Former S'pore Idol contestant on beating ovarian cancer

Singapore Idol contestant Daphne Khoo reveals how she pulled through a series of health scares, including a rare form of ovarian cancer last year.

SINGAPORE - It is harder to recognise former Singapore Idol contestant Daphne Khoo, 26, these days with her chic pixie cut.

The third runner-up in the first season of singing contest Singapore Idol in 2004 and former lead singer of indie band West Grand Boulevard had long locks that the audience came to know her by.

She snipped them off in June last year in preparation for chemotherapy.

That was also the year she had a most stressful experience battling wave after wave of debilitating illnesses.

The 26-year-old was diagnosed with a form of ovarian cancer so rare that it affects perhaps one Singaporean a year.

Yet, she does not pity herself, telling Mind Your Body: "I see the illnesses as part and parcel of life. When life knocks you down, you just roll with the punches."

The petite music student takes a light-hearted approach to her hiatus from school, joking that the cancer was a welcome break after four rigorous semesters at the Berklee College of Music in Boston in the United States.

But while she looks on the bright side, she will not easily forget how she discovered her cancer. After a morning gym session in March last year, she had an outbreak of hives from her neck to her ankles.

Her eyes swelled up "like golf balls", so her Korean roommate whisked her off to the emergency department at Brigham and Women's Hospital nearby, where she was given antihistamines intravenously for close to eight hours.

Though her symptoms were alleviated, Miss Khoo decided to consult an allergist.

When skin prick tests yielded no conclusive results, she underwent a full-body check-up, which included a Pap smear of her cervix.

10cm growth in left ovary

It was during this physical examination that a nurse raised the alarm about Miss Khoo's bloated abdomen, which Miss Khoo said she had had since she was 18.

Back then, she had asked her mother to feel her abdomen, but there did not seem to be an abnormal mass.

Unknown to them then, it was abnormal for a woman to have swelling of the abdomen without weight gain in other places.

Miss Khoo said: "We just never thought it could be cancer as I felt no pain there."

After a pelvic ultrasound scan, she was told there was a 10cm growth in her left ovary which had to be surgically removed.

She still held up well when told by a nurse over the phone that it might be cancerous, but broke down when she was asked if any of her family members were with her.

She had lived alone in the US for the last two years for her studies, and the bad news could not have come at a worse time. Her parents, both 60 years old, and 30-year-old elder sister were then on vacation.

Miss Khoo first called her younger sister, a 25-year-old marketing executive, and then called her parents.

Her retiree father cut short his golf vacation in Atlanta and was by her side three days later. Her mother, a treasury manager in her own firm, steeled herself on her flight back to Singapore from Japan.

Mrs Denise Khoo said: "I had no mood to enjoy being in business class. I just kept praying for Daphne."

Mrs Khoo had herself been diagnosed with early stage breast cancer at the age of 49 and had had surgery, chemotherapy and radiation therapy.

So it pained her to know that her daughter was faced with a similar ordeal.

Rare form of ovarian cancer

Miss Khoo had surgery on May 17 last year at Brigham and Women's Hospital while her parents and then-boyfriend waited anxiously outside the operating theatre during the four-hour procedure.

The surgeon told them he removed her left ovary and left fallopian tube, together with the tumour which was, in fact, 13cm in diameter.

A few days later, they learnt, to their relief, her cancer had not spread to other areas of the pelvis.
However, it had spread to the tissue lining her peritoneal cavity or abdomen.

Miss Khoo had a rare type of germ cell cancer, known as dysgerminoma. The Singapore Cancer Registry noted that there were nine such cases in a decade, from 1998 to 2007.

A spokesman from the Ministry of Health said there was just one case between 2008 and 2010. Of every 100 cases of ovarian cancer, only about five are cases of germ cell cancer, said Dr Tay Eng Hseon, medical director of the Thomson Women Cancer Centre.

Germ cells are cells in the ovaries or testes that go on to form eggs or sperms. Most germ cell tumours are not cancerous, though the testicular cancer suffered by disgraced cyclist Lance Armstrong was a form of germ cell cancer.

The other, more common, types of ovarian tumours are those of the epithelium (tissue covering the ovaries) and sex cords (structures that develop into ovarian follicles where immature eggs grow).

Dr Tay said dysgerminoma can grow rapidly, from being impalpable to a large tumour in the span of a few months.

The typical symptom, therefore, is a fast-enlarging abdominal mass associated with pain. The cancer tends to strike women between 15 and 25 years old.

Dr Tay said this cancer was highly fatal until the late 1970s, when the platinum group of chemotherapy drugs was introduced.

The disease is highly sensitive to this class of drugs, to the point that almost no one will die from it now. The exception is a small group of patients with an even rarer and highly aggressive form of germ cell cancer which is still difficult to treat, Dr Tay said.

Obstructed bowels

A few days after her surgery, Miss Khoo was racked with such pain she could hardly lay still. She was constipated and vomiting bile.

She had fallen prey to an uncommon complication of abdominal surgery. Adhesions, or internal scar tissue, forming as part of the healing process, were creating blocks in her bowels.

The obstruction prevented her intestines from functioning properly.

Back at the hospital, Miss Khoo had a tube passed through her nose, down the oesophagus, and into the stomach to remove the contents that had accumulated since the bowel obstruction.

She said: "It felt like someone was stabbing me in the throat. It took everything in me to stay calm during the insertion."

Five days later on her mother's birthday on May 29, Miss Khoo finally had the tube removed. By that time, her intestinal obstruction had somehow resolved on its own. She was able to move her bowels.

The problem recurred a week later but, fortunately, the obstruction cleared on its own. Then there was also the trauma of losing her hair, for which Miss Khoo had been mentally prepared by her mother.

Two weeks before she began chemotherapy at the Memorial Sloan-Kettering Cancer Centre in New York, she had her chest-length hair cut in an avant-garde style with a bob on one side and the other shaved bald.

She said with a grin: "I felt it was a fun way of preparing myself for hair loss. I wanted to do it in style."

She also had her eggs retrieved and frozen to preserve fertility.

Don't brush off complaints

That was the positive part. After three cycles of chemotherapy that lasted nine weeks, Miss Khoo lost 7kg to weigh 45kg, though her body mass index (a measure of body fat based on weight and height) showed that this was still normal for her 1.52m frame.

The food lover tried to stimulate her appetite by viewing pictures of food, and tried to swallow the soup her mother cooked lovingly for her but nothing helped.

She joked that the upside to chemotherapy drugs was that they helped to clear her eczema and gave her baby-smooth skin.

She has since gone back to college, where she is completing her final semester to graduate in May. She has also switched her major from songwriting to professional music.

The past year has been hard for her as she loathes being dependent on others for her needs and kept indoors mostly.

When asked what she missed most during her illness, she said it was her hearty appetite, before adding softly: "I also appreciated my mum more."

Mrs Khoo said parents should take note.

"When young girls say they feel bloated, don't brush it off as nothing. Bring them for ultrasound scans because this could save lives."

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Can Sabah Snake Grass cure cancer?

SINGAPORE - Its leaves look like shoots of wild grass and its stem appears plastic-like.

Nothing about this fruitless plant stands out. And it's not surprising if most people mistake it for something worthless.

Yet this unassuming plant - called the Sabah Snake Grass, or Clinacanthus nutans - is highly prized in Singapore.

Sabah Snake Grass - named for its initial use in treating snake bites - is worth its weight in gold because its claim to be a cure for cancer.

Despite these claims, which come amid anecdotes of its curative properties, there has not been any scientific proof that the herb has any actual effect on cancer.

One nursery owner in Pasir Ris in particular has watched with amazement as demand for the plant has slithered upwards in just four years.

Mr Alan Loh, 67, tells The New Paper on Sunday: "More than five years ago, nobody asked for it."

Only a small group of people with kidney problems bought the Sabah Snake Grass initially from Mr Loh.

He says: "At its peak two years ago, the demand grew from almost zero to about 10 customers each day asking or wanting to buy the plant from me. I often ran out of stock."

Mr Loh said the popularity of the herb can be traced back to the story of a Malaysian's miraculous recovery from Stage 4 thyroid cancer.

The man, Mr Liu Hui Lian from Perak, was told by doctors in 2008 that he had only three months to live.

Every medical treatment he tried proved futile until he found out about Sabah Snake Grass. After five months of consuming the leaves, he claims that his cancer had disappeared, he tells TNPS in a telephone interview this week.

Mr Liu, 58, says in Malay: "This March will be the fifth year that my cancer has not returned. It's a bonus for me and there's a good chance I'm totally cured."

After Mr Liu's story was covered by several Chinese newspapers and a TV station in Malaysia, the plant's popularity soared.

A website - www.sabahsnakegrassfarm.com - by another farm owner in Seremban, Malaysia, documents Mr Liu's medical history from diagnosis to an apparent improvement shown in a medical examination taken in 2009.

To date, that site has garnered 97,000 views from 90 countries.

Malaysians make up 56 per cent of those who had visited the site while Singaporeans, the second largest group, make up 18 per cent.

Now, Mr Liu runs an eight-acre farm - about the size of eight football fields - that grows the herb. He usually gives away small samples to cancer sufferers.

He also teaches them how to replant the herb in their gardens.

Mr Liu says: "If you believe (that you can be cured after consuming the herb), half the battle is won. You're on the way to being cured like me."

Yet, some medical professionals here remain unconvinced. Medically, there's no "magic bullet" for cancer, they say.

Still, Mr Liu's story has led to a healthy demand here as well, said the general manager of Hua Hng Trading, a plant and tree wholesale centre off Sembawang Road, who gave her name as Madam Ang.

The woman, in her 50s, says: "Five years ago, I stocked 50 small pots of Sabah Snake Grass at any one time.

"Today, I stock close to 1,000 pots."

Smaller nurseries, like Mr Loh's outfit in Jalan Loyang Besar, have also hopped on the bandwagon.

At his nursery, roughly the size of two basketball courts, seven small plots are devoted to Sabah Snake Grass harvesting.

He sells three pots for $10 while its leaves can be bought for $30 per kg.

Mr Loh isn't the only one peddling the plant.

There are other herb farms and several online "agents" here selling the Sabah Snake Grass. About four other nurseries here supply the plant at wholesale quantities, says Mr Loh.

Those who consume the Sabah Snake Grass usually blend the leaves with green apple juice.

"You could also eat it raw," says Mr Loh, handing this reporter a leaf he had plucked from a potted plant.

There wasn't any nasty aftertaste.

How much to consume depends on which stage of cancer the sufferer is in, says Mr Loh.

"European tourists have visited me asking how to grow the plant in their gardens."

He claims: "One old man, a cancer sufferer, came in a wheelchair but three weeks later, after consuming the Sabah Snake Grass, he walks into my garden without any help.

"I'm not a doctor but I see that they've regained their strength and appear more comfortable."

Snake grass may bring false hope to cancer patients

What do you tell a child when her life may be cut short?

That's the question plaguing a mother whose daughter suffers from stomach cancer.

To Niki Ng, seven, and her mother, Mrs Ng from Taiping, Perak, the Sabah Snake Grass is a godsend.

Speaking to The New Paper on Sunday over the phone from Mr Liu Hui Lian's farm, Mrs Ng, 38, says in Malay: "I just want her to lead a normal life like other children. The herb represents hope for us."

Niki was diagnosed with the gastric carcinoma in September last year, and had undergone chemotherapy without success.

After consuming Sabah Snake Grass in November, Niki's 5cm polyp began to shrink, claims Mrs Ng.
Yet, such herbal treatments aren't all proven remedies, say medical professionals here.

Says Ms Joanna Liew, 28, a registered physician at Bao Zhong Tang TCM Centre: "The danger here is that what works for one person, may not work for another.

"There is also no 'magic bullet' in the treatment of cancer."

Dr Wong Seng Weng, Medical Director & Consultant Medical Oncologist at The Cancer Centre says that the US Food and Drug Administration (FDA) had previously approved a herbal treatment for advanced prostate cancer.

Unfortunately the approval was withdrawn.

This was due to serious problems with the quality control in the production of the herbal preparation including contamination with arsenic, says Dr Wong.

He adds: "No alternative therapies for cancer has been approved by FDA since."

Some of Dr Wong's patients have tried the Sabah Snake Grass. However, his findings may be hard to swallow.

He says: "All (his patients who consumed the Sabah Snake Grass) experienced worsening of their cancers. Hence my personal observation of the effects of Sabah Snake Grass has been very negative."

Similarly, the Health Sciences Authority (HSA) says that it is "not aware of any scientific evidence that substantiates the medical use of Sabah Snake Grass in the treatment of cancer."

Like Dr Wong, HSA reminds cancer patients to exercise caution.

Says Dr Wong: "Patients with an incurable disease may be in a state of emotional desperation and can be very vulnerable to people peddling false hope."

What's important in the treatment of cancers is its early detection, says Ms Liew, 28.

"I have heard of many horror stories of people delaying cancer treatment," she says.

She adds that the longer the patient waits in making a treatment decision, the lower the chances of success.

Snake gall bladder

The gall bladder of a snake, believed to help cleanse blood and detoxify the body, can be found in traditional Chinese medical halls here.

"It is not popular with locals, but mainland Chinese, especially those from Fujian and Xiamen, seem to like it," says a Thye Shan Medical Hall spokesman.

It is also known to alleviate rheumatism, she adds.

Snake gall bladder is mostly imported from countries such as Indonesia, Thailand, and India, and is typically consumed after soaked in wine.

The teardrop-shaped ingredient, which is sold in a dried form at medical halls, can also be sliced and cooked before being eaten.

It costs a hefty $200 to $400 per 100g, depending on the grade, says the spokesman.

Snake fruit

Also known as salak, this fruit has reddish-brown, prickly skin that resembles that of a snake.

The skin breaks away to reveal lobes of white, juicy flesh, which tastes like a combination of honey and pineapple.

The fruit grows in Indonesia, Brunei, and Malaysia. Finely sliced, it makes a great ingredient in salads, and packs a big dose of vitamin C.

Tampines St 45 dangerously accident-prone, say residents

TAMPINES - A day after the horrific accident, people were still jaywalking.

Pedestrians at Tampines Street 45 were seen ignoring traffic lights as they crossed the street, casually strolling with their earphones plugged in.

Some students even ran across the road.
This, despite the fact that the street is infamous among residents there.

"The area is dangerously accident-prone," claimed Mr Michael Seet, 60, a retiree.

The resident of Block 491C did not witness Monday's tragedy, but claimed to have seen other accidents happen on Street 45, such as one involving a woman early one morning two years ago.

On Dec 6, 2011, Madam Mislia Ahmad, 65, was killed by a car turning right from Street 45 into Tampines Avenue 9, reported The Straits Times.

Near misses

Many residents also told The New Paper about their near misses with speeding vehicles there.

Mr John Tan, 64, claimed he was almost hit by a lorry at the junction of Street 45 and Avenue 9, when the traffic lights had been in his favour.

"Many lorries speed here," said the retiree, who lives in Block 489. "They are really too fast.

Accidents like that (Monday's accident) can be avoided if they weren't so fast."

TNP understands there is a construction site beside Block 491E. Two blocks of flats and a multi-storey carpark are being built there.

Residents also complained about how there were too many heavy vehicles on the narrow road.
Street 45 is a two-lane road that runs to the four-lane Tampines Avenue 9.

Opposite the road is All Saints Home, a nursing home for the elderly.

There is a zebra crossing just outside Dunman Secondary School, with signs warning motorists of crossing students. The speed limit for Street 45 is 50kmh.

When The New Paper went to the junction at 1.30pm yesterday, many school buses were turning into the narrow road.

They were there to drop off students after school and when they turned, they took up nearly half of the street.

We also counted a total of 34 heavy vehicles between 5pm and 6pm, including buses, cement trucks and other construction trucks.

Monday's accident had happened at around 5.50pm.

"The turning is so narrow that when the heavy vehicles turn, there is no space for the children to stand. It's very dangerous for them," said Mrs Priya Senthil, 32, who lives in Block 498B.

The mother of two claimed that children often walk along the road from Dunman Secondary School or from Tampines North Primary School.

Others, like Mr Muhammad Adanan, 23, blamed the traffic lights.

Mr Adanan, a tow-head driver who moves containers around shipyards, claimed that during peak hours, only four or five cars can drive through the Avenue 9 junction each time before the light changes.

"I often see people try to speed up, to beat the lights," he said.

Between 5pm and 6pm yesterday, we witnessed at least six vehicles trying to beat the red light.
Mr Adanan lives in Block 494 with his family. In the six months he has lived there, he has heard of three accidents there, he claimed.

"It's quite a scary place, quite dangerous. I hope something can be done," he said.

Many residents are now calling for a change.

"We need more speed bumps and more traffic police here," said a resident, who wanted to be known only as Madam Koh.

Boy, 2, may not live to adulthood

His life expectancy may be less than the average person's, but Branden Lim's family are determined to make the most of his remaining years.

It is a perfectly average domestic scene set around the family dining table.

Mother Yap Sook Yee, 38, is keeping an eye on five-year-old Jaden to ensure that he doesn't get so distracted by his iPad game that he doesn't eat his lunch, and Branden, two, is demanding his father Edmund Lim's attention by repeatedly calling out "Pa! Pa! Pa!" from his baby chair.

There are only two things to disturb this pretty family picture: the nasogastric tube going into Branden's left nostril, and the two blue support cushions tucked in snugly on either side to help keep him sitting upright.

Life has not been easy for the Lims ever since they discovered that Branden is suffering from a genetic disorder called spinal muscular atrophy (SMA).

Unsuspected disorder 

With firstborn Jaden being a regular, healthy kid, and no known history of genetic diseases in either family, Yap and Lim, 39, had no inkling that they were actually carriers of a defective, recessive copy of the SMN1 gene.

This gene is in charge of producing a protein called survival motor neuron (SMN), which, as its name states, is crucial for the survival of motor neurons.

Motor neurons are nerve cells located within the central nervous system, which control both voluntary and involuntary muscle movement.

The lack of the SMN protein leads to the early death of these motor neurons; and as neurons have very limited regeneration capacities, this spells very bad news for the affected person.

While carriers of the defective gene are not affected physically, each offspring of two such carriers has a one-in-four chance of inheriting two recessive copies of the SMN1 gene, resulting in them developing SMA.

Warning signs 

Yap shares that while her pregnancy with Branden was normal, the first intimation that something might be wrong came during his birth.

"When Branden was delivered, he was immediately admitted to the NICU (neonatal intensive care unit) because he didn't really cry - there was fluid in his lungs." she says.

Lim, a commercial manager with a multinational company, recalls that Branden had to be put on continuous positive airway pressure (CPAP) at that time, in order to help him breathe.

However, he recovered enough to be discharged eight days later, although the doctor advised that he be kept away from crowded places.

The next few months passed by uneventfully, until Branden reached three months of age.

Yap recalls: "He was able to turn at three months, but that was the first and last time he ever did it."
As the months went on, Branden started missing more milestones, like sitting up and crawling, but his parents thought that he was just a more "relaxed" baby. He also developed trembling fingers.

Then, at five months, Branden's paediatrician found him to be hypotonic, ie his muscles had less tone or strength than normal.

"He said it was a general symptom, which could indicate multiple different conditions, from simple to complex," says Lim.

"Branden was then started on physiotherapy, which worked for awhile, but then, it stopped having any effect."

However, the alarm bells really started to ring when Branden was about a year old.

"At one year of age, he had only gained 100g (from six months)," says Yap.

Lim adds: "That was one of the key indications that something was wrong; he was missing more milestones."

It was then that Yap started researching Branden's condition, and soon realised that something was not right with him.

With a few conditions in mind, she took Branden to his paediatrician, who agreed with her on the possibilities, and referred them to a paediatric geneticist. "He did multiple tests, then confirmed that the diagnosis was SMA."

Immediate reaction 

Initially, Yap had kept quiet about the tests to Lim, as he was working in London on an overseas assignment. But he arrived back in time for them to receive the results together.

"It was like the whole house had fallen down around us; we were totally shocked by the diagnosis," he recalls.

And if that weren't bad news enough, three days later, Jaden came down with chickenpox.

Yap had to move with Branden to her sister's house as a quarantine measure, while Lim took care of Jaden at home.

This meant that the shock and heavy weight of Branden's SMA diagnosis had to be borne separately for the mother and father, on top of caring for each son. "We went through the stages of grief separately," Lim shares.

Those 14 days of quarantine also gave them time to research the condition.

"We quickly signed up with Families of SMA, who reached out to us and sent us a care package on SMA immediately," says Lim.

Families of SMA is an American-based non-profit organisation formed by parents of children with SMA, which aims to support families affected by SMA, and to fund research, which could lead to a treatment, and eventual cure, for the condition.

They also decided to inform their family and friends via a Facebook note and email of Branden's diagnosis. "After all, we had nothing to be ashamed of," says Lim, who adds that sending out that message also helped them to move on from their initial shock and grief.

Emotional support 

While medical help and expertise were readily at hand, what Yap and Lim wanted was emotional and practical support from parents who are, or have been, in their position.

"We knew that time was not on our side; SMA is a genetic killer, so we had to be really quick in finding other people who also have it.

"We wanted to reach out to other parents to learn from them and also, for emotional support."

Their paediatrician had told them about a local 16-year-old SMA patient, whom they were eager to get in touch with.

Coincidentally, two days after they had posted their Facebook note, one of their friends realised that she knew this girl and her family, and was able to put the two families in touch.

"It gave us hope, to see someone with a fairly bad case of SMA, still able to live until her teens," says Yap.

Prioritising needs 

The scares were not over though, as Jaden contracted hand, foot and mouth (HFM) disease about a month after his chickenpox, which promptly got passed on to Branden.

Unfortunately, the disease hit the younger boy harder, and he had to be hospitalised for five days.

Following that, the Lims' Cambodian maid got a belated case of the chickenpox, and had to be sent off to Yap's mother's house.

"Our hearts never stopped beating really fast that whole time," Yap recalls, with a smile.

Their maid's chickenpox fortunately, turned out to be the last of the two months of bad news and domestic chaos, allowing them to finally settle down and prioritise what needed to be done for Branden's condition.

Yap, who had worked part-time in the fashion and beauty industry prior to Branden's birth, and had intended to go back to work after he turned one, now gave up that idea to remain a fulltime homemaker.

Lim, being of practical mind, immersed himself in research for solutions to Branden's multiple problems.

SMA can be divided into four categories based on age of onset of the disease, with Type I being the most severe form, and Type IV, the least severe.

Branden's symptoms and age of onset place him between Type I and Type II.

At his current two years of age, he is able to sit up with support, move his arms and legs, and eat solids. However, he gets physically tired easily, and does not have enough strength to press a piano key down.

Nutrition has been a major concern for Yap, as Branden is underweight for his age.

"That's my biggest headache - I don't know if it is because he is in his terrible twos, but because he can't talk properly, it's difficult to tell if he is full or doesn't like the food," says Yap.

Lim adds: "We have to figure out what are the most 'power-packed' foods to give him, for example, juice versus water.

"And now that he's getting fussy, we have to figure out what he likes, which is also nutritious enough for him."

Like Yap, most people are unlikely to realise the sheer number of muscles involved in the digestive process.

From chewing and swallowing, to the involuntary muscles that prevent food from coming back out the stomach, and those involved in passing motion, every muscle that participates in this process is affected by SMA.

Living in fear 

Thus, Branden frequently gets constipated because he doesn't have the strength to push out his stool.

He also vomits fairly often, as the involuntary muscles of his stomach are not strong enough to hold in too much food, which ends up being regurgitated.

Because of this, aspiration pneumonia is a major source of concern. In fact, pneumonia is one of the main causes of death for SMA patients.

In aspiration pneumonia, food that is regurgitated up the oesophagus gets diverted into the trachea and down the lungs. Once in the lungs, it results in pneumonia.

Branden has already been hospitalised for pneumonia once last August. That is where he obtained his nasogastric tube, which his parents are using to supplement his nutrition.

"We were so happy with the tube, but we didn't know the flow rates. We thought that we could give him as much milk as he needed through it, but then it all just came out again, like the Merlion in Singapore," says Lim with a laugh.

"That's where support is so important," says Yap. "We called a friend in Singapore who is an SMA mother, and she advised us on the best way to use the tube."

Lim adds: "Maintaining his calorie intake, and trying to track whether he has silent aspiration, are our current priorities."

Continuing challenges 

Breathing is another major concern for SMA patients.

While Branden can currently breathe on his own, he does need help clearing out the secretions from his lungs, and his parents are careful to monitor his oxygen levels both day and night.

However, Lim acknowledges that at some point in the future, Branden may be unable to breathe on his own, and will need some sort of mechanical assistance.

A further complication is likely to be the onset of scoliosis, which tends to develop in SMA patients at the age of seven or so.

Branden's range of movement will also becoming increasingly limited, as he grows older and his muscles, weaker.

In order to give him a shot at as regular a life as possible, he will need items like custom-made wheelchairs, bath equipment and special utensils; intensive and ongoing physiotherapy, occupational therapy, speech therapy and hydrotherapy; and home-schooling, among others.

Lim laments that while many of these things are provided for, and even taken for granted in the United States, Malaysia is lagging far behind in terms of appropriate and available home equipment, and educational opportunities.

No insurance company here covers SMA, and while medical treatment and adjunct therapies are available in public hospitals for a minimal fee, the Lims have to provide for the various equipment Branden needs at home.

And there is also his older brother, Jaden.

"The other challenge is having a sibling - teaching him to care for his sibling, and also, a lot of attention has to be given to Branden, so he is also being challenged emotionally," says Yap, adding that they try to allocate time for herself and Jaden, Lim and Jaden, as well as couple time for herself and Lim.

Lim adds: "We always try to think of activities we can do as a family, things that Branden and Jaden can do together."

Thankful 

They are also fortunate to have a good support system.

Lim says: "Family support is very important and so helpful. All we need to do is ask, and they will help us.

"Support from our friends has also been invaluable, although some have not known how to react to the news.

"My company and my boss have also been very understanding and supportive."

Even their neighbours are very helpful, being ever willing to help provide meals, or even lend their maid when needed, says Yap. (Their own maid has returned to her country, and they now cope alone with the help of Lim's mother, who stays with them.)

Because there are so many bodily functions affected by SMA, which develop at different times, Yap and Lim are focusing on one step at a time.

"We will follow Branden's development, and react accordingly," Yap says.

Although Branden may not live a normal lifespan, his parents are determined to enjoy him in the time that they have.

"We accept that it is not going to get any better, but we are going to make the best of it," she says.

"Branden is such a happy boy, he brings us a lot of joy, and there's really a lot to celebrate about him. We want to enjoy him in the present, as he is."

SMA Facts

• Some basic information on the genetic disorder spinal muscular atrophy (SMA):
• It is a rare autosomal recessive disease affecting one in 6,000 - 10,000 individuals.
• It is the leading genetic cause of death in children under two years of age.
• Around one in 40-50 people are carriers of the defective SMN1 gene.
• There is no cure.

Type I (Infantile; Werdnig-Hiffmann disease)

Age of onset: 0 - 6 months
Characteristics:

• Ususally exhibits floppy baby syndrome, a weak sucking reflex, difficulty breathing and sucking, and is unable to stand or sit without help.
• Has a poor prognosis, with most patients dying before two years of age from pneumonia-induced respiratory failure.

Type II (Intermediate Dubowitz disease)
Age of onset: 6 - 18 months
Characteristics:

• Has delayed motor development, usually unable to crawl or stand, but can sit unsupported.
• At higher risk of respiratory infections
• Often live into their teens, but with significant motor impairment

Type III (Juvenile; Wolhlfart-Kugelberg-Welander disease)
Age of onset:   After 18 months
Characteristics:

• Characteristics: Symptoms can appear any time from 18 months to adolescence.
• Can usually stand and walk independently, but may eventually lose these abilities as their condition progresses. Fingers and hands may tremble.
• Life expectancy is near normal

Type IV (Adult)
Age of onset:   Adulthood
Characteristics:

• Symptoms usually appear after the age of 35, although they can manifest as early as 18 years of age.
• The least common type of the disease.
• Shows progressive muscle weakness and tremours.
• Life expectancy is normal.

Navy regular critically injured after incident onboard ship

SINGAPORE - A Singapore Armed Forces (SAF) regular serviceman, Military Expert (ME) 2 Chee Weng Fai Jason, was critically injured onboard the Landing Ships Tank RSS Endeavour while it was berthed at Changi Naval Base.

He was caught between the motorised winch and the rope while checking on one of the berthing ropes that was being tightened.

Below is the full press statement from the SAF:

A Singapore Armed Forces (SAF) regular serviceman, Military Expert (ME) 2 Chee Weng Fai Jason, 29, a Weapon Systems Supervisor was critically injured onboard the Landing Ships Tank RSS Endeavour.

At 2.22pm, ME2 Chee was checking on one of the berthing ropes that was being tightened and in the process was caught between the motorised winch and the rope. At the time of the incident, RSS Endeavour was berthed at Changi Naval Base.

The medical centre was alerted to the incident at 2.25pm. From 2.30pm, ME2 Chee was attended to by a medical team led by four medical officers from the Changi Naval Medical Centre.

The medical team stabilised his condition before careful extrication was carried out to prevent further aggravation to his injuries.

Following extrication, ME2 Chee was sent via an SAF ambulance from RSS Endeavour to Changi General Hospital (CGH) at 3.26pm and was admitted to CGH at 3.52pm. The medical officers continued to stabilise him in the ambulance en route to the hospital.

ME2 Chee has undergone emergency surgery and remains in critical condition.

The SAF is conducting an investigation to determine the cause of the incident.

Fire at Hougang flat leaves one woman dead

SINGAPORE: A woman died in a fire that broke out at a 6th floor flat in Hougang Avenue 10.

Singapore Civil Defence Force (SCDF) said it was alerted to the incident at block 413 around 3.20pm.

Two fire engines, one red rhino, one supporting vehicle and one ambulance were sent to the location.

Officers found the victim on the ground floor, directly beneath the kitchen window.

SCDF said the fire was near the kitchen window and involved newspapers and kitchen products like liquid detergents.

They also found the kitchen gas stove left in an 'on' position but there were no cooking on the stove.

The case has been handed over to the police.

'Fire' in CTE tunnel on Sunday morning

SINGAPORE - A chain collision between three vehicles travelling in the Central Expressway (CTE) tunnel during the evening peak hours led to a spill of toxic chemicals, a car being engulfed in flames, as well as mass casualties arising from the chain collision.

This was the scenario of the joint emergency exercise conducted by the Land Transport Authority (LTA) and the Singapore Civil Defence Force (SCDF) in the CTE tunnel early on Sunday morning.

About 200 LTA and SCDF officers took part in the exercise which tested inter-agency readiness in managing a fire situation in the CTE tunnel.

LTA and SCDF carry out joint exercises in road tunnels at least once every year. The last CTE tunnel exercise was conducted in June 2009.

If a fire occurs within the road tunnels, emergency services such as the SCDF, Police, LTA Traffic Marshals and EMAS crew will be activated to manage the fire, assist motorists to evacuate, as well as to implement the tunnel closure and traffic diversion.

The operators at the LTA Operations Control Centre (OCC) will activate the ventilation system to push the smoke downstream out of the tunnel and raise the tunnel lighting level to maximum brightness.

They will also broadcast tunnel closure messages advising motorists to avoid the area through various channels such as radio break-in, LTA traffic news, Twitter and on EMAS signs.

Should motorists encounter a fire or other emergencies while travelling in the tunnel, they can dial 995 for SCDF’s assistance.

They can also tune in to the local radio channels to listen to the LTA emergency announcements and instructions.

 They should stop their vehicles if red crosses are lit on the overhead lane use signs, stay calm, turn off their vehicle engines and leave their vehicle for the nearest escape staircase or cross passage doors to evacuate the tunnel.

NSFs escape death by minutes

SINGAPORE - Just 15 minutes after the 19 full-time national servicemen (NSFs) got off the bus, it exploded.

But the driver of the CNG-fuelled bus died from complications arising from his burns four days later, a coroner's inquiry into his death in the August 2010 incident heard on Wednesday.

Mr Chan Beng San, then 56, had picked up the group of NSFs from Jurong Camp 1 at 6.45am on Aug 13, 2010.

He had ferried them to the Poyang Range at Old Lim ChuKang Road and the group alighted at 7.05am.

The group had smelled something similar to petrol or fuel when they boarded the bus earlier.

They alerted Mr Chan but he dismissed it and even suggested that some previous passengers could have brought durians onto the bus.

He then drove the bus away from the range. About 15 minutes later, the group, which had left some items behind in the bus, called Mr Chan's mobile phone for help.

It was answered by someone who told them that the bus had exploded.

Investigations also revealed that the explosion could have happened while Mr Chan was still in his driver's seat and the bus was on the move.

The explosion, which started at the front of the bus, was so great that all the seats in the bus were pushed backwards.

The windscreens were completely shattered and the roof above the door and the driver's seat were completely burned.

A witness who was driving along the same stretch of Old Lim Chu Kang Road spotted Mr Chan sitting on the road, a short distance away from the front of the burning bus.

The witness pulled him away from the bus to the side of the road and called the police.

When they arrived at the scene, officers found that Mr Chan could not speak and was disorientated.

He was rushed to the Singapore General Hospital by ambulance for treatment.

Complications

Mr Chan suffered burns on 39 per cent of his total body surface area. He underwent burns excision and skin grafting the next day.

But he faced complications such as acute renal failure and acute respiratory distress, in his recovery post-operation.

He died of broncho pneumonia on Aug 17.

Investigators later found a gas leak at a joint between the nut and the valve of some black tubing recovered from the rear left compartment of the bus.

There was also a part missing and this meant gas could have leaked out from the joint between the nut and the connector.

The gas had seeped into the passenger cabin of the bus and accumulated at the front of the bus, investigations showed.

An inspection of the bus also found a dashboard- mounted cigarette lighter near the driver's seat.

The court heard that the dashboard-mounted cigarette lighter wasn't part of the bus and that Mr Chan may have mounted it himself.

He was the only driver of the bus since its registration.

The eight CNG cylinders mounted on the roof of the bus were found intact.

The investigation report did not specify what sparked the ignition.

Design lapses

State Coroner Eddy Tham concluded that it was likely that CNG fuel had leaked at the joint of the tubing and had accumulated inside the bus.

An ignition of the leaked CNG fuel into the interior of the bus had resulted in the explosion at the front of the bus, followed by fire that went through the bus, he said.

He also said that the missing part on the tubing could have resulted in the gas leak.

The bus, owned by Sun-Gee Travel (SGT), was still under its one-year warranty.

Though its remaining 22 buses did not have missing parts, investigations by the Land Transport Authority (LTA) revealed that there were other several non-compliances to LTA's pre-registration approval standard in the design of the CNG buses.

The buses were impounded on Aug 24.

The bus manufacturer, Xiamen King Long, acknowledged that there were indeed lapses in their CNG bus design.

The 22 impounded buses were returned to SGT to be converted into diesel-powered ones in January last year. The licences for the buses were reinstated on July 25 last year.

Mr Chan's family members were not present in court during the inquiry.

They also declined to comment when The New Paper visited them at their home yesterday evening.

Poly student dies in accident that almost severes leg

SINGAPORE - He left the shop to deliver what would have been his last pizza order for the night. But Mr Muhammad Amirulhayat Mahadi never got to deliver it.

The 21-year-old student was killed after the Domino's Pizza motorcycle he was riding was hit by a white Mazda RX8 sports car at the intersection of Sembawang Road and Yishun Avenue 5 on Thursday night.

The red motorcycle was completely wrecked, lying crushed below the car, while Mr Amirulhayat's body lay about 10m away.

The storage compartment containing the pizzas was knocked loose and landed on a pedestrian walkway. Blood was splattered over the twisted front of the car and its front windscreen was cracked.
The police and the Singapore Civil Defence Force (SCDF) received calls about the accident at about 9.30pm.

Dead at the scene 

When paramedics arrived, they pronounced Mr Amirulhayat dead at the scene.

About an hour later, his family and friends arrived at the scene after being informed of the tragedy.

Overwhelmed with grief on seeing his younger brother's lifeless body, Mr Mahadir Mahadi, 24, kicked the debris from the accident and shouted: "Who is the driver?"

Two police officers and two passers-by rushed forward to restrain him while asking him to control himself.

He struggled in their grasp, demanding that he be allowed to see the Mazda driver, until his friend came forward to console him.

Mr Amirulhayat was a third-year student at Ngee Ann Polytechnic, taking a diploma course in multimedia and animation.

He had taken a part-time job as a delivery rider for Domino's Pizza to earn extra money.

His father, Mr Mahadi Timan, 52, who went to the scene that night, told The New Paper that his son was about to make a legal U-turn in the other direction of Sembawang Road to make his delivery.

It was then that the Mazda collided into the motorbike, causing Mr Amirulhayat to be flung about 10m, he said.

An uncle, Mr Khairudin Timan, told TNP that he was in disbelief when he got to the scene at almost midnight.

"His body was still lying on the road when I got there, and I could see his injuries even though it was quite dark. It was really sad for all of us who were there," he said.

Emotions ran high among his family and friends, with many crying when they saw his body.

Mr Mahadi said that his son's leg was almost severed. He said: "The impact had to be very strong because his leg was very badly injured and his body was flung quite a distance from the bike.

"Plus, the damage of the bike and car was terrible... The car's airbags had inflated as well."

Mr Mahadi said they had to be very careful and delicate in preparing his son's body for the funeral as they did not want to cause more damage to the leg.

The police arrested the Mazda driver for causing death by reckless or dangerous driving.

The driver, who is in his 30s, told Chinese newspaper Lianhe Wanbao that when the accident happened, the traffic light at the intersection was green in his favour.

"When I passed the traffic light, there was a sudden flash of light in front of me. I then heard a loud crash and immediately stopped the car," he said.

He said that it was only then that he realised that his windscreen had cracked and that his car's airbags had been activated.

When he got out of the car, he was shocked to see a body covered with blood lying nearby. If convicted of causing death by reckless or dangerous driving, he could face jail for up to five years.
Police investigations are ongoing.

Families of dead servicemen to receive compensation: Mindef

SINGAPORE - The Singapore Armed Forces (SAF) has said it will strengthen training safety in the light of lapses leading to the deaths of two full-time national servicemen this year.

Private Dominique Sarron Lee, 21, died on April 17 after he experienced breathing difficulties during a training exercise at the Murai Urban Training Facility in Lim Chu Kang. On May 11, Third Sergeant (3SG) Tan Mou Sheng, 20, died after the jeep he was in overturned in the Marsiling training area.

Compensation

According to a statement by the Ministry of Defence (Mindef), the family of the deceased serviceman will receive a lump sum death gratuity, equivalent to 12 months of the last drawn monthly gross salary of a regular of equivalent rank.

This sum is outside of the compensation framework.

Under the Mindef framework, a sum will be awarded to the family if the death was due to service.

The spokesperson said the amount is consistent with the principles adopted by the Work Injury Compensation Act (WICA) and the civil courts, declining to reveal the exact amount due to MINDEF policy.

In addition, if the death had occurred during military training, the family will also receive a Special Award that effectively doubles the total compensation award, compared to what is prescribed under WICA.

For the cases which have resulted in the two deaths, Defence Minister Ng Eng Hen said "due process" would be followed, whereby the chief military prosecutor would decide - based on military investigations - if the cases are to be put to a general court martial.

He said that the findings of police investigations would be submitted and a decision made later whether there will be any civil prosecution. A coroner may decide to hold an open inquiry as well, he added.

Energy drink may have killed 13 people

The US Food and Drug Administration is investigating 13 deaths that may be linked to consumption of an energy drink called 5-hour Energy, an FDA spokeswoman said Thursday.

"FDA is continuing to investigate reports of illness, injury or death of people who took products marketed under the label 5-Hour Energy," Shelly Burgess told AFP in an email.

There have been a total of 92 patient reports, including 33 hospitalizations and 13 deaths, she said.

She emphasised, however, that "the existence of an adverse event report does not necessarily mean that the product identified in the report actually caused the adverse event."

The FDA warns that energy drinks - rich in stimulants like caffeine - cannot substitute for rest or sleep and advises people to consult a doctor before consuming them, to ensure the product will not aggravate any undiagnosed medical problem.

This is the second investigation the FDA has launched in the last two months into potentially harmful effects from energy drinks.

In late October, the agency announced it was investigating five deaths and a non-fatal heart attack for possible links to consumption of Monster Energy drinks.

Monster Beverage is also being sued in California by the family of Anais Fournier, a teenager who died of an arrhythmia in December 2011, allegedly after drinking two cans of Monster Energy over a 24 hour period.

Her parents accused the company of not warning consumers of the potential dangers of its product.

Two Democratic senators, Dick Durbin from Illinois and Richard Blumenthal from Connecticut, have demanded a meeting with FDA director Margaret Hamburg.

The meeting is "to discuss the steps the agency is taking to ensure the safety of these products," according to a release.

Living Essentials, the maker of 5-hour Energy, said it was taking the reports of deaths very seriously, while insisting it has not yet been proven any deaths were actually caused by consuming 5-Hour Energy.

Monster Beverage released a similar statement in October.

Other deaths/hospitalisations due to energy drinks: 

December 2011: Monster Energy 

Anais Fournier, 14, drank two 24-ounce energy drinks on one December day while hanging out with her friends at the mall. The next day, she went into cardiac arrest and died just six days later.

Her parents are suing the California makers of Monster Energy, alleging that too much caffeine in the popular energy drink led to her death.

2007: Spike Shooter 

Doherty High School in Colorado Springs banned a drink called Spike Shooter after two students were taken to hospital complaining of nausea, vomiting, fatigue, and heart palpitations.

They had been drinking Spike, which holds the dubious honor of being the most highly caffeinated 8oz drink. It contains 300 mg of caffeine per eight-ounce can.

Safety breaches led to deaths of NSFs

SINGAPORE - Defence Minister Ng Eng Hen revealed in a ministerial statement to Parliament on Wednesday the details of the Commitees of Inquiry (COI) into the deaths of Private (Pte) Lee Rui Feng Dominique Sarron, 21, on April 17, and Third Sergeant (3SG) Tan Mou Sheng, 20, on May 11.

He revealed that Pte Lee died of an allergic reaction in a training exercise after a platoon commander threw six smoke grenades, even though regulations specified no more than two grenades were to have been used.

He revealed that the cause of death was certified by the forensic pathologist of the Health Sciences Authority (HSA) to be due to an "acute allergic reaction to zinc chloride due to inhalation of zinc chloride fumes".

The COI believed that "if the Training Safety Regulations had been complied with, PTE Lee and his platoon mates would not have been subjected to smoke that was as dense as that during the incident".

In the case of 3SG Tan who died after a jeep he was in overturned, it was found that individual negligence and breaches of safety had contributed to 3SG Tan's death.

Firstly, the master sergeant had assigned an unlicensed driver to the vehicle, and the rear passengers including 3SG Tan did not wear a helmet or put on their seat belts.

Other incidents of unlicensed driving were also found at the Combat Intelligence School, where the accident happened.
A Commanding Officer and six other commanders have been redeployed to other assignments which do not require them to supervise soldiers for training or operations.

The Chief Military Prosecutor will determine if these personnel should be subjected to a General Court Martial (GCM).

Police investigations are also ongoing to determine if the personnel involved, including the unlicensed driver of the jeep, should be prosecuted in a Civil Court.

Dr Ng said the SAF and Mindef were "deeply sorry for the untimely and tragic loss of Pte Lee and 3SG Tan and the anguish and distress it has brought to their families".

He concluded: "These two deaths could have been avoided if safety instructions had been followed."

"The SAF will learn from the incidents, correct any inadequacies and punish those who disregarded safety regulations," he also said.

The Singapore Armed Forces (SAF) will strengthen training safety in the light of lapses leading to the deaths of two full-time national servicemen this year.

In both cases, the respective Committees of Inquiry (COIs) uncovered breaches of training safety regulations in the events leading to their deaths, Defence Minister Ng Eng Hen said in Parliament yesterday.

Private Dominique Sarron Lee, 21, died on April 17 after he experienced breathing difficulties during a training exercise at the Murai Urban Training Facility in Lim Chu Kang. On May 11, Third Sergeant (3SG) Tan Mou Sheng, 20, died after the jeep he was in overturned in the Marsiling training area.

"These two deaths could have been avoided if safety instructions had been followed," Dr Ng said.

Seven servicemen - including a training school's commanding officer - have been relieved of their duties over their involvement in the incidents. They have been redeployed to assignments where they will not supervise soldiers in training or operations, and may face general courts martial as well as prosecution in the civil courts, Dr Ng added.

He announced that the SAF will make "three key systemic changes" across the whole organisation: First, more safety officers will be deployed on the ground. Their primary role will be to ensure that safety measures are followed.

Second, an Army Safety Review Board chaired by a senior civil servant has been set up outside of the Ministry of Defence. It will review the army's overall safety structure, processes and culture.

Third, an SAF Inspectorate will be set up to oversee the entire SAF. It will promulgate best practices and ensure that safety-related policies are sound and up to date. The Inspectorate will report directly to the Chief of Defence Force.

Citing inquiry findings, Dr Ng said Pte Lee had an "acute allergic reaction" after inhaling fumes from zinc chloride, a primary component used in smoke grenades.

He said the zinc-chloride smoke grenades have been used by the SAF since the 1970s, and Pte Lee's death - due directly to zinc-chloride inhalation - was the first in SAF's records.

Dr Ng said SAF has suspended the use of all smoke grenades with zinc chloride in training, and is looking for alternatives.

In 3SG Tan's case, the COI found that the jeep driver, 3SG Cavin Tan, was not licensed to drive the vehicle. The deceased, along with another rear passenger, were not wearing helmets or lap belts at the time of the accident. SAF has since made it mandatory for drivers to display their licences on the dashboards of vehicles.

The Combat Intelligence School, where the deceased was an instructor, was found to have a weak safety culture, with previous cases of unlicensed driving. The school's vehicular-management system has been tightened and SAF has checked other units as well, he said.

Struck with lymphoma cancer at 23

SINGAPORE - June 2009 started out like any other school holiday for Mr Raymond Tan.

Then 23 years old, he had just finished his third year in theatre studies at the National University of Singapore (NUS) and was lazing about at home and hanging out with friends.

He had one more year to go before graduating. He had no idea what he wanted to do after that but he was not overly worried. Life stretched out in front of him and things would just fall on his lap, he thought.

He was, however, feeling a little down because his 80-year-old grandmother, who had raised him, died at the end of May that year. She was diagnosed with stomach cancer about six months earlier. He comforted himself with the thought that she had led a long and relatively happy life.

But it turned out that his grandmother's death was not the only bad news to hit him that school holiday. Something else happened which changed his world forever.

On the third day of his grandmother's wake, he woke up with a throbbing pain in his chest.

When it would not go away after he took painkillers, he went to see the family doctor, who found nothing but advised him to go to the hospital's accident and emergency department.

He said: "I felt a bit worried. I thought I was on the verge of a heart attack. My father has a history of heart disease while my grandfather died many years ago from a heart attack."

But at the hospital, he was not prepared for what he saw on the X-ray of his chest. He said: "There was a black mass about the size of my fist near my heart."

The doctor told him it was likely to be cancer.

The next three days, as he waited for the result of the biopsy, were the closest he felt to death because he did not know how serious his condition was.

Depression 

When the results came back, he was somewhat relieved.

The doctor told him he had an aggressive form of lymphoma cancer called mediastinal large B-cell lymphoma, which was growing on the lymph nodes in his chest. The rare cancer tends to occur in the young.

It was at a relatively early stage as the cancer had not spread beyond the lymph nodes.

The good news was, mediastinal large B-cell lymphoma tends to respond well to treatment.

Over the next six months, he went through six cycles of aggressive chemotherapy, once every two weeks, followed by 20 rounds of daily radiotherapy.

When his hair came out in clumps after the first chemotherapy cycle, he shaved it off. His worst experience came after the third cycle.

Mr Tan, who describes himself as a fairly optimistic person, said the nausea and vomiting was so bad he sank into depression.

He said: "I was vomiting every few hours. I couldn't hold down any food except for a piece of bread or biscuit." Negative thoughts abounded.

He said: "I thought about my peers going on with school and wondered why this had to happen to me."

As his illness had occurred during an outbreak of influenza, his mother, a 62-year-old administrative clerk, forbade him from having visitors to prevent him from catching the flu from them.

Mr Tan resented the isolation and having to depend on everyone else. He had to be accompanied each time he went for a chemotherapy session. One of the chemotherapy drugs made his head feel prickly, almost as if he had eaten too much wasabi.

His mother took unpaid leave for his first two weeks of treatment and then for each of his chemotherapy sessions.

She lost almost as much weight as he did as a result of exhaustion and worry. After she went back to work, his aunt came by every day to cook lunch and dinner for him.

Touched by the concern of those around him, he slowly emerged from his depression.

His twin brother, who was then studying economics at NUS, would tell him jokes and show him funny videos to make him laugh. His father, a 69-year-old operations manager, and his sister, a 32-year-old senior executive, would often ask about his health.

Whenever possible, they also took turns to drive him to the hospital for his check-ups.

Slowly, he started to feel stronger and was able to go for radiotherapy on his own.

When it all ended, his doctor said he had responded well. Six months after his diagnosis, he was able to go back to school for his final year of studies and graduated in December 2010.

He now works as a relief teacher in a secondary school and writes movie reviews for magazines as a sideline.

But he wants to do more. He is now pursuing a master's degree in counselling, something which he had considered but did not pursue until now.

His goal is to be a counsellor who works with young people or other cancer survivors.

He said: "Having cancer makes you very focused on what you want in life. You realise that your time here is limited. There is a sense of urgency and you don't muck around anymore, waiting for things to fall on your lap."

His diet and lifestyle have also undergone a change. He pays attention to what he eats.

He said: "I eat more greens and I think twice about eating fast food, ice cream or fried hawker food such as char kway teow."

Regular exercise is now part of his life, when it did not use to be. He goes to the gym twice a week for about an hour each time during which he jogs on the treadmill and does weight-lifting.

He said: "To prevent a relapse, I have to live healthily and responsibly. I cannot afford to take chances."

Disease which mainly affects the young

Mediastinal large B-cell lymphoma is a rare form of lymphoma cancer, accounting for about 2 to 3 per cent of all lymphomas, according to the National Cancer Centre Singapore (NCCS).

For unknown reasons, it tends to occur in young people aged 25 to 40.

It leads to swelling of the thymus gland and lymph nodes in the mediastinum.

This is the part of the body inside the chest, between the lungs and behind the breast bone.

Symptoms are breathlessness and discomfort in the chest.

It is a high-grade lymphoma, which means it grows rapidly and needs to be treated immediately.

The good news is it responds well to treatment, which is usually a few chemotherapy drugs combined with a monoclonal antibody, a class of agents that target specific proteins on the surface of cancer cells and stimulates the body’s immune system to destroy these cells.

The NCCS found that after treatment, more than 80 per cent of its patients remained in remission after five years.

Mediastinal large B-cell lymphoma belongs to group of lymphoma called diffuse large B-cell lypmphoma, which is the most common type of lymphoma cancer in Asia.

Lymphoma cancer is a cancer of the lymphatic system, which is part of the body’s immune system that helps fight infection. The lyphmatic system includes the thymus gland and the lymph nodes.

Lymphoma cancer, of which non-Hodgkin’s lymphoma is the most common, happens when lymphocytes (a type of white blood cell found in the lymphatic system) grow in an uncontrolled way.
There are two main types of lymphocytes – B-cells and T-cells.

Cancer involving B-cell lymphocytes are more common.

Diffuse large B-cell lymphoma is the most common type of aggressive non-Hodgkin’s lymphoma.

Source: Associate Professor Lim Soon Thye, the deputy head and senior consultant at the department of medical oncology at the National Cancer Centre Singapore
 
On Nov 18, the 26-year-old will be taking part in Run For Hope, a fund-raising event for cancer patients.

While cancer is not a good thing in itself, he said it has taught him invaluable lessons. He said: "I appreciate my family more and I am more empathetic towards people in general."

RUN FOR HOPE 

Join a 3.5km or 10km run to raise funds for NCC Research Fund, which is managed by National Cancer Centre Singapore.

Details
Date: Sunday, Nov 18
Location: The Padang, 7am 
Price: $45 for an adult; $25 for a child/youth aged five to 18; Buddies special ($80 for two adults); Group special (20 adults or more - $35 each). 
Children below the age of four have free entry.

Sign up or donate on Runforhopesingapore.org 

Cancer drug helps multiple sclerosis patients, trials show

PARIS: A drug initially developed to treat some types of cancer now appears to help people suffering from multiple sclerosis (MS), a study said Thursday.

The drug, alemtuzumab, proved effective in patient trials at reducing relapses -- a key feature of MS which sees symptoms appear sporadically.

In one trial, patients who received the drug "were nearly half as likely to relapse within two years than those who received interferon", the most commonly-used MS drug, said a statement by The Lancet medical journal which published the research.

A second trial had similar results.

The outcome "offers the prospect of substantial improvement in quality of life and a better future for thousands of people with MS," said Alastair Compston from the University of Cambridge, principal investigator on both studies.

Many MS patients already use alemtuzumab, even though it has not been licenced for this purpose.

Both trials were Phase III, which is the final testing stage in a process to vet a new drug. Together, the two involved some 1,400 patients.

About 100,000 people in Britain and about 400,000 in the United States are believed to suffer from MS, which sees the immune system attacking the body's own nerve fibres.

This affects vision, movement, balance, sensation, bladder control and eventually also memory and thinking.

About 85 percent of patients start with a form of the disease known as "relapsing remitting" MS, with symptoms appearing sporadically (a relapse) before fading away again.

There is no cure, and existing drugs seek to reduce symptoms, said the statement. Success of a drug is measured by a reduction in the frequency of relapses.

The researchers found that alemtuzumab, licenced to treat leukaemia, appeared to increase the risk of certain auto-immune disorders, particularly those affecting the thyroid, but said these could be treated effectively.

The Lancet, in an editorial, said the results were encouraging but added that there were concerns that licencing the drug for MS may lead to a rise in cost.

"More effective, affordable, evidence-based treatments with long-term benefits are desperately needed," it said.

"Finding promising treatments such as alemtuzumab is important. But so is keeping alemtuzumab accessible and affordable if its early success in these trials proves to be of enduring value."

Regulatory authorities in the US and Europe are likely to approve the drug for MS use during the course of 2013, according to University of Cambridge spokeswoman Genevieve Maul.

Man found dead in MRT tunnel

SINGAPORE - The body of a Chinese Singaporean in his 20s was found in the tunnel between Redhill and Tiong Bahru MRT stations.

He was found lying motionless beside the train tracks, and was later pronounced dead at the scene.

Police say that it is unclear how he got there, and they had received a call for assistance at 7.45pm.

Netizens also observed police cars outside Redhill station, and a train that was stopped while entering a tunnel midway.

Redhill station is located above ground, while Tiong Bahru station is underground.

This incident caused train services on the East-West SMRT line to be disrupted for more than 2 hours on Sunday evening.

Train services between Queenstown and Outram MRT stations were temporarily stopped at 8.23pm for about 11 minutes.

This was to allow the police to investigate the incident.

However, east-bound trains had services fully restored at 10.30pm after several starts and stops.

SMRT has apologised for the inconvenience caused by the service disruption. Police investigations are ongoing.

Family who earned $16k a month complained the most: Chan Chun Sing

Providing help, building families 

Mr Chan Chun Sing will never forget the three families who turned up to ask for help at his Meet-the-People Sessions.

One of them earned just $2,000 a month, but managed to raise three children. Another had double that income, of $4,000 to $5,000, and had no children.

But it was the third, a family that earned $16,000 and had two children, who complained the most, saying the Government was not doing enough to help them.

The incident, says Mr Chan, illustrates the rising expectations that Singaporeans have and the challenge that policymakers face as they try to work out who should get more help.

"It's not an easy question to answer and we will have to find the answer as a society going forward," he says.

It is also a challenge Mr Chan's new ministry, the Ministry of Social and Family Development (MSF), will have to grapple with as it streamlines its responsibilities to focus more on policies affecting Singaporean families.

On Thursday, the Ministry of Community Development, Youth and Sports (MCYS) will be renamed the MSF and pass on its youth and sports portfolios to the newly created Ministry of Culture, Community and Youth.

That will give Mr Chan's ministry more time and space to look at longer-term challenges such as meeting the needs of singles when they age in 20 years' time and finding ways to tap the energies of healthy elderly people to serve other senior citizens.

At an hour-long interview at the MCYS headquarters in Toa Payoh this week, the Acting Minister laid out the priorities for his new ministry.

One of them will be to strengthen the social safety net - which will require the ministry to factor in Singaporeans' changing expectations. Another is to improve the delivery of social services, and a third is to strengthen families.

Mr Chan notes that it is no longer only those at the bottom of the ladder who need help. Those in the middle are starting to feel unsettled by the growing income gap too.

"They wonder whether they can meet their aspirations because of the people at the top end," he says.

"The question for us is, as a society, to what extent we can actually help this group of people beyond the people at the bottom of the socio-economic scale."

As economic cycles become shorter and more volatile, people are also more likely to be in and out of jobs, he observes. They will have to relearn their skills at a much faster rate as well.

"If I use my mother as an example, she was a machine operator, stamping metal plates. She did that for at least 30 years."

With just one set of skills, notes Mr Chan, his mother, a divorcee, was able to raise him and his sister single-handedly.

But no longer.

The churn in jobs and the instability of people's incomes today pose a serious challenge and could even disrupt the way children are brought up and their education.

Another concern for Mr Chan is Singapore's changing demographics: More people are staying single, marrying later, having fewer children and living longer.

As he looks into the next 10 to 15 years, he foresees a shrinking of the support that extended families can now give in raising children and caring for sick relatives.

"So that is where you see us... not just building the nursing homes, which are institutional care, but growing the community care sector and the home care services," he says.

Strengthening elderly care services in the community and at home will allow people to grow old in familiar settings, he explains.

Longevity will pose another challenge as people in their 80s and 90s will be increasingly cared for by those in their 50s and 60s.

But Mr Chan also sees these healthy retirees as a source of volunteers and helpers to beef up the delivery of social services at the local level, as is being done in Japan.

Singapore is now trying out this idea: Lions Befrienders, for instance, is getting the old to befriend the old, while a seniors' activity centre in Choa Chu Kang pays elderly folk a stipend to run activities.

As for the larger challenge of strengthening families, Mr Chan thinks measures should be targeted at people's four life stages: when they are young, when they marry, when they have children and when they are maintaining a family.

He believes that a central plank of the efforts - besides helping couples with housing, health care, childcare and education - should be to inculcate from young values for marriage, parenthood and family.

"If we bring up our children appreciating the joy of a family, then I think when they grow up, chances are that they will also aspire to have their own family," he says.

It means getting people not to see their career as an obstacle to starting a family, helping them to appreciate the joy of parenthood, and maintaining healthy relationships between parents and teenagers.

Such values can be transmitted through schools and the media, he says, especially as children may not live with their grandparents and parents may be working. Positive role models are also needed, he adds.

The 43-year-old says his own values were shaped by his family and the people he met. Watching Hong Kong sword-fighting drama serials and movies helped, he quips.

The former army chief married his colleague in Mindef in 1997 at the age of 28 - the median age then. They have three children, aged 11, three and one.

Recalling their decision to wed and have children, he cites a senior's advice: "He told me that there's never a perfect time to get married or to have a child... The perfect time is when you have the commitment to overcome life's challenges with your partner.

"But through the whole journey, you find a new sense of joy and purpose beyond just the pursuit of material well-being for yourself."

'Acid attack' baby an active boy now

When Samuel was just three months old, a maid poured acid down his throat. His injuries were so bad, nobody expected him to live. But today, the 13-year-old goes to school, swims and hangs out with his friends just like other kids. 

The only difference? Samuel has never tasted food - something his doctors hope he will be able to do someday. 

SINGAPORE - Like most boys his age, Samuel Lim Hong Xiang, 13, loves music, enjoys sports like badminton and spends hours on the computer, surfing the Internet and playing games.

But unlike other teenagers, Samuel has never tasted food. For almost his entire life, he has been breathing and feeding through tubes inserted into his body.

He was three months old when a maid poured sulphuric acid down his throat.

On June 29, 1999, the family had left baby Samuel at the flat of his grandmother before going to work. The grandmother had gone out, but the couple’s Indonesian maid Latifah was in the flat with him.

While she was in the kitchen and Samuel lay asleep in the living room, Sumiyem, 17, another Indonesian maid working with the family and jealous of Ms Latifah, poured sulphuric acid into Samuel's mouth. She wanted to get Ms Latifah, then 27, into trouble.

Sumiyem was jailed for eight years in 2000.

Tears well up in Ms Tan's eyes as she recalls that day 13 years ago, and what happened afterwards. Samuel was taken to the Paediatric Intensive Care Unit at the National University Hospital. He spent six months there.

The horrific attack left the infant with terrible scars, and also severely damaged his tongue, throat and vocal chords. His upper airway was completely blocked.

Associate Professor Daniel Goh, head of the paediatric department, saw Samuel right after the incident. He recalled: "Because the airway and the gut were badly burnt by the acid, his life was definitely in danger. His prognosis then was very poor."

'Nobody expected him to live' 

Samuel needed two major operations to enable him to breathe and be fed, his father said. Ms Tan learnt cardiopulmonary resuscitation (CPR) skills and kept vigil by her baby's side round the clock after he returned home.

She remembers waking up countless times during the night to feed and check on him.

"There were so many times when he choked on his phlegm or his airway got blocked, and we had to rush him to hospital in the middle of the night," she said.

"Once his whole face turned blue and I could not resuscitate him even after I performed CPR on him.

Somehow, out of instinct, I used a pair of scissors and snipped off his tracheostomy tube. Then I put in a new one for him before rushing him to hospital."

A doctor told her that Samuel probably could not breathe as his tracheostomy tube could have been blocked, and she had done the right thing by cutting the tube.

"Nobody expected him to live," recalled his father, Mr Lim Boon Keong, 41. "The surgeons said they would try their best. The rest would depend on him."

Amazingly, baby Samuel pulled through.

"It's a miracle that he survived. Doctors later told me that he is a very special child. The pain that my wife and I went through was indescribable," said Mr Lim.

But ask Samuel today and he describes his life as if everything is pretty normal.

What is different about him is that he depends on the tracheostomy tube to breathe. It is inserted in the front of his neck and into his windpipe.

He also relies on a gastrostomy tube inserted into his stomach for feeding.

Good listener 

He told The Sunday Times he got through the Primary School Leaving Examination last year with a score of 219 and is in Secondary 1 at Yuan Ching Secondary School, in Taman Jurong.

"When I am in school, I go to the pantry for my meals," said Samuel, covering the opening of his tracheostomy tube with his chin to make his speech clearer. "I am afraid people can't understand me.

So I don't like to speak."

His mother, Madam Tan Poh Ling, 41, piped in: "That makes him a good listener and earns him many friendships too."

When he was seven, Samuel started piano lessons. In Primary 4, he learned to play the guzheng, the Chinese zither.

Mr Lim said: "We wanted him to be able to use music to express his feelings when he got older."

Samuel's love for music grew and his talent has been recognised by Club Rainbow, which gave him a talent development fund grant for the fourth time this year.

"I have passed my Grade Three practical piano exams and Grade Five for theory," said Samuel softly.

"I don't like to speak, I like to play the piano. Now I play the piano daily and the guzheng twice a week."

His passion for music and opportunities to perform on stage helped to develop his self-esteem and he has grown to be a cheerful boy, said his parents.

The couple, former engineers, work in Mr Lim's family hardware business, which gives them the flexibility they need to care for Samuel and their younger children, son You Jun, 10, and daughter Yong Zhen, seven.

"Samuel is always surprising me with what he does," said Mr Lim. "Just the other day, he told me that he signed up for the hip hop dance class as part of his physical education programme. That's him, never afraid to try new things."

Samuel walks and runs like a typical teenager. On weekends, the family plays badminton together.

An attempt at a normal childhood
When Samuel was younger, he would go with the family on outings to McDonald's, even though he could not eat. He has never complained or asked to eat, said his mother.

Samuel said: "I just find food disgusting."

His birthdays used to be at a Swensen's restaurant, complete with an ice cream cake. But as he grew older, he told his parents he preferred not to have such celebrations.

Madam Tan recalled how Samuel would attract a lot of attention in public, and she would find herself fighting back tears when strangers asked about his condition.

But she and her husband wanted their special son to have as normal a childhood as possible and did not believe that he should be kept at home, away from stares.

"We wanted it to be easy for him to grow up, so we did not see the point in hiding him at home," she said.

"We took him to swim at public pools and we taught him to take care of himself and not let water get into his tracheostomy tube. We would find a quiet corner in public to feed him." Mr Lim said: "Now that he is older, he has no problems feeding himself in public when he goes out with his friends."

Samuel’s recovery, repeated hospital trips and his growing-up years have been a long journey for the couple.

And they are always prepared for the unexpected.

Last year, Samuel had to sit his Chinese and science papers for the Primary School Leaving Examination in hospital, as he was suffering from an intestinal obstruction as a result of his tube feeding.

Strong will to live 
 
Ms Tan said: “We rushed him to hospital on a Sunday night after he complained of a severe pain in his stomach.

“The next morning, I informed the Ministry of Education of his condition and the ministry managed to arrange for him to take his exams at the hospital.”

Mr Lim said: “After the accident, doctors told me that he is a very special boy. Every time I’ve needed to rush him to the hospital, I would be praying that he survives the ordeal and for his pain to be reduced. Samuel has shown that he has a very strong will to live.”

Samuel's school principal, Mrs Saraspathy Menon, told The Sunday Times that her staff help to make sure Samuel takes his meals punctually, at three-hour intervals, in the privacy of the staff pantry.

"In class, he is just like everyone else and he has been participating in most activities," she said.

"Samuel is a pleasant and friendly boy who interacts with classmates and teachers actively through non-verbal communication such as gesturing, writing and Facebook posts."

She added: "Samuel is a remarkable child. He has a smile for everyone and he has never complained about the challenges that he is grappling with.

"He exemplifies resilience and courage and all of us in Yuan Ching Secondary School have much to learn from him."

What lies ahead for Samuel? 

Associate Professor Daniel Goh, head of the paediatric department at the National University Hospital, has been seeing Samuel since the day of the acid attack and monitoring his progress.

He said that later this year a team of paediatric surgeons will attempt to reconstruct Samuel's gullet, and another team will re-evaluate his upper airway for possible reconstructive surgery later.

"It is hoped that he may ultimately be able to breathe and eat without the tubes. The reconstruction will likely be complicated and may require many staged operations," he said.

Describing Samuel's condition as unique, he said: "The circumstances under which the injury occurred as well as the extent and severity of the damage are certainly not something we have seen before.

"What's also special is Samuel himself, and his parents. Samuel has been a very brave young man who has overcome the odds and not only survived the initial ordeal but also lived to lead a good and fruitful life.

"His parents are also fantastic in supporting him through the years and have loved and cared for him very well. Despite his injuries, Samuel has grown up to be a well-adjusted, polite and delightful young man."

Samuel knows what happened to him when he was a baby. Asked what he feels about the maid who assaulted him, he said: “I don’t hate her.”

The rainbow connection 
 
Club Rainbow, a charity that helps children and young people with chronic illnesses, was one of the first to offer help to Samuel Lim and his parents after the acid attack. It has remained a source of support for them.

Its president, Mr Gregory Vijayendran, said: "One of the greatest joys I have experienced in service in Club Rainbow is watching Samuel grow up.

"At first, five to six years back, he was a shy, slightly withdrawn child with a budding musical talent and a quietly expressive demeanour and manner.

"He has blossomed and matured into a confident, socially engaged young man with wonderful piano playing skills that are a gateway to his soul filled with joy, hope and great sensitivity." Three months ago, Samuel played the piano for more than 300 guests at Club Rainbow's 20th anniversary celebration.

He was among 19 young people who received the charity's talent development fund grant, of between $400 and $800, that night.