Healthnews Jan03-cast - Raffles Medical Group

Ladan and Laleh Bijani are one of very few living sets of
craniopagus twins i.e. conjoined twins who are connected at their
heads. And very few can identify with the kind of adjustments and
compromises they have to make every single day.
“We are two completely separate individuals who are stuck with
each other. We have different lifestyles and we think very differently
about issues,” Ladan told a media gathering at Raffles Hospital in
December. If they continued living the way they do, she said, they
would not be able to stand it anymore.
One wants to pursue a career in law, the other in journalism and
communications. One wants to go home to Shiraz, the other wants
to stay in Tehran. But they share a common, much cherished dream
– to lead separate lives.
Conjoined Twins - Ladan (left) and Laleh Bijani
“
We are two completely
separate individuals who
are stuck with each
other. We have different
lifestyles and we think
very differently about
issues,
And they are looking to Raffles Hospital to help
them fulfill this dream.
Ladan and Laleh had sought international help for high-risk surgery
to separate themselves but to no avail. They turned to Singapore
after hearing of Dr Keith Goh and his team’s success in separating
Nepalese twins Ganga and Jamuna – conjoined twins also
connected at the heads – in April 2001.
They arrived in Singapore in late November and have completed
a comprehensive series of physical, psychological and psychiatric
tests to determine if they could be surgically separated.
Thorough testing and evaluation is paramount. “We need to
determine the best plan with the least amount of risk,” said
Dr Goh who is now Raffles Hospital’s Consultant Neurosurgeon
and leading the care of Ladan and Laleh.
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13
At an earlier press conference, Executive
Chairman Dr Loo Choon Yong had said: “This
is a very serious undertaking. We must make
sure that the investigations are thorough and our
evaluations are supported by independent experts
before we decide to proceed to the next step.”
The twins went through in-depth tests that included
detailed brain scans by a multi-slice Computed
Tomography (CT) Scanner and high-field Magnetic
Resonance Imaging (MRI) System, angiograms and
various functional tests.
The multi-slice CT scanner and MRI system provided
different high resolution three-dimensional X-ray
images of their brain and surrounding tissues. The
angiogram is an x-ray test of the arteries.
The findings are studied and evaluated by the medical
team at Raffles Hospital. Second opinions have also
been sought from specialists from other hospitals in
Singapore and overseas.
While preliminary findings indicate that surgery to
separate them is feasible, our doctors are now deep
in deliberation, evaluating various surgical strategies
we can adopt and the risk that each carries.
Ladan (left) and Laleh Bijani preparing for a CT Scan in
Raffles Hospital in November 2002
At press time, the decision whether to go ahead with
the separation surgery is pending. An announcement
will be made through the media once the decision is
reached.
Since news of the twins broke, well-wishers from
Singapore and overseas have contacted us to offer
their assistance. The local Iranian community in
particular has rallied around the twins. The Iranian
Ambassador has offered his support during his visit
to the twins at Raffles Hospital.
Dr Goh said: “Discussions are still going on among
the doctors and with the twins. In the meantime, we
are also dealing with issues of medical ethics, legal
consent and arrangements for post-operative care and
follow-up care in Iran should the surgery go ahead.”
HE Mr Abdollah Zifan, Iranian Ambassaor, (left) and
HE Mr Gopinath Pillai, Ambassador to Iran, visit the twins
in December 2002.
Mr Reza Rezaie, 2nd Secretary to HE Mr Abdollah Zifan,
talking to the Bijani Twins.
MEDICAL SAMARITANS FUND
2
The doctors involved and Raffles Hospital are donating
our services and facilities to Ladan and Laleh.
If you would like to make a donation to assist
Ladan and Laleh, you may make a cheque to
“Medical Samaritans Fund” and send it to
Should the landmark surgery to separate Ladan
and Laleh go ahead, we will still need to appeal
both internationally and locally for funds to
defray other expenses such as medicine and use
of equipment.
Raffles Medical Group
Attn: Medical Samaritans Fund
585 North Bridge Road
Raffles Hospital #11-00
Singapore 188770
Raffles Healthnews • Issue 1/2003
New Specialists
at Raffles Hospital
Dr Seng Yi Chern
MBBS (S’pore), MRCP (Paed) (UK), MRCPCH, FAMS
Consultant Paediatrician
Dr Seng Yi Chern joined us in October 2002 and now
practises at the Raffles Children’s Centre at Raffles
Hospital as well as our Women’s and Children’s Clinic
at Tampines Junction.
Before joining Raffles Hospital, Dr Seng was an
associate consultant in the Respiratory Medicine
Service, Department of Paediatric Medicine, at Kandang
Kerbau Women’s and Children’s Hospital.
Dr Seng is a graduate of the National University of
Singapore and obtained her post-graduate degree,
Member of the Royal College of Physicians (UK)
(Paediatrics) in 1998.
She obtained the Certificate of Specialist Accreditation
in Paediatrics from the Ministry of Health in 2001. The
following year, she became a Member at the Royal
College of Paediatrics and Child Health, and a Fellow
of the Academy of Medicine Singapore.
Dr Keith Goh Yu-Ching
MBBS, FRCSED, FHKCS, FHKAM
Consultant Neurosurgeon
Dr Keith Goh joined Raffles
Hospital in November 2002 as
Consultant Neurosurgeon.
He was previously Consultant
Neurosurgeon at Singapore
General
Hospital,
with
concurrent clinical and research
appointments at KK Women’s
& Children’s Hospital, National
Cancer Centre and National
Neuroscience Institute. He is
also a Visiting Lecturer to the National University of
Singapore.
Dr Goh will spearheard the development of a NeuroCentre at Raffles Hospital to provide specialised
programmes of care that integrate neurosurgery and
neurology services with associated specialties. These
include Brain Tumours, Paediatric Neurosurgery, Stroke,
Epilepsy, Spine Functional Restoration and Pain
Management.
Dr Goh’s main research interests are in neuro-oncology,
tissue engineering and virtual reality surgical techniques.
He has an extensive bibliography of more than 90
papers, abstracts and book chapters in various peerreviewed journals, scientific meetings and neurosurgery
textbooks.
Dr Goh earned his medical degree from the National
University of Singapore in 1985. This was followed by
neurosurgical residency at the Prince of Wales Hospital
in Hong Kong and subspecialty training at the Institute
for Neurology and Neurosurgery of the Beth Israel
Medical Centre in New York.
Dr Lim Lian Arn
MBBS (S’pore), FRCSG
Consultant Orthopaedic Surgeon
Dr Lim Lian Arn joined Raffles
Hospital as our Consultant
Orthopaedic Surgeon in
December 2002.
Prior to joining Raffles
Hospital, Dr Lim was a
Consultant in the Adult
Reconstructive Service of the
Department of Orthopaedics
in Tan Tock Seng Hospital.
Dr Lim graduated from the National University of
Singapore in 1989 and obtained his post-graduate
degree in surgery in 1994. On completion of his
advanced orthopaedic training, Dr Lim spent a year at
the Mayo Clinic in Rochester, USA. His surgical training
at the Mayo Clinic focused on joint reconstruction
techniques such as primary and revision hip and knee
replacement surgery.
In addition to his general orthopaedic work, Dr Lim now
specialises in minimally invasive partial knee
replacement, total knee replacement and hip
replacement surgery. He also has extensive experience
with sports injuries including shoulder instability, knee
ligament reconstruction and arthroscopy.
Aside from his work in Singapore Dr Lim has lectured,
organised and run orthopaedic training workshops and
performed surgery in China, Indonesia and Myanmar.
Raffles Healthnews • Issue 1/2003
3
Raffles Medical Group
Achieves ISO 9001:2000
Raffles Medical Group marked another milestone in its
quality journey with the ISO 9001:2000 certification on
24 October 2002.
“This quality certification is a demonstration of our
service commitment to our clients and patients,”
said General Manager Mr Lawrence Lim.
“It is also a special achievement because the
certification included all departments from our RMG network clinics, Raffles Care,
Raffles Diagnostica to Raffles Hospital.”
RMG’s ISO certification is aimed at reinforcing our
organisation-wide quality culture and a quality management
system that assures a high and consistent quality.
Completed within 10 months, ISO 9001:2000 has
provided us with a system that is very much revolved
around our clients and patients. Our start point had been
to identify their requirements, and map the processes
for meeting them.
Assistant Quality Manager Ms Kartini Sameejan said:
“We traced the flow of how we serve patients.
We reviewed and streamlined processes to achieve
consistent practice, and identified indicators that
monitor and assess the efficiency and effectiveness of
these processes.”
The ISO effort is one of a programme of initiatives
organised by our Group-wide Quality Steering
Committee. The Committee, comprising General
Managers, Medical Directors, Directors and Senior
Managers from various departments, articulates our
quality vision, and charts out and tracks the quality
initiatives and activities for the entire Group.
Bigger Premises to Serve You Better
Our clinic in Caltex House has moved to OUB Centre at
1 Raffles Place
#05-03/04 OUB Centre
Singapore 048616
Tel : 6535 2222
Fax : 6533 7811
The operating hours are
Monday - Friday
Saturday
Sunday & Public Holiday
OUB Centre
4
Raffles Healthnews • Issue 1/2003
8:30am to 5:30pm
8:30am to 1:00pm
Closed
Our Indonesian Representative Office is now located at
10th Floor Wisma Nugra Santana
JL Jend Sudirman Kav 7-8
Jakarta 10220
Indonesia
Tel : (62) 21-5701919
Fax : (62) 21-5704974
Healthy Eating
By Melissa AIYATHURAI-Johnston, Dietitian
Food, food, glorious food! Food
makes up a big part of our life.
Besides providing nutritional
benefits, food is also a source
of enjoyment, an adventure and
it tastes great!
Trim the fat
Reducing your fat intake will lower your risk of becoming overweight
which reduces your chance of certain conditions such as diabetes,
heart disease, hypertension and certain cancers. Reducing your
saturated fat intake will also go a long way to help keep your
cholesterol in check.
Despite huge and beneficial
gains in knowledge about
nutrition over recent years,
healthy eating has become
harder because of the way we
live and eat today. There is less reliance on home cooked meals
and if we are not mindful, our meals may not be necessarily healthy.
They may not be complete (e.g. not being served with enough
vegetables) or the portion sizes may be too large.
Removing the skin from poultry and limit your intake of fatty meat
such as pork belly, luncheon meat. When dining away from home
choose more soup based dishes which are low in fat and limit those
dishes made with coconut milk.
In addition, the modern diet is usually overloaded with calories for
energy compared to the amount we expend, has too much fat
(especially saturated fat), sugar and salt and lacking in fruits,
vegetables, fibre and dairy products.
One way to reduce your sodium intake is by tasting your food before
adding salt. Also limit or avoid high sodium condiments such as soy
sauce, oyster sauce, tomato ketchup. Opt for herbs, spices, chili
or lime juice to add flavour instead.
This state of “over nutrition” has seen an alarming rise in the
incidence of chronic lifestyle diseases. Today 1 out of 3
Singaporeans are overweight or obese which sets the scene for
other conditions such as diabetes and heart disease. Excessive fat
or salt and the lack of fibre have also been linked with an increase
risk of certain cancers (e.g. breast, bowel, stomach), diabetes,
stroke, hypertension and osteoporosis to name a few.
There is no secret to healthy eating. You just need to “EAT SMART”!
Enjoy a wide variety of foods
Variety is the spice of life! Everyday your body
needs nutrients and other healthful
substances (such as antioxidants) that only a
wide variety of foods can provide. Most foods
and beverages are made up of more than one
nutrient, however no one food or food
category has them all.
Add grains and legumes
These low fat foods should make up a large proportion of your
meals. This group including bread, cereals, rice, pasta and other
foods made from grains provides you with carbohydrate (your body’s
fuel), B vitamins, fibre and a number of minerals. Legumes (e.g.
peas, beans and lentils) provide you with good amounts of protein
(important for vegetarians), B vitamins and fibre.
Having more soluble fibre in your diet, such
as the type found in legumes will help to lower
your cholesterol. The slow digesting
carbohydrate they contain will also help those
trying to control their weight or diabetics with
their blood sugar control.
Shake the habit - reduce your salt intake
Too much salt has been linked to the development of high blood
pressure or hypertension. The average diet contains more sodium
then actually required.
Munch those fruits and vegetables
Besides being an excellent source of fibre, this
low calorie, nutrient dense group provides you
with essential vitamins and minerals,
antioxidants, and phytochemicals that may not
be present in other groups of food. Studies have
shown that those people with a high intake of
fruits and vegetables have a low rate of heart disease and cancer.
Aim for 2 servings of fruits and vegetables daily.
Alcohol - enjoy in moderation
A moderate to heavy intake of alcohol has been associated with
high blood pressure and certain cancers. An excessive intake can
also lead to weight gain as gram for gram alcohol has almost twice
the calories of carbohydrate or protein.
A safe intake would be no more than 2 standard drinks a day for
women and no more than 3 for men.
Reduce the sugar intake
Food high in sugar tend to be “empty calories” as they have no essential
fibre, vitamins or minerals and can sometimes displace more nutritious
food. Most foods high in sugar also tend to also be high in fat, which if
taken in excess can lead to weight gain. It is best to enjoy these foods
in moderation.
Track your weight
A balance between the right food and regular exercise will ensure that
your weight is healthy. Choosing low fat meals with ample
carbohydrates, vegetables, fruit and protein will help you lose excessive
weight, if you need to and help you to stay slim if you do not.
Be careful of fad diets or diets that offer fast weight loss as they
more often do not change your eating habits and are nutritionally
unbalanced. Once you go off them, the weight tends to come back
straight away.
To eat healthily you do not need to give up your favourite foods. It is a matter of balance and remembering to
“eat smart”. If you need further advice, please contact your dietitian for an appointment.
Raffles Healthnews • Issue 1/2003
5
Arthritis: FIRE In The Joints
by Dr Lim Lian Arn
Consultant Orthopaedic Surgeon
Arthritis is a condition that we will see more and more
of as we and the people around us get older. This article
explains what arthritis is, how to know if you have it
and if you have it, how to manage it.
What is Arthritis?
Obesity
Arthritis is a condition that involves inflammation of a
person’s joints. When a joint is inflamed it becomes
painful and sometimes swollen, warm and stiff.
A healthy weight minimises the stress on weight-bearing
joints, such as your knees. There is also a clear link
between obesity and the development of osteoarthritis
of the knee in women.
Over time, as the joint becomes progressively damaged,
deformities of that joint might become obvious. The
most common knee deformity is genu varum or bowlegs. In the elderly this is often a result and a cause of
knee arthritis.
Joint Deformities or Prior Joint Injuries
These can also predispose one to the development of
osteoarthritis.
Work Factors
There are two major forms of arthritis:
Osteoarthritis
A condition of wear and tear of the cartilage lining a
joint. It mostly affects joints that bear a lot of weight or
undergo a lot of use. These include the hands, hips,
spine and ankles. In Singapore, the most common joint
affected is the knee. Osteoarthritis occasionally affects
a joint that had previously been damaged by injury or
infection.
Repetitive injury and physical trauma contribute to the
development of osteoarthritis. If you have a strenuous job
that requires repetitive bending, kneeling or squatting, you
are at high risk for osteoarthritis of the knee.
Do I Have Arthritis?
If you have any of the following symptoms, you should
see your doctor or a specialist for evaluation and
treatment:
•
Joint pain that worsens with activity and does not go
away without treatment after 2 or 3 weeks.
•
Joint pain associated with joint swelling and stiffness.
Occasionally the joint pain and stiffness is worse in
the morning and gets temporarily better after some
activity.
•
Joint deformity such as “bow-legs” or “knock knees”
•
Joint pain associated with redness, warmth and
swelling.
Inflammatory Arthritis
A condition involving active destruction of the cartilage
lining a joint, often by cells and substances from one’s
own body. In Singapore, common forms of inflammatory
arthritis are rheumatoid arthritis, gouty arthritis,
ankylosing spondylitis and reactive arthritis.
Your Risk of Getting Osteoarthritis
Age
The risk of arthritis increases with age and activity.
Inflammatory arthritis tends to start showing symptoms
at an earlier age.
Sex
In general, arthritis occurs more frequently in women
than in men. Before age 45, osteoarthritis occurs more
frequently in men; after age 45, osteoarthritis is more
common in women. Rheumatoid arthritis also occurs
two to three times more often in women than in men.
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Raffles Healthnews • Issue 1/2003
“
arthritis is a
progressively destructive
disease of the joints, early
As
diagnosis, prevention and
intervention is important.
Treatment of Arthritis
Depending on the diagnosis and the severity of the
patient’s arthritis, many of the treatment options can
be carried out at the same time.
Prevention and Early Intervention
As arthritis is a progressively destructive disease of
the joints, early diagnosis, prevention and intervention
is important.
Some risk factors that lead to arthritis can be controlled
and when inflammatory arthritis (e.g. rheumatoid
arthritis) is diagnosed and treated early, joint destruction
can be lessened or even prevented.
Prevention and
Early Intervention Measures
Weight loss and appropriate exercise
Wearing good footwear including corrective heel
inserts
• Minimising excessive stresses on joints at work
or recreation
• Maintaining good posture at work, rest and
recreation
• Taking appropriate supplements such as
glucosamine
•
For those with significant
pain when walking, walking
sticks, canes, crutches or
frames can make movement
easier. Heel wedges and
knee braces help those with
pre-existing knee deformities
or ligament problems to partly
overcome these problems.
Medication
Medications used to treat
arthritis can be divided into the
following broad groups:
Disease Modifying Agents
These drugs alter the natural course of inflammatory
arthritis. Such medication can have significant side effects
and should only be prescribed by a specialist. There are
no disease modifying agents for osteoarthritis yet.
•
Diet
There is no clear-cut relationship between diet and
arthritis even though certain forms of arthritis (such as
gout) are clearly linked to diet.
However, it is clear that a healthy balanced diet leads
to a healthier body and indirectly to having less bone
and joint problems. If certain foods make your joints
feel worse, you should avoid such foods.
Calcium per se has little effects on arthritis though it is
important in the prevention and treatment of osteoporosis.
Exercise
Regular exercise in moderation helps to maintain a good
body weight, a healthy cardiovascular system and
prevents osteoporosis. It helps an arthritic patient
maintain muscle strength and a good range of joint
motion, and can decrease the requirement for pain
medication.
A patient with arthritis may have to alter his or her
exercise programme. A person with arthritic knees can
swim, cycle and walk while minimising high impact
exercises like running or jumping.
Physiotherapy and Occupational Therapy
In addition to exercise, therapy helps to loosen tight
joints, strengthen weak muscles and maximise range
of motion.
Anti-Inflammatory Medications
Taken orally or applied in the form of creams, gels or
plasters, such medications decrease the swelling and
inflammation associated with arthritis. They are very
effective in decreasing the pain associated with arthritis.
The main side effects include gastric irritation, bleeding
and kidney problems. However, new forms of antiinflammatory agents such as Vioxx, Celebrex and Mobic
can lessen these side effects.
Injections
The most common injection that can be given into a
joint is “H&L” – a combination of a local anaesthetic
agent and a steroid. It is effective in decreasing joint
pain and inflammation for a few weeks to a few months.
It can be useful for someone who has an acute flare up
of arthritis.
However, if given too frequently, “H&L” can accelerate
the breakdown of cartilage. There is also a risk of
developing an infection in the injected joint.
Another form of injection is an artificial joint fluid. Injected
into the knee, this acts as a lubricant, and decreases
inflammation and pain. However, contrary to popular
belief, it does not make cartilage grow back.
Supplements
Studies have shown that glucosamine can slow down
the rate of wear and tear, decrease pain and improve
function.
Evidence for other supplements, however, is not
conclusive. Some of them can interfere with other
medications and should be taken after consultation with
your doctor.
Raffles Healthnews • Issue 1/2003
7
Calcium per se does not affect arthritis but has
other health benefits, notably in the management of
osteoporosis.
Total Joint Replacement
For elderly patients and when the arthritis is extensive,
total joint replacement has proven to be the most
reliable form of treatment.
Surgical Treatment
Surgery for arthritis ranges from day procedures like
arthroscopy to total joint replacement. Common surgical
options are:
Arthroscopy
This is commonly done for
knee arthritis, in particular
those who have clicking and
locking of the knee, or tears
of the cartilage or meniscus.
It involves making a two or
three 1cm incision in the
tissues around the arthritic joint and inserting a small
video camera and instruments to perform surgery.
It is generally useful for early to moderately advanced
arthritis. For advanced arthritis, it can give temporary
relief by “washing out” the joint.
Cartilage Grafting
Cartilage grafting or transplanting surgery is usually
done in patients who have small areas in their joints
where the cartilage is worn or damaged.
Many elderly patients hope to avoid major surgery if
they have cartilage transplanted into their joints.
Unfortunately most of them have too large an area of
cartilage damage for this to succeed.
Osteotomy and Realignment.
When a person has knee deformities like bow-legs or
knock-knees, the uneven pressure distribution in their
knees can lead to early arthritis.
Surgical correction – taking wedges of bone out of the
leg and straightening or realigning the joint – can delay
or even prevent the onset of arthritis. Healing takes 6 to
8 weeks. This is usually done for early arthritis in young
patients. This surgery can also be done for hip arthritis.
Minimally Invasive Partial Knee Replacement
When the cartilage damage is too severe for any of the
above operations, the only surgical option left is to
replace the damaged part of the joint.
If only part of the knee is damaged, a minimally invasive
operation can be done to replace just the damaged part.
The incision usually measures about 8 to 10 cm, and
recovery is much faster than a total knee replacement.
Most patients also say it feels more “normal” than a
totally replaced knee.
For patients with severe arthritis, joint replacement is
very effective in removing pain, correcting deformity,
restoring joint motion and restoring recreational and
daily activities.
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Raffles Healthnews • Issue 1/2003
In this operation, the worn surfaces of the damaged
joint are replaced with a combination of metal and plastic
parts. The most common joints being replaced are knee
joints followed by hip joints. Less common are shoulder,
elbow and finger joints.
As the artificial joint requires a metal part to move
against a plastic part, the plastic can get worn out over
time. In the knee, 5 to 10% of patients might need to
replace the plastic after 10 to 15 years.
Alternative Treatment
These are treatments not traditionally taught or used
by the western scientific community. Examples are
Chinese-based physical methods such as acupuncture
and moxibustion, Chinese-based oral medications and
supplements, and Indian-based Ayurvedic treatments.
The scientific basis of these treatments is still being
evaluated. While some forms of alternative treatment
such as acupuncture can give short-term relief, their
effects are not as quantifiable or reproducible as
“western” medicine.
Summary
Arthritis is a common condition that we will see more
of as we and the people around us get older. Early
diagnosis and intervention is important. A healthy
lifestyle including a good diet, exercise in moderation
and the adoption of good work and recreational habits
are also helpful.
Once arthritis is diagnosed, there are many treatment
options – medications, supplements, injections and
therapy – many of which can be done simultaneously.
5 to 10% of patients will require some form of surgery
and your orthopaedic specialist should discuss with you
your best options.
Anxiety and Phobias
by Dr Lim Yun Chin
Consultant Psychiatrist
Anxiety and fear are normal human emotions and are often found
as reactions to stress. Stress is a difficult word to define, because it
includes both the things that make you anxious, such as working too
hard or becoming ill, and your reactions to them.
Normal anxiety is what we feel when we are exposed to
external stresses such as losing a job, having difficulties in
marriage, or our children getting ill. This type of anxiety is
often called worry and remains with us until the problem is
sorted out in some way.
When anxiety occurs in response to a more immediate
threat, like being attacked by a huge snarling dog or looking
over a cliff edge, this is called fear.
When we are anxious it shows in our minds and bodies.
We cannot concentrate; we are irritable and easily distracted
and become inefficient. We tend to sleep badly and get
tired easily. The body shows the effects of anxiety by more
powerful heartbeats (palpitations), tensions and pains in the
muscles, inability to relax, sweating, over breathing,
dizziness, faintness, indigestion and bowel disturbance.
These symptoms are easily mistaken by anxious people
for evidence of serious bodily illness, like heart disease or
cancer, and so the anxiety can escalate. Sudden unexpected
surges of anxiety are called panic and are often so
unpleasant that people can become fearful of having panic
attacks. Anxiety and panic are often accompanied by
depression, when we feel glum, lose our appetite and the
future seems bleak and hopeless.
People under stress with anxiety,
fears and obsessions often cope
with them well if they recognise
what causes them and realise that
it will not last. Thus someone about
to take the driving test can be
extremely anxious but knows that
the feeling will go once the test is
over. If the symptoms persist, though, and it is not possible
to see an end to them, help is often sought. Some people
delay-seeking help because they are afraid that they might
be regarded as ‘mad’. In fact people with anxiety and fears
rarely have severe mental illness, and it is much better for
help to be sought early than late.
“
Troublesome anxiety appears
in up to a tenth of all people
in the course of a lifetime, though
only a minority of sufferers go and
ask for treatment of these problems.
People who are anxious and fearful can be helped in various ways:
Talking about the problem. This can help
when anxiety comes from recent knocks, like a spouse
leaving, a child becoming ill or a job folding up. Who should
we talk to? Try trusted friends and relatives whose opinions
we value and who are good listeners. They may have had
the same troubles themselves, or know someone else who
has, and so can share our feelings and give us a perspective.
We may learn how they felt and what they did about it.
There are also many professionals to turn to – the family
doctor, psychiatrist, psychologist, social worker, nurse or
counsellor. They may also be able to put us in touch with
helpful community organisations, women’s groups,
bereaved parents’ groups and so on.
Psychotherapy. This is more intensive talking
treatment, which helps patients to recognise, understand
and come to terms with reasons for the anxiety, which may
not at first have been apparent to them. Psychotherapists
may or may not be medically qualified. The treatment may
be more than once a week, for several weeks or months.
Learning to relax. It’s a great help to learn a
relaxation technique, to help us unwind and bring our tensions
and the anxiety, which accompanies them under control.
Professionals like psychologists can help us do this, but there
are several books and audiotapes which we can use ourselves.
It is very reassuring to know that we have mastered a means
of relaxing. It is a good idea to practise regularly.
Medication. A variety of drugs have a part to play
in the treatment of some patients. However there has been
a tendency to overuse them. The two most common are
tranquillisers and antidepressant drugs.
The main tranquillisers used are the benzodiazepines. Some of
these are used primarily for anxiety during the day and others
at night, to help sleep. Although benzodiapezines are effective
drugs they can cause dependence after regular use; this can
become a problem after as little as a month’s treatment.
Antidepressant drugs can help to relive anxiety as well as
the depression from which they are commonly prescribed.
The main snag is that they may not work until they have
been taken regularly for 2-4 weeks, and some can give such
side effects as drowsiness, dizziness, dry mouth and
constipation, especially at the start of treatment. You can
eat a normal diet on most of these tablets.
Raffles Healthnews • Issue 1/2003
9
Raffles Aesthetics Centre
~ Reveal A New You
Radiant skin and looking good give clear
expression of how you feel about yourself.
Make the choice – rekindle the glow in your
life and give your confidence a boost by
unveiling a new you.
Make a date with us at Raffles Aesthetics
Centre. We have for you a one-stop
sanctuary – cosy, comfortable and private providing a wide range of aesthetics
services.
At Raffles Aesthetics Centre, we have brought together
the expertise of our dermatologists and plastic surgeons,
and state-of-the-art technology for your aesthetic needs.
Complementary services by Glamores International such
as facials, body treatments and massage, manicure and
pedicure, waxing etc are also available within the Raffles
Aesthetics Centre.
Our services include:
Aesthetic Facial Procedures
• Facial Rejuvenation and Pigmentation Treatment
• Acne Scars and Stretch Mark Treatment
• Wrinkles Treatment
• Botox
• Chemical Peel
• Iontophoresis for Skin Whitening
Aesthetic Laser Surgery
• Hair Removal
• Removal of Tattoos of Multiple Colours
• Removal of Vascular Lesions
• Removal of Benign Pigmented Skin Lesions
Aesthetic Surgery
• Abdominoplasty (Tummy Tuck)
• Blepharoplasty (Eyelid Surgery)
• Rhinoplasty (Nose Reshaping)
• Breast Augmentation
• Face Lift
• Liposuction
Specialists at Raffles Aesthetics Centre
Prof Walter T L Tan
MBBS, M. Med (Surgery), FRCSE, FRCSG, FACS, FICS, FCPS (Pak),
FACP (Hon), FRACP (Hon), FCPSA (Hon), FRACS (General Surgery),
FAMS (Plastic Surgery)
Dr Wong Saw Yeen
MBBS (Queensland, Aust), M.Med (Surg) (S’pore), FRCS (Edin), FAMS
Dr Wong Soon Tee
MBBS (S’pore), MRCP (Int Med) (UK), FAMS
Dr Tulip Tan
MBBS (S’pore), FRACP, FAMS
Raffles Menopause Programme
at S$499.20
(including GST)
1ST VISIT (with Female GP)
at Raffles HealthScreeners, Level 2, Raffles Hospital
Menopause is the medical term
for the end of a woman’s
menstrual periods. It is a natural
process of aging, and occurs
when the ovaries stop making
hormones called estrogens.
Raffles Menopause Programme
comprises of menopause
screening and advice to help you
understand menopause and the
treatment options available. You
will be cared for by both your
general practitioner (GP) and
gynaecologist at Raffles Hospital
in a structured way as follows:
• Medical History, Physical Examination (including
breast examination) and PAP Smear
• Blood Tests (no fasting required): Estradiol (E2),
Follicular Stimulating Hormone (FSH), Ovarian
Cancer Marker (CA-125)
• Mammogram (screen for Breast Cancer)
• Bone Mineral Densitometry (measure thickness of
bones)
2ND VISIT (with Gynaecologist)
at Raffles Women’s Centre, Level 12, Raffles Hospital
• Review of Results
• Ultrasound Pelvis (if no hysterectomy)
• Counselling and Explanation on Hormone
Replacement Therapy and Menopause
For more information on Raffles Aesthetics Centre and Raffles Menopause Programme,
please contact us at
10
Tel: 6311 1222 or email: specialist@raffleshospital.com
Raffles Healthnews • Issue 1/2003
Skin Surgery
Remove unsightly skin lesions at
a RMG Clinic nearest to you
✓ Warts (Verrucae Vulgaris)
Warts are common lesions caused by a virus that is
transmitted by direct contact either from an infected
person, or even from an infected part of your body to
another uninfected part. (autoinnoculation).
✓ Moles (Nevocellular Nevus)
Moles are generally small (less than 1 cm), tan to dark
brown, uniformly pigmented, well-demarcated nodules
that can occur anywhere. Larger moles sometimes have
hair growing from the top as well.
✓ Skin Tags (Fibroepithelial Polyps)
Skin tags are common lesions that occur in middleaged and older individuals. They are harmless and are
commonly found on the neck, trunk and face.
✓ Corns (Verrucae Plantaris)
Corns are similar to warts. They are usually more
contagious and appear as rough scaly lesions that
commonly occur on the soles of your feet.
What does the treatment involve?
For the procedure, the doctor will administer a small
anaesthetic injection at the base of the lesion to numb the
area. The lesion can then be removed using a special device
with no sensation at all. New skin will grow over the lesion
and improvements can usually be seen in a week or so.
Make an appointment today at the
RMG Clinic nearest to you:
• Changi Airport Terminal 2
6543 1118
• Jurong East
6899 6688
• Marsiling
6363 9000
• OUB Centre
6535 2222
• Siglap
6442 0488
• Tampines Junction
6788 2222
Living with Diabetes
Diabetic Nurse Counselling Service
Diabetes is a chronic disease that requires patients to take
responsibility for their day-to-day care. Patient compliance
and co-operation is paramount in maintaining good blood
sugar level control.
From 11 February 2003, Raffles Medical Group will start a
Diabetic Nurse Counselling Service to assist diabetic patients
in making the lifestyle modifications and take a more active
role in the control of their condition. This will in turn prevent
the onset of complications and a better quality of life.
The service comprises personalised one-to-one sessions
with specially trained and experienced Diabetic Nurse
Educators. They will be held at our Bedok Clinic on Tuesday,
Wednesday and Thursday between 2pm to 5.30pm.
Training and educational materials provided during the
sessions are developed by RMG’s senior physicians.
Topics
Duration
Price
• Overview On Diabetes
Management (Core)
45-60 min
$15.60*
• Diet And Nutrition
• Shopping For Food
30-45 min
30-45 min
$12.48*
$12.48*
• Personal Hygiene
• Foot Care
30-45 min
30-45 min
$12.48*
$12.48*
• Administration Of Insulin
• Diabetes In The Elderly
30-45 min
30-45 min
$12.48*
$12.48*
• Diabetes During Pregnancy
• Diabetes During Childhood
30-45 min
30-45 min
$12.48*
$12.48*
• Diabetes And Travelling
30-45 min
$12.48*
* Inclusive of 4% GST
Counselling is by doctor’s referral only.
For more information or to make an appointment, please contact us at
Tel: 6441 1736, Fax: 6441 1640
or visit our clinic at Block 202, Bedok North Street 1, #01-489, Singapore 460202
Raffles Healthnews • Issue 1/2003
11
Directory
Raffles Hospital
585 North Bridge Road Singapore 188770
www.raffleshospital.com
General Enquiries
Fax No.
6311 1111
6311 2390
24 Hour Walk-In Clinic
Accident & Emergency
Admissions / Business Office
Raffles International Patients Centre
Physiotherapy Centre
Radiology
6311 1555
6311 1888
6311 1666
6311 2350
6311 1290
H E A L T H Y
H E A D S TA RT
H E A L T H Y
L I V I N G
Raffles Specialist Centre
Start the new year in good health. We
offer you 3 packages to meet your
specific health needs and provide
guidance for a healthy 2003.
Live life to the fullest. We offer
2 packages for the health-conscious
individuals wishing to maintain excellent
fitness.
• Lifestyle
Screening Package
$48
• Basic Health
Screening Package
$208
Raffles Aesthetics Centre
Raffles Cancer Centre
Raffles Children’s Centre
Raffles Counselling Centre
Raffles DentiCare
Raffles Eye & ENT Centre
Raffles HealthScreeners
Raffles Heart Centre
Raffles Internal Medicine Centre
Raffles Japanese Clinic
Raffles Surgery Centre
Raffles Women’s Centre
• Cardiovascular
Screening Package
• Renal Screening Package
• Liver Screening Package
$35
$62
$50
24 Hour Appointments Hotline 6311 1222
Fax No.
6311 2136
Email:
specialist@raffleshospital.com
Raffles Medical Group
M A I N TA I N I N G
H E A L T H
H E A L T H Y
F A M I L Y
Protect against illness. Sign up for an
immunisation package to safeguard your
health and those of your loved ones.
• General Immunisation
Programme Package
• Travel Immunisation
Programme Package
• Children Immunisation
Programme Package
Give your family the gift of good health.
We offer 2 packages for the women,
men, and couples aspiring for a healthy
and vibrant family life.
• Premarital
Screening Package
$123
• Well Women Screening
Programme Package
$178
to
$198
Please check with our clinic staff for pricing details.
K E E P I N G
H E A L T H Y
Visit your nearest RMG Clinic
to make an appointment today!
We offer 2 packages designed to help
you or your loved ones maintain
excellent health and joie de vivre
through the seasons of your lives.
• Osteoporosis Screening
Programme Package
$168
• Cancer Risk Screening
Programme Package
$198
For enquiries,
please call
6311 1111
All prices include GST.
www.rafflesmedical.com
Corporate Accounts Enquiries
Fax No.
6311 1333
6311 2383
Singapore Clinics
Fax No.
• Anchorpoint
• Ang Mo Kio
• Anson
• Bedok
• Bishan
• Capital Tower
• Causeway Point
• Clementi
• Compass Point
• Grand Plaza
• Hougang 809
• Jurong East
• Lot 1
• Loyang Point
• Marina Square
• Marsiling
• Millenia Walk
• Ngee Ann City
• Ogilvy Centre
• OUB Centre*
• Raffles Airport Medical Centre
Passsenger Terminal Two*
Airport Transit One
Airport Transit Two
Changi Cargo Complex
• Raffles Hospital
24 Hour Walk-In Clinic and
Accident & Emergency*
• Siglap
• Singapore Post Centre
• Suntec City
• Tampines DBS
• Tampines Junction*
• Toa Payoh
• Yishun
6311 1111
6311 2392
6479 3818
6453 2288
6225 2188
6441 1736
6456 7122
6323 5212
6894 0777
6872 9043
6881 7337
6333 0551
6386 7896
6899 6688
6765 3363
6585 3333
6339 6644
6363 9000
6337 6000
6734 7355
6223 1188
6535 2222
Editorial Board Lawrence Lim, Dr Teo Sek Khee, Dr Bina Kurup, Moiz Tyebally, Ng Siao Sze & Celine Ong
*Clinics with X-ray Facilities
The information contained in this publication should not be regarded as a substitute for detailed medical advice in individual cases.
Hong Kong Clinics
6543 1118
6543 1113
6543 1118
6543 1038
6311 1555
6442 0488
6841 2007
6334 7667
6788 6833
6788 2222
6254 7667
6755 0049
(852) 2525 1730
Please address all correspondence to The Editor, Raffles Healthnews, Fax no. 6311 2383.
Raffles Healthnews is published by Raffles Medical Group Ltd, 585 North Bridge Road, Raffles Hospital #11-00, Singapore 188770.
12& Production
Raffles
Healthnews
Design
by Creative
Essence • Issue 1/2003
January 2003