How do we give way to ambulance?

Last week, while driving along the CTE, I saw an SCDF ambulance ahead of me with its siren on, trying to make its way through very heavy traffic. It is not hard to imagine a patient in need of emergency care inside the ambulance, whose life could depend on how fast he/ she would arrive at the nearest hospital.

The behavior of motorists in response or lack of it to the ambulance's siren was disappointing. There were at least 3 types of behavior that I noticed that are either reckless or insensitive:

Type 1: The ambulance tailgaters - these are the motorists who would switch lanes and tailgate the ambulance with the anticipation that the path ahead will be opened and they could speed up in their journey. This behavior is reckless because it will put the ambulance at risk should the need arise to suddenly slow down and switch lanes.

Type 2: The "What Can I do" behavior - This applies to motorists ahead of the ambulance who do not know how to give way because the traffic is so heavy. They feel that they can't speed up and also can't switch to another lane because others won't allow them to.

Type 3: The "If I let others switch to my lane, I will slow down" behavior. These motorist refused to let other motorists switch lanes to give way to the ambulance and over time reinforce their behavior as Type 2.

My general conclusion is that Singapore motorists are not trained to give way properly to emergency vehicles. In the US where I lived for 3 years, the behavior is very different. When the siren from an emergency vehicle such as an ambulance is sounded, it will be obvious that cars ahead of the ambulance will move to the side and come to a halt. The other vehicles on the adjacent lanes will all move to the side and also stop. In doing do, they open up a "new" lane for the ambulance to move speedily through. It is only only after the ambulance has made significant progress ahead that vehicles will continue on their journey. I am sure we can do it too, just some public education and motorists will soon be accustomed how to properly give way to ambulances. This way, we help save lives!

The NOSE Study says...

Ever since my successful surgery (balloon sinuplasty, septoplasty and turbinate reduction) in Jan 2008, a silent lingering thought ever so gently whispers "...the blocked nose will soon come back". My new found freedom of being able to breathe well again through both sides of my nose is something too precious for me to give up!

Tonight, I decided that I will search the web to see what does the literature out there says. I did the most obvious thing, I googled the term "septoplasty research" and an entire list followed. The most interesting is the NOSE study, a multi-centre clinical research study conducted by the American Academy of Otolaryntology and the Head & Neck Surgery Foundation. NOSE stands for "Nasal Obstruction Symptoms Evaluation Scale". It is a study to see if nasal septoplasty increase the quality of life in factors such sleep pattern, snoring, smell, improves nasal obstruction and if the improvements are sustained.

The conclusion is that Nasal septoplasty with or without turbinate reduction reduces nasal congestion, trouble sleeping, etc and the improvements are sustained for at least 6 months. This is good news! I want more and will certainly be on the look out for other studies to see if improvements are sustained for longer period of time. I am optimistic...

Sinusitis and toothache...strangely, can be related

I chanced upon this article from the mayo clinic website. According to mayo doctors, sinus infection (sinusitis) can cause pain in the upper teeth due to the close proximity of the sinus and the teeth.

So, the next time you have a toothache and the dentist could not find anything wrong, you next stop could well be an ENT specialist!

What exactly do we miss about the SGH Housemen Canteen?

The Housemen canteen closed today. On Monday, when we return to work at SGH, our usual morning instincts may walk a number of us back to the doors of Housemen Canteen for our caffeine fix and breakfast only to be reminded that it is closed. There may be a fleeting moment of disappointment as our minds rapidly reprogramme on where next to satisfy our hunger pangs. Given that we are all creatures of habits, this may take a while...

Today, I made a special trip in the late afternoon to have my won tan mee tah and kopi-c. As I settled with my kopi with my colleague, a 95.8FM reporter came up to my table. She asked if I could speak mandarin and proceeded to ask what are the most special memories about the housemen canteen. I had 2 thoughts, the first being my chinese really sucks and her second questions set my mind searching.

I have always felt that there is something about the atmosphere at housemen canteen. Is it the sense of familiarity that the stallowners have grown to know me? All I have to do is to make myself visible in the busy line at the drink stall, and when I advance close enough, my teh-c in the morning and kopi-o in the afternoon will be ready. Is it because the prawn noodle stall lady would would ask me in chinese "...the same..." and proceed to make my bowl of heh mee tah?

Is it the coffee shop environment and informal table arrangements that make just being there a more relaxing place compared to the workplace? That said, I don't remember being at other coffee shops and feel anything close to what I feel at housemen canteen. Discussions with colleagues at housemen canteen somehow seem less constraint and more productive. Of course, it is a great place to unwind and whine after a hard day's work.

Could it be the price of food and drinks? May be not the most important factor because till today I do not know how much I paid for my regular teh-c, kopi-o or kopi-c. But maybe because the price is not way out there that will trigger a reaction that "interacts" with the taste of food. I met up with a security staff from SNEC when I queued for free coffee yesterday. We quickly struck up a conversation as we tried to kill time in the long line. I asked him what will be his alternatives after Housemen canteen is closed, he said "I will bring my bread and coffee...I cannot afford the other places...". Then again, maybe it is the price...

Yesterday, the hospital held a "Farewell Housemen Canteen" event. Many staff took turns to talk about their memories at Housemen canteen. I realised I could count a "Housemen Queen" as my friend and colleague and also heard that Housemen canteen is the place where "announcements" are shared and gossipped before the formal communication by the boss. Whatever the reasons why we are so fond of our SGH Housemen canteen, we proposed a kopi toast towards the end of the event and toss Lo hei with all the stall owners. It was special time because at that moment I felt a sense of family at Housemen canteen.

SGH Housemen Canteen will always hold a special place in the hearts of staff on outram campus. I pray this special spirit will not be lost when we reopen soon in a location nearby.

Stay away from cold drinks...?

Today, I was on my way to a chinese new year lunch when I got bunched up with a group of colleagues riding the lift up. After the greetings, one of them looked at me and asked about my nose surgery. She said, "I did mine 20 years ago and 5 years later, it came back". But she quickly added, "just remember to stay away from drinking cold water and you will be alright...".

This the the second time I have received the same advice about cold water. I am wondering is there any truth to this or is it yet another old grandmother's myth going around?

Anyone care to comment?

Nasal Polyps also cause blocked and running nose?

The answer is "Yes"... the list of causes for blocked nose is getting longer!

According to Mayo Clinic, nasal polyps are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses. The larger the polyps, the more problematic leading to blocked nose and in extreme cases may even alter the shape of the face.

For smaller polyps, medication can help but surgery may be the most optimal option when they become larger. Problem is, the polyps tend to return even after they are removed surgically.

So, when you have a persistent blocked nose, don't just brush it away. Get it checked and treated... You can smell the roses again :-)

Blocked Nose could be a symptom for Nose cancer

An illness becomes personal when someone that we know has it. It is worst when someone that you love is stricken. As healthcare professionals, the work that we do involves patients on a daily basis. Every once in a while, we need a reminder to take the work that we do personally.

Today is one of those days. I met an old police colleague when I was back serving my police reservist today. He lost weight, looked slightly tired and when we met at the canteen, he was happy to see me and got up to buy kopi for me. We chatted, and soon I found that he has had nose cancer and had just returned to work after surgery and radiation therapy. By his own admission, he was scared but gained confidence and renewed fighting spirit as a result of the professionalism of his doctor and the support of his wife and puppies.

He discovered the nose cancer after suffering symptoms similar to what I had...blocked nose, persistent infection of his throat (he attributed it to post nasal drip), sinus pressure, running nose, a "lump in the throat", etc. He decided to see an ENT specialist and on examination, the cancer was found. One can take often take such symptoms for granted. Thank God he took action and received the appropriate treatment. When he heard that I too had also undergone surgeries for my nose, he hesitated to ask why, but he was relieved to hear that it was nothing sinister.

I am reminded of the realities and significance of my work in healthcare, although unfortunately through the plight of my friend. I am encouraged to find out more about nose cancer and post them on this blog so that readers can find it handy. I found great information from the National Cancer Institute website expressed in layman's terms. Take a read!

I am thankful for the "liberation" that I experienced for my nose and at the same time I pray for complete healing for my friend.

The "Housemen Canteen" at SGH Closes next week... Many sniffles but not from allergic reactions

Next week, on the 22 Feb 2008, a favourite icon on SGH campus - The Housemen Canteen shuts down to make way for the new SGH Pathology building.

Not exactly the best looking building nor one with the best finishes, but the Housemen canteen is one of the favourite destinations for staff and patients in SGH. It is the place where the official business gets done, rumours shared, gossips exchanged, discussions completed and hungry stomachs filled. Doctors, nurses, porters, cleaners, clerks, administrators, therapists and even patients in hospital pyjamas can be found there. Most will prefer a cup of Kopi at housemen anytime and if you are running out of time...nevermind, you can always carry the coveted Kopi or teh-C in a plastic bag and savour it later.

Too bad the Housemen canteen has to close... but not for the lack of trying to save it. The boundary of the new building will be too close to the canteen during construction to ensure structural integrity and safety. A new home has been found but it is still sad to see the Housemen canteen close...

I went to the housemen canteen for my kopi this evening. If not because of the dinner prepared at home, I would have topped it off with my regular wanton mee dry... I could see the writings on the wall. Staff are encouraged to pen their feelings and thoughts for the housemen canteen on her walls during the last days. Reading them, I could sense the SNIFFLES that must have come with the writings. "I'll Miss You...", "...where can I go for my Kopi ...", "you are the heartbeat of SGH..." are just some of the emotional expressions amongst many others that filled an entire wall. Just as the patient is the common rallying point for staff in SGH, I could sense the unity that this old housemen canteen brings. I reminded myself that I will bring along a marker to add my thoughts too tomorrow.

Goodbye Housemen Canteen, you will be missed... till we meet again soon :-)

Did you get a "Nose Job"?

This is one of the most common teasing that I got after I return from hospitalisation leave following my surgery... "Did you get a nose job?"... "I heard you went for a nose job, but I thought you did not look too bad..."... "Hi Michael Jackson..." often followed by some friendly laughters.

So... I decided to look up what is a "Nose Job". The technical word for a nose job is "rhinoplasty". It is a surgery to correct the appearance and shape of the nose - a plastic surgery, typically not covered by insurance or by company medical benefits. As I found out, during Rhinoplasty, a deviated septum will also be corrected, leading to better breathing if the deviation was the original cause of block nose. Gee...

A piece of cartilage, usually from the septum, occasionally from the ear will be used to augment the nose as appropriate. Based on my reading of the rhinoplasty procedure at on the website for the American Society for Plastic Surgery website, I can't help but feel that the procedure is very similar to septoplasty. In a sense, all the teasing that I got were "technically" correct, except that my procedure did not consciously shape my nose. But with my brand new functional nose that could "smell the roses" better now, I do feel that I have a better and nicer nose! My gratitude to Dr Tan NG for doing a wonderful job!

In conclusion, the answer is "NO", I did not do a nose job, BUT I did get a brand new and better nose.

Just had a wonderful dinner with colleagues from GPO, our annual Lo Hei and a celebration of the good work done. I am blessed to have great colleagues who are eager to make a difference in the lives of others through our work in healthcare. I shared with them this poem (told to me by a great friend C Bhagat and sent to me by Hidayat) which has been a source of inspiration for me. It is entitled "Lifters and Leaners" by Eller Wheeler Wilcox. Let us all be LIFTERS and make a difference...Cheers

THERE are two kinds of people on earth to-day;
Just two kinds of people, no more, I say.
Not the sinner and saint, for it's well understood,
The good are half bad, and the bad are half good.
Not the rich and the poor, for to rate a man's wealth,
You must first know the state of his conscience and health.
Not the humble and proud, for in life's little span,
Who puts on vain airs, is not counted a man.
Not the happy and sad, for the swift flying years
Bring each man his laughter and each man his tears.
No; the two kinds of people on earth I mean,
Are the people who lift, and the people who lean.
Wherever you go, you will find the earth's masses,
Are always divided in just these two classes.
And oddly enough, you will find too, I ween,
There's only one lifter to twenty who lean.
In which class are you? Are you easing the load,
Of overtaxed lifters, who toil down the road?
Or are you a leaner, who lets others share
Your portion of labor, and worry and care?

You know you have Allergic Rhinitis when ...

... you sneeze and sneeze and become the family's alarm clock when you wake up in the morning :-) your eyes are itchy and there is a lingering discomfort in your throat from the post-nasal drip causing you to cough; and your wife complains that you are running out of tissue paper again from the running nose!

It's the body's reaction to allergens in the air. I have found that my allergic rhinitis was worst when I enter a dusty room, transition from a warm to a cold place (and vice versa) and deprived of sufficient sleep. In the past, I have been prescribed antihistamine to take care of the running nose and itchy eyes. I only take the medicine when the symptoms are very bad as I have grown used to it.

This article from WebMD provides an excellent description of allergic rhinitis and the associated symptoms. Take a read.

After the combination surgery that I described in my earlier posts, my allergic rhinitis problems seem to disappear almost completely! I did not expect this to happen and am glad it did.

Today is still the 5th day of the chinese lunar new year. To all chinese readers, Gong Xi Fa Chai!

When you have a "crooked" nose (deviated septum) and enlarged air warmer (Turbinates), you may need 2 additional procedures...

If you also have a deviated septum and enlarged turbinates, they may give rise to blocked nose as well. Two procedures, namely Septoplasty and turbinate surgery may be required. The Medical University of South Carolina website provides quite a good description of what these 2 surgeries entail.

I had both this surgeries as well. If you look through my previous posts, my only "complaint" is when the splints (put in during surgery to support the corrected septum) are removed. It almost feels like the splints have "grown" into the flesh in the nose after 3-4 days post-surgery and removable was uncomfortable. However, you will experience a good sense of relief - before that I had this little nagging pain (tenderness) when I touched the tip of my nose; this sensation completely disappears when the splints were removed.

By the way, the MRI image attached, shows a deviated septum. Before a surgery, a CT of the nose and the head is usually done. This is to establish the nose structures and the proximity of these structures that need to be operated on relative to the eye and the brain to avoid "collateral" damage during surgery.

To those of us who is has opted for surgery, good luck and smell the roses soon...

FESS, The older Cousin of Balloon Sinuplasty

FESS is an acronym for Functional Endoscopic Sinus Surgery. 'Functional" because the surgery is intended to restore the natural clearing function of the sinus. Due to the advancement in surgical technique, this surgery is performed through the nostril without the need for facial incision using fibreoptic telescope and small cameras to enlarge the drainage pathways of the sinuses. Diseased tissues and bones are removed to open up the sinuses. According to what I have read, complications are rare but possible because the sinus structures are so close to the eys and brain.

The balloon sinuplasty procedure operates on the same principle as angioplasty, which uses an inflated balloon to unblock blood vessels. According to most literature that I have read, the advantage of sinuplasty when compared to FESS is that it preserves the mucous membrane and does not disrupt the structures or tissues in the sinuses... and patient seem to heal faster.

Balloon sinuplasty was approved by the US Food and Drug Administration during the summer of 2005. A study of 115 people who have undergone sinuplasty showed that there is no difference in outcome at 1 year mark but there is no long-term research so far on its success rate.

If one has as complicated a problem that I had, one will need to consider beyond the difference between FESS and Balloon sinuplasty. As in my case, I had to undergo a septoplasty with concurrent surgical shaping of my turbinates. More about these in my subsequent posts.

Happy Lunar New Year - The Year of the Rat!!

Read this article on Balloon Sinuplasty...how similar the experience from across the globe...

Here is an article from the Daily Gazette. Because this is a less invasive procedure that does not involve cutting and incisions, patients are more willing to consider it when offered as an option by doctors.

And it is true, not only will the patient find relieve, so will the spouse as blocked nose generally lead to snoring problems.

By the way, it the lunar new year eve today. This is my favourite time of the year not only because of the long holidays but also because it is time for family get together. I am really looking forward to my reunion dinner at Marina Mandarin. Can't wait to see my children decked out in their pink Cheong Sam and my son in his bright red attire.

Here wishing you abundance and health for the new year!