Monday, June 14, 2010

Interview with Minister Khaw

Straits Times interview with Minister Khaw

Friday, June 11, 2010 at 9:13am
ST’s Health Correspondent, Ms Salma Khalik interviewing Minister Khaw on his recent bypass.
On how his family coped with the discovery of the blockage, and the experience of going through the operation

Min: My wife was fully and promptly informed of all the findings. My daughters were partially informed at the initial stage as I really thought that it would turn out to be a false alarm. After the CT angiogram which showed a blockage at the left main artery and a bypass recommended, I kept the children fully informed, except for the daughter who works in Shanghai, who was told only after the surgery was over. She flew back the next day. They were naturally concerned and worried: this was a major operation and things could go wrong. I was calm and accepted the need to go through the trauma. That was very helpful, I think, to enable the family members to go through this difficult period.

My wife was next door observing the coronary angiogram, and the next morning saw me off to the OT for the bypass. She returned with my youngest daughter at noon when I was wheeled off to the ICU. I have no clear recollection of that but my wife told me several days later that my daughter burst into tears when she saw me out of the OT, on trolley, with tubes in various places. I vaguely recalled someone crying next to me. I thought it was my wife. It must have been very traumatic for them. I felt very sorry to have caused the distraught.

On the importance of regular health screenings

Min: Plaque build-up takes time, and in my case, I think the blockage would have been picked up at my next Electrocardiogram (ECG) Stress Test. There are many possible tests and the choice of the test will depend on the risk profile of the patient. Calcium score is not meant for the masses, but it could be useful for those with a significant family risk, as in my case. I think we need different screening tests at different frequencies for different patient profiles – some need more frequent testing and additional tests; others do not. They should consult their GPs and if indicated, their cardiologists.

On the impact his operation had on National Healthy Lifestyle Movement

Min: After I have ended my denial, I was completely at peace with myself. I was mentally and physically ready for the bypass.

I only had one worry: how would the public interpret my bypass?

I have been a champion and an active practitioner of the Healthy Lifestyle Movement. Would my bypass cause a dent to the movement? I must have seemed to be a disappointment to the movement!

A few friends whom I aggressively promoted brown rice to several months ago told me, half-in-jest, that they had a debate after hearing of my bypass. They were split in their views: one group felt that they should go even more aggressive and eat red rice; another group felt that they should abandon healthy diet and just eat as they desire.

In fact, besides divine intervention, I was likely saved by a healthy lifestyle. An unhealthy lifestyle with poor diet, no exercise and smoking might have precipitated a fatal heart attack earlier.

The doctors found my right arteries to be normal. They commented that regular exercise must have contributed to that. Other than the blockage in the left artery, the heart is functioning well.

The physiotherapist told me last week that I am ahead of many other patients in my cardiac rehabilitation programme. I was able to start the programme soon after surgery, as an inpatient. This she thinks is a positive factor in rehabilitation.

Certainly, for my new lease of life, I will be even more aggressive in pursuing a healthy lifestyle. Being predisposed to high cholesterol, my job is to prevent new blockages from being formed. Besides a higher dose of anti-cholesterol medication, I will have to persist in my regular exercise and strict diet. And I must continue to be vigilant in my regular health screening, including the ECG stress tests.

Statistically, about 10% of bypass patients have re-admissions for their heart conditions. In the ward, I met a patient who had his bypass 15 years ago. He has been back to hospital for 3 angioplasty sessions (stenting and balloon). I did not probe but I think he continued to smoke.

Ladybird Khor likes this.

F Teck Seng Heng
Mr. Khaw , You should not worry about what the public thinks of your by;re only human and more often than not you "inherit" many ailments from your family line which you have absolutely no control over. Who says a doctor cannot get ill or for that matter the Minister of Health cannot have heart disease ? A healthy lifestyle is what "saved" you. Warmest regards and get well soon.
June 11 at 10:26am

Cheng Siong Lim
Mr Khaw,I am glad to hear you have fully recovered from the by-pass surgery and would be able to return to work in the coming week.

I would also like to hear your view on many younger generation have been migrated to singapore and grow their roots here. ... See More

For my case, my parents was granted long term visit passes so that our family could stay in unite. However medical expenses has always been on the steep side. My dad was hospitalised and perform a angiogram and angioplasty in May 2010 and the total hospital bill chalked up > S$50K in SGH.

Although we did bought a medishield plan from NTUC income but under the current system, the family would have to pay up the bills before they are able to claim the amount back from the insurance company.

Do you think the Govn should step in to assist by formulating a policy where it would lessen the burden (in term of medical expenses) of the younger generation whom migrated here?

Wish you get well soon.
June 11 at 11:00am ·

Leong Seng Chen
Agree with F Teck Seng Heng! Mr Khaw - perhaps a calm cool healhty with clarity of mind make a great difference toward any possibly disappointment if any in one's life-journey. What there to worry as everything is afterall conditional. I think you had been doing an excellent job with kind heart too except the 6 weeks of self-delay or self-denial - but overall I must praise that you had been blessed with your own wholesome karmic energy. Smile with Cheers Always~~~
June 11 at 11:23am ·

Ladybird Khor
I fully agree with F Teck Seng Heng and Leong Seng Chen. May the minister be well and happy always!
June 11 at 12:35pm ·

Teo Cheep Lee
Dear Sir,Thanks for your sharing of your incident & it enlightened me on such incident affect not only yourself but deeply impact your family members, those who love you!
Get well soon.

Saturday at 12:34am ·

Laura Ng
Hi Mr Khaw, I always support your effort in promoting Healthy Lifestyle Movement and no, your surgery doesn't render you a disappointment to the Movement because you've taken responsibility for your health. Without a healthy lifestyle, worst could have happened, even perhaps without warning. Wishing you a speedy full recovery, Mr Khaw. And for those who use your heart surgery as an excuse to revert to unhealthy lifestyle, well, I wish them good luck.
Sunday at 12:27am ·

Soong See Choo
Take good courage Mr Khaw and family, wish you all the best in family loving and growing together too. May you have warm words on a cold evening, a full moon on a dark night, and the road downhill all the way to your door. We need one another to be stronger to enjoy life again. Smiles to you too.The Myth of Cholesterol
The Myth of Causality
See More belief that cholesterol causes atherosclerosis and consequently heart disease.

How did cholesterol get such a bad reputation? Part of the answer lies in the approach taken by modern medicine.
The reasoning along "Germ Theory of Disease", has been to focus on determining a single cause for a given disease, begins to falter when applied to most other diseases. Causation is not so straight forward, especially in cancer and heart disease.

Louis Pasteur himself re-evaluated his germ theory in later years. He is believed to have said : "It is not the germ ; it is the terrain." This statement opens the door for a deeper analysis of disease causation, taking into account the significant role played by the individual's general health (the "terrain").

The Case Against Cholesterol. (Victimization?)
While searching for "the cause" of heart disease, pathologists notice that blood vessels were clogged with plaques and debris. These plaques were areas of hardness with a mushy center ; hence, the term atherosclerosis from the Greek words atheroma meaning "gruel" and sklerosis meaning "hardening." They later determined that the mushy center had a high concentration of cholesterol. Logic followed : Since the narrowing of arteries was caused by atherosclerosis, and cholesterol was at the center of these plaques, cholesterol must be the cause of the disease. The culprit had been found. Oversight in reality. This circumstantial evidence seemed enough to convict the criminal for life.

This line of reasoning is analogous to the following: A pipe in your house breaks. You look inside the pipe and see a white crusty buildup of calcium phosphate compounds. You see that the buildup is greater particularly where the pipe snapped. Did the buildup cause the pipe to break? Of course not. The more likely explanation is that there was a defect in the pipe that allowed for more calcium phosphate to collect at that point. That is all. The buildup was a symptom of the problem, not the cause.

Only a few doctors really understood how cellular dehydration can cause the body to overproduce cholesterol in order to protect some of the drying up cells from premature death. The only logical remedy and step to reverse this overproduction of cholesterol is to replenish the body with correct amount of water daily. Water deficit is the cause, and higher cholesterol is just a symptom.

Protein-rich diet cause plaque buildup in pathology specimens. A high-protein diet was the cause of atherosclerosis. Avoid protein foods, but have a diet of amino acids, no atherosclerosis development.

At first glance, the case against cholesterol appears solidly grounded. But upon further analysis, it becomes evident that circumstantial evidence is being used to convict an otherwise innocent bystander-cholesterol.

France has a high intake of fat and cholesterol and a low incidence of heart disease. Wine. Holland and Norway consume less wine and more fat than France had even lower incident of heart disease. Sorry, it is not wine.

Lipid hypothesis has many weaknesses.
Note: Lipoprotein Cross Section : Since oil and water do not mix, there need to be a way to transport lipids (mainly oils) in the blood (mainly water). Lipoprotein encases the lipids so that they can be transported on the blood.

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