There’s a better chance of elderly patients recovering faster if a hospital ward is able to cater to their specific needs in a holistic way. Dr Munirah Alhamid, who is Associate Consultant at the Department of Geriatric Medicine at Changi General Hospital (CGH) talks about how the Integrated Building (IB) helps her geriatric patients.
Patients who do not benefit from conventional hearing aids may benefit from a surgically implanted hearing device called the cochlear implant. Dr Vanessa Tan, Associate Consultant at the Department of Otolaryngology at Singapore General Hospital (SGH) explains how this new technology is changing lives for the better.
A cracked tooth can be a pain to live with, but a dental microscope is helping dentists identify the extent of the damage more accurately, thereby helping patients get treatment faster, says Dr Chan Pei Yuan, Endodontist and Associate Consultant at the Department of Restorative Dentistry, National Dental Centre Singapore (NDCS).
A More Accurate Way To Diagnose
Diabetic Retinopathy: Dr Daniel Ting
With Prime Minister Lee Hsien Loong highlighting diabetes as a “very serious” problem in his 2017 National Day Rally, you know it is a subject that needs to be tackled urgently. Diabetes is a disease that occurs when the body doesn't produce any or enough insulin, leading to excess sugar in the blood. Singapore has one of the highest incidences of diabetes among developed countries.
This illness is a major risk factor for other serious medical problems such as heart attacks, stroke and kidney failure. Blindness is another complication. According to Dr Ting, about one in four Singaporeans suffers from diabetes. Of this number, 28 per cent has some form of diabetic retinopathy (DR), a disorder of the blood vessels in the retinas of patients with diabetes. “People are at risk of developing DR if their blood sugar level, blood pressure and cholesterol are not well controlled,” he says. Fortunately, early screening and detection can prevent up to 98 per cent of vision loss in sufferers.
A more accurate and advanced screening system
At present, the screening system, known as the Singapore Integrated Diabetic Retinopathy Program (SiDRP), involves taking photographs of a patient’s retina. Trained technicians then manually analyse and grade the photographs. Dr Ting is developing an AI (artificial intelligence) system using deep learning (a novel machine learning technique) to replace this manual method.
“The AI system acts like the human brain, which is capable of using multiple layers of neurons to analyse subtle details in an image. Using close to half a million retinal images, this system is able to achieve more than 90 per cent accuracy in detecting diabetic retinopathy,” explains Dr Ting.
Helping DR patients in Singapore
The system is now being integrated into the SiDRP. Dr Ting hopes the system can take care of patients with mild to average DR, which comprises up to 70 per cent of the manual grading workload. This will in turn speed up the process so that patients can seek treatment as quickly as possible.
Find out more about diabetic retinopathy at
How Apps Can Help You Keep Track
Of Your Health: Dr Eunice Png
As a family physician at Bukit Merah Polyclinic, Dr Png sees patients from all walks of life and knows, first-hand, the importance of screening tests.
Early detection and treatment of diseases such as hypertension, diabetes, high cholesterol, colorectal cancer, breast cancer and cervical cancer can help to prevent debilitating and potentially life-threatening complications. According to the Health Promotion Board’s guidelines for health screening, it is recommended that people start screening for different diseases at various ages.
“For example, when you’re 40 years old, it is advisable to start screening for hypertension, cholesterol and diabetes. If the first screening is normal, it is advisable to continue screening for cholesterol and diabetes every three years, and to screen for hypertension yearly,” says Dr Png. But she stresses that it is best to consult your doctor to ask what screening tests you should take for your age and risk profile. “Depending on your family’s medical history, you may have to get screened for certain diseases more frequently,” she adds.
Take charge of your health with a few taps
Today, healthcare apps make it easier to manage one’s health. “Apps like Health Buddy allow you to manage your upcoming appointments or change existing ones,” says Dr Png. Health Buddy also lets you pay your bills at SingHealth institutions via Mobile Pay, and allows you to monitor the number of people ahead of you in the queue. Apps with such handy features can help reduce waiting time in hospitals and clinics.
Get tips for common health screening tests at
An Elderly-friendly Environment Designed To Optimise Patients' Medical, Cognitive And Functional Recovery:
Dr Munirah Alhamid
When patients are given the right care in the right environment, they recover faster – and the wards in the IB are designed to do just that, says Dr Alhamid.
The 280-bed facility has five acute geriatric wards and numerous rehabilitation and outpatient facilities to provide optimised rehabilitation for patients, especially those who are elderly or recovering from stroke or traumatic injuries.
As the first such purpose-built facility in Singapore, it incorporates special features to help patients achieve functional ability and independence as much as possible before they return home. For example, to encourage mobility, the bathrooms are about 10m away from the patients’ beds (about the same distance the patients would have to walk in their own homes); to help with orientation, the cubicles allow plenty of natural light in; and to increase the patients’ appetites and socialisation, communal dining is offered.
In addition, patients have access to cognitive activities such as games, puzzles, colouring books and DVD players so that they can be mentally engaged during the day.
Optimised for elderly patients
“The average age of patients admitted to the Department of Geriatric Medicine is 85. Most have pre-existing frailty and multi-morbidity issues,” says Dr Alhamid. “The IB is unique in that it features a dementia-specific ward that sees to the psychosocial and medical needs of dementia patients.”
Other noteworthy services offered at the IB include the geriatric sub-acute ward for patients who have medically stabilised but still have ongoing medical and functional needs; rehabilitative services including an Active Rehabilitation and Therapy Centre (ARTC) for inpatient use; an acute rehabilitation ward run by rehabilitation physicians; and a stroke rehabilitation unit run by geriatricians specialising in stroke medicine.
Of course, the elderly-friendly ward environment is not complete without its multidisciplinary team. “All members of our team have the common goal of optimising the functional and cognitive recovery of our patients,” Dr Alhamid adds. “This team comprises geriatricians, nurses, physiotherapists, occupational therapists, speech therapists, dietitians, pharmacists and social workers, and they meet every week to discuss the progress of the patients. This is crucial in ensuring that our management and discharge plans are holistic and meet the multiple needs of our patients.
Get more nutritional tips for the elderly at
How The Cochlear Implant Improves The Lives Of
The Hearing-Impaired: Dr Vanessa Tan
The foundation of relationships is good communication, and speech is fundamental to communication. When people are hard of hearing, says Dr Tan, their relationships often become strained as a result of misunderstandings. It’s also hard for the hearing impaired to enjoy meaningful conversations with their loved ones, and this can cause feelings of frustration and isolation.
Cochlear implants – changing lives
Hearing aids can certainly make a positive difference to the life of a hearing impaired person. However, some patients do not experience any benefit from conventional hearing aids, and that’s where the cochlear implant comes in. “For babies born with profound hearing loss, for instance, the surgically implanted hearing device can give them the potential to hear and speak – in other words, to give them a normal childhood,” says Dr Tan. “As a child or parent with a disability, you simply yearn for normalcy.”
How hearing restoration can improve relationships
When their hearing is restored, people with hearing problems enjoy a more fulfilling life. When they can hear their loved ones, communication is a lot easier and there are fewer misunderstandings. “I often see adult patients whose families are frustrated that they have to shout to be heard, and that the home TV is always too loud,” says Dr Tan. “Hearing restoration in these situations can ease tension, allow better communication and meaningful conversations amongst loved ones.”
She stresses that the success of hearing restoration is a team-effort. Besides the hearing device technology and a motivated patient and family, it takes a dedicated team of audiologists, speech therapists, medical social workers and doctors to work together to help a patient hear well.
Learn how to prevent hearing loss at
Biologics - The Latest In The
Treatment Of Eczema: Dr Mark Koh
Eczema is a common skin condition in children and adults. Usually caused by skin dryness, and triggered by stress, environmental and climate changes, upper respiratory tract infections, strong detergents and house mites, eczema appears as red, scaly rashes and causes a great deal of itching and discomfort. “Many patients also have a personal or family history of other atopic conditions such as asthma, allergic rhinitis or allergic conjunctivitis,” says Dr Koh.
How biologics are helping eczema patients
Topical treatments such as moisturisers, corticosteroids and anti-itch creams are traditionally used to reduce the symptoms of eczema. Lately, however, new and targeted medications called biologics have been showing promise in the treatment of the skin condition. Biologics target the underlying inflammation in eczema, making them more effective than traditional medication. They also have fewer side effects than traditional medication. Dr Koh says that the first biologic for eczema, Dupilumab, has been clinically trialled on patients with moderate and severe eczema, and has proven to work in a significant number of patients.
Minimise your risk of eczema
“Many patients with eczema have dry skin – it is thought that, due to genetic reasons, their skin barrier is less resilient and more prone to moisture loss. To reduce your risk of developing eczema, you should not only avoid environmental triggers but also moisturise your skin regularly,” Dr Koh advises.
Learn all you need to know about eczema at
Breast-Conserving Surgery-Improving The
Quality Of Life Of Breast Cancer Patients: Dr Yan Zhiyan
Breast cancer is the most common cancer among women in Singapore, but according to Dr Yan, all is not lost, because early detection offers an excellent survival outcome. “The five-year survival rate for women with stage 0 or stage 1 cancer is close to 100 per cent. For women with stage 2 cancer, it is about 80 to 90 per cent.”
And with the help of advanced surgical techniques, you can also have a better cosmetic outcome post-cancer. “Many women still think the diagnosis of breast cancer equates to losing the whole breast via a mastectomy operation. However, studies have shown it is safe in certain circumstances to preserve the breast via a breast-conserving surgery,” says Dr Yan.
Benefits of breast-conserving surgery
Thanks to new oncoplastic techniques (this combines cancer resection with established plastic surgery techniques), doctors can safely remove the tumour while maintaining the shape and symmetry of the breast. “Generally, patients with smaller tumours in comparison to breast size are suitable for breast-conserving surgery,” says Dr Yan. “This is why we emphasise the importance of breast self-examinations and regular screenings – so that the tumours can be detected when they are smaller.” She adds that the psychological factor plays a part – by preserving the breast, the patient is not reminded of her cancer diagnosis whenever she looks at it post-surgery.
Improved treatment options
Breast cancer treatment typically includes surgical removal of the cancer followed by adjuvant therapy, which may consist of endocrine therapy, radiation therapy or chemotherapy. Technology will continue to change the way breast cancer is treated. For example, better imaging modalities will allow for earlier detection, which leads to better survival rates. “The trend for breast cancer surgery is doing less,” says Dr Yan. “Less is more.”
Learn more about breast cancer at
Some Activity Is Better Than None For Rheumatoid Arthritis Patients: Dr Bernice Liu
Rheumatoid arthritis can affect both men and women, but women are two to three times more likely to be affected. An autoimmune condition, it occurs when the layer of connective tissue that covers a joint becomes the target of the immune system’s attack. The condition affects 0.5 to 1 per cent of the general population, and patients are usually aged between 30 and 50 years old.
How rheumatoid arthritis impacts mobility and mental health
The attack on the connective tissue eventually leads to the breakdown of the bone and cartilage of the joint. Rheumatoid arthritis causes significant joint stiffness that can last for hours, limiting patients’ mobility and affecting daily functioning and participation in social activities. In turn, these issues may lead to depression.
“Evidence shows that people with rheumatoid arthritis are weaker compared with age- and gender-matched healthy individuals,” adds Dr Liu. “This is mainly due to muscle atrophy because of disuse. Besides that, the condition is associated with increased morbidity and mortality from cardiovascular disease.”
Easing symptoms of rheumatoid arthritis
While exercise may not change the severity or progression of the disorder, it can improve the aerobic fitness of patients, thus boosting their stamina, reducing fatigue and pain, and even helping with their depression. “Patients should do a combination of aerobic, strength and flexibility exercises – start small and gradually build up the frequency and intensity of the exercises,” says Dr Liu. Contrary to popular belief, exercise will not worsen the pain and stiffness.
Furthermore, they can take advantage of various assistive devices such as electric toothbrushes and voice-activated switches. These can make living with rheumatoid arthritis easier.
Learn more about rheumatoid arthritis at
Brachytherapy - Delivering A High Dose Of Radiation To Kill Cancer Cells: Dr Kiattisa Sommat
The most common gynaecological cancers in Singapore are uterine, ovarian and cervical cancers. Typical risk factors include family history of these cancers, obesity, age, a history of abnormal pap smears and the use of unopposed oestrogen. Brachytherapy is an integral component in the treatment of patients with cervical cancer as it delivers a high dose of radiation to kill cancer cells.
How traditional brachytherapy works
“Conventional brachytherapy is also known as intracavitary brachytherapy,” says Dr Sommat. “The radioactive source is placed into the womb and vaginal cavity, next to the tumour.” However, as the device is not placed directly into the tumour, in most cases, it is difficult to deliver a high-dose of radiation to patients with big tumours.
A new type of brachytherapy
Patients with advanced cervical cancer now have the option of interstitial brachytherapy in cases where the tumour cannot be adequately treated with the conventional method. “With interstitial brachytherapy, we are able to place special devices directly into the tumour, allowing the delivery of high-dose radiation. On top of that, we incorporate an MRI scan to guide the placement of the devices, thus enhancing the accuracy of the treatment,” explains Dr Sommat. “This technique improves the tumour control rate with acceptable side effects.”
Dr Sommat stresses that cervical cancer is highly curable if detected early. “I would advise sexually active women aged 25 and above to get a pap smear once every three years at the minimum to screen for cervical cancer.”
Learn about cervical cancer prevention at
Not All Cracked Teeth Are A Lost Cause: Dr Chan Pei Yuan
Most of us think nothing of grabbing a handful of nuts or lounging with a bag of crisps. But chewing on hard foods like these, as well as clenching or grinding your teeth (due to stress or habit), may cause the teeth to crack.
Cracks can lead to bigger problems
If you think you have a cracked tooth, you should seek help from a dentist. This is because chewing on a cracked tooth can cause micro movements of the affected fragments and result in changes in the dentine and pulp, resulting in pulpal inflammation. The release of biting pressure on the affected tooth can also cause sharp pain.
Worse, cracks can harbour bacteria, leading to infection of the pulp and its surrounding tissues. When this happens, the tooth may hurt even when it’s not functioning, and there may be swelling of the gums around the affected tooth.
“The treatment and outcome for a cracked tooth depends on the type, location and extent of the crack”, says Dr Chan. “Usually, we will need to stabilise or splint the tooth with a band to prevent further crack propagation. Root canal treatment may be necessary if there is pulpal involvement arising from the crack.”
It’s important to note that while root canal treatment will relieve the pain and resolve the pulpal inflammation, it will not cure cracks, as these are physical defects on the tooth surfaces. When the cracked tooth does not show any more symptoms and has stabilised, a crown will be placed over it. The crown provides maximal protection and retards the progression of cracks, although it does not guarantee success in all cases.
How a new dental microscope helps patients with cracked teeth
Thanks to the use of a dental microscope during root canal treatment, dentists can now better assess the location, depth and extent of the crack. They can then show patients the cracked tooth and give them a better idea as to whether the tooth can be saved. “The prognosis of a cracked tooth is improved when the cracks are detected early, before they extend into the root,” Dr Chan adds. “Once treated, the tooth can continue to function and provide years of comfortable chewing.”
Find out how a root canal can save your tooth at
Urgent Treatment Restores Blood Flow To The Heart Muscle Of Heart Attack Patients: Assistant Professor Chin Chee Tang
A heart attack occurs when a blood clot forms suddenly inside one of the blood vessels supplying blood to the heart. When the blood supply is disrupted like this, the heart muscle starts to get damaged, and if the damage is too extensive, the heart may fail and this then becomes life-threatening.
“We know a few of the risk factors that increase one’s risk of a heart attack,” says Asst Prof Chin. “Some of these are not modifiable, such as increasing age and family history. However, there are others that the individual may be able to do something about – these include reducing their risk of diabetes mellitus and high blood pressure, lowering their cholesterol levels, and stopping smoking.”
Intervention treatment saves lives
According to Asst Prof Chin, emergency percutaneous coronary intervention (PCI) – while not particularly new – is one of the most important technological advancements in the treatment of a heart attack. “The patient is brought to the cardiac catheterisation laboratory as soon as the heart attack is confirmed. A tube is then inserted into the blood vessel in the wrist or the thigh, and through this tube, wires are passed into the blocked blood vessel in the heart. Using this wire, a balloon is used to break up the blood clot blocking the blood flow. Usually, a metal tube – called a stent – is inserted to reduce the chances of the blood vessel narrowing in the future.”
Better quality of life for patients
Thanks to emergency PCI and other advancements, including expert nursing care in the coronary care unit, and better medication, heart attack victims today have a higher chance than in the past of surviving and returning home.
“Despite heart attacks being responsible for a significant number of deaths around the world every year, most patients are able to return to their normal activities after a heart attack,” he adds.
Find out all you need to know about a heart attack at
Mechanical Clot Retrieval Extends The Treatment Window For Stroke: Dr Yu Wai Yung
Ischaemic stroke is one of the leading causes of disability and mortality in the world. Simply put, an ischaemic stroke is caused by a sudden critical reduction in blood supply to the brain, resulting in brain tissue death. However, if blood supply can be restored early, the functionally impaired tissue can be “rescued”, thereby minimising the eventual damage.
Benefits of mechanical clot retrieval
“Retrieving an acute clot in the brain vessel is like clearing a blocked pipe”, says Dr Yu. “Mechanical clot retrieval devices have the advantage of targeting the clot directly.” These devices come in different designs, and over the years their designs have been improved to enhance the devices’ clot-retrieving ability.
How mechanical clot retrieval is done
“At NNI, a combination of mechanical techniques is tailored to each patient, depending on the situation encountered,” explains Dr Yu. “Through a right groin femoral artery puncture, a catheter is navigated into the vessel of interest and the mechanical device is then introduced through the catheter to engage the clot. Once the device is in place, the retrieval process begins, and the clot is pulled through the catheter.”
Find out how ischaemic stroke can lead to full-blown stroke at
Easy Ways For Elderly Patients To Follow Their Medicine Regimen: Joey Tan
Some elderly patients have to take more than one type of medicine in order to keep certain chronic medical conditions under control. However, many find their regimen hard to follow, for various reasons: forgetfulness, confusion about the medicine or regimen, misconceptions about the medication or disease, and unwanted side effects, which may discourage the patient from continuing to take their medicine.
Reminder tools for tech-savvy and non-tech-savvy patients
If they don’t follow their medicine regimen, the patients’ condition may worsen and result in unnecessary additional treatments and hospitalisation, says Tan. But high-tech tools are available to remind them to take their medicine. “The Medicine Reminders feature in the Health Buddy app allows patients and caregivers to easily set and customise reminders that prompt them to take their medication on time,” says Tan. “Those who are not tech-savvy can use multi-dose packs or customised pillboxes.”
How you can help if you’re a caregiver
If you’re caring for an elderly loved one, help them stick to their medicine regimen. Tan advises you to prepare their pillboxes, set the alarm on their pill reminder app, update their medication list with photos so they know what they have to take, and encourage them to speak up about whatever side effects they experience.
Get tips to help the elderly keep to their medicine regimen at
SEE WHAT OTHER HEALTHCARE PRACTITIONERS HAVE TO SAY
Dr Daniel Ting
Dr Eunice Png
Dr Munirah Alhamid
Dr Vanessa Tan
Dr Mark Koh
Dr Yan Zhiyan
Dr Bernice Liu
Dr Kiattisa Sommat
Dr Chan Pei Yuan
Assistant Professor Chin Chee Tang
Dr Yu Wai Yung
GET AN EXCLUSIVE BEHIND-THE-SCENES LOOK AT THE MAKING OF SINGHEALTH CALENDAR 2019
Brought to you by: