieces of tissue, collected over the last 14 years. In contrast, avail-able breast tumour tissue samples number close to 2,000.

But if we can collect sufficient tissue, researchers can identify specific genes that trigger a condition, which means better screening, earlier diagnosis and more effective treatment.

But before we hype up the potential of tissue research, we need to think what we would do if we were in Mdm Foo’s shoes. Only if we choose to donate our leftover tissue can the full potential of this rela-tively young field be realised.

Associate Professor Tan Soo Yong is Director, SingHealth Tissue Reposi-tory, and Senior Consul-tant, Department of Pathol-ogy, Singapore General Hospital. He also teaches at Duke-NUS Graduate Medi-cal School.

Instead of disposing leftover tissue, patients can donate it to research.

During her preoperative tests, a member of the hospital’s tissue bank talked to her about tissue donation and asked whether she would donate some of the tissue – about to be cut out – to research. But what is tissue donation all about?

DNA and the appreciation of tissueWith the mapping of the human genome completed in 2003, scientists now have the tools to discover what causes cells to become cancerous, how to recognise them early and come up with more tar-geted treatments. This research requires tissue material.

Following surgery, the tumour is examined by a pathologist to determine what type of cancer it is, how far it has spread and how aggressive it is likely to be. This information enables the doctor to make a diagnosis and determine the best treatment for the patient.

The leftover tumour tissue (which is valuable to scientists) is normally dis-carded, meaning a precious resource that may lead to breakthroughs in cancer diag-nosis and treatment ends up in the bin.

Let’s return to our example. With the information from the pathologist, Mdm

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You may be at risk of: havingalargebaby(weighingmorethan4kg),whichcouldmeanadifficultdelivery,ordeliverybyCaesareansection

havingamiscarriage(ifyouhavepre-existingdiabetes)orstillbirth

aggravatingexistingdiabetes-relatedproblemsoftheeyesandkidneys

developinghighbloodpressureandexcessproteinintheurine,aconditionknownaspre-eclampsia,inthelaterhalfofpregnancy

developingtype2diabetes(twotothreetimesmorelikelythanotherwomen)afterpregnancy

Your baby may be at risk of: sufferingfromcongenitalabnormali-ties,suchasheartanomalies

havinghealthproblemsshortlyafterbirth,suchasbreathingdifficulties,lowbloodsugarorlowcalciumlevels

becomingoverweightorobeseand/orgettingdiabeteslaterinlife

sufferingphysicalinjuryduringnaturaldelivery(ifheislarge)

Mar⁄ apr2011 singaporehealth 23

Sweet pregnancyThe risks are many, but with help from doctors, nurses and other specialists, it’s possible to be diabetic and still have a successful pregnancy

Spotlight

But during pregnancy, it became difficult because I had to ensure the baby was get-ting the right nutrients and that I also gained the right amount of weight,” said Ms Han.

People with diabetes do not produce enough insulin, which is involved in the metabolism of carbohydrates, proteins and fat. Without insulin injections or tablets, their blood sugar levels escalate, especially after a meal, said Dr Soh.

Like Ms Han, Ms Jamilah Abdul Latiff, 41, had to be careful about her food intake during her fourth pregnancy. But unlike Ms Han, Ms Jamilah only developed diabe-tes during pregnancy. The body is some-times unable to produce enough insulin to counter the insulin resistance caused by hormonal changes during pregnancy, resulting in a form of the disease known as gestational diabetes. It usually goes away after the baby is born, but for some, the diabetes becomes chronic.

Although controlling her diet helped Ms Jamilah maintain good blood sugar control at first, she had to start insulin

Ms Han Yoke Leng and her husband’s baby was delivered early as it had grown unusually large, despite the efforts of Dr Abel Soh (right) and the team.

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Ms Han Yoke Leng’s second pregnancy was a pleasant sur-prise, but the 36 weeks that followed were filled with many anxious moments.

Diagnosed with type 1 diabetes mel-litus at 19, Ms Han has to control her blood sugar levels through daily insulin injections. When she became pregnant, the hormonal changes began to interfere with the action of the insulin, leading to insulin resistance and a build-up of blood sugar levels.

“In an unplanned pregnancy for a patient whose blood sugar level is not adequately controlled, we need to get the level of blood sugar under control quickly, within a few weeks, if possible, to reduce the risk of a miscarriage or birth defects,” said Dr Abel Soh, Associate Consultant, Department of Endocrinology, Singapore General Hospital (SGH).

Apart from high blood sugar levels, the 30-year-old office administrator in a multinational corporation also had to worry about low blood sugar levels which can occur when waiting too long between meals, doing too much exercise, or if too much insulin is taken. Frequent or prolonged instances of low blood sugar levels can have serious consequences: The baby’s growth may be retarded, and/or the mother may experience a seizure.

Right nutrition is critical Eating properly – getting enough nutrients without overloading on the calories – can be tricky too. “When I was not pregnant, I could control my carbohydrate intake.

injections in her seventh month to deal with rising blood sugar levels.

Teamwork for successBecause of the complications that come with diabetes, women like Ms Han and Ms Jamilah are seen by a team at SGH’s Dia-betes Centre that includes an obstetrician, an endocrinologist, a nurse and a dieti-tian. It is essential that all are present to understand the patient’s overall condition, and to decide on a treatment that takes into consideration different aspects of the patient’s needs.

For instance, the dietitian advised Ms Han to eat frequent small meals to mini-mise sugar spikes that occur after each meal. The endocrinologist checked Ms Han’s sugar profiles regularly, and adjusted her insulin doses according to changes in her blood sugar levels.

Underscoring the difficulties that can occur with such pregnancies, Ms Han’s baby grew unusually large – a potential problem among women with diabetes. “Unfortunately, despite our best efforts to control her blood sugar levels, the baby continued to grow. The team decided to deliver the baby earlier,” said Dr Soh.

Overly large babies are hard to deliver naturally, and may suffer injuries during delivery. They are also prone to diabetes later. Ms Han’s son weighed 4.07kg when he was delivered in December 2010.

Ms Han’s first child, a girl, was smaller and weighed 3.5kg at birth. Her first preg-nancy, which was planned, was smoother. Before she even became pregnant, Ms Han and her husband made sure her blood sugar levels were under control.

“However, many women with pre-exist-ing type 1 or 2 diabetes do not plan their pregnancies, despite being told the risks of having a baby when their blood sugar con-trol is suboptimal,” said Dr Soh.

“We are working on improving our pre-pregnancy counselling, so the risks of miscarriage and congenital abnormalities are reduced in early pregnancy for these women,” said Dr Soh.

BY Thava Rani

The team at SGH Diabetes Centre works closely with diabetic patients to ensure a safe outcome for both mother and child.

Are you at risk of gestational diabetes?

You are more likely to develop gestational diabetes if:

anyofyourparentsorsiblings

hasdiabetes

youareoverweightwitha

BMi(bodymassindex)ofat

least25

youhavepreviouslygivenbirth

toalargebaby(morethan4kg)

youhavepreviouslyhad

gestationaldiabetes,highblood

sugarlevelsduringfastingand/or

highbloodsugarlevelsafter

takingasolutionwiththeequiva-

lentof75gsugar

This type of diabetes starts only during pregnancy – most commonly during the second half – and may or may not go away after delivery.

Risks of being pregnant and diabeticIf you are pregnant and have diabetes, whether type 1, 2 or gestational diabetes, there are risks to you and your baby, according to Dr Abel Soh, Associate Consultant, Depart-ment of Endocrinology, SGH.

24 SINGAPORE HEALTH MAR/APR 2011

Money Matters

What is critical illness and what is su�cient insurance cover?

Funding healthcare costs

1 Major Cancers 2 Heart Attack 3 Stroke 4 Coronary Artery Bypass Surgery 5 Kidney Failure 6 Aplastic Anaemia

7 Blindness (Loss of Sight) 8 End-stage Lung Disease 9 End-stage Liver Failure 10 Coma 11 Deafness (Loss of Hearing)

12 Heart Valve Surgery 13 Loss of Speech 14 Major Burns 15 Major Organ/Bone Marrow Transplantation 16 Multiple

Sclerosis 17 Muscular Dystrophy 18 Paralysis (Loss of Use of Limbs) 19 Parkinson’s Disease 20 Surgery to Aorta21 Alzheimer’s Disease/Severe Dementia 22 Fulminant Hepatitis 23 Motor Neurone Disease 24 Primary Pulmonary

Hypertension 25 Terminal Illness 26 HIV due to Blood Transfusion and Occupationally Acquired HIV 27 Benign Brain

Tumour 28 Encephalitis 29 Poliomyelitis 30 Bacterial Meningitis 31 Major Head Trauma 32 Apallic Syndrome 33 Other

Serious Coronary Artery Disease 34 Angioplasty and Other Invasive Treatment for Coronary Artery 35 Progressive Scleroderma

36 Systemic Lupus Erythematosus with Lupus Nephritis 37 Loss of Independent Existence

Coverage What will my health insurance

policy cover? Am I already covered for the

same thing under another health insurance policy?

Are there any policy exclusions? How is my health insurance policy

a�ected by other schemes that pay for healthcare?

Is coverage for a lifetime or only up to a certain age?

Is coverage worldwide or for only specified countries or regions?

Premiums How much will I be paying for my

health insurance and will I be able to a�ord the premiums in the long term?

How often will the premium be charged and will it be a fixed or variable sum?

Will my policy automatically be renewed and what is the penalty if I do not pay my premiums on time?

When or under what circumstances will my health insurance policy end?

Claims How do I make a claim? Are there claim limits for each

illness, per year or for the lifetime of the policy?

Is there a waiting period for the policy?

Are there any limits to the benefits that can be paid out from my policy?

How will my future premiums and coverage be a�ected after I have made a claim?

Adequate coverage helps put the pieces of your life back together when illness strikes.

37critical illnesses:

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By Erniza VEEl

Half a year after her mother’s death, the woman continued to grieve. to help her come to terms with the loss, ms saryna ong, Senior Medical Social worker (msw), National Cancer Centre Singapore (NCCS), encouraged her to put together a collage of her feelings about her mother.

“She painstakingly searched for the ‘right’ pictures and organised the place-ment,” said Ms Ong, who is also Art Psy-chotherapist, Department of Psychoso-cial Oncology, NCCS. Once the collage was done, Ms Ong and the woman dis-cussed her memories, guilt and loneli-ness – all prompted by the collage. “After about five sessions, she was better able to move on,” said Ms Ong.

The senior MSW had always dreamt of combining her passions for social work and art. “I never imagined it would be possible as there were no art therapy qualifications available locally then,” she said. However, SingHealth’s sponsorship of her 2008 Masters in Mental Health (Art Therapy) at the School of Medicine, University of Queensland, made her dream possible.

Today, she supports patients both as a senior MSW and art therapist. Her role as an MSW includes assessing and assist-ing patients with practical needs such as financial or discharge care planning and other practical needs.

“Another very important part I play as an MSW is to provide supportive coun-selling in areas like acceptance of illness, treatment-related issues, depression coun-selling, grief and bereavement work,” said Ms Ong.

Her expertise as an art psychothera-pist is a natural complement. A cancer diagnosis can be devastating to patients and families. “It can stir up a lot of emo-tions and issues for them. I find art ther-apy a useful tool. What is difficult to put into words can be expressed visually. Very often, patients begin to talk more through their art.”

In one case, a patient drew graphic images of death. Later, she revealed her experience of witnessing a death in the intensive care unit – and her own fear about death. “After another session, she drew a picture of heaven and decided that death might not be so scary, as she

MAr⁄ APr 2011 singAPOre HeAlTH 25

The art of social workSaryna Ong uses two essential skills to help her patients

People

knows where she will go after passing away,” said Ms Ong.

She has benefited from art therapy herself. “I use art to process my feelings and thoughts after sessions. Art therapy has helped me in my own growth, devel-opment and insight.”

The busy MSW also facilitates support groups such as a Chinese language one for cancer patients and group art therapy for patients and their families. During her 11 years at NCCS, her role has also included being a field teacher for social work undergraduates, supervising junior MSWs, as well as giving talks and train-ing for healthcare workers.

No regrets!It was his childhood dream to be a doctor, and after nearly four decades, Dr Wong Chow Yin says he has “no regrets”. He remains passionate about treating breast cancer patients and training young doctors

At the age of 60, Dr Wong Chow Yin, Senior Consultant and Direc-tor, Ambulatory Surgery Centre, Department of General Surgery, Singapore General Hospital (SGH), continues to inspire many doc-tors and nurses with his dedica-tion and commitment to care. Dr Wong looks back on 36 years as a doctor, including 26 as a surgeon.

What are the high points of your career? I am originally from Malaysia, but I stud-ied at the University of Singapore, as it was called in 1975. I worked in various public hospitals before joining SGH in 1988. I started the first breast subspecialty team in Singapore. The Friday Breast Clinic was set up in 1989 to receive all breast refer-rals from polyclinics. Through the years and with hard work, the clinic remains the premier referral centre even though breast units have been established in other hospitals.

I also started the first breast counsel-

is to inform them that they do. Seeing cancer patients recover after treatment and remain cancer-free for the next 20 or 30 years, and young patients who were initially devastated with the cancer diag-nosis coming back years later with their children at their follow-up consultations – these make me feel great and give me tremendous job satisfaction.

How do you break bad news to patients?It’s important to understand the anxiety patients feel when they are referred to my clinic. Will the lump in their breast turn out to be cancerous? The possibility of losing the breast, the side effects of che-motherapy and the cost of treatment add to their fear and anxiety. A lot of patience is needed to calm the patients and explain the disease to them. It’s important to con-vince them that it’s not the end of the world, as with treatment, most of them can be cured. It is also important to be frank with the patients, looking them straight in the eye and maintaining eye contact at all times when explaining the disease and treatment alternatives. It helps a lot when Ms Saraswathi is around as she is able to comfort the patient and provide emotional support.

What advice do you have for women?Start doing breast self-examinations when you are in your 20s. Go for a mammogram yearly in your 40s and twice yearly after 50. See your GP or polyclinic doctor when in doubt about a lump.

with terminal breast cancer, and had badly infected cancer wounds. I had to do a toilet mastectomy to give her a better quality of life. But she died three months later. That was in 1982 when I was a young registrar at Alexandra Hospital. Around that time, I treated another young woman – a bank officer – for breast cancer. She had a mastectomy and chemotherapy. Her fiance left her and the cancer recurred two years later. She told her story – her thoughts and feelings during the illness – to a local magazine.

What are the best and worst parts of your job? The best part of my job is to tell patients they do not have cancer, while the worst

Ms Ong teaches patients to understand and discuss their innermost thoughts and feelings with the help of pictures and art.

I use art to process my feelings and thoughts after sessions. Art therapy has helped me in my own growth, development and insight.MS SarYna Ong, SenIOr MeDICal SOCIal WOrker, MeDICal SOCIal ServICeS, anD art PSYCHOtHeraPISt, DePartMent Of PSYCHOSOCIal OnCOlOgY, natIOnal CanCer Centre SIngaPOre

ling service in a Singapore hospital. Ms Saraswathi Nagalingam (a Senior Nurse Clinician), was sent for overseas training in 1992 and has been with me since. She attends to the emotional and psychological needs of breast cancer patients while my team and I tend to their medical needs. The department has trained many doc-tors and nurses over the years. More than 10 breast surgeons trained in SGH are now working in other public hospitals, and several have set up successful private practices. Numerous breast nurses who trained with us have continued the good work elsewhere.

Why did you choose breast as your sub-specialty? I came to choose this as my subspecialty as it was the only area that was still avail-able after the rest of the consultants had chosen theirs! A couple of other incidents also contributed to my decision. One involved a 16-year-old Malay girl waiting for her O-level results. She was diagnosed

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Dr Wong has been a surgeon with Singapore General Hospital since 1988.

Count me, Can?

3,317 canswent into making this

Taj Mahal replica as part of Singapore General

Hospital’s (SGH) recent Go Green Charity Sale.

Clothes, bags, books and handicrafts went on sale

to raise more than $13,600 for the SGH Needy Patients Fund.

the Breast Cancer exhibition Time 10am-6pm daily Venue Science Centre Singapore Price Science Centre admission rates apply Contact Visit www.science.edu.go or call 6425-2500

eastern Community Health outreach (eCHo) Health Screenings for Changi Simei residents aged 18 and older Time 8am-1pmVenue Blk 164, Simei RoadPrice $2 for basic health screening (ages 18 to 34), $10 for full health screening (ages 35 and above) Contact Visit www.cgh.com.sg/eCHo or Changi Simei Community Club (tel: 6781-6058) from 9am-9pm daily

How Dietitians Can Help YouTime 11am-3pmVenue SGH Postgraduate medical Institute (PGmI), Block 6, Level 1Price Free

SingHealth Women’s ForumTime 10-11am (special interactive sessions), 1.30-5.30pm (forum) Venue Hilton, Grand Ballroom, Level 3Price $18 per person (forum) or $30 for two. $5 per person (special interactive sessions) Contact marcom@singhealth.com.sg or download the registration form from www.singhealth.com.sg/womensforum

SGH eczema Public ForumTime 2-5pmVenue SGH Postgraduate medical Institute (PGmI), Room 3 and 4, Block 6, Level 1 Price $5 per personContact For registration, please call 6326-5284

1. What is one risk a pregnant diabetic woman faces?

2. Which story did you enjoy reading most in this issue of Singapore Health?

Closing date: April 8, 2011

Singapore Health issue 9 contest

eVenT Calendar

Mar 10 (Thur)

Include your name, age, gender, address and telephone number. all winners will be notified via phone or e-mail. Incomplete entries will not be considered.

e-mail: editor@sgh.com.sg Post: the editor, Singapore Health, Singapore General Hospital, Communications Department, outram Road, Singapore 169608

Winners of Contest 8these winners will each receive a box of Collagen extreme 10000 worth $78. 1. Chen Wenjie 2. Chua Guan Seng 3. Girish R Lakhani 4. Lim Geok Hwa 5. ulrike Zeitz

Prizes must be claimed by april 29, 2011.

all rights reserved. Copyright by SGH (registra-tion no: 198703907Z). opinions expressed in Sin-gapore Health are solely those of the writers and are not necessarily endorsed by SGH, SingHealth Group and/or SPH magazines Pte Ltd (registra-tion no: 196900476m) and their related compa-nies. 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, e-mail: editor@sgh.com.sg. unsolicited material will not be returned unless accompanied by a self-addressed enve-lope and sufficient return postage. While every reasonable care will be taken by the editor, no responsibility is assumed for the return of un-solicited material. aLL InFoRmatIon CoRReCt at tIme oF PRIntInG. mICa (P) 060/06/2010. Printed in Singapore by Singapore Press Holdings Limited (registration no: 198402868e).

Publisher Publishing Agent

Managing Director Dennis Pua

General Manager Christopher Chan

Group Editor Joanna Lee-miller

Senior Editor azreen noor

Associate Editor Jason Lim

Sub-Editor Winnie Fong

Content Advisor tan-Huang Shuo meiGroup Director, Communications & Service Quality, SingHealth & SGH

Editorial Teamangela ng (SGH), Lim mui Khi (SGH), nicole Lim (SingHealth), tina nambiar (SingHealth)

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

Creative Director alex Goh

Art Director Janice tan

Senior DesignerJolene tan

Executive, Client Management Jessie Kek

Account Manager, Advertising SalesJobina ong

Senior Executive, Publishing ServicesZulkiflee mohd ali

Co-funded

For more listings, please visit www.singhealth.com.sg/events or the respective institution websites.

Ongoing till Oct 8

Mar 27 (Sun)

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

Send in your answers and stand to win a box of Sun Chlorella A tablets worth about $55.

26 SInGaPoRe HeaLtH maR⁄ aPR 2011

FYI

Apr 16 (Sat)

Apr 23 (Sat)

Older women in Singapore are more depressed than their male counterparts

a study of

4,489Singaporeans

aged 60and above who live at home, found

that women in general had higher

depressive symptom scores than men.

But regardless of gender, living alone

without a spouse and with only one’s

children, and having access to a

weak social network, led to a

higher probability of experiencing

depressive symptoms. the researchers

from Duke-nuS Graduate medical

School, Duke university and national

university of Singapore also found that

for men, a strong social network made

a significant difference. It is therefore

important for older adults, particularly

those living alone, to strengthen their

social networks.

Save money, save livesFrom now till March 31, 2011, spend $5 on a Savemoney Savelives booklet and enjoy fantastic savings on shopping and dining, plus the chance to win fantastic prizes!

Save money with more than $1,500 worth of discounts from more than 35 popular brands in your booklet. Save lives as all

proceeds will go towards providing medical assistance for needy patients.

Win big with scratch-and-win prizes up for grabs, as well as the Grand Lucky Draw prize of a Subaru Impreza 1.5 MT Sedan worth $60,000!*

Booklets are available at: Singapore National Eye Centre lobby, Mon-Fri, 9am-5pm, or call SingHealth Foundation at 6377-7613 / 6377-7608.

Savemoney Savelives is brought to you by SingHealth Foundation. UEN T02CC1576B The draw for the Subaru Impreza 1.5 MT Sedan will be held on Thursday, May 5, 2011. The winner will be notified by post by Friday, May 20, 2011. *Excludes COE, road tax, registration fee, insurance, IU and number plate.

AnSwer tO In fOcuS (PAge 3):

This device plays an important role in Singapore General Hospital, transporting blood, urine and tissue samples via a network of tubes to the labs for urgent examination, bypassing human traffic on the ground. A 19th-century invention, the pneumatic tube system uses compressed air to propel cylinders through a tube to their intended destination.

page 29

切勿掉以轻心

项服务制定医疗方案。纪医生说：“跟随日本专家学习，让来自不同医疗领域的移植小组能为所有可能出现的并发症和结果做充分准备。”

2009年11月，在接受ABO血型不相容肾脏移植手术（以A、B和O主要血型来命名）前，陈崇能的免疫系统必须抑制到一定的水平，以防血型不合的捐赠者肾脏遭排斥。如果不加以控制，受益者免疫系统的抗体将快速攻击捐赠者肾脏，就像人体自然产生抗体对抗病菌一样。

page 30

享有清晰视觉

page 27-28

无私的奉献

page 31

病房提升

新加坡中央医院

与新加坡保健服务

集团的双月刊

3月

20114月

> 文转 page 28

不同而和 再献新生命虽然血型不合，但一名母亲通过一项新移植手术，能减少手术后器官遭排斥的现象，成功捐肾给她的儿子

新移植手术让陈崇能无需等上九年就能换肾。

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正值青少年时期的陈崇能，因为药物无法抑制肾功能恶化，已接受多年的肾脏透析治疗，而且他能获得合适器官捐赠的希望越来越渺茫。这名年轻人在18岁时被诊断出因遗传而导致肾功能衰竭。

因此，当与他的家人讨论其他治疗建议时，其中一项疗法是为血型不合的器官捐赠者和受益者而设的新移植手术，陈崇能的母亲立刻接受了这个方法。

这对母子的血型不一样，但他们是唯一合适的组合，其他家人因种种因素而不适宜进行这项手术。在这之前，只有血型相同的人才适合进行肾脏移植。

5 4岁 的 家 庭 主 妇 陈 亚娥说 ： “ 我说，‘我们进行吧。’我只是觉得这是一个可以让我为儿子做一点事的机会。”

希望有个更美好的未来陈女士和其他家人一样，如果有更好的医疗选择，她不愿让儿子花九到十年边做肾脏透析边等待器官捐赠。陈女士负责接送儿子往返医院进行检验和看诊，

眼见儿子因治疗无效而愤怒和绝望，让她倍感难过。

她也不愿让儿子失去接受移植手术的机会，因为长时间接受肾脏透析，会使病人出现并发症而无法接受移植手术。根据全国器官移植组统计，在新加坡，肾脏移植等候时间平均为九年五个月。

陈女士及其儿子是新加坡中央医院第一对接受血型不合移植手术的人，但他们一点也不担心。

毕竟，自卫生部修改人体器官移植法令，取消逝世病人捐献器官的60岁年龄上限后，新加坡中央医院的肾脏移植小组是首个在2010年成功从年迈逝世捐赠者移植肾脏的医疗团队。该院也成功将一名75岁母亲的肾脏移植到她46岁女儿身上。这名母亲也是新加坡年纪最大的活体肾脏捐赠者。

血型不合的肾脏移植手术在新加坡中央医院属于一项新服务，但新加坡中央医院肾脏科肾脏移植顾问兼主任纪怡胜医生说：“日本早在1980年代就已进行这种移植手术，并取得成功。”

他补充，肾脏移植小组花了一年时间数次到日本向专家学习技术，以及为这

之前，有许多病人因与自愿捐赠者的血型不合而无法进行移植手术。我们在成功进行首个血型不合的移植手术之后，发现有25%的捐赠者与病人的血型不合，我们估计今年将会从中进行七宗这类型的移植手术。

新加坡中央医院肾脏科肾脏移植顾问兼主任纪怡胜医生

原文 ThaVa Rani

陈学华的非恶性肿瘤占了脑部的30% ，将其切除后，他在一星期内就失明了。

不过，这并没有削减他自力耕生以及帮助他人的意志。54岁的他在失明后，学习弹键盘。如今，他在疗养院为乐龄人士表演，同时也是一所音乐学校的客户服务部门主管，并负责管理学校的各个分行。

他积极的态度不但启发了他帮助的人，也深深地影响了照顾他的医疗工作者。这也是他获颁首届新加坡保健服务集团的激励人心病人及看护奖的原因。另外有其他36人也获颁此奖项。

对于能够得奖，陈学华说：“我希望我的故事能给别人一点启发。”

2008年，在一次例行身体检查后，陈学华因疑似患有白内障，被转介到新加坡眼科中心。结果，医生发现陈学华脑部有一个比网球还要大的肿瘤，而它正影响了陈学华的视力。肿瘤必须立刻被切除。不过，这将是个既复杂又危险的手术。陈学华有一星期的时间来准备接受手术。在这期间，他把手头上的公司业务处理好，并将运输公司转交到妻子名下。

平凡英雄新加坡保健服务集团颁发奖项鼓励积极面对逆境的病人及看护者

文 谢洁仪

> 文转 page 28

陈 学 华 虽 然 失去 了 视 力 与 味觉 ， 但 却 过 着独 立 、 充 实 的生活。

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纪医生说：“在进行移植手术前，陈崇能需每隔一天接受类似透析的治疗，去除血液中的抗体，直到抗体水平降低至可进行移植手术的安全水平。”

捐赠者的器官受到排斥是所有器官受益者所面临的问题，但对于接受血型不相容移植手术的病人而言，这个风险更高。和所有器官移植者一样，陈崇能必须终生服用免疫抑制药。由于他的免疫

28 新脉动 MAR⁄ APR 2011

新闻

文接

不同而和 再献新生命

在动手术前，医生吩咐他将5颗松了的牙齿拔掉。他解释道：“如果牙齿在手术时松脱，我可能会被呛着。在让牙医把牙齿拔掉前，我告诉他我想趁周末把我爱吃的食物一次吃光。”

手术非常成功，但陈学华的复原之路非常漫长、艰辛。除了失去视力，他也失去了味觉。他患有幻觉，并经常责骂家人及向医护人员扔杯子等。

偶尔，他回家时会迷路，衣服穿反时会慌张，不小心撞到人而对方向他道歉时，会觉得不好意思。可是，他却拒绝接受别人，甚至是妻子或孩子的帮忙。为了自立，他学习如何自己搭巴士、煮饭等日常琐事。

他说：“做人必须要有正面思考。你必须承认动了手术后，你失去了视觉和味觉。你必须接受这个事实。然后，就继续活下去。不管怎么样，日子还是要过的。这是一条漫长的道路。”

“每天我沿着同样的道路走着，但是每天都是一个新的体会。”他补充说。

无私奉献 3月1日颁发的新加坡保健服务团队的激励人心病人及看护奖，同时也是为了表扬在看护方面有杰出献身精神的看护者。

获颁此奖项的安佳娜，就因丈夫患有慢性骨髓性白血病，而成为了白血病的“专家”。无论是病症、疗法或最新的药物，她都相当了解。

她说：“我非常沮丧，但我也是个实际的人。我丈夫的心情大受影响，根本没办法想这么多。所以我必须挺身而出，支持他。”

安佳娜是个拥有博士学位的化学师。她翻遍了网上的资料，阅读无数的研究报告并积极参与各个海外的网络互助团体，因为本地没有类似的组织。

她说：“我有幸加入了一个美国雅虎慢性骨髓性白血病的互助团体。他们讨论一种称为‘Gleevec’的实验性药物。有病人已经接受了第一阶段和第二阶段的临床试验，而他们的病情获得完全缓解。”

安佳娜和丈夫因此向主治医生询问有关治疗。他符合临床试验的条件，所以他的主治医生吴耀智副教授也是新加坡中央医院血液部门资深顾问让他参与这项当时在新加坡进行的临床试验。

九年后，安佳娜丈夫的病情已经完全缓解了。

安佳娜一点也不吝啬于和别人分享她的知识。当时40岁的她，决定成立一个专为像她丈夫一样的病人而设的互助团体。

她希望通过这个互助团体让内向的丈夫敞开胸怀，把内心的感受说出来。

她说：“他非常文静。不过，不爱说

文接

平凡英雄话的人通常会把感情憋在心理，胡思乱想。所以我在2003年决定成立一个名为亚洲慢性骨髓性白血病互助团体的网络互助团体。我想，和其他病人多接触对他的心理健康有所帮助。”

这个亚洲慢性骨髓性白血病互助团体的成员日益增加，目前有超过1000个来自世界各地的会员。不过安佳娜没有因此而止步，她让一些到新加坡中央医院接受治疗的外籍病人到她家去，并花时间照顾其他在医院接受临床药物试验的病人。

她解释道：“因为这些病人大老远从印度等地来新加坡接受临床试

直到上世纪末，人们一直以为所有人的血型都是相同的，以致因输血而引发的惨痛后果屡见不鲜。

如今，人们已知道红血球就像所有组成人体组织和器官的细胞，含有A抗原或B抗原。根据红血球上的抗原，血型可分类为A型、B型、AB型

（同时含有A抗原和B抗原）或O型 （既不含A抗原，也不含B抗原）四种。

如果有一种不属于体内红血球的抗原出现，身体就会产生抗体对抗它，就像产生抗体对抗病菌一样。

因此，在输血时，A型或B型只能接受相同血型的，而AB型可以接受A型或B型，比较灵活和容易配对。O型适宜捐血给任何血型，是血液捐献中最为珍贵的血型。

但是，O型只能接受相同血型的 输血。

同样的，在接受血型不相容移植手术之前，受益者体内的抗体必须先被去除。否则，抗体将攻击和摧毁不同血型捐赠者的新肾脏。

在移植手术中，去除这些抗体的方法被称为血浆置换术。这个过程有点像血液透析，通过瘘管或导管把病

人体内的血液通过一台机器去除抗体之后，将血液重新输入病人体内。病人每隔一天就要做一次血浆置换术，直到抗体降低至一个适合移植的安全水平。

一般移植手术的排斥风险为10%至15%，而在ABO血型不相容肾脏移植手术中，排斥风险高达25%。由于病人须要服用更多免疫抑制药以防排斥和进行血浆置换术，他们受感染的风险也比较高。

不过，现今科技发达，接受这种移植手术的病人存活率每年高达95%至100%，跟一般移植手术的病人存活率不相上下。

验，所以他们需要很多精神上的支持。我开始陪他们到医院去接受治疗，并帮助他们向医生沟通，告诉医生他们是否感到任何的副作用。”

她也补充说，从照顾自己的丈夫到帮助其他的病人，是一个很自然进阶过程。

为了让海外病人不要时刻想着自己的病情，同时也为了疏解他们恐惧和孤单的心情，她邀请病人到家里吃饭，带他们

到新加坡的旅游景点去散心，也给他们精神上的支持。

认识ABO血型系统

纪怡胜医生（右）和队友是首个在新加坡中央医院进行血型不合的肾脏移植手术的医疗团队。

安佳娜把帮助及支持癌症病患视为她的使命。

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直到上世纪末，人们一直以为所有人的血型都是相同的，以致因输血

如今，人们已知道红血球就像所有组成人体组织和器官的细胞，含有A抗原或B抗原。根据红血球上的抗原，血型可分类为A型、B型、AB型

（同时含有A抗原和B抗原）或O型（既不含A抗原，也不含B抗原）四种。

如果有一种不属于体内红血球的抗原出现，身体就会产生抗体对抗

陈崇能在住院的四个月里有时间好好地反省自己的人生。

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系统已被抑制，他很容易受感染，所以他无法上学，也需避开人多的地方直到情况稳定。

一年多后，目前陈崇能是新加坡管理学院工商管理一年级的学生。

陈崇能说：“在这之前，我只待在家里，或跟朋友出去玩。在我住院的四个月内，我意识到我的生活毫无意义。现在，我要充分利用每分每秒，过个充实的人生。”

在生病期间，陈崇能和母亲的感情更加亲密。有了母亲的支持和鼓励，陈崇能更勇于面对他的疾病。

他说：“她是我的好朋友。”

樟宜综合医院的职员一直在寻方设法改善营养不良的年长病人的诊断和治疗，最近终于推出了一套方案。由多名医生、营养师、护士和一名语言治疗师组成的跨学科团队，提出了几种方法来改善年长病人的健康状况，包括：

所有被诊断有营养不良风险的住院病人应转介给营养师，以便能根据他们的营养评估来提供适当的治疗。这包括调整病人的日常饮食或指定一些营养品。

对于严重营养不良的病人，院方应在他们的餐牌上注明“营养不良警戒”，清楚列明营养师规定他们摄取的食物。这类病人的床头也贴上红色标志，以便提醒职 员 他 们 是 营养 不 良 的 高 风险病人。

护士应特别留意高风险病人，确保他们有进食和摄取营养品。

密切留意病人摄取的食物和排出的粪便。

每周替病人量一次体重，以便有系统地检查和检讨他们的进展。

帮助年长病人改善他们的营养摄取

早餐

零食

午餐和晚餐

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MAR⁄ APR 2011 新脉动 29

老龄化向来都不是一件轻松的事。年长者往往须要面对不必要的体重下降及其引发的健康问题。年长者必须更注重他们的营养均衡，因为营养不良的后果足以致命。

樟宜综合医院营养与餐饮服务部门主任张爱桃说：“老年人体重下降多数不是特意的，它会引发功能衰退的高风险，例如不能自己穿衣服或吃东西。这也会增加死亡的风险。”

如果一个年长病人的肌肉和组织质量衰退，他很可能是营养不良。这种年长病人可能会出现呼吸困难、行动不

切勿掉以轻心

养不良的原因主要有情绪忧郁、老年痴呆、急性或慢性疾病、无法自己进食，以及靠别人喂食或靠静脉注射来进食。

张爱桃说：“社会问题也会导致年长者食量下降，尤其是在缺乏看护者支持、住在养老院、粮食不足和孤独等因素发生时。其中一种补充营养的方法是在他们平常的饮食中增加一些营养品，例如蛋白质或热量饮料。”这些以牛奶为主的营养品并不便宜，而且不是年长者特别喜欢的食物。但是，张爱桃表示，如果他们的饮食受到特定限制，例如无法忍受某种食物、无法或不愿摄取足够的营养食品，或者无法安全地准备食物，让这些年长者摄取营养品可以是

年长者体重下降可能会有危险

新闻

原文 BALVINDER SANDHU

给营养不良年长者的其中一种补充营养的方法是在他们平常的饮食中增加一些营养品, 例如蛋白质或热量饮料。

最好的解决方法。独居和无法自己准备食物的年长者

需要有人帮忙做家务和监督他们的饮食，以确保他们摄取足够的维生素和矿物质。有些年长者可能因为不吃凉食或者水果吃得不够而缺乏维生素或纤维。那些咀嚼有困难的年长者则可能因为肉类和蔬菜吃得不够而缺乏蛋白质，导致肌肉萎缩。

住在医院、疗养院或在居家护理计划下的年长者普遍出现营养不良的现象。有鉴于此，张爱桃建议这些机构的医生、营养师和护士组成团队，定期检讨和建议均衡的饮食计划，以应对年长病人的营养需要。

下午茶/夜宵

便、体力下降的问题，以及胸部和肺部受感染的风险也会提高。其他症状还包括伤口愈合缓慢、疾病难以痊愈和难以保持身体暖和。

营养不良的年长者很瘦弱、行动缓慢，而且容易疲劳。肌肉质量和体力会逐渐衰退，久而久之便会过度消瘦。造成营

为年长者设计的饮食计划

一至两片涂植物奶油或果酱的全麦或白面包或一小碗燕麦或一碗汤面或粥加牛奶的茶或咖啡

两片全麦饼干或一片面包一杯豆奶 一份（75-90克）

肉类、鱼或鸡肉新鲜蔬菜一碗白饭或面包或印度薄饼新鲜水果

一杯牛奶一份水果

30 新脉动 Mar⁄ apr 2011

黄丽萍（48岁，行政人员）多年来一直面对视力模糊、头晕和头痛的问题。 她以为是因为长时间使用电脑而加重了近视。

她说：“我一直头痛和偏头痛。我感到很沮丧，因为我不知道问题出在哪里。”去年三月，她再也无法忍受模糊的视力，于是到新加坡全国眼科中心寻求协助。经过一连串的眼睛检查后，发现她患上一种晶状体混浊的眼疾——白内障。

享有清晰视觉新闻

别让白内障毁了你的视力

原文 Jessica Jaganathan

保护您的双脚一些足部护养的建议

任何一个年龄层都可能患上白内障，但它更常见于老年人。

全球性的问题根据世界卫生组织，白内障是全球人类视力下降的主要成因。全球将近一半

（1800万）的失明人士是由白内障造 成的。

新加坡全国眼科中心近期的研究发现，超过90% 70岁以上的本地华人患有白内障。多数本地白内障患者选择在新加坡全国眼科中心进行手术，这里每年进行的白内障手术有1万多例。随着人口老化，到了2020年白内障患者的数量估计会增加一倍。

新加坡全国眼科中心资深眼科顾问、白内障与综合眼科部兼眼部炎症与免疫部主任徐纯碧副教授说，白内障的最初症状通常为视力模糊和近视加重，看到的颜色会变得暗淡，可能会开始看到灯周围出现光晕、在亮光下视力不佳，以及阅读和晚上开车有困难。

她也表示，患者应该定期进行眼睛检查，以便及早发现疾病。虽然这种眼疾无法预防，但患者可以戴太阳眼镜，以保护双眼免受紫外线的照射。患者还可以注重饮食均衡、治疗疾病如糖尿病和戒烟。

及早治疗白内障以前，眼科医生要等到“时机成熟”和视力退化，才会为患者摘除晶状体。如今，由于技术先进，医生可以在患者视力开始变得不清晰而影响到日常生活时，

患上白内障时，晶状体会变得朦胧或混浊。

就为他进行手术。一般上，该种手术是在局部麻醉下进行的日间手术，不需 住院。

新加坡全国眼科中心的白内障手术大多使用一种晶状体乳化的技术，在角膜划一个非常小的切口，手术后根本无须缝合。

动手术时，医生会摘除患有白内障的晶状体，然后植入清晰的人工晶状体。这就是所谓的人工晶状体植入术。人工晶状体会永久留在患者的眼睛里。根据患者的需要定制人工晶状体，以矫正视力。这项手术适合大多数患者。但是，病人若在手术前已患有某些眼疾，例如严重青光眼和永久性的黄斑退化，而几乎失明，就无法进行该手术。

白 内 障 手 术 的 标 准 收 费 为 每 只 眼$2,100至$3,200不等，须视眼科医生的资历而定。如果病人要求特殊晶状体，例如多焦点的晶状体 —— 可以同时看近距离和远距离的物体，或者环形晶状体以减轻散光， 那就须支付更高昂的费用。

徐副教授表示，患者在两三个星期内就可痊愈，有些人甚至在手术后不需要使用眼镜。

黄丽萍进行了人工晶状体植入手术后，双眼视力非常好。她说：“我发觉我错过了很多事物。以前所有东西都是模糊的，但现在我可以看得非常清楚，简直就像是一个全新的世界。”

白内障常见于老年人，但也可能发生在儿童和青年身上。患者眼睛无法正确聚焦，导致视力变得模糊或朦胧。

白内障的主要成因包括紫外线照射、长期服用药物如类固醇和患有某些疾病如糖尿病。白内障大多数发病缓慢，在初期阶段不会影响视力，但久而久之就会造成困扰。视力会变得模糊不清，影响一个人阅读和晚上开车等日常活动。黄丽萍说：“有时候，我的同事告诉我，他们遇见我时，我并没有跟他们打招呼。我不是不想打招呼，我只是没看见他们。”

原文 Keith g emuang

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珍妮（非本名）非常喜欢穿高跟鞋，她在教书生涯中一直穿着高跟鞋教课。长时间不舒服地站着对她的脚造成损伤。结果，到退休时，她得了严重的拇囊炎肿。她大脚趾底的关节处出现肿块，导致她站立或行走时都感到不舒服。专家说这种情况非常普遍。

新加坡中央医院足病学医师麦耀铨说：“脚有问题的病人以女性居多，他们若不是长时间穿高跟鞋，就是穿了不合适的鞋。”虚荣心往往是罪魁祸首。

据麦耀铨说，每个月大约有50个女病人的足部问题都是与高跟鞋有关。越来越多年轻女性（有些不超过30岁）出现拇囊炎肿、脚跟骨刺和胶皮硬化等问题。他说：“高跟鞋对脚无益。如果你要穿高跟鞋，鞋跟的高度不应超过一、两寸。”

最好也不要把大脚板挤进窄小的鞋子里。许多女性认为，足部长水泡是

适应新鞋过程中的必然现象。麦耀铨说，穿了两三次之后，脚就不应该再长水泡了。

麦耀铨说：“你穿得下鞋子，不代表它就很合穿。脚有很多软组织是不能被压缩的。”如果要确认鞋子是否合适，你可以把鞋垫取出，放在平地上，然后把脚放上去比对。如果脚太大，就表示鞋子太小。

一双好的鞋子除了合穿，也应具备把脚恰当地往下压的功能 ， 例 如 鞋 带 、 带 扣或带子。具有弹性的橡筋带无法提供充分的支撑，所以并不理想。此外，不要忽略

鞋后跟，它是用来固定你的脚，在走路时提供支撑。你可选择鞋后方有坚固支撑或牢固带子的鞋，也就是说，走路时穿凉鞋比穿人字拖鞋来得好。糖尿病患者不适宜穿日式人字拖鞋，因为夹脚处的摩擦会损伤脚趾间的部位。

女性没有选择正确的鞋子，男性则缺乏足部卫生的意识。麦耀铨说：“男性通常会在他们的脚趾间出现细菌感染，因为他们流汗比较多，而且没有恰当地擦干他们的脚，也没有每天更换袜子。”对于光顾美甲中心的女性，他劝告说：“假如美甲中心的用具没有清理干净，细菌和病毒就会轻易地从一个顾客传染给另一个顾客。”

说到底，保持个人的足部健康与卫生是自己的责任。首先，每个人应该勤换袜子、滋润干燥部位和选择真正合

穿的鞋子。麦耀铨说：“尽管很多女性可能在选购鞋子时不太理智，但让常识情理战胜虚荣心，才能确保足部健康。”

麦耀铨说，很多年轻女性选择鞋跟过高、不合穿的鞋子。

穿窄脚高跟鞋会使拇囊炎肿的情况恶化。

常见的足部问题脚癣脚癣的细菌会造成皮肤疼痛发痒，然后开始龟裂和脱皮。不注重足部卫生会使脚癣恶化。人们经常光着脚走路的地方，例如更衣室、游泳池和美甲中心，最容易感染脚癣。

足茧足部经过不断摩擦和挤压，就会逐渐变厚形成足茧。这通常出现在脚跟和脚趾侧。平足者较易出现足茧，特别是在他们的脚心和脚跟内侧，因为他们的脚心过低，导致这些部位承受太多压力。其他成因还包括经常光脚走路或穿不合脚的鞋子。如果不加以治疗，足茧中心会堆积死皮细胞，导致鸡眼。

脚跟骨刺脚跟骨头生长异常（骨头隆起）多半是由钙质沉积所致，站立或走路时会感到剧痛。平足、脚心过高的人或常穿高跟鞋的女性易于患上脚跟骨刺。

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