Dr. Paul Chiam performed Asia’s first Transcatheter Aortic Valve Implantation (TAVI) in 2009, and subsequently led the TAVI programme at the Centre. Recognising his expertise, several Asian centres have appointed him consultant and proctor to help initiate their TAVI programmes. Recently he has successfully performed three TAVI for critical Bangladeshi patients in Singapore.
What are some daily practices that can minimise the risks of heart diseases?
Heart related diseases are the second largest cause of deaths around the world. Research suggests that approximately one in every four members of a room anywhere, is likely to end up with a heart disease. In order to prevent this, one must be very careful indeed. Two key factors to focus on are diet and lifestyle.
It is important to avoid deep fried food, saturated fats, refined sugar and soft drinks. A diet high in fibre such as green leafy vegetables and fruits is important. People develop various diet preferences and patterns over time that are not very easy to break away from. They might not find the suggested healthier diet easy to follow. However, I would like to advise them to take things in moderation. Exercising at least three days a week is necessary to maintain good metabolism and fitness. For busy souls, any exercise is better than no exercise.
The last point I want to make is to get regular health screenings. You must screen for diabetes, high blood pressure and high cholesterol levels which are all contributing factors to getting heart diseases. You should never pick up smoking and if you are a smoker, you must quit through a personal program or professional help. Chances of smokers being affected by heart illnesses are significantly higher than that of non-smokers.
Which age group is most prone to getting heart diseases? What is your advice to them?
Most heart attacks happen in the age range of 50-70 with the exception of some cases that occur in 40s depending on the hereditary factors and lifestyle choices of the individual. My advice to these people (40-45 years old) is to carry out the three aforementioned screening tests every six months or so and if you have a strong family history of heart disease you may start screening from 35 years of age.
The government should raise awareness within people regarding the kind of life they should live to avoid getting a heart disease
What are some symptoms of a developing heart disease?
Narrowing of heart arteries is a major indicator. In terms of external symptoms, chest pain accompanied by breathlessness can give some clues as well.
In the status quo, are there more babies born with heart conditions? Why is this the case?
There are very few cases of children born with a heart disorder. The rare cases often entail a baby born with a hole in the heart. The cause for this is mostly undetermined.
What immediate measures should be taken when somebody in the family is seen to have an attack?
FIRST, call an ambulance! Secondly, give aspirin to chew or grind it so they can swallow easily. Stay with the patient at all times and only perform CPR if you are trained by professionals or have a degree.
What is the government’s responsibility in keeping numbers of heart patients low?
To keep numbers low, the government should raise awareness within people regarding the kind of life they should live to avoid getting a heart disease. They can do so through various campaigns and pay special attention to underprivileged and vulnerable groups so the information is disseminated uniformly. The campaigns should give detailed information regarding the right diet to encourage healthy lifestyle choices. There must be provision and facilities to provide the three screening tests, ensuring access and affordability for all. One of the most effective measures taken can be to make smoking as inaccessible as possible by introducing various incentives for refraining or increasing the barriers to access cigarettes.
Could you tell us the unique features of TAVI which is considered a medical breakthrough and its associated costs?
The TAVI procedure allows a new valve to be inserted within your diseased aortic valve. The new valve will push the leaflets of your diseased valve aside. The frame will use the leaflets of your diseased valve to secure it in place. This procedure is for people who have been diagnosed with severe symptomatic aortic stenosis and are at intermediate or greater risk for open heart surgery.
There are several factors your doctor will take into consideration when deciding whether or not you are at intermediate or greater risk for open heart surgery, and therefore, a possible candidate for TAVI. These are: age, current health status, medical history, patient’s frailty and condition of the heart.
Given the magnitude of expenses, many hospitals around the world have installment schemes with TAVI patients to ease the process of payment. Countries like Indonesia, Bangladesh and Vietnam are places where the first case of TAVI has already been performed. But they must now have a sustainable plan which makes it a feasible method of treatment. This is currently missing.
Dr. Tan Seng Hoe has more than 20 years of experience in the field of nephrology. He currently practices out of his clinics at Mount Elizabeth Novena, Mount Elizabeth and Gleneagles Hospitals where he sees patients with various kidney-related critical and complex conditions. A firm believer of educating and molding future doctors, he is a Senior Clinical Lecturer at the National University.
What is the major cause of kidney failure?
Registry data in Singapore show that about 60% of patients diagnosed with a kidney failure also have diabetes. About 10-20% patients have immunodeficiency disorders of various kinds. Some have polycystic kidneys, stones on both sides while others have prolonged obstruction and blockage.
In developing regions, where diabetes is high
How long can a patient undergo kidney dialysis in the absence of a transplant?
Please understand that transplant comes in first. Dialysis should not be thought of as equivalent to a transplant. But in the case of an absence of transplant, dialysis must start very early and not kept for later. Some patients come in very late and they suffer severely due to the time lag.
The renal replacement therapy is where doctors sit down with the patient and their families to discuss both transplant and dialysis options, their associated risks, costs and benefits. In this conversation, the doctors will point out donor options and fitness requirements. And this might take about two hours in itself. There should be more information sessions, as many as required spread over an allowable time period and many follow up conversations to evaluate the decision.
Is a country like Bangladesh with water shortage likely to suffer more kidney related illnesses?
Most patients with stones have problems with access to water not just because of the location of residence but also due to their occupation. There is a difference seen amidst the developed world and the developing countries. In the developed world, most kidney related problems are caused by metabolic problems which boil down to lifestyle issues. In developing regions, where diabetes is high, the propensity of renal diseases is also very high. These happen to be places where there is no facility to treat hypertension. Furthermore, certain chemicals found in the water cause harm to renal organs.
What are some symptoms of kidney problems?
Frequent urination is tricky to place as a symptom. This is because it may not be a metabolic problem at all but may be a urological problem at the end of the day as there is a physiological group who drink too much water. But if the number is too often, then it is good to get checked just to be safe.
However structural problems such as irritable bladder and prostate enlargement may be worth looking at.
What are the prerequisites a patient must meet prior to a renal transplant and what is the approximate cost for one?
It is most important to ensure there are no underlying infections such as hepatitis. If there is, the infection must be treated first. Any heart disease also needs to be tended to such as cardio vascular disease. We have to absolutely rule out cancer. If the patient has cancer, we have to wait for a period of time and use treatments before the transplant can take place.
In Singapore, renal transplants range from $ 100-120,000(Sing) to cover the whole package.
What are some ways to help us maintain a healthy set of kidneys?
In the presence of various types of kidney stones, the general measure should be to remove them as they can cause blockage of filtration. Increase your fluid intake and reduce your salt intake. Sometimes we ingest too much salt by including too many processed nuts in our diets.