An interview with doctors from Mount Elizabeth Hospital, Singapore.

Guardians in White

There has been a perceptible rise in cardiovascular disease in South-east Asia. The obvious culprits here are unhealthy eating habits and lifestyle. What is your opinion on this topic? Are we oversimplifying a complex problem? What role does stress play here?
I think what the physicians have said are true. They say “We are what we eat”, and our poor diet has led to a rise in conditions like high blood pressure, high cholesterol and diabetes. These are the biggest risk factors for cardiovascular diseases and are often the consequence of an unhealthy lifestyle and diet. Another risk factor is smoking. A smoker has twice the chances of getting a heart attack when compared with a non-smoker. People are also leading a more sedentary lifestyle, which also increases the risk of them developing heart disease.

Most people think that stress plays a major role here since stress can lead to higher blood pressure, higher heart rate. Most physicians believe that stress does contribute to cardiovascular diseases, although it may be hard to prove this. This is simply because it is difficult to quantify stress and thus determine its impact on our body.

What patients are the most susceptible to heart disease? Does genetics play a major role in determining the health of our heart?
The patients with the risk factors of diabetes, high blood pressure, high cholesterol as well as the ones who smoke, are the most susceptible to heart disease. Genetics unfortunately also plays a role in determining your cardiovascular health. Having a first-degree relative suffering coronary heart disease at a young age predisposes you to also developing it. In Asia, studies have shown that individuals of Indian/South Asian ethnicity are at five times increased risk of heart disease when compared to their Chinese counterparts.

If you had one piece of health-related advice as a cardiologist, what would it be?
Prevention is always better than cure. Heart disease, while not 100% preventable, is certainly treatable. We need to start early by being mindful of our lifestyle choices and exercising regularly from a young age. Engaging in moderate forms of exercise for 30 minutes at least 5 days a week will be enough. We should also go for regular check-ups, to keep track of our blood pressure, cholesterol and sugar levels.

One of your sub-specialty is heart transplant. The process can be grueling on the patients. What would you like to say to patients who are waiting for a heart transplant?Heart transplant is a high- risk surgery and is reserved for very sick patients with advanced heart failure. However, a heart transplant can offer a significantly better quality of life for a heart failure patient. I would encourage all potential heart transplant patients to look to the past thousands of patients who have successfully gone through the surgery for motivation and inspiration.

The rate of heart transplants in the world has reached a plateau in the past 20 years. This is simply due to the limited supply of healthy donor organs. Due to an aging population, greater number of people getting cardiovascular diseases and better survival rates due to medical and technological advancements.

One of the most established treatment methods for end-stage heart failure these days is the Ventricular Assist Devices (VAD), otherwise commonly known as an artificial heart pump. The VAD is implanted into the heart and its key function is to pump blood out of the heart to the rest of the body. With a VAD patients have an 80% chance of surviving beyond 2 years, based on statistics from worldwide data. In Singapore, patients who use VAD have an 80% chance of surviving for more than 4 years.

What has been the most challenging aspect of working as a cardiologist?
I have witnessed many patients who were on the brink of death. It is heart-wrenching when we cannot manage to save a patient despite our best efforts. On the other hand, it is extremely rewarding when a patient survives and recovers fully. I think the most challenging part of working as a cardiologist is going through these critical situations with the patients, keeping my emotions in check and not let them affect my objectivity.

What is the most common form of respiratory problems faced by population in the South-East Asian regions? What causes this?
The two main things we look for as a lung specialist, are tuberculosis and lung cancer. Just by sheer statistics alone, pneumonia is the disease that outstrips all the others. Other common diseases include chronic obstructive pulmonary disease (COPD) and asthma. And as for the reasons, air pollution is a significant factor. Moreover, densely packed urban areas increase the transmission of infectious diseases like tuberculosis and pneumonia. There’s also a large number of smokers in South East Asia, which causes COPD, and is a risk factor for lung cancer and tuberculosis.

What steps can a person take to ensure that they have a healthy respiratory system?
I think that the first thing that a lung specialist advises to a person is to stop smoking and to tell your loved ones to stop smoking. Passive smoking, also known as second hand smoking, will increase the chances of cancer. Other things that we could try to do is exercise, which even I personally don’t do enough of. Exercising improves the respiratory muscle strength.

If one has respiratory symptoms that don’t go away, he or she should seek early medical attention to achieve early diagnosis. Taking tuberculosis as an example, you have to diagnose it early to prevent it from harming your body even further and secondly to prevent transmission to another person.

At present, 55% of the world’s population live in urban areas and UN predicts the numbers will rise to 68% by the year 2050. Given that urban regions have a higher degree of pollution, what does it mean for the respiratory health for those living in cities?
Firstly, as I’ve previously mentioned, tuberculosis is a communicable disease, which may have increased transmission with increased urbanisation. Secondly, the pollution will lead to more irritation of the airways, resulting in people having more respiratory symptoms, and worsen underlying respiratory disease. But with proper urban planning, if we manage to reduce air pollution, reduce carbon emissions, it can potentially be reversed.

You have been very vocal about your love for teaching. What inspired you to be a teacher? How has that helped you as a physician?
My teachers inspired to teach. I was blessed to have them in my life. They told me that the only way to repay them was by paying it forward. I cannot repay my teachers but I can respect the wishes of my teachers by imparting knowledge to the new generation. During teaching, I need to distil difficult concepts into simpler terms, and I will end up learning more myself. I will also need to keep myself up to date to teach effectively. Another good thing about teaching is the opportunity for networking among doctors and allied health professionals.

What is the most challenging part of working as a Respiratory and Intensive Care Physician?
Definitely the working hours because they’re unpredictable. Patient don’t choose a certain time to be sick. My own potentially skewed observation is that the wee hours of the morning tend to have sicker patients. Then there’s the fine balancing act of emotions and practicality that every doctor has to face. I try to put myself in the patients’ and their families’ shoes, but that can be emotionally draining. At the same time, I have to step back and view the situation objectively, so that I can give better advice to the patients and their families.