Professor Lim Yean Leng, former Director of the National Heart Centre, joins Raffles Hospital as

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1 Professor Lim Yean Leng, former Director of the National Heart Centre, joins Raffles Hospital as Director of the Raffles Heart Centre and Consultant Interventional Cardiologist. An eminent cardiologist, academic and administrator, Prof Lim was the first Director of the National Heart Centre. He held concurrent positions as Honorary Professor in the Faculty of Medicine at Australia s Monash University as well as Clinical Professor at National University of Singapore s Faculty of Medicine. Prof Lim is the Secretary General of the Asia Pacific Society of Cardiology and Permanent Secretary of the Asia Pacific Society of Interventional Cardiology. He has also authored an impressive body of books and scientific papers that are published internationally. He is a respected cardiologist in Singapore and the region. An Honorary Visiting Cardiologist to Alfred Hospital s Heart Centre in Melbourne, Australia, Prof Lim is also visiting professor to many Chinese universities. These include Peking University s Institute of Cardiovascular Sciences, Shanghai Second Medical University, Dalian Medical University, Liaoning Medical University and the 4th Military Medical University in Xian. We are honoured to have someone of Prof Lim s stature join Raffles Hospital, said Raffles Hospital s Medical Director, Prof Walter Tan. Prof Lim brings to Raffles Hospital a wealth of experience. More importantly, he shares our vision of a group practice where doctors work as a team for a peer reviewed approach for the most appropriate care for our patients. Raffles Hospital is a tertiary hospital with two centres of excellence - Raffles Cancer Centre, which is affiliated with New York s Memorial Sloan Kettering Cancer Center, and Raffles Heart Centre. Prof Lim, who heads Raffles Heart Centre, says his immediate plans include building up a team of people with a common vision of achieving clinical and academic excellence. He says: I am keen to build Raffles Heart Centre up to be a medical practice with a strong reputation for clinical and academic excellence. Good service and research will be a priority, as is on-going training of both medical and paramedical staff. When we work in concert as a team, we achieve real excellence. Raffles Heart Centre provides one-stop specialist care for patients concerned with maintaining a healthy heart. Its services include a wide range of diagnostic and treatment strategies for heart diseases.

2 Health & U Hyper tension: What is Hypertension? Detect and Stop Silent Killer ypertension also known as high blood pressure is a very common condition affecting 1 in 4 adults. It has been estimated that the H lifetime risk of developing hypertension is 90%. Normal Blood Pressure (BP) can vary to very high levels at times even for normal people. The diagnosis of hypertension requires the patient to have high BP most time of the day even when rested. Normal BP is 120/80 and high BP is when the reading is consistently above 140/90. Readings in between these two represent a grey area and they are often referred to as highnormal and borderline hypertension. Patients with BP in this category are usually not treated with medications. Types of Hypertension The majority of patients with hypertension about 95% have what is known as essential hypertension. What this means is that we do not know why they are hypertensive. The cause of hypertension in patients with essential hypertension is thought to be multifactorial in origin. This explains why a particular medication can work for one patient but not another with similar readings of BP. The other 5% of patients have the form of hypertension called secondary hypertension. Such cases have definite and identifiable causes and these include kidney diseases and endocrine disorders. It is important to identify patients who suffer from secondary hypertension as treatment of their existing conditions can normalise their BP. Why do I Need to Know Whether I have Hypertension? It is a fallacy that we can actually know when our BP is high. By Dr Ng Wai Lin, Consultant Cardiologist It is also a myth that when our BP is high, our face or ears would become red and we would develop a headache. Hypertension is a silent killer. The majority of patients with hypertension do not have any symptoms. Untreated hypertension will lead to damage of lining of arteries supplying major organs in our body. It would also accelerate the process of atherosclerosis the hardening of arteries. Over time, this can lead to damage of our heart muscle by causing thickening of the muscle or through death of part of our heart through heart attacks. Hypertension can also lead to stroke, impaired vision and kidney failure. When is Hypertension Not Hypertension? Your blood pressure is variable throughout the day. In fact, about 20% of patients who are diagnosed with hypertension do not actually have hypertension. Our BP has a circadian rhythm which is set by our body s biological clock. Your BP is variable throughout the day, rising in the morning and falling during sleep. During the day, it also varies depending on the activity you do. The BP obtained by random measurements at home and in the clinic can only suggest whether you have hypertension or whether your BP is inadequately controlled by the medication you are taking. More accurate measurements of BP can be done very easily with sphymomamometers. These are ambulatory blood pressure monitors (ABPM) that can measure our BP throughout the day. It gives a more comprehensive account of your BP and can determine if a patient truly has hypertension. It is also a better predictor of your likelihood of developing complications and will enable your doctor to better manage your hypertension. What is Ambulatory Blood Pressure Monitoring (ABPM )? ABPM is a small machine that records your BP over a 24 hour period. It will not interfere with your daily activities. In fact, most people do not have any problems wearing the device to work. An inflatable cuff is worn on your arm and a recording device about the size of a walkman is worn at the waist. Your heart rate and BP is measured at 15-minute interval during the day and at 30-minute interval during sleep. The recorded data will be downloaded to a computer the next day for interpretation. Health & U Who Should Consider ABPM? ABPM is now used frequently for the diagnosis and management of hypertension. It is especially useful for the following subgroup of patients: Untreated hypertension will lead to White Coat Hypertension There are some patients who have high BP damage of lining of arteries supplying when they see their doctor but monitoring of major organs in our body. It would also their BP at home is normal. This is a very common problem in newly diagnosed accelerate the process of hypertensives. These patients do not require drug therapy and unnecessary treatment with atherosclerosis the hardening of arteries. drugs can be avoided if correct diagnosis of white coat hypertension is made. Borderline Hypertension Some patients have borderline or high normal BP reading. It is possible that their average BP reading outside the doctor s office is higher because of work or personal stresses. ABPM would provide a much more accurate picture of their BP status and whether treatment is necessary. Resistant Hypertension Some patients have high BP which is difficult to control despite being on multiple medication. It is possible that the BP obtained during the clinic visit is not representative of the BP throughout the day. ABPM would provide the doctor with important information on the control of BP and whether changes in medication need to be made. Hypertension and BP Control ABPM can also be used to monitor their hypertension and the response to drug therapy. Some patients with hypertension on medical treatment can develop symptoms such as giddiness or drowsiness which suggest that the BP is excessively reduced. ABPM would give us an average reading of BP and we could also correlate the BP to the time when the patients experience the symptoms. There are many effective treatments available for hypertension. Your doctor will individualise your treatment plan and advise you on lifestyle changes to help bring your BP down. Over time, this can lead to damage of our heart muscle by causing thickening of the muscle or through death of part of our heart through heart attacks. 2 Raffles Healthnews Issue 4/2002 Raffles Healthnews Issue 4/2002 3

3 Health & U The Choice between Generic and Brand Name Drugs Rising healthcare costs worldwide are putting the spotlight on several issues in medical practice such as: Inappropriate and unnecessary care Variation in clinical practices Lack of integration in care Improper prescribing and use of medication With respect to the last point, there has been considerable debate on the use of generic medication. There is a perception that generic drugs are poor quality alternatives to brand name proprietary drugs. This article provides an insight into this topic. What are Brand Name Drugs? The first approved version of a drug is known by its brand name and thus called a brand name or proprietary drug. As the cost of developing and introducing a new drug involves a huge investment, a brand name drug is often given patent protection for its initial years usually about 20. Drug companies of brand name drugs have to recover hefty costs that went into research, development and marketing, especially before the patent protection period expires. This is the reason why brand name drugs are expensive. What are Generic Drugs? Once the patent period of a brand name drug lapses, other drug companies can manufacture the drug. Generic drugs typically cost less than brand name medications but they are just as safe and effective. Generic drugs contain the same active ingredients as its brand name predecessor. For the same strength and dosage, generic drugs should produce the same effect on the patient as its more expensive counterpart. Generic drugs may look different because of the inactive ingredient used. Such ingredients do not affect the efficacy as substances added for non-medical reasons e.g. to prevent the tablet from crumbling, to give it a size or shape for ease of handling, and to give it a pleasant colour or taste. Safety and Efficacy of Generic Drugs Generic drugs can be manufactured after the patents on brand name drugs have expired. For every brand name drug, there are sometimes many generic versions or none at all. In Singapore, you can be assured that all brand name and generic drugs are tested, approved and registered with the Centre for Pharmaceutical Administration of the Health Sciences Authority before they are made available. The government agency s mission is to safeguard public health by administering a robust, scientific and responsive regulatory framework. The Health Sciences Authority (HSA) ensures that pharmaceuticals and health-related products in Singapore meet appropriate standards of safety, quality and efficacy. At its Centre for Drug Evaluation, all drugs submitted for registration are assessed in accordance with international practice to assure their effectiveness, safety and quality before they are allowed into the market. What is RMG s Commitment to Our Patients? Our RMG clinics stock a variety of brand name and generic drugs. Your doctor will prescribe for you generic drugs when it is appropriate to keep down the cost of medications, while maintaining safety and effectiveness. We obtain all our drugs from established and reputable manufacturers of pharmaceutical products. These are manufactured in facilities comparable to those of brand name drug companies. Very often, such manufacturers produce both brand name drugs and their generic equivalent. Advantages of Generic Drugs You have the same for less! For Patients... If you co-pay for your medical charges, you will enjoy cost savings by using generic drugs. For those with chronic illnesses and are on long term medication, this translates into significant savings. Talk to your doctor and see if there are generic alternatives that are right for you. For Companies... The savings in expenditure on medications is multiplied by the number of staff and could add up to a sizeable amount. You can better manage your healthcare expenditure and channel the savings back to your employees in other forms of benefits. More Information For information on how drugs are controlled in Singapore and tips on the safe use of medicine, you may check out the website of the Centre for Pharmaceutical Administration of the Health Sciences Authority at For independent information on generic drugs, you also may check out the US Food and Drug Administration website at 4 Raffles Healthnews Issue 4/2002

4 Clearing the Myths on Heart Attack, High Blood Pressure and High Cholesterol By Dr Bina Kurup, Senior Family Physician Medical Myths I m only 35 years old! I can t be having a heart attack! Some younger patients in their 30s and 40s tend to ignore symptoms of chest pain, thinking it is merely musculoskeletal. This is especially so if they had done a work-out at the gym or lifted heavy objects preceding it. Another mistaken symptom is heartburn, which can actually be a heart attack but patient dismisses it as just wind or indigestion. Patients tend to ignore chest pain especially if it is not associated with sweatiness, giddiness, breathlessness or left arm pain, thinking it cannot be heart in origin. The FACT is Ischemic Heart Disease (e.g. Heart Attacks, Angina) can affect younger individuals even in their 20s and can present in a very atypical or unusual way. Some patients, who are actually having a heart attack, may only experience jaw pain, or gastric pain or left arm pain at that time with no chest pain and no other symptoms. So, the next time you have any discomfort that is bothering you, regardless of your age, don t ignore it...pay your Family Doctor a visit! My father had hypertension when he was 70 years old. It was due to old age and nothing to do with genes, so I m not at any increased risk. Hypertension, or high blood pressure can even occur at the young age of teens or 20 which is usually due to other underlying medical problems e.g hormonal, endocrine or kidney problems. This is called secondary hypertension. But as one grows older and approaches mid-30s to 40s, no underlying cause is usually found. This is called essential hypertension, which is attributed to genetic factors. Quite often too, hypertension can occur in an older individual secondary to diabetes (if the kidney function is affected). Studies have confirmed a genetic basis for high blood pressure but its occurrence cannot be predicted simply on the age of presentation of the preceding generation. Hence, it is advisable to check your blood pressure regularly, at least 6 to 12 monthly for those at low risk, but more frequently about 3 to 4 monthly for those with positive family history and above 35 to 40 years old. I m so thin...how can the doctor say I ve got high cholesterol?! Raised cholesterol can actually be independent of body weight. Diet however does contribute to increased levels of lipids which is why obese individuals are more likely to have an abnormal lipid profile. However, in some individuals, the lipids may remain very high despite stringent diet, regular exercise and maintenance of ideal body weight. This is often due to hereditary factors and such individuals usually need to be on long-term lipid lowering medication with regular monitoring. Hence, hyperlipidemia as with hypertension, both of which are coronary risk factors, are usually silent. It is therefore recommended that at least these two parameters (blood pressure and lipid profile), and preferably including fasting blood sugar and assessment of body mass index, should be the minimum risk profile check for all individuals more than 35 years old. I lead a clean life, I don t smoke nor drink alcohol and I exercise regularly, at least 3 to 4 times a week. It is almost impossible for me to get a heart attack. While it is true that smoking and sedentary lifestyles with lack of regular exercise are risk factors for a heart attack, they are not the only ones. Genetic factors play a major role. Diabetes, hypertensives and those with raised cholesterol and triglycerides are also at increased risk. Locally, male Indians who are more than 40 years old belong to the highest risk group. So one has to look at the composite risk profile to predict one s risk of getting heart problems later or in life. While certain risk factors (like age, sex, race and family history) cannot be changed, those that can be modified with lifestyle changes should certainly be attempted. Top on this list would be to quit smoking (if you are a smoker) and not to start (if you are not a smoker). Other healthy lifestyles which would certainly impact on a healthier heart, would be regular exercise, lower fat intake to maintain a good lipid profile (including adequate level of good cholesterol viz HDL cholesterol), maintaining ideal body weight and good control of hypertension and diabetes (where applicable). Remember Prevention and Early Detection is key to keeping a Healthy Heart! Raffles Healthnews Issue 4/2002 5

5 Corporate Scene For Our International Patients We understand the anxieties of patients and their family members when they have to travel to a foreign country for medical treatment. What patients and family members look forward to is a friend in the new environment to help see them through their visit in Singapore. At Raffles Hospital, we have dedicated a centre to assist international patients in a variety of services to help ensure a pleasant and comfortable stay. Some of the services include: Appointments and Referrals for consultation at Raffles Specialist Centre Admission Services including reception and advice on fees and bill estimates Accommodation arrangements (e.g. Studio@Raffles, hotels or service apartments) Transportation arrangements including airport transfers and visa Visitor Information including services available in Raffles Hospital and tourist information Concierge Services including interpreters, foreign exchange, laundry service, mail postage and delivery, private nursing, portering service, and Business Centre services. Raffles International Patients Centre is located on Level 2 of Raffles Hospital. We can be contacted at: Hotline: (65) Fax: (65) enquiries@raffleshospital.com Clinic Announcement Our new clinic at Compass Point opened in August, providing GP services as well as Obstetrics & Gynaecology, Paediatrics and Dental services. Compass Point 1 Sengkang Square, #04-11/12, Singapore Tel: Mon - Sun 8.30am pm 2.00pm pm 6.30pm pm Our clinic at Ten Mile Junction has moved to Lot 1. Lot 1 Shopper s Mall 21 Choa Chu Kang Ave 4, #B1-07A, Singapore Tel: Mon - Fri Sat / Sun / PH 8.30am pm 2.00pm pm 6.30pm pm 8.30am pm Compass Point 6 Raffles Healthnews Issue 4/2002

6 Corporate Scene New Specialists joining Raffles Hospital Dr Wong Soon Tee MBBS (S pore), MRCP (UK), FAMS Consultant Dermatologist & Physician Dr Wong Soon Tee joined Raffles Hospital in October this year as our Consultant Dermatologist and Physician. Prior to this, Dr Wong was a Senior Lecturer in the Department of Medicine in National University of Singapore and was practising in National University Hospital as a Consultant Dermatologist and Physician. He was awarded the Commonwealth Fellowship by the Association of Commonwealth Universities (United Kingdom) in 1998 and spent 20 months in UK for his research and subspecialty training. He also received training at Bedford NHS Laser Treatment Centre on all aspects of cutaneous laser surgery including vascular, pigment/tattoo, hair removal and skin resurfacing laser surgery for facial wrinkles and acne scarring. Dr Wong has two on-going NMRC grants on molecular genetic research in psoriasis and keloids. His other special interests include skin cancer surgery and all the minimally invasive facial rejuvenation treatments of photoaged skin and facial pigmentation. Dr Vincent Lee Meng Shian MBBS (S pore), MRCOG (Lond), FAMS Consultant Obstetrician & Gynaecologist Dr Lee joined Raffles Hospital in September and now practises in the Raffles Women s Centre at Raffles Hospital, as well as in our Compass Point Clinic in Sengkang. Before joining Raffles Hospital, Dr Lee worked in the Department of Obstetrics and Gynaecology at KK Women s and Children s Hospital. Dr Lee has special interests in Reproductive Medicine and Infertility, and also Minimal Access Surgery. He has published with the British Journal of Obstetrics and Gynaecology on the successful use of Intrauterine Insemination techniques for the treatment of infertile Singapore couples. Dr Lee graduated with MBBS from the National University of Singapore in He obtained his postgraduate degree in 1998 and became a Member of the Royal College of Obstetricians and Gynaecologists. He is accredited in Minimal Access Surgery and Laser procedures of the Lower Genital Tract. Dr Chuah Khoon Beng MBBS (S pore), MRCP (UK) Consultant Gastroenterologist and Physician Dr Chuah Khoon Beng joined Raffles Hospital in July. Before joining Raffles Hospital, he practised in Singapore General Hospital and Tan Tock Seng Hospital. Dr Chuah is trained in the luminal aspect of Gastroenterology as well as hepatology. His experience includes conducting a busy Hepatitis B and C Liver clinic during his posting in Sydney, Australia, using ribavarin and/or interferon. He was also involved in the Asia Hepatitis Lamivudine Study Group from Dr Chuah graduated from the National University of Singapore in 1990 with MBBS. He obtained his post-graduate degree and became a Member of the Royal College of Physician (UK) in 1995 and was accredited with the Conjoint Committee of the Royal Australasian College of Surgeon and Physician for both Upper and Lower therapeutic Endoscopy in Register Your New Born Baby at Raffles Hospital From 1 August 2002, all our Obstetrics patients may register their babies at Raffles Hospital. Said Mr Lawrence Lim, General Manager, Raffles Hospital who is gazetted Deputy Registrar, Birth Registration for the Hospital. It s a delight for us to be able to offer our patients this service. It accords our patients a one-stop convenience of being able to register the birth of their babies just outside the nursery. Our Birth Registration service is available from the Admission counter at Ward 8 / Labour Ward at the following hours Monday - Friday 9.00 am to 4.00 pm Saturday 9.00 am to pm The cost of the registration is $ Raffles Healthnews Issue 4/2002 7

7 Special Packages Directory Raffles Hospital 585 North Bridge Road Singapore General Enquiries Fax No Hour Walk-In Clinic Accident & Emergency Breast Awareness Class Jointly organised by Breast Cancer Foundation and Raffles Hospital Learn About: The Importance of Early Detection Breast Screening Methods BSE Demonstration and Hands-On Practice Tour of the Mammography Centre Breast Cancer Foundation Support Services Class Schedule for 2002 Thursday, 7 November 2002 Thursday, 5 December pm 8.00pm 6.30pm 8.00pm Register now for our Breast Awareness Class to find out how early detection can help save your life. To register, please call Anne (Breast Care Nurse) at: DID: or Pg: or breastcarenurse@raffleshospital.com Travel agents are welcome to call our Corporate Services Executives for more information at on how we can tailor a programme that best suit your clients needs. Editorial Board Lawrence Lim, Dr Teo Sek Khee, Dr Bina Kurup, Moiz Tyebally, Ng Siao Sze & Celine Ong The information contained in this publication should not be regarded as a substitute for detailed medical advice in individual cases. Please address all correspondence to The Editor, Raffles Healthnews, Fax no Raffles Healthnews is published by Raffles Medical Group Ltd, 585 North Bridge Road, Raffles Hospital #11-00, Singapore Design & Production by Creative Essence Admissions / Business Office Raffles International Patients Centre Raffles HealthScreeners Physiotherapy Centre Radiology Raffles Specialist Centre Appointments Hotline Fax No Raffles Aesthetics Centre Raffles Cancer Centre (Affliated with Memorial Sloan Kettering Cancer Center, New Tork, USA) Raffles Children s Centre Raffles Counselling Centre Raffles DentiCare Raffles Eye & ENT Centre Raffles Heart Centre Raffles Internal Medicine Centre Raffles Surgery Centre Raffles Women s Centre Raffles Medical Group Corporate Accounts Enquiries Fax No Singapore Clinics Fax No Anchorpoint Ang Mo Kio Anson Bedok Bishan Caltex House* Capital Tower Causeway Point Clementi Compass Point Far East Square Grand Plaza Hougang Hougang Jurong East Lot Loyang Point Marina Square Marsiling Millenia Walk Ngee Ann City Ogilvy 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 *Clinics with X-ray Facilities Hong Kong Clinics (852) October 2002