A life threatening experience with Myasthenia Gravis crisis left Wu How Yih struggling to breathe and a 48-day stay in hospital, but it also taught him precious life lessons along the way.
Trained as an engineer, Wu How Yih, 57, is accustomed to solving problems. The former Director of a Japanese MNC would often travel around the region to group companies to support them on technical matters beside the manufacturing operational responsibility he held in Singapore. ”I've never switched my handphone off even when I sleep, in case an emergency crops up!” laughed How Yih.
Last November, he encountered some difficulty in swallowing again, and symptom of breathing difficulty when lying down. Worried, he saw his neurologist whom he has been consulting for Myasthenia Gravis (MG in short), and was told to be hospitalised.
MG, a neuromuscular autoimmune disorder, is caused by a defect in the transmission of nerve impulses to muscles. This occurs when antibodies produced by the body's own immune system attack itself, blocking the transmission of nerve impulses to the muscles, resulting in muscle weakness and fatigue.
The most common symptoms are weakened eye muscles causing droopy eyelids, slurred speech or, like How Yih, difficulty in swallowing. Severe effects include weakness in the arms, hands, fingers, legs and neck, and shortness of breath.
Gasping For Air
How Yih was initially to be hospitalised for a six-day course of intravenous steroid infusion but by the fourth day, he couldn't even sleep properly as lying down caused instant breathlessness. He tried to get some sleep while seated on a sofa chair, however, by the sixth day he encountered severe breathing difficulty. He was then immediately transferred to the Critical Care Unit (CCU) and hooked to a respiratory support system.
How Yih found himself flat on his back, too weak to even breathe on his own; a big contrast from his usual active and dynamic lifestyle before. Coincidentally, a friend who also suffered from a neuromuscular problem and once spent three months in hospital. ”She advised me to ”˜shut my brain' because she knows I'm a highly active person,” recalled How Yih. ”But I couldn't. My body wasn't working but this was!” he jabbed at his head.
”Being an engineer, I questioned everything,” said How Yih. For example, he worried about the mask he wore every night while he received immunoglobulin via a drip to build up his antibodies during his sleep. ”What if the machine breaks down?” he asked his doctor. ”Will the mask suffocate instead of helping me?”
Overwhelmed by his sudden illness and feeling helpless and frustrated at his inability to breathe on his own, he lapsed into depression. His wife Grace, 53, two children “ Lawrence, 24, and Louisa, 21 “ and his three elder siblings rallied around him. Big brother How Thian, 60, visited him every morning while his sisters Felicia, 61, and Patricia, 59, even helped to bathe him. ”It turned out to be a good opportunity for family bonding, especially with my siblings” said How Yih.
Helping Others to Help Yourself
How Yih's doctors warned him that recovery was a slow process that couldn't be rushed. He was so weak that brushing his teeth took 25 minutes. What pulled him through his 48 days in hospital were his faith and interestingly, his work philosophy.
Confessing that he was a ”not very pious” Christian, he started praying to God one day when it felt like nothing was working. ”I truly felt the presence of God and excitedly shared it with my son when he and his church mates visited me that evening!”
Determined to find a solution to his depression, he thought back about how he had handled challenges at work. How Yih often preached and practised this philosophy “ ”Help others to help yourself”. Since he was confined to his four-bedder ward, he looked around to see what he could do. One fellow roommate was a retired Indonesian Chinese businessman who underwent amputation. He only spoke Hokkien and Bahasa Indonesia, which the nurses had difficulty to understand, and was so foul-tempered that he even pulled out his catheter and hit the nurses.
How Yih volunteered to be his interpreter and gently struck up a friendship. When the old man refused to replace the catheter because he said it'd be painful, How Yih encouraged him: ”Never mind, it's just a bit of pain. You were a businessman who has experienced so much, this is nothing! Chat with me while the nurse does it, and it'll be over very quickly!”
He even found ways to communicate with a 97-year-old bedridden patient who was unable to talk. Most mornings, How Yih greeted him and the elderly man ”˜replied' with a blink of his eyes.
When new and elderly patients were warded, he communicated with them and if there were opportunities, found ways to assist them especially where language was an issue.
Previously, How Yih was always too busy to do voluntary work. ”This time, I scaled down my skills honed in a business environment for our little ward, but it was good enough for me and kept me going,” related How Yih contentedly.
Nurses hailed him a model patient and appreciated his extra pair of eyes. When the nursing head of the CCU found out that 12 Dec 2013 was How Yih and Grace's 26th anniversary, she even arranged for a cake for the loving couple, who celebrated it with their son Lawrence!
On one hand, How Yih was trying to find a way out for himself. On the other, he saw the difficulties both the nurses and the patients faced. True to his ”˜help others to help yourself' motto, How Yih realised that lending a hand indeed helped him not to focus on his helplessness, and even get over his depression, thus allowing the time for the respiratory function to return. ”It's a work philosophy I'd adopted and taught to my team in my years as a director of operations. But I certainly never dreamed that I'd one day use it in my personal life and for my health rehabilitation!” he said in amazement.
Keep Calm and Keep Breathing
Today, though How Yih knows ”my battery will never be 100% charged like everyone else”, he is feeling much better. To maintain his health while accommodating his lowered energy level, he takes slow walks every morning. Being diagnosed with MG has also inspired him to eat more healthily. To make up for his current less active lifestyle, he reduced his food volume, choosing more protein and plenty of veggies and fruits over carbohydrates. A non-smoker but an occasional social drinker before, he has also since cut out all alcohol.
He is able to breathe normally on his own, though he will be on long-term medication to manage his MG.
Currently taking a break from work to focus on his health, he is still mulling over his next step which may include writing a book or doing voluntary work. ”I don't want to retire yet!” he exclaimed.
Despite his close brush with death, How Yih described his 48 days in hospital as ”an unfortunate but very good experience”. ”I truly experienced God's love and presence, and how I can help others and myself,” said a grateful How Yih. While spiritual faith and the physical care of doctors and nursing staff may have given him a second chance, his gungho, giving spirit certainly helped in the process.
Dr Lam Pin Min, Director of Paediatric Ophthalmology & Strabismus Service at Eagle Eye Centre, shares his bags of tricks when it comes to treating the sensitive eyes of fretful children.
If one's eyes are really the window to your soul, then Dr Lam Pin Min's peepers reveal a deep love for kids and animals alike. They light up as the experienced Paediatric Ophthalmologist regales us with stories about cheeky ”˜uns, from his brood of pets and his young patients.
Dr Lam, who grew up with a pet dog, gave up his dream to become a veterinarian as it required him to study abroad which would have wiped out all his parents' life savings meant for his and three other siblings' tertiary education. ”Studying hard to get into the Medical School in Singapore seemed to be the most logical and feasible option then. Besides, becoming a doctor was an easy decision as I always felt the need to help the sick and vulnerable,” recounted Dr Lam in his gentle, measured tone. He eventually fulfilled this calling in more ways than one when he became a politician in 2006, currently serving as the Member of Parliament for Sengkang West Single Member Constituency.
After graduating from the National University of Singapore in 1993, he was a House Officer with the Ministry of Health who later trained to be an eye specialist because ”I felt that looking after the eyes was a fairly precise practice which did not involve a lot of blood or life-threatening situations.” His love for kids shaped his interest to sub-specialise in the field of Paediatric Ophthalmology.
Today, the 44 year-old is daddy to two daughters Kate-Lynn, 13, and Emma-Lynn, 10, (with his wife, Dr Jeanette Chen, an Obstetrician and Gynaecologist in private practice, whom he met at Wesley Methodist Church), two furkids named Brisby the beagle and Keagan the dachshund, over a dozen dwarf rabbits (”They all have names too!”) who roam free in his garden, and two terrapins. ”I spend more time with the dogs, especially Keagan, an eight-month-old pup. But his legs are so short that when we go for walks, I end up carrying him and walking around,” shared Dr Lam with a crinkly-eyed laugh.
From Soldier to Paediatric Eye Doctor
In 1997, Dr Lam signed on with the Republic of Singapore Airforce (RSAF), ”a decision that took me a lot of courage and deliberation to detour from mainstream doctoring to embark on a military profession”. The first qualified Aviation Ophthalmologist in Singapore, he spent three months in East Timor in 2000 at the United Nations military hospital, as part of SAF's humanitarian support mission.
He received the United Nations Medal for Service but more importantly, that experience taught him invaluable lessons. ”Because it was a war zone, we had very basic facilities and we had to improvise to care for very varied cases, from gunshot and grenade wounds, to even aircraft accident injuries,” recalled Dr Lam. In his free time, he helped with humanitarian work in the villages and orphanages. ”It made me realise how lucky we are in Singapore and how we shouldn't take things for granted. I also learned to appreciate the little things in life that we often overlook.”
Among these little things, perhaps, are the tiny steps he takes to connect with even the most fretful of kids. The former senior consultant in KK Women's and Children's Hospital paediatric eye department joined Eagle Eye Centre in January 2014 to help set up and head the Paediatric Ophthalmology & Strabismus Service. ”Most people hate to work with children because it takes a lot of patience but I find it tremendously challenging and satisfying to be able to gain their trust and to treat their eye problems,” said Dr Lam.
His office is decorated with colourful robot animals, trains and all sorts of toys. ”You've to bring yourself to the children's level in order to make them feel comfortable; and when that happens, you would have won half the battle. Use their lingo. Make funny noises. Try to make conversation. Distract them with toys and gadgets.”
When all else fails, he pulls open a drawer filled with stickers, ink stamps, sweets and erasers, which he personally replenishes. ”I'll coax them by promising them extra stickers and treats! Children lose interest very quickly and you have got to be swift and purposeful in your examination. So yes, they come for an eye examination and go home all smiles, often with a present.”
I (Can't) Spy With My Little Eyes
His young patients' most common eye problems are refractive error conditions such as myopia, astigmatism and hypermetropia, squints (or misalignment of the eyes), allergic conjunctivitis and lid infections (styes and chalazia). ”Singapore has the reputation of being the myopia capital of the world. The prevalence of myopia is about 27.8% at age seven years, 34.5% at eight years and 43.4% at nine years. This increases to about 50-60% at 12 and reaches almost 80% at 18,” noted Dr Lam, who started wearing glasses at the age of nine.
In Singapore, eye screenings as early as at Kindergarten 1 under the National Myopia Prevention Programme (NMPP) help identify children with amblyopia (lazy eyes) and other refractive errors early in life, so as to facilitate prompt treatment. Though the exact cause of myopia is unknown, the high incidence of myopia in Singapore has been attributed to genetic and environmental factors. Chinese kids face higher risk of developing myopia compared to Malays, Indians and other races, a common phenomenon observed in other Chinese-centric countries like Hong Kong, Taiwan and China. Moreover, children of myopic parents are at an increased risk of developing the condition.
Dr Lam urged parents to try to reduce the environmental harm. ”Children who read a lot and play computer, iPhone, iPad and handheld games frequently tend to develop myopia. Parents, help your children adopt good reading habits early, such as sitting upright, proper lighting, maintaining a reading distance of at least 30 to 50cm and avoid prolonged near work. The children should also take a 5 to 10-minute break after every 45 minutes of near work. More outdoor activities have also been proven to be useful in slowing down the progression of myopia.”
Scientific studies also show that using Atropine eye drops can effectively retard the progression of myopia. ”Eagle Eye Centre is one of the first in Singapore to use the ultra-low dose Atropine 0.01% eyedrops, which has been shown in recent studies to be effective in controlling myopia without the side effects of the original Atropine 1% dosage,” shared Dr Lam.
Most importantly, seek treatment early. Will wearing glasses early in life worsen the condition? ”This is completely untrue. In fact, children with myopia who receive medical attention late can develop lazy eyes or (amblyopia), which can be potentially severe and irreversible!” he cautioned.
As our interview came to a close, we asked the doctor who wears two hats if his vocation has helped him to become a better MP. ”Being a doctor taught me to be compassionate and empathetic; I learnt how to lend a listening ear to my patients and constituents. Of course, my analytical skill as a doctor also gives me the edge to help solve my constituents' problems systematically and effectively.”
Dr Lam Pin Min is based at Mount Alvernia Medical Centre Block B, #02-11/17, Tel: 6456 1000.
Grappling with constantly wetting or soiling your pants can be embarrassing but with the right treatment, pelvic floor disorders can be managed without further suffering, says General Surgeon Dr Aileen Seah.
You're terrified of going anywhere without close access to a toilet as you have trouble holding your pee. Or there's a pain in your nether areas which you're hoping will go away by itself. Perhaps you just can't seem to ”˜coordinate' a proper bowel movement, leading to uncomfortable constipation. These are some symptoms of pelvic floor disorders which, though not life-threatening, can lead to a lot of disruption to a sufferer's daily routine and even lead to feelings of embarrassment or shame.
To understand why some suffer from pelvic floor disorders, we must first understand how the pelvic floor works. ”It's a set of flat muscles with its supporting structures at the bottom of pelvis which hold up the pelvic organs “ the rectum, the bladder and for women, the vagina and uterus,” explained Dr Aileen Seah, a general surgeon with Colorectal Clinic Associates. These organs are tubular and serve as conduits; for example, the rectum for faeces, the bladder and urethra for urine, and the uterus and vagina for babies.
”Hence, the pelvic floor has a complex function of supporting these structures while playing a role in continence. It holds the stool or urine in whilst a person is moving around and relaxes when it is time for a bowel movement or a pee, so that the conduit can open up and allow the passage of stool or urine.” Read on as Dr Seah reveals more.
What are the different types of pelvic floor disorders and what causes them?
Pelvic floor disorders can be subdivided into:
Problems of support: Pelvic organ prolapse occurs when the pelvic organs slide out.
Problems of continence: Urinary and faecal incontinence. The pelvic floor plays a gatekeeper role and has to open and close the ”˜door'. It can't remain constantly open or it will result in incontinence.
Problems of passage: A patient could suffer from constipation due to pelvic floor dyssynergia. Having a bowel movement involves the coordination of multiple muscles; the abdominal muscles have to contract to increase intra abdominal pressure to push the stool out while the pelvic floor muscle has to relax to allow the rectum to straighten so that the stool can pass out. Dyssynegia happens when the pelvic floor muscles close up instead of opening and prevent the stool from coming out. It is akin to pushing against a closed door.
Problems of spasm of the pelvic floor muscles: These are pelvic pain or certain types of rectal pain which can contribute to sexual dysfunction.
Can one suffer from multiple disorders at the same time?
Yes. Pelvic floor disorders involve multiple organs and hence, multiple subspecialties such as gynaecology, colorectal surgery and urology. Often, symptoms do not just involve one system so at Colorectal Clinic Associates, we have a collaborative relationship with gynaecologists and urologists in evaluating patients with pelvic floor disorders to look out for other dysfunctions.
Are pelvic floor disorders part and parcel of ageing?
The pelvic floor comprises of a complex support system of muscles and ligaments. As we age, our muscles get weaker and less bulky; as our ligaments are stretched, the pelvic floor can sag. So yes, pelvic floor disorders tend to become more prominent as we grow older.
Young people can get pelvic floor disorders as well when there is damage to the structures. If just one part of the system fails, sometimes the other parts can compensate. Usually, the problem occurs when there are multiple failure points; that's why pelvic floor disorders tend to manifest at a later age, when the other compensatory mechanisms also fail. For example, a patient whose anal sphincter was damaged when he was 20 years old may not have issues with faecal incontinence until he hits about 60, because his other muscles were previously able to make up for it.
Why are women more prone to pelvic floor disorders?
Women go through childbirth so the passage of the baby through the pelvic floor stretches the pelvic floor. Women have a uterus which swells up with a baby and strains the pelvic floor. Women also have a vagina which is a space or channel where the neighbouring organs like the bladder or rectum can herniate through it (rectocoele or cystocoele).
That said, men can also get pelvic floor issues as well such as pelvic, rectal pain or bladder irritation, bowel dysfunction and rectal prolapse.
How serious are pelvic floor disorders? Can it lead to other health complications?
Some pelvic floor disorders such as urinary or faecal incontinence can be embarrassing and turn sufferers into social recluses just to avoid these embarrassing moments. This can be crippling to a person as social interaction contributes to a person's wellbeing. There may also be other issues such as frequent bouts of urinary tract infection.
A pelvic organ prolapse causes pain and discomfort, especially if the organs prolapse out of the vagina. These contribute to a sensation of constantly wanting to void. For some, the prolapse causes the organ structure to be distorted which can cause difficulty in voiding, be it urine or stool. Pelvic floor disorders may not really be life threatening but it can really be bothersome.
How do you treat pelvic floor disorders? Is surgery recommended?
In evaluating the patient, a thorough assessment should be conducted to find out how much it affects the patient's life and other concerns. Every patient has different needs and lifestyle while different treatments have their pros and cons. It doesn't mean going in to do the surgery and just fixing it. The pelvic floor is dynamic and is a complex structure. Sometimes, by repairing one area, an issue with another area becomes prominent. Hence, I usually work in a team with colorectal surgeons, gynaecologists and urologists. Sometimes multiple surgeries may be needed. Thus, the treatment plan has to be customized for individual patients.
Some people may be embarrassed to seek help for pelvic floor disorders. Any words of advice?
We do know that pelvic floor disorders can be a source of embarrassment. Take heart, you're not alone as there are other fellow sufferers around, but we can help. By talking with your doctor, you will better understand your condition and learn ways to cope and deal with it. Do not suffer silently.
Dr Aileen Seah is based at Mount Alvernia Medical Centre Block A, #02-28, Tel: 6643 9922.
How should you take care of your pearly whites? Dental Surgeon Dr Anthony Goh answers your FAQs.
Q: What is the correct way to brush teeth?
A: The correct way that is taught by dentists today is to first get a soft-bristled toothbrush with a small head and a straight handle. The softer the better, as they can bend more and fit into the differently-shaped curved surfaces between teeth. People who use hard bristles may think that their teeth are cleaner but in reality they are only scrubbing at the most bulbous parts of the teeth, and gradually sandpapering down their teeth (usually at the root). Large-headed toothbrushes are more appropriate for horse-sized mouths!
Hold the bristles at a 45-degree angle to the tooth surface and allow the bristles to reach under the gum collar that fits around each tooth. Keep movements small and circular where the tip of the bristle just jiggles in the gum collar; no large sawing strokes that are more apt to damage the gums and teeth.
Be systematic and don't miss spots. After brushing, give each tooth a run-through with floss. Flossing gets to the hard-to-reach-with-a-toothbrush bits of a tooth where gum disease usually starts. This is especially true for the wider back teeth as the bristles of the toothbrush cannot reach in between to effectively clean off the plaque.
How often should we change our toothbrushes?
A: Once the bristles look less-than perfectly straight, it's time to replace it. This varies from a few weeks for the really hard brushers (highly discouraged!) to a few months for the gentler ones. However, a toothbrush tends to collect colonies of the bacteria that grow in the mouth, and are kept in damp places. It may be wise to change it, even if it's not frayed, after three to four months to maintain good hygiene.
Q: Can oral gurgles rinses replace brushing?
A: How we all wish we can do away with the tedium of brushing teeth! Unfortunately, there are no mouthwashes, rinses, gargles, gurgles, nor tonics that can replace the mechanical removal of the layer of plaque that forms in the mouth. Most of these solutions have a psychological effect because they smell good! It's like not bathing and hiding the smell with lots of perfume. If one brushes properly, there is no need for any oral rinses.
Q: When should we start practising good dental care?
A: Dentists recommend the first dental visit at age 12 to 18 months. This is when the first teeth have started cutting through and before the child develops stranger anxiety. It's good for spotting any early decay, for example, from Baby Bottle Tooth Decay, and for any growth disturbances. As the child gets familiar with the dentist, there is less fear and the visits are not associated with discomfort nor pain.
I always beg parents never let our own dental anxiety cloud the child's experience. And never, never, never use ”If you don't behave, I'll take you to the dentist and ask him to pull all your teeth out” as a threat. It breaks my heart to have to re-train children not to be afraid of dentists because of ”˜faulty programming'.
Dr Anthony Goh is based at Mount Alvernia Medical Centre Block B, #03-10, Tel: 6251 1189.