Stroke is a major cause of death or disability in Singapore. Stroke occurs when blood supply to part of the brain is reduced or interrupted, causing the brain tissue to be deprived of oxygen and nutrients.

Being overweight will increase your risk of cardiovascular diseases. Please discuss with your staff regarding measurement of your body mass index (BMI). Body mass index (BMI) is a measure of body fat based on height and weight.

C-reactive protein is a protein substance present in the blood in response to injury or infection. High-sensitivity C-reactive protein (hs-CRP) is more sensitive compared to a standard test and can be used to evaluate the risk of developing coronary artery disease. High levels may be associated with increased risk for heart attacks and/or stroke.

Resting ECG is a non-invasive test that is useful in detecting cardiac abnormalities such as arrhythmias, heart blockages (bundle branch blocks), coronary artery disease, left and right heart enlargement (hypertrophy). It is also useful in pre-exercise assessment.

• The test is generally safe with very low risk of complications
• Life-threatening heart rhythm (<0.2%)
• Acute myocardial infarction (0.1%)
• Death (0.1%)
• Fall

• Develop chest pain or shortness of breath
• Abnormally high or low blood pressure/ heart rhythm
• Dizziness /fatigue / unable to continue exercise
• Abnormal changes in your electrocardiogram

A cataract is a clouding of the lens – the structure in the eye responsible for focusing light rays entering the eye so that we can see.

Patients complain of blurring of vision, visual distortion and a general deterioration in the acuity (sharpness) of images seen. They may also complain of glare, need more light to read, have poorer night vision or see faded colours.

This form of visual loss, though common, is reversible. The cloudy lens is removed using the latest techniques via a small incision that does away with the need for stitching, and an artificial lens is inserted in place of the cataract. Recovery is swift with this method of surgery and success rates are high at almost 100

Glaucoma is the most common cause of blindness in Singapore. It results in 34% of all blindness in Singapore. Even though the disease affects 3% of those above 50 years old, many Singaporeans have not had their eyes screened for the disease.

If detected early, further loss of vision can be prevented with eye drops. Only a small proportion of patients would ever need laser treatment and an even smaller group would have to undergo surgery. This makes it very worthwhile to screen early for the disease.

Essentially, there are two main types of glaucoma viz. Open Angle and Close Angle Glaucoma.

The open-angle variety accounts for the bulk of glaucoma sufferers. Yet it is difficult to detect because the affected patient may only start to detect changes when it is too late. Peripheral vision is lost gradually and central vision remains till the end, resulting often in patients seeking consultation only when it is too late.

The closed-angle variety presents more acutely, with a rapid spike in the intra-ocular pressure, resulting in patients experiencing eye pain and a quick deterioration in vision. The closed angle type of glaucoma has been found to be especially common among the Chinese, with the elderly having a higher risk for the condition. Laser treatment has a role in prevented attacks of close-angle glaucoma

A pterygium is a fleshy growth on the eyeball that starts from the transparent membrane (conjunctiva) covering the white of the eye (sclera).  It gradually encroaches on the clear central portion of our eye (the cornea), causing astigmatism and if advanced, significant scarring and direct obstruction of the visual axis.

Its formation is thought to be due to disordered growth secondary to excessive ultraviolet light exposure; as such, the trusty pair of sunglasses comes in handy again. Eye surgeons often encourage our patients by explaining that pilots are frequently spotted with sunglasses on not so much as to look like Tom Cruise, as to prevent the formation of this dreaded condition as they are high up in the stratosphere.

We do not need to lose sleep even if you notice this fleshy growth in your eyes. It is however prudent to have an Ophthalmologist (eye doctor) check it to make sure that it is not in danger of causing astigmatism, scarring or blocking the visual axis

When the eyes are dry, patients may complain of strain, a dull ache, or even a stinging and burning sensation over the eye region. Occasionally, their eyes may water as in a reflex secretion of tears.

In our hot climate, the air conditioner is almost indispensable to some and with that, the air blowing in your face is most certainly drier and contributory to dry eyes.

The constant use of computers, handphones, Ipads and other hand held devices also contribute to eye strain. To explain this simply, think of our eyelids as a windscreen wiper and our eyes as the windscreen. Whenever we blink, a layer of tears is even spread over the cornea; but if we do not replenish this, it would evaporate.  Research has shown that we blink an average of 15 times a minute, and that a minimum of 10 blinks a minute is needed to ensure a healthy tear film, assuming that the eyes produce enough tears in the first place. If however, we are staring incessantly at our hand held devices, we only average a blink rate of between 7-8 blinks a minute.

The solution is to take frequent breaks if time permits. Otherwise, keep that lubricant in hand. The author suggests an eye drop that is preservative free, which then can be used as and when necessary

Patients will complain of itchy and/or watery eyes, and perhaps a foreign body sensation due to the presence of ‘cobblestone like protrusions/papillae’ on an otherwise smooth eyelid surface (see picture). Patient with a history of asthma, eczema, sinusitis, or rhinitis may concurrently be afflicted by this condition. It is also found in soft contact lens users, when it is subtyped as giant papillary conjunctivitis.

When left untreated, patients will rub their eyes incessantly, often leading to secondary discolouration under their eyes that makes them almost ‘racoon like’, they will always look tired even though they feel otherwise. The eyelid skin above and below the eyes are only one third as thick as the skin elsewhere on the face; as such, chronic rubbing will cause the skin to quickly assume a crepe-like appearance.

Treatment of the condition, besides avoidance of the allergens that irritate the eyes, is with eye drops

This is the third most common cause of blindness in Singapore and affects the elderly. Although patients may experience distortion or darkening in their central vision, the condition is sometimes picked up in asymptomatic patients

These are conditions which are very common and when not properly managed, become a nuisance either because they are painful, or because they are unsightly on the eyelids.

A stye is an infection of the oil gland of the eyelid involving either the meibomian gland (the oil gland situated on the inner aspect of the eyelid margin) or the Gland of Zeis, the oil gland found at the base of an eyelash, and are therefore in a more outlying/superficial location on the eyelid.

A chalazion is a blockage of the oil gland and is strictly speaking, not painful. It may however become secondarily infected.

Much confusion exist as regards these terms, even amongst doctors, but all agree that if properly managed, one can avoid a nasty looking or painful problem.

• Liver
• Pancreas
• Gallbladder
• Bile duct

• Esophagus and stomach cancer
  
• Colorectal cancer
  
• Small intestine cancer
• Hepatopancreatic biliary cancer surgery
  
• Liver cancer 
• Pancreatic cancer and cysts

• Hernia operations
  
• Piles
  
• Circumcision
  
• Laparoscopic cholecystectomy
  
• “lumps and bumps” removal
  
• Thyroid surgery
  
• Varicose veins surgery
  
• Liver abscess
• Biliary stones 

Tests and procedures that we can do to determine whether you have an H. pylori infection:

• Blood test.  Helicobacter Pylori IgG – Analysis of a blood sample may reveal evidence of an active or previous H. pylori infection in your body. However, breath and stool tests are better at detecting active H. pylori infections than is a blood test.
• Urea Breath Test. During a breath test, you swallow a liquid that contains tagged carbon molecules. If you have an H. pylori infection, carbon is released when the solution is broken down in your stomach.Your body absorbs the carbon and expels it when you exhale. You exhale into a bag, and we will the do testing to detect the carbon molecules.  Acid-suppressing drugs known as proton pump inhibitors (PPIs), bismuth subsalicylate (Pepto-Bismol) and antibiotics can interfere with the accuracy of this test. You should stop taking those medications for a week or two weeks before you have the test.  This test is available for both adults and children.
• Gastroscopy.  This can be done as a day-surgery procedure.  During the exam, the specialist threads a long flexible tube equipped with a tiny camera (endoscope) down your throat and esophagus and into your stomach and duodenum.  The specialist will look for irregularities in your upper digestive tract and may remove tissue samples (biopsy) to analyze for H. pylori infection.  This test is more invasive than a urea breath test, it may be used to diagnose for H. pylori ulcers and also evaluate for other digestive conditions.

• Neurogeriatric rehabilitation
• Falls prevention program
• Pregnancy-related back pain

• Urinary Incontinence for ladies

Sleep Apnoea can be thought of as an extreme form of snoring. But unlike snoring, which is mostly a relationship or quality of life issue, Sleep Apnoea is a disease with significant health implications. Snoring and Sleep Apnoea both result from vibration of soft tissue in the throat. When we fall asleep, our muscles relax, and as we breathe through the relaxed tissues in the throat, they tend to vibrate. If they vibrate a little, we snore a little. If they vibrate a lot, we snore a lot. Sleep apnoea is when they vibrate enough so that the tissue actually blocks the airway.

Sleep Apnoea is dangerous because it prevents you from getting normal, restorative sleep. Every time your airway is blocked, your brain awakens you (very briefly) to re-open the airway. This disrupts normal sleep patterns and cycles. In addition, the stop breathing episodes can cause dangerous decreases in blood oxygen levels, robbing your brain and vital organs of the oxygen they require. Sleep apnoea increases your risk of high blood pressure, heart attack, obesity, erectile dysfunction and even depression and anxiety. As such, Sleep apnoea must be treated.