Looks DO matter - even for kids

Do looks matter, even for kids? Should we consider surgery in kids to improve on their looks?
Just ask any person with bat ears, adult or child, how they endured all the teasing while growing up. All because their ears look different from others.

A simple surgical procedure is all it takes, to transform a child's life. In bat ears, the cartilage that forms the majority of the shape of the ear (conchal cartilage), is flat and not bent backwards, resulting in a flat and featureless ear, just like a bat's. Surgery to correct bat ears involve an incision at the back of the ear, and sculpturing the cartilage and fixing it in such a way as to pin the prominent ear back. It needs surgery because some permanence is required (cartilage has "memory" - it may sometimes spring back)

This ear pin-back operation, or otoplasty, should be done as soon as the kid is conscious of it before he goes to school. It can also be done in adult-hood.

Undergoing plastic surgery should not be misconstrued as indulging in a frivolous luxury. Just ask any kid (or for that matter, any adult), with bat ears.

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Looks DO matter

We often say that what is inside is more important than what is outside. A person's character and personality rank matters more than outward appearance (and for religious believers, the soul above all else). Are looks therefore important? Should one undergo anything to enhance one's looks? Everybody is beautifully and wonderfully made, both inside and outside. Looks DO matter...it matters in getting a job, in progressing in one's career, perhaps also in relationships. It is a reflection of what is inside.

A common complaint for example is the presence of eyebags. If you have eyebags, you tend to look older and more tired than you actually are. Perhaps you are in a job that requires people to trust that you are AWAKE and ALERT in handling their deals. Having prominent eyebags surely convey the impression that you have not slept enough and perhaps, maybe, you may not be up to scratch to deal with the job at hand. This may, who knows, cause you to loose the deal. Or the eyebags betray your real age, and you really want to look younger.

Surgery affords the most effective and quickest way to remove eyebags. Using the laser to remove the eyebags help to ensure that bleeding is kept to the absolute minimum. This translates into quicker recovery and shorter down time. We are talking about the potential of being able to get back to work after a few days.

When you look better after removing those eyebags, you will feel better, and you will live better. It will influence and impact upon(for the better) your personality and character, boost your self-confidence and improve your opportunities.

Looks are not the most important thing in life, but they DO matter.

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Restoring Nature's Beauty

Everybody is beautifully and wonderfully made. Unfortunately, sometimes disease or injuries mar that beauty. October is Breast Cancer Awareness month, a month where ladies are reminded to do regular breast examinations.

But what happens when there is cancer, and the breast needs to be removed? Breast Cancer is the commonest cancer amongst women in Singapore. Because of improved and more widespread screening like annual mammograms and ultrasound surveillance, breast cancer is increasingly being picked up in younger women.

The mainstay of the treatment of breast cancer is breast removal surgery, or mastectomy, in conjunction with adjuvant therapy, either chemotherapy or radiotherapy.

When faced with the prospect of needing a mastectomy, do not despair, because that beauty need not be gone forever...it can be restored and reconstructed. Preferably with your own body tissue.

Breast removal and reconstruction techniques have so evolved that now, the end result is really very close to the original. Several refinements in surgical techniques have contributed to the restoration of nature's beauty, performed within a reasonable space of operation time of 4 to 6 hours.

Skin-Sparing Mastectomy - means that the Breast Resection Surgeon removes as little skin and nipple as is possible, and the Plastic and Reconstructive Surgeon is able to utilise the remaining breast skin pocket to help shape the new breast.

Simultaneous and Immediate Breast Reconstruction - means the breast reconstruction is performed at the same operation as the mastectomy. Simultaneous when the donor tissue is performed at the same time as the removal surgery, thus saving almost 2 hours of operation time.

Shortening the operative time translates into reduction in facility costs, reduction in exposure to general anaesthesia time with resultant quickened recovery time.

No doubt Breast Reconstruction means additional surgery, but that additional surgery is worth the discomfort and cost in the long-run.

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Know Your FA(:-c)Ts!

My friend told me he has lost 7 kgs and was thrilled. I was thrilled for him too, as it was a step in the right direction. So, I whipped out my laptop and said, "Let's take a look at your BMI!" BMI stands for Body Mass Index. And we keyed in the facts, and the answer read " BMI = 29". And it meant that he was hovering just below the threshold of obesity. He asked, what will it take to be classified as normal, so we did a "goalseek" by setting the target of 25 for BMI, and the answer was : " You need to loose another 7 kgs!: He can start first by reducing intake of food by about 300 calories daily and or by exercising more. And as the program also tracks the amount of calories consumed, we selected one of our favourite food items, "ham ", and queried for a breakdown of calories. To our surprise, we found that it contains 34% fats, with the remaining percentage comprising proteins. So in a double whammy sort of way, it dawned on us that not only we need to watch our weight, we need also to be aware of the amount of fats we are consuming. We ran out of time as we need to go for a meeting. We will continue after we return on what to do next.

In the meantime, do you know your fats? You can drop us a line and share with us your insight.

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Sleep Apnoea – A Wake-Up Call

By Dr Ong Kian Chung
Consultant Respiratory Physician

Sleep apnoea is a medical condition that has 2 potentially serious consequences: (1) excessive sleepiness in the day and (2) cardiovascular disease.
While one can possibly put up with the former (a lot of people are sleep-deprived anyway), the development of cardiovascular disease such as hypertension as a result of sleep apnoea is something most people would like to avoid.

There is now a large amount of evidence showing that sleep apnoea is independently associated with a wide spectrum of clinical cardiovascular disease (reference: Obstructive Sleep Apnoea and Cardiovascular Risk. Lancet 2005;365:1046-1053).

Evidence for a causative effect of obstructive sleep apnoea (OSA) is strongest for hypertension. It has been recommended that: "given the high prevalence of OSA in the community and its effects on the cardiovascular system, as well as the established improvement in blood pressure with treatment of OSA, symptoms of this disorder should be sought in patients being investigated and treated for hypertension." But a lot of the scientific findings and evidence of the link between sleep apnoea and cardiovascular disease are so new, not many people are familiar with this issue. How often does you doctor inquire about your sleep when you consult him or her anyway? Read on to find out more about sleep apnoea for yourself.

What is Sleep Apnoea?

Obstructive sleep apnoea (OSA) is a condition characterized by intermittent episodes when breathing is interrupted (apnoeas) due to obstruction of the upper airway during sleep.

Sleep predisposes one to narrowing - and in susceptible persons, to collapse - of the upper airway by reducing the tone of the upper airway muscles. The areas of the upper airway that are predisposed to obstruction during sleep is usually behind the soft palate and behind the tongue. Complete airway collapse during sleep is usually preceded by years of narrowing that produces snoring. Thus by the time adults with OSA come to medical attention, they have a long history of loud snoring, often beginning in childhood. When outright obstruction of the airway develops, however, the snoring is interrupted by periods of silence lasting 15 to 90 seconds, coincident with the complete cessation of airflow. During these episodes of apnoea, severe reduction of oxygen level in the body often develops until the apnoea is terminated by a brief awakening or arousal, and airway patency is restored. These events are usually accompanied by a generalised startle response, snorting and gasping. After a few deep breaths, the patient returns to sleep, only to have the cycle of events repeated as many as 200-400 times during 6 to 8 hours of sleep.

OSA is a common medical problem that affects about 5% of the population. OSA should be suspected in people who are obese, habitual snorers, sleepy in the day or have hypertension.

Obesity and Sleep Apnoea

Perhaps the most important determinant of whether one is at risk of OSA is whether one is overweight or not. OSA is present in about 40% of obese individuals and about 70% of OSA patients are obese. A recent study showed that a 10% weight gain is associated with a 6-fold increase in the odds of developing OSA and a 10% loss in weight led to a 26% decrease in the severity of OSA.

Even children are not spared. OSA was found to be moderately prevalent among obese children-namely, 13% to 36%. The severity of OSA was positively related to the degree of obesity. Blood pressure is found to be elevated in obese children with OSA and weight reduction is an effective treatment.

Typically, a person with OSA has "male-pattern" obesity with predominance of fat deposition in the central and upper parts of the body, especially the neck region. A prediction rule based on neck circumference can be used to estimate a person’s probability of having OSA (Table 1) - the thicker the neck, the higher the chance. The "adjusted neck circumference" in cm is calculated by adding 4 cm if the person has hypertension, 3 cm if the person is a habitual snorer, and 3 cm if the person is reported to choke or gasp most nights. Table 1 illustrates how the adjusted neck circumference corresponds with a person’s clinical probability of having a positive test result for OSA.

Table1: Adjusted neck circumference and corresponding clinical probability of OSA

*Calculated by adding 4 cm to actual measured neck circumference if the person
has hypertension, 3 cm if the person is a habitual snorer, and 3 cm if the person is reported to choke or gasp most nights

Consequences of Sleep Apnoea

There are 2 major consequences of OSA that should be of concern to the sufferer and these are: excessive sleepiness in the day and the link between OSA and several forms of cardiovascular disease. The first is bad enough. Excessive Daytime Sleepiness is associated with adverse effects on job performance, family relationships and quality of life and is also an important cause of motor vehicle accidents. Sleep deprivation in patients with OSA is associated with a worrying seven-fold increase in driving accidents. The second consequence of OSA is also alarming. Increasingly, OSA is identified as an independent and significant risk factor for several forms of cardiovascular disease such as hypertension, heart failure, heart, heart attacks, heart rhythm disturbances (especially during sleep) and even strokes.

OSA and the Heart

In OSA, the recurring episodes of apnoea lead to disruption of normal restful sleep and a lack of oxygen during sleep. These result in the body’s production of higher levels of stress hormones throughout the night that are deleterious to one’s cardiovascular system. To the body, this is akin to experiencing many near-suffocation episodes every night, except that the OSA sufferer is usually not aware of these recurring episodes during sleep. Not surprisingly, OSA patients have higher blood pressure during sleep – an average of 9 mmHg increase in blood pressure compared to healthy individuals without OSA, in whom blood pressure should be lower during sleep. People with mild to moderate OSA are also twice as likely to become hypertensive and people with moderate to severe sleep apnoea are almost three times as likely to become hypertensive. In people already with a "weak heart" (heart failure), undiagnosed and untreated OSA may also worsen their heart function. The good news, nonetheless, is that effective treatment for OSA is available. As mentioned above, weight reduction can significantly reduce the severity of OSA. Other established forms of treatment include continuous positive airway pressure (CPAP) and specific forms of surgery. However, in all cases, the condition has to be recognised first and the diagnosis confirmed. The standard way to confirm if one has OSA is to undergo a sleep study.

Sleep - the new vital sign?

In view of the strong association between OSA and the development and worsening of cardiovascular illness, we should be on the look out for symptoms of OSA such as loud habitual snoring, excessive daytime sleepiness/fatigue and restless or unrefreshing sleep with frequent awakenings, especially in people who are overweight with hypertension without any known secondary causes. How we sleep at night may really affect our heart health.

Written by:

Dr Ong Kian Chung
Consultant Respiratory Physician

Keywords: cardiovascular, hypertension, OSA, sleep

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Diet and Colon Cancer: Opportunities For Prevention

By Dr Yap Chin Kong
MBBS, MMED, MRCP(UK), FAMS, FRCP(Edinburgh)
Senior Consultant Gastroenterologist

Approximately 58-80% of cancers are caused by environmental factors and dietary factors may be involved in 35% of cancers.



Environmental factors act to promote or protect cells from mutations. Environmental factors that are linked to cancer include:

1.Smoking: lung, pancreas, bladder cancer
2.Obesity: breast, endometrium, colon cancer
3.Infection with viruses: Human Papilloma virus for cervical cancer, hepatitis B
and C for liver cancer, Ebstein-Barr virus for nasopharynx cancer.
4.Bacteria: Helicobacter pylori for stomach cancer
5.Radiation: Leukemia, thyroid cancer.

An important component of environmental factors is our diet. Dietary factors that have a protective effect include: high fiber intake, fresh fruits, vegetables; dietary factors that are linked to cancer include: high salt intake, high fat intake, smoked meats, betel nut, excessive alcohol. A lean body weight has a protective effect against cancer. Medications such as hormone replacement therapy can protect against colon cancer but promote breast cancer. Dietary supplement and anti-oxidant are attractive concepts but have not been proven to reduce cancer when used as treatment.

Cancer is the result of uncontrolled growth of cells in an organ, with the capacity to spread outside of the organ. It gradually results in interference with normal function and its consequences. The different cancers are classified according to the organ of origin. In Singapore, the top five common cancers in males are: lung, colon, stomach, liver, nasopharynx; in women: breast, colon, lung, cervix, stomach. The commonest cause of death is due to cancer, followed by heart disease. Throughout life, genetic changes (also called mutations) occur in our cells. These changes occur over time and can be inherited directly from our parents, or acquired due to the aging process and from environmental factors.

The epidemiology of colon cancer in the Asia-Pacific region varies widely. IARC statistics place New Zealand and Australia with the highest incidence rates: 55.3 per 100,000 in New Zealand and 50 per 100,000 in Australia. Some countries in South Asia e.g. Bangladesh and Sri Lanka have among the lowest rates: 1 per 100,000 in Bangladesh and 1.8 per 100,000 in Sri Lanka. In many countries, colon cancer is on the rise. Environmental and life-style factors play a role and urbanization seems to be associated with the increase. In Singapore, the incidence in the Indian race is approximately double that in Madras. Studies from Asia point to an increase in consumption of dietary meat and fat, a reduction in dietary fibre, fresh fruit and a sedentary life-style as associations with colon cancer. These data point to the presence of genetic, environmental (including diet) and life-style influences in the causation of colon cancer.

Colon cancer: detect it early

About one in twenty or 5% of people will develop colon cancer during their life-time. Colon cancer is the commonest cancer in Singapore and has doubled in the last 30 years. The rising trend is worrying and is likely related to dietary factors and an aging population.

Almost all colon cancer arise from polyps. The progression from polyp to cancer takes many years due to the accumulation of genetic mutations. Polyps that are detected and removed by “polypectomy” effectively prevents the development to cancer. If cancer has developed, detection at an early stage I and II, can result in cure in approximately 80%. The chance of cure of more advanced stage cancer (III and IV) falls to 40%. Hence early detection by screening is an attractive concept.

For the “average risk” person, several options for screening are available, starting at age 50 years. These are: stool occult blood test, sigmoidoscopy, combined stool test and sigmoidoscopy, colonoscopy, barium enema and CT colonography. The best studied and scientifically proven method to reduce the chance of dying from colon cancer is the stool occult blood test. There is a 15-30% reduction in the risk of dying from colorectal cancer. A positive test should be followed by colonoscopy. A negative test should be repeated annually. Because of false positive and negative readings, the search is on for better methods to improve on the accuracy of tests to detect early cancer. These include stool cancer markers and CT colonography. Currently, colonoscopy is the preferred method as a screening test because it examines the entire colon is considered the current “gold standard” in the examination of the colon. The benefits in reducing death from colon cancer are potentially greater than stool occult blood screening. Polyps and early cancer that are found can be removed non-surgically using snare polypectomy. If no polyps are found, colonoscopy offers “protection” against cancer for 5-10 years.

For “high risk” persons, only colonoscopy is recommended. “High risk” refers to persons with a personal or family history of colon cancer or polyps, or a personal history of inflammatory bowel disease. “Very high risk” refers to persons who may have inherited a colon cancer gene in rare genetic conditions.

Opportunities for prevention
Environmental and dietary factors are likely to influence the development of cancer over many years or even decades. Immigrants to a country have a risk of cancer that is between their country of origin and the adopted country. It is their children who acquire the cancer risk of their adopted country. Hence, environmental factors may have an effect in the early part of life and explain why adopting healthy dietary and lifestyle habits later in life have little impact on the cancer risk. For these measures to work, they probably have to be adopted for many years, starting early in life.

Logically, the strategy to reduce the problem of colon cancer is two pronged approach. The first approach is to screen “average risk” individuals starting at the age of 45-50 years (with colonoscopy as the preferred test). This approach benefits the immediate large numbers of persons who are at risk. The second approach is to adopt a healthy lifestyle and dietary habit now. This is because a good habit has to be adopted by adults before it can be passed on to our children. Although it may not affect cancer risks in adults now, it has benefits to reduce cardiovascular risk which is a major cause of death. The aim to reduce cancer risk and may not be achieved until the next generation.


Contributed By Yap Chin Kong
MBBS, MMED, MRCP(UK), FAMS, FRCP(Edinburgh)
Senior Consultant Gastroenterologist
Keywords: gastroenterology, polyps, diet, colon, cancer

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Smoking and Your Lungs

By Dr Ong Kian Chung
Consultant Respiratory Physician


The most prevalent form of tobacco addiction is cigarette smoking and intuitively, the lungs would have to put up with the brunt of harmful effects of the cigarette smoke that is inhaled. Among the many lung diseases in smokers, 2 major respiratory diseases are most significant, because these illnesses are almost always caused by or associated with smoking, and these diseases have major impact on the sufferer in terms of quality of life and longevity.

The 2 common and serious lung diseases in smokers are: (1) Chronic Obstructive Pulmonary Disease, and (2) Lung Cancer. While Lung Cancer is garnering a certain amount of and public awareness and media attention (Newsweek August 22, 2005 - cover story), chances are, you do not know much about the other smoking-related “lung problem” - Chronic Obstructive Pulmonary Disease (COPD). This is unfortunate, as from a general perspective, more smokers suffer from COPD than lung cancer and COPD is a deadlier disease than lung cancer (i.e. causing more deaths annually).

Chronic Obstructive Pulmonary Disease

A major public health burden

COPD is a common disease afflicting millions of people worldwide and exacting a very heavy global disease burden. Surprisingly, public awareness of this disease is lacking and many people have not even heard of it. In America and many developed countries, COPD is the 4th leading cause of death and, among the top 5 leading cause/s of death in the US, COPD is the only one that is increasing in incidence - a disparity all the more striking amid the dramatic decline in deaths from heart disease and stroke. If the present trend continues, COPD will be the 3rd leading cause of death in the US in about a decade. In 1990, a study by the World Bank and World Health Organization (WHO) ranked COPD 12th as a burden of disease; by 2020, it is estimated that COPD will be ranked 5th.

What is COPD?

COPD is an umbrella term that encompasses 2 main disorders--- emphysema and chronic bronchitis--diseases that are characterized by obstruction to air flow in and out of the lungs. Emphysema and chronic bronchitis frequently coexist. Thus physicians prefer the term COPD. Smoking is the major cause of this condition. Air pollution, exposure to industrial smoke or dust and long term inhalation of smoke from wood fires in developing countries are other minor causes.

Smoking progressively and gradually destroys the lungs and causes a decline in lung function (the capacity of our lungs to ventilate i.e. bring fresh air in from the environment and expired gases out from the body). This capacity of the lungs to ventilate can be measured by undergoing a simple lung function test known as spirometry. One of the measurements during spirometry is the FEV1 (Forced Expiratory Volume in One Second), the volume of air exhaled in the first second after a deep inhalation. For COPD patients, FEV1 is used to determine the severity of obstruction in the air passages of the lungs. In normal people who do not smoke, a loss of lung function (FEV1) is expected as one grows older (see Figure 1 below).

In smokers, the rate of decline of lung function (FEV1) is about double that of smokers. In smokers who have COPD, the rate of decline can be 4-6 times that of non-smokers, i.e., the patient has greater obstruction in the air passages and less lung function as the patient gets older. The problem is that the loss of lung function in COPD patients is so gradual that most patients with COPD do not realize that they have the illness till it is severe. By the time most patients are diagnosed to have COPD, they may have lost at least 50% of their pulmonary function. This is exactly why the Chronic Obstructive Pulmonary Disease Association (Singapore) (www.copdas.com) in cooperation with other international agencies such as the Global Initiative for Chronic Obstructive Lung Disease (www.goldcopd.com) strongly encourages smokers, especially those with symptoms such as persistent cough and/or breathlessness to undergo spirometry testing.

Who is likely to have COPD?

The symptoms of COPD can range from chronic cough and sputum ('phlegm') production to severe disabling shortness of breath. In some individuals, chronic cough and sputum production are the first signs that they are at risk for developing the airflow obstruction and shortness of breath characteristic of COPD. In others, shortness of breath may be the first indication of the disease. Individuals with COPD increasingly lose their ability to breathe. Acute infections or certain weather conditions may temporarily worsen symptoms (exacerbations), occasionally where hospitalization may be required. Bear in mind that the progression of the disease and the loss of lung function can be so gradual that, presently, many patients don't realize they have COPD till late. Hence if you are smoker or ex-smoker who is (A) Above 40 years old, with (B) Breathlessness and/or (C) Chronic cough, please consult your doctor, and preferably undergo spirometry testing to assess if you are have COPD.

Double-barrel smoking gun

Smokers with COPD are at least 2 times more likely to develop lung cancer than smokers who do not have COPD. Thus, COPD may be an additional risk factor for smokers developing lung cancer! So the message is - do not smoke and if you are a smoker, do quit for it may not be just a gun you are smoking but a double-barrel one at that.

Contributed by:

Dr Ong Kian Chung
Consultant Respiratory Physician

[Dr Ong is the President of the Chronic Obstructive Pulmonary Disease Association (Singapore)].

Keywords: COPD, spirometry, lung cancer

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Balanced Approach - Healthy Lifestyle, Prevention and Medical Conditions, Treatment

We came together with a group of friends to review our site. It was a pleasant and relaxed evening, but for a minor glitch on the broadband ( and as expected we improvised ), we got off to a good start and received many constructive pointers. There are 2 segments generally - one, those who seek health and wellness from a lifestyle perspective while another segment for more indepth insights on medical conditions and treatments. They would like to read postings relevant to their needs, easy to browse and read ( conversational and personable ). Generally, it was felt that the ability to reach out through this media is pretty cool. The use of tags will make it easier to reach out to the numerous micro-markets. Examples: Young Mother, Nutrition, Diet, Stress, Fitness, Depression, Weight Control, Flu, Sinus, Eczema, Insomnia, Diabetes, Pain Management, Eye, Joints.

Overtime, we hope to gather sufficient feedback and fine-tune the postings. The overall idea is to inform - of needs that may not be known, so that the audience is better empowered to evaluate and seek alternatives before deciding on whether to proceed with consultation and or treatment.

Please feel free to add your comments to this post.....cheers

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How Much Should I Eat?

Your body burns (metabolizes) carbohydrates, protein and fat to produce energy and perform other necessary functions. This energy is measured in calories. The amount of calories you need will depend on basal metabolic rate and total daily energy expenditure.These factors in turn depend on your activity level, body size, sex and age.

For example, an older, petite, sedentary woman may need only 1,600 calories a day, but a 25-year-old woman of the same size who is very physically active may need 1,800 to 2,200 calories a day.
On average, daily calorie goals are as follows:
• 1,600 — children ages 2 to 6, most women and some older adults
• 2,000 — average adult
• 2,200 — older children, teenage girls, active women and most men
• 2,800 — teenage boys and active men • For better accuracy of your calorie requirement , we can compute using more complicated formula but will leave it for another session. For those of you who are interested, please drop in a line and we can provide with you a template.

Contributed by Dr Sophia Chew.
Next serving: What should I eat?

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