PES FAQs

Obviously you have no complete idea of how the medical centre is running in a smooth operation inside out at the Formation / Division level where only each Formation's Medical Centre & MMI are having Medical Board Meets to discuss PES reviews.

Can you tell if his specialist memo he had gotten now in hand is before or after the surgery?

Since individuals experience some differences in post-surgery side effects, can you tell me how's the camp doctor is able to know if this particular medical case is different/ similar from another one after the post-op, without any post-op correspondences between the hospital specialist and camp doctor?

There is such a thing called the "DATE". And PACES II can now check the medical report from ALL government hospital (including MRI, X-ray, blood test ... diagnosis), directly without presenting the memo to the doctor. Whether the Camp MO knows how to use it, that is another question. 

It is important to update the SAF with specialist memo, there is no doubt about it. But SAF MO are not stupid. They get their MBBS by passing their NUS exam. It is not uncommon knowledge for people to know that  people with gall bladder removal have to eat special diet, that is low-fat diet and something else. That means that he cannot eat normal canteen food, cookhouse food, combat ration AT ALL, else he will have frequent diarrhea. 

hey dude relax man .. i was just posted as a combat medic when i went for the ops .. why are you getting so piss off for ... i haven't even been to medical center more than 4 -5 times as a full fledge medic .. i was posted to a service medic vocation after my operation and i was just asking for opinion if theres a chance to ask for a perm status .. and you are lecturing as if i didn't know what to do and a total idiot for asking ... hey thanks lokey again whats IBS btw .. i  feel weird after the surgery as if something is missing in my body  .. i 'm afraid of this .. i took this from the net ''

Choledochal cysts and malignancies

Malignancies in choledochal cyst can arise from the distal CBD, the wall of the cyst (even after successful drainage at cystoenterostomy), or the intrahepatic bile ducts. The risk of cancer appears to be related to the age of the patient; it is high (>20 times) compared with that of the healthy population.^{12,31,32,7,2,33,34,35} The risk of detecting a biliary tree malignancy in a resected cyst is 0.7% in patients who undergo surgery before age 10 years, 6.8% in patients who undergo surgery at age 11-20 years, and 14.3% in patients who undergo surgery after age 20 years.

More than half of the cancers arise from the cyst wall, even after successful internal drainage. Total cyst excision has not prevented the risk of malignancy in the remaining bile ducts. Malignancy can develop many years after excision of the cyst and can develop in areas of the biliary tree remote from the cyst such as the gallbladder and terminal common duct, which is left behind after excisional surgery.

Any type of cyst is susceptible to malignancy, but the greatest prevalence is observed with types I, IV, and V. Factors thought to contribute to the development of malignancy include prolonged bile stasis and chronic inflammation of the cyst wall. Inflammatory and metaplastic changes increase with patient age, and they are frequently observed in association with carcinoma of the bile duct. The increased risk of biliary tract malignancy, even after surgery, warrants close surveillance in any case of choledochal cyst. ''

do you think the mo will look at this ? or even my specialist ? i want to settle my army stuff as soon as possible cause i'm going to ord very soon ...

IBS stands for irritable bowel syndrome. It can be frequent diarrhea, constipation or  diarrhea and constipation (altered).  The gall bladder stores the bile salt for digesting fats and many other stuff. So without a gall bladder to regulate bile secretion, if you eat normal diet, you will have problem with fat digestion, which will causes you to have diarrhea. It means that your stomach gets upset easily, for thinly little things. Which you will learn to alter your diet to cope with your "new" digestive system.

Ya lor, no specialist memo no talk...Hahaha!

There is such a thing called the "DATE". And PACES II can now check the medical report from ALL government hospital (including MRI, X-ray, blood test ... diagnosis), directly without presenting the memo to the doctor. Whether the Camp MO knows how to use it, that is another question. 

It is important to update the SAF with specialist memo, there is no doubt about it. But SAF MO are not stupid. They get their MBBS by passing their NUS exam. It is not uncommon knowledge for people to know that  people with gall bladder removal have to eat special diet, that is low-fat diet and something else. That means that he cannot eat normal canteen food, cookhouse food, combat ration AT ALL, else he will have frequent diarrhea. 

Anyway, it's up to him and his willingness to put in his own efforts when he wants a permanent downgrade of PES.

It cannot all depend on the camp doctor and just the PACES2.

Anyway, it's up to him and his willingness to put in his own efforts when he wants a permanent downgrade of PES.

It cannot all depend on the camp doctor and just the PACES2.

Okay. I will see my specialist next year. And make effort to downgrade further, instead of bulldozing my way through. 

Hi there. 

I am graduating from poly next year, and will need to go for the army medical checkup.

I have Obsessive Compulsive Disorder, and on daily medication, clomipramine and fluoxetine. I have also been prescribed alprazolam before. All these are anti-depressants. I have regular sessions with both psychologist for therapy and psychiatrist for medicine prescription and review. Psychiatrist has said that I cannot have any stress, as it will be bad for my disorder. I having this for about 3 years plus already. I also have some anxiety issues my doctor didn't diagnose or specify.

Also, I have some conditions that have no doctor certification, like flat foot and lazy eye. For these conditions, how am I to get a specialist letter? Who sees a doctor for flat foot and lazy eye? Can I just declare on the army medical checkup or do I die die need to get a letter?

With regards to all my above conditions, what kind of PES status am I likely to be placed?

Hi there. 

I am graduating from poly next year, and will need to go for the army medical checkup.

I have Obsessive Compulsive Disorder, and on daily medication, clomipramine and fluoxetine. I have also been prescribed alprazolam before. All these are anti-depressants. I have regular sessions with both psychologist for therapy and psychiatrist for medicine prescription and review. Psychiatrist has said that I cannot have any stress, as it will be bad for my disorder. I having this for about 3 years plus already. I also have some anxiety issues my doctor didn't diagnose or specify.

Also, I have some conditions that have no doctor certification, like flat foot and lazy eye. For these conditions, how am I to get a specialist letter? Who sees a doctor for flat foot and lazy eye? Can I just declare on the army medical checkup or do I die die need to get a letter?

With regards to all my above conditions, what kind of PES status am I likely to be placed?

You just need to get a specialist to write in for your mental illnesses (albeit in a severe manner). You are guaranteed to be Pes E and below. 

Hi there. 

I am graduating from poly next year, and will need to go for the army medical checkup.

I have Obsessive Compulsive Disorder, and on daily medication, clomipramine and fluoxetine. I have also been prescribed alprazolam before. All these are anti-depressants. I have regular sessions with both psychologist for therapy and psychiatrist for medicine prescription and review. Psychiatrist has said that I cannot have any stress, as it will be bad for my disorder. I having this for about 3 years plus already. I also have some anxiety issues my doctor didn't diagnose or specify.

Also, I have some conditions that have no doctor certification, like flat foot and lazy eye. For these conditions, how am I to get a specialist letter? Who sees a doctor for flat foot and lazy eye? Can I just declare on the army medical checkup or do I die die need to get a letter?

With regards to all my above conditions, what kind of PES status am I likely to be placed?

Please read this: www.sgforums.com/forums/1390/topics/392446

When strongly supported by written medical evidence in black and white (memos from hospital specialist/ psychologist/ psychiatrist), you can safely say that you are guaranteed to be within PES C to E range.

Otherwise, if you just declare by mouth that you have this or that, the CMPB doctor will still simply ask you to please go get hospital specialist certifying memos to proof and then come back another day for further review together with the memos.

So in the end, as always advised, "No specialist memo, no talk" applies.

Ok, so for the psychiatric issue, I do have a specialist agreeing to write a memo for me. What kind of language he will use (convincing or severe) I do not know, but definitely I can get. My doctor may just write a neutral letter saying that I have this disorder, and I don't think he will write anything more? By the way, I happen to saw my medical record in the system when the doctor was viewing it on his computer, I'm stated as "active" being diagnosed with "neurotic disorder". Will MINDEF look at our health records in the system? The system is accessible by all doctors from the govt polyclinics and hospitals.

Regarding my lazy eye and flat foot, do I really have to see a specialist? These are very minor issues to be seeing a specialist. Lazy eye I have been to TTSH 10+ years ago for check but didn't follow up. Will it still be in the system, and will MINDEF go look at it? Cos I still have lazy eye now and its quite significant. For flat foot, can just declare without memo rite? Cos it dosen't warrant any specialist attention.

Many thanks in advance and for the above replies. They have been helpful.

Okay, an update from my previous case which I posted here a while ago.

I have a tear in my abbrum smthsmth in my left shoulder, which basically means there's a tear in my left shoulder joint, which if not properly cared after can completely rupture which means going for surgery. At this point the swelling has not decreased and I'll be recommended to undergo injections to help relieve the pain and swelling if it doesn't improve over the next two weeks.

I'm currently OOT from BMT and I'm awaiting my new posting. My BMT batch will be POPing in coming week, but I'm not entitled to my 10 day leave since I'm OOT. Instead, based on protocol I can only recieve 3 days of leave and I can choose whether or not to use it. In my case, it makes no sense to go back home overseas just for 3 days since tickets are fairly expensive.

So in my case, I'm not going to use the 3 day leave, instead I've been advised to wait till my next posting and apply for overseas leave then. This brings up my question:

My specialist review from CMPB is in mid jan, which means that they can only post me permanently to a unit after my medical review. So during my temp vocation, is it possible to apply for overseas leave from them? And what are the chances of them granting my leave so soon after joining the unit? Most likely I'll still be under my company until I get my permamnent posting, so can they grant me the leave? Or will I have to wait for my permanent posting to apply for overseas leave?

 Also I'm wondering what PES and Vocation will I most likely be posted to? I have three physio sessions a week with a bi-weekly specialist check up.

Okay, an update from my previous case which I posted here a while ago.

I have a tear in my abbrum smthsmth in my left shoulder, which basically means there's a tear in my left shoulder joint, which if not properly cared after can completely rupture which means going for surgery. At this point the swelling has not decreased and I'll be recommended to undergo injections to help relieve the pain and swelling if it doesn't improve over the next two weeks.

I'm currently OOT from BMT and I'm awaiting my new posting. My BMT batch will be POPing in coming week, but I'm not entitled to my 10 day leave since I'm OOT. Instead, based on protocol I can only recieve 3 days of leave and I can choose whether or not to use it. In my case, it makes no sense to go back home overseas just for 3 days since tickets are fairly expensive.

So in my case, I'm not going to use the 3 day leave, instead I've been advised to wait till my next posting and apply for overseas leave then. This brings up my question:

My specialist review from CMPB is in mid jan, which means that they can only post me permanently to a unit after my medical review. So during my temp vocation, is it possible to apply for overseas leave from them? And what are the chances of them granting my leave so soon after joining the unit? Most likely I'll still be under my company until I get my permamnent posting, so can they grant me the leave? Or will I have to wait for my permanent posting to apply for overseas leave?

 Also I'm wondering what PES and Vocation will I most likely be posted to? I have three physio sessions a week with a bi-weekly specialist check up.

Pes "B2"(last time C1) L2. IPPT excuse chin up only (may be shuttle run). Vocation: medic, clerk, storemen, mechanics, driver... 

I suggest you just do an MRI and sew back the torn tendon through surgery. This is because right now you are young so you may not find the impact yet. But this tear will get bigger. Eventually you may need to fix in using your own money, due to SAF's fault. So fix it now, even if it is one stretch. 

 Overseas leave ... forget it, save you the trouble from the procedure and being in the spotlight. 

Pes "B2"(last time C1) L2. IPPT excuse chin up only (may be shuttle run). Vocation: medic, clerk, storemen, mechanics, driver... 

I suggest you just do an MRI and sew back the torn tendon through surgery. This is because right now you are young so you may not find the impact yet. But this tear will get bigger. Eventually you may need to fix in using your own money, due to SAF's fault. So fix it now, even if it is one stretch. 

 Overseas leave ... forget it, save you the trouble from the procedure and being in the spotlight. 

I can get pes B2 even if I can't do any physical activity? My specialist said that I can't do the following: Push up, pull up, situps (arms behind my head), running, carrying heavy load, handling rifle (puts strain on my shoulder). The tear is caused by my shoulder blade being 2 cm higher than normal, which im doing physio to correct.

The MRI showed swelling of the joint coupled with the tear. My specialist said that as of right now there is no reason for surgery if it can recoup by itself, if not then it may be a possibility later.

And the overseas leave is not to go to bahamas or whatever, it's to go see my family. I came from overseas to do NS, so wanted to see my family =(

Ok, so for the psychiatric issue, I do have a specialist agreeing to write a memo for me. What kind of language he will use (convincing or severe) I do not know, but definitely I can get. My doctor may just write a neutral letter saying that I have this disorder, and I don't think he will write anything more? By the way, I happen to saw my medical record in the system when the doctor was viewing it on his computer, I'm stated as "active" being diagnosed with "neurotic disorder". Will MINDEF look at our health records in the system? The system is accessible by all doctors from the govt polyclinics and hospitals.

Regarding my lazy eye and flat foot, do I really have to see a specialist? These are very minor issues to be seeing a specialist. Lazy eye I have been to TTSH 10+ years ago for check but didn't follow up. Will it still be in the system, and will MINDEF go look at it? Cos I still have lazy eye now and its quite significant. For flat foot, can just declare without memo rite? Cos it dosen't warrant any specialist attention.

Many thanks in advance and for the above replies. They have been helpful.

Bring along any medical documents to support your existing medical conditions.

If you think that the psychiatrist memo is good enough, then just bring that and declare those minor ones by saying.

But if you think the doctor will patiently and slowly take his own sweet time to view your online record when there are hundreds of boys waiting in line to have their checkup, then you are just trying to play with your luck.

I can get pes B2 even if I can't do any physical activity? My specialist said that I can't do the following: Push up, pull up, situps (arms behind my head), running, carrying heavy load, handling rifle (puts strain on my shoulder). The tear is caused by my shoulder blade being 2 cm higher than normal, which im doing physio to correct.

The MRI showed swelling of the joint coupled with the tear. My specialist said that as of right now there is no reason for surgery if it can recoup by itself, if not then it may be a possibility later.

And the overseas leave is not to go to bahamas or whatever, it's to go see my family. I came from overseas to do NS, so wanted to see my family =(

You see. B2 is only talking about IPPT. That is excuse chip up and perhaps shuttle run (cose u need to pick up the stuff). You can still run 2.4 km, do sit up and standing broad jump (These are lower limb activities). The other part is the land deployment code, which determined your vocation. 

SAF expect you to do physio and fix the upper limbs. And not leave it unfixed. Anyway, fixing the limbs through surgery is the best and fastest option. NS is only 2 years, nothing compared to a unusable arm for 80 years? Believe me, unfixed shoulder join can lead to shoulder impingement syndrome -> nerve impingement syndrome -> finally lost of limb function at 30s to 40s. (if you dont fix it now)  

" if it can recoup by itself" -  personally, I prefer to do surgery and walk around in camp with arm support for half to a year. Nobody will bother you then.  

You see. B2 is only talking about IPPT. That is excuse chip up and perhaps shuttle run (cose u need to pick up the stuff). You can still run 2.4 km, do sit up and standing broad jump (These are lower limb activities). The other part is the land deployment code, which determined your vocation. 

SAF expect you to do physio and fix the upper limbs. And not leave it unfixed. Anyway, fixing the limbs through surgery is the best and fastest option. NS is only 2 years, nothing compared to a unusable arm for 80 years? Believe me, unfixed shoulder join can lead to shoulder impingement syndrome -> nerve impingement syndrome -> finally lost of limb function at 30s to 40s. (if you dont fix it now)  

" if it can recoup by itself" -  personally, I prefer to do surgery and walk around in camp with arm support for half to a year. Nobody will bother you then.  

I understand that an upperlimp injury may seem to only effect upper limb, but please try to imagine how you would run if you weren't allowed to swing your arm. Again, with SBJ, how would you do it if your arms were tied to your body. The pain that spreads from swinging my arm, moving it constantly is actually quite painful, too the point where it's almost unbearable.

Surgery right now would be pointless since the main reason why my shoulder joint is in this position is because having a higher than normal shoulderblade exposes more of my shoulder joint to friction from my bones. So if I were to get surgery now, it'd be pointless since the main cause, my shoulderblade, is still prevelant. So it'd be better to correct the solution in the correct order, rather than doing surgery and still have it get worse.

I'm not trying to sound mean, but this is what my specialist has told me, hence why I'm asking for some experience people to tell me what I'm going to be looking forward too in my case, sorry if I wasn't clear before about my situation.

I understand that an upperlimp injury may seem to only effect upper limb, but please try to imagine how you would run if you weren't allowed to swing your arm. Again, with SBJ, how would you do it if your arms were tied to your body. The pain that spreads from swinging my arm, moving it constantly is actually quite painful, too the point where it's almost unbearable.

Surgery right now would be pointless since the main reason why my shoulder joint is in this position is because having a higher than normal shoulderblade exposes more of my shoulder joint to friction from my bones. So if I were to get surgery now, it'd be pointless since the main cause, my shoulderblade, is still prevelant. So it'd be better to correct the solution in the correct order, rather than doing surgery and still have it get worse.

I'm not trying to sound mean, but this is what my specialist has told me, hence why I'm asking for some experience people to tell me what I'm going to be looking forward too in my case, sorry if I wasn't clear before about my situation.

I think you misunderstood.  What you are having is a temporary problem. For example, the person have leg fracture, broken completely. He surely cannot walk at all. So he is temp downgrade to E9L9 or excuse lower limb for half a year to 1 year. After a year, he heal back but cannot run. So he is still Pes B2 L 2 excuse lower limb activities.

Your shoulder problem is a temp problem. I think you better get another specialist at SGH. From my understanding, there is a tear with your tendon in your shoulder. So this result inflammation and swelling which should subside with NSAIDS drugs. Then shoulder blade is actually tightening to pull to make room for the acromion region. So as long as the tear is present, shoulder will protect itself by pulling up itself.

Anyway, u may get lower like C9L9, depends on how bad it is. 

I think you misunderstood.  What you are having is a temporary problem. For example, the person have leg fracture, broken completely. He surely cannot walk at all. So he is temp downgrade to E9L9 or excuse lower limb for half a year to 1 year. After a year, he heal back but cannot run. So he is still Pes B2 L 2 excuse lower limb activities.

Your shoulder problem is a temp problem. I think you better get another specialist at SGH. From my understanding, there is a tear with your tendon in your shoulder. So this result inflammation and swelling which should subside with NSAIDS drugs. Then shoulder blade is actually tightening to pull to make room for the acromion region. So as long as the tear is present, shoulder will protect itself by pulling up itself.

Anyway, u may get lower like C9L9, depends on how bad it is. 

Yea, so I need to bring my shoulderblade down to the normal position, which will alliveate the pressure it's placing on my joint. So that's why I said surgery as of now wouldn't help in the long run, only after I get my shoulderblade down will it make sense. And to do that I was told can take 6months to a year.

But put aside the if's and buts, my pes will be temporary right? After how long will they decide to review my again? 3,6 months? a year?

The swelling is caused by the irritation from moving my arm, since my shoulderblade is higher than normal, my shoulder joint doesn't have enough space, so it's constantly getting rubbed by my shoulder bones. Just wanted to clear that up. I'm on anti-imflammatory drugs, but it can only help so much. Need to get my shoulder blade back to normal before the swelling can completely stop.

Yea, so I need to bring my shoulderblade down to the normal position, which will alliveate the pressure it's placing on my joint. So that's why I said surgery as of now wouldn't help in the long run, only after I get my shoulderblade down will it make sense. And to do that I was told can take 6months to a year.

But put aside the if's and buts, my pes will be temporary right? After how long will they decide to review my again? 3,6 months? a year?

The swelling is caused by the irritation from moving my arm, since my shoulderblade is higher than normal, my shoulder joint doesn't have enough space, so it's constantly getting rubbed by my shoulder bones. Just wanted to clear that up. I'm on anti-imflammatory drugs, but it can only help so much. Need to get my shoulder blade back to normal before the swelling can completely stop.

Shoulder problem will one roll to the another . Hard to get rid of. Probably u might need to downgrade several times over the yearsss.

My friend has frequent dislocation. Squeeze also can dislocate shoulder. Pes B2 L2?    

Hi all,

So do I still need specialist letter for lazy eye and flat foot?

And for my OCD, I have been instructed by doctor to not put stress in my life, because stress can magnify my symptoms. Also, I have many different obsessions, including cleaning, counting, superstition and aggressiveness. I think I may have some anxiety issues, which I will bring up again in greater detail on my next appt with my psychiatrist. I have actually mentioned my anxiety issues with my psychologist before, but only just talked abit about it. I tend to get anxious easily and this makes me less capable than normal, and my hands tremble frequently. I have done thyroid test and other test for trembling hands and body but show nothing. I think it is because of my anxiety/anxiousness? When I get anxiety attacks, I get paralyzed with fear, as in I just freeze and not do anything with a blank mind. 

I think at most my specialist might just write something like just declaring I have and been diagnosed with OCD, and on regular medication. I don't think he will write any special "strong worded" letter?