Dual Organ Transplant – Double the Bliss - NUH

Issue 1 / 2011
A quarterly publication of the National University Hospital
05 06 08
New
treatment
for enlarged
prostate
NUH
doctors
produce
iPad app
Managing
hearing
loss
Dual Organ Transplant
– Double the Bliss
Surgeons at NUH have scored a first in Singapore by
successfully performing a combined liver-kidney transplant
in a single surgery on a teenager. Sixteen year-old Quek
Weihao became possibly the youngest person in Singapore
to undergo such a surgery. Weihao, who suffered from a rare
genetic condition called primary hyperoxaluria, is now on
the road to recovery.
MICA(P) No. 071/09/2010

cover story
02
On 3 November 2010 at 4am,
which was about the same
time the alarm went off to wake
Weihao for his kidney dialysis, he received
a call that would change the course of his
life. His long wait was over - a suitable liver
and kidney had been found.
Weihao suffered from primary
hyperoxaluria – a rare genetic disorder
which led him to form kidney stones at the
tender age of five.
Sometime in 2009, Weihao’s father noticed
that something was not right with his only
son as he was losing weight. Weihao
also got tired very easily. His kidney was
starting to fail.
Weihao started dialysis - which took him
around 10 hours everyday - when his
kidney failure became more acute.
‘His weight dropped drastically from
68kg to 58kg in a matter of weeks. He
was about 50kg when he went in for the
operation,’ said his mother.
On that fateful night, Professor K
Prabhakaran, Director, Paediatric Organ
Transplant Programme at NUH was
awoken from his sleep by a call at 2am,
informing him that there was a suitable
liver for Weihao. At the same time,
Weihao’s primary physician Prof Yap
Hui Kim contacted him to discuss the
possibility of a simultaneous liver and
kidney transplant.
When both organs were found to be
suitable, they called to inform the family
at 4am. Weihao was admitted at 7am to
prepare for the surgery.
The multi-disciplinary team led by
Professor Prabhakaran started with the
liver transplant operation which took
eight hours. Professor Prabhakaran
and Dr Tiong Ho Yee, Consultant,
Department of Urology, NUH then
moved on to the kidney transplant
which took another three hours.
Weihao received a new kidney and
liver in slightly over 24 hours.
The surgery scored a first in the
medical history in Singapore, making
it to a selected list of success stories in the
world. A 2006 American report stated that
to date, only 1,032 combined liver-kidney
transplants (inclusive of adults) had been
performed worldwide.
Now Weihao is able to do
the one thing he has always
dreamed of - to travel
the world.
Mdm Lim Kim Hiok,
Weihao’s mother.
What Weihao had - Primary Hyperoxaluria
A person suffering from this condition will have too much
of a substance called oxalate, or salt crystals present in
the urine. It is a natural by-product of metabolism but too
much of it causes kidney stones. The stones can cause
urinary obstruction, secondary infection of urinary tract and
eventually kidney damage. It becomes progressively more
severe, and can lead to death.
In Type 1 primary hyperoxaluria, which is the genetic
disease that Weihao is suffered from, the liver creates
too little of an enzyme called alanine/glyoxylate
aminotransferase (AGT).
Very large amounts of oxalate are produced when there is
not enough of this enzyme in the liver.
Among patients with primary hyperoxaluria, half will have
kidney failure by age 15, and about 80 per cent will have
kidney failure by age 30. For that reason, it is critical to
have primary hyperoxaluria diagnosed and treated as early
as possible.
Patients most often develop the first symptoms, typically
kidney stones, anywhere from birth to the mid-20s.
However, the condition may go undiagnosed until age 30
to 40. In some patients the first symptom is kidney failure.
Patients with Type 1 primary hyperoxaluria who do not
sufficiently respond to Vitamin B6 will need a liver and
kidney transplant to cure their disease.

Dual
Transplant
The team behind Weihao’s successful
surgery:
Department of Paediatric Surgery, University
Children’s Medical Institute
Professor K Prabhakaran (Head & Senior
Consultant) (Director, Paediatric Organ
Transplant Programme)
Dr Dale Loh (Senior Consultant)
Dr Mohamed Abubacker Ahamed Faiz Ali
(Registrar)
cover story
03
Division of Hepatobiliary & Pancreatic
Surgery, University Surgical Cluster
Associate Professor KK Madhavan (Head &
Senior Consultant)
Dr Iyer Shridhar Ganpathi (Consultant)
Dr Victor Lee (Consultant)
Department of Hand & Reconstructive
Microsurgery
Dr David Tan (Consultant)
Department of Urology, University Surgical
Cluster
Dr Tiong Ho Yee (Consultant)
Department of Anaesthesia
Dr Wong Weng Hoa (Senior Consultant)
Division of Paediatric Nephrology, Dialysis &
Renal Transplantation, University Children’s
Medical Institute
Professor Yap Hui Kim (Head & Senior
Consultant)
Dr Perry Lau (Consultant)
Division of Paediatric Gastroenterology,
Hepatology & Liver Transplantation,
University Children’s Medical Institute
Professor Quak Seng Hock (Head & Senior
Consultant)
Associate Professor Marion Aw (Senior
Consultant)
Source:
The Straits Times @ Singapore Press Holdings Ltd.
Reprinted with permission.
Liver & Kidney Transplant Office
Ms Priscilla Wee (Transplant Coordinator – Liver)
Ms Hamidah Bte Mistam (Transplant Coordinator
– Liver)
Ms Manjit Kaur (Senior Manager, Clinical
Transplant – Kidney)

NUH news bites
04
NUHS Residency Programme Receives
ACGME-I Accreditation
The National University Health
System (NUHS) Residency
Programme is now one of the
few outside the US to be accredited by
the Accreditation Council of Graduate
Medical Education-International
(ACGME-I), a non-governmental
organisation responsible for the
accreditation of international Graduate
Medical Education (GME) programmes.
The six specialist training programmes
that have been accredited include
Emergency Medicine, Internal Medicine,
Paediatrics, Pathology (Preventive
Medicine and Transitional Year). The
accreditation is testimony that these
programmes have been assessed to
provide high quality training which is
comparable with the standards set for
the US.
The NUHS postgraduate training
programme for doctors moved from
UK-based training to the US-styled
ACGME-I in May 2010. Under the
ACGME-I structure, trainee doctors (or
residents) undergo structured specialist
training conducted by dedicated senior
clinicians after graduating from medical
school. They are regularly assessed on
their medical knowledge, patient care
skills, professionalism, interpersonal and
communication skills. This ensures the
aspiring specialists are well-trained and
equipped with the necessary skills and
knowledge before they see their first
patients.
One of the key strengths of the ACGME programme is that of structured training -
what needs to be taught in the curriculum is not left to chance but it will be planned to be
covered.
A director and core faculty with dedicated time for teaching and curriculum development
are specially appointed for each programme. The very structured program evaluation with
the sponsoring institutions having ‘ownership’ of the residents, will hopefully improve the
standard of training and teaching among the residents.
With the programme, the residents will be able to receive timely feedback and remediation
rather than wait till the intermediate/final exams to know their gaps in knowledge.
Associate Professor Shirley Ooi, Designated Institutional Official,
NUHS Residency Programme
Residents like myself now undergo a structured education programme that is wellsupervised.
We now have designated protected time for teaching and regular sessions
with our Programme Directors on our learning and performance. This represents a major
change from the existing system where learning is largely opportunistic and mostly takes
place in our free time.
Dr Ng Chew Lip, NUHS Resident
The NUHS Residency Programme is
one of the three postgraduate medical
training programmes in Singapore.
Thirty specialists from the first batch are
expected to graduate in 2013, adding to
the 907-strong clinical staff at NUH.
Irregular meals, Helicobacter pylori infection and gastritis
According to a recent study conducted by the Dietetics Department at
the NUH, people who eat irregular meals too often are likely to raise their
risks of getting Helicobacter pylori (HP) infection, which may in turn up
their risks of gastric cancer.
Helicobacter pylori (HP) is a type of bacteria that can penetrate and infect the
protective layer of the stomach lining, causing the individual to develop gastritis
or an inflamed stomach lining.
“We found that people who frequently ate earlier or later than their usual meal
timings and over a prolonged period were associated with a significantly higher
incidence of HP infection and gastritis,” said Ms Lim Su Lin, NUH’s chief dietician
who led the study.
Results showed that compared with individuals who had regular eating patterns,
those who deviated from their meal times by exactly or more than two hours at least
twice a week were six times more at risk of developing HP – a condition estimated
to affect 30 per cent of Singaporeans. People infected with HP are at increased risk
of gastric cancer in the long run.
The study won the Singapore Allied Health Award at the inaugural Singapore
Health and Biomedical Congress jointly organised by the National University
Health System and National Healthcare Group late last year.
Four fast tips on managing your diet
while keeping up with a busy schedule
1. Fix your meal times and keep to that
schedule as much as you can.
2. Keep some snacks at hand in case you
are held up at work or long meetings.
Consider healthy snack bars, fruits or
dried fruits, nuts or biscuits.
3. Whatever little you can have is better
than nothing. Don’t fix your meetings or
appointments during lunch time if you can
help it. Otherwise, try to bring along your
lunch or check if lunch is provided.
4. Have a quick bite before meetings if they
are likely to stretch beyond your usual
lunch time.

New treatment for enlarged prostate
Men with prostate enlargement
or Benign Prostate Hypertrophy
(BPH) can now be treated in
the clinic using a new minimally invasive
procedure called Transurethral Needle
Ablation of Prostate Gland (TUNA). The
procedure offers faster recovery, enabling
patients to return to their normal day-today
activities within a week.
on medication experience significant
voiding improvements. Medication is also
expensive and comes with side effects.
“This new procedure offers patients with
BPH a minimally invasive treatment option.
It bridges the gap between medication
and surgery,” says Dr Chua Wei Jin,
Consultant, Department of Urology, NUH.
difficult to control my urine for almost one
year. After the surgery, I was able to return
to my normal activities within one week.
Now, I can travel without having to rush
to the toilet at every stop and I can sleep
undisturbed through the night,” says Mr
Tony Tan, 73.
NUH news bites
05
NUH is the first hospital in Southeast Asia
to offer such a procedure in an outpatient
setting.
Doctors estimate that BPH affects 40
per cent of men aged 60 and above,
both globally and locally. Though noncancerous,
the condition affects the
quality of life of both the men and their
spouses, with interrupted sleep at night
and disruptions to daily routines due to the
frequent need to visit the toilet.
Traditionally, surgery and oral medication
have been used to treat BPH and its
symptoms. However not all patients
“TUNA is currently offered at the clinic
and the procedure takes on average 30
minutes. It is done under local anesthesia
and the patient is able to return home on
the same day.”
TUNA has been used increasingly in the
United States and it has shown to be safe
and effective in relieving the symptoms
of BPH. So far, more than 30 patients
have been successfully treated since the
procedure became available in NUH last
year.
“I was advised by the doctor to consider
TUNA because I was finding it increasingly
Using radiofrequency waves, two needles are inserted into the prostate.
The heat generated from the needles causes the prostate gland
to shrink. The procedure takes about 30 minutes, and patients are
discharged within hours with a urinary catheter that can be removed
from the bladder after three to five days.
Photo: Medtronic, Inc. 2008
Symptoms of BPH
- Difficulty in starting urination (hesitancy)
- A weak urinary stream
- Interruption of the stream (‘stopping’
and ‘starting’ effect)
- Sensation of incomplete bladder
emptying
- Urgency (the person has difficulty in
holding the bladder)
- Frequent urination
- Waking up frequently at night to
urinate (Nocturia)
Who should consider going for
TUNA?
Patients with mild or moderate
bladder obstructive symptoms
who:
- Are not able to tolerate the side
effects of medication (which can
include giddiness, lethargy and
transient drop in blood pressure
- Do not wish to continue with
long term medical therapy
because of cost considerations
Contact Us
Location
Operating
Hours
Appointments
Urology Centre
Kent Ridge Wing Level 9
Monday to Friday
8.30am – 6.30pm
Tel: (65) 6772 2002
Email: ent@nuhs.edu.sg
Enquiries Tel: (65) 6772 5087
Email: urology_centre@nuhs.edu.sg
Web: www.nuh.com.sg/usc
NUH Women’s Centre now open
in the evenings
To better serve our working patients and mothers-to-be, the NUH
Women’s Centre at the Kent Ridge Wing is now open in the evening from
6.30pm to 8.30pm from Tuesday to Thursday.
The NUH Women’s Centre provides treatment for a range of obstetric and
gynaecological conditions including high-risk pregnancies, infertility and recurrent
pregnancy loss.
For appointments, please call 6772 2255 / 2277.

NUH news bites
Link between low birth weight and metabolic
diseases
NUH researchers are looking into the link between low
birth weight and obesity by studying the metabolic profile
of overweight adults.
06
The three-year study, which is part two of the Singapore Adult
Metabolism Study (SAMS), is led by Dr Eric Khoo (Consultant,
Division of Endocrinology). It is funded by the National Research
Foundation and administered by the National Medical Research
Council. The Principal Investigators include Associate Professor
Tai E Shyong (Head and Senior Consultant, Division of
Endocrinology) and Associate Professor Lee Yung Seng (Senior
Consultant, Division of Paediatric Endocrinology and Diabetes).
On top of studying participants from birth in a related study -
Growing up in Singapore Towards healthy Outcomes (GUSTO),
the researchers are working backwards by recruiting healthy
Chinese men aged 21 to 40 with a BMI of 23 to 30, and looking
into their medical histories including birth weight. The ultimate
aim of SAMS is to design strategies to reduce the burden of
chronic diseases like diabetes and obesity.
Participants first undergo a battery of tests to measure their
energy expenditure and physical activity levels, fat distribution
A SAMS participant having his metabolic readings recorded as part of the study.
and how sensitive they are to insulin. They then go through a
four-month weight loss programme, followed by post-intervention
studies and follow-up visits over a year at three-monthly intervals.
While the target is for participants to lose five to eight per cent of
their weight, one has managed to shed 10 per cent of his original
weight since he joined the study.
The study started in September 2010 and it has since recruited
24 participants. The team hopes to recruit 180 participants
eventually. Interested individuals may wish to contact Mr Melvin
Tan via 9061 7588 or email info@devos-sams.sg.
NUH doctors produce iPad application on
minimally invasive surgery
Surgeons at the NUH have become the first in Singapore to develop a medical application
on iTunes, the Apple online store.
The information in the application is based on the second edition of the Manual of Endo-
Laparoscopic and Single-Port Surgery by Associate Professor Davide Lomanto, Director of
NUH’s Minimally Invasive Surgical Centre and Dr Cheah Wei Keat, Chairman Medical Board
at Jurong Health Services and Visiting Consultant with NUH’s Department of Surgery. The
manual is used in teaching medical students in Singapore and more than a dozen surgeons
from NUH had contributed chapters to the book.
On the iPad, a subscriber gets not only all the text information but also videos showing how
procedures are done. The application also has a section on the equipment needed and how
each one works.
This Application is an interactive teaching tool that is
accessible any time, anywhere. Medical students and resident
trainees in surgery can surf up the Manual and know about
indications and contraindications for every surgical procedure, the
kind of preoperative work up the patient requires before surgery,
to the type of instrumentation and follow-ups required.
A/Prof Davide Lomanto, Director, Minimally Invasive Surgical Centre, NUH

NUH upgrades to serve patients better
Over the last year, patients and
visitors to NUH will not miss the
massive ongoing redevelopment
works happening in the hospital premises.
For one, the Main Building facade is
undergoing an overhaul. The new entrance
facing Lower Kent Ridge Road is just steps
from the exit of the soon-to-be-opened
Circle Line Kent Ridge MRT Station. From
here, patients and visitors will be able to find
their way easily to the specialist outpatient
clinics and wards using newly created
walk ways. Come mid April, patients to
the Dental Clinic and Centre for Hand
and Reconstructive Microsurgery will be
pleasantly greeted by a more comfortable
and spacious waiting area.
NUH news bites
07
The new wing will also be home to the
National University Heart Centre, Singapore,
the second national centre on the NUH
campus for the management of cardiac
conditions.
The Main Building remodeling project, which
started in September last year, is expected
to be completed in phases by 2014.
Artist’s impression of the refurbished main building entrance
Reaching out, Enabling lives
In January this year, our occupational therapists and 22 volunteers from NUH
marked the celebration of Occupational Therapy Day through a special community
outreach programme at the Bethany Methodist Nursing Home.
Together with the nursing home staff, our NUH volunteers engaged 30 of its residents
in various activities to promote their physical, cognitive and social well-being.
“We were very encouraged by the residents’ smiles, joy and participation, as well as
the positive feedback from the volunteers and nursing home staff. As occupational
therapists, it was yet another opportunity to empower the residents by engaging
them in meaningful activities. A refreshing experience,” said Cassandra Seah, an
occupational therapist at NUH.
Residents having fun with the “parachute game”
Residents actively engaging in a beanbag activity
Our volunteers from NUH with nursing staff from the Bethany Methodist Nursing Home

health matters
Managing
Hearing
Loss
08
Imagine not being able to hear the
voices of your loved ones or listen
to your favourite music. Losing your
hearing can have an adverse impact
on the way you communicate with
others. Associate Professor Lynne
Lim, Senior Consultant & Director,
Centre for Hearing Intervention
and Language Development, and
Ms Kek Tze Ling, Audiologist,
Department of Otolaryngology -
Head & Neck Surgery, talk about
hearing loss and the treatment options.
Hearing loss – ways in which it
affects our lives, work
and relationships
Hearing loss can be categorised into
different levels of severity. Different
degrees of hearing loss have different
impacts on people in terms of their
ability to communicate with family
members at home and friends in social
situations in daily life.
In a child, hearing loss results in speech,
language and learning problems. In
adults, hearing loss reduces job and
social options, and poor communication.
In the elderly, not hearing well has
been linked to depression, reduced
safety, reduced cognitive abilities, drop
in quality of life, social withdrawal and
reduced work options.

The struggles
Hearing loss is an invisible disability.
Often, the onset of hearing loss goes
under-detected. The advance from mild
loss to awareness may last anywhere
from a few days to years.
Situations that often alert people to a
problem include having to turn up the
television or radio volume, having to
ask people to repeat their messages,
not hearing a doorbell or someone
calling their name, and missing out on
conversations that occur in the home.
In most of these situations, it is first
noticed by the people around them and
who then advise the individual to seek
help. Many people will try to keep the
condition to themselves, often for fear
of stigmatisation and discrimination.
the inner ear and cochlear. Age
related hearing loss, noise induced
hearing loss, congenital infective
or genetic hearing loss cannot be
reversed. Certain acute infective
conditions can be reversed. Hearing
aids and aural rehabilitation can
be of great help. Assistive listening
devices should also be used
wherever possible. Middle ear
implants can help in selected cases
of both bilateral and conductive
hearing loss when hearing aids do
not give enough improvement. In
profound bilateral sensorineural
hearing loss, cochlear implants may
be needed. If there is malformed
pinna or absent ear canal, bone
anchored hearing aid (BAHA) or
middle ear implant can be used.
Hearing test results showed that
Anthony had sensorineural hearing loss
in both ears. He was advised to wear
a pair of behind-the-ear hearing aids.
Initially, Anthony was skeptical about
the effectiveness of hearing aid and
very concerned about the cosmetic
aspect of the hearing device. He
decided to try out with one hearing aid.
After the first fitting, he was very happy
with the improvement. He was now
able to hear his children better with the
hearing aid! Encouraged by the good
result, Anthony came back to the clinic
and requested for the second hearing
aid.
* The name of the patient has been changed for
privacy reasons.
health matters
09
Treatment options
Treatment options depend on the
individual’s type and degree of hearing
loss. Hearing loss can be categorised
into conductive hearing loss,
sensorineural hearing loss and mixed
hearing loss:
• Conductive hearing loss affects
the outer and middle ear. Wax and
foreign bodies in the ear canals
are easily removed. Perforated ear
drums may need surgical repair.
Middle ear tumors and malformed
or diseased ossicles require surgical
intervention. Hearing aids can also
be used in cases where surgery do
not help or is not needed.
• Sensorineural hearing loss affects
• Mixed hearing loss is a condition
when the hearing loss involves both
outer or/and middle ear as well as
inner ear. It may happen when a
patient with sensorineural hearing
loss also suffers from middle ear
infection.
Case Study
58-year-old Anthony* came in to the
ENT clinic at NUH complaining that
his children always mumbled when
speaking to him. His children in return
blamed him for not paying attention
whenever they spoke to him. The
breakdown in communication between
Anthony and his family members led to
frustrations and eventually discouraged
him from interacting with his children.
Contact Us
Location
Operating
Hours
Appointments
Clinic F – Main Building
Level 1
ENT Clinic – Kent Ridge
Wing Level 3
Monday to Friday
8.30am – 5.30pm
Tel: (65) 6772 2002/4486
Email: ent@nuhs.edu.sg
Services Provided
Ear (Otology) and Dizziness
• Otologic Surgery
• Neuro-Otology
• Dizziness Clinic
• Vestibular Testing
Hearing and Language
• Auditory Verbal Therapy
• Cochlear Implant Programme
• Hearing Assessment
• Hearing Aid Fitting
• Universal Newborn Screening
Programme
For the full listing, please visit
www.nuh.com.sg.

NUH news bites
Project Safe Hands
NUH and Changi General Hospital have become the first two local
hospitals to test-bed a new technology that aims to raise the
compliance of handwashing among hospital staff.
10
The project, named ‘Project Safe Hands’, is being developed by A*STAR
and the Boston based CIMIT (Center for Integration of Medicine and
Innovative Technology).
A sensor “safe zone” is created around each patient bed. The identity tags
on the doctors and other ward staff will sound an alarm if the individual
were to exit this “safe zone” without stopping at the washing points such
as the sinks and alcohol-rub dispensers.
Said Associate Professor Aymeric Lim, Chairman Medical Board, “We are
very excited about the collaboration to test-bed the technology. Smarter
and automated compliance auditing is the way of the future and is likely to
become standard over the next decade.”
Since October 2006, NUH has been actively promoting various measures
to reduce the rate of hospital acquired infections like MRSA transmission.
One of these is hand hygiene, which is one of the most effective measures
to prevent nosocomial infection.
Advocate for
mature workers
NUH is now ranked among a selected group of employers
around the world for having outstanding practices and
policies in attracting and retaining mature workers. The
hospital received the prestigious International Innovative Employer
Award in November 2010, after it was named by the AARP
(American Association of Retired Persons) and the Singapore
Council for Third Age for its efforts in encouraging older workers
to continue working.
We value our staff and have always
recognised the experience and contributions
of our matured employees. We will continue
to review and enhance our policies to benefit
our mature workers.
Ms Clara Wee, Director Human Resource
NUH currently employs more than 5,500 staff, of which about
11 per cent are aged 50 years and above. Over the years, it
has explored various ways to make it more conducive for its
matured workers. For example, a lighter and more compact food
trolley system was introduced in 2008 to make it easier for the
housekeeping staff to deliver meals to the wards.
Re-employment is offered to staff who reach retirement age and
contracts are extended by up to three years. Staff are entitled to
an additional three days of family care leave. The hospital is also
extending medical benefits to the spouses of these older workers.
Mature employees like lab manager, Mr Ricky Ong, 63, has worked at NUH for more than 20 years
and is an asset to the organisation

Ask The Expert
I was jogging when my toe started to
hurt. The nail bed turned black a few
days later. The general practitioner
I consulted said that it would heal
by itself and there was no need to
remove the nail. It has since been a
month and the blackened part of the
toe nail has grown out. My toe nail
is now separated from the nail bed.
There is also fresh blood in the nail
bed. Will the toe nail be permanently
separated from the nail bed?
It is likely that you had injured the toe nail
while jogging, resulting in some bleeding
under the nail bed. The new nail should
not be permanently separated from the
nail bed. If you are experiencing discomfort
or if bleeding continues, you should
consult a doctor.
Dr Tan Ken Jin
Associate Consultant
Department of Orthopaedic Surgery
I am in my early 20s and have had
“sleep shouting” syndrome since I
was 18. While asleep, I often dream I
am in an unpleasant situation where I
end up shouting in the dream when in
fact, I am actually shouting out loud
in my sleep. Should I be concerned
about this?
The medical term for this is “somniloquy”
which means talking aloud in sleep. The
talking can range from mumbling to
shouting.
Somniloquy is very common. Up to 50 per
cent of young children have been reported
to talk in their sleep with a few continuing to
do so into adulthood. About five per cent of
adults are reported to talk in their sleep.
The condition can take place in any stage
of sleep, but occurs less often during REM
(rapid eye movement) sleep, the stage of
sleep associated with dreaming.
Somniloquy which occurs by itself is
harmless and does not require treatment.
However, people who begin talking in their
sleep as adults and during REM sleep
can sometimes have certain conditions
causing other sleep problems that bring
out sleep talking. Somniloquy may
therefore be the result of another sleep
disorders such as sleep apnea, a mental
health problem, a medical condition, drug
use or substance abuse. In such cases,
an evaluation by a doctor with expertise in
sleep disorders is advisable.
Dr Chua Ai Ping
Consultant
Division of Respiratory & Critical Care
Medicine
I am 45 years old and have been
experiencing irregular but frequent
spotting in recent months. Each
episode lasts between one to two
days. Is this a symptom of menopause
or is it something more serious?
Regular monthly menstruation is the result
of the interplay of several organs and the
hormones secreted by them.
The ovaries contain tiny eggs that grow
in response to hormones secreted by
the brain. As the eggs grow, they secrete
hormones that cause thickening of the
inner lining of the womb in preparation for
pregnancy.
Irregular menstruation is common in
women of all ages. Based on what you
have described, it appears you are having
frequent but light periods. This is quite
common in women your age and is usually
a result of hormonal changes that occur a
few years prior to menopause.
As the number of eggs in the ovaries
declines, the brain needs to secrete
greater quantities of hormones to make
the eggs grow. This makes the egg ripen
faster than usual, resulting in shorter
menstrual cycles (or frequent menses).
This most likely explains the symptoms
you are having. However, you are advised
to consult a doctor to rule out any serious
problem.
Dr Anupriya Agarwal
Consultant
Department of Obstetrics and Gynaecology
My 11-year-old nephew still wets his
bed despite various attempts to curb
the problem. Because he is a deep
sleeper, he also faces difficulty waking
up at night to empty his bladder. How
can I help him?
When bedwetting persists beyond age five
or six years old, it becomes unacceptable
and this condition is also known as
nocturnal enuresis.
The impact of bedwetting on affected
children is mainly psychological and
may be severe. You may wish to bring
your nephew for a medical consultation
so the appropriate treatments can be
recommended to improve his condition
over time.
An example is the bedwetting alarm which
is known to have the best cure rate among
users. It is a urine-sensitive pad attached
to the child’s underwear before he goes
to sleep, and is triggered once the urine
comes into contact with the pad. This
will wake the child and prompt him to
complete voiding in the toilet. The alarm
trains the brain to recognise the signals
coming from the bladder when it is full and
the need to wake up to void. Typically the
resolution of bedwetting is seen only after
three to four months of using the alarm.
Another treatment option is a pill known
as desmopressin, which helps to
decrease the urine production at night.
Sometimes, both the bedwetting alarm
and desmopressin can be used together.
Treating bedwetting problem requires
patience and understanding. Reassure
your nephew that the bedwetting will
eventually stop and continue encouraging
him to get up to urinate during the night.
Develop a system of rewards for him if he
is able to get up to urinate and praise him
if he wakes up dry in the morning.
Dr Perry Lau
Consultant
University Children’s Medical Institute
ask the expert
11

thumbs up service
12
During the 35th week of my pregnancy, I
experienced contractions while my doctor was
away. Worried that I would deliver prematurely
and incur huge medical expenses if my baby
required intensive care, I decided to visit a
restructured hospital.
At that moment, I suddenly remembered Dr
Roy Ng (Senior Consultant, Obstetrics &
Gynaecology) whom I used to consult, and that
he’s now practicing at NUH. With the help of Ms
Lee Foong Yin, a Patient Care Assistant from the
NUH Women’s Centre, I managed to arrange an
appointment to see Dr Ng immediately.
I felt fearful and agitated when I was admitted into
the delivery ward as I was alone. But the nurses
were reassuring, and even hugged me to show that
they were really there for me. While waiting for
Dr Ng to arrive, Dr Amelia Loke (MO Obstetrics
& Gynaecology) attended to me, with Dr Ng
constantly updating me on my condition over the
phone. My husband and I were confident of Dr
Ng’s ability to ensure the safety of my baby and I.
The next day, Dr Raymond Goy (Consultant,
Anaesthesia) administered an epidural within
30 minutes and I felt very at ease with his jovial
nature. My baby girl was delivered later that day
and I was so happy she did not require intensive
care.
During my stay at Ward 96, the team of doctors
and nurses, especially NM Chan Yin Yee, was very
helpful. Observing that I was feeling depressed and
suffering from breast engorgement, she referred
me to NM Wong Lai Ying (Lactation Consultant)
whose encouragement helped lift my spirits.
NUH is a baby friendly hospital, and I will refer
my friends to NUH. Thank you to all the doctors
and nurses from Wards 22 and 96 for making my
stay a wonderful and memorable one.
Mrs Seah-Lee Pei Ling
We are thankful for all the letters of
appreciation we have received. Your
words of encouragement will spur
our staff to continue to do their
best for our patients.
We would like to pay tribute to Emeritus Professor Robert
Pho (Emeritus Consultant, University Orthopaedics, Hand &
Reconstructive Microsurgery Cluster) and his team. They have been
very professional, caring and responsible throughout our visits and
stay in the hospital. E/Prof Pho and team went out of their way to
preserve our child’s life and limb. Indeed, we are very fortunate and
grateful to them, especially E/Prof Pho.
We would like to compliment them for the great job that they have
done for our child. We were very distraught by our child’s illness till
we met E/Prof Pho, who has given us hope and strength.
Kok Kian Lan Kent (Senior Patient Service Associate, Clinic B)
also went the extra mile to assist us and schedule an appointment
with E/Prof Pho at the earliest date. She was very positive and kept
encouraging us. Though we were strangers, she was very open,
approachable and was like a close friend known to us for years.
We cannot express our gratitude more for all that they have done. It
is heart warming that doctor and team are cohesive and dedicated to
their job. We believe that the admirable team will continue to excel
in their medical discipline and bestow all goodness to all patients.
Mr and Mrs Dave Lee
I would like to thank all the staff at Ward 78 for the amazing care
that you have provided me during my stay.
A stay in the hospital was not easy to begin with, but thanks to your
kindness, attention and sense of humour, I felt that I was in safe
hands. My appreciation, especially to the nurses for your excellent
care and willingness to help - even down to the smallest request.
To the housekeeping staff, I would like to thank you for helping me
choose my meals that suited my preferences. And not to forget, for
keeping my room neat and tidy.
I would consider myself a fussy patient yet all of you had been very
kind and professional when helping me, all the time.
Alysha
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Please contact:
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Corporate Communications
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