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Plumber Of The Heart
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Plumber Of The Heart

For someone with three kids aged 15, 13 and eight respectively, Dr Julian Tan certainly looks youthful. When THIS Quarterly met him last December at the Julian Tan Heart Specialist Clinic, located at Mount Elizabeth Medical Centre, his head of thick hair was rakishly combed into a slight bouffant, while his scrubs were hidden under a dressy blazer. Adding the final touch of style was a leather bracelet adorning one wrist.

Although he may appear to be too young to be an experienced physician, Dr Tan surely is. He has been a practising cardiologist for close to 16 years. Prior to establishing his own practice in 2015, he had worked in health institutions such as Tan Tock Seng Hospital, National Heart Centre Singapore and National University Heart Centre, Singapore.

To be more precise, Dr Tan is an interventional cardiologist. What does an interventional cardiologist do? “To the general public, I am essentially a plumber,” he says with a smile. “I basically unclog water pipes, which are the arteries of the heart. When the arteries get choked they’ll call me and I will go and unchoke the arteries in a minimally invasive way.”

More often than not, minimally invasive refers to the application of a balloon angioplasty. Dr Tan calls it his bread-and-butter procedure because of the prevalence of heart blockages. “Coronary artery disease is very common and getting more so as sedentary lifestyles and fatty diets become more widespread in our society,” he warns.

When plumbing won’t do

Does this mean that openheart surgery is going out of business? Definitely not, insists Dr Tan. “There are situations when plumbing can’t solve the problem.”

For instance, when there are numerous blockages, the cost of putting in five or six stents can be prohibitive. “If you just go for one open-heart bypass surgery to treat all the blockages at the same time, the cost may be considerably lower,” Dr Tan estimates.

Another situation when plumbing can’t resolve the issue is when even such a minimally invasive approach is deemed too dangerous. “The plaque could be building up in a precarious position, such that placing a stent there could potentially damage other arteries,” he explains.

In these situations, the cardiologist will have a discussion with the patient and the surgeon. “We call this the heart team collaboration, where we discuss and weigh the pros and cons of surgery versus stenting, and we come to a collective decision.”

"I am essentially a plumber. I basically unclog water pipes, which are the arteries of the heart."

New developments

Dr Tan reveals that he was involved in studies of absorbable stents when they first arrived in Singapore about seven years ago. “We were the first few to try it, put it through trials, and shared the results with the international community,” he enthuses.

HOW A BALLOON ANGIOPLASTY WORKS

When an artery is discovered to have plaque build-up, a long, thin tube called a catheter is inserted and moved through the artery until it reaches the point of blockage. A small balloon connected to the end of the catheter is then inflated. This flattens the plaque against the artery wall, thus creating more space for better blood flow.

In about 80% of the time, a stent is used in the procedure. A stent acts like a scaffold that keeps the artery open. It inflates with the balloon, and stays expanded even after the balloon is removed.

"Without the heart, everything else will fail, because it provides nutrients to the other organs. The heart is thus very important.."

Since then, new generations of stents have been developed, created from collaborations between doctors and engineers. “While we’re always trying to come up with something better, I am actually quite contented with the state of stent technology,” he shares. “In my opinion, it is way ahead of its time. The newer generation of stents, I feel, offer very good results: they last longer, are easy to deliver down to the artery, and so on.”

Besides the stents themselves, the point of entry of the stents has also seen some development. “When plumbing work started in the 1970s, access to the heart started from the groin, in what is called transfemoral catheterisation, across the femur,” explains Dr Tan. These days, access to the heart can be done transradial, through the wrist. However, he always advises younger doctors to be proficient in both methods, “in case the need arises and they have to adapt”.

Dr Tan also points out that, sometimes, neither points of entry are workable. The patient could have severe peripheral vascular disease, leaving him with too-narrow vessels in the legs, while the vessels from the arm to the heart could be rather tortuous. “So we have to treat them with medicine.”

Risk factors and trends

If you wish to keep heart problems at bay, Dr Tan advises you to be aware of and work towards reducing risk factors for coronary artery disease. “Smoking, high blood pressure, high cholesterol, diabetes and, of course, family history, which you can’t do anything about,” he lists.

He opines that hypertension, high cholesterol and diabetes are on the rise because “we eat too much salty, fried and oily stuff”. Focusing on diabetes, he adds, “The prevalence of diabetes is highest in Singapore compared to other countries in the world. Between 30 and 40% of our population have it, and that is a lot!”

"One facial expression can convey a specific theme about God. I think that it speaks volume, and it is a privilege."

He warns that when someone presents a combination of these risk factors, compounded by a family history of heart problems, the chances of this person developing coronary artery disease is very high, “and he’ll need to see me”.

Dr Tan has also observed certain trends in the risk factor of smoking. “I would say it is more prevalent in the lower social economic class,” he observes. This demographic also appears to take less ownership of their health, he adds.

As for diabetes, he has noticed that people of Malay heritage seem to be more prone to the disease. “It may not necessarily be that the disease is more prevalent among them, but the severity is higher and the level of control is poorer in this particular racial group,” he states.

Medicine runs in the family

Dr Tan was inspired to become a doctor by his father, who is a paediatrician.

“I remember, as a child, seeing my dad get called up in the middle of the night and rushing to the hospital to save a young child,” he shares.

“I think this altruistic side spoke to me. Since time immemorial, a doctor is the noblest of professions, so no regrets!”

So why did he not take up his father’s speciality? “If your kidneys fail, you can go for dialysis; if your leg rots, you can amputate them,” assesses Dr Tan. “But without the heart, everything else will fail, because it provides nutrients to the other organs. The heart is thus very important; understanding the intricacies of this complex organ is something that appeals to me.”

Does Dr Tan hope that his children would take up medicine one day? “I don’t put any pressure on them because, frankly speaking, being a doctor is not like Grey’s Anatomy on TV; it’s a lot of hard work,” he quips, adding that medicine is not for people who don’t like interacting with people or who can’t take the long hours.

Fast cars and silent theatre

Apart from his clinics (his second one, The Cardiology Practice, located in Connexion on Farrer Park Station Road, opened in April 2018) and family, Dr Tan’s other passions include his Porsche 911 Carrera 4S and — more surprisingly - mime.

“People think that it’s an expensive hobby,” he says, referring to his sporty vehicle. However, he justifies it by pointing out that Porsche cars are “solid” and “last long”; maintaining the engine is also “not that expensive”. It also helps that he got it second-hand.

Dr Tan is a member of the Porsche Club Singapore, which organises road trips and race track sessions. “I have been on tracks in Sepang and Australia,” he says. “There are also breakfast drives to Johor; not just on highways, but also on back roads, which are windy and fun to drive.” He is clearly excited to be heading to Munich later this year at the invitation of the club.

While doctors and fast cars have a somewhat logical association, Dr Tan’s deep involvement in the art of mime is arguably less anticipated. In fact, he has been involved in acting for the past 30 years. His mum discouraged him from making it his profession, though. “Unless you are born rich, it is difficult to feed the family just by acting alone,” he surmises.

Dr Tan confesses that mime appeals to him because he doesn’t have to memorise scripts. “You convey emotions and themes just by your actions and facial expressions,” he reveals, explaining the rules of this art form. “The audience captures that idea and I receive appreciation.”

As a founding director of the Wesley Players, an acting troupe from the Wesley Methodist Church, he enjoys using mime to enrich the worship experience. “One facial expression can convey a specific theme about God,” he describes. “I think that it speaks volume, and it is a privilege.”

Dr Tan used to be active in church productions at Easter and Christmas, but cut back on his commitment when his children arrived. “Now that my kids are a little older, I foresee myself getting more involved again!”

BIGGEST MISCONCEPTION

Of the numerous misconceptions among his patients, Dr Tan says the biggest is the idea that getting a stent gives them licence to resume their unhealthy lifestyles.

“A stent is only a stopgap measure,” he advises. “If you continue to be naughty, not take your medicine and not watch your risk factors, you can develop new plaque within the old stent. Then you will be back to square one!”

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