From ‘he’s very nice and patient’ to ‘he is worth the long queue’ and ‘it’s like talking to an old friend’ – Dr Arthur Tseng’s patients only have good words for the young doctor. They have one common concern, however –the queue at his clinic is always long – which only goes to show how good he is at what he does. An Obstetrician & Gynaecologist and Urogynaecologist at Gleneagles Medical Centre, Dr Tseng’s former patients still remember him fondly years after he has delivered their babies.

Born to parents who are both general practitioners, Dr Tseng and his two older brothers practically grew up in a health service environment. However, he was the only one who followed in his parents’ footsteps. “I remember spending hours in my mother’s GP practice as a child, watching her deal with her patients, and attempting to help ‘dispense’ medications to them,” Dr Tseng shared. “The early formative years did influence me to pursue medicine, even though my parents had hoped that I would take up law.”

Dr Tseng graduated in 1996 from the University of Sheffield with honours, placing third in a class of 186 students, and returned to complete his Housemanship. By 2002, he had passed his membership examinations (the MRCOG), and in 2005, he was awarded the Healthcare Manpower Development Plan award for Urogynaecology and Pelvic Reconstructive Surgery. He completed his subspecialty training at King’s College Hospital, London. Upon returning to Singapore, he spent a very fulfilling time at KK Hospital honing his skills, pursuing research in clinical drugs and devices pertaining to Urogynaecology, as well as teaching at the Yong Loo Lin School of Undergraduate Medicine and the Duke-NUS Postgraduate School of Medicine. Eventually, in March 2012, he decided to set up his private practice at Gleneagles Medical Centre. Ezyhealth recently managed to take him away from his busy practice for a few minutes to catch up with the amiable doctor.

Ezyhealth: What exactly does your job as a urogynaecologist entail?

Dr Tseng: Urogynaecology is a recent subspecialty of Obstetrics & Gynaecology, which deals with pelvic organ problems that become more prevalent with age. These can include bladder problems like urinary incontinence and complicated urine infections, as well as prolapse of the pelvic organs, such as uterine (womb) prolapse, bladder (cystocoele) and rectal (rectocoele) prolapse through the vagina. This can cause problems which range from discomfort, pain, vaginal bleeding, to painful intercourse and obstruction of urination. More importantly, these conditions are extremely embarrassing to women, and many suffer in silence, as such things aren’t talked about at all. Awareness is only starting to build amongst Singaporeans that these problems are not considered normal, and can be treated or cured. I would love for ladies to be able to say “I’m not accepting this anymore”, and be able to do something about it.

Ezyhealth: What prompted you to set up your own practice – Arthur Tseng Women’s Health Services?

Dr Tseng: After 15 years in service, I decided that it was time to set different goals and challenges, in a different environment. Working in a relatively controlled environment like KK Hospital, it felt like a frenetic routine, requiring physical effort but not much mental activity. Learning new skill sets, new processes and methods of dealing with medical conditions, staff and patients has been a thoroughly enjoyable experience for me. I don’t think I’ve laughed so much with my patients or enjoyed their company as much as I do now. Ezyhealth: What are the common cases you handle at your clinic? On average, how many of these cases do you handle every day? Dr Tseng: I see obstetrics and gynaecology patients as part of my daily work schedule, but I am very grateful that there is growing awareness amongst Singaporeans about urogynaecological conditions. I would estimate that 30% of my patients have urogynaecological conditions requiring my attention.

Ezyhealth: What are the most challenging cases you’ve ever handled in your career so far?

Dr Tseng: It’s a good question to ask! The most challenging cases are patients with Painful Bladder Syndrome, where treatment is chronic, often with multiple drug regimens, and often requires help from a dedicated pain specialist. I respect how much effort these patients put into managing their daily symptoms. Their courage and perseverance and the positivity they project help to tide through very trying times.

Ezyhealth: What do you think needs to be done in order to change the people’s mindset about this urinary incontinence?

Dr Tseng: Patients need to be brave enough to broach the subject with a trusted doctor or specialist. Medical institutions need to realise that apart from increasing birth rate numbers in Singapore, there is a rapidly increasing ageing population that need equal care and attention. I think that increasing public awareness is important, and KK Hospital Urogynaecology Department was heavily into raising awareness. We used to hold multiple public forums on the different urogynaecological problems. The Obstetric & Gynaecological Society of Singapore, of which I was the previous Treasurer, also promoted all aspects of women’s health. We have World Continence Week from the 24 to 30th of June this year, which helps to raise international awareness of bladder problems.

Ezyhealth: Aside from your private practice, you are also involved in public forums to help raise awareness about urogynaecological conditions. Please share with us the latest projects you’ve done.

Dr Tseng: I talk at CME events, to GP’s, trainees at KK Hospital, and the public at different forums locally. Internationally, I am honoured to be asked to speak about urogynaecological conditions in front of peers and colleagues, so I do travel regionally and further afield for my round of talks. The latest would be at this year’s International Urogynaeoclogical Association (IUGA) Pan-Asian conference, to discuss on recurrent Stress Urinary Incontinence (SUI) management strategies.

Ezyhealth: Please give our women readers out there some valuable advice on how to prevent having the most common urogynaecological conditions.

Dr Tseng: For prevention of urinary infections, drink enough fluids and have a healthy diet rich in immune-boosting foods, probiotics and cranberry juice. Practice good perineal hygiene and good toilet habits. If an infection occurs, see a doctor as soon as possible for a urine culture and appropriate antibiotics. The culture result allows us to tailor antibiotic therapy. For urinary incontinence and pelvic organ prolapse, I cannot go against the government’s directive to make more babies; in fact, I am all for our population renewing itself. I would suggest that an experienced obstetrician is vitally important, as minimising pelvic floor injury is important for future health. And I cannot emphasise enough the need to perform daily pelvic floor exercises (or Kegel’s exercise) in pregnancy, after delivery and throughout a woman’s life! It may prevent, and certainly can reduce, symptomatic pelvic floor dysfunction in the long run. An experienced obstetrician would be able to teach and assess pelvic floor exercise and its results. An interesting fact is that antenatal training of the pelvic floor does allow a woman to consciously control the pelvic floor muscles, and that has definite benefits during delivery.

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by Maripet L. Poso

WITH HER GENTLE demeanor, soft but determined voice and kind face, Dr Goh Ping Ping is the sort of person you would randomly approach for directions at a busy street. Listen to her talk and discuss about things she’s passionate about, and you would probably wish she was your university thesis advisor. Witness her take-charge attitude in and out of the clinic, and you would understand why she’s one of the well-known and respected cardiologists in the country.

Dr Goh’s interests, however, go beyond treating patients within the four corners of her clinic. A strong advocate of Preventive Cardiology, she looks after heart patients on a daily basis, many of whom have serious conditions such as heart attack and heart failure. But she’s also very interested in educating the public about heart diseases and what they can do to prevent them. Having found the perfect platform in Singapore Heart Foundation’s Go Red for Women – a campaign that encourages awareness of the issue of heart disease and stroke in women – where she is the official spokesperson for more than eight years now, Dr Goh has been giving educational talks and leading activities that encourage heart healthy living.

A graduate from the Faculty of Medicine, National University of Singapore in 1988, Dr Goh worked as a House Officer and Medical Officer and went on to specialise in Internal Medicine and Cardiology. She became a qualified Cardiologist in 1996 and did a fellowship in the USA in Echocardiography, sub-specialising in Cardiology. She is also a Clinical Exercise Specialist accredited by the American College of Sports Medicine. Until 2012, she has worked as a Cardiologist in various public institutions in Singapore. She was the Chief of the Department of Cardiology in Changi General Hospital from 2007 to 2012. Currently, she runs her own practice in Cardiac Specialist Centre at Mt Elizabeth Medical Centre.

Married with three children, Dr Goh is also a teacher for both undergraduate and postgraduate medical students and is an Adjunct Assistant Professor of the Yong Loo Lin Medical School, National University of Singapore. Aside from her vast experience in managing patients with a broad spectrum of cardiovascular disease, Dr Goh’s subspecialties include transthoracic echocardiography, transesophageal echocardiography, and pharmacological and exercise stress echocardiography. Ezyhealth recently caught up with the amiable doctor for a little heart to heart.

Ezyhealth: Is there any interesting story behind your decision to specialise in cardiology?

Dr Goh: I don’t really have any actual interesting story, but Cardiology appeals to me because it provides a combination of science and art. In my subspecialty of Echocardiography, ultrasound technique is used to reproduce pictures of the heart to enable the cardiologist to study and detect any abnormal structure and function and to form a treatment plan. Another area I enjoy is Preventive Cardiology, where I can provide guidance to patients and motivate them to improve their heart health by lifestyle modification.

Ezyhealth: What are the most challenging cases you’ve ever done in your career so far?

Dr Goh: I have dealt with patients with weak or failing heart who are prone to relapse. Some went on to develop complications such as kidney failure and stroke; hence, the importance of prevention – to reduce disability, premature death, etc.

Ezyhealth: What are the common cases you handle at your clinic at Mt Elizabeth Medical Centre? On average, how many of these cases do you handle every day?

Dr Goh: I mostly handle patients with a wide spectrum of heart disease. Most are patients with coronary artery disease. They usually have one or more risk factors such as high blood pressure, diabetes mellitus and hyperlipidaemia. I also see patients with heart failure, abnormal heart rhythm and heart valve disease. There are also patients who are quite well but want to find out whether they are fit to start an exercise regime.

Ezyhealth: What are your signature treatment methods, if any?

Dr Goh: Besides thorough evaluation and determining the optimal medical treatment, I also look into the lifestyle of the patients for possible aggravating factors. Patients need a lot of motivation and advice for better diet and exercise regime.

Ezyhealth: You’ve been the official spokesperson of the Singapore Heart Foundation’s Go Red for Women Campaign since 2006. Please tell us more about it – your role, the campaign’s goal, etc.

Dr Goh: The campaign aims to raise awareness among women to take care of their heart health. It hopes to empower women with the knowledge and means to have a heart healthy lifestyle. In the past years, we tried to put across our message through various activities, usually between Valentine’s Day and Mother’s Day. A few memorable ones included lighting up of landmark buildings in red, such as the City Hall and Singapore Flyer, and activities that target lifestyle-related issues for both working women (healthy breakfast for working women in the Central Business District) and women in the heartland (supermarket tours). We have also held public symposiums and outdoor activities such as mass exercises and kite-flying.

Ezyhealth: Do you think women in Singapore are more aware now about heart diseases than say, five or 10 years ago?

Dr Goh: We hope to show this by ongoing surveys. But my impression is that women are on the whole more aware and also more enthusiastic now about leading a healthy and active life.

Ezyhealth: What are the three basic things a woman needs to know about heart disease?

Dr Goh: Women need to know that they are at risk, especially as they approach, and after, menopause. They need to know the risk factors, which include high blood pressure, high cholesterol, diabetes, obesity and smoking. Last but not least, they need to know the essentials of a heart healthy diet and exercise.

Ezyhealth: Please give our women readers out there some valuable advice on how to make sure they lead heart disease-free lives.

Dr Goh: It’s important that you know your own blood pressure, cholesterol level, blood sugar levels and body mass index. Be aware if any of these is abnormal. Review your diet and know what to avoid – diet needs to be low in sugar, salt, fat and alcohol. Eat more fresh food, plant-based protein and high fibres. Ensure you stay active. Aim for regular 30 minutes of moderate intensity exercise at least five days a week. You also need to keep a positive outlook. Learn to relax more and worry less.

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by Maripet L. Poso

Who would have thought that being good at playing video games in his childhood would one day play a big role in Dr Dean Koh Chi-Siong’s chosen career. A senior consultant and general surgeon at Colorectal Clinic Associates in Mount Elizabeth Novena Hospital, Dr Koh has been performing robotic-assisted laparoscopic colorectal resections since 2008. And he had his love for video games to thank for it, among others. “I spent honing my hand-eye coordination playing video games when I was younger,” he shared sheepishly. According to him, the 2-D to 3-D spatial relational perception enabled him to better grasp and master laparoscopic and robotic surgery.

A graduate from the National University of Singapore, Dr Koh obtained his fellowship diploma from the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow. He completed his advanced surgical training in Tan Tock Seng Hospital and the National University Hospital and moved on to complete the Joint Specialty Fellowship in General Surgery examination in 2003 and was admitted as a fellow to the Academy of Medicine (Surgery) in the same year.

Married to a lawyer with three children, Dr Koh was a senior consultant in Colorectal Surgery in Division of Colorectal Surgery, National University Hospital, before leaving for private practice at the Colorectal Clinic Associates in 2012.

Ezyhealth: Having performed enough colorectal robotic surgery, you have qualified and to this day remains to be the only one listed on the official da Vinci surgery locator site in Southeast Asia. What did it take for you to be one?

Dr Koh: I was fortunate enough to have been trained in laparoscopic (keyhole/minimally invasive surgery) and when robotics came into light, it was a natural progression because robotic surgery is actually a more advanced technology that enables the surgeon to perform laparoscopic surgery with greater precision, greater control, and arguably, better results. However, it took a tremendous amount of patience, practice, countless hours of video reviews to be able to better grasp and master laparoscopic and robotic surgery. I had to keep running every single step of the procedure in my mind, sometimes even in my sleep.

Ezyhealth: Please tell us about minimally invasive techniques in colorectal surgery.

Dr Koh: Minimally invasive (keyhole) techniques are increasingly practiced for a myriad of colorectal conditions. With ample evidence from randomised controlled trials, it is now established that a good oncologic clearance can be achieved via laparoscopic surgery, and outcomes are no different from open surgery. With early post-operative advantages such as smaller incisional scars, less post-operative pain and quicker recovery with shorter hospital stays, it is no wonder that more patients are asking for keyhole surgery. Ezyhealth: What are the usual challenges encountered in performing this kind of surgery? Dr Koh: Patient factors include the need to perform complex multi-quadrant abdominal surgery, handling large inflammatory masses and bulky rectal tumours in the narrow pelvis, especially in males. Surgeon factors that are often cited include the long learning curve, use of hand held long shafted instruments and operating whilst standing and craning the neck for long hours. This, however, has changed with the introduction of the surgical robot.

Ezyhealth: Please tell us more about the da Vinci Surgical System?

Dr Koh: The da Vinci Surgical Robot was first approved by the FDA for patient use in general laparoscopic surgery in 2000. The first documented use of the robot was for removal of the gallbladder. Since then, the use of the surgical robot has been extended to various disciplines: urology, gynaecology, cardiothoracic, thyroid, head and neck, and now colorectal surgery. I have been performing robotic colorectal surgery since August 2008. Beginning with the standard da Vinci system, I have been fortunate to have been using the latest da Vinci Si system since January 2010. The da Vinci System consists of a surgeon’s console that is in the same room as the patient and a patient-side cart with four robotic arms controlled from the console. The surgeon will sit at the console and whilst looking through two eye holes at a 3-D image, he will be manipulating the robotic arms and the camera with two hand controllers. Foot pedals operate the energy source supplied to the instruments to cauterise, coagulate, or cut the tissue. The robotic system is able to scale, filter and translate the surgeon’s hand movements into precise micro-movements of the instruments, which operate through small incisions in the body. All these serve to provide surgeons with superior visualisation, enhanced dexterity, unsurpassed stability in platform and ergonomic comfort.

Ezyhealth: What’s the most common-cited drawback to robotic surgery?

Dr Koh: The only downsides to robotic surgery are the higher cost, since the only robot available in the world at this moment is manufactured by one company in Sunnyvale California, and the steep learning curve required for surgeons to master the technique. Ezyhealth: What’s your typical day like at the Colorectal Clinic Associates? Dr Koh: My day starts with seeing patients in the various private hospitals that they are warded in. After that I would see patients by appointment at the clinic, or attend to endoscopy procedures in between and surgery whenever patients require it. It’s been unpredictable. There is no real routine. It’s all about the patients’ needs and requests so it can be pretty hectic. The key is good time management. Ezyhealth: What are the most common cases you treat at the clinic? On average, how many of these cases do you handle every day? Dr Koh: The most common cases that I handle at the clinic are haemorrhoids, anal fistula, and colorectal cancer. There are patients presenting to us with one or more of these three cases every day. Another common complaint is abdominal discomfort and bleeding during or after bowel movements.

Ezyhealth: What do people need to know about colorectal cancer?

Dr Koh: Colorectal cancer is one of the most common cancers in Singapore at present. Worldwide, over 1.2 million new cases are estimated to be detected each year, resulting in about 600,000 deaths. It takes five to 10 years for the adenomatous polyps to transform into a cancer, so early detection is key to preventing colorectal cancer. Mortality can be reduced simply by screening asymptomatic individuals for the presence of adenomas and early cancers. Studies in the medical literature have demonstrated that the numbers of early staged colorectal cancers detected have been doubled just by instituting an effective screening programme. Reduction of mortality rates of between 15% and 30% has been reported.

Ezyhealth: What advice can you give to our readers to avoid getting colorectal diseases, including colorectal cancer?

Dr Koh: The paradigm in screening for colon and rectal cancer has shifted from ‘early detection’ to ‘prevention’. By detecting polyps during colonoscopic screening and removing them, one is able to prevent them from ever turning into cancer. Proven modifiable risk factors for colorectal cancer include smoking, excessive alcohol consumption, physical inactivity, obesity, red and processed meat consumption. So eat well, exercise regularly, and seek the appropriate screening tests at the appropriate times.

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by Maripet L. Poso

 We often take our eyes for granted. Save for a few swipes of mascara in the morning, we seldom pay much attention to our eyes on a daily basis. Until something serious happens, that is. But even then, some patients do not go for check-ups right away. This is the bane of the ophthalmologists’ existence.

“If patients only come to see an eye doctor several months after they start experiencing problems, the outcome will likely be of limited success, even with the best treatment,” shared Dr Gemmy Cheung.

A Consultant Ophthalmologist at the Singapore National Eye Centre, Dr Cheung’s interests lie in imaging and treatment of retinal disorders, including age-related macular degeneration (AMD) ‒ which is fast becoming the number one eye problem in the country, idiopathic polypoidal vasculopathy, diabetic retinopathy, and retinal dysfunction in association with ocular inflammation.

According to Dr Cheung, awareness of eye diseases, especially about AMD, is necessary so patients can seek treatment immediately. “The awareness of AMD in Singapore is generally much lower when compared to countries such as Australia and UK,’ she shared. “Many patients have not heard of this condition, and even fewer are aware of how quickly it can irreversibly damage one’s vision.”
Dr Cheung was attracted to Ophthalmology even during medical school. Soon after graduating from the University College London Medical School in London, she got into an Ophthalmology training rotation in the West Midlands Deanery, UK, and carried on from there. During her training, she managed to take one year out as a junior research fellow, which gave her her first clinical research experience. She has continued to be interested in research since and is now been practicing as a specialist in Singapore for about five years.

Last year, Dr Cheung was among the recipients of Bayer Healthcare’s Global Ophthalmology Awards Program (GOAP) for her research project that aims to improve the diagnosis of polypoidal choroidal vasculopathy (PCV), a subtype of AMD. Ezyhealth spoke to the amiable doctor about the life and feat of an ophthalmologist.

Ezyhealth (EH): Among other specialisations, what attracted you to ophthalmology?

Dr Cheung: I find it fascinating to look at the eye under high magnification. It is such a well-designed organ. Of course, it is very gratifying to bring sight to patients, not to mention that most eye surgeries are also very delicate, clean, and highly precise.

EH: What are the most challenging cases you’ve ever done so far?

Dr Cheung: I wouldn’t specify at one or two cases. Every case is different, and it is the need to understand and balance all the different aspects of patient and family’s needs and expectations that challenges us on a daily basis.

EH: What are the common cases you handle at Singapore National Eye Centre?

On average, how many of these cases do you handle every day? Dr Cheung: In addition to general ophthalmology and cataract surgery, I sub-specialise in medical retina. The conditions that I look after, in particular, are age-related macular degeneration and diabetic retinopathy. On average, I see about 30 to 40 patients during each of my clinics.

EH: You’re currently doing a research to improve the accuracy of diagnosis of AMD. Please tell us more about it?

Dr Cheung: The title of my project is ‘To design a predictive algorithm for indocyanine green angiography usage to differentiate polypoidal choroidal vasculopathy from age-related macular degeneration’. In most Asian populations, including Singapore, a subtype of AMD, called PCV, is relatively common (up to 50% of all AMD compared to up to 15% in Caucasians). However, diagnosis of PCV currently requires additional invasive test, which is only available in selected centres, expensive, and contraindicated in a subgroup of patients with allergy. What’s worse is that if the PCV subtype is not accurately diagnosed, patients may not receive the correct treatment. My research project aims to improve the ease of diagnosing PCV. First, we’ll study a multitude of individual factors, such as age, gender, amount of blood or fluid in the eye, and how likely they are seen in PCV. Then the ones with the highest individual predictive power will be selected and further tested in combinations. The final product we aim for is a simple and easy-to-use algorithm that can differentiate patients at ‘high risk’ of having PCV from those with low risk.

EH: What are the challenges you encountered in doing this research so far?

Dr Cheung: The most challenging part is to make sure I provide adequate time and explanation during busy clinics to our patients who have very kindly agreed to participate in the research. Their contribution is invaluable and we hope to make good use of the information to benefit future patients. Apart from that, there are also challenges in logistics and in managing the large amount of clinical data. However, we are very lucky to have a good team of research coordinators, imaging specialists and data managers who work together. Finally, obtaining funding to support research activities (such as sponsoring patients’ tests, manpower, etc.) continues to be one of the major challenges for clinical research. Obtaining the Bayer Global Ophthalmology Research Award will help provide funding for these areas.

EH: What are the usual eye care tips do you give to your patients?

Dr Cheung: Apart from serious eye conditions, many of us in this day and age suffer from dry eyes and straining, thanks to our dependence on computer and electronic devices! It is important to take regular breaks during computer work. I recommend a short break after an hour so that the eyes do not get so tired and dry. For my patients with AMD or diabetes, quitting smoking is my number one advice, followed by a healthy diet.

EH: Where would we normally find you when you’re not working? Any hobbies/activities you like to do with your family/by yourself?

Dr Cheung: The East Coast Park is one of our favourite hangout places. I often go cycling with my kids there during the weekends.

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With a passion for surgery and affinity for engineering, Dr Chin Pak Lin champions robotic surgery in Singapore

For most people, engineering and medicine are poles apart. You either have a passion for healing and making the sick better or an inclination towards designing systems and structures. For Dr Chin Pak Lin, Consultant within the Adult Reconstructive Service in the Department of Orthopaedic Surgery at the Singapore General Hospital (SGH), however, the two actually complement each other.

As a child, Dr Chin had always liked taking things apart and analysing them; thus, he dreamt of becoming an engineer. Born in Malaysia to a family of five – his dad was a high school teacher and his mom a homemaker, Dr Chin never thought of becoming a doctor. He was awarded an engineering scholarship after his SRP “O” levels in Malaysia. He was excited at the opportunity but eventually found out that it was not his true calling. Not long after, another opportunity opened for him. He was awarded the ASEAN scholarship to pursue his “A” levels at the National Junior College. He entered the National University of Singapore (NUS) Medical School despite reservations from his dad. “As my family were not really well-off, I had to finance my education from a bank loan, like most Malaysians,” he shared. And the rest, like all interesting stories, is history. “All these challenges in life helped to shape my character to be more resilient.”

Dr Chin graduated from NUS in 1998 and obtained both his post-graduate Membership of the Royal College of Surgeons of Edinburgh as well as his Masters of Medicine in Orthopaedic Surgery in 2003. He subsequently obtained his Fellowship of the Royal College of Surgeons of Edinburgh in Orthopaedic Surgery in 2007. Dr Chin’s expertise lies in hip and knee replacement using the latest techniques. This includes joint preservation techniques and major reconstruction. He is a regional expert in computer-aided techniques and most recently robotic assisted surgery.

Ezyhealth has recently had the opportunity to pick the brain of one of the country’s brilliant orthopaedic surgeons.

All Roads Led to Medicine

EH: Among other specialisations, what attracted you to orthopaedic surgery?

Dr Chin: Medicine, I must admit, was not my primary goal in life. My dream was to be an engineer and nearly made it with the scholarship obtained after my SRP “O” levels whilst studying in Malaysia. Since I managed to get into medical school in NUS, life has been tough. I was not prepared to be a doctor. But luckily, a posting in surgery made me see the light. I fell in love instantly! In the orthopaedic practice, I can enjoy being a doctor and indulge myself in a myriad of big boys’ toys.

EH: What do you find most satisfying about your job?

Dr Chin: My wife says I am a workaholic! Not really! I just love my job! You see, being a doctor is not just about healing the sick. There is really so much more to it and it is really rewarding. The medical profession is still regarded as a noble profession where society holds us in high regard. We save lives, and often many of us dedicate our lives to our profession, even neglecting our own. I have known some of them, like the heroes during the SARS outbreak. We are also teachers to our students and colleagues. Thus, with the unique skills I have acquired, I have been able to travel far to share my expertise and knowledge in medical missions, conferences and workshops. I have the best passport to travel! My medical expertise has opened new doors to places that I didn’t even know exist. Such poverty serves to remind me on the blessings that I have now and why I should return to help my colleagues improve their standards. Of Surgery and Technology

EH: You specialise in complex joint replacement surgery. What are the latest techniques available in Singapore now?

Dr Chin: I have always wanted to do joint replacement surgery because the outcomes are the most consistent and favourable. Although by training I am supposed to be doing rescue or “revision” surgeries, i.e. complex surgeries, my pet interests are into computer-aided technologies, minimally-invasive techniques, and robotic surgery. I fervently believe that there are two types of surgeons – followers and innovators. The latter can bear both success and failure. Like a TCM practitioner, most surgeons often practice the way they were trained. For me, the training serves as the foundation. From my “tinkering” childhood ways, I challenge the way things are done to be the Gospel truth. Thus, I am lucky to have brought new “toys” into Singapore: Computer Navigation – at SGH I am blessed to have seven different systems at my disposals, Patient-Specific Jigs – customised jigs for patients and implants, and Robotic Knee system – the only one in the Southeast Asia other than Korea, Japan and India.

EH: What are the common injuries and disorders do you treat at SGH?

Dr Chin: Total hip and knee replacement remains the bulk of my work. Most of the complex revisions and infections are also handled by me. That’s great as this focused referral helps to build my experience quickly. Humanitarian and Daddy Duties

EH: You do volunteer work not only in community hospitals here but in Cambodia as well. Tell us a little bit about it.

Dr Chin: For a while now, I have been doing my rounds at the AMK Community. During these visits I offer my advice as an Orthopaedic Surgeon to help relieve the burden for immobile patients from traveling between hospitals for consultation. Thanks to Prof Tay Boon Keng, who has often guided me on the correct path to return back to society. In the Cambodia project, I work with the Singapore International Foundation to help set up a joint replacement centre at the Calmette Hospital in Phnom Penh. This is a Specialist project targeting benefits to subsection of the nation. Now I am glad to see some results! I have stopped my Phase I disaster relief mission trips like the one I did in Pakistan. I have two lovely boys now, and I cannot forgive myself if I deliberately put myself in harm’s way.

EH: Where would we normally find you when you’re not working? Any hobbies/activities you like to do with your family/by yourself?

Dr Chin: For the little time left for myself, I spend it all on my eldest son’s football training and matches. As a result, I have taken up football again, too! During evenings, I enjoy just being with my 17-month-old son, playing, pretending and swimming. That really leaves very little time left for my supportive and lovely wife.

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A lowdown on antibacterial drugs

by Gloria D. Gamat

ANTIBIOTICS (OR ANTIBACTERIALS) are medicines that are used to fight off bacterial infections. These are powerful medicines that cannot be used against viral infections (e.g. flu, colds, most coughs and bronchitis, and sore throats not due to Streptococcus bacteria). When used properly, antibiotics can save lives. On the other hand, improper use can cause resistance and can be detrimental, as in the case of Methicillin-resistant Staphylococcus aureus (MRSA) – a bacterium responsible for several difficult-to-treat infections in humans. MRSA is also called multidrug-resistant Staphylococcus aureus or ORSA (Oxacillin-resistant Staphylococcus aureus).

According to the Centers for Disease Control and Prevention (CDC), outpatient antibiotic overuse in the USA is a particular problem in the Southeast, and the ECDC (European Centre for Disease Prevention and Control) has reported that antibiotic resistance continues to be a serious public health threat worldwide.

Types, Uses and Mechanism of Action

Antibiotics work by destroying or slowing down the growth of bacteria. Our body’s immune system can usually destroy bacteria before they can multiply and cause symptoms of infection. Even though symptoms have occurred; the immune system can usually cope and fight off the infection through the actions of special white blood cells that attack harmful bacteria. However, on occasions when the infection is too much, the help of antibiotics is needed. Illnesses such as syphilis, tuberculosis, salmonella, and some forms of meningitis are caused by bacteria.

Antibiotics are grouped into various classes depending on what type of bacteria they target and the mechanism of action involved [Table 1]. Although there are various types of antibiotics, they all work in one of two ways – a bactericidal antibiotic kills the bacteria (e.g. penicillin is a bactericidal), whilst a bacteriostatic antibiotic stops bacteria from multiplying.

Misuse and overuse of antibiotics are worldwide concerns. They are the main reasons for the development of antibiotic-resistant bacteria (i.e. MRSA). Also, antibiotics come with side-effects; the most common of which are diarrhoea, nausea and fungal infections of the mouth, digestive tract and vagina. Other rare side effects include allergic reaction, formation of kidney stones, abnormal blood clotting and deafness, among others. Intake of antibiotics must be prescribed for strict compliance in order to avoid bacterial resistance. In addition, some antibiotics cannot be taken with certain food, drinks, and other medicines. So if you are taking other prescriptions or supplements, your doctor must be made aware of it, before prescribing antibiotics.

References U.S. National Library of Medicine (www.nlm.nih.gov) U.S. Food and Drug Administration (www.fda.gov) eMedicineHealth (www.emedicinehealth.com)

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Fighting infectious diseases on a daily basis

by Maripet L. Poso

Every year since 1988, we have been commemorating World AIDS Day, but the stigma and discrimination surrounding AIDS and HIV continue to prevail worldwide. Thanks, however, to some few good men who choose to venture where few men dare to tread – opting to spend their time and effort treating, managing, preventing, and spreading awareness on HIV and other infectious diseases – people tend to understand little by little about these dreaded conditions.

Dr Leong Hoe Nam first wanted to become an endocrinologist, a decision which was made within his first year of work as a doctor. But through the years, the discipline involved in the treatment of infectious diseases started to intrigue him, and the passion of his seniors impressed and inspired him. “In a masochistic way, I felt that the Infectious Diseases discipline involved a lot of hard work and long hours. But the rewards were nothing short of exhilarating. The sight of seeing a patient get well is most rewarding for the doctor,” Dr Leong shared. Before he knew it, he was on his way to specialising in Infectious Diseases.

An Infectious Diseases Specialist at Rophi Clinic, Mount Elizabeth Novena Specialist Centre, Dr Leong graduated from the National University of Singapore in 1996 and earned his Masters of Medicine in 2001. Right after, he started his advanced specialist training in infectious diseases and further pursued his interest in virology in London. He was a consultant in the Department of Infectious Disease at the Singapore General Hospital, and has published several papers on virology. He is a clinical tutor at the Yong Loo Lin School of Medicine, as well as an Adjunct Assistant Professor at Duke-NUS Graduate Medical School.

Default Career Choice

Ezyhealth (EH): What was the driving force that made you decide to become a doctor?

Dr Leong: The decision to become a medical doctor was a default choice. I enjoyed studying, and when it came to the A levels, it was the most natural choice to continue with a triple science course (this I understand is no longer available). And when I completed my exams, the option to be a doctor became realistic.

Having been a doctor for 16 years, I have absolutely no regrets in choosing this career. Being a doctor will not make you rich. However, it will let you embark on the most interesting and fascinating career in the entire world. Medicine is science. You never stop learning, and new information is discovered daily.

What we learnt years ago becomes obsolete after a while. And yet, it is also an art. Being a good doctor is not about how much we all know, but how we deliver care to our patients. A loving, caring, thoughtful doctor will do a lot more good to a patient than a brash, crude, uncaring doctor. The difference that makes one doctor from one to another is the passion, the love the doctor puts into care of the patient. That is the art of medicine. This is what I hope to master instead.

EH: What do you consider most satisfying about being a doctor?

Dr Leong: Seeing a patient recover is extremely satisfying. One example was an elderly man who had severe infections post operatively, and when he recovered, he was found to have tuberculosis. All in all, he stayed for more than three to four months in the hospital. He was eventually discharged to a community hospital and rehabilitated. I saw him in the outpatient clinic soon after discharge, and he came in a trolley. He was thin, still emaciated, but you could see the fire in his eyes. The next time, he came in a wheelchair. And subsequently, he walked in with a quad stick with someone helping him. Needless to say, one year after discharge, he walked in and out of my clinic unassisted, completely well. I couldn’t resist but give him a big hug, though that would have been against infection control practices.

EH: What are some of the challenges you face in your line of work?

Dr Leong: Challenges are plentiful. This includes less than truthful patients, patients who have few insights into their body. They lack self awareness and have difficulty appreciating their symptomatology. Sometimes the differences in culture exaggerate it.

Expectation of an immediate cure in this increasingly fast paced society is another. Patients expect a one/two-day cure for a condition that has persisted for days. Often, the disease is a setback and wake up call for the patient. As a physician, we remember this mantra − we listen always, heal frequently (hopefully), and cure only sometimes.

EH: Apart from treating patients, what other hobbies or passions do you have to keep your life balanced?

Dr Leong: I am a Christian, and I am glad for the salvation that was offered through my faith. I find the love of God and His word to be most intriguing and fascinating. It gives me great pleasure to read the bible and other Christian books, listening to Christian music, and doing fellowships with others. It also gives me great pleasure to share my testimonies on my God with others. There are only a couple of things which I can speak on for hours without rest. One is infectious diseases; the other is about God and His many wondrous things.

On AIDS Advocacy

EH: In view of the World AIDS Day, please give us a brief update on the current global situation of AIDS, as well as some statistics in Singapore.

Dr Leong: The global situation on AIDS has changed over the years. We see better control of HIV with tapering of growth rates in some countries, especially Africa. This is due in part to the increasing awareness of the disease, active surveillance, early screening and availability of treatment. In recent times, there has been increasing push for disease detection and better test kits.

There are still very similar figures on new cases of HIV/AIDS in Singapore for residents. About 400 to 500 new cases are identified every year. Majority are still men (90%) and half are engaged in same sex sexual relations (we call them MSM or men having sex with men). Vertical transmission (mother to child) are very rare due to the good work in the MOH mandated compulsory opt-out HIV screening of pregnant women and the support from the various voluntary organisations in providing HIV-related access.

In significant epidemiological data, we see two groups of individuals: those who are detected earlier tend to be gays, and those who are detected later tend to be men involved in heterosexual sex. Unfortunately, the latter group tends to be single individuals involved in non-professional occupations. It suggests that many young professionals engage in high risk sexual behaviour, but having made aware of the risks, do screening often.

EH: What are the latest advancements in the treatment of AIDS?

Dr Leong: We have much better medications compared to the previous years. Broadly speaking, they are of much lesser side effects, better tolerability and easier convenience (once-a-day vs twice-a-day). Studies have shown convincingly that this once-a-day therapy leads to better compliance, and lesser risk of resistance. Treatment is still life-long combinational therapy or HAART (Highly active anti-retroviral therapy). Cost of medications is still prohibitive, as these drugs are offered at developed world pricing for Singapore.

More recent studies discussed the role of prophylactic antibiotics for individuals who may be exposed to HIV transmission. Studies were done primarily on prostitutes. This drug is taken daily, and used in addition to the best advice given (safe sex and condom use).

EH: Do you think enough has been done on AIDS awareness in Singapore?

Dr Leong: As a physician looking after patients living with AIDS, I am all for greater awareness of the disease, and more frequent screening for early detection.

Using a condom provides protection of 85 to 95%. It certainly is not 100%. The individual is also at risk of picking up other sexually transmitted diseases. We can also do a lot more by understanding that HIV can only be transmitted through sexual and blood contact. In addition, having HIV does not mean that he or she has “sinned”.

Singapore being a first world country offers HIV medications that are sold at first world pricing. For a good regimen, this costs about $1,200 per month. More expensive regimens will approach $2,100 per month. This is clearly out of reach for many Singaporeans, especially the non-professional groups. The government of Singapore has taken a bold step in offering funding through Medifund, and I am appreciative of it.

Given that men form a significant proportion of the infected, it may be worthwhile that HIV screening be done more frequently with national service call-ups. This is something for the Ministry of Defence to consider.

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Crystal Clear
Never take your vision for granted
by Dr Lee Sao Bing Co-ordinated by Joseph Lim

EZYHEALTH MET DR Lee, Medical Director and Principal Surgeon of Shinagawa Lasik & Eye Centre, Singapore, and he stressed the importance of having our eyes checked annually. Dr Lee has many years of experience in using Lasik to treat myopia, hyperopia, astigmatism and presbyopia. Prior to this, he was the Head of the Cornea Service at the National University Hospital Eye Centre, where he performed cataract surgeries, cornea transplants, Lasik and PRK (Photorefractive keratectomy) surgeries. He was instrumental in setting up Shinagawa Lasik & Eye Centre in 2008 – designing the layout of the centre, acquiring equipment and training the staff. Dr Lee is one of a few doctors in Singapore who holds a Bachelors, Masters and also a Doctorate degree in Medicine. His degrees in Medicine and Surgery are from Singapore while his postgraduate degrees in Ophthalmology are from Singapore and United Kingdom. He also completed two fellowships, one in United States at the prestigious Bascom Palmer Eye Institute and one in Toronto, Canada. He is fellowship-trained in the field of Cornea and Refractive (Lasik) Surgery, which means that he has special interest in treating dry eyes, contact lens problems, allergic eye disease and all aspects of Lasik surgery. He has been invited to many international conferences to speak on Wavefront Lasik and Intralase and has published many research papers in international peer-reviewed journals. He is also the winner of four research awards in various research meetings and was awarded several research grants from the National Medical Research Council.

EH: Tell us why are you passionate about specialising in ophthalmology?

Dr Lee: Ophthalmology is a very visual field. An eye doctor can literally look at the patients’ eyes and come up with a diagnosis. Most eye diseases have good treatments available. This means that the patient will recover well and fast. It is very rewarding to make people see well again and I’m happy when my patients are happy.

EH: How does your usual day at the centre begin?

Dr Lee: I usually start my day by seeing a few patients in the clinic and then go into the operating theatre to perform surgeries.

EH: Share with us the USP of Shinagawa Lasik & Eye Centre

Dr Lee: The most important component at our centre is the human touch. We treat each patient as an individual. We believe that no two eyes and no two humans are the same. We therefore individualise our treatment plans according to the patient’s history and the eye data acquired from the patients’ eyes. This customisation is possible by not stinging in our investment of new and modern technologies.

EH: What has been your biggest challenge in your career?

Dr Lee: I can’t think of any particular event or milestone that has been the biggest challenge. It has been a series of challenges to get to where I am today. And I would say that I am still facing challenges. A constant challenge is to give every single patient the best vision possible. I work hard at every surgery to optimise the outcome.

EH: Share with us things that we take our eyes for granted?

Dr Lee: Many people in Singapore overuse their eyes. For example, many people spend too many hours in front of the PC or some hand-held device. Also some individuals do not follow the advice of their eye-care practitioner, such as wearing contact lenses for long periods or sleeping with lenses on.

EH: Tell us the latest innovation/trend in eye surgery/research.

Dr Lee: An exciting advancement in the field of Lasik is the use of cross-linking to strengthen the cornea. This has increasingly gained popularity in Europe, Japan, Canada and South America.

EH: Can you shed some light on cross-linking treatment?

Dr Lee: Cross-linking refers to a surgery that is used to strengthen the cornea. This was invented back in 1998 to help strengthen a cornea that is inherently weak (a disease known as Keratoconus). The first machine used took one hour of treatment time. But with advancements in technology, the treatment now takes a matter of minutes. This short treatment time allows it to be executed at the time of Lasik procedure (known as Lasik Xtra) in order to strengthen the cornea. We can now prevent a cornea from getting too weak from Lasik. This treatment is suitable for those with thin corneas and high spectacle correction.

EH: Give us some tips on maintaining healthy eyes

Dr Lee: Always rest your eyes after every 30 minutes of computer use, reduce the use of hand-held devices and get enough sleep each night, do not use tap water to rinse the eye instead use lubricant eye drops, and follow the advice of your eye-care practitioner with regards to contact lens usage.

EH: Are there any misconceptions to Lasik procedure?

Dr Lee: Yes, there are. Firstly, Lasik cannot treat astigmatism. Also, Lasik cannot treat presbyopia – we can treat this by doing monovision, i.e. one eye to see far and the other eye to see near. People think Lasik is a painful procedure when in fact, there is no pain experienced, however, some will experience some tearing and discomfort over the next few hours as the anaesthesia wears off. Another misconception to note is that Lasik cannot be done above a certain age. Lasik can be performed in an eye that has already undergone a cataract procedure of an 80-year-old individual.

EH: What would be the greatest harm we can do to our eyes without realising it?

Dr Lee: The most common error is to overuse contact lenses until an eye infection develops. This can potentially lead to blindness.

EH: What can you say about Singapore being the myopia capital of the world?

Dr Lee: This is a combination of genetics and environment. We cannot change genetics (at least not yet for myopia) but we can definitely change environment. So please take good care of your eyes by practising good eye care habits. EH: What are your leisure pursuits? Dr Lee: I enjoy outdoor activities such as tennis, jogging and swimming. I also have a penchant for good movies.

Lasik & Myopia – Interview with Dr Lee Sao Bing

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Going into battle
Fighting Singapore’s number one cancer
by Joseph Lim

EHB: Share with us what are the USP (unique selling points) for Fortis Colorectal Hospital (FCH).

Dr Koh: FCH occupies a unique position as the first and only hospital in Southeast Asia with a dedicated focus on the full spectrum of colorectal care. Our area of focus allows us to be very attuned and focused on the needs of our colorectal patients, ensuring optimal clinical outcome and patient experience. Resources will also be fully committed to this focus area, allowing for the provision of the most advanced medical technologies, and furthering the expertise, knowledge and skills of our medical team. Our team of four colorectal surgeons – Dr Francis Seow Choen, Dr Ho Kok Sun, Dr Lim Jit Fong and myself – each has a specific area of interest within the field of colorectal disease management and can effectively tap into one another’s experience and expertise as we seek the best treatment available to ensure optimal surgical outcome for our patients. Dr Lim’s area of focus is in pelvic floor disorders including fecal incontinence; Dr Ho in robotic surgery; and myself in colorectal cancer genetics and genetic counselling. Our Medical Director Dr Seow-Choen is one of the earliest to offer stapled haemorrhoidectomy in Singapore and also a pioneer in laparoscopic colorectal surgery in the private sector. This group practice model has enabled our patients to benefit from the expertise of not one, but multiple specialists with super-specialty interests in various aspects of colorectal care. In addition to clinical care, FCH, as a hospital focuses on a single specialty, in a unique and advantageous position to contribute actively to research and education in colorectal surgery. This focus on the academic mission is a crucial component, and unprecedented in Singapore’s private healthcare scene. We hope that through the education of other healthcare professionals in Singapore and the region, we are able to enhance and uplift the skills necessary to effectively treat colorectal conditions and create new knowledge that will help us as a medical community care better for colorectal patients.

EHB:  What are latest innovations in colorectal treatments today?

Dr Koh: The last two decades bear witness to the development of advanced minimally invasive (key-hole) surgical techniques in the management of colorectal cancers. Starting with conventional laparoscopic resections, single-port laparoscopic surgery and robotics-assisted surgical resections are now becoming more commonplace in many top centres in the world. At Fortis Colorectal Hospital, we are now embarking on the use of advanced robotic systems to more precisely dissect and remove colorectal cancers. Significant advancements are also seen in endoscopic techniques. We can now remove large polyps in the colon using the latest “Hybrid Knife” system through a colonoscope. Previously, these large polyps would require surgery for safe removal. In the area of anal disease management, hemorrhoidal surgery can now be done in a less painful manner using a stapling device to remove prolapsing piles. Those where symptoms of bleeding piles is the main issue can be treated using a doppler-ultrasound guided procedure to target the vessels for ligation with minimal discomfort and no down time from physical activities. Our understanding of the genetics of both sporadic and hereditary colorectal cancer has also advanced by leaps and bounds with the dawn of the genomic era. Deep sequencing technology has made available new discoveries and allowed more insight into the genetic changes that leads to colorectal cancer formation.  There are suggestions that hereditary colorectal cancers (such as Lynch Syndrome) in Asians may not share the same genetic expression as those in the West. We can expect more collaborative research and data sharing taking place to elucidate if there is indeed a unique genetic subtype in Asians. This will allow for better risk stratification and clinical management through comprehensive predictive genetic testing. To enable this effort to bear fruit, we have started a collaboration with one of the key research institutes under A*Star, the Institute of Bioengineering and Nanotechnology (IBN). Through a S$4.5 million grant, we have started the Fortis-IBN Tissue Bank that will allow us to perform cutting edge molecular research to gain more insights into the biology of colorectal cancer.

EHB: What is the mortality rate in Asia for colon cancer?

Dr Koh: Colorectal cancer is the third most common cancer worldwide with almost one million new cases diagnosed each year. It is now also the third leading cause of cancer mortality in men and women with more than half of diagnosed patients dying from the disease. Over the past three decades, the age-standardised incidence rate for colorectal cancer has increased from two to fourfold in Asian countries such as China, Japan, South Korea and Singapore. Mortality rates in Asian countries have risen concomitantly and in Singapore rates have doubled over the same period, now with incidence rates amongst the highest in Asia; colon cancer has recently surpassed lung cancer as the commonest cancer diagnosed in Singapore.

EHB: Do you think Asian diets and lifestyle have a huge role to play in the increase of colorectal cancer?

Dr Koh: I think the increasing ‘westernisation’ of our diet with more ingestion of refined, processed foods coupled with the pollution of our environment (especially air pollution) plays a role in our increased risks of developing colon and rectal cancer. Cigarette smoking is known to increase the risk of colorectal cancer by 30% and increase by two to three times the risk of developing polyps in the colon. A more sedentary lifestyle with a rising incidence of obesity in developed countries can also increase the risk of colorectal cancer by 1.5 to 3 times.

EHB: What is the leading cause of colorectal cancer?

Dr Koh: Colorectal cancer (CRC) arises from a combination of lifestyle/environmental factors (e.g. cigarette smoking) as well genetic factors. In some individuals with a strong family history of cancers, genetic factors probably play a larger role to increase their risks of developing colorectal cancer. Hence, even if one eats and lives healthily, genetic predisposition can still lead one to develop colorectal cancer. In fact, up to 30% of all colorectal cancers exhibit some degree of familial inheritance. At least 5% to 8% of these are inherited in an autosomal dominant fashion, i.e. the children of affected individuals carrying the mutated gene(s) have a 50% chance of inheriting the defective gene. Patients carrying these genes are at extremely high risk of cancers of multiple organs, including the colon, rectum, uterus, ovaries, stomach, small intestine, liver, kidneys and the brain. Their estimated lifetime risk of CRC is 80% and the lifetime risk of uterine and ovarian cancer is 30%.

EHB: What is your day-to-day profession like?

Dr Koh: My day starts with a quick breakfast at 6.30am with my wife then it is off to the office by 7.30am where I attend to emails. By 8am, I am usually at the wards to see the inpatients before starting the clinic at 9am. In between patients, I may do a few colonoscopies or minor surgical procedures. Afternoon usually see me performing major surgeries at the hospital. Evenings are mostly filled with administrative meetings at FCH or research meetings at A*Star starting at 5pm till 8pm. Then it is home for dinner and a couple of hours with my two daughters (aged three and eight). I usually read them bedtime stories before putting them to bed.

EHB: What led you to pursue the study of the colon?

Dr Koh: I am particularly interested in the genetics of colorectal cancer as I firmly believe that young people shouldn’t be afflicted with cancer. Unfortunately, most of the young people who develop cancer are likely to have a hereditary genetic problem that predisposed them to getting cancer. I hope that through my work in colon cancer genetics, I can help to better assess the risk of these high risk families and help to prevent more family members from getting cancers. I am particularly excited about the use of advanced technology such as the Da Vinci surgical robot that we now have to treat colorectal cancer. Which guy doesn’t like playing with fancy toys?

EHB: What is your most gratifying experience in this job?

Dr Koh: The most satisfying experience is in being able to remove a tumor from a patient whom others could not resect and being able to give the patient a chance to live. Seeing the patient recover from the brink of death and being able to spend meaningful time with their loved ones brings tremendous job satisfaction.

EHB: What are three main tips you can share with regard to having a healthy colon?

Dr Koh: Eat healthy, do regular exercises and most importantly, have a regular colonoscopy!

EHB: How do you spend your leisure time?

Dr Koh: I run regularly for leisure and to keep fit. I try to do at least two runs a week with a longer 10km run on the weekends. I take part in half-marathons yearly and as a Commander of a NS Battalion, I take my physical fitness very seriously. In my leisure time, I also indulge in writing Chinese calligraphy. This art form requires steady hands and a stillness of mind. Such attributes are useful in my line of work where surgical precision is a must.

Colorectal Cancer – Interview with Dr Koh Poh-Koon

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by Maripet L. Poso

Without passion, a dentist’s job is just that, a job with long, painstaking hours, cleaning and attending to every cavity and oral health concern there is. Imagine seeing 10 to 15 patients a day, with various dental problems, pacifying kids who are visiting a dentist for the first time, being careful with elderly patients, putting up with irate and whiny ones, while trying to give them the best dental care. Ideally, dentists do all these for the love of the profession, but sadly, some do it these days for obvious reasons – dentistry is one very lucrative industry.

Knowing somebody who is not only passionate about his profession but is willing to suffer criticisms of his conventional colleagues in order to give his patients innovative service to date is inspiring, to say the least. Soft-spoken and mild-mannered, Dr Oliver Hennedige of Oliver Dental Surgery Pte Ltd is one dentist you wished you had when you were five years old. You would have saved yourself from developing dentophobia.

Dr Oliver’s dental magic, however, is not confined to the four corners of his dental clinic. He endlessly seeks improvement and demands enhancement of his profession and services. It was through this exact passion that his patients nowadays get to benefit from Mini Dental Implants (Minis), small diameter implants that considered to be painless, require much less surgery and cause less trauma to patients.

After more than 20 years in the dental practice, he noticed that certain aspects of dental treatment could not be adequately addressed without the use of implants. Since he knew of some significant drawbacks of conventional implants, he began exploring the benefits of Minis. Ten years and 20,000 successful implants later, Dr Oliver is not resting on his laurels any time soon and is continually pursuing advancements and improvements of the craft, either by giving workshops and lectures or receiving them.

Ezyhealth & Beauty (EHB):

Share with us your journey to becoming one of Singapore’s most respected dentists practicing orthodontics.

Dr Oliver: At one stage of my career I focused on orthodontics and obtained excellent training in it. As a result, I’m able to provide orthodontic treatment, which maybe complex and involve either some surgery or orthodontic implants.

Today, my emphasis is on mini dental implants which I find extremely useful especially in fixed crowns and bridges. It is an uncomplicated system which makes it affordable to many patients especially the elderly. It is also a system which many more dentists could and should learn and be competent in.

Aside from practice, I’m also involved in organised dentistry, having been the President of Singapore Dental Association for six years and later the President of the Asia Pacific Dental Federation. Subsequently, I became its current Secretary General. I’m also concurrently the Executive Director of the International College of Continuing Dental Education as I’m passionate about upgrading the skills and expertise of dentists in the vast Asia Pacific region.

EHB: You are among the few dentists in Singapore who advocate the mini-dental implants procedure. We learned that when you were starting, you received a lot of criticisms for doing the Minis. Can you tell us a little bit about it, and how you have proven your critics wrong?

Dr Oliver: As there are detractors in the profession who cannot conceptualise the usefulness of Minis or for other reasons condemn it, I’ve written articles, conducted workshops and also given public lectures to educate both dentists and the public towards a better method of implantology with mini dental implants.

When I started, some of my colleagues made disparaging remarks about the Minis, and they in fact dismissed the procedure as not functional and only for temporary use. Today, many have taken me seriously. I’m convinced the public will see the benefit of Minis as it is happening in the USA and elsewhere. Minis for long term use are part of mainstream dentistry in USA.

EHB: You have been in the dental practice for so many years now. What do you consider your biggest achievement in your career so far?

Dr Oliver: I’ve been in practice from 1970 and I consider my greatest achievement was to recognise the usefulness of mini dental implants when I first heard about it at an American Dental Association’s Conference more than 10 years back. There was a learning curve and after carefully documenting my cases and studying them, especially those which gave trouble, I’ve honed my skills in the use of Minis. I understand how to use them effectively especially for fixed crowns and bridges.

I’ve not kept the knowledge to myself but have given lectures and conduct workshops widely in Singapore and several overseas countries.

It is with great satisfaction that I read recently in a leading mini implant report that in USA, among general dental practitioners and specialists, Minis today are one of the fastest growing sectors of implant dentistry. It is the treatment of choice of an increasing number of dentists and specialists worldwide. Research is supportive of these implants with proper treatment planning and placement.

EHB: They say dentists are workaholics, is there any truth to that? How do you keep your professional and personal life balanced?

Dr Oliver: Though it appears that I maybe a workaholic, I really enjoy working in my chosen profession. To me money has never been the motivating factor. I treat all, and if patients cannot afford the service, I do not charge them or I do give them a discount well below my cost sometimes.

I work hard but I enjoy doing dentistry. Part of my time is utilised in organised dentistry through the Asia Pacific Dental Federation; and the demand for lectures and workshops on mini dental implants in several countries keep my travel schedule pretty tight.

EHB: Any hobbies you wish to share to our readers?

Dr Oliver: To keep myself physically fit I do brisk walking in the morning and work out at the gym.

EHB: Please give our readers some fool-proof tips to take care of their oral health.

Dr Oliver: The best advice I can give to patients is that oral health is important to general health and wellbeing. It is not difficult to achieve optimum health by constant brushing your teeth and gums. Visit your dentist regularly. It will keep your mouth in a good condition. Do not neglect dental decay and gum disease.

Pushing Minis – Mini Dental Implants

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With age, most women experience a change in hormone metabolism, slowing the cell turn over and growth. Not only does this affect skin and bones but also hair, which can cause greying, hair loss and a change in hair texture that tends to become drier and finer.

With this natural ageing process comes the realisation that styles and products that once worked well for your hair no longer give the same results, which can be quite frustrating. But that does not mean that you can’t still have great looking hair. All you need to do is be aware of the changes that are taking place and understand what you can do to still look great no matter what age you are.

Handling Hair Loss

While it is quite natural to lose about 50 to 100 strands of hair a day, more severe hair loss could be due to poor nutrition and stress, which causes hair quality and texture to be dry and brittle to touch over time. To replenish moisture and strengthen the hair, use a hair mask once a week and go for a hair or scalp treatment at a hair salon once a month. A wide-tooth comb should also be used when detangling wet hair too as it is more vulnerable to breakage.

Heat damage (e.g. overuse of curling irons, improper use of the hair dryer, and frequent use of chemical treatments such as perm, colour, straightening) is another cause of hair loss. Thus, a serum or leave-in conditioner should be applied to protect hair from the heat before styling. The sun’s UV rays and environmental aggressors affect your hair too, so use a hair sunblock before going out and avoid excessive sunlight, chlorine and seawater where possible.

Getting Over Grey Hair

Over time, our natural production of hair colour pigments, melanin, slows down and our natural colour loses its colour strength, resulting in grey hair which can look dull and make you appear pale. To avoid doing so, you can use a volumnising shampoo and conditioner that gently cleanses the hair and adds volume while enhancing luster and bring out the hair’s natural shade.

You can also opt to colour your hair to add radiance and glow to your skin. Try warm shades such as Chestnut brown, Mahogany or Ash Brown that also lessen the colour contrast when your hair grows out. Avoid dark shades, brown or jet black though as these colours would make you look fierce and older.

Cinching the Right Cut

Gone are the days when you need to have a conservative haircut as you get older as your choice should only be limited by what best suits your features. If you have a round face shape, opt for hairstyles with volume at the crown of the head with soft gradual layers and wispy ends as it helps make the face appear slimmer, softer and sexier. If you have a square face shape on the other hand, mid hair length with curls or choppy ends are advisable to soften your angular jaw line to create a more balanced look.

Being older does not mean having to resort to short hair too. Medium length hair, which is well-textured, can be very sexy as you should be in your 50s and having shorter layers around the face styled up and away from your face (using a round brush) helps soften the frown lines around the eyes and gives the face a lift. Opt for bangs too as they are great for concealing forehead lines. If you have fine, thin hair though, short bobs help disguise it by providing volume.
Embrace your 50s and let your hair express your timeless beauty.

Shunji Matsuo is the Founder and International Director of Shunji Matsuo Hair Studio.

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Tips to Fight Skin Ageing - By Maripet L. Poso

Getting old is inevitable. But some people get more wrinkles sooner than others. Experts believe that wrinkles are due to genes (10 percent), lifestyle and the environment (90 percent). If this were true, then you have no one to blame but yourself for your premature wrinkles and age spots.

To remind you once again of what to do (and not to do) when it comes to caring for your skin, we’ve listed down some easy tips for you.

Dos:

Drink lots of water

It’s simple, lack of water causes dehydration, which in turn takes a toll on our body, especially on our skin – dryness and flakiness. Water intake not only helps to increase your body’s energy levels and aid in digestion, it is also essential in maintaining skin moisture.

Get enough shut-eye

Sleep allows your body to repair itself. So when you lack sleep, not only do you feel terrible, you look horrible, too. Go to bed early for a good rest, and your skin will thank you for it.

Load up on antioxidant foods and supplements

Antioxidants help boost your body’s ability to fight free radicals and protect your skin. Fresh fruits and vegetables, such as pomegranates and bok choy, are a good source of antioxidants, as well as yoghurt, whole grains, red wine, fish and even dark chocolates. Anti-ageing supplements have been found to be helpful in slowing down the ageing process as well.

Don’ts:

Smoke nor drink

Smoking breaks down collagen and elastin and causes your body to age prematurely. Cigarette is not only bad for your health, it’s bad for your skin, too. Another rapid ageing agent you should try to avoid is alcohol. Occasional drinking is not bad, even good, if it is red wine. But chugging three to six glasses a day will eventually take its toll on your liver and your skin.

Stress out

Stress makes you lose essential sleep and produces hormones that are bad for your skin. Notice how you break out when you’re stressed out? Do calming activities, like yoga or art, to deviate your mind from stressful situations.

Skip sunscreen

When it comes to your skin, the sun is your worst enemy. Just like smoking, the ultraviolet (UV) rays cause the elastin and collagen in your skin to break down. Wearing a good sunscreen everyday keeps your skin safe from harmful sun rays.

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- By Maripet L. Poso
“Choose a job you love, and you will never have to work a day in your life.”- Confucius

Dr Elias Tam, one of Singapore’s pioneers in aesthetic practice, must have taken Confucius’ saying to heart by the way he works and treats his profession: all heart and passion. Long before the term “aesthetic medicine” became all the rage, Dr Tam’s interest in the field was already clear cut.

In 1993, Dr Tam completed his medical degree from NUS. At a time when there were very few courses available in his chosen field, he took every opportunity to learn as much as he could about it, and that meant travelling to different countries to train with various experts. His passion for aesthetics started when he noticed that so many people were affected by skin and hair ailments, problems which he said can be prevented with the right treatment. “Because at that time, these problems were regarded as a ‘part of life’ and not even recognised as a health issue, people had to suffer in silence or resort to expensive yet useless treatment at beauty salons,” Dr Tam shared. “I started to look for a better solution for these patients. One thing led to another and before I knew it, I became deeply involved in aesthetic medicine.”

Today, he is one of the most respected names in aesthetics medicine and dermatology in the country. If he’s not at Elias’ Hair & Aesthetics (EHA) – a skincare clinic he established – providing hands-on treatments for his patients, Dr Tam is either attending or conducting seminars and training courses on aesthetics.

He remembered having his first laser, which was a simple CO2 laser, when he first opened EHA. Now half of his clinic space is filled with a profusion of different lasers and machines. We caught up with the boyish-looking doctor to fill us in on the latest beauty buzz in Singapore.

EHB: Among the many procedures you perform on clients, which are the most popular ones?

Dr Tam: Our EHA FUE (follicular hair extraction technique) hair transplant is a surgical procedure that is very popular with men who suffer from hair loss. For non-surgical procedures, having a facelift using Ultherapy is very popular both to improve as well as to maintain a firm and visibly lifted skin. My patients also have regular laser or IPL to rejuvenate their skin followed by Botox and fillers to smoothen and contour their facial features.

The most popular treatment for body contouring at the moment is “Coolsculpt by Zeltiq” because it has no down-time, is non invasive and very safe. The procedure uses extreme cold to destroy the fat cells similar to liposuction but without any surgery. Cool Sculpt is the only non-invasive treatment that actually destroys fat cells unlike other treatments that simply reduce the content of the fat cell temporarily.

EHB: What do you consider most satisfying about your profession?

Dr Tam: The looks of happiness on my patients’ faces when I help them solve an issue that has been plaguing them and eating away at their self-esteem and confidence is the most satisfying thing about my job. To be able to help someone look good and feel good about themselves is what made me choose this area of specialisation.

EHB: EHA has been around for more than a decade. What’s the philosophy behind your clinic?

Dr Tam: My belief that everyone can and should ‘look good and feel great’. We owe it to ourselves to look and feel our best at all times and my staff and I do our utmost to ensure that our patients leave the clinic looking and feeling wonderful.

EHB: You have a very busy lifestyle. How do you keep it balanced?

Dr Tam: By having forced Thursday nights and Sundays off to spend with my family. I also try to squeeze in regular exercise in the mornings before work. When I go for overseas conferences, my wife will come along with me so that we can have a short break together.

EHB: Aside from making other people look beautiful, what are you most passionate about? Any hobbies/passion you want to share with our readers?

Dr Tam: My wife tells me that I am married to my job because I am constantly striving to keep abreast of the latest innovations in the field of aesthetic medicine. Beyond my work in the clinic, I try to do my part for the community and volunteer my services for the Yellow Ribbon Project. For this project, I visit the prison to do tattoo removal for the inmates so that they can better assimilate back into society once their period of incarceration is complete. I believe that everyone deserves a helping hand and it is a privilege to be able to help in whatever small way possible.

I have also recently partnered up with local song-writer/singer Hagen Troy Tan to conduct school visits with the theme “The Choice is Mine”, a program to encourage the youth to adopt the right mindset and positive activities through interactive games, music and activities.

EHB: How does a well-known aesthetics doctor such as yourself take care of his body? Any skin and fitness tips for our readers?

Dr Tam: I believe in moderation, eating a balanced diet, getting adequate sleep and exercise. However, this is not always possible in today’s fast paced society. Playing with my three children – aged seven, 11 and 14 – gives me adequate exercise. I follow a basic skin-care regime using EHA gentle cleanser, moisturising gel and lightening eye cream from my own range of Japan-made skin care products. I also have my regular ”Skin Exercise”, a term I coined to stress the importance of light-based treatment and collagen stimulation using Ultherapy.

EHB: Organic skin care -  what’s your take on it?

Dr Tam: Many people have the misguided notion that anything natural should be safe. Unfortunately, this is not always the case. The truth is that any substance that has an effect comes with a potential side effect, regardless of whether it is organic. Therefore, in the case of organic skin care, it is important that these products be evaluated based on its efficacy and suitability for each individual.

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Growing up was not easy for Dr DeAndre. He was brought up in the streets of the poorest, most violent areas in United States – Hell’s Kitchen, New York City – known for its Mafia, druggies and high crime rates.

Having grown up in a poor Sicilian Mafia family where nobody ever graduated from high school, one wonders how Dr DeAndre made it to where he is today. “I was the first to graduate from high school and I decided to go to college. I wanted to become a doctor. We had no money so the only way was to study till I got a scholarship.”

A scholarship saw him through medical school in the University of New York where he successfully completed an accelerated program within six years. He later took the path into surgical residency. Today, he is a successful medical director and naturopathic doctor who works with the King of Thailand. He is also the representing doctor of MFIII’s stem cell therapies with a hand in reconstructive surgery, Traditional Chinese Medicine, Herbology, Hypnotherapy, Linguistic Programming, Social Psychology, Oxygen Therapy, just to name a few.

Why the choice of medicine and alternative healing therapies, I ask. “I came from a family where taking care of people was very important. My family was involved in the Mafia so it was very important that we were united and took care of one another. That propelled me to take up medicine. I wanted to make my family and my community better. I wanted to make things happier for people, and I thought the best way was to take care of their suffering.”

Work and norms

Having lived most of his younger years in New York, one would have thought it was only natural for Dr DeAndre to build his business of two clinics in the swankiest parts of the city. Instead, he chose Bangkok, Thailand. “I like Thailand for many reasons. People there are compassionate and happy. Plus, I believe that Thailand, being affordable, will become a medical hub of Asia.”

After years based in Bangkok, one would imagine Dr DeAndre has adopted the friendly, affable culture of the Land of Smiles. But he shares he is not the easiest person to work with. “I am very hard on myself, I focus a lot on details. I tell my staff that they can only make one mistake. If they repeat the same mistake, they will not be working with me anymore. I work to help and heal people. I cannot afford any mistakes. You like me only because you are not working with me.” The corners of his eyes crinkle with laughter but I suspect he means business.

Transition of knives – From Mafia to surgery

Dr DeAndre’s life story reminds me of the noblest of tales, only truer. At the tender age of seven, Dr DeAndre’s biological father left the family in the ghettos. At 14, his stepfather came into the family. Playing an active part of the Mafia,

Dr DeAndre’s new father had no qualms on encouraging his teenage stepson to join the Mafia. “Time and again, he would ask me to join the Mafia. We finally agreed that I would help them but not work for them.” Stabbings and gangs were just some of the day-to-day threats Dr DeAndre faced growing up in the notorious neighbourhood. “I was good with the knife because of the environment I grew up in. My cousin, my only close friend, nearly died from a stab wound. My stepfather was Sicilian, heavily involved with the Mafia and he often reminded me if school didn’t work out, there was always the Mafia I could count on.”

It certainly took young DeAndre an admirable amount of perseverance and hard work – but he found his place in the prestigious, ivy-leagued Princeton University in New Jersey. “I decided on joining Princeton instead of the family’s Mafia business. My dad told me, you could join me, or pay for your own education. He was not supportive of me becoming a doctor.”

But like any other father, Dr DeAndre’s dad was no different – he loved and was proud of his son in his own way. “When I graduated from medical school he showed up and said to me, ‘Alright, let’s see what you can do from here.’ My father and I share a good relationship. We often disagree but we respect each other. We are close. He is coming to live with me in Bangkok where I will look after him. Today he is asking why I am in my forties, still unmarried,” chuckles Dr DeAndre.

His mother, on the other hand, is far from her flamboyant husband, Dr DeAndre shares. She is a quiet lady who wishes happiness for everyone and finds joy in simple things like feeding her pet bird. “My mother is an Egyptian Jew and the only fan in my fan club. She is dyslexic and has attention deficit. She had little education but she knows how to love, and she loves me unconditionally. She always reminds me to do what makes me happy.”

Life matters

Dr DeAndre thinks about life a lot. Like a light bulb that projects light, Dr DeAndre is a fountain of knowledge, information and curious thoughts. “I’ve been in 28 countries and I’ve lived in eight. I’ve been to less-travelled-to places such as Saudi Arabia, Lebanon and Palestine. I speak English, Spanish, and Italian, and understand some Yeddish and a little Thai.”

When asked about his favourite place in the world, he jumps in without any hesitation. “I’ve seen many cities and they don’t do anything for me. They just look like they are trying to out-create each other. I like nature. I love Papeete, a small island of Tahiti. There are only 5,000 people on the island and you live by when the boat comes to bring the food, and you walk in the dirt every day. It’s also the only place in the world where I can surf alone, with nobody taking the surf from me. I think about going back there, staying in a little hut, eating fruit, surfing all day, and settling down with a Tahitian girl.”

As our interesting chat drifts on, the well-travelled doctor goes on to share random philosophies and thoughts on religion and culture. “I’ve been in many different cultures, travelled to many parts of the world and read at least 10 religious books – the Quran to the Bible. In Middle East, people kill each other. My mother is Muslim so I wanted to understand more. See, belief is beautiful. As soon as you believe something, you will guard it with your life and you will harm others for it though it is just a thought in your head.”

From ghetto to Princeton, all over the world, and then West to East (New York to Bangkok), Dr DeAndre’s heart stays with the people of Thailand. “People in Thailand don’t really live thinking about the future or the past. There is the negative side and the positive side to it as well. I realise that I spend too much time worrying about what is going to happen ten years from now!” And his honest take on Singapore? “Singapore has a culture like an Apple computer compared to a PC. It’s straight to the point, no bull***t in order to make sense – everything is clean and accessible.”

I let out a laugh and nod my head in agreement.

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Many probably didn’t know that March is Colorectal Cancer Awareness month, or that colorectal cancer is one of the top cancers in Singapore. Unless you have it, or someone in the family has it, it’s easy to not care about colorectal cancer. But do you know you might have it and not know it yet?

According to the Singapore Cancer Society (SCS), about 1,400 Singaporeans are diagnosed with colorectal cancer every year. In most cases, the cancer develops slowly and over a long period of years, starting either in the colon or the rectum. Although there is no single cause of colon cancer, all colon cancers start as benign polyps and progress slowly into cancer if left untreated. Polyps are growth of tissue that begin in the lining and grow into the center of the colon or rectum. Not all polyps are cancerous, and removing these polyps prevents them from becoming cancer.

People who have a family history of cancer, above 50, and have a diet high in red meat are at risk of getting colorectal cancer. The good news is, when it is detected before symptoms develop, this cancer is highly curable.

Early detection

Colorectal cancer is a silent disease. People who have colorectal cancer are often unaware they have it because it does not show any signs, until during its late stages. Abdominal pain and rectal bleeding are some of the symptoms of colorectal cancer.

 To spread awareness and promote screening of the disease, the SCS is offering free Faecal Occult Blood Test (FOBT), a preliminary screening test for colorectal cancer. This safe and easy-to-do test detects for the presence of hidden small amounts of blood in the stools. The SCS encourages those who are 50 years old and above to get their free FOBT kit from the SCS office or select Guardian stores. Visit http://www.singaporecancersociety.org.sg for more details.

 Other modalities of advanced screening, such as sigmoidoscopy, colonoscopy and double contrast barium enema, are also used to detect cancerous and pre-cancerous growth in the rectum and lower colon. If detected, colorectal cancer requires surgery, and sometimes radiation and chemotherapy, for complete cure. Most patients go back to their normal, healthy selves once cancer is detected and treated in the earliest stages. But those who are diagnosed and treated in the later stages of the cancer don’t usually have the same fate. Awareness and early detection are key to combating colorectal cancer.

Specialty centre for colorectal care

Thanks to dedicated medical and healthcare specialists, Singapore has a new ally in its fight against colorectal diseases. Dr Francis Seow-Choen, Dr Ho Kok Sun, Dr Lim Jit Fong and Dr Koh Poh Koon have partnered with healthcare group Fortis Healthcare to establish the Novena Colorectal Centre, which was launched in February. The new specialty centre is committed to the introduction of innovative techniques in colorectal research, investigation, and treatment of colorectal diseases.

The new centre aims to offer the best standards of care to patients, focusing on providing comprehensive and integrated colorectal care, specialising in the areas of minimally invasive treatments, robotic surgery, genetic testing and pelvic floor disorders. One treatment that the centre offers is Video Assisted Anal Fistula Treatment (VAAFT). VAAFT is a minimally-invasive technique used in the treatment of a common colorectal condition called anal fistula, where a small channel develops between the end of the bowel and the skin near the anus.

According to Dr Seow-Choen, Medical Director, Novena Colorectal Centre, colorectal diseases are unique and cannot always be treated in just one way. Effective treatment requires involvement of several complementary specialties.

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By Maripet L. Poso

At a time when becoming a cardiologist was all the rave for aspiring doctors in Singapore, Dr Ang Peng Tiam has decided his calling was to help conquer cancer. And he was right. Decades later, he still finds satisfaction in personally looking after his cancer patients, even leaving a prestigious post at Singapore General Hospital to focus on his private practice.

Dr Ang, Medical Director and Senior Consultant at the Parkway Cancer Centre, studied medicine on the Singapore President’s scholarship and finished with flying colours. He received the Prof Sir Gordon Arthur Ransome gold medal for topping the clinical examinations in 1986. He then pursued his fellowships at the prestigious MD Anderson Cancer Center in Houston, Texas, and at the Stanford University Medical Center in California. Upon his return to Singapore 20 years ago, he founded the first ever oncology department in the country, and the rest, as they say, is history.

For Dr Ang, his fight against cancer does not end within the four corners of his clinic. He utilises the power of words and the media to inform people about this deadly disease. He has written a couple of books, such as “Doctor I have cancer. Can you help me?” and contributes regularly to DocTalk in Mind Your Body, a health supplementary of Straits Times. He gives talks and presentation about cancer in various events and health forums. He grabs any chance he gets to empower people about cancer.

Ezyhealth & Beauty is honoured to get a chance to pick on the mind of a true blue cancer warrior.

The road to oncology

Ezyhealth & Beauty: You initially thought of specialising in cardiology, what made you change your mind and pursue oncology instead?

Dr Ang: At that time, all the “bright” doctors in Internal Medicine wanted to specialise in cardiology.  Considering myself “amongst the best”, I too wanted to do cardiology. I met with Dr Kwa Soon Bee, then the Director of Medical Services, who encouraged me to consider oncology. He felt that cancer was fast becoming a major problem, and that he needed committed doctors to consider specialising the field and provide leadership in care for cancer patients.

EHB: How was it like founding the first ever oncology department in Singapore 20 years ago? What were the challenges you faced, support you received?

Dr Ang: It was very exciting. Soon after I returned from my oncology fellowship at M.D. Anderson Cancer Center and Stanford University Medical Center, I was tasked to establish the first Department of Medical Oncology, and train medical oncologists to meet the manpower needs to care for cancer patients.

I remember the early days when I was head of department; I had one, then two registrars under my charge.  I was given ample resources and funding. The hospital gave me full support in developing the department. Today, there are probably no fewer than a hundred medical oncologists in Singapore.

EHB: After establishing and heading the oncology department of Singapore General Hospital for years, why did you decide to go into private practice?

Dr Ang: I left in 1997 for private practice. Many could not understand why I gave up a promising career in institution. At the age of 36, I was already a senior consultant, head of department, clinical associate professor and a member of the medical board.

In institution, one has to balance clinical care, research, teaching and administration. As I climbed the corporate ladder, I gradually spent more and more time attending meetings and less and less time looking after patients.

After serious reflection, I felt that I enjoyed caring for the patient more than anything else. Furthermore, I was looking for greater personal challenges. Hence, I decided to give myself time to “try out” private practice. If I didn’t like it, I knew that I left behind open doors which I could always go back to. I never looked back after joining Mount Elizabeth Hospital. I started off as a one-man oncology practice. One after another, my colleagues joined me and in 2006, we merged the various clinics to form Parkway Cancer Centre (PCC).

EHB: Of all the things you’ve done in your profession, what do you consider your biggest accomplishment so far?

Dr Ang: It is not for me to say what I have accomplished but for history to decide. What I may consider an achievement today may one day be considered folly.

Beating cancer

EHB: The mere mention of the word cancer makes a lot of people shudder, what do you always tell your patients about this dreaded disease?

Dr Ang: Cancer is not a death sentence. There have been many who have contracted the disease and beaten it. As doctors, our responsibility is to keep ourselves updated on the advances in cancer management and to treat each patient with dignity and compassion.

I like to tell stories to my patients; stories of hope to inspire them that they should not be disheartened but instead to battle the illness with courage.

At PCC, we strive to not only attend to the physical needs of cancer patients but also to provide the necessary psychosocial support for our patients. We do this through our CanHope counselors, monthly HealthNews, regular public seminars, medical documentaries on Channel News Asia – “Journey of Hope” and “Edge of Life.”

EHB: Have people’s perceptions toward cancer changed now from when you were starting as an oncologist 20 years ago? How so?

Dr Ang: Of course! One person who has made a significant impact on people’s perception of cancer is our Prime Minister Lee Hsien Loong. When he was diagnosed with lymphoma, a cancer of the lymphatic system, he did not hide the disease but instead came out publicly to talk about it.

He was shown, in the media, bald as he was undergoing chemotherapy. He talked about how he continued to exercise while he was on treatment. He talked about his own mortality. But when he triumphed over his cancer, he brought hope to many others who were battling the disease, or had family members and friends who were with afflicted with cancer.

Many do not see cancer as a death sentence any more but merely one of many illnesses that can be controlled and even beaten.

EHB: Please educate our readers on the cancer situation in Singapore.

Dr Ang: Our most common cancer is colorectal cancer. In my opinion, this is one which no one should even get, let alone die from. I say this because this is a cancer that takes a long time to develop – three to ten years. Colon cancer starts off as benign polyps, and these polyps undergo transformation and turn into cancers.

However, the process of transformation is very long. If we all go for screening colonoscopy once every three years, theoretically, no one should even develop colon cancer. During the procedure, these polyps can easily be snared off, so that they are not given any chance to turn

into cancer.

The Ministry of Health has approved the use of Medisave funds to pay for screening colonoscopy. My sincere hope is for everyone above the age of 50 to go for their scopes regularly. This will help us to nip the problem in the bud before the polyps can develop into colorectal cancer.

EHB: What do you say are the biggest hurdles of patients in battling cancer? What needs to be done to alleviate these hurdles?

Dr Ang: One of the biggest hurdles in battling cancer is the cost of treatment. I have never been an advocate of insurance, but I am now a convert. Cancer treatment is very expensive. Each year, new and better cancer treatments are available. But these new drugs do not come cheap. There is nothing more frustrating for a doctor than to know that there is an effective treatment for the cancer, but cannot offer it simply because it is not within the financial means of the patient.

I sincerely hope that all Singaporeans will sign on to the enhanced medishield plans as this can truly make a difference between life and death.

Keeping a balanced life

EHB: Amidst your busy profession, how do you relax and keep a balanced life?

Dr Ang: I enjoy eating and I enjoy the company of good friends. Every morning, after I finish seeing the inpatients, I sit down with a bunch of buddies to have a drink and share a good yarn. We call ourselves the “car big cannon” club. In Cantonese, it’s which simply means telling a tall tale.

During these sessions, we discuss every topic imaginable – politics, medicine, scandals and what have you. My New Year resolution for 2012 is to try and lose 5kg but so far, I’ve lost only 0.5kg! Seeing how many big dinners I have had since the start of the year, I’m not hopeful that I’ll succeed.

EHB: Any hobbies and other passion you want to share to our readers?

Dr Ang: I’m a rather boring person. Besides my work, there’s nothing that really excites me. I enjoy watching movies in the cinema with my wife. Traveling is fun – be it for holiday or even just for work. I dislike exercise, but I force myself to run on the treadmill and go for walks. I enjoy going out with friends and family to eat and fellowship.

EHB: Is there anything else you want to accomplish in life?

Dr Ang: I want grandchildren….  If possible, lots of them.

“There is nothing more frustrating for a doctor than to know that there is an effective treatment for the cancer, but cannot offer it simply because it is not within the financial means of the patient.”
Dr Ang Peng Tiam, Medical Director and Senior Consultant at the Parkway Cancer Centre

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Colorectal cancer is the cancer of the large
intestine, which consists of the colon
and rectum. The incidence of this bowel
cancer is increasing at an alarming rate
in South East Asia and may become
the number one cancer in the next 10 to 20 years.
Health education remains the cornerstone in the early
detection of this cancer, which is curable.

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By Maripet L. Poso

Articulate, soft spoken and passionate about promoting health education, Dr Asha K Karan of Smile Makers Dental Clinic commands attention whenever she speaks, evoking a sense of calm and authority. Her ability to make her patients understand the importance of dental care in a simple language and engaging style is among her traits that sets Dr Asha apart from other dentists.

A graduate from the National University of Singapore, Dr Asha has been practising dentistry for more than
20 years. She also holds a Diploma in General Dental Practice from the Royal College of Surgeons, United Kingdom. She founded Smile Makers Dental Clinic to help change people’s attitude towards dental care.

Her passion for health education goes beyond the four corners of her dental clinic. In her spare time, Dr. Asha has volunteered within the community, providing pro bono dental care for residents of charitable homes. For 13 years, she was president of the Singapore Dental Health Foundation, an organisation dedicated to public education and health promotion.

A true smile maker

Ezyhealth & Beauty: What do you find most satisfying about your work?

Dr Asha Karan: The smiles my patients give me. We are Smile Makers after all. I like dressing up my clinic with photos of my patients’ smiles.

EHB: Why is a smile important?

Dr Asha:   Your smile is a reflection of yourself. It’s a reflection of your self-esteem, your values. If you have taken the time to take care of yourself, it means that you are a careful person who values your health, and you want to portray yourself in the best way possible.

EHB: What does it take for you to bring your patients’ beautiful smiles back?

Dr Asha: One, we want to help the patient get the smile that they desire. But we must be realistic. Patients’ expectations must also be realistic. Two, we empower them with the right techniques, the right information, so that they can maintain the health of their teeth.

When someone comes for veneers, for example, we must first assess whether their mouth is healthy. Veneers are largely a cosmetic procedure. We can’t do a cosmetic procedure if we find that the basic health is not there. So we may have to spend some time getting their gums and teeth into good health first. But there are people who say ‘I’m very busy, I’m flying here and there. Do it now’.

EHB: How do you deal with such patients?

Dr Asha: We want what’s best for them so sometimes we have to say, “No”. We explain to them that it is in their best interest to have treatment done in the right sequence. After the mouth is much healthier, do the cosmetics. There are times when patients come in with the wrong perceptions about what they need. For example, if their teeth are irregular, then veneers may not be the answer. They may need to straighten their teeth first. After straightening the teeth, then, if needed, improve the colour and shape with veneers.

Patient care through education

EHB: How important is health education for you?

Dr Asha: For me, health education has always been important. I see myself as a health professional. The very word, “profession” implies a duty to the community. I feel strongly that I have a duty to patients, not only to give them what is best for them, but to equip myself with knowledge and skills to give them what is right for them. The duty of care for the patient involves keeping myself abreast of the latest techniques and technology in dental care. Health education comes naturally to me. I see it as an essential part of my work as a health professional.

EHB: When it comes to your dental practice, you believe in putting health first before beauty. Can you elaborate on this?

Dr Asha: Dentists are not mere service providers. There has to be congruence between patient’s values and the doctor’s values. I’d rather restore health before I chase beauty. Patients need to know how to maintain health. For example, straight teeth are more important than white teeth. Straight teeth are easy to clean. With straight teeth you have more efficient bite. If you have straight teeth, your smile looks more refined. Whitened teeth is like the icing on the cake. But first you have to make sure that the cake is good.

EHB: How necessary is oral health education in dental practice?

Dr Asha: If the patient does not understand what I’m doing, they won’t appreciate why I do it. They’re not going to take care of themselves either. Also, it has something to do with fear. People fear what they don’t know. If you make it known to them, if you explain to them in a very simple language, they will say, “Hey, that makes sense!”. Knowledge about their health gives them better sense of control. It gives them confidence that they are getting the right treatment.

The importance of consultation

EHB: Do you have a fool-proof approach to treating each patient that comes to you?

Dr Asha: There is no one size fits all. There is no one solution for everything. That’s why spending time at a consultation, understanding the patient’s condition, understanding their limitation of time, budget and priorities is necessary. It’s all about patient-centered healthcare. Understanding the patient’s values helps us to customise the treatment. So the initial consultation process is important.

EHB: What do you consider the most valuable service you provide to your patients?

Dr Asha: A person can spend several thousands of dollars straightening teeth or getting crowns and implants made. But if he does not maintain his teeth, all that sophisticated work is not going to last. Straightening teeth, inserting implants, making crowns and dentures, that’s just one part of my work — the more technical part of the work. But helping you, the patient, understand the nature of the problem, and then helping you to control it or to overcome it — that’s my most valuable service. That’s patient empowerment.

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The discovery of antibiotics, also known as microbial drugs, has been considered one of the most relevant healthcare breakthroughs in the world. Antibiotics are medications that fight infections caused by bacteria. Penicillin, the first antibiotic, was discovered by Alexander Fleming in 1928. By 1940s, the use of antibiotics has transformed medical care, saving lives and reducing illnesses caused by infectious diseases. However, many studies reveal that over the years, the effects of antibiotics have been declining. One of its causes is the continuous spread of antimicrobial-resistant bacteria.

As with the rest of the world, Singapore faces increased risks of widespread antibiotic resistance. According to a study, there is sufficient evidence that the problem is pervasive in Singapore. And the country’s public sector hospitals currently have some of the highest rates of antimicrobial resistance worldwide, evolving with surprising speed over the past two decades.1

A serious medical concern

Antibiotic resistance has been one of the most serious public health problems worldwide. Because of antibiotic resistance, common infections become untreatable with antibiotics. This poses significant health risks.

According to US Centers for Disease Control and Prevention, “If a microbe is resistant to many drugs, treating the infections it causes can become difficult or even impossible. Someone with an infection that is resistant to a certain medicine can pass that resistant infection to another person. In this way, a hard-to-treat illness can be spread from person to person. In some cases, the illness can lead to serious disability or even death.”2

Another study found penicillin to be ineffective against 40% of the streptococcus pneumonia (SP) strains in Singapore3. This is alarming since SP is a major cause of pneumonia, meningitis, acute sinusitis, sepsis, bacteremia and other pneumococcal infections.

Causes of antibiotic resistance

There’s a reason why doctors are very strict when it comes to antibiotics usage. Repeated improper use of antibiotics is one of the top causes of antibiotic resistance. Whenever a person takes antibiotics, sensitive bacteria are killed, but resistant germs are left to grow and multiply.

To promote growth and prevent diseases in healthy food-producing animals, antibiotics are also routinely used in animal husbandry. According to the World Health Organization, this practice causes the emergence and spread of resistant bacteria in both humans and animals. For example, “the use of fluoroquinolones (e.g. enrofloxacin) in food-producing animals has resulted in the development of ciprofloxacin-resistant Salmonella, Campylobacter and Escherichia coli, which have caused human infections that proved difficult to treat. In several instances, such bacteria have spread worldwide through travel and food trade.”4

Many countries also have available over-the-counter and substandard antibiotics, which gives way to inappropriate usage of the drugs. Failure of medical institutions to implement infection control practices is also a major cause of antibiotic resistance.

Hope for managing antibiotic resistance in Singapore

The Southeast Asia faces a serious issue of antibiotic resistance, as the region is a hotspot for emerging infectious diseases, including those with pandemic potential like severe acute respiratory syndrome (SARS) and avian influenza A H5N15. And Singapore is not spared from risks of these infectious diseases.

Recently, GlaxoSmithKline (GSK) did a Survey of Antibiotic Resistance (SOAR) study, focusing on antibiotic resistance among three types of bacteria from Singapore. SOAR is an antimicrobial resistance surveillance study of key respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) isolated from patients with community-acquired respiratory tract infections. The study “confirmed that although penicillin’s effectiveness is decreasing, 98.5% of streptococcus pneumoniae strains can still be effectively treated with amoxicillin-clavulanate and amoxicillin.”

“It is welcome news to have antibiotics such as amoxicillin-clavulanate and amoxicillin that remain highly effective against most SP strains for first line defense,” said Dr Leong Hoe Nam, Consultant Infectious Diseases Physician at Raffles Hospital. Amoxicillin-clavulanate has been providing good susceptibility protection against SP strains for the past 30 years.

To help prevent antibiotics resistance, Dr Leong advised patients to avoid taking an antibiotic for a viral infection like a cold, a cough or the flu. He said, “The key is to treat it right the first time with the right dose. Never skip doses, and always complete the prescribed course of treatment, even if you are feeling better. Patients must become compliant and finish off the full course antibiotics prescribed. Their doctors must prescribe antibiotics more prudently and moderately.”

The SOAR studies have been conducted in various countries in the Middle East, Africa, Asia Pacific and Latin America since 2002 as an extension to the Alexander Project. SOAR is running in 28 countries in 2010.

Tips to prevent antibiotic-resistant infections
     Only use antibiotics when they are likely   to be beneficial.

    Talk with your healthcare provider about antibiotic resistance.

    Do not take an antibiotic for  a viral infection like a cold or the flu.

 Do not save some of your antibiotic for the next time you get sick.

   Take an antibiotic exactly as the healthcare provider tells you.

      Do not skip doses.

   Complete the prescribed course  of treatment even if you are feeling better.

  Do not take antibiotics prescribed for someone else.2

References:

1.    Reducing antimicrobial resistance through appropriate antibiotic usage in Singapore, Singapore Medical Journal, Hsu LY, et al, 2008

2.      http://www.cdc.gov/getsmart/antibiotic-use/anitbiotic-resistance-faqs.html#d

3.      Antibacterial resistance among Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis from Singapore, Brien et al. 2009-2011

4.  http://www.who.int/world-health-day/2011/presskit/whd2011_fs4d_subanimal.pdf

5.      Emerging infectious diseases in southeast Asia: regional challenges to control, Coker et al., 2011

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