Gleneagles Singapore - Your Health Guide

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Welcome! F inding a trusted GP or family doctor is one of the first things a newly arrived expat family needs to do. Just as important is knowing where to go and what to do in case of a medical emergency – and that’s exactly what you’re going to find out on these pages. Medical practice in Singapore is of an excellent standard, and this city-state boasts several outstanding hospitals with advanced technology, facilities and personnel. What’s more, a recognised institution like Gleneagles Hospital is home to dozens of specialist doctors who fur ther trained in the UK, North America or Australia – often experts in their own right. More good news is that private patients experience minimal delay in seeing a specialist in Singapore. Many expats are amazed to find how quickly they can get in to see an OB-GYN, paediatrician, gastroenterologist, cardiologist or whomever they require. So, whether you’re an old hand in Singapore or have just arrived, welcome to this useful booklet! We suggest you read it carefully and then keep it somewhere handy.

1 Health Essentials Part One 2 Chest Pain 4 Loving Your Liver 5 Essential Screening 7 Tummy Trouble 8 Colonoscopy 9 Back on Track 10 Baby Talk 11 Playing it Safe 12 Balancing Act 13 Health Essentials Part Two Contents

GLENEAGLES HOSPITAL 6A Napier Road, Singapore 258500 24-hr Patient Assistance Centre: 6575 7575 www.gleneagles.com.sg WhatsApp Hotline: 8799 7767 (Weekdays 9am to 5pm)

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Essentials Health

Part One

Are You Covered? Singaporeans and Permanent Residents (PRs) have varying access to subsidised government healthcare. The rest of us either have corporate medical insurance through our employers, or we have to purchase it privately. Have peace of mind by making sure you’re comprehensively covered! – not only here, but also while travelling for work or leisure. That way, when the need arises, you’ll be able to benefit from Singapore’s healthcare without sacrificing your hard-earned assets. Corporate and individual medical insurance are the two primarytypes of international health insurance. Gleneagles Hospital accepts patients with insurance from companies including: • Aetna • AIG • Alliance Worldwide • Aviva • Bupa Global • Cigna • Henner • MSIG • Prudential

Corporate Insurance Ask your HR department what you’re covered for and the extent of coverage, namely: • A&E visits

• Outpatient visits • Hospitalisation

Some corporate insurers require a co-payment for higher bills and more extensive surgery, or impose annual limits on hospitalisation benefits. Does your insurer have direct billing facilities with private hospitals like Gleneagles? If yes, get your specialist to fill in the approval form from your insurer for a letter of guarantee, preferably at least three days before admission or treatment. Showing your insurance card is sometimes sufficient, but for a scheduled procedure, pre-authorisation with a letter of guarantee is crucial to smoothen the admission process. Personal Insurance Here too, you will need a letter of guarantee to facilitate your insurance claim. Ask the clinic nurse at the hospital admission counter for the necessary documentation. Check whether your personal international insurance covers A&E consultations as some will only cover the cost of an A&E consultation if it leads to admission. Travel Insurance Typically, you will pay your bill upfront and submit it later to your insurance provider for reimbursement.

• Tokio Marine • United Health

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Chest Pain Never ignore chest pain! – or assume you know the cause. Though you can’t take every twinge to a specialist, self- diagnosis is a risky business. It would be a grave mistake to dismiss the signs of an actual heart attack as indigestion caused by over-indulgence at Sunday brunch! Here’s some advice from the multi-disciplinary team at Gleneagles Hospital.

#1 According to cardiologist DR PETER TING , angina is

a warning sign of heart disease, and is due to inadequate blood supply to the muscle of the heart. It’s not always that clear-cut, though. Rather than obvious chest pain, women, especially,may have subtler symptoms such as breathlessness and fatigue. Angina is typically felt as a gripping or pressing sensation over the central chest. This pain may radiate to the neck or jaw, or to the left shoulder and arm; you may feel nausea, sweating or giddiness – either concurrently, or alone. This lack of blood can be caused by narrowing of the coronary arteries from atherosclerotic plaques or spasm, or by disorders of the heart muscle or small blood vessels, or due to increased stickiness of the blood. What’s more, says Dr Ting, angina may easily be mistaken for gastric problems.

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Apart from traditional risk factors like high cholesterol, high blood pressure and being overweight, contributing factors include a poor diet, lack of exercise, chronic sleep deprivation, chronic stress and excessive alcohol intake. Blockages may not require surgery or invasive procedures like the insertion of balloons or stents. Almost 90 percent of heart attacks and strokes can be attributed to nine reversible risk factors: hypertension, diabetes, high cholesterol, obesity, poor nutrition, sedentary lifestyle, stress, excessive alcohol and smoking. Systematic lifestyle changes, along with appropriate medication, may help reverse the situation. “All recurrent or significantly disturbing chest pain should be evaluated,” he emphasises – especially as we get older. #2 Many causes of chest pain can arise from t h e oe s ophagu s , s a y s gastroenterologist DR TAN CHI CHIU . You’re likely to feel it in the centre of the chest, and when it radiates to the left lower chest, it can be misinterpreted as a heart attack or angina and cause alarm. Inflammatory causes include: • gastroesophageal reflux disease (GERD), typically felt as “heartburn”, when acid from the stomach backs up into the oesophagus; • a variant of oesophagitis called eosinophilic oesophagitis (EoE), thought to be related to allergies to particular food groups or other environmental allergens; • less common causes of oesophagitis including a yeast (candida) infection, a viral infection such as herpes, or swallowing scalding or caustic liquids.

Chest pain can also be caused by food getting stuck in the oesophagus, possibly linked to cancer of the oesophagus or the upper stomach, scarring from oesophagitis, or to one of many other disorders. Some drugs such as aspirin or other painkillers can injure the lining of the digestive tract, including the oesophagus; and pills such as some antibiotics or even large vitamin pills can become lodged there if improperly swallowed, potentially causing painful ulcers. Not only children swallow foreign objects, warns Dr Tan. Adults – possibly in a semi-drunken state – have been known to swallow a toothpick together with a hastily munched cocktail snack! As a rule of thumb, the more severe the pain, the more urgent it is to see a doctor, or to go to a 24-hour clinic. The 24-hour clinic at Gleneagles Hospital has specialists like Dr Tan on call. #3 Finally, your chest pain may be a symptom of something musculoskeletal in origin, says orthopaedicsurgeon DRLESLIELEONG – most commonly after viral illness such as the flu. Some other possible causes include trauma such as a fracture, a sprain or a strain; more rarely, autoimmune illnesses or bacterial or viral infections may be the cause. Costochondritis is a painful inflammation of the cartilage that connects a rib to the breastbone, often flaring up after a viral illness, or after a strenuous workout. You’ll usually feel localised pain next to the sternum, at any level from the second to the sixth rib. It might also hurt when you breathe deeply, cough, lie on your side or change position. Oral and topical anti- inflammatories,warm packs and appropriate rest should soon resolve the problem. But if none of these possibilities apply to you, you’re over 40, or you have any of the angina-related symptoms described above,have yourself checked out immediately!

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Loving Your Liver

Before you flip the page and pour yourself another large glass of wine, pause for a minute to read gastroenterologist DR LUI HOCK FOONG ’s sobering advice.

What is fatty liver? It’s a medical condition associated with obesity. In most cases, storing excess calories as fat does not harm the liver. But in

a minority of cases, for example when diabetes is present or the degree of fat accumulation is very high, the fat cells can cause inflammation, scarring, cirrhosis and even liver cancer. How prevalent is it? Fatty liver is the new liver disease epidemic. Up to 30 percent of the general population may have fatty liver and, of these, 15 percent have the more serious type.The good news is that it can be reversed by lifestyle changes. Can drinking too much alcohol cause fatty liver? What is a safe amount to drink? Yes,fatty liver can also be caused by excessive alcohol intake. Both men and women should drink no more than 14 units of alcohol a week. One unit of alcohol equates to one shot of hard liquor, one small glass of wine or half a pint of beer.

Myth #1 Women are more prone to alcohol-induced liver injury Recent studies point to equal risk for both men and women. Fourteen units is the recommended upper limit for everyone, regardless of gender. Myth #2 Hard liquor is more harmful than beer or wine What matters is the quantity of alcohol, not the type. Myth #3 Only alcoholics get alcoholic liver disease Alcoholics are people who have a physical and psychological addiction to alcohol,often associated with harmful and compulsive behaviours. Many people who drink do not develop dependence, but will nevertheless be vulnerable to alcohol-induced liver injury if they exceed the safe limits.

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Essential Screening for Women & Men While a healthy lifestyle is the basis of wellness, looking slim, fit and well on the outside is no guarantee that everything inside our miraculously complex bodies is actually working properly. With so many types of screening, three specialists highlight the essentials for us.

Cervical Cancer

Regular screening and the HPC vaccination are your best defence against cervical cancer, says gynaecologist DR CHIA YIN NIN .

Precancerous changes in the cervix begin many years before cancer develops, offering a great window of opportunity for screening and detection. “What’s more, they can be easily treated – and early treatment saves not only a woman’s womb, but also her life.” The former gold standard of screening for precancerous cervical change, the Pap smear is subject to sampling and interpretation error, says Dr Chia – the rate of false negatives could be as high as 30 percent! A much better screening tool nowadays is HPV testing , based on the fact that cervical cancer is caused by persistent HPV (human papilloma virus) infection. She recommends that women aged 30 and older should be tested at least every three to five years. The relativelyrecent HPVvaccination is a major scientific breakthrough in women’s health, says the doctor. “All women should be vaccinated, ideally from the age of nine onwards – before any form of sexual encounter.” That’s because HPV infection occurs not only through penetrative sex but also through sexual petting. It’s usually transient, but in about 20 percent of women it persists, setting the stage for cancerous transformations. Even i f a woman has been vaccinated, Dr Chia stresses, she must continue with regular screening. That’s because none of the current vaccines completely covers all strains of the HPV virus.

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What’s Best for Breasts? Should you be going for regular breast cancer screening? According to Singapore National Screening guidelines, says general and breast surgeon DR BERTHA WOON , an annual mammogram is recommended from the age of 40, and then every two years after 50.

Prostate Problem Consultant urologist DR HO SIEW HONG tells us why there’s still a place for the prostate-specific antigen (PSA) test . An elevated PSA reading acts as an early indicator for detection of prostate cancer.But as high PSA can

also be caused by a prostate infection or benign prostate enlargement, only a biopsy can confirm cancer. So, how can we avoid unnecessary biopsies and surgeries? “For early detection, the latest US guidelines call for yearly PSA testing in men aged 55 to 70,” says Dr Ho – or from 40 for those with a family history. Here are the new risk classification and treatment recommendations, based on biopsy pathology results: • very low risk – observation only, no surgery or radiation • low risk – observation only, no surgery or radiation • intermediate risk – surgery or radiation • high risk – surgery or radiation. This avoids unnecessary treatment in the lower-risk groups, focusing it on higher-risk groups where cancer progression has been proven to lead to earlier death if left untreated. Technology, too, has lessened the risks of diagnosis and treatment. “Our current MRI ultrasound fusion biopsy helps us perform even more accurate and targeted prostate biopsy,” explains Dr Ho. In addition, robotic-assisted radical prostatectomy now offers better cancer clearance, preservation of urinary continence and erectile function.

Breast cancer incidence in Singapore has more or less tripled in the past 50 years, Dr Woon points out, and the age-group statistics support mammogram screening from the age of 40. “Nevertheless, I discuss with my patients the risks, benefits and limitations of mammograms, so that they can make informed decisions,” says Dr Woon. What about alternatives such as breast ultrasound , which can detect early breast changes and does not emit radiation? “Breast ultrasound is not the accepted gold standard for breast screening,” she replies – the mammogram is. “Mammograms can pick up micro- calcifications that can be a sign of atypia or ductal carcinoma in situ. Breast ultrasound is unable to pick this up.” She adds: “We do use breast ultrasound as an adjunct investigation, together with mammogram, to increase the pick-up rate for cancers and other suspicious lesions.” More welcome news is the minimally invasive ways we have nowadays of biopsying suspicious breast lesions, says Dr Woon. Gleneagles Hospital, for example, uses a vacuum-assisted, imaging-guided biopsy technology called EnCor Enspire. “What’s more, if a lesion is confirmed to be early cancer, exciting advances in molecular genetics enable us to tailor the treatment to the patient.”

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You are what you eat, they say. More accurately, you are what you’re capable of digesting and absorbing! DR QUAH HAK MIEN , genera l and co l orec ta l surgeon, talks irritable bowel syndrome (IBS), a disorder that affects ten to fifteen percent of the population. IBS Tummy Trouble

How do you diagnose IBS? IBS diagnosis depends on the symptoms – there is no specific diagnostic laboratory test or scan for it.And, as IBS symptoms can be similar to colon cancer or inflammatory bowel disease (for example, Crohn’s disease or ulcerative colitis), it’s important to differentiate between these serious conditions and IBS. We do that by means of a colonoscopy. What is your approach to IBS? To some people, the symptoms of IBS may appear trivial or funny. But they can seriously disrupt the lives of sufferers, who may frequently be bothered by tummy cramps or embarrassed by excessive gas and stress-induced diarrhoea. Our goal is to relieve symptoms, and to educate patients to understand their condition and help us to manage it. Fortunately, however distressing its symptoms may be, IBS does not lead to cancer or other life-threatening diseases. Can you recommend a suitable diet? A good, balanced diet is always important. However, I can’t recommend one specific diet, because IBS affects each person differently, and no one diet works for everyone. In general, avoid caffeinated food and drinks such as chocolate, tea and coffee, as caffeine stimulates the bowel. Eat your fruit and vegetables,but remember that excessive amounts of fibre may worsen bloating and gas. Finally, get enough sleep and exercise to reduce stress levels.

What is IBS – and what causes it?

Symptoms of IBS include b l o a t i n g , d i a r r h o e a , constipation, belly pains and so on, often made worse by

stress.It may develop after an episode of upset stomach or food poisoning, leading some to believe that the bowel infection or subsequent use of antibiotics may have disrupted the balance of the intestinal bacteria ecosystem. It can start in the teenage years or early adulthood, and tends to affect women more than men.

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Focus on Colonoscopy

Colorectal cancer, or bowel cancer,is the number one cancer in Singapore – from 2,000 to 2,500 new cases are diagnosed here every year,mainly in people over 40 years of age. In most cases,it has a pre-cancerous stage in the form of a small, benign growth called a polyp, which grows slowly from a few millimetres to about two centimetres in diameter before transforming into bowel cancer. Detecting these polyps early and removing them before they become cancerous is the only proven way to prevent colorectal cancer. Colonoscopy is the procedure that can detect these precancerous polyps and remove them at the same time, simply and easily. Colonoscopy is advocated for everyone from the age of 50, or earlier for some. Someone with a family history of bowel cancer should start about ten years before the age his or her family member’s cancer was diagnosed. Recent advances in colonoscopy allow even larger polyps to be safely removed via colonoscopy.What’s more,laparoscopic (keyhole) surgery promises bowel cancer patients less post-surgical pain and a better recovery.

There’s no doubt about it – colonoscopy saves lives. General surgeon DR NG KHENG HONG explains why.

What should I expect during a colonoscopy? Early in the morning of your colonoscopy, you clear your bowel by taking a strong laxative. Then, in the hospital’s endoscopy centre, an intravenous sedative will ensure that you feel no discomfort. To start the colonoscopy , a colonoscope – a small tube with a camera attached to one end – is introduced into the colon via the anus. During the 10 to 15 minutes of the procedure, the doctor will

examine the bowel closely for polyps and signs of cancer.

Any polyp encountered will be removed immediately. If possible bowel cancer is detected, a biopsy will be taken for further evaluation. After a normal and satisfactory colonoscopy, you can wait for 5 to 10 years for your next colonoscopy, as long as you remain symptom-free.

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No injured sportsman or sportswoman wants to be told to hang up their trainers, as avid marathoner and orthopaedic surgeon Back on Track

DR LIM LIAN ARN understands perfectly.

Are injuries growing along with the amazing increase in mass sports participation in Singapore?

How do we avoid injury? It all boils down to the following:

• Firstly, proper preparation –having the right baseline fitness for the activity you want to do, and using the right techniques and equipment. • Secondly, constant review , which entails doing your activity fairly regularly,addressing niggles and aches early, and reviewing your techniques and equipment as these niggles pop up. • Thirdly, earlymanagement of injuries , which means being disciplined enough to see your doctor when a pain or injury doesn’t resolve after an appropriate period of rest. Any new advances in the field of sports science and orthopaedic surgery? There are many that aim to return injured athletes back to their sports in the shortest period of time with the least invasive methods. Stem cell injections for soft tissue and cartilage recovery are promising, but unfortunately don’t work well for all patients and all conditions.

Yes – the upside to participants is the health benefits of these activities,and the downside is the injuries.On the whole, I think the advantages far outweigh any potential disadvantages. What sorts of sports-related injuries do you see in your practice? There are two major types: chronic overuse injuries, like knee cartilage wear and tear, or shoulder tendon wear and tear; and acute or traumatic types of injury, like knee ligament and meniscus tears, ankle sprains, shoulder tendon tears and dislocations, and fractures in the limbs. How do you treat them? Most can be managed with rest and anti-inflammatory medication. Overuse injuries need to be evaluated for predisposing causes such as limb misalignments, poor technique or equipment, or simply over-activity. The three most common surgeries we do for acute, traumatic injuries are: anterior cruciate ligament reconstruction, meniscus tear repair and rotator cuff repair.

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Baby Talk Having a baby when you’re far from home, family and your trusted support network may be a daunting

prospect. The good news is that Singapore’s cutting-edge medical facilities make this a great place to be pregnant and to give birth. Gleneagles Hospital gynaecologist DR CHRISTOPHER CHONG tells us more.

What’s your approach to the choices surrounding labour and birth? I frankly discuss modes of delivery and pain relief, and encourage my patients to tell me their fears and wishes.In general,normal delivery may be safer for the mother, and Caesarean section safer for her baby. C-section can protect the pelvic floor and guard against pelvic organ prolapse for up to three deliveries.That said,vaginal delivery promises faster recovery and less post-delivery pain. A s we e t , s mo o t h a n d memorable delivery includes good hydration, adequate pain relief, and no suffering or trauma. Being a uro-gynaecologist who sub-specialises in the pelvic floor, I take special care – especially with vaginal deliveries – to make my patients “as good as new”, if not better! What support do you offer on the pregnancy journey? Whether or not it’s their first baby, each couple has different n e e d s a n d q u e s t i o n s , s o communication is important. We

provide ultrasound scans at every visit for assessment; antenatal, lactation and postnatal classes; financial counsel; physiotherapy; informative talks and reading materials, and much more.

Why do you think mums- to-be choose to deliver at Gleneagles Hospital?

I think it is the sincere ambition of the Gleneagles team to make patients feel assured that they will be looked after to the best of our ability and leave with a good experience; we want them to return for the “next round” – and to recommend the hospital to their friends. Everyone here strives to understand patients, their families and their needs and anxieties, and to put patients at the centre of the experience. It can be reassuring for a first-time mum when everyone from the specialists and the nurses, to the midwives and other departments like the operating theatre and neonatal wards are well-trained. We even have postnatal massage and hairdressing services in the hospital.

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Playing it Safe Viral infections and minor emergencies are part and parcel of childhood – and you can’t rush every sniffle or scratch to the hospital A&E. Here are some guidelines from consultant specialist Ear, Nose & Throat surgeon DR DAVID LAU .

Foreign bodies stuck in noses, ears, and throats need medical intervention. “Attempting to remove them yourself may cause more damage to the delicate tissues and structures,” he says. Likewise, trauma and lacerations of ears and noses from sports may require medical attention: “Always look out for breathing obstruction, bleeding or severe pain.” Be prepared before heading to A&E. “Take along the child’s ID document, like a passport or birth certificate, plus your own.” Having your insurance card, document or policy number for e-filing at A&E might speed up the paperwork, too. For everyday colds and flu , keep children hydrated and cool, with lots of rest and cuddles, and vitamin C gummies if they’re able to swallow them. Keep an eye on your child’s temperature. A temperature that stays at 40 degrees Centigrade or higher means it’s time to see a doctor. The same goes for seizures or fits, inability to swallow fluids

for more than a day, a stiff neck, bad headaches, a rash, or a cough lasting more than a fortnight. Avoid antibiotics unless clearly indicated for bacterial infections. “Most childhood colds and flus are viral in nature, and best treated by our own immune systems, which allows the child’s immunity to be properly built up.” Allergic reactions bring children to A&E too. “ The numbe r one allergy I see in kids is to house dust mites,” says Dr Lau. “You can discourage allergies during infancy by breastfeeding and trying to avoid excessive cleanliness, by not smoking and by ensuring healthy, balanced nutrition.” A trip to the A&E is normally unwarranted unless the allergic reaction is severe. Identifying the allergy is the first step towards effective treatment of its symptoms. “Allergies (particularly of the nose) can affect sleep and behaviour, and can even exacerbate conditions such as hyperactivity disorder.”

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Balancing Act With worrying reports that today’s 11-year-olds are as inactive as their 65-year-old grandparents, it’s great to see youngsters out there playing and competing in sports – but, could they be overdoing it? Keep your children safe with some balanced advice from orthopaedic surgeon DR LIM YI JIA .

Apart from being smaller, how is a child’s physiology different from an adult’s?

Our main physiological concern for children is for their growing bones; most serious injuries involve

children’s growth plates.Another is for their evolving ability to take instruction. Regardless of the type of sporting activity, they need to learn proper techniques so as to avoid injury. In addition, they should be supervised closely and competently at all times. Some parents are so eager to see their child excel that they encourage them to focus on just one sport, such as swimming or tennis. Is this a good thing? It’s important to develop each child in multiple aspects, to promote balance in their social and physical development.When children show a special talent, it’s perfectly all right for them to spend more time on that sport – but specialisation and intense training can have negative outcomes. We see this in what’s known as the Female Athletes Triad: eating disorders, disruption of the normal menstrual cycle, and osteoporosis (loss of bone mass). Parents of young female athletes need to be aware of this danger.

What kind of approach do you suggest? Children should enjoy whatever sport they play. Enjoying sport and playing it safely is integral to a child’s healthy lifestyle. Intensive training and early specialisation is often more the decision of parents or coaches than of the child themselves. Even if children do take on intensive training, their joy for the sport should not be lost in the process.

Top Tips for Kids #1 Learn proper technique

#2 Listen carefully to your coach, and discuss how any new techniques can be done safely #3 Enjoy yourself!

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Essentials Health

Part Two

Emergency! Here’s what you need to know in advance of any unforeseen dramas: • Both public and private hospitals have Accident & Emergency units (commonly known as A&Es), and those in private hospitals also operate as 24-hour walk-in clinics. • Trauma cases such as road accident victims are taken to public hospital A&Es with dedicated trauma units. Emergency Medical Services (EMS) 995 ambulances are solely for such medical emergencies, and will proceed directly to such hospitals. • Parkway Ambulance Services supports Gleneagles Hospital with both emergency and non-emergencymedical transportation,and is accredited by the Ministry of Health. Call its 24/7 Hotline on 6575 7575. • Gleneagles’ 24-hour walk-in clinic has a full roster of specialists on standby. Notify the hospital admission counter if you’re already under the care of a specialist practising at Gleneagles and would like him or her to attend to you. • If you’re admitted to hospital from the clinic, you can ask at the admissions counter or call 6575 7575 to find out if your insurance coverage allows direct billing.

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By your side 24/7

Location: 6A Napier Road Singapore 258500

24-Hour Hotline: 6575 7575

Make an appointment with our specialists via WhatsApp: 8111 9777 Monday to Friday, 9am to 5pm.

gpac@parkwaypantai.com

www.gleneagles.com.sg

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