Sunday, December 16, 2007

Clinic Hours during the Holidays

Our clinic will be closed from Hari Raya Haji, 20th Dec till Christmas Day, 25th Dec 2007. We will resume operations on 26th December as usual.

Happy Holidays!

Thursday, December 13, 2007

Welcome MiB/MHC members!



A very warm welcome to holders of MHC-MiB cards!

We look forward to providing for the healthcare needs for your whole family! You can learn more about our clinic by clicking here

Other Health Benefits cards that we accept:
  • Advantage Health Benefits
    • CHS
    • AIA
    • GE Primecare
    • Staffcare
  • IHP
  • AVIVA

Monday, December 10, 2007

Gout: Please be careful during the Festive Period!

It's the end of the year and the time for parties and feasting! I don't think I would be doing my duty as your Family Doctor if I d0 not gently remind our patients who may be suffering from gout to remember to eat in moderation as all that rich food and alcohol may just trigger another gout attack!

What is gout?

Gout is one of the oldest disorders known to humans. Those suffering from gout may console themselves that they are in the same company as some of the greatest men in history, namely Alexander the Great, Kublai Khan, Michelangelo, Martin Luther, Isaac Newton and Henry VIII.

Gout occurs because of the build up of uric acid crystals accumulating in the joints, usually of the big toe, the hands and some other large joints. Uric acid is a by-product of purines (a protein) and it is the kidney's job to get rid of excess uric acid by passing it out through the urine. If you suffer from gout and there is an excessive overload of uric acid in the blood which the kidneys cannot get rid of fast enough, uric acid crystals will start to form which are then deposited in the joints. And that is when you limp into the clinic with excruciating pain.

Who gets gout?

Like many diseases, it is hard to say who will or will not get gout. But there are a few factors which puts you on a higher risk of developing the disease. It seems to run in families and occurs more often in men then women. It is also associated with obesity and high blood pressure. Just because you indulge in rich food and alcohol does NOT necessarily mean that you are going to develop gout. However, if you do suffer from gout, then the rich food and alcohol may trigger another attack.

What are the triggers?

1. Purine rich foods:
  • Red meat and organ meats like liver, kidneys (ie Kway Chap, Pate, Foie Gras)
  • Shellfish eg scallops, cockles, prawns, crabs
  • Tinned Fish eg sardines, ikan bilis, herrings
  • Legumes eg dried beans, peas
  • Meat extracts and gravies eg Bovril
2. Alcohol

3. Medications eg Diuretics

4. Trauma: Injuries, surgery or starvation

What should I do?

During an acute attack, you should rest in bed with a cold compress. Your GP can also prescribe some painkillers or even give you an injection if the pain is severe.

For most people gout occurs occasionally. So aside from eating purine rich food in moderation, there is no need for regular medications. Weight loss and drinking lots of water do help to prevent attacks. However, if you suffer from several attacks every year, you should ask your doctor about preventive medications. Repeated gout attacks can affect the joints in the long term.

A word on Tofu

There is a little bit of confusion over whether people who suffer from gout should take tofu or not. Beans are moderately high in purines but one study has suggested that though tofu does raise the uric acid levels a little, the effects are negligible.(1) Based on the finding, my opinion is that tofu may be a suitable protein alternative between attacks, but is best still avoided during an acute attack.

1. Yamakita J., et al. (1998). Effect of tofu (beancurd) ingestion and on uric acid metabolism in healthy and gouty subjects. Adv Exp Med Biol, 431, 839-42.

Reference:
Murtagh, Patient Education 4th Edition, McGraw Hill Press

Sunday, November 04, 2007

Happy Deepavali!

Here's wishing our Hindu friends a very Happy Deepavali!

Please note that the clinic will be closed on during the Deepavali Holiday on 8 Nov 2007.

Thursday, October 18, 2007

Recommended Vaccinations for the Elderly

Singapore has a very effective vaccination program for our children and most parents are very diligent about vaccinating their kids. However, when it comes to the elderly, there is much room for improvement. I hope this article will encourage you all to get your parents and grandparents to the GP to get their vaccinations done.

The elderly, especially those with chronic diseases like diabetes, asthma or other medical conditions do benefit a lot from vaccinations. It is a fact that influenza and pneumonia are the leading causes of death in the elderly. These diseases can be prevented by giving a simple vaccination.

So what are the recommended vaccinations for the elderly?

1. Influenza Vaccine

The "Flu" vaccine is giving yearly and is useful for preventing the "Flu" which often leads to lung infections and eventual hospitalization. It is recommended for all adults above 50 years old or adults of any age with medical problems.

More info HERE

2. Pneumoccal Vaccine

This vaccination is recommended for those above above 65 years of age or adults of any age with medical problems. It is useful to prevent the elderly from developing lung infection (pneumonia). A second dose is given after five years for people with medical problems or if the first dose was given before the age of 65.

More info HERE

New Vaccine against Herpes Zoster to be released soon!

Perhaps you know of someone who had Herpes Zoster or what is commonly called "Seh Zhua" (Appearance of the Snake). It is a painful condition that affects the skin in a certain part of the body and even when the condition subsides, patients can be left with constant pain (post herpetic neuralgia). The Good News is that there is a new vaccine which has been approved which should be available soon in Singapore. It is recommended for adults above 60 years of age and only one dose is needed. I will write more about Herpes Zoster when the vaccine becomes available.

Conclusion

If you have elderly living in your household, do encourage them to visit the GP to get their vaccinations done. These vaccinations are recommended for the HEALTHY elderly but especially so for those who have medical problems. Remember that vaccinations are potential life savers!

Reference: The Singapore Family Physician Vol 33 (3) July-Sep 2007 "Value of Vaccination"

Thursday, October 11, 2007

Selamat Hari Raya Aidil Fitri!

Wishing all our Muslim patients a Selamat Hari Raya!

Our clinic will remain open this weekend as usual in case you need medical attention.

Monday, September 17, 2007

Health Screening Packages: No Later! Later!

By now everyone should be familiar with the Health Promotion Board's ad campaign where the man keeps saying "Later! Later!". The take home message being that when it comes to your Health, you should be more diligent and not leave it till later.

Just as your car needs regular maintenance, you also need regular check ups especially as you get older. Chronic diseases like hypertension, diabetes and high cholesterol can creep up on you without your knowing and early prevention can save you from developing diseases like heart attack and strokes later in life.

In my opinion, health screening is best done in consultation with your GP who can tailor the package to your needs. Doing a "blanket" screening with everything thrown in is not helpful. For example, if you are a young and relatively fit individual, all you need may be to have your blood pressure and cholesterol checked. Doing a Lung Spirometry test if there is no breathing difficulty or history of asthma is really not necessary. Whereas if you are older and have a history of hypertension, diabetes and a family history of heart attacks, then an Excercise Stress Test may be what you require. So the bottomline is this: Work with your GP to tailor a Health Screening Package to your needs!

Our clinic offers different health screening packages depending on your needs. These are basic packages from which we can add on different other tests if required. Do drop in if you have any questions regarding your need for a health checkup.

Remember, don't leave it till "Later! Later!"



Click Image to Enlarge

Immunization Packages



Please Click to Enlarge

Our Synflorix and Prevenar Packages work out to be $135 nett per injection and can be purchased through the Baby Bonus.

Friday, August 24, 2007

Wow Doc, these Traditional Pills really work!

Just the other day a young lady asked me this question:

Hey Doc, I have been taking these pills from the Philippines and it really works! I lost 5 kg over the last month! BUT, my heart has been beating really fast and I sometimes get a headache. Do you think it is safe? They only cost me six dollars!

Let me answer the question indirectly by highlighting this recent report by the Health Science Authority concerning adverse reactions to traditional medicines.

You all may be aware of the drug called Viagara right? Viagara is the trade name the drug sildenafil. It acts by dilating the blood vessels in the penis and is useful in men with problems with sustaining an erection.

Well, the HSA reported that two illegal "traditional" herbal remedies were found to contain sildenafil. The first one was unabashed about what its capsule could potentially do for its customers. It was called "Santi Bovine Penis Erecting Capsule". (Bovine=Bull) With 32mg of sildenafil per capsule (Viagara has 50mg), it is no wonder that this "Herbal" medication could produce a Bovine sized result. The second was "Urat Madu" which contain 48mg of sildenafil. Both of these medications were reported to have caused eye problems in their unsuspecting users.

There was another drug called "Asam Urat Flu Tulang" which was used as a pain killer. One young female patient was reported to develop drug reaction to the capsule. The lab tests reveal that the capsules contained diclofenac (a commonly prescribed painkiller), dexamethasone (a steroid) and paracetamol. Little wonder it works!

The Bottom Line

Sometimes a particular herbal medication works because the medication has been spiked with known western medications. The problem is that there is poor quality control in the production of the pills so you will never know what will happen to you because of impurities. The other problem is that if you take a "Herbal" medication thinking that just because it is "Herbal" and it cannot harm you, then you might be in for a rude shock.

So my advise is to make sure you know what you are taking and don't fall for something that is both "cheap" and "effective" and can only be bought from certain obscure sources. It might cost you more than you think.

Source: Adverse Drug Reaction News, HSA, Aug 2007 Vol 9 No. 2 Pg 8

Wednesday, July 18, 2007

Want a Painless injection? Cough!



If there is one thing that most people fear most about seeing the Doctor, it is the possibility of getting an injection. So great is the fear, especially in kids, that parents sometimes use it as a threat to get their kids to behave themselves in the clinic.

A lot of the pain is psychological and stems from the fear itself. I sometimes give myself an injection when I feel really sick. At first it was very difficult because we have a built in mechanism that makes it difficult to inflict pain on oneself. But after you get over the psychological barrier, it is actually quite painless.

So the first thing about having a painless injection is to overcome the psychological barrier itself. This is easier said than done. Thankfully, there are other techniques that can help.

1. Cough

Surprised? I certainly was when I watched this on "Brainiac" last night. This discovery may make the fear of needles a thing of the past! The latest study published in the British Medical Journal found that the pain of injection is significantly reduced when the patient coughs hard at the time of the injection. It is thought that coughing increases blood pressure which in turn reduces the perception of pain. Not convinced? Try getting a friend to pinch your arm. Then ask him to do it again, but this time cough hard. Can you feel the difference? Link to BMJ article

2. Local Anaesthetics

This works very well for kids. The only drawback is that the anaesthetic cream is applied and you have to wait for half an hour to an hour before the skin becomes numb. Works well especially if their eyes are also covered at the same time so that they can't see what is going on.

3. Distraction

This was the old method I used before I discovered the cough method. Essentially, I tell patients to relax and think of their favourite things or simply tell them something startling, for example, that there is a Gorilla standing behind them. Works pretty well, but the mother-in-law standing behind them may not be very happy being called a Gorilla. But you get the idea. The other way to distract is to pinch or tap the skin just prior to the injection. By the time the injection goes into the skin, the skin is still processing information about the tapping, so the pain information going to the brain from the needle has to contend with a narrow bandwidth, ie a traffic jam, so to speak.

Conclusion

The fear of injections is a thing of the past! Next time you need to get a jab, cough hard when the injection goes in. But please warn the Doctor first because he might miss the spot if you suddenly start jerking your body about!

Tuesday, July 03, 2007

Help Doc! My Baby's Belly Button Sticks out!


Umbilical Hernia in a 8 week old Baby

Many parents get very anxious when they see a protruding belly button in their newborn babies. I guess all parents want their babies to come out perfect and when there is something not quite right we get rather anxious, especially so for first time parents.

There is a funny little story told about the difference between the first time, second time and third time parents. The story goes like this....

With the first baby, when the pacifier drops onto the floor, the parent picks it up, washes it with baby safe dishwashing liquid, pops it in the sterilizer before giving it back to the baby. With the second child, the parent picks it up, rinses it under the tap and pops it back in the baby's mouth. By the time they have their third child, they simply pick it up, pop it into their own mouths and gives it to the baby.

This story brings home one very important point and that is that knowledge and experience empowers. So for the first child, parents are very careful about everything because they don't know enough. By the third child, parents have enough knowledge and experience to be able to discern what is important and what's not.

Another way to get knowledge and experience is to learn about it from other people which is why you are reading this blog.

Anyway this baby first came to the clinic at 8 weeks of age with a protruding Belly Button. This is a condition known as an Umbilical Hernia. What happens is that there is a small defect in the muscle wall that allows some of the intestines to pop out, thus forming the hernia.

Umbilical Hernias are very common. As the baby grows, the defect in the muscle wall gets smaller and by 12 months, most hernias would disappear. Larger hernias may take longer to disappear. If by the age of 4 the hernia is still present, then a minor operation may be required to fix the defect in the muscle wall.

There is a small chance that the bowels in the hernia gets stuck so that the contents of the hernia cannot be pushed back into the abdomen. When that happens, the baby needs to be seen by a doctor straightaway. Thankfully, such cases are not common.


Umbilical Hernia in same Baby now 3 months old

As you can see from these 2 pictures that were taken 1 month apart, the hernia is already noticeably smaller. The baby's parents are obviously relieved and happy.

Conclusion

Umbilical hernias are very common and most will resolve by themselves. There is no need to do anything unless they persist past 4 years of age.

Reference:

Murtagh, Patient Education 4th Ed, McGraw Hill Companies, 2005

Latest Update:

I saw the baby again and now the belly button is normal!

Wednesday, June 27, 2007

Monday, June 18, 2007

Schizophrenia: It's NOT about Split Personalities

I had one patient who came into the clinic behaving rather "Siow" (mad). She believed that the CIA was after her because she had some secret information that would reveal something about the PAP which will cause the ultimate collapse of the government. The patient was a homemaker. She claims the CIA were waiting for her outside the clinic to nab her and I had to help her or else this information will be lost forever. We got her husband to bring her to IMH where she was treated with an anti-psychotic drug. A few months later, she stopped having such delusions. She has been well since and has returned to work. (The details have been altered to protect the identity of the patient)

Schizophrenia is often misconstrued as having a split personality like the classic Dr Jekyll and Mr Hyde. As you can see from the story above, it is anything but that. A more accurate portrayal of Schizophrenia would be the character of the great economist, John Nash played Russell Crowe in the movie "A Beautiful Mind". In that movie, John Nash was under the delusion that he is part of a group of elite scientist on a mission to decode the German cryptic communications .

Rather then thinking of Schizophrenia as one person with 2 different personalities, it is perhaps better to think of Schizophrenia as a person who has his feet in different realities. It may be akin to a person who is so immersed in the Virtual Universe of "2nd life" or other forms of role-playing games, that the online persona is as real as the real world outside.

Who does it affect

It tends to occur in both men and women from ages 15 to 25 and 1 in 100 people will have it to some degree. It tends to run in families.

How do I tell if my friend may be Schizophrenic?

There are 4 features to look out for:

1. Hallucinations and Delusions: When I was working with the recalcitrant Schizophrenics in Australia, a lot of the women there thought they were the Virgin Mary. The men thought they were Jesus. One day one "Jesus" met another one who also claimed to be "Jesus". Now they worked out that both of them can't be "Jesus" so one managed to persuade the other one that he was the real "Jesus" and the other fella was his most trusted disciple "Peter". The both of them then went about happily preaching to the rest. I never really found out what happened with "Jesus" met his mother, the Virgin Mary.

2. Periods of Low Activity: Sometimes in between periods of Hallucinations and Delusion, they sufferer may under go periods where they are flat. They don't talk much, don't have much motivation to do anything and don't express their emotions.

3. Disorganized speech and thinking: This is one of the key aspect of Schizophrenia. You might have come across "Siow" people who come up to you to beg for money while you are having a meal at a coffeeshop. They either talk to themselves a lot or when they talk to you it is hard to follow their train of thought.

4. Grossly Disorganized Behaviour: Again you will also be familiar when these "Siow" people exhibit bizarre behaviours like scolding an invisible person, exposing themselves or other "silly" and socially unacceptable behaviour.

What all this means for you, the sane person?

It must be emphasized that Schizophrenia can be treated and the patient can actually live a normal life again! I think a lot of people have the misconception that once you became insane, you are basically a "gone case" for the rest of your life. So if you spot any of the behaviors in your friend or family members, do seek help early.

What you can do

For Early Psycosis

There is a Early Psychosis Intervention Program which you can receive help from a multidisciplinary team of Drs, psychologist, social worker etc. The website is at www.epip.org.sg
In doubt, bring your friend to see your Family Doctor for the initial assessment who can even start some simple medications before referring you to the EPIP.

For Acute Cases

For cases where the sufferer is likely to 1. Harm others, 2. Harm himself or suicidal or 3. The behavior is severely disorganized, the person should be sent to the hospital for to be hospitalized. Any of the major hospitals should be able to handle the problem.

The Mental Disorders and Treatment Act

This act gives the power to a medical officer to admit and detain the person for a period of 72 hours.

Can Schizophrenia be cured?

One third of cases have favorable outcomes. One third have intermittent relapse of their symptoms and the rest remain chronically disabled despite treatment.

More information can be found at the EPIP website

Wednesday, May 23, 2007

Croup: My Child has a Very Bad Cough!

This is a common scenario in kids suffering from Croup:

Parents bring their young child into the clinic clearly very distressed (both parents and child). The child is breathing noisily and has a cough that sounds like a seal barking. Everyone is very stressed except for the Doctor because he thinks to himself: "Ah, Croup! Now I can do some magic and make myself look like a hero!"

The Doctor quickly examines the child to assess the severity of the Croup and determines that it is not severe enough to require immediate admission. He then goes to the dispensary and reappears with a dispensing cup of "magic potion". The parents then hastily force the child to drink the yucky powdery medicine to which the child protests vehemently with even louder "Barks".

The Doctor then asks the patients to bring the child out of the clinic for a while so that the other patients in the waiting room can have some peace and quiet.

An hour or two later, the parents return into the consultation room obviously relieved. The "magic potion" worked its miracle. The child is now sleeping peacefully, the noisy breathing has stopped and the child no longer coughs as severely. The parents are so appreciative and thank the doctor and nurses profusely for their help. The Doctor thinks to himself: "Gee, I love my job!"

Now this of course is a case of mild Croup and it is a common scenario that we see in the clinic. Sometimes Croup can be very severe and even fatal. So it is important to have your child checked by your Doctor who will determine if the child needs to be admitted to hospital. If you are in any doubt, just bring the child to Accident and Emergency.

What is Croup?

Croup is a common viral infection of the upper airways. The virus affects the windpipe (trachea) and the voicebox (larynx) causing inflammation and narrowing of the airways, and hence difficulty breathing.

It usually occurs in young children between 6 months to 3 years of age, but it can affect kids up to 6 years old.

Symptoms of Croup.

The child may start by having a runny nose and fever and then progress to have noisy breathing, hoarse voice and a loud barking cough. It is important that parent recognize when croup becomes an emergency. This is when the child looks very sick (toxic) and tired and is having very noisy breathing (stridor) at rest. Another sign that it is very serious is when you look at the chest and you can see the ribs prominently when the child is breathing in (retractions). These are signs that you need to seek medical attention straightaway.

What usually happens in cases of mild Croup?

Mild Croup can be treated without hospital admission. The illness may last around 5 days with the first 2 days being the worse. The child does not need antibiotics since it is a viral infection.

Can Croup be dangerous?

Severe croup can be rapidly fatal as the passage of air in the voice box and larynx get so narrow that the flow of air into the lungs is severely limited. The child will need to be treated immediately with a procedure to put an airway tube into the throat so as to ensure that air can get into the lungs.

What to do?

In the Singapore context where clinics are readily available, it is best to just bring your child to your family doctor if you suspect your child is having Croup. If it is severe, bring the child straightaway to KK Children's emergency. However, if it is a mild case, Croup can be treated at the clinic. The doctor can give a immediate dose of steroids which can have amazing results. The child may improve markedly within 1 to 2 hours after giving the medication and can then be looked after at home. However it is important to note that the child should be observed closely over the next few hours to make sure the condition does not start deteriorating again.

The doctor may prescribe some fever medication and simple cough and cold syrups for the child. It is also useful to prop the child up and help the child relax by watching some TV or reading a book. Moist air can also be useful. You can do this by turning on the hot shower in the toilet for a while before giving your child a bath or by using a humidifier.

Conclusion

Croup is a common illness affecting younger children. It is usually mild and can be treated at home with the help of your family doctor. However, there are some instances where Croup can be so severe that the child will need to be admitted to hospital. So it is important for parents to be able to recognize severe Croup and seek medical attention immediately.

More information can be found here

Reference:

Murtagh, John 2004, Patient Education, McGraw Hill Australia 4th Ed

Tuesday, May 15, 2007

When is a Flu not a Flu?

A Flu is not a Flu when it is just a Cold.

Lately there seem to be an increase in patients coming into the clinic complaining of "Flu". But what the layperson calls "Flu" and what the Doctor considers "Flu" is quite different.

When the Doctor says you have got a "Flu", we mean that you have a condition known as Influenza. Influenza is a condition that is caused by the Influenza virus. There are lots of viruses and bacteria that cause people to have fevers and runny noses. So how does the Doctor know if the condition you have is Influenza or just a normal cold?

The truth of the matter is that the Doctor cannot be 100% sure. But we can look at the signs and symptoms and make a "best guess". The only way to confirm that you have the Influenza virus is to do a lab test.

However you can tell the difference between a "Flu" and a "Cold" by noting the different characteristics:



We all get cough and colds round the year. But occasionally, you get a bout that is so bad you feel as if you have been sat on by a Sumo Wrestler. Your bones and joints are all aching and your fever rises faster than the housing prices. When you feel like this, you might well be suffering a real "Flu".

If you are having a "Flu", you will be infectious to others a day before the onset of the symptoms and throughout the period when you are suffering from the illness. You might also feel very lethargic for up to 10 days. The Influenza virus spreads through droplets. So everytime you sneeze and cough you are helping to spread the virus around.

What you can do:
  • Visit your Doctor and make sure you get an accurate diagnosis. It could be other things like bacterial pharyngitis which can be treated with antibiotics.
  • Make sure you isolate yourself from other people so you don't spread the virus.
  • Take lots of fluids and rest in bed as much as you can.
  • There is a new medication called Tamiflu which may be prescribed depending on the patients' needs.
  • Avoid getting the flu by vaccination. This vaccination is currently recommended for young children with chronic diseases like asthma, the elderly, pregnant mothers or if you are going to be in a situation where there is a high chance that you get the Flu.
More information on the Flu can be found by clicking here

Friday, May 04, 2007

Ear Wax and Cotton Buds

My son used to be quite restless and active in kindergarten. One day teacher began to complain that he doesn't seem to want to listen to instructions in class. They suspect that he was just being naughty and rebellious. I knew my son was active, but he is usually a very obedient boy, so I wondered if there was anything wrong with his ears. When I examined his ear, lo and behold, it was chock full of ear wax! After I syringed out the ear wax, the teachers stop complaining that he was not listening to instructions in class.

Impacted ear wax is one of the commonest cause of temporary deafness both in adults and children. Our ear produces wax to protect the ear canal and to give it a waterproof coating. But sometimes for some reason, there is a build up of ear wax which causes symptoms of deafness, itching, earache and sometimes even infections.

The usage of cotton buds to clean the ear is a common practice globally. It is one of the common causes of impacted ear wax. The tip of the cotton bud acts like a ram rod and pushes the wax deeper into the ear canal while it cleans the sides of the ear canal. Everyone knows how satisfying it is to have your ear canals cleaned, which explains why people continue to do it.

I once had a patient with 80% deafness in one ear. On examination, there was a huge plug of wax in the ear and it took me quite a long time to extract all of it. What I managed to extract will give you goose bumps. It was a piece of waxy, mouldy cotton bud tip which had been lying in the ear for who knows how long!

So please be advised not to put anything smaller than your elbow in your ear!

What you can do:
  • Use ear drops to soften the wax
  • Avoid using cotton buds
  • When using a hair dryer, avoid blowing the warm air into the ear as it may cause the wax to harden
  • Do not try to use a pair of tweezers or any instruments to dig out the wax as you may accidentally perforate the ear drum
  • Do not try to syringe out the ear wax yourself, as it there might be a middle ear infection so you might accidentally cause a perforation of the ear drum.
  • Visit your doctor if you suspect that there is a lot of wax built up in the ear
The ear has a self cleaning mechanism by which the wax that is produced is removed naturally. So you don't really need to do anything to remove the wax yourself. However, sometimes, it does build up due to various reasons. When that happens, you are advised to visit your doctor.

A Word on Ear Candling

This is quite popular nowadays and I guess it can be quite soothing to undergo the procedure. There has been a few reported cases of injuries caused by ear candling that you should be aware of. To read more about Ear Candling, please click here.

Tuesday, April 24, 2007

Alert! Hand, Foot and Mouth Disease is on the rise!

If you have been following the news, you would note that the number of HFMD cases has been on the rise this year. This is consistent with the increased number of cases that we are seeing in our clinic. So parents please be on a high index of suspicion if your child develops a fever, mouth ulcers and rash on the hands and feet.

Here are some important information about HFMD you should know:
  • It is usually a mild and self limiting illness
  • The incubation period ie the time of when the child is exposed, to the time he develops the illness, is about 3 to 5 days
  • It usually affects children under 5 years of age
  • The features are multiple ulcers in the mouth and spots on the hands and feet. Sometimes there may be spots on the buttocks as well
  • It is spread by direct contact through droplets, saliva, faeces or blister fluid from the infected person.
  • The lesions resolve in 3-5 days and there is no scarring
Please note that several years ago, there have been a series of deaths caused by the EV71 virus. So far this year, the predominant strain is the Coxsackie A16 virus which usually causes a mild illness.

What you should do:
  • Consult your doctor immediately if the child has a fever and has been exposed to HFMD or if you see rashes or mouth ulcers.
  • Isolate the affected child so he/she does not spread the illness to other kids
  • Wash hands with soap before eating and going to the toilet
  • Cover mouth and nose when coughing or sneezing
  • Maintain good air circulation
  • Clean all toys and appliances that may be contaminated by the affected child
  • Do not share eating utensils
  • Do not return to school until certified fit by your doctor
If in doubt, always seek medical advise.

Channel News Asia Report Here

Depression and Suicide

I have never met Ms X. She was a Chinese National who married a local Singaporean man. My first contact was with her newborn and I was curious that it was the grandparents who were the main caregivers. During their second visit for the baby's vaccination, I found to my horror that Ms X had committed suicide. She had been suffering from post-natal depression.

I think one of the most devastating things in life is to find out that someone you know has committed suicide. And it doesn't have to be someone you know very well. I remember when Leslie Cheung committed suicide, I was somehow affected by the news even though I can't even remember watching any of his movies. Last year, a friend of mine whom I had shared some makan adventures with was found dead at the bottom of his HDB flat. I cried, even though I did not really know him that well.

These suicides were a culmination of months of depression. They could have been helped. In Singapore, it is reported that there is one case of suicide everyday.

It is important to be able to recognize that your friend, colleague or family member may be suffering from depression and quickly get them assessed by the Doctor. It can potentially be life saving.

How to recognize Major Depression
(Modified from the DSM IV criteria)

Five of the following symptoms have to be present for at least 2 weeks:

1. Depressed mood
2. Diminished interest or pleasure in all or most activities
3. Significant weight loss or gain, or decrease or increase in appetite nearly every day
4. Unable to sleep or sleeping too much
5. Slowing of mental or physical activity or agitation
6. Fatigue or decreased level of energy
7. Feeling of worthlessness or inappropriate guilt
8. Poor concentration or indecisiveness
9. Recurrent thoughts of death or suicide

Conclusion

If you think that someone you know might be suffering from major depression, it is important that you seek medical help ASAP. The patient can be helped with medication and therapy. This is especially important if the patient has expressed a desire to commit suicide which should never be taken lightly. If the doctor determines that the patient may indeed be at risk of suicide, he has the legal authority to detain the patient in a medical facility (IMH) against the patients' wishes. Friends and family members thus have a very important role to play in preventing suicide by being able to recognize the symptoms of major depression.

Monday, April 09, 2007

For Women: Help Doc! I am losing my hair

Hair loss (Alopecia) in women is often more devastating than men. While society can accept balding men, it does not offer the same courtesy to women. Hollywood may still have leading men like Sean Connery, but I can't remember ever seeing a bald lady superstar.

There are many reasons why women lose hair. The most important thing is to understand the reason for the underlying hair loss. Some hair loss is reversible while others are not.

Here are some interesting facts about hair
  • We produce around 1km of hair per month
  • There are on average 100,000 hairs on our heads
  • About 50-100 hairs are shed everyday
  • Hair that is shed takes 3-5 years to replace
  • At least 25% of hair must be shed before we notice the hair loss
  • Abnormal shedding is when the hair clogs up the shower drain or you see clumps of hair on the pillow
There are many different causes of hair loss in women

Androgenetic Alopecia (Inherited hair loss)

This is the most common cause of hair loss in both men and women. By the age of 60, 50% of women would have noticeable hairloss. This is also caused by male hormones (Women do produce some male hormones). The pattern of hair loss is different from the men. Women do not lose their frontal hairline and the hair loss affects the crown of the head (the top). There are treatments available for this form of hair loss but it is controversial and it is best to discuss this with your doctor.

Alopecia Areata (Patchy hairloss)

In this type of hair loss, women (and men) may find that there is one patch of clean normal scalp surrounded by normal hair. It looks as if the barber accidentally shaved off the hair on that part of the scalp. This condition usually recovers spontaneously after 12 months, but there are some medications and treatments which may help to shorten the recovery process

Diffuse Alopecia (Universal hair loss)

Sometimes severe stress can cause hair loss. Classically this type of hair loss is seen in women after pregnancy. It usually occurs 2-4 months after the stressful event. Aside from giving birth, other events such as severe illness or surgery, accidents, severe dieting and weight loss etc can also cause this form of hair loss. The good news is that spontaneous recovery can be expected in 6 months. Medications such as minoxidil can be used to help accelerate the process.

Certain medications can also cause hair loss. The obvious ones are the drugs used to treat cancer. The less obvious ones are drugs used to treat gout, gastric pain, worms, arthritis etc. You should check with your doctor if you suspect that your hair loss is caused by a certain drug.

Other Conditions

There are also a number of medical conditions that can cause hair loss such as hypothyroidism, anaemia, polycystic ovarian syndrome etc. Your doctor would be able to confirm the diagnosis by doing blood tests and other investigatons.

The bottomline

It is important to get to the root (pun intended) of the problem. Understanding the cause of the hair loss is the most important first step in treatment. There are some medications available from your doctor that can treat hair loss. So it is important to seek expert medical opinion before seeking other treatment options for your hair.

References:

Murtagh, John Patient Education 4th Ed 2005 McGraw Hill Australia

Thursday, April 05, 2007

We are closed on Good Friday

The clinic will be closed on Good Friday. Consulation times as usual on Saturday and Sunday.

To read my thoughts on Good Friday, please click here

Tuesday, April 03, 2007

For Men: Help Doc! I am getting BALD!

This is probably every man's nightmare.

I remember looking at my own scalp last year and wondering if my hair was a little thin on top. Of course, with my medical knowledge, I told myself that it is unlikely since I don't have any predecessors who are bald and that the area I felt my hair was thin was not typical of male pattern baldness.

But it was a whole different story emotionally. When it comes to issues of the heart, we tend to behave irrationally. I was gripped by the fear that one day I might end up with a "Chrome Dome" and being able to use my head to reflect the sunlight into a dark room. Worse than that, I remembered that my Maths Lecturer in RJC used to grow his hair really long on one side and use it to cover the bald area. The students used to giggle in class when those strands of hair lift off the bald part and swing 180 degrees to end up dangling over the shoulder.

What is the Cause? And what do Eunuch's have to do with it?

Male pattern baldness tends to run in families. So there is not much you can do to prevent it. However, it is prudent to let your doctor have a look at your scalp to determine if there may be other causes for your hairloss. For example, you might be suffering from a fungal infection which may be causing the hair to drop off. This is a condition that can be easily treated with medications.

Male pattern balding is caused by too much testosterone circulating in the body. There are androgen receptors on the scalp which react to the high level of testosterone resulting in hair dropping off. These are found in high density in the forehead and crown area of the scalp which explains why men start to bald in those areas. Male pattern baldness is unheard off amongst Eunuchs (Men who have been castrated), since they have very low levels of testosterone. However, castrating oneself in order to protect one's hair is a bit extreme. And besides, when you castrate yourself, you lose your sexual drive, so what's the point of looking attractive?

So what are my options?

Male pattern baldness is an incurable condition. Most men come to accept it as a natural part of their lives and some like Yul Brynner and Vin Diesel even embrace it. In fact, they actually look more sexy bald than when they have hair.

Other men like William Shatner (Capt Kirk) and Ted Danson (Becker) prefer to wear toupees to hide their bald spot. Incidentally, if you are interested in moviestars who are secretly wearing wigs, please click here.

Are there any medical treatments?

There are only two medical treatments that have been found to be effective in reducing hairloss.

The first is a medication known as minoxidil. It is a lotion that is directly applied to the scalp. The other is a tablet known as finasteride. Both have to be taken for life. Once you stop medications, the hair loss resumes. These are prescription medications which are available from your Family Doctor who will be the best person to advise you on whether they are suitable for your condition.

Conclusion

If you have inherited the gene from your forefathers then your hairloss is inevitable. Those that really want to keep their hair can do so by taking regular medications. The best time to start taking medications is before you lose too much hair as it is easier to retain the hair you have rather than to replace the ones you have lost. If you have a problem with male pattern baldness and want to do something about it, you should visit your Family Doctor to discuss different treatment options.

Tuesday, March 27, 2007

Sunday Night Clinic

Our clinic is opened from 6.30pm to 10pm on Sunday nights for your convenience!

Monday, March 26, 2007

Can Diabetes be Prevented?

Diabetes is a devastating disease. Anyone who has a family member with diabetes will understand this. It takes a downward course and patients will need to keep increasing their medications as the get older. For some it might get so bad that they need to inject themselves with insulin daily. Uncontrolled diabetes will also lead to a host of other problems like heart disease, kidney disease, blindness and numbness and poor circulation in the legs which may eventually lead to an amputation.

The good news is that Diabetes can be preventable if spotted early. So the question is, how do I know if I am at risk of diabetes and how do I prevent it?

You are a candidate for Diabetes if you:
1. Are overweight ie your BMI is more than 25kg/m2 BMI = Weight in kg/(Height in m)(Height in m)
2. Have high blood pressure (>140/90mmHg)
3. Have a first degree relative with diabetes
4. Had diabetes during pregnancy
5. Have polycystic ovary disease
6. Have heart disease
7. Have Cholesterol problems
8. Have Impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT)
Now the important thing I want to look at today is the last point. IFG and IGT are conditions recognized as prediabetic conditions. That is to say, people with such conditions will go on to develop diabetes if nothing is done. IFG is defined has having a fasting blood glucose level of 6.1 to 7.0 mmol/l. Diabetes is defined as having a fasting blood glucose level greater than 7.0 mmol/l. So if you have done a screening test and the test results come back and you are told you have no diabetes, it means that your fasting glucose levels are below 7 mmol/l. BUT unless the results are explained to you by your doctor, you might have a level between 6.1-7.0 mmol/l which would be overlooked.

Why is IFG and IGT important?

There have been several studies that show that early intervention in people with IFG and IGT can prevent the development of diabetes! So there is a certain group of people out there in whom diabetes can be prevented but they still may not know about it!

So what do you do?

1. If you are above 40 years of age, then you should at least know your fasting glucose levels. It is easily checked by visiting your family doctor.

2. If you have any of the risk factors above, you should check your blood glucose level at least yearly to make sure that you spot the early signs of diabetes.

3. If you have already done a screening test, see if the fasting glucose levels are in the range of 6.1-7.0 mmol/l. If it is than go visit your family doctor immediately to get it properly assessed. You might just prevent yourself from developing Diabetes and a whole lifetime of medications and complications by doing so!

For more information on Diabetes Mellitus, please click here

Monday, March 12, 2007

A Diabetic's Checklist


A 60 year old man walked into my clinic the other day to get his diabetes medication. This was the first time I am seeing him. He said he was taking a certain type of medication for the last 5 years and this has not been changed.

So I went through some preliminary questions to see how well his diabetes is being controlled.


What was your last HbA1C reading?
He replied: "What is HbA1C?"

Ok, when was your last blood test done?
He replied: "Never had any blood test"

How is your fasting blood glucose levels?
He said the last time it was tested it was a bit high

When was the last time you did a Retinogram?
He said: "What's that?"


At the end of the consultation, I told him there was quite a few things he needed to do to manage his diabetes because it was clearly not under good control.

To which he replied: "I just want to take my usual medication, that's all I need"

I hope you are shocked, because if you are not, you should be.

Diabetes affects 8.2% of the Singaporean population. Uncontrolled diabetes will invariably lead to other more critical problems like heart disease, kidney disease, eye problems and may even cause legs to be amputated. This man was heading towards an inevitable fate and he does not even know it.

Diabetes is a disease that is best managed by the patient himself in consultation with his Family Doctor and may involve other paramedical persons like the podiatrist and dietician.

Since it is such a long topic and I don't want to bore you, I will just quickly distill the most important information so that if you know of anyone with diabetes, you can sort of tell if his condition is managed properly.

Things a Diabetic Patient needs to do:
1. Ensure his Fasting Blood Sugar is between 4.0-8.0 mmol/l.

2. The HbA1C needs to be done at least twice a year or more often if necessary. The HbA1C gives an indication of how well the blood glucose level has been controlled in the last 2 to 3 months. The levels should be between 4.5-7.0%

3. The Blood Pressure must be kept below 130/80mmHg and monitored every 3 months

4. The Cholesterol levels must be checked at least yearly to ensure that it is below 2.6mmol/l or 100mg/dL

5. The BMI should kept between 18.5-22.9kg/m2. ie, he should lose weight if he is too fat!

6. A Retinogram, which is a photograph of the retina (back of the eye), should be done yearly.

7. Urine and blood tests should be done at least yearly to screen for early kidney problems

8. The feet should be checked at least yearly to screen for early nerve deterioration.
Diabetes is a progressive disease. That means that diabetics will invariably have to keep increasing medications as they age. Uncontrolled diabetes coupled with high blood pressure and cholesterol is a recipe for disasters like heart attacks, strokes and kidney failure. On the other hand, all these problems can be avoided and the person can lead an almost normal life without suffering severe disabilities if it is managed well. So it is important to MANAGE the disease from the start rather than waiting till something goes wrong.

More information about diabetes can be found here.

Wednesday, March 07, 2007

ALERT! Hand, Foot and Mouth Disease reported in our area

I have been seeing quite a number of Hand, Foot and Mouth Disease cases in the last 2 days and I hope parents will take note of this. Some of these suspect cases only have ulcers at the back of the mouth without the spots on the hands and feet. These are strictly speaking not HFMD but a variant known as Herpengina. Both of these conditions are caused by the same Coxsakie Virus. If your child is complaining of a sore throat and fever, please consult your Family Doctor and don't allow them to attend school

Teenage Eating Disorders: Anorexia and Bulimia

There are three main types of eating disorders that affect mainly teenaged and younger females. They are Anorexia Nervosa, Bulimia Nervosa and Binge eating. We will focus on the first 2 conditions in this blog.

Since most patients with these conditions will fail to recognize that they have a problem, I hope that this article will help you recognize the condition in the people you know so that you can help them seek medical attention. Conditions such as Anorexia Nervosa can potentially be fatal. Remember Karen Carpenter who sang "Yesterday once more"? Her death in 1983 from Anorexia Nervosa was one of the key events that brought this disorder into the limelight.

So how do you tell if a person is suffering from these disorders?

Anorexia Nervosa

People suffering from Anorexia Nervosa have an obsessive desire to lose weight through dieting and fasting leading to extreme weight loss. The condition is easy to spot. They are usually teenaged girls who refuse to eat and lose a lot of weight over a short period of time. They look haggard and they skin becomes dry and scaly. They may also be obsessively excercising and counting their calories.

It is important to note that when these people look at themselves in the mirror, they DO NOT see a thin person. ie they have a distorted view of themselves.

Bulimia Nervosa

These people are harder to spot because though they want to lose weight they are less successful than those with Anorexia Nervosa. Rather then not eat, they will secretly binge eat lots of stuff, frequently desserts, and then try to lose all the extra calories by inducing a vomit, fasting or resorting to the use of laxatives or diuretics to effect weight loss.

Bulimia usually begins later than Anorexia and affects women from 17 to 25. (Remember Princess Diana?) You may be able to spot them because they may frequently excuse themselves to go to the bathroom after eating or they might eat lots of food but fail to gain weight. They may also be always trying to lose weight and excercising. Sometimes you may be able to see erosion of the skin at the base of their fingers because they would frequently stick their fingers into their mouths to induce vomiting.

Severe and repeated vomiting may lead to loss of electrolytes which can become a medical emergency.

How to manage these eating problems.

This is a primarily a behavioural and psychological problem and there are often problems in the family relationships like crisis, sexual and physical abuse, drug and alcohol abuse that may need to be addressed. Problems with self esteem in this age group often stem from lack of acceptance from friends. It may be that they are not accepted because of their being overweight.

The disorder thus needs to be managed by a multidiciplinary team comprising the doctor, behavioural expert and dietician. Severe anorexia is an emergency and the patient may need to be warded.

In Singapore, children below 19 with eating disorders may be referred to IMH while those above 19 can be referred to SGH which has a specialised clinic dealing specifically with the disorders discussed above.

More information on Anorexia and Bulimia can be found here

Reference: John Murtagh, Patient Education, Fourth Edition, McGraw-Hill Australia

Monday, February 26, 2007

Why you should Vaccinate against Chickenpox

This is one of the commonest comments from Parents:

I think it is better for my child to get Chickenpox. We all went through it and it is more natural that way!

Sound familiar?

But I have never heard a parent say something like,

I think it is better for my child to get Meningitis or

I think it is better for my child to get Polio.

I think the main reason is that most unlike Meningitis or Polio where there might be long term serious disabilities, most parents assume that Chickenpox has no long term effects on the child.

But is this assumption true and what are the facts?

The fact is that in most cases Chickenpox is a mild disease and most children recover without long lasting effects, BUT in some cases Chickenpox can cause long term disabilities and even death.

Why you should consider vaccinating your child:

A few points for you to think about:

1. There is a small chance that your child might develop serious complications like long term brain damage from chickenpox encephalitis (brain infection) or might even die from widespread chickenpox infection. An article published in the Singapore Medical Journal gives 8 cases of chickenpox complications. (Click Here) One child died, another was left with poor memory and behavioural changes. The rest although fully recovered, went through the illness with neurological problems such that they lost their sense of balance and there are also some who suffered from kidney problems during the length of the illness.

2. Consider the child pictured above who is one of my patients. He unfortunately had chicken pox as a baby and was left with a line of chicken pox marks on his face. You might think this is only a small thing, but he certainly was very sensitive about having his picture taken, which is why he tried to cover his face with his hand. The scars are having an impact on his sense of self esteem.

3. If the child has chickenpox, it would be a week long illness where the child will be uncomfortable and also infectious. Inevitably the people whom the child have contacted prior to the illness will start to panic and wonder if their own kids have contracted chickenpox. I even had one pregnant lady who was so worried that she would get chickenpox. If you vaccinate your child against chickenpox, then you really don't have to worry about these things.

4. In adulthood, chickenpox can be very severe with the lesions covering the entire body and face. If your child does not contract chickenpox as a child, he may still get it during adulthood.

Here is another common misconception:

Even if I vaccinate my child, he will still get Chickenpox!

If this were really the case, why would we even give Chickenpox vaccinations?

The fact is:

Children who have been vaccinated have a 75%-85% chance of protection against Chickenpox and the ones who still get it have a milder disease.

One of my patients asked me:

If I get vaccinated against Chickenpox, I will get Shingles later in life!

Quite the opposite is true! And this is another reason why you should consider vaccinating against Chickenpox.

Shingles, better known in Singapore as "Seh Zhua" (Snake) is a reactivation of the chickenpox virus when the immune system is weakened. When one suffers from an episode of chickenpox, some of the virus take up residence in the body and lie domant until something occurs to reactivate it.

When you vaccinate yourself or your child against chickenpox, you are essentially giving your body a deactivated virus which does not cause chickenpox, but is still recognized by the body as chickenpox. Thus the body's immune system arms itself against this particular virus and stores the information in memory. The next time when the body gets exposed to the real chickenpox virus, it mounts an effective response so that the chickenpox virus does not have any chance of replicating in the body and causing the chickenpox symptoms.

So if you never get chickenpox, you will not be harbouring the virus in your body and thus will not get Shingles later in life.

More information on Shingles may be found by clicking this

Conclusion

Chickenpox is a disease that can be avoided. There is no compelling reason NOT to vaccinate yourself or your children. So please consider the facts and make an informed decision on your family's health!

Friday, February 16, 2007

Chinese New Year Opening Times

We would like to wish every one a very Happy and Prosperous Year of the Pig! Remember to eat moderately and avoid Suckling Pig if your cholesterol is high (well at least try not to eat too much).

Our clinic will be closed on the 1st and 2nd day of the New Year and we will be opened half day on the 3rd. The opening times are as follows:

17 Feb Sat 8.30am to 12.30pm
18 Feb Sun Closed
19 Feb Mon Closed
20 Feb Tues 8.30am to 12.30pm
21 Feb Wed Business as usual

Friday, February 09, 2007

New Vaccine that protects Women against Cervical Cancer

There is good news in the fight against Cervical Cancer. A new vaccine has been recently launched in Singapore which is designed to reduce the risk of women developing Cervical Cancer significantly.

How does it work?


There is a virus called the Human Papillomavirus (HPV) that is spread through sexual contact. About 50% of sexually active females with become infected with the HPV in their lifetimes. It has been found that infection with the virus will predispose the person to develop Cervical Cancer later in life. So if you can prevent the person from getting the infection in the first place, you can prevent the development of Cervical Cancer.

How common is Cervical Cancer?

Over 490,000 cases of cervical cancer are diagnosed annually worldwide. Up till the introduction of this vaccine, the primary way of dealing with cervical cancer was to detect it early through regular Pap Smears. It is recommended that sexually active women have a Pap Smear at least once every 3 years. When Cervical Cancer is detected in the early stages, it is easily treated. Cervical Cancer can be life threatening when detected late.

How effective is this Vaccine?

There are many different strains of the HPV. This vaccine protects against two of the most common strains that cause 70% of Cervical Cancers. Aside from protecting against Cervical Cancer, the vaccine also protects against the development of Anal and Genital Warts.

Who should get the vaccine?

It is recommended that the vaccine be given to girls 9 to 26 years of age preferably before any sexual contact.

What is the schedule like?

The vaccine should be given at 0, 2 and 6 months.

Where can I get vaccinated?

You should be able to get this vaccination at your Family Doctor or Gynaecologist.

Conclusion

This is real breakthrough against one of the commonest cancers affecting women and its introduction should see the incidence of Cervical Cancer in woman reduced significantly.

Other Resources

Link to Vaccine website
Fact Sheet on Human Papilloma Virus
Link to News Article

Friday, February 02, 2007

My Baby Won't Stop Crying!

My two kids are now 7 and 4 so nowadays,the kind of prolonged crying is usually due to tantrums which are easy to handle, because I know that they are just being naughty. But when they were newborn it was very different. I was a young medical officer in the hospital undergoing training then, and did not know as much as I know now. So when my 1 month old son, James started crying incessantly, I panicked like any first time parent would.

What Crying Means

Before my son was born, I remember being worried about being a parent. It is not as if you go for courses to prepare for such a thing. I am the kind of person who would read through the instruction manual for my handphone before using it, so I was hoping my son would come with an instruction manual! But no, parenting is "on the job" training. By the time you get proficient at taking care of your newborn, they become toddlers and you start "on the job" training again. The skills you learn are only useful for your second child, which is why by the second child, when the pacifier drops on the ground, you simply rinse it instead of sterilizing it before sticking it back into the baby's mouth.

Anyway, I learnt that looking after a newborn is pretty straightforward. They only do five things. Eat, sleep, cry, pass motion/urine and breathe. So as a parent, you only need to learn how to feed, get them to sleep, pacify their crying, change their diapers and bathe them. Now, crying is the only way the baby communicates with the parent. And at that age, the baby only communicates a few things with you. So when the baby cries, he might be saying:

1. I'm hungry, feed me Mummy
2. Time to change my diaper
3. I am in pain eg teething and colic
4. I am lonely, play with me
5. I am sick

So if you always go through the checklist, you will find some reason for the crying and rectify the problem accordingly.

What is the normal crying pattern?

Up to about 6 weeks of age, the average baby would sleep and when awake will start crying or fussing. They might cry for about 3 hours a day. By about 6 weeks they begin to have periods where they will be awake without crying. By 6 months they will be able to smile and play with you.

Infant Colic (Crying on and on and on.......)


In the first 3 months of life, the baby may have prolonged periods (more than 3 hours) of incessant crying where a cause is not found. He may look like he has abdominal pain and draws his arms and legs towards the body and cries till he is red in the face. It is a distressing condition for most parents especially first time parents or even for 2nd time parents experiencing it for the first time.

It is important to make sure your child is not sick before assuming that he has infant colic. So measure their temperature and look out for signs that the child is sick, then go through the checklist of why the child is crying. If in doubt, always bring the child to the doctor for a proper assessment.

What to do after I have gone through the checklist?


Remember the "Rule of 5 Ss" by Paediatrician Harvey Karp who rediscovered the ancient techniques of soothing the baby:

1. Swaddling: Make sure you learn how to wrap baby up firmly
2. Side or Stomach: Lie your baby on the side or stomach
3. Shushing" as loud as they cry
4. Swing (Sway) them from Side to Side
5. Sucking: Use the Nee Tu (Pacifier) or Bottle

For more information on Infant Colic, please click here

Conclusion

Remember that most cases of infant colic only lasts for up to 3 months after which things get better. Once you ensure that the baby is not sick and that everything else on the checklist is covered, DON'T STRESS! Prolonged crying is not going to cause long term harm to the baby, despite what the older folks will say about the testes dissappearing if the baby is allowed to cry for too long. Our Chinese Culture does not look favourable upon a parent who does not try to stop the baby from crying, so aside from looking after the baby, we also have to please our family members and this adds to the stress levels. Just understand that it is not your fault that the baby has colic and there is not much else that can be done except to be patient and go through it!

Reference: John Murtagh: Patient Education 4th ed, McGraw Hill, 2005

Wednesday, January 31, 2007

Taking Medications during Pregnancy

"I don't need to see any Doctors because I know I cannot take medications during pregnancy"

I had a pregnant patient recently who said that she had a friend who has been having a sore throat for 2 weeks but has been refusing to see the doctor because she claims that the doctor can't do anything because she believes a pregnant woman cannot take any medications at all.


If you believe that you cannot take any medications at all during pregnancy and refuse to seek medical attention, you may be endangering yourself and your baby. People say that one has the right to believe anything you want and that is your right. But one really has to make sure that the belief is based on facts and not hearsay. This is one of the biggest challenges in family practise because most patients have beliefs which come from various sources. Some of these beliefs are wrong and so patient education is an ongoing process.

The fact of the matter is that during pregnancy, there are some medications which will affect the developing foetus and which should be avoided. BUT, there are also medications which are shown to be safe during pregnancy. If you have say, a mild chest infection and you refuse to see the Doctor because you believe that you should not take medications when you are pregnant, that mild infection may develop into full blown pneumonia and you may become septic (germs get into the blood). Then you may need to be admitted to hospital for intravenous antibiotics. That will be more dangerous for you and your unborn child.

The bottomline is this: If you are ill, see your doctor. He will be able to properly assess the condition and tell you if the illness requires medications.


Thursday, January 25, 2007

Help Doc! I missed my Pill today, What should I do?i

OK, now this is what you do:

Remember the rule of 7s:

1. Always take the forgotten pill once you realize that you forgotten to do it. Do this even if it means you have to take 2 pills at a go.

2. Then take the next pill at the usual time.

3. If you missed your pill by more than 12 hours, then you should assume you may be able to get pregnant and use another form of contraception for the next 7 days.

4. If the 7 days run beyond the last hormone pill in the pack, then you should just continue with the next pack immediately without a break. Ie you will miss the menstrual period that month.

Thursday, January 18, 2007

Is Wagyu Beef really Healthy?

Wagyu Beef is quickly gaining popularity amongst beef lovers in Singapore and around the globe because of its unsurpassed marbling and tenderness. When I first heard of this marbled beef, my Doctor half thought "Oh oh! So much fat! Its got to be bad for your heart!" while my Foodie half rebutted "Hey, that's got to be the shiokest, tenderest beef steak!". Imagine my joy when I read on the Internet that Wagyu was also higher in monounsaturated fats than normal beef and that it was healthy! As you know, monosaturated fats eg olive oil (which melts at a lower temperature) are better for your heart then saturated fats, eg butter.

My initial reaction was: "Rejoice! Rejoice! Now I can have my beef steak AND lower my cholesterol levels at the same time!"

But the cynic in me just could not accept this without reservations. So I began to do some research. Sad to say that the medical community has not really gotten wind of the fact that Wagyu beef is lower in monosaturated fats yet (maybe they are all too busy avoiding beef and staying healthy) so a casual search of the usual medical sites revealed no official position on Wagyu Beef.

When you look at the information from Wagyu Beef Suppliers, they will tell you that Wagyu is high in monounsaturated fats and with the ratio of monounsaturated to saturated fats of 2:1.(1) Then they go on to tell how a diet high in monounsaturated fats can lower your bad cholesterol levels. Although it seem to be the logical conclusion, one needs to be careful to and look at the whole picture before starting to eat chunks of Wagyu beef thinking that you are doing your heart a favour! Bear in mind that even though there is more monounsaturated fats in Wagyu, there is still that 30% of saturated fats! And since Wagyu is so well marbled, you are taking in a lot more fat than a normal beef steak.

So real question is: "Does eating Wagyu really lead to lower cholesterol levels, compared to eating normal Beef?". As far as I can tell, there is not enough data (available to me) to form a conclusion. I did managed to find one article (2) that addresses this issue, but it was a research paper funded by a beef supplier AND it was only done in a small population of people, so the results have to be taken with a grain of salt.

In this experiment, they had 2 groups of people with high cholesterol levels and they fed one group with lean Wagyu beef (lean but still higher in monounsaturated fats) and another group with normal US choice beef. They measured their cholesterol levels before and after 6 weeks of eating the beef. At the end of the trial, one of the conclusions was that there was no difference in the cholesterol levels of the group eating lean Wagyu compared with the group eating normal beef.(2) So it appears that Wagyu may not confer the benefits of lowering cholesterol compared to normal beef as assumed.

Even if the Wagyu does really lower cholesterol levels, there are still other ill effects of red meat that needs to be considered. There is some evidence that high consumption of red meats can lead to colon cancer. (3) Eating too much fat will also lead to obesity and consequently cause other health problems.

Conclusion

Wagyu beef suppliers would like you to assume that Wagyu is healthy because it contains more monounsaturated fats than normal beef. At this point in time, it is only an assumption and has yet to be proven. If you are suffering from high cholesterol, it is still better for you to eat fish (eg, Salmon, mackeral, sardines) which is high in Omega 3 fatty acids (3) rather then a Wagyu Steak. There is just not enough evidence to advise people to eat more Wagyu beef in order to lower cholesterol levels. Oh how I wish there was! That would be a piece of dietary advise that would be easy for a lot of people to swallow.

To read my other blog on Wagyu Beef, please click here

References:

1. Link to Wagyu article

2. Increased Beef Consumption Increases Apolipoprotein A-I but Not Serum Cholesterol of Mildly Hypercholesterolemic Men with Different Levels of Habitual Beef Intake

3. Fats and Cholesterol - The Good, The Bad, and The Healthy Diet

Tuesday, January 16, 2007

Doctor, Is my child Hyperactive?

"Doctor, my son is always running around and can't seem to sit still. Is he hyperactive?"

When my son was younger, he was very active and could never sit still. He would constantly be playing with toys or disturbing his friends at nursery and is always "up to something". In fact he seemed to always need stimulation. So some of my friends (from a non-medical background) proclaimed him to have ADHD (Attention Deficit Hyperactivity Disorder). I never believed them. Afterall I was the Doctor and here you have laypeople trying to tell me about health conditions? (Happens all the time, and the main culprit is my mother who still insists and telling me what to do when I fall ill, Bless her heart!)

The fact is that my son is able to sit through a whole episode of "Ultraman" completely glued to the TV. He won't move until the part when Ultraman's warning light starts beeping and when everything looks bleak, he summons up all his strenght, shoots his Killer Beam and obliterates the Monster. Then, when the credits begin to roll, he would start running around again.

Last year in Primary one, he did initially have some problems fidgeting in class and constantly disturbing his friends, but he managed to end the year with an acceptable result and even earned a certificate for best improved student. Now in Primary two, he still gets into trouble every now and but now no one would say he has ADHD anymore.

My son is active, but he does NOT have ADHD.

How common is ADHD?

As many as 40% of prescholers may be excessively active and considered to have a short attention span but only 1 in 20-30 will eventually be diagnosed as having ADHD. It is a condition more common in boys (about 6 times more common). It can present as early as infancy and seldom appears after the age of seven.

How do you recognize ADHD?

There 3 main features:

1. Inattention
: This is difficulty in concentrating, following directions and forgetting instructions. If your child is able to sit down with you for 10-15 mins when you read a story or if he is able (like my son) to be glued to the TV or computer game for an extended period of time, then he probably does not have this problem even though he may seem to get distracted easily.

2. Excessive activity
: Fidgeting and restless and never seems to be able to sit still. We Teochew like to say their Kah Cherng Seh Tang (Worms infesting the Backside). A child may still have ADHD even if he is not excessively active.

3. Impulsiveness
: In preschoolers this may be expressed as being easily excitable, having temper tantrums, excessive crying and a tendancy to just do "stupid things" like grabbing a hot cup of Kopi or punching a strange dog. Older children may have problems completing tasks, taking turns and doing things without considering the consequences. My son for instance had a heightened sense of danger and did not take to the slides at Wild Wild Wet until much older, so he can't be said to display impulsive behavior.

Some additional considerations:

1. The symptoms must appear in at least 2 situations, eg home and school

2. The symptoms usually appear before the age of 7

3. It is important not to wrongly label the child as having ADHD because it will cause unnecessary emotional distress for the child and the family! Not all children who are inattentive, overly active and impulsive have ADHD, the symptoms must be more severe then their peers and last at least for 6 months

4. Some kids who are very bright may seem to be inattentive. But when you check their work you may realise that they have completed their tasksare looking for other things to do!

What you should do

1. If your child is a preschooler, it is useful to look at how they react in a group of their peers. If they have ADHD, their characteristics of impulsiveness, inattentiveness and inattention will be much more evident then their peers.

2. If you do find that their attention span is much shorter then their peers or that their inability to sit still is very much worse than their friends, you may want to consider having him assessed by your family doctor who may then refer the child to a child psychiatrist.

3. Even if your child does not have ADHD, it is important to always protect their self esteem and praise them for positive behaviour. When asking them to do certain tasks, be very clear and reinforce the rules frequently. It helps to get their attention when talking to them by making sure they are looking at you when you talk to them. Always make sure they understand what you want them to do.

This is just a short blog to help parents recognize if their kids have ADHD. For more information on medications and therapy, please click here