Body & Mind 2016

2016

EXPATLIVING.SG

Feeling Beautiful Nutrition Tips Keeping Fit Medical Advice Staying Healthy YOUR SINGAPORE GUIDE TO:

Dental Care

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HEALTH • BEAUTY • FITNESS • MEDICAL SERVICES

EDITOR’SNOTE

Striving to improve our wellbeing remains as important as ever, but we understand all too well that when the daily grind gets hectic, looking after our health can take an undeserving back seat.

With our lives seemingly getting busier and busier, what we can all benefit from are those things that help make our routines a little bit easier and save us time. That’s what prompted us to create our Body & Mind Guide for 2016, a one-stop wellness resource for living in Singapore. These pages are packed full of advice and recommendations across a range of topics from the island’s top health and medical experts – from doctors and orthodontists to personal trainers and nutritionists. Want to discover new running trails or the facts about dengue fever? How about where you can get a customised facial or your teeth whitened for that all-important date? You’ll find it all right here – and more. Another bonus is that it’s handbag-sized, so you can keep it close by as a handy resource throughout the year ahead. Whenever you need to call on the professionals, we’re sure it will point you in the right direction.

Stay fit, healthy and feeling fabulous!

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Rebecca Bisset Shamus Sillar Verne Maree

Editor-in-Chief Group Editor Executive Editor Body & Mind Guide Editors

Susannah Jaffer Smita DeSouza Aimee Fordos Leanda Rathmell Liana Talib Nur Hanani Kamal Luddin Michael Bernabe Beatrice Ng Jeanne Wong Anna Tserlingas Valmai Dhir Grace Bantaran Katie Peace Susan Knudsen-Pickles Veena Gill

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Regional Sales & Marketing Partnerships & Events Marketing & Business Development Executive

Karin Galley-Dick Danielle Rossetti Jacqui Young Lara Sage Colin Purchase Juliet Keys

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CONTENTS

MEDICAL SPECIALISTS 26 Hospitals & GPs:

A helpful guide to important health contacts

TERRIFIC TEETH 16 Teeth Whitening: A brighter, more attractive smile 17 Avoiding Gum Disease: The importance of well-aligned teeth 18 Dental Implants: A solution for teeth that go missing 19 Correcting Dental Habits: Embracing a popular new method 20 Invisible Braces: New ways to straighten crooked teeth 21 Wisdom Teeth: To remove or not to remove

29 Cancer Talk:

Why you should have a colonoscopy

32 Dengue Fever:

The facts you need to know

36 Debunking ENT Myths: Hearing loss, sneezing, snoring and more 38 Heart Screening: How early detection saves lives 40 Skin Screening: What exactly does it involve? 41 Breast Health: Five important tips from an expert 42 All About Melanoma: Recent breakthroughs in treatment 43 Stomach Spotlight: From belly fat to tummy pains 45 Kidney Stones:

How this common problem is treated

48 Vein Issues:

From DVT to varicose and spider veins

FOR THE LADIES 53 Pregnancy Care: Bringing twins safely to term 56 Ovarian Cysts: When to see your gynaecologist 58 Fertility Issues: Five things you may not have known

CONTENTS

FEEL BEAUTIFUL 70 Sun Safety: Staving off heatstroke and skin cancer 72 Tackling Pigmentation: A system for brighter, blemish-free skin 73 Laser Hair Removal: Unwanted fuzz, gone for good 74 Anti-Ageing Treatments: Profile of an aesthetic clinic in Bali 76 Pampering Spas: Rejuvenation retreats from Sentosa to Orchard 80 Clinical Facials: Bespoke skincare for best results PEACE OF MIND 62 Hypnosis: From stress to clarity and resilience 63 Coping with Anxiety: Strategies to avoid feeling overwhelmed 64 Preventive Health Screening: Early disease detection and more 66 Health Insurance: Linking your personality with your coverage

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Lace up your shoes and hit the trails

EAT RIGHT 98 Macronutrients & Micronutrients:

How they work and the food they’re in

GET ACTIVE 86 Running Routes:

102 Artisan Breads: Simple ingredients used to great effect 103 Online Food Shopping: Get healthy groceries delivered to your door 104 Magnesium and Our Diet: Symptoms of deficiency and what you can do 105 Grow Your Own Food:

Singapore’s best spots for a jog

92 Pilates Benefits:

80 Tips for taking care of your skin

What parts of the body it can improve, and how

93 Training Tips:

Employing mindfulness for a better workout 94 Abdominal Separation: All about the mummy tummy

A clever vertical-garden solution for the home

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HEALTH UPDATES

Want to find out the health benefits of yoga? Or learn medical tips and advice from seasoned professionals? Then you’ve arrived at the right spot.

FOOD REVIEWS From the latest spots for quality grub to hip bar reviews, we publish daily updates on our site!

BEAUTY NEWS You’ll find top beauty adv i c e and coo l new treatments and products to try every month

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What we’re up to on …

INSTAGRAM Follow @expatlivingsg for all our behind-the-scenes antics!

Providing you with Singapore- friendly fashion ideas

Scouring the island for yummy (and healthy!) foodie delights

Serving up major holiday inspo – to the Maldives we go!

Behind-the-scenes action and sneak peeks of our photoshoots

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TERRIFIC TEETH

ArtFamily | Shutterstock.com

TERRIFIC TEETH

SHINE Whiter teeth can make for a brighter, more attractive smile. DR THEAN TSIN PIAO gives us more information on the treatment methods available. Dazzling Who is and who isn’t eligible for teeth whitening? Most people with natural teeth are eligible for teeth whitening. However, those with porcelain veneers or composite fillings on their front teeth, or those who lack or have very thin tooth enamel, aren’t suitable. We will take a look at and examine the suitability of your teeth. Any that lack enamel, have cracks or have composite resin fillings are excluded from the whitening process. What treatment options are available? There are two options for whitening: using a home kit, or having it done at our practice, but both of them use a peroxide-based whitening system. The home kit includes a low-peroxide concentrated gel, which is applied to the teeth by means of customised dental trays that we fit to you on your visit. The trays are designed to ensure that the whitening gel doesn’t cause any irritation to your gums. You wear the trays for 30 minutes each day, from 10 days to two weeks. What happens during the initial consultation!

For the in-office treatment, we use a high- concentration peroxide system, and the whole procedure is completed in less than an hour. The two systems produce the same results, so it’s just a matter of choosing which one fits your routine best. What can we expect to feel during the treatment? Both systems are safe if performed properly. The higher concentration of peroxide may make teeth feel slightly sensitive in certain cases – especially if you have any cracks or thin enamel. Certain people may experience tooth sensitivity during the treatment, but this soon subsides. Is there any aftercare required? There is no particular aftercare required, but it is best to avoid coloured food and drinks – such as coffee or red wine – for 24 to 48 hours after whitening. Drinking coffee or tea with a straw will help prevent stains from building up, as will avoiding eating too many highly coloured foods and drinks. That said, there are no side effects from repeated teeth whitening – you can always have it done again. Aesthete Smilestudio #02-04 Clifford Centre, 24 Raffles Place 6438 3811 | aesthetesmilestudio.com What are your tips to avoid future staining? Are there any side effects after the treatment?

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More Than Mere

Crooked teeth are not just an aesthetic issue; they’re potentially life-threatening. Oral health is an integral part of general health care, orthodontistDRCATHERINE LEE points out. Here’s her timely reminder that straight, well- aligned teeth are essential for avoiding gum disease – and that gum disease has a proven link to life-threatening inflammatory conditions such as heart attack and stroke. What is gum disease? The short answer is dental plaque build-up, which generally results from poor oral hygiene habits. Other factors such as smoking, hormonal changes and various types of illness, such as diabetes, can also make our gums more vulnerable to gingivitis (gum inflammation) and less able to heal themselves. Chronic gingivitis can lead to periodontitis, causing irreversible damage to the supporting structures of the teeth. How exactly does orthodontics help protect us against gum disease? By enabling us to maintain good oral hygiene. Straight, correctly spaced teeth are far easier to

keep clean than crooked or overlapping ones. Even with the best will in the world, twice-daily brushing and daily flossing, it is almost impossible for someone whose teeth are out of position to maintain a high standard of oral hygiene – they are fighting a losing battle. Do we know how gum disease is related to cardiovascular and other diseases? We must remember that oral health is not something that stands alone and divorced from overall health; far from it! The two are inherently entwined and codependent, and oral disease can quickly become systemic. We now understand that the bacteria and toxins involved in gum disease readily enter the bloodstream and – through a rather complex process involving the liver – become responsible for causing inflammation of the heart and the vascular lining, leading to vascular plaque formation, the breakdown of the vascular lining and the onset of heart disease and stroke – and probably other chronic inflammatory conditions. It has even been implicated in pregnancy complications. Dr Catherine Lee Orthodontics #06-05 Camden Medical Centre 1 Orchard Boulevard 6835 9571 | drcatherineleeorthodontics.com

Gum inflammation and heart health – the link

Researchers at Columbia University in New York found that improving dental care slows down the build-up of plaque in the arteries. Another study found that those with the worst oral hygiene had a whopping 70 percent higher risk of developing heart disease than twice-a-day brushers.

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TERRIFIC TEETH

IMPLANTS

1 1

Missing teeth not only affect your smile and the way you speak, they can knock your confidence. Dental implants are a solution, but how do they work? DR WILLIAM CHONG gives us the facts.

There are various ways to replace missing teeth, but dental implants are the most sophisticated method and are widely regarded as the preferred form of tooth replacement. With new surgical techniques and intravenous sedation, the procedure is almost painless and the final results are exceedingly natural, both in function and appearance. An implant comprises three parts. The first part, the “fixture”, is made of titanium and placed within bone. The second part, the “abutment”, emerges through the gums; it is used to carry the third part, which is the crown, bridge or denture, depending on how many teeth need to be replaced. After the decayed or fractured teeth have been removed, the implant is surgically placed into the jawbone and the area allowed to heal. During this time, temporary teeth are provided. After three months, once the implant has integrated with the bone, the abutment and the final crown, bridge or denture are connected. Same-Day Teeth In some cases, when the quality of the jawbone is good, a temporary tooth or teeth can be fitted the same day, allowing you to resume your normal lifestyle almost immediately. Implants can be placed directly into extraction sites for patients who are missing front teeth; that’s not always possible for back teeth, though. What’s more, thanks to the latest computer-assisted techniques, it’s sometimes possible to deliver aesthetic-looking temporary teeth within three hours of surgery. (Note that it is advisable to avoid chewing on the implant in the initial weeks after the surgery.)

Pacific Healthcare Centre #19-01 Paragon Medical Centre 290 Orchard Road 6883 6977 | pachealthholdings.com

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Naturally Aligned Bad dental habits in growing kids can put them at risk of jaw misalignment and teeth c rowd i ng . The Myob race appliance is an increasingly popular method of correction. DR NIJAM LATIFF tells us more.

What are the bad habits that cause early orthodontic problems? Bad habits can actually start as early as infancy. If a baby is not breastfed at the right posture, which is from a 45 to 70 degree angle rather than a lying down position, it can lead to an improper swallowing pattern that can result in the baby developing a mouth breathing pattern. Mouth breathing is a serious health concern; it can lead to a child developing allergies and respiratory problems. A child who is mouth breathing has his or her tongue resting at an improper position, whichmeans the jaw muscles aren’t balanced and don’t develop properly. Other common bad habits that inhibit the proper development of teeth are the extended use of pacifiers, milk bottles and thumb sucking. While braces and at times extractions are still an efficient way of moving and straightening teeth, they don’t address the original bad habits themselves, which means – if not corrected – there is a possibility to relapse even after treatment with braces. Tell us more about Myobrace. The Myobrace focuses on proper jaw development during childhood, and aims to correct the causes of crooked teeth by eliminating poor myofunctional habits such as mouth breathing, tongue thrusting and incorrect swallowing patterns. The appliance allows the facial development of a child to reach its full genetic potential.

Are the results lasting? Unlike traditional orthodontics, the main goal of Myobrace is to allow proper development of the face and jaw so that the teeth naturally erupt straight and the need for braces, extractions or retainers is avoided. Treating the main causes of crooked teeth at an early age improves general health and allows a child’s face and jaw structure to develop to its full potential. For older children, a combination of braces with the Myobrace appliance is sometimes used to improve facial development. How does it work? The special programme includes breathing, tongue, lip and swallowing exercises, together with dietary advice for your child. This prescribed routine, together with the use of the Myobrace appliances, will correct any bad myofunctional habits and retrain the oral muscles so as to align the teeth. We also give parents access to an online Myobrace program, so that they can easily keep track of their children’s exercises on their computers or other devices. Coast Dental 479 Joo Chiat Road 6440 4605 | coastdental.com.sg

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TERRIFIC TEETH

On the STRAIGHT andNarrow

Thanks to recent dental innovations, straightening adult teeth has never been faster or easier – or less obvious, for that matter. The team at Smilefocus talk us through the options.

There’s one fact about ageing many of us don’t pay attention to: as we get older, our teeth have an increased tendency to shift, and can become crowded or crossed-over. And because our smile is one of the first things people notice, having crooked teeth – especially in our adult years – can make us feel embarrassed or self-conscious. Instead of just living with the problem, you could consider Invisalign, a system that uses clear, custom-made removable aligners to gradually move teeth into the optimal position. Not having wires or brackets, they’re virtually undetectable. Another option is Cfast (Cosmetically Focused Adult Straight Teeth). These braces have a white wire and clear brackets that straighten the teeth in less time than traditional orthodontics. It’s described as “cosmetically focused” because the treatment straightens crooked or misaligned front teeth only, without correcting the bite. It’s a great alternative for adults who would prefer to avoid prolonged conventional orthodontic treatment.

#08-02 Camden Medical Centre 1 Orchard Boulevard 6733 9882 | smilefocus.com.sg

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WiseWords

Do I have to worry about wisdom teeth that are fully erupted, or ones that haven’t come through? If your wisdom teeth are fully erupted or completed buried, they can be left alone. Nonetheless, buried wisdom teeth do carry a small risk of infection (if they change in position) and cystic development, so it’s a good idea to visit your dentist for regular check-ups. When is the best time to have wisdom teeth removed? Those who have their wisdom teeth removed when they are younger (below the age of 35) tend to recover faster and experience fewer complications. How long does recovery take? There may be slight discomfort after the surgery, and swelling can last for five to seven days. Most patients, however, are able to resume their regular diet on the same day. Specialist Dental Group #08-03/08/10Mount Elizabeth Medical Centre #07-17 Gleneagles Medical Centre 6733 7883 | specialistdentalgroup.com

Oral and maxillofacial surgeon DR HO KOK SEN talks about wisdom teeth. When do wisdom teeth form? They form typically around your tenth birthday, and are the last set of molars to develop. Not everybody has wisdom teeth, but if you do, they usually erupt between the ages of 17 and 25. If you’re experiencing pain and swelling at the back of the mouth, or at the side of the jaw due to infection, then yes. The most common cause of infection is a partially erupted tooth. This creates a flap of gum tissue around the tooth that traps food and bacteria, which can lead to infection and tooth decay. You may also feel pain when a wisdom tooth is trying to erupt. In such cases, it’s advisable to visit an oral surgeon who can examine you to see if there is enough jaw space for the tooth to grow, and if it’s aligned with the rest of your teeth. Is it always advisable to have them removed?

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A SPECIALISED APPROACH

Iriina Braga | Shutterstock

A SPECIALISED APPROACH

SingaporeSnapshot

Singapore’s eight public hospitals consist of six general hospitals (Singapore General Hospital, National University Hospital, Changi General Hospital, Khoo Teck Puat Hospital, Tan Tock Seng Hospital and Ng Teng Fong General Hospital), a women’s and children’s hospital (KK Women’s & Children’s Hospital) and a psychiatry hospital (Institute of Mental Health). National specialty centres provide cancer, cardiac, eye, skin, neuroscience and dental care. Private hospitals include Parkway East Hospital, Gleneagles Hospital, Mount Alvernia Hospital, Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital, Raffles Hospital and Thomson Medical Centre.

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Looking for a GP?

There are many reasons why you, as a newly arrived expat, may require the services of a healthcare professional. You may have an existing medical condition that needs regular monitoring. You may be on medication that requires a prescription renewal when you run out of the medicine. You and your children may need vaccinations for living in this country and travelling in the region. You may have a clean bill of health but will need to know where to go if you or a family member needs medical attention. You’ll be glad to know that Singapore has a very high standard of healthcare. The system comprises a network of public and private providers offering a wide spectrum of services, from basic to tertiary healthcare. Medical practice here is strictly regulated by the Singapore Medical Council. A good starting point would be to establish care for yourself and your family with a family physician, or GP (general practitioner). As well as treating you for day-to-day illnesses, a good family doctor will also be well-versed in preventative medicine, offering routine health checks (for example, blood pressure, cholesterol testing, Pap smear and breast examination for women, well-child visits) and provide information on immunisation recommendations. If you have a more complex condition that requires specialist care, it’s highly advisable that you consult your family doctor for a recommendation to see a specialist that is appropriate for you. So, you’ve just moved to Singapore. One important part of establishing a new life in your adopted home is finding a good family doctor.

International Medical Clinic (IMC) specialises in family, paediatric and travel medicine with the international community in mind. To register with aGP, findout where your nearest clinic is via imc-healthcare.com/home, and pick up a copy of their Newcomer’s Health Guide at any of their clinics.

Niyazz | Shutterstock.com

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CombattingCancer

The Colon Colorectal cancer is one of the top cancers affecting men and women in Singapore; however, early detection can lead to a complete cure. You are most at risk if: You have a history of colorectal cancer in your family, especially if your relative had it at a younger age. You smoke or your diet is high in fat and low in fruit and vegetables. You have had it before. Also, women who have had breast, ovary or uterus cancer have a somewhat higher risk. You are over 50 and have polyps (growths) on the inner wall of your colon or rectum (which are quite common for over 50s). Most polyps are benign (not cancer) but some can become cancerous. You have ulcerative colitis or Crohn’s disease, which causes an inflammation of the colon.

Common symptoms include: Change in bowel habits (diarrhoea or constipation) Feeling that your bowel does not empty completely Finding blood (either bright red or very dark) in your stool Finding your stools are narrower than usual Frequently having gas pains or cramps, or feeling full or bloated Losing weight with no known reason Feeling very tired all the time Nausea or vomiting Most often, these symptoms are not due to cancer but other health problems. Early cancer does not usually cause pain. Therefore, anyone with these symptoms should see a doctor to be diagnosed and treated as early as possible.

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A SPECIALISED APPROACH

The Cervix Cervical cancer is the tenth most common cancer found in women in Singapore, but it can easily be prevented with a Pap smear test. We spoke to Ms Tan, whose 2006 Pap smear showed that she was developing abnormal cells on her cervix. “For the next year and a half I saw my gynae every six months,” she told Expat Living . “After a colposcopy in 2008, she diagnosed me with late-stage pre-cancerous cells and I was advised that I’d need a cone biopsy with laser to remove them.” A colposcopy is very similar to a smear test, whereby a mild vinegar-like solution is applied to the cervix to help the doctor examine the surface area.

For some women, having a smear test can be a daunting prospect, but the simple procedure far outweighs the consequences of not having regular checks and ending up with cervical cancer. Ms Tan continued: “As I was wheeled into the operating theatre my fear got the better of me and I was a little weepy. However, the doctors were kind and reassured me that it was a routine procedure. Afterwards, the worst pain that I experienced amounted to nothing more than bad period pain and I was back to my daily routine within a day. I had to continue to have Pap smears every six months in case of a recurrence.” Fortunately, most cervical pre-cancers grow very slowly, so having a regular smear test will help detect almost all abnormalities before they have a chance of progressing to cancer.

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A SPECIALISED APPROACH

Dengue: What you need to know A record 3,965 cases of dengue were seen in the first seven weeks of 2016. Warm weather, faster mosquito breeding patterns and a switch in the predominant dengue virus fromDENV-1 to DENV-2 has experts predicting the number of cases this year could exceed 30,000. Be prepared, and don’t be one of the unlucky ones.

What is dengue fever? It’s a severe, flu-like illness that’s transmitted by the bite of the Aedes mosquito.

What does an Aedes mosquito look like? It has black-and-white stripes on its body.

What are the symptoms? It usually takes four to seven days before a person infected with the virus starts to show symptoms. They might experience a sudden onset of fever (which can last for up to seven days). This can be accompanied by headaches, muscle and joint pain, loss of appetite, nausea and a rash. Can dengue fever be life-threatening? Severe infections can lead to dengue haemorrhagic fever, which causes bleeding and can result in death. However, statistics from the World Health Organization (WHO) claim

As of February 2016, 25 hotspots (10 or more cases) have been identified. Check dengue.gov.sg for the latest information. *Statistics: Ministry of Health Singapore

Apichart Meesri | Shutterstock.com

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that dengue haemorrhagic fever represented less than one percent of the 21,000 officially reported cases in Singapore between 2000 and 2004. Is it infectious? No, not person-to-person. The virus is passed on to humans only when they are bitten by an infective female Aedes mosquito; likewise, the mosquito generally acquires the virus while feeding on the blood of an infected person. Visit a doctor, rest and drink plenty of fluids. Try to stay away from areas where there are mosquitoes, to avoid being bitten and thus spreading the virus to other people. If you develop severe pain or persistent vomiting, go to a hospital immediately. Can I be immunised against it? No. However, there are four strains of the virus here in Singapore; having been infected by one usually gives lifelong immunity to that type, but only short-term immunity to the others. What’s the best prevention? Avoid getting bitten. Apply insect repellent before you enter areas where there are mosquitoes. On alternate days, remove water from flowerpots, vases, toilet-brush holders and empty anything that stores or collects water outside; stagnant water is where mosquitoes breed. If you are going on holidays, put the lid of the toilet down. What should I do if I think I have dengue fever?

The Zika virus Spread by the same Aedes mosquito as dengue, the Zika virus has been hitting the global headlines for a suspected link with microcephaly (abnormally small heads) in babies born to infected mothers. While there have been no cases in Singapore thus far, a Clinical Advisory Group has been set up to ensure medical practitioners stay vigilant and are able to answer questions from concerned pregnant mothers. Find out more at moh.gov.sg.

Luciano Cosmo | Shutterstock.com

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MEDICAL SPECIALISTS

fromHead toToe Your family doctor will be happy to refer you to a specialist when you need one – but here, unlike many other countries, you’re at liberty to book a specialist appointment without a GP referral. With this inmind, we asked a dozen sizzling Singapore specialists to supply sound advice on everything from ENT issues down to the dangers of lower-leg blood-clots (DVT).

wavebreakmedia | Shutterstock.com

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A SPECIALISED APPROACH

#1

Ear, Nose & Throat

Myth No. 3: Sneezing and a blocked nose point to a sinus problem They’re also symptoms of the common cold, flu or allergy to inhalant allergens. Your sinuses are air cavities in which pressure can build up or infection can occur; sinusitis is often worsened by untreated allergic rhinitis, by polyps, or by structural nose anatomy problems such as bony deviations or swelling. Skin Prick Testing can identify common allergens such as house-dust mites, grass pollen, or cats and dogs. Myth No. 4: Snoring is just noise Snoring may be associated with oxygen deprivation in sleep, resulting in poor concentration, headache, crankiness, mouth- breathing, bed-wetting and tiredness. Longer-term risks include hypertension, obesity, diabetes and heart disease. In children, snoring is often due to enlarged tonsils and adenoids. A sleep study can be helpful in evaluating the severity and guiding treatment. Myth No. 5: Removing the tonsils weakens the immune system Research has shown this not to be true. For chronic tonsillitis, micro-organisms deep within the tonsil crypts may need to be removed by tonsillectomy surgery. If tonsils or the adenoid are causing mouth-breathing or snoring, removing them can solve the problem.

ENT, head and neck surgeon DR LYNNE LIM debunks some common ENT myths. Myth No. 1: Hearing loss in adults doesn’t need treatment Do you find yourself turning up the TV or asking people to repeat themselves? One in five people over 50 has hearing loss (HL), and 70 percent of those over 65. Left untreated, it can affect your safety and quality of life, increasing the risk of memory problems and dementia. Proper diagnosis is the first step to recovery, so go for a professional hearing test. Myth No. 2: Ringing in the ears (tinnitus) after a loud concert is OK Noise-induced HL is the second leading cause of HL worldwide. Many people don’t realise they have it until it’s quite severe, as only high-pitch sounds are not heard well at the start. Tinnitus after noise exposure can indicate permanent hearing damage, even if the ringing sound goes away.

Dr Lynne Lim ENT & Hearing Centre (Child & Adult) #17-07 Mount Elizabeth Medical Centre (at Orchard) 6737 7787 | drlynnelim.com

Oksana Kuzmina | Shutterstock.com

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A SPECIALISED APPROACH

#2

to

Heart

Heart

Moving to the heart of the matter, anyone above the age of 40 should have their cardiac risk assessed. It’s all about prevention, as cardiologist DR LIM ING HAAN reminds us.

controlled through lifestyle changes. Borderline hypertension, for example, can sometimes be corrected by losing weight and eating less salt. Can you tell us what is meant by “early screening”? Nowadays, we practise screening for early detection of heart disease, because early treatment can prevent its progression. Early treatment of blockages of the arteries, for example, can reduce the chance of heart attacks or strokes. It can also stabilise any plaque build- up, preventing the development of extensive blockages that would require major bypass surgery. How is that different from “preventive cardiology”? In preventive cardiology, we distinguish primary from secondary prevention. Primary prevention is the detection of risk factors to prevent the development of any blockages, and also to prevent a first heart attack. Secondary prevention means prevention of heart attacks, heart failure or arrhythmias after the first event has occurred. This encompasses

What does cardiac risk assessment entail? Firstly, we assess the controllable risk factors such as smoking, blood pre s sure , b l ood cholesterol, diabetes and obesity. Anyone who

has a family member who suffered from heart disease at an early age – a mother or sister before the age of 65, or a brother before the age of 55 – should be screened as young as 20. If you already have diabetes, peripheral vascular disease, carotid disease or abdominal aortic aneurysm, you’re at high risk and should be screened immediately. What are the risk factors for heart disease? The two non-modifiable risk factors are age and sex – the risk increases with age, and is higher in males. Modifiable risks include blood pressure, cholesterol profile and smoking status, which can largely be

goldyg, StockLite | Shutterstock.com

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Specialists trusted by specialists Dr Lim belongs to a specialist medical group called eMenders , whose approximately 50 (and growing) members are medical and dental specialists in private practice representing 19 different branches of medicine in Singapore. Tellingly, specialists cannot apply to join eMenders; an existing member has to recommend them for membership on the basis of shared ethical standards and values, including “advancing medical care and improving patient outcomes”. Members are encouraged to practise evidence-based medication, to eliminate unnecessary procedures, and to avoid overcharging patients. Through its portal, eMenders.com , you can quickly access a specialist compatible to your needs – and the service is free. Search either by specialty – for example, cardiology, gastroenterology or dentistry – or by the specialist’s name. With medical specialists numbering over 1,700 in Singapore, it’s a great way of cutting out the guesswork.

Lim Ing Haan Cardiology #04-02 Mount Elizabeth Medical Centre 6235 2050 drliminghaan.com emenders.com Just this week, I treated two male smokers aged 42 and 47 who were admitted for heart attack and were found to have blockages of all three heart arteries. If they’d gone for cardiac screening at the age of 40, stopped smoking and been prescribed medications, those first heart attacks may have been prevented. not only advice on medications, but also cardiac rehabilitation, counselling on nutrition, smoking cessation and other lifestyle factors. An analogy can be made between heart health and skincare, where prevention and early treatment can make a lot of difference to the appearance of wrinkles and age spots, not to mention cancerous lesions. Would you say that early screening and primary prevention save lives? Yes, they do. We often see male smokers in their forties being brought to the emergency department with their first heart attack. Invariably, they’ve been smoking since they were young and have never undergone any health screening.

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Skin Deep #3 They don’t say “soft as a baby’s bottom” for nothing – most of us are born with pristine, smooth and blemish-free skin. As we grow older, though, freckles, pimples, moles and various other blemishes may start to appear. Dermatologist DR PATRICIA YUEN shares her views on skin screening, the various lumps and bumps we tend to develop – and when action is needed. What causes these changes in our skin? Many are genetic, but environmental factors play a big role. If you come from a moley family, not using sunscreen can cause you to develop more of them, or cause them to change. Similarly, freckles are genetic and benign; but solar lentigines and actinic keratosis are caused by sun damage. Genetics and fluctuating hormones can cause a woman with previously perfect skin to develop adult onset acne in her 40s. While terribly frustrating for her, nowadays we can treat the inflammation with antibiotics, advanced skin care and topical retinoids like tretinoin.

Who should come for skin screening, and how often?

If you have a positive family history, at least once a year from about the age of 30, especially if you have either Skin Type 1 or 2 – meaning fair hair and blue eyes – and come from a climate like Australia’s. Once we’ve found dysplastic moles or early skin cancer, six months is the recommended screening interval. What does skin screening entail? I start by taking a history to get a sense of your current lifestyle, family history, history of past sunburns, whether you use sunscreen and so on. Then I take a detailed look at all your moles, using a dermatoscope to examine them for the criteria A, B, C, D and E: A for Asymmetry , B for Borders that are irregular, C for change in Colour , D for a Diameter bigger than 5mm, E for Evolution , such as enlargement or elevation. I may take a tiny punch biopsy to send to a pathologist. If it’s found to be normal, we’ll leave it; if it’s dysplastic, you’ll need to start paying more attention to skincare. I might recommend a prescription- strength oral sunblock that’s been proven to repair DNA damage caused by UV radiation, such as Heliocare, whose main ingredient is a patented plant extract called fernblock. And if you find something suspicious?

Dermatology, Lasers & Aesthetics Clinic #19-01 Paragon, 290 Orchard Road 6883 6978 | drpatyuen.com

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Staying Abreast #4 Valuable advice on breast health and aesthetics from breast and general surgeon DR GEORGETTE CHAN. 1 Know your breasts well , so you’ll be able to detect any changes. Monthly self-screening is ideally done after your menses when your breasts are at least dense. Keep a lookout for lumps, dimpling or puckering of the skin, changes in the nipple, or any soreness, swelling or redness. Ask a doctor to assess anything that may be worrisome. If you do find a lump, don’t panic; the vast majority are benign.

4 If you are considering post-pregnancy breast enhancement , it’s best to wait until you’ve completed your family – otherwise, you might find yourself back at square one. 5 From the age of 40, an annual mammogram is recommended; after the age of 50, if you haven’t had any problems, the suggested schedule is a mammogram every two years. As you grow older, regular exercise, a nutrient-rich diet, not smoking, not drinking too much, and avoiding stress will go a long way towards keeping you and your breasts healthy and happy.

2 Wear a properly fitted bra – and especially so while you’re pregnant and breast-feeding, to provide optimal support. 3 Don’t gain too much weight during pregnancy, or at any time. Apart from the health implications of being overweight, it may cause breasts to lose their elasticity, making it difficult for them to bounce back into shape after the birth or when you’ve lost weight.

#11-09 Mount Elizabeth Medical Centre 6836 5167 | georgettechan.com.sg

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Spotlight on #5 Surgical oncologist DR DENNIS LIM is excited about recent breakthroughs in melanoma research. Until recently, the diagnosis of a melanoma that had metastasised – that is, gone beyond its original skin location into other organs of the body – was practically a death sentence. “Nowadays, we have good treatment available for patients at any stage of melanoma,” says Dr Lim, including Stage 4. “But it’s crucial to accurately identify the stage the patient is at, because these treatments are so different.” Early stage melanoma can simply be surgically removed. Timely detection depends on regular screening by a dermatologist, including ongoing monitoring of any suspicious changes.

Melanoma The intermediate stage is where he generally comes in, using sentinel node mapping to establish whether and how far the tumour cells have spread along the lymphatic pathway. “If they have reached the groin or the armpits, for example, those lymph nodes must be removed; but we don’t want to perform this aggressive treatment unless we need to.” The metastatic stage is where most of the recent breakthroughs have been made, with the use of drug- based immunotherapy treatments to give the body a helping hand to eradicate cancer cells. In time, melanoma may even be treatable as a chronic disease, like HIV-AIDS and diabetes; for now, though, get those moles checked! Dennis Lim Surgery #11-09 Mount Elizabeth Medical Centre 6386 5167 | dennislim.com.sg

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Metabolic Magic #6 Advancing down the human body, we come to belly fat, which is not just unsightly but also a major risk factor for cancer, heart disease, hypertension, stroke – and Type 2 diabetes. DR GANESH RAMALINGAM is a founding member of the national committee for obesity – the OMSSS (Obesity and Metabolic Surgery Society of Singapore).

Tell us about the various procedures that you perform. For someone who just needs to shed a few kilograms over a maximum of six months, the intra-gastric balloon allows you to eat only small amounts, slowly, until you get used to eating smaller, healthier portions. Two surgical options for the morbidly obese are: a laparoscopic sleeve gastrectomy that removes approximately 60 percent of the stomach, greatly reducing the volume of food that can be present in the stomach at one time; or a laparoscopic gastric band (lap- band), which slows the rate of food entering the stomach to a slow trickle. A laparoscopic gastric bypass entails bringing the small bowel up to the stomach, rerouting food from the stomach directly into the small intestine and bypassing the liver-pancreas complex. It’s also known as metabolic surgery, because it immediately alleviates the trio of disease associated with metabolic syndrome: diabetes, high blood pressure and high cholesterol. Exactly how does a laparoscopic gastric bypass cure diabetes? Surgically bypassing the liver-pancreas complex relieves the stress on the pancreas and reverses the diabetes immediately, even without weight loss.

You must see many patients who are desperate to lose weight and restore their health. How would you describe your approach? My approach is holistic. There is no one method that works for everyone who needs to lose excess weight and keep it off. While some manage to do it through proper diet and exercise alone, others succeed through a combination of diet, exercise and surgical intervention. We’re all different, so any weight management programme needs to be tailored to the whole individual.

G&L Surgical @ PanAsia Surgery #10-43/44 Mount Elizabeth Novena Specialist Centre 38 Irrawaddy Road 6570 2608 | glsurgical.com.sg

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Acute Abdomen #7

#7

The term “acute abdomen” describes a mixed bag of abdominal conditions and emergencies that can be life-threatening if urgent surgery is not done. Apart from pain, associated symptoms include abdominal distension, fever, vomiting, diarrhoea or constipation. These arise suddenly and escalate quickly. “See your family doctor straight away,” says DR MELVIN LOOK, or, better still, head to the emergency department of any major hospital. Causes and Diagnosis From your symptoms and a detailed clinical examination, the surgeon’s provisional diagnosis will be confirmed with the help of lab and radiological tests. “An immediate CT scan gives us an accurate image and is often the most useful investigation.” For example, free air in the abdominal cavity indicates a perforation of the gut – this might be, say, an ulcer in the stomach or duodenum that has penetrated right through the wall. The CT scan also shows inflammatory changes associated with gallstones, pancreatitis, colitis, diverticulitis or appendicitis . Possible

intestinal obstruction includes blockage of the small or large bowel, or from a number of different problems, including cancers, adhesions from previous surgery or a strangulated groin hernia. Gynaecological emergencies include a twisted ovarian cyst, pelvic inflammatory disease or even a ruptured ectopic pregnancy. Treatment Though antibiotics and medication are sometimes sufficient, surgery is often required. “Nowadays,” says Dr Look, “ keyhole surgery allows us to perform almost any abdominal surgery laparoscopically, making only small incisions.” That means only a day or two in hospital to recover after surgery for appendicitis, gallbladder stones or even perforated ulcers. PanAsia Surgery Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital and Parkway East Hospital 6333 5550 (24-hour hotline) panasiasurg.com

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#8 Double Trouble There’s little chance of being able to ignore the excruciating pain of a kidney stone attack, says DR SAM PEH, and it’s one of the most common problems he sees. But he warns of the danger of permanent damage – even leading to kidney failure – if kidney stones aren’t carefully monitored. Mostly consisting of calcium oxalate, kidney stones are often caused by eating a calcium-rich diet and not drinking enough water. They’re more common in men, and in those who are in their 30s or older. While it’s in the kidneys, a kidney stone may remain silent; a urine test may show tiny amounts of blood or tiny stone crystals in the urine, but that’s all. When it moves from the kidney into the ureter, however, you will know all about it! A stone that lodges in the ureter and causes obstruction causes sudden, severe pain radiating from the loin to the groin on the affected side. Treatment … and a Warning Appropriate treatment ranges from not doing anything for a small stone, to external shockwave therapy , to minimally invasive surgery to break the stone in the ureter. Surgical intervention is necessary for a stone that’s too big to pass on its own, when backed-up urine gets infected, when there’s a danger of irreversible kidney damage, or in the case of severe and repeated pain attacks. Don’t assume that when the pain stops, the stone has already passed. It’s essential to make an accurate diagnosis using a CT scan; that’s because a stone can stay in the ureter, not causing pain but still causing obstruction and damage to the kidney. PanAsia Surgery Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital and Parkway East Hospital 6333 5550 (24-hour hotline) panasiasurg.com

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The Silver Screen #9

Sometimes described as a “silent killer”, colorectal cancer tends to be symptom-free during its early stages. That’s what makes screening so important, says colorectal surgeon DR QUAH HAK MIEN. Diagnosed early, the disease is almost entirely preventable. Risk and development Most cancers of the large intestine develop from small polyps. Colonoscopy detection and the removal of polyps reduce your colorectal cancer risk – a polyp removed is a potential cancer prevented. Though colorectal cancer may occur at any age, says Dr Quah, the risk increases with age: around 90 percent of patients are over 50. “You’re at average risk if you have no relatives with colorectal cancer and have no symptoms at all. For an average-risk person, screening should begin at the age of about 50 years.” Having one or more close relatives with colorectal cancer puts one at high risk, he explains. In this case, you should undergo colonoscopy at an earlier age. The three main screening options are: A stool test , or occult blood testing, checks for traces of blood in the stools, so minute that they’re usually not visible to the naked eye. If found, a colonoscopy is recommended. If the stool test is normal, it needs to be repeated every year * A colonoscopy , the “gold standard” for testing, is considered the most accurate examination of the colon and rectum. Biopsies and removal of polyps (polypectomy) can be done at the same time through the colonoscope. In experienced hands, it’s a very safe procedure. * A CT scan virtual colonoscopy is a minimally invasive imaging test of the colon and rectum that looks for large polyps and cancer. It tends to be expensive, it’s associated with radiation exposure, and any abnormal growths that it may detect will have to be removed during the course of a subsequent colonoscopy.

Colonoscopy 101 After an injection into a vein, you’ll be relaxed and sedated during the 10-to- 30-minute procedure. The surgeon may take one or more biopsies (tissue samples) as necessary. Any polyps found are removed on the spot (polypectomy) and sent to a laboratory for analysis. Biopsies do not mean cancer! – most polyps are benign . Removing polyps essentially prevents the progression of the polyp and development of colorectal cancer.

Quah Hak Mien Colorectal Centre 6 Napier Road #05-01 Gleneagles Medical Centre 6479 7189 | colorectalcentre.com.sg

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Deep, Deep Trouble : DVT #10

Of all the vein conditions and diseases that endovascular surgeon DR CHENG SHIN CHUEN sees and treats, deep vein thrombosis or DVT is one we should all be aware of. Do people know enough about DVT? Definitely more than they did ten years ago, especially after a few rare, fatal cases from DVT were reported in the media. One telling sign of DVT being in the public consciousness is the layman’s term to describe it: “economy class syndrome”. Yet DVT doesn’t only happen to people who fly long-haul in cramped cabins. In fact, we distinguish two types of DVT patients: “well” ones and “sick” ones. An example of a well patient is one who, for example, is on the oral contraceptive pill and then undergoes a long flight or car journey. Sick DVT patients may include those who have cancer or bone fractures. How would I be able to tell that I may have DVT? How can I avoid it? Normally, DVT shows itself as swelling and pain on the side of one of the calves. If the clot is extensive, the whole leg might turn bluish, too. Keep yourself hydrated and mobile during long-haul travel; if possible, massage your calves and move your feet periodically. As for elasticated stockings, I must honestly say that only medical grade ones are helpful. What causes a thrombosis (or clot) to form, and what are the dangers? Clots occur when the flow of blood has slowed down or stopped, there is injury to the lining of the blood vessels and clotting factor levels are abnormal. The most feared complication, though rare, is bits of clot breaking off and making their way to the lungs and

heart, which can be fatal. In ten to twenty percent of cases of extensive clots, pain and swelling may become permanent; in other rare cases, the blockage can lead to gangrene. The biggest advances are two- pronged: medications to thin the blood, and devices to suck out the clot. New oral anticoagulants (NOACs) are far more convenient for dosing and don’t require troublesome blood tests. As for sucking out the clot, the new devices are delivered via an injection behind the knee or from the groin, often giving immediate relief from swelling. Pacific Vein & Endovascular Centre #19-01 Paragon 6238 2966 | pacificvein.com.sg What are the latest treatments?

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